Complete denture complaintsCategories of complete dentures complaints :

1 .Pain and discomfort

2 .Appearance

3 .Inability to eat espicially with first time denture wearer

4 .Lack of retention and stability

5 .Clicking of teeth

6 .Nausea

7 .Inability to tolerate denture

8 .Altered speech

9 .Biting the cheek and tongue

10 .Food under the denture

11 .Inability to keep denture clean

*** pain & discomfort :

Causes:

-over extension of the periphery

-poor fit

-insufficient relief

-occlusal faults

-teeth off the ridge

-retained root or unerupted tooth

Ideally in your clinic you should take panoramic radiograph (some pathology not appear during examination … so you need radiograph )

If theres retained root or unerupted tooth ….completly impacted …not assotiated with pain leave it& construct the denture

* Pain results from direct pressure on an area already tender

If theres remaining root or un erupted tooth ……with pressure from denture …thinning in mucosa …. Appearance the remaining root or unerupted tooth localized pain to direct pressure on the area "already tender"

* Well fitting denture may obstruct undetected sinus

If the denture well fitted & the remaining root assotiated with sinus …….the pressure causes sealing to the sinus may end with flare up & infection

# treatment :

Extraction of the root or tooth, followed by relining of the denture in that site.

Or easing the fitting surface over it if extraction is not indicated ."relief the area around the root or tooth"

-narrow resorbed ridge

* Often the lower ridge. The denture squeezes the mucosa against the sharp bony ridge.

" Most common on the lower ridge….pressure from the denture against the mucosa"

Knife edge …very sharp crest

* Pain may be accompanied with burning sensation. Worst after meals.

# treatment :

Alveolectomy followed by relining the denture, or simply: relief over the sharp irregular ridge.

We start with conservative treatment relief around that area

If not sufficient alveolectomy " remove bone & smooth it " & relining

-mental foramen

Normally it is situated below the alveolar ridge. With resorption, it becomes over the crest of ridge.

pressure from denture may elicit localized or referred pain

In many pt. with sever resorption of the mandible …… the mental foramen on the crest of the ridge …….. when the pt. wear the denture or eat something direvt on that area pain or something like electric shock or burning sensation

# treatment :

Relief around it

If sever surgical repositioning of nerve it self

-irregular resorption

The extraction on stages …mostly post. Teeth then ant. Teeth

This results in rough area of the crest of ridge with sharp specules of bone.

Pain will be elicited when the intervening mucosa is pressurized.

Similar to pain due to narrow resorbed ridge, but pain is localized

# treatment :

Surgical smoothing of the affected area followed by relining the denture or; just

relieve the denture

.

-rough contact or fitting surface

*Small pimples or blebs of acrylic over the fitting surface due to inaccuracies of the surface of the cast.

Treatment#:

Remove roughness by acrylic bur.

-swallowing & sore throat:

pain on swallowing”painful swallowing " or “sore throat” or feel tonsillitis are indicative of over-extension of the denture (upper or lower ).

The upper will be over-extended over the soft palate or pressing over the hamular

notch or the postdam region.

The lower will be over-extended distally in the lingual pouch "myelohyoid area" .

There will be an area of slight redness , erythema or ulceration.

# tretment :

Apply PIP Reduction of the over-extension . .

-under cuts

often used by dentist to aid in denture retention.*

Associated with redness and ulceration *

Most common site ….. tubrosity upper Lingually lower

& some pt. labially

We apply PIP " in insertion stage " on undercuts area to ease & relieve the pressure

In some pt. there's bilateral undercuts " sometimes we need preprosthetic surgery either one side or two side depend on severity

# treatment : *If not sever (in border line ) painful when

put the denture straight soo educate the pt how to remove & put the denture in

rotation path &PIP to relieve pressure area

if sever alveoloctomy** Teach the patient how to insert the denture painlessly. If not successful, relief fitting surface. Or alveolectomy then, construction of new buccal orlingual flange

"note " slide #48summary about painful area with & without ulceration

*** Appearance *It is difficult for some patients to formulate adecision regarding aesthetics at the try-instage.*the presence of a friend, spouse or

relative at the try-in stage will help thepatient make such a decision and accept it.* The patient might accept the trial dentureand still remain unsatisfied with the finisheddenture.*Final esthetics can be assessed only 4-6weeks after the insertion of the denture due to adaptation of lips and muscles. Appearance : 1. Facial appearance (general facial appearance,general look )delayed complain not immediate complain :the lips & cheek falling in2.about teeth : color,shape,position

1.facial appearance:*May complain: nose and chin are prominent or are approximating. This is due to failure to restore the OVD correctly. Or if the complaint is delayed,it will be due to alveolar resorption.* May complain: that the lips and cheeks are falling in. This is because teeth have been set too far lingually or having insufficient width to the buccal and labial flanges.

2.teeth :Color :Usually the complaint is that teeth are too dark or too yellow. The dentist should explain the colour does get darker and yellower with age.

Shape :*Complaint: “ They don’t look right”. *Treatment: remove teeth, mount other new teeth of different shape, or shape in wax until suitable ones are obtained.Position :*Complaint: “ Teeth too far back” or “too far fowrward”. Reason: the setting has been left to the technician who sets teeth onto crest of ridge (but remember there is upper labial resorption, makingthe teeth too far lingually).* Complaint: “Teeth too low and show toomuch”. Anterior teeth may be removed and replaced at a higher level or better by remaking the denture.

*** Inability to eat especially with first time denture wearer-Usually, new denture wearer.- Certain food types are more difficult toconsume." Not harder than rice for the first 2 weeks "the reasons : 1. Cusp teeth vs low-cusp or zero-cusp teeth.2. Lack of interdigitation of posterior teeth. "interference ant. & separation post."3. Unbalanced occlusion.4. Locked occlusion (plane line articulator). -plane " hinge" articulator no lat. Movement setting on this articulator not balanced .5. Restricted tongue space." The problem related to the setting too lingually "…… redo the denture6. Over-extension of periphery."cause Either pain or unretentive denture … in ability to eat ." 7. Habit of eating on anterior teeth only

***. Lack of retention and stability

When mouth is opened:-Low (or defensive)(retracted) tongue position" main stabilizing factor in the lower denture tonge "- Over-extension or under-extension: if slight affects retention, if severecauses pain also.- Tight lips: exerts unseating pressure on lower denture" in some syndrome like scleroderma "- Restricted tongue space: Trim lingual cusps altogether.- Under-extension and lack of peripheral seal: very common, check by adding tracing compound, then reline.-Lack of saliva: artificial saliva." Because of syndrome or medication ".

when the mouth is closed

When coughing or sneezing.: *coughing … soft palate moves … breakage the seal …. The denture come out . *normal physiological process *we cannt do anything

***. Clicking of teethCauses :1-most common cause Excessive vertical dimension especially with sibilant (hissing) sounds. "excessive vertical dimension causes 1. Clicking of teeth 2.inability to swallow "2-movement of lower denture" cause clicking sound & depend on the amount of resorption "… sometimes we use adhesive3- Cuspal interference and lack of balanced occlusion.4 -Excessive incisal guidance angle and low overjet.5- Porcelain teeth . "porcalin against porcalin" like " glass against glass "…. High sound Not recommended nowadays

*** nausea1-Upper denture slightly over-extended (over extension on the soft palate ): remove over-extension and readapt post dam."the same as inability to swallow &sore throat "

2- Denture under-extended ( means no retention ): this causes intermittent contact with the tissues.3. Thick posterior border: irritates dorsum of the tongue. relieve from the thickness ..from polish surface ."thickness not extension "4- Protrusive imbalance( theres interferences either post. Or ant. …. Cause dislodgment ): this will cause upper denture to dislodge posteriorly and tickle tissues there.

***. Inability to tolerate denturesIt would help in this case to compare it to the old dentureSeveral reasons : Cramped tongue space ( main reason ): as the ridges have resorbed with failure to set the teeth in neutral zone." Teeth too lingual & no space for the tongue " Altered vertical height. "extreme loss of vertical dimention …the pt. not adapt to this change…. (compared with old denture)" Altered occlusal plane.

Unemployed ridge " when theres severe resorption in the mandible ": difficult to wear lower denture.huge Changes in shape"appearance": unless the patient can accept the change in shape after some time, remake preferably with the copy denture technique.

***. Altered speech- Can be enhanced by exercise,otherwise remake- Check position of the teeth

***. Biting the cheek and tongueBecause of loss vertical dimension … more space…cheek &tonge biting Cheek biting:- Insufficient buccal overjet: reduce buccalsurfaces of buccal cusps." Buccul cusps edg to edge"*normal relationship positive overjet post" upper slightly outword" …. Sooo in this case we reduce buccul surface of lower teeth

- Reduced vertical height: remake at the proper VDO.

Biting the tongue: due to decreasedtongue space or decreased VDO

***. Food under the denture-Due to lack of peripheral seal of the lower denture " the denture not retentive ". This can be treated by maximum lower denture coverage with maximum peripheral seal.-Delayed complain due to resorption but if immediate in new denture the impression not accurate.

***. Inability to keep denture clean-Careless pt…" we must reinforce oral hyiegene instruction " ( pt. side )Other reasons :

-Inadequate finishing of denture especially interdentally.

- Use of hard abrasives.

- Failure to clean dentures regularly.(pt. side )

- Incorrect use of denture cleansers.

- Reduced manual dexterity of the elderly (or ill) patient.

*if theres general complaints ….when the pt. can't tell the dentist what the exact complaint (pain , appearance ,….etc)-no good communication skills -so we go through list of differential diagnosis in our mind … we think about the source … extension of borders , malocclusion , seal, VD , nerve pressure on mental foramen , or the pt. has problem with mucosa "fragile" (such as vit. Deficiency , diabetes, syndromes , diseases )….. , cheek or tongue bitting …etc

-TMJ problems "maybe if the VD too little "or " unbalanced occlusion " or " medical history if the pt has arthritis ".

So we check everything .

Islam AL-Dagag