Identification of complete denture problems: a summary

J. F. McCord¹ and A. A. Grant<sup>2

1</sup>Head of the Unit of Prosthodontics, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH; ²Emeritus Professor of Restorative Dentistry, University Dental Hospital of Manchester, Higher Cambridge Street, Manchester M15 6FH

Prof. J. F. McCord
email: Learj@fs1.den.man.ac.uk

In this section, guidelines to the diagnosis of complete denture problems are presented in tabular form. Suggestions to the management of these problems are listed.

There is, inevitably, the potential for problems to arise subsequent to the insertion of complete dentures. These problems may be transient and may be essentially disregarded by the patient or they may be serious enough to result in the patient being unable to tolerate the dentures.

Factors causing problems may be grouped, essentially into four causes.

• Adverse intra-oral anatomical factors eg atrophic mucosa.
• Clinical factors eg poor denture stability.
• Technical factors eg failure to preserve the peripheral roll on a master cast.
• Patient adaptional factors.

By far the most critical factors are the patient adaptional factors. Many patients with positive stereotypes may overcome errors of prescription. Some patients, however, are unable to adapt physically and/or psychologically to dentures that satisfy clinical and technical prosthodontic norms. Clearly it would be in the best interests of the clinician and the patient to determine this at the assessment stage, and was referred to in Part 2.

The prescribing clinician is responsible for planning complete dentures after diagnosing potential problems; be they anatomical, physiological, pathological or emotional.

Once a denture-wearing problem becomes apparent, it is important that it is addressed in a logical and systematic way. That is to say, an adequate history of the problem must be obtained and a careful examination of the mouth carried out so that an accurate diagnosis can be made, and an appropriate treatment plan devised.

Without doubt listening to the patient (as their difficulties are described) is the most important first step in the process, and its importance cannot be overemphasised.

Because of the plethora of potential complete denture problems, this section is largely confined to those that are most commonly encountered at the time of insertion of replacement dentures or during review appointments in the days and weeks after insertion. For a comprehensive overview of the diagnosis and management of complete denture problems, readers are referred to standard prosthodontic texts.

Problems reported by patients shortly after provision of replacement dentures include discomfort, looseness or general problems in relation to adaptation. Some of these problems/difficulties may have a very large number of possible causes, and, indeed, can be multifactorial in origin. For simplicity the problems will be discussed in the order they tend to occur most frequently.

In the following tables, a list of causes and suitable forms of treatment to address the problems are summarised.

Discomfort associated with dentures

Many patients experience some discomfort for a period of up to a few days following receipt of new or replacement dentures. The great majority of patients achieve comfortable co-existence with their appliances following a short period of adjustment to the new conditions. This can be greatly assisted by a careful, detailed explanation of any difficulties that the operator might anticipate.

For some, however, especially where potential problems were not identified at examination or at the time of insertion, the consequent discomfort can be prolonged.

In addition, discomfort may arise some time after apparently successful prosthodontic provision as a result of intra-oral or systemic changes or of denture wear or damage. Discomfort is most frequently - but not exclusively - associated with the lower denture supporting area.

The Tables (Tables 1, 2 and 3) summarise commonly experienced sources of discomfort, and means of addressing the causative factors.

Looseness of dentures

Looseness of dentures (Tables 4, 5 and 6) is more commonly associated with the lower denture, and may be referred to by patients as their denture 'rocking', 'falling' (complete upper) or 'rising' (complete lower), 'shifting' or sometimes that they 'feel too big'.

In simple terms, retention and stability of complete dentures may be likened to a simple balance ie on one side retaining forces and on the other displacing forces. If the latter exceed the former, instability/looseness will arise. It must be stressed, however, that the fulcrum is the patient, or rather the patient's ability to adapt to dentures - this is less easy to anticipate. This is illustrated in Figure 1, which is a line drawing of factors influencing complete denture stability.

Problems relating to an inability to adapt to dentures

There are a variety of symptoms which may be functionally-related (ie eating associated problems, speech etc), psychologically-related or may relate to patience. Clearly there is a need to diagnose the former at the planning stage of treatment and to avoid the latter by virture of trial denture visits which focus on the functional and aesthetic components of the compete dentures.

Some of the psychologically-related problems may be recognised at an early stage but even if psychological assessments are taken, not all are infallible.

A brief list of factors affecting adaptation to dentures including their causes and modes of treament are listed in Table 7.

Summary

This chapter has attempted to summarise in a tabular form a list of factors that are commonly found at recall visits. The tables themselves are self-explanatory and serve as a 'useful tip' list.

For more detailed lists, readers are referred to standard prosthodontic text.

Table 1 List of factors resulting in discomfort related to the impression surface of dentures

Table 2 List of factors resulting in discomfort - relating to occlusal and polished surfaces of dentures

Table 3 List of factors resulting in discomfort - factors with possible systemic associations. Some of these conditions may occur several months post insertion

Table 4 List of factors resulting in looseness of dentures - arising from decreased retention forces

Table 5 List of factors resulting in looseness of dentures: arising from increased displacing forces

Table 6 List of factors resulting in looseness of dentures - arising from increased displacing forces - occlusal and anatomical factors

Table 7 List of denture problems associated with problems of adaptation

Fig. 1 Factors influencing complete denture stability

Refereed paper.

"Far and away the best prize that life offers is the chance to work hard at something worth doing."

Thomas Jefferson (1743-1826)
third president of the U.S.
principal author of the
Declaration of Independence