Post insertion review

Question 1

Take careful history of problems

Answer 1

Listen before speaking
Be sympathetic
Start by saying ‘I bet its been a tough week with your new teeth’
Remember psychology is vital

Question 2

Problems encountered

Answer 2

Pain
Insecurity
Appearance
Speech
Chewing
Nausea

Question 3

Pain

Answer 3

At periphery of denture-bearing tissues
Centrally on denture-bearing tissues
Cheek/ lip biting
Numbness

Question 4

Nasty ulcers and common sites

Answer 4

Mylohyoid region - denture coming out at floor of mouth
Hamular notch - lower denture pain
Post dam/ junction of hard and softpalate
Around frenal attachments
Genial tubercles - atrophic mandibles

Question 5

Using ‘pick up’ technique when adjusting dentures

Answer 5

1. Dry surfaces
2. Mark with ZnO2 or Dycal paste
3. Transfer to denture
4. Adjust denture accordingly

Question 6

Central pain

Answer 6

Often due to bony ridges

Palpation test

Question 7

Cheek biting

Answer 7

Buccal fat pads
Can be caused by a lack of space
Try to keep a bit of space for fat pads (why 7s are usually left out)

Question 8

Numbness/ shooting pain

Answer 8

Superficial mental nerves associated with numbness of lips

Question 9

Tongue biting

Answer 9

Lack of freeway space

Question 10

Insecurity

Answer 10

When speaking
-muscle interference at periphery
-muscle interference of polished surfaces
When eating
-occlusal interference
-poor ridge form

Question 11

Insecure upper denture

Answer 11

Usually due to lack of peripheral seal - again, usually at the distal margin
Underextensions - self curing acrylic

Question 12

Insecure lower denture

Answer 12

Overextension

Lingual undercut

Question 13

Appearance

Answer 13

Complaint about teeth

Complaint about soft tissues

Question 14

Speech

Answer 14

Tooth position
Shape of base
Lack of FWS
Ridge of acrylic lingual to upper anterior teeth (placed to ensure good bonding between teeth and resin) - speech improves when removed
Palatal cusps of 4s can be too bulky compared to the old set
Tongue cramping

Question 15

Chewing

Answer 15

Almost invariably occlusal error
Locked occlusion
-corrected by pre-centric check record

Question 16

The Gothic arch tracing

Answer 16

Digital tracing which captures occlusal vertical dimension and centric relation

Question 17

Nausea

Answer 17

Insecurity - usually post-dam deficient
Thick posterior margin (distal margin should be ‘knife-edged’)
Intolerance
Dropping on to posterior tongue

Question 18

TMJ or facial muscle pain

Answer 18

Nearly always FWS or occlusal problem
Does px sleep with dentures in?
-parafunctional activity still occurs in edentulous
Check for general redness on ridges
Palpate ridges for general tenderness
Often no discernible ulcers