ORAL MANIFESTATIONS

OF ABUSED COMPLETE
DENTURE USAGE

CLASSIFICATION
DIRECT SEQUELAE:
-mucosal reaction
-oral galvanic currents.
-altered taste perception.
-burning mouth syndrome.
-gagging.
-residual ridge reduction.
-caries & periodontal disease of the abutments.
INDIRECT SEQUELAE:
-atrophy of masticatory muscles.
-nutritional deficiencies.

EPULIS FISSURATUM
Mucosal hyperplasia
that results from
chronic low grade
trauma induced by
a denture flange.

CLINICAL FEATURES
Examination reveals folds of
hyperplasic tissue which
encompass the border of the
denture flange. The mass runs
parallel to the edge of the
denture. the edge of the denture
usually fits in a groove between
the folds.
Surface-smooth or ulcerated or
papillary.
size-variable, small or extensive
& involve the entire length of the
vestibule.

TREATMENT
Rest to the supporting tissues.
Institute a program of regular & vigorous
massage of the damaged site.
Surgical excision is carried out only after the
edema is subsided which makes conservative
surgical intervention possible.
Making a new denture or relining the old
denture.

PREVENTION
Regular dental care.
Educate the patient
that oral tissues are
constantly changing
and that denture is
not permanent and
need adjustments
over time.

DENTURE STOMATITIS
It is a common oral
mucosal lesion. It is
the chronic
inflammation of the
denture bearing
mucosa.

CLASSIFICATION OF DENTURE
STOMATITIS(NEWTON,1962)

Type I: pinpoint
hyperemia or
localized simple
inflammation

Type II: diffuse

erythema confined
to the mucosa in
contact with the
denture base.

Type III: granular

surface or
inflammatory papillary
hyperplasia of the
palate. It involves the
epithelial response to
chronic inflammatory
stimulation secondary
to yeast colonization
& possibly, low grade
local trauma resulting
from an ill fitting
denture.

Associated with: angular chelitis, atrophic

glossitis.

TREATMENT
Medical care.
- stomatitis.dentures should be soaked in a
antiseptic solution such as 0.2-2%
chlorhexidine.
- Antifungal therapy
Surgical care.

ANGULAR CHEILIOSIS
a painful
inflammation at the
corners of the
mouth.
Synonyms:
angular stomatitis,
perleche, angular
cheilosis

Predisposing
factors:
-Reduced
vertical dimension
a fold produced at
the corner of the
mouth tends to
collect saliva and
harbor
microorganismsCandida albicans,
staphylococci,
streptococci.

Secondary to denture stomatitis.

Riboflavin & thiamine deficiency.

CLINICAL FEATURES
epithelium at the
corner of the mouth
appears wrinkled,
macerated, one or
more deep fissures,
cracks which appear
ulcerated & tends to
bleed.

TREATMENT
Elimination of the primary cause.
Antifungal treatment & supplement
antifungal ointment at the lesion site.

BURNING MOUTH SYNDROME

characterized by a burning sensation or
several oral structures in contact with
the dentures with the absence of clinical
& laboratory findings.
oral mucosa usually appears clinically
healthy.
most commonly females ,50 yrs of
age ,wearing complete denture.

ETIOLOGY

Characters of the pain:

quality of the pain: gradual onset, pain is
often present in the morning & tends to get
aggravated during day. Its usually absent in
night.
burning sensation often presents with
feeling of dry mouth & persistent altered taste
sensation.
site: often occurs in more than one site
with the anterior two thirds of the tongue,
anterior hard palate & mucosa of the lower lip
mostly involved.

MANAGEMENT
Systematic approach is necessary to identify
the possible causes.sympatomatic treatment
should be given.
- Mucosal disease-diagnosis & treat the
mucosal condition.
-Dry mouth- high fluid intake &
sialagogue
Any systemic disease present should be
identified & treated.
-Menopause-hormonal replacement
-Nutritional deficiency-oral
supplementation.

if no organic basis is found, proper

counselling of the patient, help the
patient to understand the benign nature
of the problem & with subsequent
elimination of fears.
comprehensive prosthetic treatment
should be carried out as collaborative
effort of psychiatrist & prosthodontist.

FLABBY RIDGE
It is mobile &
extremely resilient
alveolar ridge due to
the replacement of
bone by fibrous
tissue.
They provide poor
support for the
denture.

TREATMENT
CONSERVATIVE:
judicious selection of
impression materials
& technique. Controlled
- Minimally
displacive
impression
techniques.
SURGICAL

TRAUMATIC ULCERS

Commonly develop
with in 1-2 days after
the placement of
new dentures.

CAUSES
overextended flanges.
unbalanced occlusion.
sequestration of spicules of bone under
denture.
roughened or high spots on the inner
side of the denture.

TREATMENT
Correction of the cause- relief of the
flange, removal of a tiny sequestration
or relief of the high spots.
Prognosis: if no treatment given
patients tend to adapt to the situation &
develop into irritation hyperplasia.

GAGGING
is a normal, healthy defence
mechanism function to prevent foreign
bodies entering the trachea.

Persistent complaint of gagging after the

denture placement is due to:
Overextended borders.
Poor retention of maxillary denture.
Unstable occlusal condition.
Increased vertical dimension of
occlusion.

TREATMENT
Correction of the denture.

RESIDUAL RIDGE REDUCTION

A term used for the
diminished quality & quantity
of the residual ridge after the
teeth are removed.(GPT-7).
First year after tooth
extraction ,the reduction of
the residual ridge in the
midsagittal plane
maxilla:2-3mm
mandible:4-5mm.

CONSEQUENCE OF RR
REDUCTION
Apparent loss of
sulcus width &
depth.
Displacement of
muscle attachment
closer to the crest of
the ridge.
Loss of vertical
dimension of
occlusion.

reduction of lower
facial height.
Anterior rotation of
mandible & increase
in relative
prognathism.
Sharp, spiny, uneven
residual ridge &
location of mental
foramina closer to the
ridge.

TREATMENT
Preprosthetic surgical initiation such as
vestibuloplasties or in severe case with
ridge augmentation.

PREVENTVE MEASURES

Dietary / nutrition intervention, estrogen

therapy when indicated, maintenance of
teeth & placements of implants.
Overdentures.

OVERDENTURE ABUTMENTS: CARIES

& PERIODONTAL DISEASE

Wearing of overdenture
are often associated
with high risk of caries &
periodontal disease of
the abutments when
oral hygiene measures
are not adequate.

TREATMENT

Good oral hygiene.

Motivate the patient & introduce regular
follow up examination at 3-6 months
interval.
Superficial caries-fluoride-chlorhexidine
gel & polishing.

Deep cariesplacement of coping

over the exposed
part of the dentine &
root.
Periodontal pockets
greater than 4-5mm
should be eliminated
surgically.

ILL EFFECTS OF INCREASED

VERTICAL DIMENSION
Discomfort to the patient.
Trauma due to sudden &
frequent blows.
Muscle fatigue. Clicking of
teeth during eating &
speaking.
Elongation of lower facial
height, lips are apart even
at rest.

ILL EFFECTS OF DECREASED

VERTICAL DIMENSION

Inefficiency to eat.
Cheek biting.
Appearance is
affected-closer
approx of nose to
chin, soft tissue sag
& fall in, lines on the
face are deepened.

Angular cheilitis.
Pain in
tempomandibular
joint.

 COSTEN SYNDROME: result of

prolonged over closure.
mild catarrhal deafness &dizzy spells
which are relieved by inflation of the
Eustachian tubes .
Tinnitus.
Pain & tenderness on palpation over the
TMJ.
Burning sensation of the tongue ,throat&
side of the nose.
Atypical head pain typically on the
temporal region.
Dryness of mouth.

ORAL CANCER IN DENTURE

WEARERS
Association between
oral carcinoma &
chronic irritation of the
mucosa by the
dentures has often
been claimed.
Patients should follow
strict & regular recall
visits at 6 months to 1year interval.

Patients with sore spots that does not

heal even after the correction of
dentures & with clinically aberrant
manifestation of denture irritation
hyperplasia should be referred
immediately to a pathologist for proper
diagnosis.

INDIRECT SEQUELAE
ATROPHY OF MASTICATORY
MUSCLES:
Maximal bite forces tend to decrease in the old
age.
Chewing efficiency decreases as the number of
natural teeth is reduced.
Reduced bite force & chewing efficiency are
sequelae caused by wearing the complete
denture .
Complete denture wearers need approx seven
times more chewing strokes than those with
natural dentition.

MANAGEMENT:
retaining small number of teeth
as overdenture abutments/ placement
of implants shows improvement in
masticatory function & maximal occlusal
forces.

NUTRITIONAL DEFICIENCIES
Four actors related to
dietary selection & the
nutritional status of
complete denture
wearers:
-masticatory function
& oral health
-general health
-socioeconomic
status.
-dietary habits.

Improvement & maintenance of

nutritional status:
-modify dietary habits.
-poorly adapted dentures replaced by
well fitting dentures.
-mechanical preparation of food.
-general health care.

CONTROL OF SEQUELAE WITH USE

OF COMPLETE DENTURES

Every effort should be made to retain

some teeth in good positions to serve
as overdenture abutments.
Proper patient education & good oral
hygiene practices.
Patient should be motivated to practice
proper denture wearing habits.

Patients wearing complete dentures

should follow a regular control schedule
at yearly intervals so that acceptable fit
& stable occlusal condition to be
maintained.
Patients wearing overdentures should
follow a program of recall &
maintenance for continuous monitoring
of the denture and the oral tissues.