DENTURE PROBLEMS
Causes, Diagnostic Procedures, and ClinicalTreatment.
I. Retention Problems
Maxillary denture lacks retention at time of insertion
• Treatment
• Diagnostic Procedure
• Possible Cause
• Patient reassurance
• Checking
• Tissue contours or fluid balance change
• 1.
• Use P.I.P and correction.
• Pull lip or cheek
• Inadequate clearance for labial or buccal frenum
• 2.
• Correction
• Checking
• Incorrect posterior palatal seal
• 3.
• Relieve
• Check posterior extension
• Seal placed on non-displaceable tissue
• a
• Shorten
• Use transfer ink
• Seal on movable tissue.
• b.
• Replace wax with autopolymerizing resin.
• Add wax seal along posterior border and check
• Inadequate depth of seal
• c.
• Extend posterior border
• Transfer ink line to palate with denture .
• Posterior border and seal does not extend into haimular notch
• d.
• Relieve
• Use. P.I.P
• Posterior palatal seal causing tissue rebound and denture displacement
• 4.
• Relieve
• Use. P.I.P
• Thin tissue covering over prominent mid-palatal suture or torus.
• 5.
• Saliva substitute
• Saliva substitute
• Dry mouth (alcoholism, radiation, medication , or disease).
• 6.
• Reline or remake
• Thin mix of alginate impression material
• Inaccurate denture base
• 7.
• Correction
• Retract cheek
• Posterior border too short or too thin
• 8.
• y
• Correction
• Retract lip and check
• Short labial flange or excessive notch.
• 9.
B. Maxillary denture loosens when patient opens widely
• Treatment
• Diagnostic Procedure
• Possible Cause
• P.I.P and correction
• P.I.P and correction
• Pull cheek
• Checking
• Posterior borders too
• thick or too long
• Interference with
• coronoid process
C. Maxillary denture loosens while patient is speaking
• Treatment• Diagnostic Procedure
• Possible Cause
• Correction
• Checking
• Inadequate posterior palatal seal
• 1.
• P.I.P and correction
• Checking
• Interference with coronoid process
• 2.
• P.I.P and correction
• Pull cheek
• Posterior border too long or too thick
• 3.
• Correction
• Retract lip
• Short labial flange or excessive notch for labial frenum
• 4.
• P.I.P and correction
• Checking
• Notch for buccal frenum too thick or of insufficient size
• 5.
D. Mandibular denture lacks retention at time of insertion
• Treatment
• Diagnostic Procedure
• Possible Cause
• Reassurance
• Checking
• Change in tissue contours or fluid balance since impression
• 1.
• Correction
• Checking
• Borders too wide or too long in labial or buccal frena and/or flanges
• 2.
• Impression wax . Replace with resin
• Pull cheek
• Buccal flanges undere xtended
• 3.
• Impression wax. Replace with resin
• Pull lip
• Labial flange undere xtended
• 4.
• P.I.P and correction
• Patient forceably places tongue to touch posterior palate .
• Inadequate notch for lingual frenum
• 5.
• Correction
• Patient lightly places tip of tongue into right and left buccal vestibule.
• Overextension or excessive thickness of lingual border in molar area
• 6.
• Correction
• Patient protrudes tongue from mouth.
• Overextension or excessive thickness in distolin gual area
• 7.
• Correction with resin
• Patient lightly protrudes tongue from mouth
• Underextension of lingual border in molar and/or distolingual area
• 8.
• Replace wax with resin
• Impression wax
• Inadequate lingual seal
• 9.
• Tongue exercises
• Relationship of tongue to denture
• Retracted tongue position
• 10.
• Denture adhesives
• Patient ability checking hypotonicity
• Lack of adequate neuromuscular control
• 11.
• Reposition teeth
• Position of. Lingual cusps
• Posterior teeth set too lingual
• 12.
• Reshape denture base
• Polished surfaces
• Poorly contoured polished surfaces
• 13.
• Prescribe saliva substitute
• Place saliva substitute
• Diy mouth
• 14.
E. Maxillary denture loosens at different times of day.
• Treatment
• Diagnostic Procedure
• Possible Cause
• Remove and clean
• Tissue surface covered with rbpysaliva
• Heavy secretion of saliva
• 1.
• Prescribe saliva substitute
• Place saliva substitute
• Dry mouth
• 2.
F. One or both dentures loosen while eating
• Treatment• Diagnostic Procedure
• Possible Cause
• Reposition teeth
• Check lingual cusps position
• Teeth set too far buccal to crest of ridge
• Reposition teeth
• Check position
• Occlusal plane higher than retromolar pad
• Correction
• Check relationship of teeth
• Interceptive contact in occlusion
• Reassurance
• Rule out all possible errors with dentures
• Inadequate neuromuscular control
II. Patient Discomfort Problems
A. Excessive salivation
• Treatment
• Diagnositc Procedure
• Possible Cause
• Reassurance .
• Checking during first . 72 hours .
• New denture .
• 1
B. Sore mouth at 24 hour
• Treatment
• Diagnostic Procedure
• Possible Cause
• P.I. P. and correction
• Apply pressure
• Pressure over zygomatic process
• 1
• P.I.P and correction .
• Place finger on anterior teeth protrude mandible and move from side to side
• Distobuccal border of maxillary denture base too wide
• 2
D. Generalized soreness after repeated adjustments
• Treatment
• Diagnostic Procedure
• Possible Cause
• Relaxation procedures Keep denture out at night
• Shiny wear facets on teeth
• Clenching and bruxing
• 1
• Remount and reposition of teeth
• Check V.D.O vertical dimension of occlusion
• Increased V.D.
• 2
• Correct occlusion
• Check for interfernces
• Errors in occlusion
• 3
• Consultation with physician
• Dietary analysis
• Low tissue tolerance due to nutritional deficiencies
• 4
• Referral to physician
• Thorough history
• Low tissue tolerance due to disease
• 5
E. Cheek biting
• Treatment
• Diagnositc Procedure
• Possible Cause
• Round in buccal cups
• Observe relationship of posterior
• Insufficient horizontal overlap of posterior teeth
• 1
• Thin denture bases
• Check for clearance
• Insufficient clearance between denture bases distal to last tooth
• 2
• Round sharp
• edges
• Run finger
• Sharp buccal cusps
• 3
F. Tingling and-or pain of lower lip
• Treatment
• Diagnostic Procedure
• Possible Cause
• 1
• Relieve area
• Palpate
• Pressure over mental foramen
• 2
H. Patient complains of sore throat
• Treatment
• Diagnostic Procedure
• Possible Cause
• Shorten
• Determine Overextension
• Overextension and ulceration on soft palate
• 1
• Adjustment
• Inflamed ulcerated tissues in these area
• Overextension of hamular notch , distolingual of mandibular denture , above retromolar pad
• 2
III. Gagging with Dentures
A. Gagging at time of insertion
• Treatment• Diagnostic Procedure
• Possible Cause
• A piece of hard sweet-sour
• Rule out other possible causes
• Nervousness
• 1.
• Adjust denture . Reestablish a posterior palatal seal
• Apply transfer ink to posterior border of denture.
• Posterior border too long
• 2.
• Reduce thickness .
• Thickness of posterior border is 1 m mm .
• Posterior border too thick
• 3.
• Shorten borders and reduce thickness
• Use disclosingwax or P.I.P to check for overextension thickness .
• Distolingual flange of ma-ndibular denture too long or too thick
• 4.
• Reposition teeth on denture base.
• Simulate contact on tongue with mouth mirror to check for gagging response
• Maxillary occlusal plane too low
• 5.
B. Delayed gagging - begins subsequent to day of insertion
• Treatment
• Diagnostic Procedure
• Possible Cause
• Reassurance and using an astringent mouthwash
• Remove denture and observe thick ropy saliva
• Heavy mucinous saliva
• 1.
• Grind lingual surface of man dibular posterior teeth or reposition teeth .
• Correct buccal lingual position
• Mandibular teeth set too far lingtially.
• 2.
• Reposition
• Use rest position and phonetics
• V. D. of occlusion occlusal incr- eased beyond physiologic limits
• 3.