POST-INSERTION COMPLETE DENTURE COMPLAINTS & THEIR

SOLUTIONS

BY Dr. MARYAM ARBAB

Outline

• Patient’s experiences & discomforts

• Problems occurring following insertion & their solutions

ZARB BOLENDER STATES …

“Explanations provided after problems develop often are interpreted as excuses by the dentist for dentures that function less than satisfactorily.”

1. First Oral Feelings2. Retention Comparison Between Natural &

Artificial Teeth3. Saliva4. Speech5. Eating6. Tongue Position & Problems With The Lower

Denture In Contrast With The Upper Denture

Different Experiences & Discomforts

1. First Oral Feelings1. NATURE OF THE COMPLETE DENTURE

General introduction about the denture by means of diagrams or models can be used to show the pt that what he is going to wear in his mouth.

2. FULLNESS OF THE MOUTH Little change in the mouth is perceived as a big change by the pt.

2. Retention Comparison Between Natural & Artificial Teeth

NATURAL DENTITION

COMPLETE DENTURE

MODE OF ACTION Roots ( which have ability to bite tough food)

Wet slippery mucosa (which is not able to bite tough food)

BITING CAPACITY 80 pounds 11.7 pounds

SENSATION Proprioceptive mechanism

No such capacity

3. SALIVA

PROBLEM SOLUTIONExcess salivation :-As foreign object is placed inside the mouth, it’s the normal reaction of the body.

Subsides in a few weeks,Keep deglutition active.

4. SPEECHPROBLEMS SOLUTION

Distortion of speech Affected fluency

(owing to initial feeling of bulk & the accompanying excessive saliva)

Difficult rapid conversation

Quietly read aloud at home (slow reading may not put up the pt’s concentration on how the sound is pronounced.)

5. EATINGPt’s compliance

e.g. ability to eat a steak or an apple is a mark of good denture.(Such things result in soreness of the mouth.)

Pt’s education In beginning pt is advised to eat soft/crispy

foods, as they are easy to comminuted.( 1st week)

Avoid fibrous & hard food in beginning, there is an ample variety of soft food available so, pt should not compromise with nutrition.

Pt is educated to eat methodically:- Pt is instructed to divide normal forkful of food in half & place each half bilaterally.

6. TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE

MANDIBULAR DENTURE MAXILLRY DENTURE

TONGUE tongue causes lifting of the lower denture

No tongue involvement

DENTURE BEARING AREAS

approx. 14cm2 Approx. 24 cm2

MUSCLE SURROUNDINGS

Buccal & lingual muscles Only buccal muscles

Problems Occurring Following Insertion & Their Solutions

SEVERAL PROBLEMSDIRECT SEQUELAE

1. DENTURE STOMATITIS2. FLABBY RIDGE3. TRAUMATIC ULCER (sore spots)4. BURNING MOUTH SYNDROME5. RESIDUAL RIDGE RESORPTION6. DENTURE IRRITATION HYPERPLASIA7. GAGGING

INDIRECT SEQUELAE

1. ATROPHY OF MASTICATORY MUSCLES2. NUTRITIONAL DEFICIENCIES

DIRECT SEQUELAE

1.DENTURE STOMATITIS

• Denture induced stomatitis• Denture sore mouth• Inflammatory hyperplasia• Chronic atrophic candidiasis

SYNONYMS

CLASSIFICATION

• Type-I (Localized simple infection)• Type-II (erythematous type)-

generalized type• Type-III granular type

ETIOLOGIC FACTORS

Systemic factors Old age Diabetes mellitus Nutritional deficiency:- iron, folate,

vit B12 etc.

Local factors Dentures • environmental factors• night wear of the dentures• denture cleanliness

Xerostomia High carbohydrate diets:- causes

increased plaque accumulation

SUPPORTIVE MEASURES• Cleanliness of the denture• Denture & the mucosa should be

cleaned after meals.• Store the denture in the 0.2-2%

chlorhexidine during the night time.• Polishing of the denture routinely.• Not to wear the denture during night

time.

MANAGEMENT

After the infection is confirmed to be occurring because of the candida, the topical anti-fungals should be given. e.g. nystatin, amphotericin B, micronidazole,

DRUG THERAPY

SURGICAL THERAPY

necessary in the type-III.

2. FLABBY RIDGE

Alveolar ridge may become mobile & extremely resilient due to replacement of the bone by the fibrous tissue.

DESCRIPTION

Surgical correction & relining of the denture base accordingly for re-adaptation of the tissue surface.

TREATMENT

3.TRAUMATIC ULCER (sore spots)

• It develops with 1- days after placement of new denture.• They are small, painful lesions covered with a grey necrotic membrane surrounded by inflammatory halo with firm, elevated borders.

DESCRIPTION

• Overextension of the denture• Unbalanced occlusion

ETIOLOGY

In normal pts, these ulcers heal within a few days after correcting the dentures. If treatment is not administered, it may progress to denture irritation hyperplasia.

TREATMENT

4.BURNING MOUTH SYNDROMES

Local factors Systemic factors Psychological factors

ETIOLOGY

Mechanical irritation by ill-fitting dentures Prolonged masticatory muscle activity Constant parafunctional movements of the

tongue Constant excessive friction on the mucosa

LOCAL FACTORS

Vitamin or iron deficiency Menopause Xerostomia Diabetes

SYSTEMIC FACTORS

Anxiety Depression

PSYCHOLOGICAL FACTORS

o Does not show any overt clinical features.

o Mainly pain starts in the morning & aggrivates during the days.

o Burning sensation is usually accompanied with dry mouth & persistent altered taste sensation.

o Asso. Symptoms include headache, insomnia, irritability and depression.

CLINICAL FEATURES

Removal of local factors Compensation for systemic deficiency except for menopause.

Psychological counselling

TREATMENT

5. RESIDUAL RIDGE RESORPTION

• Whenever there is pressure, bone resorbs due to activation of osteoclasts.• It’s a constant sequel after extraction & continues even after inserting the complete denture.

ETIOPATHOGENESIS

• More rapidly in first 6 months and slows in later 6 months.• It’s more rapid in females than in males.• It’s precipitated by certain systemic diseases & ill-fitting dentures.

PATTERN OF RESORPTION

MANDIBLE• Initially=4-5mm• Later=0.1-0.2mm

MAXILLA• Initially=2-3mm,• Later=four times lesser than mandi.

RATE OF RRR

• The depth & width of the sulcus is reduced.• Decreased vertical dimension of occlusion.• Reduction of the lower facial height.• Increased relative prognathism.

CLINICAL FEATURES

MAXILLAE Resorption is

centripetal(toward centre)

MANDIBLE Resorption is centrifugal

(away from centre)

6.DENTURE IRRITATION HYPERPLASIA

• It is a hyperplastic reaction of the mucosa occurring along the borders of the denture. These lesions result from trauma due to unstable denture flanges.• The lesions usually subside after surgical excision of the tissues & correction of the dentures.

• Symptoms are very mild with single or numerous lesions showing flaps of hyperplastic connective tissue. Deep ulceration, fissuring & inflammation may occur at the depth of the sulcus.

7. GAGGING

• The gag reflex is a normal defence mechanism, which functions to prevent foreign bodies from entering the trachea.• It may occur due to over extension of the denture borders at posterior palatal seal of the maxillary dentures & disto-lingual part of the mandibular dentures.• In such cases it needs the correction.

INDIRECT SEQUELAE

1. ATROPHY OF MASTICATORY

MUSCLES

• Usually with age, biting efficiency decreases.

• Any part of the body which is out of function goes under atrophy.

2. NUTRITIONAL DEFICIENCIES

As masticatory muscles undergo atrophy with age, their nutrition status also goes down.

CONCLUSION Patient’s education only on a right time will lead to a successful denture.

If the annoying sequelae of denture wearing are not solved than they will lead to failure of treatment outcome.

Patient should be educated & problems complained by them should be solved without FRUSTRATING them.

The denture fabricated even with all the normal criteria may lead to discomfort to the patient.

REFERENCES

ZARB BOLENDER WINKLER

THANK YOU