Dental Prosthetics and Patient Comfort

Post-Insertion Problems in Complete Dentures

• Post-insertion problems are categorized into seven types: pain, retention and stability loss (movement in the dentures), insufficient chewing, nausea, noise on eating and speaking, poor aesthetics, and problems relating to speech.

Pain

• Pain is described as a sensation ranging from a chemical or physical stimulus to extreme discomfort, its intensity varying depending on individual pain thresholds.
• Complaints of pain increase in people with poor general health, psychological problems, or nutritional deficiencies.
• Pain assessment involves determining the duration, whether it subsides after removing the dentures, whether it is continuous or intermittent (e.g., during eating), and whether the pain is localized or widespread.

Localized Pain

• Oral tissue pain is categorized into six types: localized pain in specific supportive tissue areas, generalized pain affecting a major portion of supportive tissues, diffuse pain affecting all supportive tissues, pain from biting lips/cheeks, pain in the tongue, and pain in the temporomandibular joint (TMJ).

Extended Flanges

• Extended flanges of complete dentures can cause inflammatory changes and severe biting pain, especially with extended flanks.
• The flanges can be shortened, and the frenulum area can be opened.

Deeply Prepared Postdam Area

• Deeply prepared postdam areas can cause erythema and edema in the soft tissues.
• For assessment, whether the finishing is deep or long, it is advised to ask the patient to produce the "ah" sound while marking the area.

Irregularities on Tissue Surface of Dentures

• Irregularities observed on the tissue surface of dentures are generally dot-like rashes on the crests.
• Recommended solutions include detection and grinding.

Premature Contacts in Occlusion

• Premature contacts in the occlusion can increase forces on crests, leading to inflammatory changes.
• Occlusion correction using grinding is suggested for treatment.

Excessive Undercuts

• Excessive undercuts beneath the dentures can lead to pain during insertion/removal.
• Treatment involves identification and grinding of the undercut area from the inside of the denture.

Pain in Premolar Region

• Pain in the premolar region may originate from a lingual torus, premature contacts during impression taking, presence of impacted teeth/root remnants, crest resorption at mental foramen level, irregularities in the denture-bearing area from extraction sites healing, and excessive undercuts.

Pain at Peripheral Regions of the Denture

• Overextension of denture flanges, deep and overextended postdam area in the upper jaw, overextension of the tuber region in the upper jaw, pain in the distobuccal border of lower jaw, pain in the lingual margin of lower jaw, angled and sharp denture margins, cause discomfort.

Generalized Pain

• Pain that involves all supportive tissues warrants a detailed examination.

Pain in the Lower Jaw, Wide, Non-diffused, Hyperemic, and Painful Regions

• Thin mucosa, reduced saliva flow, and anatomical defects in the maxillary crests are common contributing factors.
• The area can be treated with occlusion failure correction using occlusal abrasions.

Pain Involving All Supportive Tissues (Diffuse Pain)

• Increased vertical dimension, patient allergy to denture base material are the primary causes for pain affecting all supporting tissues.

Noise on Eating/Speaking

• Noise during eating or speaking can be caused by premature tooth contacts, lack of denture retention, high occlusal vertical dimension, and tubercular obstructions, usage of porcelain teeth, respectively.

Aesthetic Problems

• Insufficient lip and face support, limited distance between chin tip and nose tip, color, shape, size, or position of anterior teeth, or visibility of teeth can cause aesthetic issues.

Speech Problems and Solutions

• Speech problems associated with dentures include mispronunciation of "S", "T", "D", "L", "R", "P", "B", "M", "N", "F" , "V", "G", and "K".
• Addressing these problems often involve adjusting the vertical dimension, modifying the palatal area, correct tooth alignment.

Long-Term Problems with Complete Dentures

• Long-term problems with complete dentures involve fractures, burning mouth syndrome (BMS), alveolar bone loss (ABL), TMJ disorders, fibrous crest, epulis fissuratum, papillary hyperplasia, denture stomatitis, and angular cheilitis.

Midline Fractures: Causes and Contributing Factors

• Denture-related factors include defects, porosity, cracks, thin or insufficient flanges, or poor adaptation/overgrinding.
• Patient-related factors include excessive force, natural teeth opposing the denture, tori, prominent midline suture and tissue undercuts.

Epulis Fissuratum

• Chronic mechanical irritation from poorly fitting denture flanges can lead to benign fibrous tissue hyperplasia, which presents as a single or multiple folds in the alveolar vestibule.

Papillary Hyperplasia

• Poor denture fit can cause papillary hyperplasia, characterized by inflammatory processes that lead to localized, benign epithelial proliferations.

Denture Stomatitis

• Denture stomatitis is a frequent occurrence among denture wearers, particularly the elderly and women, often presenting as asymptomatic halitosis, slight bleeding and swelling, mouth burning, xerostomia, and taste alterations.

Nausea and Retching

• Patient reports nausea/retching soon after getting dentures due to posterior region being longer or thicker than normal, lack of retention, abnormal vertical dimension, premature occlusal contacts, or hypersensitivity around the hard palate.

Insufficient Tongue Space

• Insufficient tongue space, overextension of the denture in the posterior tongue region, and improper placement of teeth outside the neutral zone can lead to nausea.

Insufficient Interocclusal Distance

• Inappropriate tooth arrangement and improper interocclusal space directly impact denture stability and comfort.

This quiz explores various factors affecting patient comfort with dental prosthetics, including issues related to denture fitting, supportive tissue evaluation, and potential complications. It covers key concepts in evaluating and enhancing the use of dentures, as well as speech issues related to prosthetics.