COMMON COMPLAINTS OF

COMPLETE DENTURE WEARERS

Arubuola E. O.
 CONTENTS
• INTRODUCTION
• COMMON COMPLAINTS
– Discomfort/pain
– Looseness
– Adaptability
– Altered speech
– Inability to eat
– Appearance
• CONCLUSION
• REFERENCES
 INTRODUCTION
• There is, inevitably, the potential for problems
to arise subsequent to the insertion of
complete 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.
 INTRODUCTION-2
• Factors causing problems may be grouped,
essentially into four causes.
• Adverse intra-oral anatomical factors eg
atrophic mucosa.
• Clinical factors eg poor denture stability.
• Technical factors eg failure to preserve the
peripheral roll on a master cast.
• Patient adaptional factors.
 INTRODUCTION-3
• By far the most critical factors are the patient
adaptional factors. Many patients are unable
to adapt physically and/or psychologically to
dentures that satisfy clinical and technical
prosthodontic norms.
• Once a denture-wearing problem becomes
apparent, it is important that it is addressed in
a logical and systematic way.
 INTRODUCTION-4
• That is to say, 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.
 INTRODUCTION-5
• Champion H et al in 1995 investigated into
the problems experienced by 114 referred
patients with complete dentures who were
considered to be difficult or to have difficult
prosthodontic problems. The commonest
problems were those of pain and lack of
retention, mainly due to occlusal
discrepancies and excessive VDO.
 INTRODUCTION-6
• Roessler DM et al. 2003 Before treatment even
begins, the patient's motivation for denture
treatment and emotional attitude towards
dentures must be evaluated. Patients will
thereby gain realistic expectations of what can
and cannot be achieved, and dentists will
understand what the patient really wants. Finally,
patients must be informed that continued
success depends on regular denture maintenance
at home combined with periodic consultation
with the dentist
• Treatment was carried out on an individual
basis with a large proportion of dentures
being remade.
• However, a small number was satisfied by
counseling alone without procedural
treatment. The overall success rate for
treatment was 80%.
 COMMON COMPLAINTS
• Common problems reported by patients
shortly after provision of replacement
dentures include.
• Pain or discomfort
• Looseness
• Inability to chew
• Inability to speak properly.
 COMMON COMPLAINTS-2
• Instabilty
• TMJ pain
• Clattering noise or clicking sound.
• Excessive salivation.
• Cheek biting
• Adaptation
• Appearance
 COMMON COMPLAINTS-3
• Some of these problems/difficulties may have
a very large number of possible causes, and,
indeed, can be multifactorial in origin.
• For simplicity, the problems will be discussed
in the order they tend to occur most
frequently.
 Discomfort
• Many patients experience some discomfort for a
period of up to a few days following receipt of
new or replacement dentures.
• The great majority of patients achieve
comfortable co-existence with their appliances
following a short period of adjustment to the
new conditions.
• This can be greatly assisted by a careful, detailed
explanation of any difficulties that the operator
might anticipate.
 Discomfort-2
• For some, however, especially where potential
problems were not identified at examination
or at the time of insertion, the consequent
discomfort can be prolonged.
• In addition, discomfort may arise some time after
apparently successful prosthodontic provision as
a result of intra-oral or systemic changes or of
denture wear or damage.
• Discomfort is most frequently—but not
exclusively—associated with the lower denture
supporting area.
 List of factors resulting in discomfort related to the impression surface of dentures

Symptoms/clinical Cause Treatment

findings
Pearls or sharp ridges of acrylic
Discrete painful areas on the fitting
surface arising from deficiency
in
laboratory finishing
Pain on insertion and Denture not relieved in region
removal, possibly of undercuts
inflamed mucosa on
side(s) of ridges
Locate with finger, or
snagging dry cotton wool
fibres. Use disclosing
material to assist . trim to
ease denture
Use disclosing material to
adjust in region of ’wipe
off’. excessive removal may
reduce retention. Also
clinician should only
insert denture and then
remove it - the patient
should not occlude as this
may confuse an
occlusal fault with support
problems
Symptoms/clinical Cause Treatment
findings

Areas painful to pressure Pressure areas resulting eg Use disclosing material to

from faulty impressions, accurately locate area
damage to working cast, to be relieved. If severe,
warpage of denture base. remake may be required.
Consider also residual Consider removal of root
pathology (eg retained root),
lack of relief for active frena,
non-displaceable mucosa over
bony prominence (eg torus)

Over-extension of lingual Over-extended lower Determine position and

flange. Painful impression: instructions to extent of over-extension
mylohyoid ridge; denture laboratory not clear or using disclosing material
lifts on tongue non-existent and relieve accordingly
protrusion; painful to
swallow
Symptoms/clinical
findings
Generalized pain over
denture-supporting
area
Lack of relief for frena or
muscle attachments;
pinching of tissue
between denture base
and retromolar pad or
tuberosity. Sore throat,
difficulty in swallowing
Cause
Under-extended denture base -
may be the
result of over-adjustment to
the periphery,
or impression surface. Check
for adequacy
of FWS
Peripheral over-extension
resulting from impression stage
and/or design error. Palatal
soreness as post dam too deep
Treatment
Extend denture to optimal
available denture
support area. If insufficient
FWS, remake may be
required
Relieve with aid of
disclosing material. Care
with adjustment of post
dam - removal of existing
seal and its replacement in
greenstick prior to
permanent addition may be
required
 List of factors resulting in discomfort - relating to
occlusal and polished surfaces of dentures

Symptoms/clinical Cause Treatment

findings

Related to occlusal Anterior prematurity or Determine where occlusal

surfaces posterior prematurity,
Pain on eating in incisal locking, lack of balanced
presence of occlusal articulation
imbalance (no support
problems)
Pain lingual to lower If no over-extension present,
anterior ridge look for
protrusive slide from Resting
cuspal position to intercuspal
position
prematurities exist.
Adjust occlusion by selective
grinding. If severe
error remount using
facebow and new
interocclusal records
Mark deflecting inclines of
posterior teeth with thin
articulating paper. If slide
exceeds half a cusp
width, re-register and reset
Symptoms/clinical Cause Treatment
findings
Pain and/or If no impression surface defect, Reduce incisal vertical
inflammation on labial may be lack overlap. If appearance
aspect of of incisal overjet causing incisal compromised, resetting the
lower ridge locking incisors may be
required

Pain about periphery of Vertical dimension of occlusion If excess less than 1.5 mm,
dentures possibly more than grind to provide FWS.
accompanied by pain in patient can tolerate If greater than 1.5 mm, re-
masseter and register to reset dentures
posterior temporalis at new OVD
muscles (classically pain
increases as the day
progresses)

Cheek and or lip biting For cheeks - likely that
functional width of
sulcus was not restored.
For lips - poor lip
support/inadequate
anterior horizontal overlap
For cheek biting, restore
functional width of sulcus
and/or reset. For lips, grind
lower incisors to provide a
more appropriate incisal
guidance angle
Symptoms/clinical Cause Treatment
findings

Tongue biting Lack of lingual overjet - teeth Remove lower lingual cusps,
generally or reset teeth
placed lingual to lower ridge
low occlusal plane
Reduced vertical height

Related to polished Flange on buccal aspect of Use disclosing material to

surfaces tuberosity too accurately define area
Pain at posterior aspect thick and constraining coronoid involved, relieve and
of upper denture on process repolish
opening
 List of factors resulting in discomfort - factors with
possible systemic associations
Burning sensation over Burning mouth syndrome often Correction of any denture
upper denture seen in middle-aged or elderly faults, may require
supporting tissues, but females. Denture faults must multivitamin/nutrition
may involve other be excluded, also general advice and treatment.
intra-oral tissues, eg organic and pyschogenic Possibly antidepressant
tongue. factors therapy.

Beefy red tongue, Vitamin B12/folate deficiency Refer for medical treatment
possibly glossodynia Where some saliva flow is
present, sugar-free
citrus lozenges may help.
Frictional lesions related Xerostomia, commonly side Where there is an
to dentures, effect of obvious paucity of saliva,
mucosa may adhere to prescribed drugs artificial saliva may
probing finger, be considered
may be complaint of dry
mouth
Symptoms/clinical
findings
Tongue thrusting. Empty
mouth ’chewing’.
Often seen in elderly
patients
Presence of herpetiform
ulcers in mouth
Painful ’click’ related to TMJ
on opening and/or closing
mouth and/or tenderness of
muscles of mastication
Painful ’click’ related to TMJ
on opening
and/or closing mouth
and/or tenderness
of muscles of mastication
Cause
May have neurological or
psychological
aspects. Possibly drug related
Herpes simplex or Herpes zoster
virus.History and distribution of
lesions to confirm
TMJ pain dysfunction syndrome
may be related to rapid change on
OVD (either
gross increase or decrease) on
production of new denture. May
have psychological
aspects, occasionally part of
general joint disease
Treatment
Difficult to manage. Treatment
may be required
to include occlusal adjustment
and/or occlusal
pivots
Dentures merely coincidental to
the condition.
May be useful to suggest
preventive remedy
(eg acyclovir) for some sufferers
If denture faults present,
careful correction
required with special care to
registration and
vertical dimension
Symptoms/clinical Cause Treatment
findings
Patient complains of Rare symptoms may relate to If excess residual monomer
allergy to denture higher residual detected, rebase denture using
material monomer content of acrylic controlled heat cure cycle. May
need to consider remaking
denture using
polycarbonate resin

Painless erythema of Denture-related stomatitis. Best to leave denture out until

mucosa related to Often has a frictional element
support of (usually) due to ill-fitting denture
upper denture, may be plus opportunistic candidal
accompanied by infection.
angular cheilitis Occasionally related to iron
or folate deficiency
condition clears,
then remake. If not possible,
correct denture
faults, eg using occlusal pivots,
regularly supervised and
replaced tissue conditioners
prior to remake. If angular
cheilitis present, combinations
of antifungal and antibacterial
agents (eg miconazole) useful
 Looseness of dentures

• Looseness of dentures is more commonly

associated with the lower denture, and may be
referred to by patients as their denture ‘rocking’,
‘falling’ (complete upper) or ‘rising’ (complete
lower), ‘shifting’ or sometimes that they ‘feel too
big’.
• In simple terms, retention and stability of
complete dentures may be likened to a simple
balance ie on one side retaining forces and on
the other displacing forces. If the latter exceed
the former, instability/looseness will arise.
• It must be stressed, however, that the fulcrum
is the patient, or rather the patient’s ability to
adapt to dentures — this is less easy to
anticipate.
 List of factors resulting in looseness of dentures -
arising from decreased retentive forces
Lack of peripheral seal Border under-extension Add softened tracing compound to
in depth Border under- relevant border, mould digitally
extension in width. and by functional movements by
Often a particular patient. Replace compound with
problem in disto-buccal acrylic resin. As a temporary
aspects of upper measure a chairside reline material
periphery which may may be used .Check border is
be displaced correctly sited on fixed tissue at
by buccinator on junction with mobile tissue of soft
mouth opening. palate. Trace thin string of softened
Posterior border of tracing compound along impression
upper denture surface of posterior border and seat
denture firmly in mouth. Replace
compound with acrylic resin. For
temporary
solution, use butymethacrylate
resin as above
Inelasticity of cheek Consequence of ageing Mould denture borders
tissues process; scleroderma, incrementally using
submucous fibrous softened tracingcompound
as functional movements
are performed - aim to
slightlyunder-extend depth
and width of denture
periphery. Repeated
treatment may be required
as inelasticity progresses
Xerostomia Reduces Medication by many commonly
ability prescribed drugs, irridiation of
to form a suitable seal head and neck region, salivary
gland disease, infirm
Neuromuscular control
Essential for successful Basic shape of denture
denture wearing: speech incorrect,
and eating difficulties lower molars too lingual;
occur occlusal
plane too high: upper molars
buccal to ridge and buccal
flange
not wide enough to
accommodate
this; lingual flange of lower
convex. Patient of advanced
biological age
Design dentures to
maximise retention and
minimise displacing
forces. Prescribe artificial
saliva where appropriate
Correct design faults by, eg
removal of lingual cusps of
posterior teeth. Flatten
polished lingual surface of
lower from occlusal surface
to periphery, fill sulci to
optimal width. May require
remake to optimal design.
Use information from
successful previous denture
if available. Denture
adhesives may be deemed
to be necessary
Air beneath impression Deficient impression. Damaged Reline if design parameters
surface. Denture may cast. Warped denture. of denture satisfactory,
rock under finger Over-adjustment of impression otherwise remake
pressure. May see gap surface. Residual ridge as required. Ensure that
between periphery of resorption. Undercut ridge. areas of heavy contact
flange and ridge. Excessive relief chamber. between denture and
Occlusal error Change in fluid content of tissues are relieved prior to
subsequent to supporting tissues impression making. Where
warpage change in tissue fluid
distribution is suspected
check medication (eg
diuretics) posture (eg heart
failure) lack of recovery of
tissues from effects of old
denture prior to working
impressions being obtained.
Stabilise fluid
content of tissues and use
minimal pressure
impression method
 Looseness as a result of
increased displacing forces
Symptoms/clinical
Denture borders Cause
If buccal to tuberosities, Treatment
Slightly under-extend
findings
Over-extension in depth denture displaces on mouth denture flange
Slow rise of lower opening, or cheek soreness and accurately mould
denture when mouth occurs. Thickened lingual softened tracing compound.
half open, line of flange enables tongue to Check borders
inflammation at lift denture; thick upper and of record rims and trial
reflection of sulcal lower labial flanges may dentures at the appropriate
tissues; ulceration in produce displacement during stages. Deep post dam to be
sulcal region. Deep post muscle activity cautiously reduced and
dam on upper base may denture worn sparingly until
cause pain, ulceration inflammation clears

Design error Reduce over-extension. Use

Overextension in width disclosing material to
Cheeks appear plumped determine
out. In what is excessive
lower, the buccal flange
may be
palpated lateral to
external
oblique ridge
Symptoms/clinical Cause
findings
Denture not in optimal Molars on lower denture lingual
space to ridge, optimum triangular
shape of dentures absent
Posterior occlusal table too
broad, causing tongue trapping
Thick lingual flanges encroaching
on tongue space, causing lifting.
Excess lip pressure to lower
anterior aspect - teeth anterior
to ridge, thick periphery
Excess pressure from upper lip to
upper denture arising from teeth
too labially sited to acute
naso-labial angle; or failure to
adequately seat denture during
relining impression procedure
Treatment
Remove lingual cusps and
lingual surface from
relevant area, repolish.
If triangular form not
restored, reset teeth or
remake dentures
Narrow posterior teeth
and/or remove most distal
teeth from dentures.
Reshape lingual polished
Surface .Thin lower labial
flange, ensure optimal
extension to retromolar
pads to resist displacement,
reset anterior teeth if
necessary Usually requires
remaking denture
Symptoms/clinical Cause Treatment
findings
Poor fit to supporting Poor/inappropriate impression Reline if all other design
tissue technique especially in parameters
Recoil of displaced tissue posterior satisfactory, otherwise
lifts lingual pouch area remake. Ensure denture is
denture removed from mouth 90
mins prior to impression
 List of factors resulting in looseness - arising from increased
displacing forces - occlusal and anatomical factors
Occlusal errors Uneven tooth contact causing
tilting of dentures and
prevents even seating of
loosened appliances
ICP and RCP not coincident
- disrupts border seal and
prevents accurate reseating
Lack of freedom in ICP
(occlusal-locking) dentures
will shift on supporting
tissues for those patients
with poor control of
mandibular movements
Adjust occlusion until even initial
contact in RCP obtained. If gaps
between teeth exceeds 1.5 mm reset
teeth or remake dentures. For gaps
less than 1.5 mm it may still be
necessary, in the interest of accurate
diagnosis, to remount the dentures,
as a patient’s mouth may be too
tender to permit chairside
adjustment.
Adjust occlusion for coincident
ICP/RCP contact. If error is greater
than half width of cusp, all teeth on
at least one denture need resetting.
Remount dentures on adjustable
articulator and adjust area of
occlusal contact. Allow 1.5 mm of
anterior movement from RCP. May
use cuspless teeth where
appropriate
Symptoms/clinical Cause Treatment
findings
Ulceration labial to Excessive vertical overlap of Reduce height of lower
lower ridge anterior teeth. Lack of balance and anteriors.
anterior tooth contact may cause Aesthetic problems may
tilting, soreness in lower ridge necessitate
Last mandibular molars placed too resetting of teeth
far posteriorly and lie over Remove most posterior
retromolar pad or ascending part teeth from denture
of ramus. Occlusal contact on this Usually requires teeth to be
’inclined plane’ causes denture to reset or
slip forward dentures to be remade
Occlusal plane/s not
orientated appropriately
and masticatory forces tend
to move dentures over
supporting tissues
Symptoms/clinica Cause Treatment
l findings
Fibrous Masticatory forces tend to Reline after removal of acrylic from
displaceable ridge cause denture to sink into impression surface until no contact
and tilt towards supporting with displaceable tissue, provide
tissues many vent holes, low viscosity
impression material, maximise
posterior border seal

Bony prominence Denture rocks over Remove acrylic from impression

covered by thin prominence which may be surface where disclosing material
mucosa (eg tori) covered with inflamed tissue shows excessive loading of
supporting tissues. Do not create
excessive relief or loss of
retention may result
Symptoms/clinical Cause Treatment
findings
Non-resilient soft Does not adapt to impression Reline dentures to obtain optimal
tissue surface of denture reducing border extensions in depth and
support and retention factors width, use low viscosity impression
material

Pain avoidance Use of excessive amounts of Eliminate the cause of pain

mechanisms fixative, or self-applied reline
material, or even cotton
wool, to attempt to relieve
contact with supporting
tissues
 Problems relating to an inability to adapt
to dentures

• There are a variety of symptoms which may

be functionally-related (ie eating associated
problems, speech etc), psychologically-related
or may relate to patience. Clearly there is a
need to diagnose the former at the planning
stage of treatment and to avoid the latter by
virture of trial denture visits which focus on
the functional and aesthetic components of
the compete dentures.
• Some of the psychologically-related problems
may be recognized at an early stage but even
if psychological assessments are taken, not all
are infallible.
 List of denture problems associated with problems of
adaptation
Symptoms/clinical Cause Treatment
findings
Noise on May be lack of skill with Where unfamiliarity present,
masticating/speaking new dentures, excessive reassurance and persistence
May be apparent on OVD, occlusal recommended. Address specific
first insertion or may interference, loose faults or remake as required
appear as resorption dentures, or poor
causes dentures to perception of patient to
loosen denture wearing
Eating difficulties Unstable dentures. Construct dentures to maximise
Dentures move over Check that retentive retention and minimise displacing
supporting forces are maximised forces
tissues and displacing forces
minimised and all
available support has
been used
Symptoms/clinical Cause
findings
’Blunt teeth’ Broad posterior occlusal
surfaces which replaced
narrow teeth on previous
denture. Non anatomical
type teeth used where
cusped teeth previously
used
’Jaws close too far’ Lack of OVD, so that
mandibular elevator muscles
cannot work
efficiently
’Cannot open Excessive OVD
mouth wide
enough for food’.
May be speech
problems and facial
pain especially over
masseter region
Treatment
Where non-anatomical teeth used,
careful explanation of rationale is
required, may be possible to
reshape teeth. Routine use of
narrow tooth moulds recommended.
May increase up to 1.5 mm by
relining but if deficiency is greater,
remake denture
Can remove up to 1.5 mm from
occlusal plane by grinding, but if
more is required, remake dentures
Symptoms/clinical Cause Treatment
findings
Speech problems Cause may not be obvious. Check for vertical dimension
Uncommon, but May be unfamiliarity - check accuracy, and that vertical incisor
presence is of that problem not present overlap not excessive. Palatal
great concern to with old dentures contour should not allow excessive
patient. May tongue contact or air leakage -
affect sibilant (eg assess using disclosing paste over
s), bilabial (eg p,b), denture palate while sound is made.
labiodental (eg f.v) NB It is recommended that the
patient’s speech is assessed at trial
insertion visit
Gagging May be loose dentures, thick Construct dentures to maximise
May be distal border of upper retention and minimise displacing
volunteered by denture: lingual placement forces. Use ’condition’ appliance
patient prior to of upper posterior teeth eg fully extended base for home
treatment, or or low occlusal plane causing use. Psychological assessment if
apparent at contact with dorsal aspect of indicated
commencement of tongue
treatment or on
insertion of
denture
Symptoms/clinical Cause Treatment
findings
Appearance Patient failed to comment at Accurate assessment of patient’s
Complaints may trial stage, or has aesthetic requirements. Ample time
arise from patient subsequently been swayed for patient comments at trial stage.
or relatives. by family or friends. Use any available evidence to
Common Perhaps the change from the assist - photographs, previous
complaints old denture to the dentures. Consider template
include: shade of replacement denture prosthesis
teeth too light or is too sudden/severe
dark; mould too
big/small;
arrangement too
even or irregular
or lacking diastema
Too much visibility Level of occlusal plane Accurate prescription to laboratory
of teeth unacceptable, teeth placed via optimally adjusted occlusal rim.
on upper anterior ridge and
no/poor lip support
Symptoms/clinical Cause Treatment
findings
Creases at corners Labial fullness and anterior Adjust tooth position as appropriate.
of mouth tooth If OVD problem, re-register jaw
position may be inaccurate. relations
OVD
may be inadequate

Colour of denture Patient’s skin colour not Remake using suitable base material
base material taken into
“unatural” account in determining
colour of base material
 Altered speech
• When complete dentures are first worn there is
always some temporary alteration in speech owing
to the thickness of the denture covering the palate,
necessitating slightly altered positions of the tongue.
• Commonly this is only a temporary inconvenience,
most rapidly overcome by the patient reading aloud;
when there is an altered position of the upper
incisors, a change in their palatal shape, any
reduction of tongue space, or alteration in occlusal
level, adaptation may be very difficult even with
perseverance
 Altered speech-2
• Treatment: the dentures must be remade
paying particular attention to the principles
and to the correct restoration of the denture
space, defined as the space in the edentulous
mouth formerly occupied by the teeth and
supporting tissues which have since been lost.
 Appearance
• In spite of the greatest care on the part of the
dentist to obtain the patient's full approval of
the appear-ance at the trial stage, there will
always be some patients who are dissatisfied
with their appearance when wearing the
finished dentures.
 Appearance-2
• The patient should not be condemned too
severely for this inconsistency, as it is difficult
to form a considered opinion on all details of
facial appearance when sitting in a dental
chair, in strange surroundings, with trial
dentures in the mouth, and being asked to
criticize the work of a professional person.
 Inability to eat
• This complaint is mainly confined to patients
who are wearing complete dentures for the
first time, and are impatient at the time spent
in acquiring new habits of eating.
• Careful attention by the operator to the
psychological approach to denture wearing,
will eliminate this complaint except in rare
cases, and these must be persuaded to -
persevere, so that they will either learn anew
how to eat or will define some specific
complaint which can then be remedied.
 Inability to eat-2
• Difficulty may be encountered with certain
fibrous foods and this is likely to be due to
low-cusp or zero-cusp posterior teeth, lack of
interdigitation of posterior teeth, the use of
acrylic teeth in a patient used to porcelain,
unbalanced occlusion, or a locked occlusion
arising from setting teeth on a plane-line
articulator.
• These faults may also cause the dentures to
dislodge during eating, a further complication
being a restricted tongue space which may
occur if the upper teeth are set directly over
the ridge, if the lower posterior teeth
overhang the tongue or if the posterior teeth,
particularly the lowers, are too broad.
• The posterior natural teeth are often lost some time
before the anterior ones, with the result that a habit
is formed of eating on the anterior teeth. When
complete dentures are being worn for the first time,
it is only natural that the patient should try to
continue his previous eating habits with bad results.
 CONCLUSION
• The patient is advised to report immediately
whenever there is any problem.
• In case of tissue reactions like ulcers,
soreness, e.t.c. the patient is advised to stop
wearing the prosthesis and report to the
dentist as soon as possible.
 REFERENCES
• Lecture note on common complaints of
complete denture wearers by Dr T. O. Esan,
consultant prosthodontics, Faculty of
Dentistry, Obafemi Awolowo University
• Presentation on Post Insertion complaints
In Complete Denture Patients ( India Dental
Academy)
• Textbook of Prosthodontics by Nallaswamy
THANK YOU