11. Denture Issues Flashcards
Reasons why are replacement denture may not be practical
- Finances
- Cooperation (patient is used to denture)
- Time
T/F Everyone can learn to wear a denture
F- not everyone can wear a denture
As we age we become (more/less) adaptable
less
T/F Psychological issues can transcend technical excellence
t
Potential causes for when patient complains of pain
- Excess salivation
- Sore mouth-new denture
- Non-specific pain- new denture
- Generalized soreness after repeated adjustments
- Cheek biting
- Burning sensation- upper lip and side of nose
- Sore throat
Areas of the denture to check when patient reports pain
- Relief of tori, tuberosities and sharp bony areas
- Errors in occlusion causing a shift (check occlusion and remount to correct)
- Overextension in masseter area of mandibular denture
- Insufficient relief over undercuts
Overextension of the denture in the masseter areas results in pain where
lingual mandibular pain
-Test with disclosing wax/PIP
Non-specific pain reported by a patient with a new denture may be caused by
- pressure over the zygomatic process
- Distobuccal border of maxillary denture base is too wide
How can you check to see if the issue is that the distobuccal boarder of the maxillary denture is too wide
Place finger on anterior teeth of maxillary denture
Have patient protrude mandible and move side to side
feel for movement of maxillary denture
Thick flange in the retrozygomal area can result in
coronoid interference with the maxillary denture
If there is coronoid interference what will happen to the upper denture when the patient opens
dislodges
Causes of generalized soreness after repeated adjustments may be
- Clenching/bruxing
- Inadequate freeway space
- Errors in occlusion
- Post menopausal endocrine changes
- Nutritional deficiency
- Low tissue tolerance
How do you fix inadequate freeway space
use rest position and phonetics
Signs a patient is clenching clinically
wear facets in denture teeth
patient awareness
What is an alternative method to doing a remount
Coble-Balancer
Role of Coble Balancer is
Detects occlusal prematurities that are tough to see
What diseases should be ruled out with someone with low tissue tolerance
diabetes and pemphigus vulgaris
Cheek biting with a denture can be caused by
- Insufficienct HO of posterior teeth
- Insufficient clearance between dentures distal to the last tooth
- Sharp buccal cusps
How can you correct for insufficient HO in the posterior teeth
- Round the buccal cusps of the mandibular molars
- If cross-bite round the buccal cusps of the maxillary molars
_-_mm clearance should be between denture bases distal to last tooth
3-4
Burning sensation upper lip/side of nose may be caused by
impingement of nasopalatine nerves in incisive foramen (relieve)
Sore throat may be caused by
- Over extension and ulceration of soft palate
- Over extension hamular notch
- Distobuccal of maxillary denture
- Distolingual of mandibular denture
- Denture on pterygomandibular raphe above retromolar pad
What is the first thing you should do when a pateint complains that their denture is loose
ask them to show how it loosens
What is one reason as to why a maxillary denture may lack retention
incorrect posterior palatal seal (wrong position, not deep enough, doesn’t extend to the hamular notch)
If the denture extends too far posteriorly the boarder will be on (movable/non-movable) tissue
movable
How will PIP look if the denture boarders are short? Long?
Short= streaks Long= burn-through
If the denture boarders are over-extended they will be retentive until
patient speaks
A tight _ can cause a maxillary denture to loosen
pterygomandibular raphe
What may be the cause for when a maxillary denture lacks retention on insertion and how should you look clinically to determine if this is the cause
- Tissue/fluid contours changed since impression (bite on 2 cotton rolls for 5 minutes and re-eval)
- Inadequate clearance for buccal and labial frenum (pull the lip down and look for dislodgement or frenal ulceration)
- Incorrect posterior palatal seal
Poor posterior palatal seal is detected clinically by
placing fingers on the lingual of the maxillary anterior teeth. If the posterior denture drops –> bad seal
The upper denture base can also be loose when the periphery terminates on bony structures such as
- Hard palate
- Zygoma
- External oblique ridge
- Before retromolar pad
Causes for the maxillary denture comming loose during speaking
- Inadequate post palatale seal
- Coronoid interference
- Post boarder is too long/short
- Short labial flange or excessive notch for labial frenum
- Notch for buccal frenum too thick or insufficient
Reasons the mandibular denture lacks retention on insertion
Change in contours or fluid balance boarders too wide or too long Buccal flanges underextended Labial flange is underextended Overextended lingual boarders Inadequate notch for lingual frenum
Clinically how can you determine there is an inadequate notch for lingual frenum
check for lifting when patient touches tongue to posterior palate
Causes for why a denture loosens at different times of day
- Heavy salivary secretions (ropey)
- Excessively dry
Perpetually loose maxillary denture may be atributed to
anterior interferences
tuberosity mucosa grows into space
space develops under midline of denture base
Lingually displaced mandibular denture caused by
incisors too far labial
Inclined ridge with no resistance
Tilting of jiggling caused by
-Contacts not centered over the ridge
contacts on inclined portion of ridge
Causes for lisping
- Too much overjet
- Triangular spaces between embrasures of maxillary and mand teeth
- palatal contour is too constricted
- INsufficient tongue space
If you can’t determine the problem what should you do
- Tell patient
- Don’t adjust
- Refer
Why should you never pretend to adjust a denture
reinforce maladaptive behavior harder for next dentist
-% patients are satisfied
80-85% (most patients aren’t problem patients)
