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ƌ͘DĂLJĂŶŬZ>ƵŶŝĂ ƌ͘ĞǀŝƉƌĂƐĂĚEŽŽũŝ
Post Insertion Instructions, Problems and
Management in Complete Denture Patients
TABLE OF CONTENTS
CHAPTER TITLE PAGE
1 Complete Denture Insertion
1.1 Introduction 2
1.2 Stages of Patient Education 3
1.3 Denture Insertion Procedure 6
2 Post Insertion Instructions
2.1 Introduction 15
2.2 Instructions to the Patient Before Denture 16
Insertion
2.3 Post Insertion Instructions to the Patients 19
2.4 Instructions to the Patient Regarding 23
Denture Care
2.5 Denture Cleanser 26
2.6 Denture Adhesive 32
2.7 Post Insertion Instructions to the Partial 39
Denture Wearers
2.8 Post Insertion Instructions to the Immediate 40
Denture wearers
2.9 Post Insertion Instructions to the 42
Overdenture Wearers
2.10 Future Research Needs 43
2.11 Conclusion 44
3 Post Insertion Problems and Management
3.1 Introduction 46
3.2 Common Complaints 48
3.3 Uncommon Complaints 55
3.4 Post Insertion Problems and their 59
Management
3.5 Patient Satisfaction with Complete Dentures 74
3.6 Conclusion 76
4 Bibliography 77
1. Complete Denture Insertion
Complete Denture Insertion
1.1 INTRODUCTION
segment of population are in increased need of special care and attention to maintain a
reasonable quality of life in the face of disability and growing frailty in this group.1 This
might result in an increased demand for health and social services over the next quarter
century.2
Tooth loss has a direct influence on reduced masticatory function and a shift
towards a poorly balanced diet.3 This in turn will result in an increase in oral diseases
status.3 This may make patients more susceptible to various infections and even
malignancies.3 Ill-fitting dentures will worsen this situation and patients may avoid
certain social activities like speaking, smiling, eating etc. in the presence of other
person.3
more teeth (up to the entire dentition in either arch) and associated dental/alveolar
structures.´ Dental prostheses usually are subcategorized as either fixed dental prostheses
masticatory efficiency.3
2
Complete Denture Insertion
can prove highly supportive. Early discussion provides clues that are useful about
treatment procedures and is especially important during insertion. The ability of the
doctor to listen and his skill at translating clues offered by the patient into positive
Patient motivation:5-7
denture insertion. This threshold is part of the motivation mechanism of the patient,
which may be identified early in treatment. Patient acceptance of treatment and reaction
to the results of treatment are measures of his motivation. The complexity of behavioral
factors involved in motivation may cause the doctor to misinterpret patient response in
any phase of the treatment procedure, especially during the initial diagnostic
procedure.5-7
patients¶ mental attitudes. The House Classification, given by Dr. Milus House is as
follows:8
3
Complete Denture Insertion
(ii)Ideal attitude for successful treatment provided the bio-mechanical factors are
reasonable.
(ii) Poor health and unfavorable oral conditions for fabrication of dentures.
insertion. The early satisfied patients do return after the insertion visit for only one or
two minor adjustments. At the other end of spectrum are patients who become an office
fixture. He or she can be found awaiting adjustments at frequent and short intervals. The
nonspecific and bizarre symptoms that contribute to massive frustration for the patient
and dentist. Between these extremes are the average denture patients whose success
4
Complete Denture Insertion
would eventual only due to the doctor who recognizes the problems at the earliest. Once
and exacting procedures. It is also the moment eagerly awaited by the patient, who has
co-operated in both time and effort toward this event. Well-made dentures enable the
patient to have comfort, adequate function and an appearance that will further societal
relationships and participation. These are the goals of denture insertion that are usually
amply repaying the skill and training of the former and the patience of latter.
5
Complete Denture Insertion
Denture insertion is not a separate and distinct from all other phases of denture
(i) That the polished surfaces are smooth and devoid of scratches.
(iii) That the borders are sound with no sharp angles in the border areas.
duplicated outside of the mouth, both because of minor distortions in the fabrication
process and because the oral tissues are dynamic. Casts of the edentulous arches only
represent the oral contours at the time the impressions were made. The insertion
appointment is the time to educate the patient on how to properly care for the new
6
Complete Denture Insertion
Evaluation is done for undercut areas and accuracy of tissue contact. Before
inserting the denture, paint the entire tissue side of the denture base with a thin coat of
pressure disclosing paste followed by insertion and removal of the denture. When tissue
undercuts are present, the paste will be dragged from the denture base in the area of
tissue contact. When undercut area is positively established, relieve the denture by
grinding with an acrylic bur. Repeat the procedure until adequate relief is assured.
Smooth the altered surface. Areas of exostosis or areas of bone covered with tissue that
is not displaceable, such as mid-palatal suture often appear as pressure areas even when
the denture is seated with very little pressure. The altered area is not smoothened until
the denture is subjected to the pressure of occlusion and are can see that no further relief
is required.
Evaluating borders5-7
Evaluate the borders and the contour of the polished surfaces in the mouth to
determine if
(i) The border extensions and contour are compatible with the available spaces in the
vestibules.
(ii) The borders are properly relieved to accommodate the frenum attachments and
(iii)The dentures are stable during speech and swallowing. Apply disclosing wax to
the borders of the maxillary denture in the same manner as the green stick
compound was applied during the border refining procedures. Instruct the patient
to open the jaws as in yawning, push the lower jaw forward, and move the lower
jaw from right to left. Disclosing wax is more displaceable than softened
7
Complete Denture Insertion
polish the relieved area. The same procedure is done for all areas of both
dentures.
the denture and then seating it with considerable finger pressure over the posterior teeth.
When evaluating support, occlusal contact should not be used to apply force, since it
would superimpose any occlusal discrepancy that may exist. Support can also be
evaluated by seating the denture and applying finger pressure in a tissue-ward direction
Evaluation of stability5-7
laterally. The amount of movement must be considered relative to the shape and
character of the supporting structures. To evaluate the stability of lower denture, apply
pressure on premolar and molar region on one side of arch, rise of denture on the other
(i) Teeth set outside the ridge or lack of denture base on pressure side.
8
Complete Denture Insertion
Evaluation of retention5-7
Retention of the maxillary denture can be assessed by two methods. When the
denture is grasped by the incisors and pulled downward between thumb and forefinger,
there should be resistance to displacement. Placing fingers on the palatal surface and
pulling forward is a second method for checking retention. Again, there should be
resistance to displacement.
against the facial surfaces of the mandibular incisors. The denture should not become
dislodged. Pressure indicating paste should be used to recheck the adaptation to the
bearing tissues of both upper and lower prostheses, even if retention seems acceptable.
Small areas of excess pressure can disrupt occlusal harmony or lead to ulceration that
(i) Retention can be evaluated for the maxillary denture by applying an upward and
anterior force on the palatal aspect of the anterior teeth to indicate the efficiency
(ii) Buccal force on palatal aspect of the posterior teeth on one side indicates the
(iii) Retention in the posterior portions of the mandibular denture can be evaluated by
applying a downward and anterior force on the lingual aspect of the anterior
teeth.
superiorly directed force. Both retention and stability can be evaluated further by
9
Complete Denture Insertion
addition confirms the location of the deficiency and indicate that improvement it
can be made.
Occlusal correction5-7
difficult to see occlusal discrepancies intraorally with complete dentures. The resiliency
of the supporting tissues and the displaceability of the tissues in varying degrees tend to
disguise premature occlusal contacts. The tissues permit the dentures to shift. As a result,
after the first interceptive occlusal contact, the remaining teeth appear to make
Occlusal indicator wax is a soft, dark wax with an adhesive surface that is applied to the
mandibular posterior occlusal surfaces bilaterally. After the patient has been instructed to
occlude, three dimensional impressions of the cusps of the opposing tooth contacts will
be visualized as light areas in the dark wax. Isolated contacts that have penetrated the
wax represent premature contacts and should be adjusted, after which the occlusion is
checked again. This process continues until all contacts represent similar degrees of
10
Complete Denture Insertion
is inserted intraorally, placed over the mandibular teeth and the patient is instructed to
gently bite together once and release. Ideally, the desired inter-occlusal scheme will be
represented by the contact marks. However, owing to subtle changes in the denture bases
and the occlusion checked again. This process continues until the desired pattern is
achieved. After one or two passes, if contacts still only appear unilaterally or bilaterally
11
Complete Denture Insertion
Some people experience difficulties with their natural teeth and believe that
having them extracted and getting dentures will solve all their problems. For some
patients with dentures that fit perfectly and they won't have to worry about their teeth
again. However, some have lifelong problems with their dentures. The following
information, concerning some of the challenges a person might face with the placement
(i) Some of the difficulties and problems associated with wearing dentures include:
difficulties with speaking and eating, food under dentures, function, loose
dentures, lack of retention, need for adhesives, feeling of fullness, poor ridge
relationship (i.e. Class II) as well as the probable need for future relines and
remakes.
(ii) It is necessary for immediate dentures to be relined or remade, usually within six
months.
(iii) Dentures fabricated within six to eight weeks after tooth removal frequently need
to be relined or remade before one year, due to continued bone resorption. This is
especially true for patients with a history of periodontal disease or extensive ridge
surgery. As shrinkage from bone loss is unpredictable and varies for individuals,
(iv) The average denture usually requires a laboratory reline or remake at least once
in every four years, due to functional wear and/or continued bone resorption. This
12
Complete Denture Insertion
replacement for no teeth. Dentures are prosthetic appliances, not real teeth, made
to imitate the function of teeth as closely as possible. However, most people end
13
2. Post Insertion Instructions
Post Insertion Instructions
2.1 INTRODUCTION
information and instructions to a complete denture patient in the use, care and
establishing a feeling of trust between the doctor and his patients. By careful listening
and observing, the dentist learns about the patient¶s problems and expectations regarding
denture, his emotional and physical conditions, the health and adequacy of his oral
tissues and associated structures and whether the present dentures are fulfilling the needs
of this patient.
A willingness to instruct the patient in the care and use of his dentures and an
patient will realize when his dentures require attention and will seek treatment before an
ill-fitting denture damages the oral tissues. Therefore, a patient should be educated to
15
Post Insertion Instructions
INSERTION
Educating a prospective denture patient about his/her oral status and systemic
Diabetes mellitus. Diabetic patients show an abnormally high rate of bone resorption
with decreased tissue tolerance and delayed wound healing. Such patients should be
informed about frequent oral examinations, denture adjustments and relines along with
Arthritis. These patients should be made aware that occlusal relationship may change as
a result of their disease and that limited jaw function may follow.13
Anemias. Mucositis, glossitis and angular cheilitis decrease the tolerance to a foreign
body in the mouth. Patients should be counseled about the diet and pharmacotherapy.13
instability of the denture base. The use of a denture adhesive may be advised in this type
of patients.13
and chronic tenderness of oral tissues. This condition requires diet modification,
Other conditions.14
i. Patients who have problems where surgery is either contraindicated or surgery
ii. Patients who cannot control tongue and jaw movements due to wasting or
muscular incoordination.
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Post Insertion Instructions
iii. Macroglossia or microglossia can result in loss of peripheral seal and loss of
iv. Patients who do not accept their responsibility in spite of excellent prosthodontic
treatment.
v. Patients with adverse mental attitude and lack of mental capacity to adjust to the
treatment.
explanation of the impression technique should be given with proper emphasis on the
role of the patient in that procedure. Dental education should include a discussion on the
harmony and beauty of the human face. Diagnostic casts, facial measurements, old and
recent photographs, profile records and the patients old dentures if available can be
At the try-in stage, the dentist should instruct the patient carefully that denture
teeth should be shaded and have embrasures and diastemas to simulate natural
appearance. Dentist should explain that the denture will seem to be bulky at the try-in
stage. The patient should be given a mirror and instructed to speak and count. Each
patient should be accompanied by a close friend or relative at the try in. It is absolutely
necessary to obtain the complete consent and satisfaction of the patient before
17
Post Insertion Instructions
denture treatment. From this point forward, the here to fore dentist-directed care
becomes patient-directed as the patient experiences new sensations and reports those that
are unexpected or intolerable to the dentist for remedy. For this reason, at the insertion
appointment, the dentist must employ both technical and interpersonal skills in order to
place the patient on a trajectory toward success. The technical quality of the prosthesis
must be of the highest possible caliber and the patient must be prepared psychologically
18
Post Insertion Instructions
Adjustment period17-18
Following the insertion of new dentures there is a variable period (generally 2-6
weeks) during which patients must adjust and accommodate. New dentures often feel
bulky and awkward at first. Soft tissues of the mouth, now covered, may have been open
Appearance19
Nervous patient at the time of insertion has a strained facial expression because
he has not been prepared psychologically for the denture. The facial expression may
seem slightly altered and it takes time for the muscles and lips to relax and assume their
Speech7,20
At first, there is a feeling of full mouth and a crowding of the tongue as the
dentures have altered the shape of the mouth. Patient will be conscious of something in
the mouth that was not there before and he/she will have to learn to speak. Because the
new artificial teeth may be placed in slightly different relationships and the plastic
denture base may feel bulky, speech patterns are often temporarily interrupted.
However, as soon as the lips, tongue and cheeks have been accustomed to the
dentures (as the muscles of the tongue, lips and cheek must learn to coordinate
movement to allow normal speech) and new muscle habits are formed, this difficulty is
overcome easily. A good way to learn to speak is by reading aloud before a mirror since
19
Post Insertion Instructions
it is a way to minimize the time required to recover normal speech patterns and carefully
enunciating each syllable. The learning process can be enhanced by practice. Practice
and patience resolves all difficulties. Continued difficulty should be brought to the
clinician¶s attention.
There is no question that the healthiest policy is to remove the dentures for at
least six hours daily to allow the soft tissues to breathe and recover. For most patients,
the most convenient way to accomplish this is to remove the dentures during sleep.
While out of the mouth, the dentures should be soaked in water or a denture cleaning
solution. Such a practice will maintain much healthier oral tissues, preserve the ridges
and the underlying bone, and allow the dentures to fit properly for a longer period of
time. Those patients who suffer discomfort and loss of sleep after removal of dentures,
may provide short periods of rest to oral tissues during the day.
Hypersalivation22
Soon after the insertion of dentures, salivary flow is stimulated which declines
after 2-3days unless something is physically wrong with the dentures which can cause
irritation. The glands try to wash out the strange ³foreign body´. Simply swallowing the
saliva more often is the best remedy and in a few days, the salivary glands will adjust
20
Post Insertion Instructions
Again, it will take practice to learn to eat a fairly normal diet with the
introduction of new dentures. During the first several days, soft diet are recommended.
ii. Although the normal tendency is to chew on one side or the other, denture
wearers may function better by chewing food on both sides over the back teeth at
the same time. This helps to balance the forces on the denture.
iii. Avoid bringing the lower front teeth forward and against the upper front teeth to
cut or incise foods. This protects the delicate upper front ridge and prevents
iv. If it is necessary to bite using the front teeth, try spreading the tongue against the
v. Try to chew vertically (up and down) rather than horizontally (side to side).
vi. Learning to eat with dentures takes time and requires positive effort from the
patient side.
Patient¶s should be advised that his/her maxillary denture will rest comfortably in
place with moderate-to-strong ³suction´. Although mandibular denture will have good
Tenderness17
The patient will experience some tenderness and discomfort from the dentures
21
Post Insertion Instructions
few weeks. The reason is that the mucous membrane of the mouth is vulnerable and not
evolve to bear stresses placed upon them by the dentures. New dentures will require
some adjustment. The patient should be told to wear the denture continuously for the first
24 hours and then immediately report to the dentist. Any irritations or impingements can
be detected easily and corrected. Later he should be instructed to only wear the dentures
at daytime without using them for eating. After 1-2 weeks he can start with soft chewy
foods and then as the ridges get accustomed to pressures, he can resume his daily diet.
Denture soreness5,7
New dentures almost always cause some sore spots. These will be relieved during
the first few post-insertion appointments. Clinicians recommend soft foods during the
first few days. The best home treatment between appointments for sore spots is to rinse
Denture life-span5,6
Ideally 5-7 years is the average life span of a well-made denture. As time passes,
the tissues and bone that support the denture will resorb. Generally, the denture will
require reline every couple of years to maintain an ideal fit. Every patient is unique and
as result, every denture case is particular to that patient. It is important to keep in mind
that not everyone can wear a denture successfully. Variable factors include anatomical
psychological tolerance.
22
Post Insertion Instructions
appointment.
i. First time denture wearers may want to know if it matters which prosthesis is
inserted first. A patient asking about this should be reassured that the order of
insertion does not matter, unless there is virtually no retention to the maxillary
ii. If the patient has significant undercuts in the retro-mylohyoid space, instruction
ultimate position to seat the posterior segment and then the prosthesis brought
iii. If the patient suffers from cognitive dysfunction due to stroke or Alzheimer¶s
disease (or other types of dementia), it may be impossible for him/her to initially
the ridge. In such an event, the dentist needs to work with both the patient and the
caregiver who will be able to reinforce the information away from the office. It
should be stressed that for some patients, use of a mirror will actually make the
break the seal by running one or both fingers along the full length of the flanges or by
23
Post Insertion Instructions
establish evidence based guidelines for the care and maintenance of complete dentures.
i. Careful daily removal of the bacterial biofilm present in the oral cavity and on
ii. To reduce levels of biofilm and potentially harmful bacteria and fungi, patients
a. Dentures should be cleaned daily by soaking and brushing with an effective,
b. Denture cleansers should only be used to clean dentures outside of the mouth.
c. Dentures should always be thoroughly rinsed after soaking and brushing with
denture cleansing solutions prior to reinsertion into the oral cavity. Always
vi. Dentures should be stored immersed in water after cleaning to avoid warping.
vii. Denture adhesives can improve the retention and stability of dentures and help
seal out the accumulation of food particles beneath the dentures, even in well-
fitting dentures.
24
Post Insertion Instructions
viii. Improper use of zinc-containing denture adhesives may have adverse systemic
should be avoided.
ix. Denture adhesives should be completely removed from the prosthesis and the
x. If increasing amounts of adhesives are required to achieve the same level of
xi. It is recommended that dentures should not be worn continuously (24 hours per
xii. Patients who wear dentures should be checked annually by the dentist for
maintenance of optimum denture fit and function, for evaluation for oral lesions
Recall appointments28
Patients with complete dentures have lower awareness of preventive dental behaviors.
A deliberate and proactive effort must be made to bring them back to the practice
annually for a recall. This is important to re-evaluate and revise the prostheses and to
assess the health of the oral cavity. Patients must be educated that annual recall
appointments are important to ensure the sustained optimal fit and function of their new
prosthesis as well as for the maintenance of mucosal health. These considerations are
particularly important for patients employing denture adhesive because the use of such
product can modify or eliminate customary cues for returning to the dental office.
25
Post Insertion Instructions
i. It should demonstrate anti biofilm activity and should be anti-bacterial as well as
anti-fungal.
iii. It should be compatible with denture materials and should not modify (roughen)
or degrade the surface of the acrylic resin denture base or prosthetic teeth.
Three literature reviews on denture cleansers were identified by the task force.
Abelson¶s review focused on the literature published between 1936 and 1983.29This
review described the nature of denture plaque and its role in oral disease. Additionally,
their efficacy. The review suggested that the use of abrasive pastes may be the most
highly effective but potentially damaging to prostheses and that new standards for
1979 and 1995. This review covered more than 20 articles that evaluated the efficacy of
denture cleansers and determined that the results obtained were highly dependent on the
methods used to evaluate the selected cleansing methods. Nikawa et al30, like Abelson29,
called for the development of a standardized method for evaluation of denture cleansers.
26
Post Insertion Instructions
Third, a Cochrane Review on interventions for cleaning dentures was recently published
by D¶Souza et al31. After careful comparison of the six clinical trials in this cochrane
review the authors suggested that there was no evidence that any denture-cleaning
method is more beneficial than others for the health of the denture-bearing tissues or has
Three in vivo studies considered the efficacy of denture paste in biofilm removal.
Dills et al32 suggested that brushing with a denture paste was inferior to use of an
effervescent cleaner or to use of the same cleaner followed by paste brushing. Panzeri et
al33 demonstrated that brushing with two types of pastes (one antibacterial and one with a
fluoro surfactant) reduced the biofilm mass when compared with brushing with water;
however, brushing with either paste had no impact on Candida species colonization.
Barnab´e et al34 compared brushing the dentures with coconut soap followed by soaking
it in sodium hypochlorite solution for 10 minutes to brushing with soap and soaking in
water. This cross-sectional study indicated that both treatments reduced the levels of
denture stomatitis. but neither treatment reduced the levels of Candida species cultured
tablets)29
hypochlorite, peroxides, enzymes, acids and oral mouth rinses to remove biofilm from
dentures. Each of these immersion cleansers has a different mode of action and they
27
Post Insertion Instructions
differentiate in efficacy for removal of adherent denture biofilms. While the denture
cleaning methods tested were capable of reducing the biomass present on dentures over
the various time courses evaluated, none of the in vivo trials reviewed demonstrated that
Ultrasonic cleaning35,36
Ultrasonic cleaning of dentures occurs frequently in both the dental office and the
dental laboratory. The mode of action of ultrasonic devices is unique in that they produce
ultrasonic sound waves (20 to 120 kHz), which create microscopic cavities (bubbles) that
grow and implode. This implosion creates voids that result in localized areas of suction.
Materials adhering to the denture are loosened and removed by this action. This action is
commercially available for use in the ultrasonic cleaner are Bio-Sonic Enzymatic
parts per million isopropyl alcohol and Ultra-Kleen (Sterilex) which requires the mixing
rates of bacteria but none of these two solutions tested were completely bactericidal. The
literature review indicated that the use of other commercially available denture cleansers
in conjunction with ultrasonic cleaning in the dental office has not been investigated.
In 2008, the U.S. Food and Drug Administration (FDA) issued a requirement for
consider alternatives to the types of ingredients present in this class of products. This
28
Post Insertion Instructions
action was in response to 73 severe reactions including at least one death linked to
allergic reactions. Persulfates are used in denture cleansers as part of the cleaning and
bleaching process.
iii. Rash
iv. Hives
The Food and Drug Administration (FDA) noted that other reactions may be the
labeling revisions to ensure denture wearers understand that these products are for use
iii. Burns
v. Seizures
29
Post Insertion Instructions
three minutes sterilizes dentures without causing surface degradation of the prosthesis.
However, the long-term effects of this technique have not been investigated.
These feature a wide handle for easy gripping, stiff bristles of one length on one
side of the head (for use against broader, flatter denture surfaces such as facial,
palatal, and lingual surfaces) and bristles set in a pyramidal arrangement on the
ii. Patients should be cautioned not to use toothpaste (other than toothpaste
toothpaste will scratch denture base and acrylic teeth, thereby dulling and
iii. Daily soaking in cleanser specifically designed for dentures is recommended for
the denture thoroughly after soaking to avoid ingesting traces of caustic cleaning
agents.
iv. Mouth should be rinsed after having food and dentures should be cleansed with a
small hand brush using soap and cold water. Gritty or abrasive powders or paste
should never be used as they remove the gloss and cause scratches which abrade
30
Post Insertion Instructions
the surfaces and destroy the fit of the dentures. While cleaning, the dentures
should be held over a basin of water to prevent breakage in case of accident from
the hands.
v. Commercial denture cleansers are available in tablet and powder forms. They are
dissolved in the water and dentures are soaked overnight and brushed in the
morning. If the dentures are left out of the mouth for any length of time, they
should be placed in a clean water. This affords them safe and effective storage.
31
Post Insertion Instructions
Introduction
Clinical data shows that proper use of denture adhesive can enhance retention,
stability, bite force, and the patient¶s sense of security with even a well-fitting denture.
Dentists are the clinical experts of the mouth and should take the initiative to educate
their denture patients about these products before the patients acquire incomplete or
inaccurate information about these and related products from other less reliable sources.
Denture adhesives should be discussed in detail at the insertion appointment with all
patients who the dentist perceives will need the psychological or functional benefits of an
adhesive product.37
Patients with additional indications for using denture adhesive, such as those with
expectations for their dentures that exceed anatomic limitations, those who place extreme
appointment about denture adhesive to enhance satisfaction with the newly inserted
denture. Patients who use denture adhesive should always be enrolled in a recall
schedule because less formal triggers for returning to the dentist, such as loosening of
dentures due to normal anatomic and physiologic changes over time may be obscured by
Denture adhesive38
denture and the tissues to enhance the normal physiological forces that hold dentures in
place. Dentures ³adhere´ to tissues because saliva adheres to both the denture and the
32
Post Insertion Instructions
tissue. Denture adhesive does a superior job of adhering to both surfaces, thereby
improving retention. Dentures also ³cohere´ to tissues because the film of saliva between
tissue and denture resists being pulled apart. But the coherence of denture adhesive is far
water.
Indications38
their prostheses such as musicians, public speakers, teachers, social workers etc.
ii. Those who feel the need for the additional sense of security conferred by use of
the product.
iii. Denture adhesives are particularly useful for mal-adaptive patients such as those
Contraindications38
iv. A patient who cannot or will not maintain adequate oral and prosthesis
hygiene.
33
Post Insertion Instructions
and stability of prosthesis are all intended to improve function and patient satisfaction.
They vary in their formulations, their physical form (powders versus creams) and in their
performance (strength and longevity). They all share a common property of being
soluble in saliva and water. They flow under the pressure and evenly distribute the
Creams offer immediate adherence that is enhanced when the product interacts
with saliva.
Powders must be applied to a moist denture and it exhibits ³hold´ only once
some water is absorbed. Both powders and creams work identically once they imbibe
water. They flow (like any liquid) under pressure thereby, move away from areas of tight
fit and concentrate where the prosthesis is not as intimately adapted to the bearing
tissues. For this reason, soluble adhesive itself is unable to cause denture trauma.
contribute uneven load on tissue bearing surfaces. Patient must be educated to avoid
products that are insoluble. These products are unable or limited in their ability to flow
under pressure and thereby, exert adverse tissue pressures when interposed between a
denture and the bearing tissues. The most dangerous among these are the ³do-it-yourself´
reline materials, which irreversibly alter the fitting surface of the denture and can cause
34
Post Insertion Instructions
i. Clean and dry the intaglio (tissue side) surface of the dentures.
ii. For the maxillary denture, apply three or four pea-sized increments of denture
creams to the anterior ridge, midline of the palate, and posterior border.
iii. For the mandibular denture, apply three pea-sized increments of denture cream
iv. If using powder adhesive (instead of cream as noted above), wet the base with
water. Apply a thin film of powder to the entire tissue-contacting surface and
v. If using pad adhesives, place the correct size onto the denture and cut off any
excess that extends beyond the denture border with sharp scissors.
vi. Seat the dentures independently. Hold each firmly in place for 5 to 10 seconds.
vii. Remove any excess material that expresses into the cheek or tongue space.
viii. Bite firmly to spread the adhesive and remove any additional excess that
ix. Use the minimum amount necessary to provide the maximum benefit.
Maxillary denture38
On a clean denture (wet or dry) three short strips of product are applied. One at
the crest of each of the ridge areas and one down the center. An alternative is to apply a
series of very small dots of product, evenly spaced. Material should be placed no closer
35
Post Insertion Instructions
The patient should insert and press the denture firmly in place and hold briefly.
Mandibular denture38
For the mandibular prosthesis, a short strip is placed in the depth of the left, right
and anterior ridge areas or small dots are evenly spaced. As with the maxillary denture,
the prosthesis must be clean but the product can be applied to either a wet or a dry
surface. The patient should insert and press the denture firmly in place and hold briefly.
The recommended method for applying powder adhesive is to sprinkle a thin uniform
layer throughout the moistened tissue-bearing surface of the clean denture. Excess
powder is shaken off and the denture is pressed into place. Whether using a cream or
powder denture adhesive, the patient should wait briefly (10-20minutes) before drinking
hot liquids or before chewing in order to allow the adhesive to attain its full cohesive and
adhesive strength.
and commercially available cream adhesive from both the intaglio surface of the denture
and the maxillary soft tissues. The authors colored the adhesive with 0.4% indigo
carmine to allow identification of the adhesive by the patient to facilitate its removal, and
also evaluated the patient¶s ability to remove the adhesive from the maxillary soft tissues
using a standardized five-stage method. Each stage involved the use of an undetermined
mouth rinse followed by application of cotton gauze or rinsing with hot water (700 C) for
two minutes. Each technique was repeated five times by each patient. The authors found
that repeating the process five times did not remove the cream adhesive while a single
36
Post Insertion Instructions
swish with warm water for a minute or more before repeating removal attempts.
Following extended rinsing, alternating cheek puffing (the P! sound) with firm
downward force applied by finger to the most disto-facial flange area will
Daily removal of the denture adhesive from the denture is important for tissue
health. Soaking the prosthesis overnight in water will loosen the adhesive material and
allow it to be readily rinsed off. Alternatively, scrubbing the tissue surfaces of the
denture under warm water will remove adherent product. Finally, when adhesive is
supplemented in the course of the day, all remaining material should be thoroughly
Clinical trials were identified and reviewed that focused on the use of denture
adhesives relative to their effect on denture retention, stability, movement, bite force,
ability to chew test foods, food occlusion or patient satisfaction. Most of these studies
were of short duration (same-day evaluation). Some trials randomly allocated patients to
37
Post Insertion Instructions
adhesives improved retention and stability of both ill-fitting and well-fitting dentures.
Some studies measured the adhesive-related improvement in retention and stability and
The use of denture adhesives has been reported to significantly improve the bite
force compared with using no adhesives. Rendell and colleagues evaluated chewing rates
in denture wearers using a multichannel magnetometer tracking device and found that
the mean chewing rates increased after application of denture adhesive.51 They also
found that chewing improved immediately after applying the adhesive and continued to
The most serious of the chronic and excessive use of denture adhesive reported to
adhesive. Zinc is an essential mineral normally found in some foods or used as a dietary
recommended allowances for zinc are 8 mg for women and 11 mg for men respectively.
Acute overdose can lead to nausea, vomiting, loss of appetite, cramps, diarrhea and
headaches. Tolerable upper limits of zinc have been recommended at 40 mg per day.
Unfortunately, material safety datasheets for denture adhesives do not list the specific
38
Post Insertion Instructions
DENTURE WEARERS
Partial denture patients may follow many of the same guidelines outlined as that
i. Do not use Clorox (bleach) based cleaner. It may corrode metal clasps.
ii. Do not bite the appliance into place. This may loosen and break the clasps and
teeth.
iii. Avoid biting against maxillary anterior artificial teeth as they may break rather
easily.
39
Post Insertion Instructions
DENTURE WEARERS
1. Do not smoke for at least 5 days after surgery. The chemicals and gases in
radioactive polonium and many other deadly gases. If patient insists on smoking:
5-7,60
a. Patient will greatly increase and prolong pain and healing time.
2. If several teeth have been extracted then swelling, bruising, and discomfort are
normal and if the surgery was difficult, all these symptoms will be greater. Apply
ice extraorally intermittently and take analgesics to help reduce discomfort. 6,7,60
3. The dentures will act as a bandage and help to limit bleeding. However, some
bleeding for the first 24 to 48 hours is normal. Even a few drops of blood will
4. Patient must keep the dentures in mouth for 24 hours after surgery. Pain
the dentures but swelling may happen and he may not be able to get the dentures
5. Patient¶s bite (the way maxillary and mandibular teeth come together) usually
corrected at the time of insertion. The final refinement cannot be completed until
40
Post Insertion Instructions
6. Diet for the first 24 to 48 hours should be liquid. Gradually increase the substance
of your diet as healing progresses and he/she can tolerate firmer foods. 6,7,60
7. One to two weeks after surgery, he should begin removing the dentures at night.
Removing the dentures will allow the tissue to rest from the pressure of the
denture and help keep oral tissue healthy and preserve the bone under the tissue
8. As initial adjustments are made and healing progresses, he/she will notice an
tissue and underlying bone will continue to remodel rapidly for 6 to 9 months and
denture will gradually become looser. If a treatment reline was placed at the time
until the dentures are relined with a hard plastic reline by the dentist who
9. Be sure to follow these instructions carefully. Only in this way patient can avoid
Patient has control over his healing by following the above mentioned
instructions. 6,7,60
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Post Insertion Instructions
i. Dentures made over the roots of teeth left in the ridges require extra care.5
ii. Remember to use a fluoridated toothpaste to clean gums around the remaining
iii. Fluoride rinses and treatments (in-office) are helpful in avoiding new areas of
decay.5
iv. More frequent recalls may be necessary to maintain the remaining teeth.5,6
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Post Insertion Instructions
The ACP Task Force acknowledges that there are significant gaps in the literature
related to complete denture care and maintenance. While primarily higher levels of
evidence were sought in the search strategy, the task force did not attempt to categorize
the reference materials on the basis of the strength of the evidence. Additionally, on the
basis of the current level of evidence, the task force recommends that future clinical and
i. Further exploration of effective cleaning methods will improve the quality of
denture use. This includes the long-term clinical evaluation and improvement of
ii. The impact of denture hygiene on oral and general health requires additional
investigation.
iv. The long-term effects (longer than 6 months) of denture adhesive use on oral
removal of adhesives from the tissue-contacting surface of dentures and oral soft
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Post Insertion Instructions
2.11 CONCLUSION
dentistry. Close co-operation between the patient dentist and the physician will result in
greater service to the patient. A well balanced diet containing a high percentage of
necessary to keep the supporting tissues of the dentures in good condition. The systemic
factors which has to be explained to the patient which implicates directly on the better
44
3. Post Insertion Problems and Management
Post Insertion Problems and Management
3.1 INTRODUCTION
dentures. These problems may be transient and may be essentially disregarded by the
patient or they may be serious enough to result in the patient being unable to tolerate the
dentures.
iii. Technical factors. Eg: failure to preserve the peripheral roll on a master cast
By far, the most critical factors are the patient adaptional factors. Many patients
with positive stereotypes may overcome errors of prescription. However, some patients
are unable to adapt physically and/or psychologically to dentures that satisfy clinical and
technical prosthodontics norms. Clearly it would be in the best interests of the clinician
and the patient to determine this at the assessment stage. Once a denture-wearing
systematic way. An adequate history of the problem must be obtained and a careful
examination of the mouth carried out so that an accurate diagnosis can be made and an
appropriate treatment plan devised. Listening to the patient is the most important first
Due to the plethora of potential complete denture problems, this section is largely
confined to those that are most commonly encountered at the time of insertion of
replacement dentures or during review appointments in the days and weeks after
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Post Insertion Problems and Management
insertion. Despite all the shortcomings and functional deficits, edentulous patients are by
and large satisfied with their complete dentures, with less than 10% expressing complete
expectations. Some patients may have very unrealistic expectations, while others may
fabrication technique for dentures has been proven to be superior and the technical
quality of dentures accounts for less than half the total treatment success. A dentist must
understanding of denture function and denture limitations. A major role of the dentist is
to guide and educate the patient through the process of complete denture therapy. The
minimized.62
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Post Insertion Problems and Management
The most frequent complaints of patients wearing complete dentures are mucosal
irritation, insufficient retention and stability, food accumulation under the dentures,
Mucosal irritation 63
The mucosa should be free from irritation, otherwise the functions will be
impaired. A typical location of denture irritation is either the non-mobile oral mucosa or
the regions where the mucosa is mobile during functional movements. Mucosal
irritations appear mainly due to two reasons - compression beyond physiological limits
and movement of denture during function. This is often seen at the freni, muscular
attachment regions, the hamular notch area, mandibular retromylohyoid area and buccal
area. Mucosal irritation may be due to faulty jaw relations or faulty arrangement of teeth,
buccal to the residual alveolar ridge. Mucosal irritation may also occur as a result of
overextended borders and can be rectified by reduction of the borders. The use of a
disclosing medium on the intaglio surface of the denture can be helpful to determine the
condition of foundation area, stability and retention of the denture before addressing
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Post Insertion Problems and Management
area of erythema beneath the denture. Its etiology is multifactorial, and it may be
associated with both local and systemic factors. Its management includes antifungal
Patients very often complain about loose or ill-fitting dentures which may be due
to lack of retention or stability. If the patient complains of looseness always, there may
be an obvious retention fault, whereas if the patient complains of looseness but the
dentures resist a direct pull, lack of stability may be suspected. Faulty occlusal contacts
also result in movement of denture and perceived as lack of stability and retention.
Mandibular denture is often the focus of frequent patient complaints such as instability,
pain, and inability to chew. Insufficient motivation and faulty tongue position often
results in inability to chew and lack of retention. Levin advocated placement of a groove
in the anterior lingual flange of the mandibular denture to train the patient. 64 A
reasonable method is to instruct the patient to touch the groove intermittently, 10 times at
a stretch. Then hold it there for two minutes. Repeat this ten times in a session for four
sessions a day. Bohnenkamp and Garcia suggested a phonetic training technique to use
the tongue and buccinator muscles to retain and stabilize the mandibular denture by
pronouncing the long ³e´ sound.65 Retention of ageing prostheses can be improved by
including use of denture adhesives, relining, rebasing and the use of endosseous dental
implants. In a quality-of-life study patient ratings showed that denture adhesives may
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Post Insertion Problems and Management
and quality of life. However, there is limited evidence that masticatory function may be
improved by adhesives.
Also, saliva plays a prime role in the retention of dentures. Patients with mucous
(low surface tension) saliva experience difficulty with retention of dentures. The most
adhesive saliva is thin, containing mucous components. Thin and watery saliva is not as
effective and can be identified by its inability to draw up a column of saliva. Thick and
ropy saliva is very adhesive but tends to build up so that it is too thick under the denture
and interferes with the overall adaptation. In the latter situation, the patient should rinse
out the ropy saliva about every two to three hours with a mouthwash.66
the denture wearing population.67 This paper studies factors affecting mucous and serous
salivation gland secretion, the aetiology of the 'dry mouth' and its associated problems,
causative factors for hospitilization and ifs treatment. Setting: two university dental
hospitals. Subjects: 587 denture wearers and 521 control subjects, and autopsy material
theiapy. biopsy of the minor glands. Main outcome measures: Palatal secretion (PAL,
uL/cm-/min) and parotid salivary flow (PAR), subjective complaints and clinical
findings. Results showed that the resting flow rates for PAL between 0 and 65 cm-/min
were seen in every age group. The flow rales of PAR (0 to 3.7 ml/10 min) were not
correlated with PAL. Most patients with a resting flow rate of PAL<6. ul/cm 2- suffer
from a 'dry mouth' and Burning Mouth Syndrome (BMS) or oral dysaesthesia (OD) with
or without chronic lesions of the oral mucosa. Etiological factors for the incidence of
reduced PAL and associated problems include xerostomic drugs, oestrogen deficiency,
PAL also correlated with the retention of maxillary denture. PAL was correlated with the
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Post Insertion Problems and Management
water content of epithelial tissues. PAL and PAR were both increased by drinking ample
position of the tongue by the patient. Wright and co-authors suggested that the ideal
resting position of the tongue is to keep the apex of the tongue in proximity to lingual
surfaces of the mandibular anterior denture teeth, with the lateral surface touching the
posterior teeth of the denture. The less adapted the patient is in stabilizing the prosthesis
during function, greater the denture movement and greater the quantity of food particles
that would collect beneath the dentures. Unilateral chewing causes greater denture
Difficulties in speech
Although the majority of patients adapt to new dentures within weeks, some
patients report difficulties during speech. Tongue plays a major role in converting a
test consists of evaluating contact between the tongue and the palate through phonetics.
Kong and Hansen demonstrated the need to personalize the palatal contour of a maxillary
denture in relation to tongue as this procedure can reduce the period for adaptation to the
prosthesis. The length, form and thickness of the lingual flange of the mandibular
denture is also critical in speech. Adaki et al showed that there was relative improvement
of speech with rugae incorporated dentures. Among these, customized rugae dentures
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Post Insertion Problems and Management
showed better results than arbitrary rugae dentures. Improper position of the maxillary
anterior teeth could also lead to difficulties in speech. Repositioning the anterior teeth
Masticatory inefficiency
A period of 6-8 weeks is necessary to establish new memory patterns for the
masticatory muscles. Koshino et al., concluded that the basal area of the denture
foundation greatly influenced the masticatory efficiency, suggesting that the masticatory
efficiency in complete denture wearers was limited by their own residual ridges and
patients should be informed about the limitation of the recovery of masticatory ability
before the beginning of denture treatment. Patients mostly assume that any difficulty
They must be taught that chewing with their artificial teeth is a complicated
mechanism where the whole masticatory system is involved. Hence, patients should be
advised to chew simultaneously on both sides to aid in the stability of the dentures. They
should be instructed to start having light, non-sticky foods and gradually shift to more
resistive food substances. Patients should also be instructed to chew with their posterior
teeth, especially those who had to chew with a few anterior natural teeth before going for
the complete dentures. Patients should be educated that the chewing efficiency of the
denture wearer is less than one-sixth that of the subject with a natural dentition.
Masticatory load values using complete dentures are much lesser (50 psi) than those
52
Post Insertion Problems and Management
Unattractive appearance
Patients generally want teeth which are lighter in shade and smaller in size. The
patient should be educated regarding good dental aesthetics. Patient should be informed
that natural teeth darken with age and light-shaded teeth look more artificial than darker
ones. Inform the patient that the teeth will be less translucent. A dentist must attempt to
create an appropriate smile and appearance that suits the patients¶ physical character and
aesthetic needs.68 Instead of imposing our aesthetic choices on the patient, the patient¶s
spouse and/or children should be included in decision making as they are the ones who
would appreciate the patient¶s smile. The dentures should never be processed until the
patient has accepted the arrangement with the teeth positioned in wax. A written consent
A patient may complain that the mandibular teeth are not visible or may be
dissatisfied with the degree of visibility of teeth. Of course, increased visibility can be
achieved by incorporating large overbite but this may present a problem in the stability
of the dentures. Another source of complaint is drooping of the lips or presence of folds
and creases near the lips and mouth.70 A further increase of the occlusal vertical
dimension to get rid of facial wrinkles mainly due to ageing should be avoided as it may
render the adaptation to the new dentures more difficult. Careful contouring of the labial
flange and the inclination of the maxillary central incisors will preserve the contour of
the philtrum and the tubercle of the upper lip by providing adequate support. If the
patient complains of lip fullness, the width of the peripheral roll and the labial flange can
esthetics.71
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Post Insertion Problems and Management
Fractured denture
The cause of fracture should be determined first when a patient arrives with a
complaint of fractured denture to know the condition under which fracture occurred.
Fracture may be of two kinds ± accidental and stress induced. Any signs of porosity or
lack of adhesion of artificial teeth to denture base or presence of tori and undercuts can
be a possible reason. A large frenum compromising factor for denture retention and
resistance. Large notches that are required to accommodate such frena are considered a
µcleavage point¶. Therefore, these notches have been considered responsible for fracture
of dentures. Instances with buccally placed teeth, resorption pattern, failure to relieve
mid palatine raphe and single complete dentures are more susceptible for fractures.
Reducing the need for a deep frenal notch by a frenectomy will be beneficial.72
resistant materials will reduce the tendency to fracture. Constructing dentures with metal
palates for patients with heavy occlusions has the dual advantage of providing greater
Debonding of teeth
Debonding of teeth may result from wax remaining between the surface of the
artificial tooth and the denture base acrylic resin and forming an insulating layer during
acrylic resin pressing. Insufficient pressure during packing and excessive trimming of the
teeth while arrangement to accommodate heavy ridges could also be the reasons for
debonding.69
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Post Insertion Problems and Management
some of the complaints are not as common as others. These include whistling,
having fluids, drooling at the corners of the mouth, cheek biting, xerostomia, nausea and
Whistling73
When the patient wears the denture for the first time, the patient may complain of
whistling while talking which could be because of increased palatal vault depth and
compressed arch form. Lowering the palatal contour should help the condition. Failure to
Swallowing difficulty74
flange and compression on the superior constrictor. This may also be caused by an
their taste buds begin to atrophy at about the same time that dentures are first worn. The
patient should be told that most of the taste buds are on the tongue and are not covered
55
Post Insertion Problems and Management
by the dentures. Placement of a denture base that decreases the stimulation and
temperature sensations to the palate may partially account for a loss of taste.
Altered taste 75
Common etiology of altered taste is poor oral hygiene. Patients should clean the
dentures daily by soaking and brushing with a nonabrasive denture cleanser. One should
follow the guidelines on the daily and long term care and maintenance of complete
denture prostheses. Tongue brushing is important for increasing taste acuity in geriatric
patients.
This problem may occur when the dentures are first worn by the patient. The
taking fluids. A patient may get used to it when the lips, cheeks and tongue learn to
This problem may occur due to a decreased vertical dimension and an attempt
should be made to correct the vertical dimension. Also if the vertical dimension is
correct, then an attempt should be made to increase the thickness of the flange in the
modiolus area.
Cheek biting 74
Cheek biting commonly occurs due to a lack of horizontal overlap in the posterior
teeth. Posterior teeth that occlude edge to edge will often catch the cheeks. This problem
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Post Insertion Problems and Management
usually can be corrected by reducing the buccal surface of the offending mandibular
tooth to create additional horizontal overlap, thus providing an escape for the buccal
mucosa. Also, a decrease in vertical dimension contributes to cheek biting since the
Xerostomia76
Many elderly patients take multiple medications and many of these drugs can
cause xerostomia which negatively affects the patient¶s ability to tolerate complete
dentures. Such patients have difficulty masticating and swallowing, particularly dry
foods. This could be overcome by instructing the patients to drink fluids while eating.
Xerostomic patients should also be advised to drink plenty of water (a minimum of eight
glasses) daily. Lack of lubrication at the denture-mucosa interface can produce denture
artificial saliva and frequent mouthrinses particularly during meals may be helpful. A
palatal reservoir filled with artificial saliva will enhance the quality of life of xerostomic
denture wearing adults. Sialogogues, which are drugs that stimulate the flow of saliva
without affecting its ptyalin content, can be prescribed to the patient if some glandular
These complaints may be seen in patients with an exaggerated gag reflex. It may
also be caused by overextended posterior extent of the maxillary denture and the
distolingual part of the mandibular denture. In such a case the denture should be reduced
posteriorly to the posterior palatal seal area. It may also be caused by unstable and poorly
retained dentures. The condition is often due to unstable occlusal contacts or increased
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Post Insertion Problems and Management
IV patients when excess resorption has lead the mental foramen to be located near the
crest of the mandibular residual ridge. If no relief is provided, then tingling and mild
paresthesia of the lower lip may occur. This area may be recorded and relieved to
eliminate the problem. A similar situation can occur in the maxillae from pressure on the
incisive papilla due to compression on the nasopalatine nerve. The patient may complain
of burning or numbness in the anterior part of the maxillae. Relief may be required in the
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Post Insertion Problems and Management
Classification5-7
1. Looseness of dentures
3. Support problems
5. Other difficulties
Loose denture
This is more commonly associated with mandibular denture and usually brought
to the dentist attention either soon after the dentures are placed or following a period of
successful wear when the dentures are nearing the end of useful life.5-7
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Post Insertion Problems and Management
a. Lack of seal because of border under extension in depth and width, resorption of
residual ridge and inelasticity of cheek.79-81 The functional depth and width of the
sulci should be utilized to provide seal and assist in optimal positioning of the
teeth. In case of residual ridge resorption and under extended border, temporarily
b. Air beneath the impression surface results in poor fit due to deficient
satisfactory. Ensure that areas of heavy contact between denture and tissues are
optimum curing cycle for acrylic resin, denture must not be heated when
trimming and polishing and resultant cast must not be over trimmed or damaged.
retention and stability.82,83 Stimulating saliva with bulky diet, chewing gum,
old dentures, high occlusal plane on mandibular denture and motor neuron
60
Post Insertion Problems and Management
design parameters are satisfactory, otherwise remake. Ensure that old denture is
Discomfort is common complaint associated with denture soon after the dentures
are fitted or after a period of successful wear. It is more commonly associated with
mandibular denture.
This may be caused due to pearls of acrylic or sharp ridge on fitting surface of
denture, denture base not relived in region of undercuts, over-extended lingual flange-
impinging on to mylohyoid ridge, or post dam too deep. Examine the impression surface
for surface irregularities by using disclosing material to identify the position and extent
of over-contour and relieve appropriately. Ensure that any trimmed acrylic is thoroughly
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Post Insertion Problems and Management
associated with opening movement. Discomfort may be due to too thick flange
constraining coronoid process. Accurately define area involved using disclosing material,
functional sulcus width is advised to avoid cheek biting. Lip biting is due to
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Post Insertion Problems and Management
a) Burning mouth syndrome (BMS)83,86,87- Some patients complain of burning sensation
in wearing complete denture. The symptoms are so severe that denture cannot be
tolerated for more than few hours. It is relevant to differentiate between burning
mouth sensation and burning mouth syndrome. In the former group, the patient's oral
mucosa are often inflamed or an allergic reaction. In patient suffering from burning
mouth syndrome, the oral mucosa usually appears clinically healthy. Majority of
patients affected from burning mouth syndrome are older than 50 years, females and
wearing complete denture. The females are usually postmenopausal women. Burning
In contrast to denture stomatitis, which is often not painful, burning mouth syndrome
normal mucosa. It may occur in subjects with all types of dental status and is thus not
limited to denture wearers. The tongue is reported to be the most frequent site of
middle aged people and more frequent in women (4%) than in men (1%). BMS has a
multifactorial cause comprising local, systemic, and psychogenic factors. There are
investigators consider the causative factors such as local denture pressure, Candida
albicans and bacterial infections, and allergic reactions to be the same for both
between such factors and BMS is not strong.87 Currently, great emphasis has been
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Post Insertion Problems and Management
placed on psychologic factors. It has been found that anxiety and depression are
frequent among patients with BMS and their personality characteristics indicate that
they are more concerned with their health and more socially isolated, depressed,
anxious, distrustful, and easily fatigued than control subjects. Such findings have led
some authors to suggest that the burning sensations are psychosomatic symptoms.
Other authors warn against the conclusion that BMS is primarily a psychogenic
disorder and maintain that changes noted in the psychologic profile may simply be a
reaction to chronic pain conditions and not necessarily its cause. Optimizing deficient
should be careful and not escalate the prosthetic treatment until a psychologic
evaluation has been performed and psychogenic causes have been ruled out. If
b) Herpetic ulcers- are caused by herpes simplex or herpes zoster virus and are
hygiene instructions.5
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Post Insertion Problems and Management
mucosa, most frequently in the palate. It is usually a benign disorder and most patients
are unaware of their denture stomatitis. The lesions may be local or general in nature and
the surface may show small or more extended areas of erythema of a smooth or granular
type. The prevalence reported for denture stomatitis vary greatly, with up to two thirds of
the maxillary and one fifth of the mandibular mucosa diagnosed as inflamed in complete
denture wearers.5
the presence of a denture, and denture-wearing habits are therefore correlated with
denture stomatitis. Four to five decades ago, the most important etiologic factors were
thought to be trauma from the dentures. Later, Candida albicans infections were
denture stomatitis is acknowledged. Poor oral hygiene that results in microbial plaque on
the fitting surface of the denture and bacterial and Candida albicans infections appear to
chemical irritations and allergic reactions to components in the denture material may also
immunologic aspects have also been added to the multifactorial pathogenesis of the
condition.
acknowledged. Good oral hygiene, thorough denture cleaning and an increased period of
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Post Insertion Problems and Management
rest for the denture-bearing tissues are essential and when indicated, may be combined
with antifungal therapy and the correction of traumatizing factors associated with ill-
fitting dentures. The use of antifungal drugs as the sole method of treatment is not
recommended because Candida albicans infections often recur if hygiene has not
improved and the dentures have not been optimized. Surgical elimination of papillary
optimal mucosal hygiene but in mild cases, antifungal treatment without surgery may be
an acceptable alternative.88
seen in cases of denture stomatitis and then often correlated with a Candida
albicans infection. Earlier, it was often believed that a reduced vertical dimension
of occlusion was the most important etiologic factor for angular cheilitis, but
research has shown that general health factors such as nutritional deficiencies and
Flabby ridges5-7- When hyperplastic tissue replaces the bone, a flabby ridge
develops, which is often seen in long-term denture wearers and clearly related to the
degree of residual ridge resorption. The reported prevalence for this condition also varies
among investigators, but it has been observed in up to 24% of edentulous maxillae, and
in 5% of edentulous mandible, and in both jaws most frequently in the anterior region.
Even if surgical elimination of the flabby ridge is a logical treatment in many situations,
care must be used when the ridge is extremely reduced. Although the flabby ridge may
provide poor retention for the denture, it may still be better than no ridge at all.
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Post Insertion Problems and Management
from an overextended and/or ill-fitting denture may be a fibrous tissue hyperplasia. It has
been reported to occur in 5% to 10% of jaws fitted with dentures, with the higher figure
for the maxillae. Healing is usually uneventful after reduction of the offending flanges
Traumatic ulcers7- Sore spots and ulcers are frequent findings the first few days after
placement of new dentures. They are usually caused by overextended flanges and
occlusal disturbances and can be expected to heal rapidly after the dentures have been
mandible have been observed in up to 7% of the patients and in the maxillae in up to 1%.
Diseases that impair the resistance of the mucosa to mechanical irritation are
predisposing to such lesions and make healing more difficult and recurrences more
frequent.7
Impact and etiology- Atwood called the continuous reduction of residual ridges in
rate of bone loss after tooth extraction and the wearing of complete dentures, residual
ridge resorption may proceed throughout the lifetime of the denture wearer. It is accepted
stimulus on the jaw bone. However, the causes of the great individual variations are not
well understood. Two decades ago, Woelfel et al. listed 63 factors that could possibly be
related to bone resorption under removable dentures. In their analysis, they found no
single dominant factor to explain the variability of bone loss. Even today, we must admit
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Post Insertion Problems and Management
that little is known about which factors are most important for the observed variations in
residual ridge resorption. Despite the large number of recent studies, a single dominant
factor for residual ridge resorption as yet to be found. Factors often used in correlation
analyses are gender, age, facial structure, duration of edentulousness, denture wearing
habits, number of dentures worn, oral hygiene, oral parafunctions, occlusal loading,
osteoporosis.
ridge resorption and one such factor. However, a simple, probable association between
reports on the influence of gender on residual ridge resorption: Most state that women
The researchers concluded that systemic factors control the final stage of residual
ridge resorption, whereas local factors (surgical method, healing capacity, bite force)
dominate the first phase after extraction. The best explanation that can be offered today
probably unknown or yet-to-be analyzed factors are of importance for residual ridge
resorption.
bone loss. When smoking was included in the analyses, it was found that smoking was of
greater significance than any clinical factor in a long-term study of peri-implant bone
loss. This does not indicate that smoking is of similar importance for residual ridge
resorption, it only suggests that new knowledge about the cause of residual ridge
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Post Insertion Problems and Management
resorption may emerge when multivariate analyses are applied to research data and
favorable solution for some edentulous patients who suffer from the consequences of
edentulous condition is rapidly decreasing in many countries, but great geographic and
socioeconomic differences still exist. Despite this beneficial improvement in oral health
and the decline in the rate of the edentulous condition, there remains a substantial
number of complete denture wearers among elderly people. A rough estimate indicates
that on a global level, only about one in every thousand totally and partially edentulous
people have benefited from treatment with implant-supported prostheses. The number of
edentulous elderly persons may even increase because of the current expansion of the
oldest segment of the population. Treatment of edentulous people will therefore continue
sometimes less so for the patient than for the prosthodontist who encounters increasing
and surgical treatments have been attempted in situations of severe residual ridge
resorption, but none has been completely predictable. The best treatment is to avoid total
tooth extraction, preserve a few teeth, and make overdentures, which are associated with
much lower rates of bone resorption. The placement of dental implants and the insertion
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Post Insertion Problems and Management
the edentulous jaw, indicating the importance of altered functional stimulus to the bone
tissue.
Temporomandibular disorders5,61.69
Complete denture wearers and people with other types of dentition can both be
that severe signs and symptoms are rare, even in subjects with old dentures of poor
quality. This can perhaps explain why in general there have been relatively few complete
denture wearers in samples of patients with TMD. That differences in the prevalence of
TMD, with respect to dental state has not been well-established and the role of dental
occlusion in the cause of TMD is still controversial. Some investigators have found
correlations between signs and symptoms of TMD on one side, and the wearing of
dentures, the quality of the dentures, and denture-wearing habits on the other, and others
have not.
when treating denture-wearing patients who have TMD. Positive effects on signs and
symptoms of TMD have been shown in several studies by fitting new complete dentures.
to sink into and tilt on supporting tissues, thus disrupting retentive seal. Relining/
rebasing of denture, giving additional vent holes in labial/ buccal/ lingual flanges
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Post Insertion Problems and Management
b) Bony prominence covered by thin mucosa (e.g. Tori, maxillary midline suture)-
denture rock over the prominence which may be covered with inflamed tissue. It
tongue/cheeks lift appliance away from tissue or patient uses excessive amounts
directions. Hence dentures are liable to move. This is treated by allowing optimal
directed at right angles to the seating surface which tends to lift the denture from the
supporting surface of the tissues. Stability refers to the maintenance of equilibrium and
to the resistance to displacement when the masticatory forces act in general, towards the
seating surfaces . Most of the patients complained about the looseness and mis-fitting of
function. The loss of retention of the dentures may have impaired the patients' ability to
chew. This complication is the main reason of need for replacement of their dentures.
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Post Insertion Problems and Management
Other difficulties5-7,61
There are a number of other difficulties which are reported from time to time by
complete denture patients. They are nevertheless important as they are not infrequently
occlusal interference, loose dentures. It is also found that porcelain teeth create
more impact noise than acrylic. These are corrected by addressing specific faults
or remake as required.
ii. Speech problems are usually uncommon but presence is of great concern to the
new teeth orientation and it can be easily managed by ensuring that palatal
iii. Eating difficulties may result from unstable dentures, incorrect occlusal vertical
iv. Appearance, Although it has to be stressed that appearance cannot fully assessed
to the patient to comment at the trial stage or using any available evidence-
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Post Insertion Problems and Management
home use.
vi. Altered taste sensation:90 Dentures do not cover many taste buds, thus no
physiological basis for this complaint. Thickness and low thermal conductivity of
acrylic base material could be the cause. This is managed by decreasing palatal
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Post Insertion Problems and Management
Prosthodontists have rightly maintained that they have been able to successfully
³Over the years, dentists have demonstrated considerable skill at replacing depleted
dentitions and in compensating for the resultant deficit in periodontal support. Prosthetic
care has evolved into an applied clinical skill of variations on a theme of ingenious
salvage.´ The great majority (70% to 85%) of edentulous patients has also acknowledged
the benefit of complete denture treatment and declared themselves satisfied with their
dentures. Older patients have been found to be more satisfied with poorly fitting dentures
such as bite force and the ability to comminute a test food, are substantially reduced in
complete denture wearers in comparison with people with natural dentitions, as well as
with implant-supported prostheses. Nevertheless, studies have shown that only a small
proportion of denture wearers (8%) consider their chewing ability to be poor or express a
would accept dental implants if available. The most important reason for declining
implant treatment (83%) was that they were satisfied with their present dentures. Even if
most edentulous people are satisfied with their complete dentures, there are some who
have complaints that need to be addressed. The diagnosis is usually simple and the
problems can, in most situations, be eliminated by counseling and either correction of the
individual basis. However, all who have worked with complete dentures know that
patient satisfaction is not based solely on the technical quality of the dentures.
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Post Insertion Problems and Management
even though they seek technical advice. To help such patients, the dentist must be able to
listen and communicate effectively. The ³iatrosedative interview´ has been suggested to
be an effective method of communication for helping patients who are unable to adapt to
dentures for various reasons. Although this method has not been systematically
evaluated, several studies have demonstrated the great impact of the dentist-patient
measurements of anatomic conditions, denture quality such as retention and stability, and
nonsignificant.91
Results from the evaluations of maxillary and mandibular dentures often differ,
making ³a total assessment´ problematic. Improving denture quality has been shown to
increase patient satisfaction but not to substantially alter the chewing ability of denture
wearers. A number of assessment methods for measuring patient satisfaction with their
complete dentures has been presented over the years. However, there does not seem to be
any reliable means for predicting a patient¶s acceptance of new dentures. Work has been
in progress to find better methods for studying these relationships. The complex nature
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Post Insertion Problems and Management
3.6 CONCLUSION
There is a vast difference in the magnitude and number of the complaints, many
of which may arise at a later stage. Some of these complaints can be minimized, a few
can be eliminated and some for which the dentist and the patient must contend with.
The patient should be dealt with in a sympathetic manner, keeping in mind that
such complaints are very important to patient. A careful scrutiny based on a thorough
complete denture prosthesis is essential in treating the problems connected with complete
denture use. There are many ways that dentures can be improved and dentists should be
able to assess the quality of a denture in terms of aesthetics, support, retention, stability,
Denture placement is not the last stage of complete denture fabrication process.
Post placement adjustments are important clinical phase following fabrication and
placement of a complete denture. Hence, a patient should always be recalled so that the
remaining complaints can be eliminated. Tooth loss will continue to be a problem and
require prosthetic restoration for the immediate future. Complete dentures restore
esthetics and function to some degree. A majority of edentulous patients adapt well to
their disability and their prostheses, while others experience a great deal of functional
and psychological disturbances. These maladaptive patients may benefit from implant
and/or maxillary dentures restore function to dentate levels and there appears to be only
76
4. BIBLIOGRAPHY
1. Wu B, Plassman BL, Liang J, Wei L. Cognitive Function and Dental Care
2007;97:2216-21.
2. MacEntee MI. Caring for Elderly Long-Term Care Patients: Oral Health±Related
3. Shah N, Prakash H, Sunderam KR. Edentulousness, denture wear and denture
76.
Publishers;2014.
6. Zarb GA, Bolender CL, Carlsson GE. Boucher¶s Prosthodontic treatment for
7. Heartwell CM, Rahn AO. Syllabus of complete Dentures 5th ed. New Delhi:
8. Engelmeier RL, Phoenix RD. Patient evaluation and treatment planning for
10.Ivanhoe JR, Cibirka RM, Parr GR. Treating the modern complete denture patient:
77
19(6):550-60.
13.Petersen AD, Morstad AT. Postinsertion denture. J Prosthet Dent 1968; 19:126-
32.
14.Beeson PE. The mouth examination for complete dentures: A review. J Prosthet
16.Nirranen JV. Diagnosis for complete dentures. J Prosthet Dent 1954; 4:726-38.
Res. 1950;29:448.
19. Hickey JC, Boucher CO,Woelfel JB. Responsibility of the dentist in complete
4.
23.Goiato MC, Garcia AR, Dos Santos DM, Zuim PR. Analysis of masticatory cycle
78
Denture Prosthodontics. 2nd ed. New Delhi: A.I.T.B.S. Publishers; 2009. 318-30.
Faculty of Dentistry. J Dent Res Dent Clin Dent Prospects 2011; 5(2):46-50.
29.Abelson DC. Denture plaque and denture cleansers: review of the literature.
Gerodontics 1985;1:202-6.
1988;60:467-70.
33.Panzeri H, Lara EH, Paranhos HF. In vitro and clinical evaluation of specific
79
1975;33:610-4.
36.Jørgensen EB. Materials and methods for cleaning dentures. J Prosthet Dent
1979;42:619-23.
related quality of life of complete denture wearers using denture adhesive: a pilot
removal from oral mucosa on a new gel-type denture adhesive. Nihon Hotetsu
40. Uysal H, Altay OT, Alparslan N. Comparison of four different denture cushion
41.Pradies G, Sanz I, Evans O. Clinical study comparing the efficacy of two denture
43. Kelsey CC, Lang BR, Wang RF. Examining patients¶ responses about the
1991;4:449-56.
80
complete dentures with the use of denture fixatives. J Oral Rehabil 1994;21:631-
40.
1967;18:550-8.
49.Chew CL, Boone ME, Swartz ML. Denture adhesives: their effects on denture
51.Rendell JK, Gay T, Grasso JE. The effect of denture adhesive on mandibular
52.Al RH, Dahl JE, Morisbak E. Irritation and cytotoxic potential of denture
53. Dahl JE. Potential of dental adhesives to induce mucosal irritation evaluated by
1993;69:314-7.
56. Kim E, Driscoll CF, Minah GE. The effect of a denture adhesive on the
81
57.Nations SP, Boyer PJ, Love LA. Denture cream: an unusual source of excess
43.
copper deficiency and high zinc levels of unknown origin : the denture cream is a
59.Wagner AG. Instructions for the use and care of removable partial dentures. J
N Am. 1996;40(1):151-67.
61.Fenlon MM. Delivery and Aftercare. In: Sharry JJ. Complete Denture
Zarb G, Hobkirk JA, Eckert SE, Jacob RF, Fenton AH, Finer Y, Chang T-L,
Koka S. Prosthodontic Treatment for Edentulous Patients. 13th ed. St. Louis, MO:
64.G. Van Huysen, Lieutenant Colonel William Fly and Major L. Leonard: Artificial
Dentures and the Oral Mucosa. J Prosthet Dent 1954; 4 (4): 446-60.
82
68.Lamb DJ. Review. In: Lamb DJ, editor. Problems and Solutions in Complete
19(6):550-60.
Update1982; 9:35-408.
73.Silverman MM. The whistle and swish sound in denture patients. J Prosthet Dent
1967;17:144-8.
1953;3:660-4.
78.Bassi BS, Humphris MJ. The etiology and management of gagging: A review of
83
79.Landa JS. Trouble shooting in complete denture prosthesis: Part I. Oral mucosa
80.Brunello DL, Mandikos MN. Construction faults, age, gender, and relative
86.Tourne LP, Luc PM Friction JR. Burning mouth syndrome. Oral Surgery, Oral
1997;78:93-7.
88.Nater JP, Groenman NH, Wakkers-Garritsen BG, Timmer LH. Etiologic factors
89.Atwood DA. Reduction of residual ridges;a major oral disease entity. J Prosthet
84
Complete Denture on Gustatory and Olfactory Senses. J Dent Res Dent Clin Dent
91.Misch LS, Misch CE. Denture satisfaction: a patient¶s perspective. Int J Oral
85
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