Retching And Loose Dentures Tutorial

Question 1

What are the main reasons for denture dissatisfaction?

How can this be mitigated?

Answer 1

Retention and stability issues

More dissatisfied with partial denture

Disconnect between pt and clinician expectations due to clinician recognising limitations but patient unaware (associated with how well dentist explains intended treatment before carrying it out)

Self esteem of denture wearing

Aesthetics

Loss of chewing efficiency

Question 2

What features of a patient can make a denture difficult to construct?

Answer 2

Severely resorted or flabby ridges

Tori

Prominent mental is muscle, mylohyoid ridges or genial tubercles

High muscle attachments

Pain on the ridge on palpation

Question 3

What is retching?

Answer 3

Physiological mechanism

Involuntary contraction of the muscles of the soft palate or pharynx, resulting in a retch

Question 4

What are the two types of retching?

Explain them

Answer 4

Somatic

• touching trigger zones, commonly palatoglossal and palatopharyngeal folds, base of tongue, palate, uvula, posterior pharyngeal wall

Psychogenic
- retching can occur from sight, smell or sound of dental surgery / material etc

Question 5

How can relaxation be achieved for a retching patient?

Answer 5

Active
- controlled rhythmic or relaxed abdominal breathing
- clench thumb in hand
- wiggle toes
- desensitisation

Passive
- dim lighting
- music / distraction
- avoid sight of materials / instruments

Question 6

What ways can one distract a retching patient?

Answer 6

Talking to them constantly

Wiggle toes

Get pt to close eyes

Press on mentalis muscle or on temple

Question 7

How can one desensitise a patient to retching?

Answer 7

Repeated brushing or stroking anterior palate, or tongue, with a finger or toothbrush

‘’Homework” of brushing / stroking of hard palate for patient

Learn to swallow with mouth open

Additional treatments like hypnosis, CBT or acupressure can be good

Question 8

How can one reduce retching during impression taking?

Answer 8

Modify stock trays or special trays to reduce palatal extension

Use lower trays in upper arch if only doing a chrome partial horseshoe design

Use rapid setting impression materials such as dental composition

Question 9

How can one modify denture design to reduce retching

Answer 9

Avoid palatal plate on upper

Consider no second molars and rounded cusps so that no contact is made with posterior dorsum of the tongue

Have a palate major connector that is not too thick