Managing Denture Problems

Managing Problems in
I. Direct from denture
Complete Dentures II. Indirect from denture
III. Related to patients
Dent 445
Removable Prosthodontics (4)
Dr Esam Alem
Textbook Reference: Chapter 17

Complete Prosthodontics:
Problems, diagnosis and management
AA Grant, JR Heath, JF McCord
p. 33-88

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
A. Related to denture surfaces A. Related to denture surfaces
B. Related to denture function 1. Borders
C. Related to esthetics 2. Fitting surface
3. Polished surface
D. Related to phonetics
4. Teeth
II. Indirect from denture
III. Related to patients

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
A. Related to denture surfaces A. Related to denture surfaces
1. Borders 1. Borders
a. Overextension a. Overextension
b. Underextension
c. Overcontoured flanges
d. Undercontoured flanges

SHORT LONG
TERM COMPLAINTS TERM

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Managing Denture Problems Managing Denture Problems
I. Direct from denture I. Direct from denture
A. Related to denture surfaces A. Related to denture surfaces
1. Borders 1. Borders
a. Overextension a. Overextension
i. Immediate effect ii. Delayed (late) effect
- Pain - Ulcer
- Bleeding and ulcer - Erythema (red area)
- Loss of retention before functional movements - Fibroma
- Loss of retention during functional movements - Hyperkeratinized mucosa
- Seen as areas exposed through PIP - TMD
- Loss of retention on functional movements

Managing overextensions Managing overextensions

Method 1 – Patient
complaint
Method 2 – Indelible (Copier) pencil

Let the patient point – Locate area of erythema or ulceration
to the area
– Mark it with copier (indelible) pencil

Problems with this
technique: – Seat the denture and allow the copier

Patient may not point pencil ink to imprint on the denture
correctly to the area

Reductions are not
controlled in amount
or location

Not all overextensions
cab be detected by this
method

Managing overextensions

Method 3 -
– Locate area of tissue reaction lesion
– Place PIP / disclosing wax
– Paste
– Wax
– Rubber
– Perform functional movements in the
affected area • Note the ulcer associated with the denture border
overlying the canine eminence.
– Trim the denture flange where the border
is exposed through the disclosing wax
– Repeat until no PIP / wax is displaced

2
 PIP or disclosing wax is used to check the length
of the denture borders. In this example it has
been placed in a disposable syringe.

• Disclosing wax is tempered in a water

bath.
• Apply PIP or disclosing wax to the dried
denture border.
• Carefully insert the denture and mold the
Note the posterior palatal seal area: The bead is too
borders of the selected area.
deep and too sharp. Note the ulcer at the midline.

• Other examples of commonly overextended

areas
These flanges are too thick

• Carefully adjust the denture flange as

necessary.
• Reapply, border mold and adjust until areas of
overextension are eliminated.

These flanges are too long

Managing Denture Problems

I. Direct from denture
A. Related to denture surfaces
1. Borders These flanges are too thick
a. Overextension
i. Delayed (late) effect
- Ulcers under labial flange
Causes:
Overextended Flanges → Shorten
Excessive overbite → Adjust anterior occl.
Habitual mastication in protrusive relationship
→ train patient to masticate in CR

These flanges are too long

3
 Managing Denture Problems Managing underextensions
I. Direct from denture
Method
A. Related to denture surfaces
Check for overextensions
1. Borders
Check retention
b. Underextensions
Anterior retention
i. Immediate effect
Lateral retention
- Loss of retention before functional movement
Posterior retention
- Loss of retention during functional movement

Add green stick to build in the area under
suspicion → Border mold with functional
movements intra-orally

Recheck retention

Replace green stick with cold-cure acrylic
(partial reline)

Anterior (labial flange) Lateral (buccal

(buccal flange)
retention check → retention check →
Hold anterior teeth and pull Hold contralateral posterior
denture down labially teeth and rotate flange away
from sulcus

Posterior (post dam) Posterior (hamular

(hamular notch)
retention check → retention check →
Place finger palatal to Press upwards on
anterior teeth and push contralateral canine to rotate
upward to rotate denture denture down posteriorly in
down posteriorly hamular notch area

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Managing Denture Problems Managing Denture Problems
I. Direct from denture I. Direct from denture
A. Related to denture surfaces A. Related to denture surfaces
2. Fitting Surface 2. Fitting Surface
a. Lateral Ridge Slopes a. Lateral Ridge Slopes
i. Nerve compression i. Nerve compression
ii. Unfavorable undercuts - Inferior Dental Nerve
b. Flat Areas - Mental Nerve
i. Palatal rugae area
ii. Palatal suture area
c. Crest of residual ridges

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
A. Related to denture surfaces A. Related to denture surfaces
2. Fitting Surface 2. Fitting Surface
a. Lateral Ridge Slopes a. Lateral Ridge Slopes
i. Nerve compression i. Nerve compression
- Inferior Dental Nerve - Inferior Dental Nerve
- Mental Nerve - Mental Nerve

Managing Denture Problems

I. Direct from denture
A. Related to denture surfaces
2. Fitting Surface
a. Lateral Ridge Slopes
ii. Unfavorable undercuts

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Managing Denture Problems Managing undercuts
ii. Unfavorable Undercuts
Leave engaged
• Maxillary
No trauma
• Natural – due to anatomy of ridges
A path of insertion present
• Tuberosities
• Premaxillary (anterior) area

Minimal undercut
• Uncompressed extraction sockets
E.g. normal max. ant. and tuberosity undercuts

Lingual undercuts in lateral wall of ling. pouch
• Mandibular
• Natural
• Anterior area
• Internal oblique ridge
• Mylohyoid ridge
• Mandibular tori
• Uncompressed extraction sockets

Managing undercuts

Leave but partially block on cast

Minimal trauma

A path of insertion is present

Minimal undercut

Block undercut with dental stone before
flasking and packing

Managing undercuts Managing undercuts

Reduce one side
Preprosthetic surgical removal or

Minimal trauma block-out and use implant-retained

Minimal undercut prosthesis

If undercut is severe

Reduce both sides without
If blockout/relief of denture will
compromising retention compromise retention

If undercuts encircle more than 180º

6
Managing Denture Problems
I. Direct from denture
A. Related to denture surfaces
2. Fitting Surface
b. Flat Areas
i. Palatal rugae area
nasopalatine nerve compression
ii. Palatal suture area
thin mucoperiostium – check post dam
iii. Lateral palate
posterior palatine nerve compression

Managing Denture Problems

I. Direct from denture
A. Related to denture surfaces
2. Fitting Surface
c. Crest of residual ridges
i. From ridge:
Bone spicules, knife edge, impacted roots,
impacted teeth, cysts, nerves, thin mucosa
ii. From denture:
Denture surface may include sharp prominences
or irregularities
iii. From occlusion:
Heavy occlusal interferences

7
 Managing Denture Problems
I. Direct from denture
A. Related to denture surfaces
3. Polished surface

• Finish borders with an acrylic bur.  Remove small particles of stone from the
Remove excess resin beyond the proximal areas with a brush wheel.
land. Be careful to preserve the
border width and contour.  The palatal portion should be about 3 mm
thick (minimum 2 mm).
• Remove all plaster or stone.
• Smooth the denture bases to the
proper contour with your acrylic
burs.
• Bubbles and other irregularities
around the denture teeth can be
removed with chisels or scrapers.

• Check the bearing • Use a very wet rag wheel with liberal amounts of wet
pumice to polish the palatal, lingual, labial and buccal areas.
surfaces of the The periphery of the denture must also be carefully
dentures for bubbles polished. Use the edge of the wheel as shown during
polishing to avoid burning the acrylic resin. Do not
and sharp overpolish and thereby loose the contours that were
projections. developed during festooning.

8
 Polished dentures • Reexamine the tissue side of the dentures
Note that the borders are rounded and smooth, and carefully remove any bubbles present
and the palate is highly polished and the proper with a sharp instrument.
thickness

Be careful not to overpolish the occlusal or incisal • Prior to delivery the dentures must be soaked in
surfaces of the denture teeth. water for 72 hours.
Do not over polish

Managing Denture Problems Managing Denture Problems

I. Direct from denture a. Cheek-biting
A. Related to denture surfaces Causes
4. Teeth • Thin or overextended periphery
a. Cheek-biting (denture base material does not provide
b. Tongue biting enough support for the cheek)
c. Unfamiliarity with modifications • Loss of tone of cheek musculature in old
patients
• Insufficient inter-arch clearance between distal
part of denture
• Inadequate horizontal overjet in molar region
(posterior edge-to-edge occlusion)

9
Managing Denture Problems Managing Denture Problems
a. Cheek-biting b. Tongue-biting
Treatment Causes
• Build out thin areas, or extend the short • Artifcial teeth positioned too far lingually
periphery • Occlusal plane of is too low
• Trim maxillary denture buccal to tuberosity • Large tongue :
and/or from over retromolar pad of mandibular if lower posterior teeth missing for long time,
denture tongue muscles will lose muscle tone and
• Tooth positions tongue will become broad and flattened.
• Re-set teeth in correct relationship Tongue will regain normal contour with time
• Recontour and polish buccal surface of mandibular
posterior teeth to create horizontal overjet

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
A. Related to denture surfaces B. Related to denture function
B. Related to denture function 1. Denture Instability
a. Looseness of mandibular denture
C. Related to esthetics b. Looseness of maxillary denture
D. Related to phonetics 2. Denture Interference
II. Indirect from denture a. During swallowing
b. Tooth clicking
III. Related to patients

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
B. Related to denture function B. Related to denture function
1. Denture Instability 1. Denture Instability
a. General looseness of mandibular denture a. General looseness of mandibular denture
i. Causes i. Treatments
• Error in occlusion (centric occlusion not in → Correct faulty occlusion by remount procedures
harmony with centric relation) and occlusal adjustment
• occlusal plane too high → Reset teeth at lower occlusal plane
• underextension of periphery (deficient → Reliner/rebase denture providing proper
impression) extension
• Inability of patient to adapt and control denture
• Poor tongue position (retracted/guarded tongue
position)

10
Managing Denture Problems Managing Denture Problems
I. Direct from denture I. Direct from denture
B. Related to denture function B. Related to denture function
1. Denture Instability 1. Denture Instability
a. Looseness of mandibular denture a. Looseness of mandibular denture
i. While yawning or opening wide i. While yawning or opening wide
ii. While rinsing
iii. While talking

Manidible - While yawning or rinsing Mandible - While talking

Causes Treatment Causes Treatment

Denture base too
Reduce thickness of
Inadequate seal in
Correct seal with
thick in buccal denture base lingual pouch area reline
posterior area
Shorten denture until
Lingual flange
Shorten
(masseter exerts pterygomandibular overextensions overextensions until
forward force on ligament does not tongue does not
posterior part of exert tension on interfere causing
denture) posterior border lifting up of denture

Overextended in when mouth opens and breakage of seal
retromolar area wide
(pterygomandibular
raphe interference)

Managing Denture Problems Maxilla – occasional looseness

I. Direct from denture Causes Treatment

Underextension in
Reline
B. Related to denture function localized area
1. Denture Instability

Faulty occlusion
Correct occlusion
b. Looseness of maxillary denture
i. Occasional

Overextension of
Adjust denture
ii. When eating on sides
peripheries
iii. Approximately every 2 hours
Xerostomia
Treat cause
iv. While yawning/opening wide
Displacement of
Modify impression
v. While rinsing flabby tissues during technique to change
vi. While bending over impression primary denture
vii. While talking
bearing area
viii. Looseness when occluding in centric relation

11
Maxilla – when eating on sides Maxilla – approx. every 2 hrs
Causes Treatment Causes Treatment

Non-yielding area in
Provide relief area
Heavy mucinous
Prescribe astringent
hard palate- over rigid area saliva mouth wash; regular
midpalatine raphe
Rebalance in lateral cleaning of dentures;
(crestal ridge tissues
Incorrect tooth
excursions; reset reduction of
yield under chewing position (teeth too far
teeth in correct carbohydrate intake
stresses so denture relationship to ridge buccally or labially)
rocks or “see-saws”
Improper incising may help

Instruct patient to
across mid-palatal habits
Train patient to
maintain soft diet
fulcrum) masticate in centric
until mouth is
Loss of posterior

Incorrect tooth conditioned to relation
palatal seal (seal on
position (too far wearing dentures
buccally) palate; posterior limit
not in hamular

Chewing resistant
foods notches)

Maxilla - While yawning or rinsing Maxilla – while bending over

Causes Treatment Causes Treatment

Denture base too
Reduce thickness of
Overextended in
Reduce
thick in buccal denture base posterior palatal seal thickness/extension
posterior area
Shorten denture until area of posterior palatal
(masseter exerts pterygomandibular
Overextended in seal area
forward force on ligament does not hamular notch area
Valsalva maneuver /
posterior part of exert tension on pip
denture) posterior border

Overextended in when mouth opens
retromolar area wide
(pterygomandibular
raphe interference)

Maxilla – while talking Maxilla – in RCP

Causes Treatment Causes Treatment

Inadequate posterior
Reline posterior
Incorrect occlusion
Correct occlusion
palatal seal area palatal seal
Poor denture
Selective pressure

Overextended in
Shorten posterior foundation (flabby impression / special
posterior region extension until soft tissues over ridge) impression /
palate does not lift
Teeth set too far preprosthetic surgery
upward and break buccally / labially
Reset teeth
contact with denture
Centric occlusion not
Enlarge centric area
base in harmony with
Provide relief in area
centric relation of midpalatine suture

Midpalatine suture
fulcrum

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Managing Denture Problems When swallowing
I. Direct from denture Causes Treatment

Maxillary denture too
Reduce thickness or
B. Related to denture function thick or overextended in adjust posterior area
1. Denture Instability posterior region
a. Looseness of mandibular denture
Mandibular denture too
Reduce thickness or
thick or overextended in adjust posterior lingual
b. Looseness of maxillary denture
posterior lingual flange flange area
2. Denture Interference area
a. During swallowing
Insufficient VDO
Increase VDO
b. Tooth clicking
Excessive VDO
Reduce VDO

Incorrect tooth position

Reset teeth
(posterior teeth set too far
lingually – tongue is
crowed)

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
A. Related to denture surfaces C. Related to esthetics
B. Related to denture function 1. Fullness under nose
C. Related to esthetics 2. Depressed philtrum
3. Upper lip sunken in
D. Related to phonetics
4. Too much of the teeth are exposed
II. Indirect from denture 5. Artificial appearance
III. Related to patients

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
C. Related to esthetics C. Related to esthetics
1. Fullness under nose 4. Too much of the teeth are exposed
a. Cause: labial flange of denture too long or thick a. Causes:
b. Treatement: reduce flange length or thickness i. excessive VDO
2. Depressed philtrum ii. Incisal plane too low
a. Cause: Labial flange too short iii. Cuspids and lateral incisors too prominent
b. Treatment: increase length or thickness of flange b. Treatment:
3. Upper lip sunken in i. Reduce VDO
ii. Reset teeth at higher plane
a. Cause: maxillary teeth set too far lingually
iii. Adjust
b. Treamtent: reset anterior teeth labially
4. Too much of the teeth are exposed 5. Artificial appearance
5. Artificial appearance

13
 Managing Denture Problems Anterior Maxilla Pattern of Resorption
I. Direct from denture • Following extraction, resorption is from labial
towards the lingual. Therefore anterior teeth should
C. Related to esthetics NOT be placed directly over the ridge.
5. Artificial appearance
a. Causes
i. Technique setup (teeth are too regular in alignment
– too perfect)
ii. All teeth have same shape – lack of individualization
b. Treatment
i. Individualization by rotating and shortening some
teeth
ii. Choose different but complimentary shades/ use
staining techniques
iii. Grind incisal edges and angles
iv. Individualize gingival contour and color

Average Value Positions Average Value Positions

Maxillary incisal length
Labial incisal position
On the average the position of the
On average the distance 8 maxillary central incisor edge is 22mm
from the center of the measured from from the labial sulcus
incisal papillae to the adjacent to the labial frenum.
frenum.
labial surface of the
Visibility of the central incisor should be
central incisor is 8-
8-10
approximately 1.0 with an average length
mm. This average upper lip in a middle aged patient.
influenced by the age Female Male
and gender of the In older patients or in patients with longer
Young 8 Young 6 lips the visibility decreases.
patient. Middle 7 Middle 5
In younger patients or with patients with
Old 6 Old 4
shorter lips visibility increases

Tooth Length – resorption of residual ridge

Tooth Length - esthetics
• In some cases the amount of residual ridge resorption will
• Incisor length is important for those patient’
patient’s who have a take precedence over the “high smile line”
line” and esthetics
significant display of anterior teeth. when tooth length is concerned.
• We normally expect to see approximately 2/3 – 3/4 of the • In patients who have had recent extraction, the residual
facial surfaces of the maxillary anterior teeth when the ridges are large because ridge resorption has not
patient smiles widely. However, the degree of display of progressed significantly yet.
maxillary anterior teeth varies greatly between individuals.
• When the maxillary anterior residual ridge is large then the
• An average “ high smile line”
line” is one where the patient’
patient’s overlying occlusal rim will be relatively short and there will
upper lip lies approximately 6-
6-7 mm above the incisal edge only be limited height for the anterior teeth to be set.
of the maxillary wax rim when the patient smiles or laughs.
• In such cases, shorter teeth are often selected to make
• If a patient has an average “ high smile line”
line” 7 mm above setting easier without the need of trimming the root end
the incisal edge, then an appropriate length of tooth to (ridge-
(ridge-lap) end of the artificial teeth.
select for good esthetics would be: 7 x 3/2 = 10.5 mm

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 Managing Denture Problems Managing Denture Problems
I. Direct from denture I. Direct from denture
A. Related to denture surfaces D. Related to phonetics
B. Related to denture function 1. Whistle “S” sound
C. Related to esthetics 2. Lisp “S” sound (“S” sounds like “Th”)
3. Upper and lower incisors contact during “S/
D. Related to phonetics Ch/ J” sounds
II. Indirect from denture 4. “F” sounds like “V”
III. Related to patients 5. “These/Those” sound like “Dese/Dose”
6. General speech difficulty

Linguopalatal sounds: “s”

Phonetic Considerations
The anterior teeth, tongue, and lips act as a part of the The “s” sound is made by contact
between the tip of the tongue and the
valving mechanism which modifies the flow of air to produce palate at the rugae area with a small
speech sounds space for the escape of air.

Linguopalatal sounds: “s”, “ sh”

sh” If the space is too small a whistle usually
 are made by contact between the tip of the tongue and the results and if the space is too broad and
thin, the “s” sound is replaced by the “sh
sh””
palate at the rugae area with a small space for the escape of sound which sounds like a lisp.
air
Labiodental sounds: “f” “v” (1) This is affected by the shape and
 are produced by contact between the maxillary incisors thickness of the denture base in the
and the posterior one-
one-third of the lower lip (vermillion border) palatal region.

Labial sounds: “p” “b” (2) The “s” and “sh

sh”” sounds also indicates
whether the (anterior
(anterior--posterior position) of
 if the lips are not supported properly by the teeth these the upper incisors is correct. If the patient
sounds may be defective says “sh
sh”” when he means to say “s”, then the
teeth may be too far forward.

Linguopalatal sounds: “s” – closest speaking space

(3) The “s” sound also indicates whether the patient has adequate “freeway space”
space”
or interocclusal clearance.

When we speak, our upper and lower teeth do not normally contact each other.
(They only contact during function and swallowing).

During speech, our teeth come closest together (1.0 mm) during the
the pronunciation
of the “s” or “sibilant
sibilant”” sounds.
(They also come close together during “ch
ch”” and “j” sounds).

During pronunciation of all other sounds, the space between the upper and lower
teeth is larger than this.

That is why we call the 1.0 mm space between the upper and lower teeth during
speech the “closest speaking space
space”
”

Teeth set too far Teeth set too far If we don’

don’t give the patient enough “freeway space”
space” during “jaw relation records”
records”,
Normal position then the patient’
patient’s denture teeth will start hitting each other when the patient
palatally labially pronounces the “s” sound.

15
Managing Denture Problems Managing Denture Problems
I. Direct from denture I. Direct from denture
D. Related to phonetics D. Related to phonetics
1. Whistle “S” sound 2. Lisp “S” sound (“S” sounds like “Th”)
a. Cause: a. Cause:
i. Existence of too narrow an air space on the anterior i. Existence of broad air space on the anterior part
part of the palate for the tongue (mis-shapen palate) of the palate
ii. Anterior teeth (i.e. central incisors set too far forward;
ii. When anterior palatal air channel is obliterated
increased horizontal overjet)
iii. Anterior part of tongue is crowded by maxillary iii. Anterior teeth placed too far palatally
premolars set too far palatally b. Treatment:
b. Treatment i. Adjust thickness of anterior palatal area; reduce
i. Reshape palatal contour correctly to mimic underlying thickness of palatal acrylic if necessary
palatal contour (remove thick acrylic in rugae area if ii. Reposition teeth further anteriorly if necessary
necessary)
ii. Correct overjet and anterior/premolar tooth positions if
necessary

Managing Denture Problems Managing Denture Problems

I. Direct from denture I. Direct from denture
D. Related to phonetics D. Related to phonetics
3. Upper and lower incisors contact during “S/ 4. “F” sounds like “V”
Ch/ J” sounds a. Cause:
a. Cause: i. Upper anterior teeth set too inferior (long)
i. Vertical dimension of occlusion too great ii. (Occasionally, upper anterior teeth too far palatal
ii. Reduced horizontal overlap and inferior)
(lower anterior teeth set too far anteriorly) b. Treatment:
b. Treatment: i. Reset upper anterior teeth in a more superior
i. Reduce vertical dimension of occlusion position (shorter)
ii. Reset lower anterior teeth for increased
horizontal overlap

Managing Denture Problems

Labial –dental “F” & “V” sounds
I. Direct from denture
The “f” and “v” sounds indicate D. Related to phonetics
whether the length (superior-
(superior-
5. “These/Those” sound like “Dese/Dose”
inferior position) of the upper
a. Cause: Upper anterior teeth set too far lingually
incisors is correct.
b. Treatment: Reset teeth anteriorly
The upper lip contacts the the 6. General speech difficulty
wet-
wet-dry line of the lower lip a. Initial disturbance of speech is to be expected
during speech production of (especially for patients who are first-time denture
“f” and “v” sounds. wearers)
b. Increased vertical dimension of occlusion
If the upper anterior teeth are set c. Poor retention
too long, then a “v” sound is made
when the patient means to make
an “f” sound.

16
Managing Denture Problems Managing Denture Problems
I. Direct from denture II. Indirect from denture
II. Indirect from denture A. Generalized discomfort
III. Related to patients B. Generalized soreness (pain)
C. Generalized burning sensation
D. Gagging
E. Temperomandibular joint pain
F. Fatigue of muscles of mastication
G. Difficulty during mastication
H. Excessive salivation
I. Unpleasant taste

Managing Denture Problems Managing Denture Problems

II. Indirect from denture II. Indirect from denture
A. Generalized discomfort B. Generalized soreness (pain)
1. Cause:
1. Cause:
i. Heavy biting force – strong musculature
i. Improper occlusion ii. Excessive vertical dimension of occlusion (VDO)
ii. Centric occlusion not in harmony with centric iii. Locked occlusion (no freedom of movement in CR)
relation iv. Failure to provide freedom for Bennett movement
iii. Excessive vertical dimension of occlusion (soreness usually on working side only)
v. Improperly processed base acrylic material
2. Treatment
2. Treatment
i. Correct occlusion i. Reduce buccolingual width of teeth, reduce VDO, use
ii. Enlarge centric contact area soft lining material if necessary)
iii. Reduce vertical dimension of occlusion ii. Enlarge centric relation contact area to allow some
“freedom of movement in centric relation”. Possibly
change occlusal scheme from anatomic to flat
monoplane occlusion
iii. Rebase acrylic of denture if necessary

Managing Denture Problems Managing Denture Problems

II. Indirect from denture II. Indirect from denture
C. Generalized burning sensation D. Generalized gagging
1. Common during menopause in middle-aged females
1. Alteration of the vertical dimension of
2. Allergy to acyrlic resin (but this condition is very rare)
→ remake material using alternative polymers or metal occlusion:
base a. Decreased vertical dimension results in
3. Dentures incorrectly processed (excessive free crowding of the tongue and soft tissues →
unpolymerized monomer remains) → rebasing may be
necessary gagging
4. Pressure on nerve b. Increased vertical dimension results in loss
a. Maxillary anterior ridge generalized burning sensation due of freeway space which can cause
to pressure on anterior palatine nerve → relieve area over
incisive papilla exhaustion and spasm of the levator and
b. Maxillary premolar/molar/tuberosity generalized burning tensor veli palatini muscles of the palate →
sensation → relieve area greater+lesser palatine nerves
gagging
c. Mandibular anterior region generalized burning sensation
→ relieve area over mental foramen

17
Managing Denture Problems Managing Denture Problems
II. Indirect from denture II. Indirect from denture
E. Temperomandibular joint pain F. Fatigue of muscles of mastication
1. Cause:
1. Excessive VDO → decrease VDO
a. Insufficient VDO
b. Centric occlusion not in harmony with centric 2. Reduced VDO → increase VDO
relation
c. Arthritis G. Difficulty during mastication
d. Truama
Most patients who have trouble chewing at first, have not
2. Treatment: had posterior teeth for several years. The patient has lost
a. Increase VDO the neuromuscular skills required to use the posterior
teeth in grinding the food. The patient should be informed
b. Make new centric relation record (clinical remount) → that a reasonable period of time is necessary to relearn the
correct occlusion masticatory process. The length of time will depend, to
c. Refer to physician some extent, on the patient’s innate neuromuscular
d. Remove dentures and treat with analgesics coordination and on the duration of the edentulous state.

Managing Denture Problems Managing Denture Problems

II. Indirect from denture II. Indirect from denture
F. Difficulty during mastication G. Excessive salivation
1. Food under denture ← due to movement, flabby ridge, This is often a normal physiological
or poor adaptation to tissues and general lack of
retention response to a foreign body by the
2. Blunt cusps or worn down cusps of teeth autonomic nervous system. It usually
3. Increase or decrease in VDO persists for a short period of time and
4. Pain and soreness under denture prevents patient from then secretion returns to normal.
chewing normally
5. Occlusal disharmonies H. Unpleasant taste
6. Excessive bulk/thickness of denture 1. If metal base is used (metallic taste)
7. Patient takes too much food into the mouth at once 2. If denture is not kept clean
8. The patient should be advised to avoid extremely tough,
stringy, or sticky food, especially during the initial 3. If denture is incorrectly polymerized, residual
period of adjustment monomer may create bad taste

Managing Denture Problems Managing Denture Problems

I. Direct from denture III. Related to patients
II. Indirect from denture A. Patient psychology: remember House’s
classification: which patient is most likely
III. Related to patients
to find fault with the denture?
Philosophical, critical, skeptical,
orindifferent.
B. Disabilities: neuromuscular, Parkinsons,
etc.
C. Medical conditions
D. Systemic medications

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