1- common complaint - Pharos University in Alexandria

Prof.Dr. Ahlam El-Sharkawy
Professor of prosthodontics.
Pharos university.
prpp

Denture patients can be classified
into three groups:
• The first group : Accept anything even badly
constructed denture.
• The second group: Hard to please even with
well constructed denture
• .
• The third group : Easily pleased and satisfied
with well constructed denture.

Complaints
Common
Uncommon

Common Complaints
1.Pain
2. Esthetics
3. Inefficiency
4.Poor Retention
5. Instability
6. Clattering of teeth
7. Nausea
8. Discomfort
9. Altered speech
10. Bitting the cheek and
tongue
11. Food under the denture

Uncommon Complaints
1. Allergy
2. Whistling
3. Lisping
4. Ear ache
5. Loss of taste sensation
6. Peculiar taste
7. Defensive tongue
8. Burning of mouth

A) PAIN

Causes of pain
• 1- Over extended periphery.
• 2- poor fit.
• 3- Insufficient relief.
• 4-Incrrect centric relation.
• 5- Other occlusal error.
• 6-Teeth outside the ridge.
• 7- Retained root or un-erupted tooth.
• 8- V shaped ridge.

Causes of pain.
• 9- Mental foramen.
• 10-Irregular resorption.
• 11- Pathological conditions.
• 12- Rough fitting surface.
• 13- infection with monilia.
• 14- Swallowing and sore throat.
• 15- Undercuts.

1- Overextension of the periphery
• Most common cause of pain.
• Incorrect molding of the impression .
• Visible in the mouth as a red line, an area of
hyperemia or an ulcer.

Visual &digital
examination
Indelible
pencil
Disclosing
wax

1- Overextension of the periphery
• Treatment: mark with indelible pencil or use
disclosing wax.

2- Poor fit
• The movement of denture rubbing the
mucosa causing pain and patches of redness.

2- Poor fit
• Treatment: new denture, relining using soft
liner or rebasing

3- Insufficient relief
Poor base adaptation
Fulcrum on bony structures
Treatment: apply PIP and
relief pressure areas.

4- Incorrect jaw relations
a. Wrong antero-posterior relationship
Treatment: If slight not more than ¼ of cusp it
can be corrected by grinding the mesial planes
of the upper cusps and distal planes of lower
cusps.
- If gross, new dentures will be required.

B- Uneven pressure.
• Treatment:
• If detectable with a spatula, a new lower
denture.
• If detectable with celluloid strips, selective
grinding using articulating paper

Increased Vertical Dimension
Excessive VD
• Sorness over entire ridge .
• Muscle/joint pain
• Denture teeth clatter during
eating and talking.
• Esthetic complaints:

Decreased Vertical Dimension
Effects of excessively reducing the
vertical dimension:
1-Inefficiency.
2- Cheek biting.
3- appearance.
4- soreness at the corners of the
mouth(Angular cheilitis)
5- Costen’s syndrome

Costen’s syndrom

Costen’s Syndrom
1- Vestibulo – cochlear Nerve ( 8 th cranial nerve)
2- Chorda Tympani Nerve(Branch from Facial Nerve-7th c.n)
3-Auriculo-Temporal Nerve(Branch from Mandibular n.
which is Branch from Trigeminal n. 5th c.n)

I – Otological Symptoms :
Pressure on Vestibulo-Cochlear nerve.
1- Vertigo.
2-Tinnitus
3- Mild Catarral Deafness

II – Oral Symptoms
Pressure on Chorda Tympani
1- Burning Sensation in the ant. 2/3 of
the Tongue
2- Metalic Taste
3- Xerostomia

III – T.M.J and Peri auricular Symptoms
Pressure on Auriculo-temporal n.
1- Pain in T.M.J
2-Pain in the Ear
3-Pain in the Periauricular Region
4- Xerostomia.

5- other occlusal errors
• Cuspal interference
• Disharmony between centric relation & centric
occlusion
• 1-Dragging of mucosa with retentive denture
• 2-Instability with un-retentive denture
• Treatment:
• Articulating paper &selective grinding
• Grinding paste
• Remounting
• New denture

6- Teeth outside the ridge
• 1-Occlusal contact not
centered over ridge
• 2-Tilting forces cause
displacement.
3-Abrasion, ulceration
in the buccal sulcus
• 4-Cheek biting

7- Retained root or unerupted tooth
• Well fit denture will stimulate eruption of
unerupted teeth
• Treatment: relief or extraction and reline

8- V- shaped ridge
• Usually associated with lower denture…
pressure during mastication pressing m.m.
against a sharp ridge of bone.
• Treatment: relief or alveoplasty & reline

9- Mental foramen
• Pressure on the mental foramen
the foramen.
Relief over

10- Irregular resorption
• Sharp spicules of bone
• Treatment: alveolectomy & relining

11- Pathological condition
• Usually diagnosed & treated before new
denture construction

12- Rough fitting surface
• Small pimples where material forced into
small air bubbles of model
• Treatment: remove the roughness

13- Infection with monilia albicans
• Acute red inflammation terminating at
borders of denture
• Low protein & vitamin diet
• Treatment:
• fungicide such nystatine
• Remove denture at night
• Diluted hypochlorite

14- Swallowing & sore throat
• Overextension on soft palate
• Excessive pressure in hamular notch
• Overextension disally in lingual pouch

15- Undercuts
• Inserting & removing denture is getting
painful
• Treatment:
• Insert this side first
• Cut away from fitting surface but not height
• Use of resilient liner or alveoplasty

B) ESTHETICS

1- Nose & chin approximation
• Reduce vertical dimension with excessive
freeway space
• Treatment: reline one or both dentures or
new one

2- Cheeks & lips falling in
• Lack of tone of facial muscles
• Lack of support by teeth & alveolar ridges
• Treatment:
building out of upper denture to compesate for
the loss muscular tone.

3-Angular cheilitis
• Loss of vertical dimension
• Secondary infection
• Treatment:
• Increase vertical dimension
• Correct position of anterior teeth
• Provide sufficient support for angles of mouth
by denture flanges

4- colour, size & position of anterior
teeth
a- Colour and size
b- position.
• Too dark or yellow, too large or small teeth
• Irregularities pt wishes to reproduce

5- Amount of tooth showing
• Too much or too little showing
• Treatment: remake

6- General dissatisfaction
• Middle aged women
• Both pt & dentist should participate activities
• Satisfy pt during try in stage

C) INEFFICIENCY

1- Inability to eat anything
• Denture wearer for first time
• Impatient
• Psychological approach

2- Inability to eat meat
• Flattening of cusps
• Cuspless posterior teeth
• Overclosure with decresed muscle efficiency
• Unbalanced occlusion
• Cuspal interference
• Inexperience

3- Denture dislodged by eating
• Cuspal interference
• Unbalanced occlusion
• Upper teeth outside the ridge.
• Treatment.
• remake

4- Insufficient tongue space
• Lower denture move during eating
• Remake, allowing more tongue space, using
narrower posterior teeth
Tongue

Tongue and cheek biting
Tongue biting may be due to;
1. the artificial teeth positioned too far lingually.
2. the occlusal plane is too low.
3. enlarged hypertroghic tongue.

Tongue and cheek biting
Cheek biting may be due to;
1. setting of teeth buccally.
2. lack of posterior overjet.
3.loss of tone of cheek
musculature with age.

5- Periphery overextended
• Commonest place is region of lingual pouch
• Treatment:
• Reduce overextension.

6- Inexperience
• Biting : function of anterior teeth
• Chewing: function of posterior teeth
• careful Explanation to the patient.

D) POOR RETENTION

1- When opening mouth
a. Overextension
b. Tight lips
c. Tongue cramped
d. Underextension
e. Lack of peripheral seal
f. Lack of saliva or a very
thin watery saliva

1- When opening mouth
Tight lips.
A. Remake with the lower anterior teeth set
more lingually, with a labial concavity on the
denture & with maximum extension in
the region of the retromolar pad.

2- When coughing or sneezing
• Explain that there is a movement when
pressure of air in mouth is greater than
atmospheric pressure
• Peripheral seal broken
• Unusual movement

E) INSTABILITY

Causes of instability
• Poor retention
• Unbalanced occlusion
• High occlusal plane
• Teeth outside ridge
• Teeth not in neutral zone
• Unrelieved median raphe

f) Clattering teeth
• Too great a vertical height
• Gross cuspal interference

G) NAUSEA
Light or intermitted contact on soft palate or back
of tongue

1- Denture slightly overextended
• Intermittent contact with denture
• Observe relation of posterior border to
vibrating line
• Remove excess

2- Denture underextension
• Intermittent contact: denture moving owing
to inadequate air seal
• A palpable ridge: the edge detected by
dorsum of tongue
• Extend denture to vibrating line & post dam

3- thick posterior border
• Dorsum of tongue irritated by thick edge
• Thin down post. border

h) discomfort
• Careful comparison with the old denture will
give a clue to the cause
1. Cramped tongue space
2. Altered vertical height
3. Altered occlusal plane
• Pt should be encourage to preserve several
weak

i) Altered speech
• Temporarily
• Overcome by reading loud
• Remake with concern thickness of palate &
anterior teeth position

1- labial Sound
2- Dental Sound
3-Labio-dental Sound
4-Linguo-dental Sound
5- Linguo Palatal Sound

-It results from contact between upper
and
-lower Lips to pronounce-: [ B,P,M]

-Result from Relation Between
Incisal Edge Of Upper ant. Teeth
and Lower ant. Teeth to
Pronounce ( S )

Result from Contact Between Lower
Lip and Incisal Edge of Upper ant.
Teeth to Pronounce ( F , V )

Result from Contact Between Tip
of Tongue and Incisal Edge of
Upper anterior Teeth to Pronounce
( Th )

-Results from :
A- Contact Between Tip of the Tongue
and ant. Part of the palate to
Pronounce ( T , D )
B- Contact Between Tip of the Tongue
and Middle Part of the Palate to
Pronounce ( H )

Lisping
Premature contact between tongue & ant.
Teeth
1. Increased vertical dimension
2. Increased denture thickness
3. Narrow arch space
4. Anterior teeth too palatally
Reduce intraoral air volume

Whistling
.
Failure of contact between tongue and
anterior teeth
1-Decreased vertical dimension
1. -Increased overjet
2. -Posterior teeth buccally
3. Increase intra oral air volume

j) Biting the cheek & tongue
a) Insufficient overjet
b) Reduced vertical height

k) Food under denture
• Maximum covering & adequate peripheral
seal

2- Uncommon complaint

Allergy
• Burning sensation
• Mucosa slightly inflamed & red in color
• New denture in another material

Ear ache
• Pain in TMJ
• traumatic occlusion

Loss of taste sensation
• Pecular taste
• Poor oral hygient
• Saulty taste from drainage of cyst or
haemorrhage

Burning of mouth
• Large doses of vitamin B complex
• A Piece of ice held in mouth
• Leave denture out of mouth as possible

Commonest causes of denture failure
1. Incorrect anteroposterior relation
2. Uneven & locked occlusion
3. Open vertical dimension
4. A cramped tongue
5. Poor retention
6. Failure to copy existing denture