Post insertion complaints in cd patients/ orthodontic continuing education

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Post Insertion complaintsIn Complete Denture Patients

INDIAN DENTAL ACADEMY

Leader in continuing dental education www.indiandentalacademy.com


Contents

• Introduction• Review Of Literature• Complaints and treatments• Conclusion• References



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Introduction• A complaint is an utterance of pain,

discomfort, or dissatisfaction.• It requires patience on the part of patients

and patience, skill and experience on the part of dentists to correct many problems associated with the use of dentures.

• Dentists also need thorough knowledge of anatomy, physiology, pathology and psychology..


• They must be capable of differentiating between normal and abnormal tissue responses.

• When a prosthodontist have a knowledge of basic sciences and the skill and experience to investigate these problems, they will readily see that in majority of the instances the problems are not real and not psychosomatic.


• John MT, Slade GD et al 2005 did a study sought to investigate problems reported by patients before and after prosthodontic treatment. They concluded that the number of problems decreased substantially after prosthodontic treatment. Fixed partial dentures more effectively influenced the problems reported before treatment than did removable partial or complete dentures.


• Roessler DM et al. 2003 Before treatment even begins, the patient's motivation for denture treatment and emotional attitude towards dentures must be evaluated. Patients will thereby gain realistic expectations of what can and cannot be achieved, and dentists will understand what the patient really wants. Finally, patients must be informed that continued success depends on regular denture maintenance at home combined with periodic consultation with the dentist


• Dervis E. et al 2002 did a study to investigate relationships between patient complaints with complete dentures and several factors such as age, gender, medical status and denture faults. Six hundred patients who received new dentures were assessed three months after insertion of the dentures.


• No significant relationship was found when age, gender, and medical status were compared with patient complaints. Statistically significant relationships were observed between denture construction faults or the condition of the patient's denture bearing mucosa and patient complaints.


• Yoshida M, Sato Y, Akagawa Y. 2001 did a study on the correlation between the quality of life (QOL), defined as overall satisfaction with daily life, and denture satisfaction in elderly complete denture wearers and concluded that edentulous elderly people who are well satisfied with their daily lives are also satisfied with their complete dentures.


• Albert A.M. et al 1997 did a study on the concept “prosthetic condition”, which combines the quality of complete dentures and residual alveolar ridges. They concluded that . Logistic regression analysis demonstrated that no variable of the “prosthetic condition” proved to explain the denture satisfaction. Some variables of the “prosthetic condition” had a significant but not relevant correlation with some denture complaints.


• Muller F et al, 1995 did a study on Studies on adaptation to complete dentures. The aim of the study was to evaluate the oral stereognosis and tactile sensibility in edentate subjects and relate these to patient age and capability of adaptation to new prostheses. In conclusion, the results cannot support a relationship between high oral stereognosis and adaptation problems. However, good denture retention facilitates the adaptation process.


• Champion H et al in 1995 investigated into the problems experienced by 114 referred patients with complete dentures who were considered to be difficult or to have difficult prosthodontic problems. The commonest problems were those of pain and lack of retention, mainly due to occlusal discrepancies and excessive VDO.


• Treatment was carried out on an individual

basis with a large proportion of dentures

being remade. However, a small number

was satisfied by counseling alone without

procedural treatment. The overall success

rate for treatment was 80 per cent.


• Basker RM, Beck CB, et al 1993 did a survey of the dissatisfied denture patient. In this study a wide range of tests was applied to complete denture wearers attending for treatment at Leeds Dental School, including an extensive interview and questionnaire, clinical examination and a personality assessment. In the majority of cases technical errors in denture construction accounted for the presenting complaint. It was not possible to identify a factor or group of factors common to those patients who had suffered chronic denture problems.www.indiandentalacademy.com

Problems and treatments

• It is impossible to discuss every complaint which may be made by a patient but the following are the most common and will give a comprehensive outline of how the dentist may diagnose their causes and how they should be treated


Most complaints will fall under one of the following headings, although frequently a patient

will have more than one complaint:

1 Pain and discomfort.2 Appearance.3 Inability to eat.4 Lack of retention and instability. .5 Clicking of teeth.6 Nausea.7 Inability to tolerate dentures.8 Altered speech.9 Biting the cheek and tongue.10 Food under the denture.11 Inability to keep denture clean.www.indiandentalacademy.com

• Pain & Discomfort– Over-extension of the periphery– Poor fit– Insufficient relief– Occlusal faults

• Wrong antero-posterior relationship• Uneven pressure• Excessive vertical dimension• Cuspal interference


Over-extension of the periphery• This is by far the most common cause of pain

with new dentures. • It is due to incorrect moulding of the

impression or incorrect outlining of the denture on the cast and is visible in the mouth as an area of hyperemia or an ulcer, depending upon how continuously the denture has been worn, or how gross is the over-extension.


Treatment: • Apply pressure-indicating paste to the

periphery and insert the denture. On removal an area of wipe-off will be seen.


• An alternative method is to dry the mucosa, touch the inflamed area with methylene blue or an indelible pencil and insert the denture.

• Remove the denture and ease the periphery with a small carborundum stone or a bur except in cases of severe ulceration this will give immediate relief, but remember that the area is slightly edematous and therefore only the minimum material should be removed from the denture.


• If the denture is an old one, the over-extension may be due to alveolar resorption and the slow, chronic irritation may have caused a local hyperpla sia. Cut back the denture periphery and line the fitting surface with tissue conditioner or black gutta percha.

• When the hyperplasia has reduced, or been removed surgically, construct new dentures


Poor fit• This is easily detected by the poor

retention, rocking, tilting and inability to seat the denture accurately in any position.

• The movement of the denture rubbing the mucosa causes pain, and patches of redness are sometimes visible.


• Treatment: New dentures, but the old ones can be worn in the meantime with a lining of tissue


Insufficient relief• This may occur over a prominent bony area,

such as the buccal canine region where the bone has been expanded at the time of extraction. The denture moves over the hard area causing pain. The painful area is red and possibly ulcerated.


• Treatment: apply pressure indicating paste to demarcate the area and ease the contact surface with a carborundum stone.


Occlusal Faults• Wrong antero-posterior relationship When the teeth occlude the mandible will

not be fully retruded. Attempts to retrude it will drag the dentures against the mucosa as they are locked together by the interdigitation of the teeth. This is often difficult to diagnose but can be seen by watching closely while the patient slowly approximates the teeth and increases the occlusal load.


• At some stage in this movement the lower denture will be seen to shift. This is often associated with a complaint of looseness.

• Treatment: if only slight it can be cured by a check record, remounting and grinding of the dentures; if gross, place occlusal pivots to reposition the lower denture


Occlusal Faults: Uneven pressure• This may be the result of faulty setting of the

teeth and, if so, is usually very slight. • More commonly it is the result of tilting of the

record blocks, undetected at the trial stage. • Pain is due to trauma caused by the one-

sided pressure and is then confined to the crest of the alveolar ridge on that side; sometimes small hyper keratinized areas are to be seen, as in an excessive vertical dimension.


• Diagnosis can be made by trying to insert a thin blade between the posterior teeth, first on one side, and then on the other, with the teeth in firm contact.

• Lesser degrees of error can be detected by inserting a thin mylar strip on either side between the occlusal surfaces of the posterior teeth while the patient closes just sufficiently to hold them in place.

• The strip on the side of the heavy pressure will be immovable while that on the opposite side will be easily withdrawn.


• Treatment: if the error is small the areas of heavy contact are detected by marking paper and the fault corrected by grinding or, better still, by remounting with a check record and adjusting the occlusion on the articulator.

• If the error is large, temporary improvement can be effected by adding cold-cure acrylic to the side of lighter pressure. When symptoms reduces either replace the posterior teeth or remake the dentures.


Occlusal Faults: Excessive vertical dimension

• This is due to an error at the registration stage and it is almost always due to increasing the vertical height beyond normal limits.

• Pain is associated with the crest of the lower ridge, as distinct from the lateral surfaces, and small white patches may be seen in the painful area.

• Easing the denture over these white patches gives immediate relief from pain, but within a few days the patient usually returns with the same complaint in a different site. www.indiandentalacademy.com

• In nearly all cases of excessive height the

patient also complains that the teeth jar,

clatter, are 'in the way' or 'too high' when

eating, and sometimes when talking.

• Treatment: if the occlusal plane of the upper is judged to be correct make a new lower denture to a decreased vertical dimension; otherwise, new upper and lower dentures.


Occlusal Faults: Insufficient vertical dimension

• Pain from this cause is not normally associated with new dentures.

• It is almost always the result of loss of vertical height through alveolar resorption.

• The pain is often indefinite in locality and may be associated with temporo-mandibular joint dysfunction and

its symptoms of facial or joint pain.


• Treatment - is aimed at restoring the vertical height and stabilizing the occlusion by occlusal pivots, followed by new dentures.


Occlusal Cuspal interference• A dragging action will be exerted on both

upper and lower dentures during all lateral and protrusive movements with the teeth in contact if cusped posterior teeth are used :– With a plane-line articulator.– With a moving-condyle articulator if care has not

been taken to obtain balanced articulation.• The same effect may result from an

excessive vertical overlap or an incorrect incisal guidance angle.


• This dragging will cause pain with well-fitting dentures and also instability with those having poor retention.

• The pain is usually widely distributed and often only experienced when attempting to eat, although 'empty mouth' grinding movements exacerbate the problem.

• Sore areas may be found on the labial or buccal surfaces of the alveolar ridges, and on the lingual surfaces of the lower ridge.


• The patient often removes the dentures after a few hours because of the discomfort.

• This condition can easily be detected by asking the patient to grind the teeth, when shifting of the dentures can be seen.

• Another simple method of diagnosing this fault is to hold the upper denture in place between the finger and thumb above the canine teeth and ask the patient to grind the teeth." The dragging can easily be felt.


• Treatment: If the cuspal interference is slight, or confined to only one or two teeth, it can be corrected by the careful use of marking paper and grinding.

• The taking of a check record and adjusting the occlusal surfaces on the articulator is the most accurate method of correcting this error. If the interference is gross, new dentures with balanced

occlusion will be required.


Teeth off the ridge• Pain from this cause is confined chiefly to the

upper buccal sulci and maxillary tuberosities. • It is usually the result of setting the upper

teeth too far buccally in an attempt to overcome marked discrepancies between the size of the upper arch and that of the lower, combined with lack of peripheral seal and incorrectly shaped polished surfaces.


• During mastication the upper denture tilts, digging the periphery of the denture into the mucosa on the working side and pulling it down over the tuberosity, or other undercut area, on the opposite side.

• The actual tilting can be seen if the patient bites on a wooden

spatula placed on the posterior teeth, first on one side and then the other.


• Treatment: Some relief may be obtained by

removing all four last molars and reducing the bulk of base acrylic over the tuberosity. This gives more space for the tongue to control the upper denture. New dentures with the above faults corrected, are the most effective treatment.


Retained root or Unerupted tooth• Pain may be caused by direct pressure on an

area which is already tender and will be felt very soon after inserting new dentures.

• It may also be caused by a well-fitting denture preventing draining from an undetected sinus.

• Well-fitting, functional dentures appear in some cases to stimulate the eruption of unerupted teeth.

• The painful area will usually be localized and often close inspection will reveal the cause.


• Diagnosis should be confirmed by radiograph.

• Treatment: Extraction of the root or tooth followed

by relining of that part of the denture. If for some reason extraction is contraindicated, then relief may be given by easing the denture over the area.


Narrow Resorbed Ridge• This is more usually associated with the

lower, and caused by the denture pressing the mucosa against the sharp ridge of bone during mastication.


• The pain is worst on the side habitually used for eating, but it may be widespread with an associated burning sensation.

• It is most severe during, and immediately following, a meal, and is increased by perseverance on the part of the patient.


• Treatment: in the lower, alveolectomy followed by relining the denture may be considered but relief over the bony irregularities is often the best treatment.

• In the upper, relief over the crest of the alveolus is usually sufficient since the palate can resist the masticatory loads


Mental foramen• Under normal conditions the mental foramen is

situated on the buccal surface of the mandible below the lower alveolar ridge and is thus outside the denture-bearing area.

• If, however, gross resorption of the alveolar and basal bone has taken place, the foramen may come to lie on the crest of the ridge and so be subject to pressure from the denture.


• When a new denture is constructed to these altered conditions, adequate relief should be given for the mental nerve.

• The pain may be localized to the immediate vicinity of the mental foramen, or it may be referred, and is then felt as a pain in the side of the face or in the lips and chin.

• It can usually be diagnosed by locating the mental foramen by radiograph.

• Treatment: relieve the denture so that the nerve cannot be subjected to pressure


Irregular resorption• Sometimes, because' of alveolar resorption,

an area is found which is rough, with a number of sharp spicules of bone, and if the mucosa covering it is thin, pain will be caused by pressure on it.

• This is very similar to the pain associated with narrow resorbed ridges except that it is localized.


• The uneven alveolus can be detected by gentle palpation and confirmed by radiograph.

• Treatment: surgical smoothing of the affected area followed by relining the denture. Treatment by surgery in such cases is often disappointing as the area remains tender for a long time and so simply relieving the denture may be a better treatment


Rough contact or fitting surface• If a denture has been processed on a cast

with a porous surface small pimples or blebs will be found on the contact surface where the acrylic has been forced into the small air bubbles of the cast.

• Normally these pimples are removed by the technician, but if they are overlooked the patient will complain of pain under pressure and a local area of inflammation can be seen.


• Treatment: remove the roughness from the denture and polish lightly. Always inspect a denture when it is dry, under a good light and magnification, to detect surface roughness or blebs.


Swallowing and sore throat• These two complaints are listed together as

they are different ways of describing pain arising from the over-extension of a denture.

• The cause in the upper is extension on to the soft palate with trauma in the post-dam region or excessive pressure in the hamular notches, while in the lower it is over-extension distally in the lingual pouch.

• The pain ceases if the denture is left out, and starts again soon after its reinsertion.


• Treatment: The patient will usually know which

denture is at fault and examination of the regions described will show a slight redness or ulceration.

Reduction of the over-extension produces relief, although the symptoms may persist for some time


Undercuts• Sometimes the dentist will make use of an

undercut area which, in his judgment, is unlikely to cause pain, and although the new denture was inserted with comfort, the patient returns with the complaint that inserting and removing the denture is becoming increasingly painful.

• The maximum bulge of the alveolus in this area is found to be red and painful, and in some cases ulcerated.


• Treatment: It may be possible to insert this side of the

denture first, quite painlessly, and then the opposite side, removing it in reverse order.

If this maneuvering is not successful the fitting surface must be cut away until the denture can be inserted comfortably but the periphery must not be reduced in height. Often the flange will be too thin to allow acrylic to be removed from the fitting surface and if this is so the flange must be thickened by the addition of more material. Should this easing ruin the retention, as is likely to be the case if much has to be cut away, an alveolectomy will be necessary followed by a new buccal or labial flange.


It might be helpful to list the causes of pain or discomfort following the fitting of dentures.

1. Localized painful areas with ulceration:• Blebs and surface irregularities. Periphery too

sharp.• Post dam too deep.• Edges of relief areas.• Lack of relief.• Occlusal error.• Excess periphery.


2. Localized painful areas without ulceration: • Upper displaceable ridge.• Rough bony alveolar ridge.• Dental remnant.• Mental foramen.• Mylohyoid ridge.• Buccal prominence of tuberosity.• Lack of relief, e.g. incisive papilla. • Excessive vertical dimension.• Peripheral over-extension.• Denture into undercuts.• Cramped tongue space.www.indiandentalacademy.com

Appearance• In spite of the greatest care on the part of the

dentist to obtain the patient's full approval of the appear ance at the trial stage, there will always be some patients who are dissatisfied with their appearance when wearing the finished dentures.

• The patient should not be condemned too severely for this inconsistency, as it is difficult to form a considered opinion on all details of facial appearance when sitting in a dental chair, in strange surroundings, with trial dentures in the mouth, and being asked to criticize the work of a professional person.



• The number of patients who. are dissatisfied with their appearance with the final dentures can be much reduced if the dentist insists on a relation or candid friend being present at the trial stage, although it has to be stressed that the appearance cannot be fully assessed until four to six weeks after insertion of the finished dentures.

• This is because of the adaptation of the lip and facial muscles to the underlying teeth and denture bases.

• This is the basis of the problem of judging the appearance at the trial stage.


Facial appearance• Patients may complain that the nose and chin

are more prominent or are approximating.• This is due, in the case of old dentures the

patient is wearing, to continuing alveolar resorption and the spatial change of position of the dentures in relation to the skull as a whole.

• If this complaint is voiced after delivery of the new dentures it means a failure to restore the occlusal face height correctly.


• The same causes operate in complaints of the lips and cheeks falling in, although this is more likely to be due to the teeth of new dentures being set too far lingually and to insufficient width of the buccal and labial flanges.


Dissatisfaction with teeth Colour• This complaint is almost invariably that the

teeth are too dark or too yellow, but before changing them it must be explained to the patient that natural teeth darken with age and that very light-shaded teeth look more artificial than darker ones.

• Treatment: comply if possible with the patient's request for lighter teeth, usually by a compromise between the shade chosen by the operator and that chosen by the patient.


Shape• Few people are sufficiently observant to be able to

describe the shape of their lost teeth and are likely to say vaguely, when referring to their dentures, that 'they don't look right'.

• Shape is closely bound up with size, and a different make of tooth of the same basic shape and size may well look more natural.

• Artificial teeth usually look larger than natural teeth of identical size, probably because their mesial and distal surfaces are not so rounded, and so the eye is. able to focus on their width more accurately.


General dissatisfaction• One of the most difficult cases to deal with is that of

the patient, fitted with new dentures, who returns a few days later with the vague remark that he 'does not like them'.

• He can specify no particular complaint and it will be found on questioning that comfort, retention, stability and efficiency are not at fault; so the conclusion, which is invariably right, is that it is a question of appearance.

• It may be due to diffidence on the part of the patient unwilling to make a specific complaint that would appear to criticize the dentist's skill.


Inability to eat• This complaint is mainly confined to patients

who are wearing complete dentures for the first time, and are impatient at the time spent in. acquiring new habits of eating.

• Careful attention by the operator to the psychological approach to denture wearing, will eliminate this complaint except in rare cases, and these must be persuaded to persevere, so that they will either learn anew how to eat or will define some specific complaint which can then be remedied.


• Difficulty may be encountered with certain fibrous foods and this is likely to be due to low-cusp or zero-cusp posterior teeth, lack of interdigitation of posterior teeth, the use of acrylic teeth in a patient used to porcelain, unbalanced occlusion, or a locked occlusion arising from setting teeth on a plane-line articulator.

• These faults may also cause the dentures to dislodge during eating, a further complication being a restricted tongue space which may occur if the upper teeth are set directly over the ridge, if the lower posterior teeth overhang the tongue or if the posterior teeth, particularly the lowers, are too broad.


• The posterior natural teeth are often lost some time before the anterior ones, with the result that a habit is formed of eating on the anterior teeth. When complete dentures are being worn for the first time, it is only natural that the patient should try to continue his previous eating habits with bad results.


Lack of retention and instability• When opening the mouth patients more often

complain that the lower denture lifts than that the upper one drops.

• If this lifting only occurs when the mouth is widely opened it may be explained by what is commonly known as a low tongue position.

• When a dentate person opens the mouth wide the tongue remains back in the mouth to protect the oropharyngeal isthmus while in an experienced denture wearer the tongue falls forward to stabilize the lower denture.


• If the low tongue position persists in edentulousness then the denture is likely to rise on wide mouth opening. Explanation of this will help the patient to counteract the problem.

Other causes are given below.Over-extension This has already been discussed under the

heading of pain, the difference in these cases being that the over-extension is so slight that the tissues do not make constant contact with it, and consequently soreness does not arise.


Tight lips • These can be a most difficult problem when in

conjunction with a flat, atrophic lower. The inward pressure from the lips will seat the upper denture more firmly in position but will push the lower denture backwards and up the ascending ramus.


• Treatment: Remake with the lower anterior teeth set more lingually, with a labial concavity on the denture, and with the maximum extension in the region of the retromolar pads. Denture space techniques are useful and surgical vestibuloplasty must be considered.


• Tongue space If the lower posterior teeth are tilted or set lingually they produce an undercut area into which the wide middle-third of thy tongue will press. Movements of the tongue then lift the denture.


• Treatment: reduce the width of the lower post erior teeth by grinding off the lingual cusps. This effectively alters the downward facing lingual surface to an upward facing one more favourable to tongue control


Under-extension and lack of peripheral seal

• This fault is by no means uncommon, and its effect on the retention of the denture is most marked. Maximum retention cannot be obtained without covering the greatest possible denture-bearing area.

• Some clinicians produce this fault by placing excessive tension on the soft tissues during the peripheral moulding of the impression, through their desire to avoid over-extension.


• Where this cause is suspected of being the fault, it can be checked by adding tracing stick round the periphery, moulding it carefully and noting the result. A conventional reline can then be undertaken


• Lack of saliva There is no specific treatment for this condition but palliative treatment such as artificial saliva will help the patient

• When coughing or sneezing Occasionally a new denture wearer will complain that his upper denture falls and his lower denture lifts, whenever he coughs or sneezes violently.


• Treatment: it must be explained to the patient that when coughing or sneezing the soft palate rises suddenly and there is a moment when the pressure of air in the mouth is considerable so that the peripheral seal of the upper denture is broken and it is liable to fall; the unusual muscular movement causes the lower denture to lift. There is no way of preventing these movements of the dentures, but covering the mouth with a hand or handkerchief is an obvious suggestion


Clicking of teethPatients are often less disturbed by contact of

teeth than relatives who are irritated by the noise. The main causes are:

1. Excessive vertical height causes the dentures to contact during speech, particularly the sibilant sounds, as the mandible moves vertically through the speaking space


2. Movement of the lower denture from whatever cause is very liable to lead to clicking of the teeth, particularly the molars if the distal part of the denture rises

3. Cuspal interference or lack of balanced occlusion is a likely cause of faulty tooth contacts. Particular attention should be paid to the retruded contact position as faults here are often missed in the examination of the occlusion.


4. Porcelain teeth by nature of the material create more impact noise than acrylic; a problem increased if the patient has been used to acrylic for many years.


Nausea• It is because of light or intermittent contact on the

soft palate or back of the tongue, and the patient's complaint is almost invariably 'that the upper denture goes too far back and makes me feel sick'. The causes are given below.

1. Denture slightly over-extended Movements of the soft palate cause intermittent contact with the denture and this may be diagnosed by observing the relation of the posterior border to the vibrating line.

Treatment: remove the excess and readapt the postdam if necessary.


2. Denture under-extended: If the posterior border of the upper denture does not extend beyond the hard palate it cannot compress the soft tissues sufficiently to maintain close contact under all normal conditions, and this will often cause nausea because of the intermittent contact and tickling effect at the back of the palate. A posterior edge which lies too far: forward is detected by the dorsum of the tongue and is a common cause of nausea.


3. Thick posterior border This is a very common cause of nausea resulting from the dorsum of the tongue being irritated by the thick edge. The edge of the upper denture should be thin, and slightly embedded in the compressed mucosa, so that the tongue is unable to detect any definite junction between denture and palatal mucosa


4. Protrusive imbalance If the occlusion is not balanced "in protrusive imbalance there is a heavy contact on the incisors and no contact between the molars. This produces movement of the back of the upper denture which causes saliva to collect at the posterior border and a tickling effect, leading to nausea.


Inability to tolerate dentures• Patients sometimes complain that new

dentures are not comfortable but can give no specific cause for complaint. These cases are difficult to diagnose since they are not accompanied by pain, and retention appears to be satisfactory, but as the patient has nearly always previously worn dentures a careful comparison of the new with the old will generally give a clue to the cause.


1. Cramped tongue space This is the most common reason for this complaint, the teeth on the new upper denture having been set on the crest of the alveolar ridge which has resorbed considerably since the older denture was made. Since the resorption is greatest on the buccal and labial aspects of the upper ridge, the teeth are now mounted

nearer to the midline, so decreasing the tongue space.


2. Altered occlusal plane As in the case of an altered vertical height, the position of the occlusal plane is unlikely to have been changed by more than a few millimetres, but even a slight alteration will require some adjustment of muscular movement and control, particularly the tongue.


3. Unemployed ridge This type of ridge is a common cause of discomfort and inability to wear a new complete lower denture because the latter applies pressure on tissue not previously loaded.


4. Changes in shape Very often when new dentures are made with marked changes in form and dimension of the periphery or polished surface as compared with the patient's existing dentures there is difficulty in tolerating the change, particularly in older patients.

• Treatment: unless any of the above-mentioned factors are gross the patient should be encouraged to persevere for several weeks, by which time, in most cases, the discomfort or intolerance will have disappeared; if not, then nothing remains but to modify the dentures or remake them if the cause of the problem has been diagnosed.


Altered speech• When complete dentures are first worn there is

always some temporary alteration in speech owing to the thickness of the denture covering the palate, necessitating slightly altered positions of the tongue. Commonly this is only a temporary inconvenience, most rapidly overcome by the patient reading aloud; when there is an altered position of the upper incisors, a change in their palatal shape, any reduction of tongue space, or alteration in occlusal level, adaptation may be very difficult even with perseverance.


• Treatment: the dentures must be remade paying particular attention to the principles and to the correct restoration of the denture space, defined as the space in the edentulous mouth formerly occupied by the teeth and supporting tissues which have since been lost.


Cheek biting1. Insufficient ovetjet 2. Reduced vertical height

1. Insufficient ovetjet The normal occlusal relationship of the posterior teeth is with the buccal cusps of the upper teeth outside those of the lower teeth; this arrangement, along with the correct peripheral width on the dentures, normally prevents the cheeks getting caught between the teeth..


• If for any reason this arrangement has been altered, or if a patient has very lax cheeks, cheek biting may occur

• Treatment: Increase the buccal overjet and make sure the peripheral form is adequate in width and height. In some cases it may be necessary to remove the last molar teeth or grind the buccal surfaces of the teeth


2. Reduced vertical height If the vertical occlusal dimension of the dentures is reduced, the resultant bunching of the cheeks allows them to be trapped between the occlusal surfaces of the teeth as they occlude. This may also occur if the occlusal plane of either denture is' incorrectly positioned.


It should be remembered that when the natural teeth are lost there is no record of the occlusal position of either the upper or lower teeth and the selection of the occlusal plane in complete dentures is entirely empiric.

Treatment: restore the vertical dimension or change the occlusal plane


• Biting the tongue This is almost invariably due to a decrease in the tongue space occurring when fitting new dentures for patients already wearing dentures, but it may also be due to changes in occlusal level as mentioned above


Food under the denture• This complaint is usually made by patients

wearing dentures for the first time and who have not yet learnt how best to control the food. Undoubtedly a perfect peripheral seal will prevent the ingress of food beneath the denture, but perfection is not always attained and, owing to alveolar resorption, never maintained. Scraping a groove on the cast, along and near the entire periphery of the denture, is sometimes carried out, but this food-line, as it is termed, causes inflammation and ulceration and should not be undertaken www.indiandentalacademy.com

• Treatment: this usually consists of covering the maximum possible area and obtaining an adequate peripheral seal; thereafter, only perseverance by the patient can bring about any improvement.


Inability to keep denture clean• This complaint may be caused by:1. Inadequate laboratory work by the

technician, especially failure to polish all round each tooth before setting in wax. Careless waxing and flasking are common faults. It is not possible to polish acrylic in the interdental space, or the col between teeth, if the original wax was rough or incorrectly designed.

2. Loss of original polish by patient's use of hard household abrasives.

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3. Failure of patient to clean the dentures regularly or efficiently. Many denture patients also wear spectacles but often the dentures are cleaned in the bathroom under poor light when the spectacles are not worn. Cleaning is therefore not always done properly.


4. Incorrect use of denture cleansers. These cleansers may be listed:

(a) Oxygenating cleansers containing alkaline percarbonates or peroxides. (b) Hypochlorite solutions containing dilute sodium hypochlorite. (c) Mineral acid, usually dilute hydrochloric acid (d) Powders and pastes containing mild abrasives, precipitated chalk or hydrated alumi na. (e) Liquid detergent.


• List of factors resulting in discomfort related to the impression surface of dentures

• Pearls or sharp ridges of acrylic on the fitting surface arising from deficiency• Denture not relieved in region of undercuts• Pressure areas resulting from faulty impressions,

damage to working cast, warpage of denture base.• Over-extended lower impression:• Under-extended denture base• Post dam too deep


List of factors resulting in looseness of dentures arising

from decreased retention forces

• Lack of peripheral seal• Inelasticity of cheek tissues• Occlusal error subsequent to warpage• Xerostomia • Neuromuscular control


• List of factors resulting in looseness of dentures: arising from increased displacing forces

• Denture borders– Over-extension in depth.– Deep post dam on upper base– Overextension in width

• Poor fit to supporting tissue• Recoil of displaced tissue lifts denture• Denture not in optimal space


• List of factors resulting in looseness of dentures arising from increased displacing forces - occlusal and anatomical factors

• Occlusal errors• Ulceration labial to lower ridge• Fibrous displaceable ridge• Bony prominence covered by thin mucosa (eg

tori)• Non-resilient soft tissue• Pain avoidance mechanisms


• List of denture problems associated with problems of adaptation

• Noise on eating/speaking• Eating difficulties • Blunt teeth’• Jaws close too far’• Cannot open mouth wide enough for food • Speech problems• Gagging• Appearance• Too much visibility of teeth• Creases at corners of mouth• Colour of denture base material unnatural’www.indiandentalacademy.com

• Factors resulting in discomfort - factors with possible systemic associations. Some of these conditions may occur several months post insertion

• Burning sensation over upper denture supporting • tissues• Beefy red tongue, possibly glossodynia• Frictional lesions related to dentures,• Tongue thrusting. Empty mouth ’chewing’.• Presence of herpetiform ulcers in mouth• Painful ’click’ related to TMJ• Patient complains of allergy to denture material• Painless erythema of mucosa related to support

of (usually) upper denture, may beaccompanied by

angular cheilitiswww.indiandentalacademy.com

Summary and Conclusion • At the conclusion it is worth stressing the

eight most common causes of problems with complete dentures:

1. Incorrect antero-posterior: relationship of the mandible to the maxilla.

2. Premature contacts in retruded contact position.

3. Lack of occlusal balance in: eccentric mandibular positions


4. Vertical dimension excessive and therefore inadequate freeway space and interference with speaking space.

5. Cramped tongue space a teeth set too far lingually.6. Inadequate periphery leading to poor

retention and failure to restore lips and cheeks to the pre-extraction form.

7. Under extended denture bases.8. Failure to recognize design of existing

dentures www.indiandentalacademy.com

References :

• Principles and practice of complete dentures: Iawo Hayakawa

• Essential Of Complete denture Prosthodontics ; Sheldon Winkler • Textbook of complete Denture: Charles

Heartwell.• Complete denture prosthesis John J. Sharey, • Prosthodontic treatment for ednentulous patients

Carl ‘O’ Boucher, www.indiandentalacademy.com

• Int J Prosthodont. 2005 Mar-Apr;18(2):124-31. • Eur J Prosthodont Restor Dent. 1993 Dec;2(2):73-

8. • J Oral Rehabil. 1995 Oct;22(10):759-67• J Prosthet Dent 1997;78:472-8.) • Int J Prosthodont. 2001 Jan-Feb;14(1):77-80.• Br Dent J. 2000 Jan 8;188(1):10-4. • Br Dent J. 1997 Apr 26;182(8):313-7. • Int J Prosthodont. 2005 Mar Apr; 18(2): 124-31.



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Post insertion complaints in cd patients/ orthodontic continuing education

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