Diagnosis and management of denture problems

Question 1

What are some common issues with dentures in the review appointment

Answer 1

Pain​

Retention ​

Instability​

Occlusion ​

Vertical Dimension ​

Patient acceptance ​

Problems Eating​

Aesthetics​

Speech​

Food trapping

Question 2

What is the most important thing in a review appointment

Answer 2

Listen to the patient

Question 3

What is the pneumonic for the stages of RPD design

Answer 3

Something really complicated is best resolved in many stages

Question 4

What is the purpose of saddles

Answer 4

Ensure coverage of the full denture bearing area
Maximise bracing and support

Question 5

What is the function of rests

Answer 5

Provide hard tissue support to complement the saddles
Deflect food and debris away from the saddle-abutment junction

Question 6

What are the different clasp types

Answer 6

Ring
3-arm
C-clasp

Question 7

What are the benefits of a lingual bar

Answer 7

Hygenic, well tolerated

Question 8

When is a labial bar useful

Answer 8

When needing to avoid a lingual tori

Question 9

What does a complaint of pain on insertion/removal of denture mean

Answer 9

Acrylic is rubbing against patient’s mucosa

Question 10

How is pain on insertion or removal corrected

Answer 10

Pressure indicating paste​

Insert and remove denture ​

Bare spots where paste has rubbed off in areas of excess pressure​

Relieve - acrylic trimming bur​

Repeat until paste is no longer rubbing off

Question 11

When a patient complains of a denture ‘digging in’ what does that mean

Answer 11

Overextended peripheries impinging on muscle attachments

Question 12

How is over extension corrected

Answer 12

Insert denture and move muscles by “muscle trimming” and see if denture dislodges ​

Can pinpoint specific area with pressure indicating paste – adjust and repeat to check ​

When happy - polish

Question 13

Why might a patient experience pain on biting

Answer 13

Occlusion incorrect causing pressure points in certain areas

Question 14

Why does a denture dislodge when eating/speaking

Answer 14

Flanges overextended and impinging upon muscle attachments – when muscles move denture gets in the way and dislodges
OR
Early occlusal contact – occluding on this causes the denture to tip around this point – dislodges

Question 15

Why would a denture be unstable (usually lower)

Answer 15

Lower teeth have not been set in a “neutral” position over the ridge ​

Tongue/muscles are interfering with denture “space” causing it to dislodge

Question 16

What does:
Pain over entire denture bearing area​

Pain/discomfort worsens as day goes on ​

Struggling to speak – teeth clattering together

TMJ/MOM pain indicate

Answer 16

No/not enough freeway space​

Fixed by:
Take note of OVD with new denture in​

Remove denture teeth and add wax in their place (bite block)​

Re-record occlusion to a smaller OVD that is less than resting face height (generate freeway space)

Question 17

When might speech be affected in particular unable to produce ‘s’ sounds

Answer 17

Tip of tongue and palatal aspect of upper teeth not harmonious