Diagnosis And Treatment Of Problems

Associated With The Use Of Complete

Dentures
Dr. Souad Ahmad.
BDS, MSc Prosthodontics.
Department Of Removable Prosthodontics, University Of Benghazi.

1 Wednesday, 21 August 2024

Introduction
• Most of the complaints associated with complete dentures are actual
and not psychological, contrary to the belief of most clinicians.
• Many patients experience difficulties in wearing dentures. This may
be due to limited functional efficiency of the dentures as compared to
the natural teeth or due to dimensioned patient ability to adjust to
the new situation.

2 Wednesday, 21 August 2024

 complaints

I-Common complaints

II-Uncommon complaints

2 Wednesday, 21 August 2024

I- Common complaints
6,Clattering
1,pain of teeth
7,nausea
11,Food
under the
denture

8,discomfo
2,esthetics 5,instability rt

10,biting
the cheek
9,Altere and tongue
4,Poor d speech
3,inefficiency retention
4 Wednesday, 21 August 2024
 I, 1-pain
Irregular
Over extended V- shape ridge
resorption

Mental Rough fitting Pathological

Poor fit
foramen surfaces conditions

Insufficient Teeth outside

infection Retained root
relief the ridge

Swallowing
Incorrect Other occlusal
and sore undercuts
centric relation errors
throat

5 Wednesday, 21 August 2024

1,A- Over extension of the periphery

causes/ - incorrect molding s of impression.
- incorrect outlining of the dentures on the models.
Diagnosis/ it is visible in the mouth as an area of hyperemia, a red line or
ulcer .
Treatment/
Mark with indelible pencil on the denture or use pressure indicating past,
then reduce the periphery at that position.
in severe ulcer cases will give immediate relief.
NOTE/
In old denture the cause of over extension periphery is
ridge resorption, irritation may have local hyperplasia.

6 Wednesday, 21 August 2024

1,B-poor fit
Cause/ poor retention, rocking, tilting and inability to seat the denture.
Diagnosis/ pain, and patches of redness mucous membrane may be
visible.
Treatment/ new denture construction.

7 Wednesday, 21 August 2024

1,C-insufficient relief
Cause/ denture rocking around hard area.
Diagnosis/ pain, painful area is red and possibly ulcerated.
Treatment/
1, Apply very thin coating of pressure indicating past or white tooth-past, to the
area which need relief, inset the denture in patient mouth, on removal the area will
be clearly marked.
2,trim this part of the fitting surface until adequate relief is obtained.

8 Wednesday, 21 August 2024

1,D-incorrect centric relation
1,wrong
anteroposterior
relationship

4,decreased
Incorrect
centric 2,uneven
vertical
pressure
dimension relation

3,increased vertical
dimension

9 Wednesday, 21 August 2024

D,1-Wrong anteroposterior relationship

• When teeth are in occlusion and the mandible will not be fully detruded.
attempts to retrude it fully will drag the dentures against the mucous membrane
as they are locked together by the interdigitating of the teeth.
Treatment/
- If only slight not more than ¼ of cusp it can be corrected by grinding the mesial
planes of upper cusps and distal plane of lower cusps.
- If gross, new denture will be required.

10 Wednesday, 21 August 2024

 D,2- Uneven pressure
Causes/
Faulty setting up of the teeth and due to undetected tilting of the record blocks.
Diagnosis/
pain patient complaint due to trauma from heavy one sided pressure and is
confined to the crest of lower ridge.
May present of small whit area.
Treatment/
• If it can only be found with celluloid strips, then spot grinding using atriculater
paper will improve the condition
• If detectable with spatula, new lower denture required.

11 Wednesday, 21 August 2024

D,3-Increased vertical dimension

Cause/ increasing the vertical height more than
normal while taking records.
Diagnosis/ [Link] associated with the lower
pressure resisting area.
2. one or more white patches are seen
in the painful area.
Treatment/
New lower denture if upper occlusal plane is judged
to be correct, otherwise, new upper and lower
denture construction.
12 Wednesday, 21 August 2024
D,4- Decrease vertical dimension
Cause/ loss vertical height through lower alveolar resorption.
Diagnosis/ pain is often indefinite in location and frequently
resembles neuralgia of the check on one or both sides.
Treatment/ new denture with exact vertical dimension.

13 Wednesday, 21 August 2024

1,E- other occlusal errors

- Cuspal interference.
- Disharmony between centric relation and centric occlusion
Treatment/
- If the cuspal interference is slight, or confined to only one or two
teeth, it can be corrected by carefully use of articulator paper.
- If interference is gross will be construction new dentures.

14 Wednesday, 21 August 2024

 1,F- Teeth outside the ridge
Cause/ setting upper teeth too far buccally in an attempt to overcome marked
discrepancy between the size of upper and lower arch.
Diagnosis/ tilting upper denture during bites on a wooden spatula placed on one
side then on other side.
Treatment/ new dentures, sometimes a new just upper denture with adjust the
proper position of posterior teeth, if necessary tilted or mounted to a crossed bite.

15 Wednesday, 21 August 2024

1,F- Mental foremen

Cause/ severe resorption of alveolar and basal bone.
Diagnosis/ 1, localized pain immediate vicinity of the mental nerve, and may be
referred.
2, it is neuralgic pain in the side of the face, in the lips or chin.
It can be diagnosed by firm pressure in that area which will cause the same type of the
pain.
Treatment/ Relief the denture so that the nerve can not be subjected to pressure.

16 Wednesday, 21 August 2024

 1,G-Irregular resorption
Cause/ rough alveolar ridge resorption with number of sharp spicules of bone with
thinning the mucous membrane covering them.
Diagnosis/ 1,localized pain during mastication pressing the mucous membrane
against a sharp part.
2, can be detected by gentle palpation and confirmed by X-ray
Treatment/ alveolectomy of the affected area followed by relining that part by soft
lining material if necessary.

17 Wednesday, 21 August 2024

1,H- Vshaped ridge

Cause/more usually associated with lower ridge and the pain caused
by masticatory pressure.
Diagnosis/ the pain worst on the side habitually used for eating, but
may be around all the ridge and immediately after meal.
Treatment/ as irregular ridge treatment.

18 Wednesday, 21 August 2024

 1, I- Rough fitting surfaces
Cause/the denture has been processed on a poorly cast.
Diagnosis/small pimples found on the fitting surface, the patient will
complain of pain under pressure and local area of red irritation can be
seen, usually in the palate.
Treatment/ remove the roughness from the denture.

19 Wednesday, 21 August 2024

1, J- Infection
Causes/
• most common one is ( fungi),
• patients lives in low protein and vitamins diet,
• and whose wears the dentures at night and has had long continued
antibiotic.
• All these causes superimposed with rough dentures surfaces.
Diagnosis/
• 1,clinically appearance in the palate:
• In acute red inflammation terminating at the dentures border,
swollen and smooth the mucous membrane in early stage and then
will present a granular type of hyperplasia.
• 2,to verified taken culture a swab from the tissues.

20 Wednesday, 21 August 2024

Treatment/
• Instruct the patient to apply daily fungicide such as(nystatin ointment)
on fitting surfaces of the dentures for 10 days.
• Remove dentures at night and immersed it in diluted hypochlorite.
• In severe cases dentures should not be worn during the day more than
necessary.
• Mouth wash Hypochlorite two or three times daily.
• Increase content of proteins and vitamins in diet and reduce the
carbohydrate intake.

21 Wednesday, 21 August 2024

1,K- Swallowing and sore throat

Cause/
• Upper: the border of the denture extended to the soft palate.
• Lower :border over extended distally in the lingual pouch.
Diagnosis/ the pain discontinue if the denture is left out, but restart
very soon after it is reinsertion.
Treatment/ reduction the overextension area.

22 Wednesday, 21 August 2024

 1,L- Undercuts
Diagnosis/
• the patient complaint that inserting and removing the dentures is getting
increasing painful,
• Alveolus bulging area is found to be red, painful and in some cases
ulcerated.
Treatment/
• Insert this side of denture firstly.
• Cut away until the denture can be inserted completely comfortable but the
periphery must not reduced in the height .
• Use resilient liner may be helpful.
• Alveoloplasty is last option.

23 Wednesday, 21 August 2024

1,M-Retained root and un-erupted tooth

Cause/ inproper diagnosis from begging
Diagnosis/ pain when directly pressure on an area which is tender and
will be felt very soon after inserting a new denture(s).
• diagnosis should be confirmed with X-ray.
Treatment/ extraction the remaining root or un-erupted tooth then
relining of that part of the denture.
• If some reason extraction is contraindicated, then relief may be given by
easing the denture freely over that area.

24 Wednesday, 21 August 2024

 1,N-pathological conditions
• These will usually have been diagnosed and treated before the new
dentures construction.

25 Wednesday, 21 August 2024

I,2-easthetics
Nose and chin
approximately

General Cheeks and lips

dissatisfaction falling in

Amount of
Angular cheilitis
teeth showing

Color, size, and

position of
26 anterior teeth Wednesday, 21 August 2024
2,A-Nose and chin approximating
This complaint may be made of new dentures, or old
dentures, and due to reduced vertical dimension.
Treatment/
Relining of one or both dentures or construction new
dentures with increasing vertical dimension.

27 Wednesday, 21 August 2024

2,B-Cheeks and lips falling in

• This is a condition which only arise after a patient has been
edentulous for number of years,
• Lack of the tone of the facial muscles, lack support of them from
teeth and alveolar ridges.
Treatment/
Building out the upper denture, in cases of retention is really excellent,
the teeth may be set-up slightly out side the ridge.

28 Wednesday, 21 August 2024

 2,C- Angular cheilitis or soreness of the mouth angles
• This is frequently the result of reducing in vertical dimension and muscles tone.
• The mouth angles fall in and become bathed in saliva and develop fissures, and may
superimposed with monilia albicans.
Treatment/
• Increase vertical height to restore the mouth angles to normal position.
• Correct anterior teeth position.
• Providing good support by dentures flanges.
• Fungal infection treatment as what we mentioned earlier.

29 Wednesday, 21 August 2024

2,D- Color, size, and position

color
• Invariably the complaint is teeth are
too dark or too yellow
size
• Teeth are too large or too small

position
• The patient wishes to reproduce
the irregularity of his individual
teeth in the dentures

30 Wednesday, 21 August 2024

2,E-Amount of teeth showing
• This complaint is nearly associated with upper anterior
teeth, and will be that either too much or too little
teeth are showing.
• Must be remembered that teeth show less in old age
due to attrition and laxity of the lips.
Treatment/
Remade new dentures with occlusal plane raised or
lowered as the case may be, with longer or shorter
anterior teeth if necessary.

31 Wednesday, 21 August 2024

2,F-General dissatisfaction
• Prevention of these complaint is the best means of treatment.

32 Wednesday, 21 August 2024

 I,3- Inefficiency

3,dentures
1,Inability to 2,Inability to 4,Insufficient
dislodged by
eat anything eat meat tongue space
eating

5,periphery 7,eating
6,inexperience
overextended causes pain

33 Wednesday, 21 August 2024

 1, Inability to eat anything/

This complaint is mainly confined to patient(s) who are wearing complete upper
and lower dentures for the first time.

 2, Inability to eat meat/

, flattening of the cusps of posterior teeth by over spot grinding to correct an unbalanced
denture.
, the use of cuspless posterior teeth.
,overclosure with it is decreased muscular efficiency.
,unbalanced occlusion which will not allow the teeth on balancing side to remain in contact
during lateral movement.
, cuspal interference preventing free lateral movements.
, inexperience on the part of a patient wearing his first dentures.
Treatment/ having discovered which of the these faults is the cause of the complaint.

34 Wednesday, 21 August 2024

  3,dentures dislodged by eating/
Cuspal interference.

Unbalanced occlusion.

Upper teeth out side the ridge.

Treatment
• Remake the dentures, if necessary with crossed occlusion

35 Wednesday, 21 August 2024

• 4, Insufficient tongue space/

Will often cause the lower denture to be moved during the process of eating, though it
may be stable under other conditions.
Treatment
Re-make, allowing more tongue space, using narrower posterior teeth if necessary.

36 Wednesday, 21 August 2024

• 5, periphery overextended/
Treatment
Cut away excess.
• 6, inexperience/
Biting, which function of anterior teeth, as opposed to chewing, which function of
posterior teeth.
Treatment
Carful explanation to the patient, followed by perseverance on his part.
• 7, eating causes pain/

37 Wednesday, 21 August 2024

I,4- Poor retention

A, When opening
the mouth B, When coughing
or sneezing

38 Wednesday, 21 August 2024

 A, When opening the mouth
1, 3, 5,
Over tongue Lack
extension cramped periphera
l seal

4, 6,
2,
under Lack of
tight lips
extension saliva

39 Wednesday, 21 August 2024

• 2, tight lips
The inward pressure from these tight lips will seat upper denture more firmly in
position but will push the lower denture backward and upward.
Treatment
Remake with lower anterior teeth set more lingually, and maximum extension of
region of retromolar bads .

40 Wednesday, 21 August 2024

• 3, tongue cramped
- Lower posterior teeth tilted lingually producing an undercut area into which the
wide middle third of the tongue will press.
 Treatment
Re-make the denture allowing more tongue space, with narrower bucco-lingually.

• 4, under extension

41 Wednesday, 21 August 2024

• 5, Lack peripheral seal

• Retention will have been poor when the dentures are first inserted, and the
operator may have persuaded the patient to wear them for a few days in the
hope.
• Treatment
Rounded the periphery, followed by a wash impression with zinc oxide past, and
relining.
• 6, Lack of saliva
• There no specific treatment but will give a certain degree of muscular control.

42 Wednesday, 21 August 2024

 •B, When coughing and sneezing
Treatment/ must be explained to the patient that when coughing or sneezing there
is a moment when the pressure of air in the mouth is greater than atmospheric
pressure.

43 Wednesday, 21 August 2024

I, 5- Instability

1,Poor retention
3,High occlusal
2,Unbalanced occlusion
plane(lower)
4,Teeth outside the 5,Teeth not present 6,Un-reliefed
ridge in neutral zone median raphe

44 Wednesday, 21 August 2024

 I,6- Clattering teeth
• The noise appears to be considerable to the patient.

•1, Too •2, gross

causes

causes
greater a cuspal
vertical interference
height
45 Wednesday, 21 August 2024

I,7- Nausea
intermittent contact with soft palate or back of the tongue, the causes are:
1- Denture slightly overextended.
• The movement of soft palate will cause it to make intermittent
contact with denture.
• Treatment: remove the excess and repost dam if necessary.

2- Denture under extended.

• Intermittent contact : the denture moves owing to an inadequate
air seal.
• Treatment: extend the denture almost to the vibrating line.

3- Thick posterior border

• This is very common cause of the nausea.
• Treatment: thin down the posterior border of the denture, so that the
46 tongue is unable to detect any definite junction of the denture and mucosa.
Wednesday, 21 August 2024
 I, 8- Discomfort
patient sometimes complain that new dentures are not comfortable
but can give no specific cause for complain.

Cramped tongue space.

Altered vertical dimension.

Altered occlusal plane.

47 Wednesday, 21 August 2024

I,9- altered speech

• In the first denture worn is always some temporary alteration in
speech owing to thickness of the denture covering the palate.
Treatment: denture remade with must be attention to the thickness
of the palate in the anterior region and position of the anterior teeth.

48 Wednesday, 21 August 2024

 I,10- Biting the cheek and tongue
• Cheek biting causes:
Insufficient overjet Reduced vertical height

Treatment:
Increase the buccal overjet and
plump the denture: in some cases
it may be necessary to remove the
;last molars or grind buccal
surfaces of the lower posterior
49 teeth Wednesday, 21 August 2024

• Tongue biting
This is almost due to a decrease in the tongue space.
Resolve this complain as mention.

50 Wednesday, 21 August 2024

 I, 11- Food under the denture
• This complain is usually made by patient wearing dentures for the
first time and who have not yet learnt how best to control food.
• A perfect peripheral seal will prevent the ingress of food beneath the
denture.
Treatment
Obtaining an adequate peripheral seal.

51 Wednesday, 21 August 2024

II-Uncommon complaints

1. Allergy
2. Whistling
3. Lisping
4. Ear ache
5. Loss of taste sensation
6. Peculiar taste
7. Burning of the mouth
52 Wednesday, 21 August 2024
 1, Allergy
• The patient complain of burning sensation of the mouth whilst
wearing the denture.
• Mucous membrane which contact the dentures appears slightly
inflamed and bright red in color.
Treatment
Construction new denture with another material.

53 Wednesday, 21 August 2024

2, Whistling
• It is failure of contact between tongue and anterior teeth during
pronunciation of sounds, it may occur immediately after dentures
insertion and then decreased gradually.
The causes:
[Link] the vertical dimension with resulting increase in the free way
space.
2. Anterior teeth placed too labially with
increase the overjet.
[Link] teeth placed too buccally or
inclined buccally.

54 Wednesday, 21 August 2024

 Lisping
Lisping result of premature contact between the tongue and anterior
teeth, due to:
• [Link] the vertical dimension with resulting obliteration of free
way space.
• [Link] the denture thickness.
• [Link] upper arch.
• [Link] teeth placed too palatal.
Treatment
Reposition the anterior teeth and widening the upper arch or remake.

55 Wednesday, 21 August 2024

• 4. Ear ache
• This may be result from pain of T.M.J. Which is usually results from
traumatic occlusion.
Treatment
Correction premature contact.

•5. Loss of taste sensation

• This complaint is more common among elderly patient.
• It will be disappear later when the patient becomes accustomed to
the use of the denture.

56 Wednesday, 21 August 2024

 • 6. Peculiar taste
This may be due to:
1. poor oral hygiene.
[Link] taste may result from drainage of cyst or from hemorrhage.
Treatment
- Ask patient to Improve oral hygiene.
- Proper mouth examination to detect any pathological condition.

57 Wednesday, 21 August 2024

• 7. Burning of the mouth

• The patient may feel burning sensation in rugea area, lips or side of
the tongue.
Treatment
- Stable denture with minimize the condition which may be associated
with anxiety.
- Give prober dose of vitamin B complex.
- Ask patient to leave the denture out of the mouth as possible.
- Piece of ice held in the mouth will provide temporary relief.

58 Wednesday, 21 August 2024