11. Denture Issues

Question 1

Reasons why are replacement denture may not be practical

Answer 1

• Finances
• Cooperation (patient is used to denture)
• Time

Question 2

T/F Everyone can learn to wear a denture

Answer 2

F- not everyone can wear a denture

Question 3

As we age we become (more/less) adaptable

Answer 3

less

Question 4

T/F Psychological issues can transcend technical excellence

Answer 4

t

Question 5

Potential causes for when patient complains of pain

Answer 5

• Excess salivation
• Sore mouth-new denture
• Non-specific pain- new denture
• Generalized soreness after repeated adjustments
• Cheek biting
• Burning sensation- upper lip and side of nose
• Sore throat

Question 6

Areas of the denture to check when patient reports pain

Answer 6

• Relief of tori, tuberosities and sharp bony areas
• Errors in occlusion causing a shift (check occlusion and remount to correct)
• Overextension in masseter area of mandibular denture
• Insufficient relief over undercuts

Question 7

Overextension of the denture in the masseter areas results in pain where

Answer 7

lingual mandibular pain

-Test with disclosing wax/PIP

Question 8

Non-specific pain reported by a patient with a new denture may be caused by

Answer 8

• pressure over the zygomatic process

- Distobuccal border of maxillary denture base is too wide

Question 9

How can you check to see if the issue is that the distobuccal boarder of the maxillary denture is too wide

Answer 9

Place finger on anterior teeth of maxillary denture
Have patient protrude mandible and move side to side
feel for movement of maxillary denture

Question 10

Thick flange in the retrozygomal area can result in

Answer 10

coronoid interference with the maxillary denture

Question 11

If there is coronoid interference what will happen to the upper denture when the patient opens

Answer 11

dislodges

Question 12

Causes of generalized soreness after repeated adjustments may be

Answer 12

• Clenching/bruxing
• Inadequate freeway space
• Errors in occlusion
• Post menopausal endocrine changes
• Nutritional deficiency
• Low tissue tolerance

Question 13

How do you fix inadequate freeway space

Answer 13

use rest position and phonetics

Question 14

Signs a patient is clenching clinically

Answer 14

wear facets in denture teeth

patient awareness

Question 15

What is an alternative method to doing a remount

Answer 15

Coble-Balancer

Question 16

Role of Coble Balancer is

Answer 16

Detects occlusal prematurities that are tough to see

Question 17

What diseases should be ruled out with someone with low tissue tolerance

Answer 17

diabetes and pemphigus vulgaris

Question 18

Cheek biting with a denture can be caused by

Answer 18

• Insufficienct HO of posterior teeth
• Insufficient clearance between dentures distal to the last tooth
• Sharp buccal cusps

Question 19

How can you correct for insufficient HO in the posterior teeth

Answer 19

• Round the buccal cusps of the mandibular molars

- If cross-bite round the buccal cusps of the maxillary molars

Question 20

_-_mm clearance should be between denture bases distal to last tooth

Answer 20

3-4

Question 21

Burning sensation upper lip/side of nose may be caused by

Answer 21

impingement of nasopalatine nerves in incisive foramen (relieve)

Question 22

Sore throat may be caused by

Answer 22

• Over extension and ulceration of soft palate
• Over extension hamular notch
• Distobuccal of maxillary denture
• Distolingual of mandibular denture
• Denture on pterygomandibular raphe above retromolar pad

Question 23

What is the first thing you should do when a pateint complains that their denture is loose

Answer 23

ask them to show how it loosens

Question 24

What is one reason as to why a maxillary denture may lack retention

Answer 24

incorrect posterior palatal seal (wrong position, not deep enough, doesn’t extend to the hamular notch)

Question 25

If the denture extends too far posteriorly the boarder will be on (movable/non-movable) tissue

Answer 25

movable

Question 26

How will PIP look if the denture boarders are short? Long?

Answer 26

``` Short= streaks Long= burn-through ```

Question 27

If the denture boarders are over-extended they will be retentive until

Answer 27

patient speaks

Question 28

A tight _ can cause a maxillary denture to loosen

Answer 28

pterygomandibular raphe

Question 29

What may be the cause for when a maxillary denture lacks retention on insertion and how should you look clinically to determine if this is the cause

Answer 29

- Tissue/fluid contours changed since impression (bite on 2 cotton rolls for 5 minutes and re-eval) - Inadequate clearance for buccal and labial frenum (pull the lip down and look for dislodgement or frenal ulceration) - Incorrect posterior palatal seal

Question 30

Poor posterior palatal seal is detected clinically by

Answer 30

placing fingers on the lingual of the maxillary anterior teeth. If the posterior denture drops --> bad seal

Question 31

The upper denture base can also be loose when the periphery terminates on bony structures such as

Answer 31

- Hard palate - Zygoma - External oblique ridge - Before retromolar pad

Question 32

Causes for the maxillary denture comming loose during speaking

Answer 32

- Inadequate post palatale seal - Coronoid interference - Post boarder is too long/short - Short labial flange or excessive notch for labial frenum - Notch for buccal frenum too thick or insufficient

Question 33

Reasons the mandibular denture lacks retention on insertion

Answer 33

``` Change in contours or fluid balance boarders too wide or too long Buccal flanges underextended Labial flange is underextended Overextended lingual boarders Inadequate notch for lingual frenum ```

Question 34

Clinically how can you determine there is an inadequate notch for lingual frenum

Answer 34

check for lifting when patient touches tongue to posterior palate

Question 35

Causes for why a denture loosens at different times of day

Answer 35

- Heavy salivary secretions (ropey) | - Excessively dry

Question 36

Perpetually loose maxillary denture may be atributed to

Answer 36

anterior interferences tuberosity mucosa grows into space space develops under midline of denture base

Question 37

Lingually displaced mandibular denture caused by

Answer 37

incisors too far labial | Inclined ridge with no resistance

Question 38

Tilting of jiggling caused by

Answer 38

-Contacts not centered over the ridge | contacts on inclined portion of ridge

Question 39

Causes for lisping

Answer 39

- Too much overjet - Triangular spaces between embrasures of maxillary and mand teeth - palatal contour is too constricted - INsufficient tongue space

Question 40

If you can't determine the problem what should you do

Answer 40

- Tell patient - Don't adjust - Refer

Question 41

Why should you never pretend to adjust a denture

Answer 41

reinforce maladaptive behavior harder for next dentist

Question 42

_-_% patients are satisfied

Answer 42

80-85% (most patients aren't problem patients)