Post Insertion Complaints in Complete Denture

Rajeev Srivastava*

Abstract
Denture insertion represents the efforts of series of carefully considered and exacting procedure on part of prosthodontist. Post insertion complaint in complete denture is an utterance of pain, discomfort or dissatisfaction. There is a wide spectrum of behavior problem associated with denture insertion. Treating the post insertion complaints associated with the complete denture plays an important role in success of a prosthodontic treatment. The prosthodontist needs a thorough knowledge of anatomy, physiology, pathology and psychology to treat these problems. This article is a review of selected literature on the post insertion complaint in complete denture. Key Words : Complaints, Post insertion, Denture stomatitis, Complete dentures

INTRODUCTION

he complaints are of excessive discomfort, poor function which is of non specific and bizare symptoms that lead to massive frustration for patient. The prosthodontist need through knowledge of anatomy, physiology, pathology and psychology to treat these problems. We must be capable of differentiating between normal and abnormal tissue response.

resorption and it has been suggested that progressive loss of bone under denture is manifestation of osteoporosis. Inadequate saliva : Adequate saliva is essential to aid retention in denture wearer. For individual with xerostomia, retention can be a major problem. Artificial saliva can be used to enhance retention and stability. The use of denture fixatives is an option.

LOOSE DENTURE
The most common complaint with dentures are that of looseness. This is more commonly associated with lower denture and usually brought to the dentist attention either soon after the denture are placed or following a period of successful wear when the dentures are nearing the end of useful life. Causes of loose dentures can be 1. Problem with the denture like, Warped dentures, Excessive palatal-relief chamber, Under extended border in depth and width, Over extended peripheries in depth and width, Polished surface not in neutral zone, Intercuspal position not coincident with retruded contact position, Premature Occlusal contact, Occlusal plane incorrect 2. Problem with denture wearers like Poor neuro Muscular control, Unstable foundation for example - Atrophic lower ridge, Upper anterior flabby ridge, High frenum attachment, Prominent mylohyoid ridge. In all these cases special impression technique should be used or even preprosthetic surgery should be done. Residual ridge resorption1,2 : Women are particularly affected by frequency and extent of residual ridge
*Professor, Dept. of Prosthodontics, Modern Dental College and Research Centre. Indore M.P. 304

PAIN
Pain 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 lower denture. I. Problem associated with denture A. Extension of borders of denture into deep undercut (overextension) B. Inadequate relief over bony prominence and where the mucosa is atrophic C. Deep Post Dam D. Polished surface and teeth not in neutral zone can result in cheek, lip or tongue biting. E. Premature Occlusal Contact2: Pain tends to be localized to the ridge in region of pre mature occlusal contact, but can be transferred to distant sites. F. Uneven Pressure due to faulty setting of teeth. G. Excessive Vertical Dimension 3 : Pain is associated with the crest of lower ridge and small white patches may be seen in the painful areas. H. Insufficient vertical dimension: Pain is indefinite in locality and may be associated with temperomandibular joint disfunction. I. Cuspal Interference: A dragging action will be exerted on both upper and lower denture during
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all lateral and protrusive movement with the teeth in contact it cuspid posterior teeth are used. II. Xerostomia/Dry Mouth: It can be due to degenerative changes in salivary gland, radiotherapy or drug therapy, which can cause loose denture and soreness. III. Allergy4 - Allergy to poly-methyl methacrylate and methyl metha acrylate monomer is rare and patch testing of individual is necessary to diagnose a true allergy. IV. Pressure on Mental Nerve - When there is excessive resorption of mandibular ridge mental foramen becomes part of denture wearing area. Pressure on mental nerve by denture result in sharp shooting pain that radiates to chin or lower border of mandible. V . Psychological 4 - In some case pain may be psychological.

DISSATISFACTION WITH ESTHETICS

Although it has to be stressed that appearance cannot fully assessed until 4 to 6 weeks after insertion of finished denture. This is because of adaptation of lip and facial muscle to underline denture. Good dental appearance is important to most individual psychological well being. 1. Choice of Anterior Teeth 2. Position of Upper Anterior Teeth 3. Facial Appearance: Nose and chin are more prominent to continuing alveolar resorption and spacial change of position of denture in relation to skull as whole. 4. Dissatisfaction with Teeth A. Colour B. Shape - Artificial teeth usually look larger than natural teeth of identical size, probably because their mesial distal surfaces are not so rounded. C. Position Speech Difficulties Usually patient with low index of Neuro - Muscular skill experience difficulties in speaking with artificial teeth.3 The thinnest, shortest, snuggest, lingual flange possibly will aid their speech. When complete dentures are first worn there is always some temporary alteration in speech owing to thickness of denture covering the palate. Problem with Mastication Difficulty may be encountered in first time wearers with certain fibrous food and this is due to low cusp or zero cusp posterior teeth, lack of inter digitation of posterior teeth and unbalanced occlusion. Difficulty in eating is also encountered if the borders are over extended.
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Clicking of Teeth A clicking noise when the teeth contact during functional movement as a result of 1) Insufficient Occlusal distance 2) Cuspal interference of lack of balanced occlusion 3) Excessive incisor guidance, usually interfere that horizontal over jet is inadequate in relation to vertical overlap. Porcelain teeth by nature of material create more impact noise than acrylic. Bruxism Patient who has bruxism of natural teeth may continue the habit with artificial denture. Sometime there are some patient in whom artificial denture have acted as trigger mechanism and as result develop bruxing habit. There are three major factors in complete denture that seen to initiate bruxing habit or aggravate on existing one. 1) Excessive vertical dimension 2) Loose unstable denture 3) Interference or pre-maturity in Occlusion Gagging Gagging can be triggered by tactile stimulation of soft palate, the posterior part of tongue and fauces. However other stimuli such as taste, noise as well as psychological factors may trigger gagging.5 Commissural Chelitis2 It is the inflammation of angle of mouth. It is frequently attributed to excessive inter - occlusal distance. However placing the maxillary posterior teeth in too far in lateral direction eliminates the buccal corridor. When the crown of teeth is against the cheek the saliva collect at the neck of teeth and make it escape in the area of cuspids. Commissural chelitis often develop when this condition exists. The Broken Dentures The cause of a fracture must be identified and correction before a denture is repaired or replaced other wise the denture is likely to fracture again in same reason. Denture Stomatitis2,6 Inflammatory papillary hyperplasia, chronic atrophic candidiasis are other names of denture stomatitis. In present day population evidence of denture stomatitis is 50% among complete denture wearer. Classification1 Type I - A localized simple inflammation or pin - point hyperemia. Type II - An erythematus or generalized simple type presenting a more diffused erthyema involving a part or
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entire denture covering mucosa. Type III - Agruanular type (Inflammatory papillary hyperplasia) commonly involving a central part of hard palate and alveolar ridge. Type III is a often seen in association with Type I or Type II Burning Mouth Syndrome1,2 Some patient complaint of burning sensation in wearing complete denture. 1 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 post menopausal women.

overextented denture result in epulis fissuratum. Other contitions like traumatic ulcer, hyperenic lesion cruitatied and ditached mucosa may also be seen.1,2

CONCLUSION
The patient should be dealt with in a sympathetic manner, keeping in mind that such complaints are very important to patient. It require patience on part of patient and patience, skill, and experience on part of prosthodontist to correct many problem associated with use of denture. In majority of instances these problem are real and not psychosomatic.

REFERENCES
1. George A Zarb, Charles L Bolender, Gunnar E Carlson. Bouchers prosthodontic treatment for edentulous patients. 11th Edition, chapter 3, Page 30. Gunnar E. Carlsson, Odont Dr and Dr Odont HC. Clinical morbidity and sequelae of treatment with complete dentures. J Prosthet Dent 1998; 79 (1) : 17-23. John J Sharry. Complete denture Prosthdontics, 2nd edition, chapter 24, page 358. Nater JP, Groenman NH, Wakkers-Garritsen BG, Timmer LH. Etiologic factors in denture sore mouth syndrome. J Prosthet Dent 1978; 40 (4) : 367-73. Jorgensen EB. Sequelae Caused by wearing complete dentures. In: Zarb GA, Bolender CL, Editor. Prosthodontic Treatment For Edentulous Patients-Complete Dentures And Implant Supported Prosthesis.12 thEdition. Mosby; 2004: 3450. Kamal N Zakhari, William S McMurry. Denture stomatitis and methods influencing its cure. J Prosthet Dent 1977; 37 (2) : 133-40. 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.

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PROBLEM ASSOCIATED WITH STRESS BEARING MUCOSA

Denture Irritation Hyperplasia2,7 The etiology of mucosal inflammation associated with dentures. A common sequela of wearing ill fitting denture is the occurrence of tissue hyperplasia of the mucosa in contact with the denture border.1 The hyperplasia occurs in an around the borders of a denture may be fibrous growth referred to as epulis fissuratum. Chronic irritation from ill fitting or

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