PROBLEM IN COMPLETE DENTURE TREATMENT AND POSTINSERTION DENTURE PROBLEMS

PROBLEM IN COMPLETE DENTURE TREATMENT AND POSTINSERTION DENTURE PROBLEMSDewey H. Bell. J. Pros. Dent . June, 1968Morstad and Peterson. J. Pros. Dent. Feb, 1968

CONTENTSIntroduction ObjectivePrerequisites in minimizing problemsBroad treatment objectivesProblems related to pain thresholdPathosis without painAdverse patient educationVarying levels of achievementPatients responsibilityOral and denture hygienePreventive dentistry for edentulous patient

Obstacles to patient educationPost insertion denture problemsPost insertion instructionsSummary and conclusion

INTRODUCTIONThe problems encountered in complete denture treatment are numerous, and they come from a variety of sources.Our current levels of scientific and biologic knowledge, technical achievements, and clinical skills are insufficient to solve all of the problems attendant to complete denture treatment.OBJECTIVEThe objectives of this article are to point out some of the conditions that contribute to the problems most frequently encountered in complete denture treatment , and to illustrate that a high percentage of these problems can be eliminated or minimized by establishing communication between the patient and dentist.PREREQUISITES IN MINIMIZING PROBLEMS1. The proper application of the knowledge and skill of the dentist in all phases of complete denture treatment. 2.The knowledge and skill of the patient pertaining to complete denture treatment.BROAD TREATMENT OBJECTIVES1.To provide adequate masticating function.2.To restore natural appearance and normal speech.3.To accomplish these objectives in a way that will insure patients comfort and preserve the integrity of the structures that support and are supported by the prosthesis. EXPECTATIONS OF EDENTULOUS PATIENTS:

The patients reference to fit generally denotes a desire for retention, stability and comfort.The patients desires; esthetics, comfort and function have a reasonable resemblance to our own objectives in complete denture treatments but, the patient omits one feature of complete denture treatment that dentists consider to be of paramount importance; that is, preservation of oral health. Complete denture treatment is a complex and challenging procedure that must be altered to meet the technical, anatomic, biologic, and psychologic needs of the individual patientPROBLEMS RELATED TO THE PAIN THRESHOLDMany problems arise from extremes of the pain threshold, a phenomenon peculiar to the individual patient. The patients comfort and oral health usually have a direct relationship. When the tissues are injured or abused, there is pain or discomfort.

An outline of the role of extremes in the pain threshold in contributing to or preventing tissue injury resulting from the use of complete dentures.

High Pain Threshold Low Pain Threshold

Poor Pain Perception Keen Pain Perception

Poor Protection Good Protection

Invites Tissue Injury Averts Tissue Injury

It is excessive denture movement, not excessive discomfort, that prompts the complaint. In these instances, denture retention should not be increased by effecting a more prominent posterior palatal seal or by rebasing, relining, or remaking the prosthesis, nor through the use of denture adhesives. The retention and stability of the dentures can be enhanced by the patient himself with great advantage to the supporting tissues by centralizing and minimizing functional forces.For these patients, additional retention from other sources will ultimately contribute to impaired oral health.PATHOSIS WITHOUT PAINMany undesirable conditions associated with the wearing of complete dentures occur without perceptible pain or discomfort to the patient. This fact leaves the patient with the illusion that all is well and there is no reason to seek further dental care.In many instances, the pathosis resulting from improperly maintained dentures reaches the point of no return before the patient is alerted to its presence.Frequently, by the time the patient experiences pain, discomfort, altered function, or unflattering facial changes, irreversible damage to the oral structures has occurred.This is damage that might have been averted or minimized under a continuing treatment program.ADVERSE PATIENT EDUCATIONPatient education pertaining to complete dentures too frequently comes from undesirable sources, and the information is incorrect, unreliable, and/or incomplete. In other words, there is a lot of patient education distributed by patients that is the source of many problems. The logical solution to this problem is patient education by the dental professionpatient education that is accurate and complete, and that is altered to meet the specific needs of each individual patient.

VARYING LEVELS OF ACHlEVEMENT A successful complete denture treatment:1.Will provide the highest level of esthetics, comfort, and function commensurate with the limitations of the patient(achievement levels will vary) 2.Will keep the functional demands of the prosthesis within the limits of the metabolic ability of the supporting tissues (this must be achieved at all cost and is our primary objective) 3.Will bring the patients expectations within the boundaries of the level of achievement possible (the patient must be satisfied, and a thorough patient education is essential to this objective)4. demands a harmonious,' cooperative effort by the patient and the dentist to maintain the treatment level that is achieved (change is inevitable--it is only a matter of time and degree).PATIENTS RESPONSIBILITYThe patient has definite responsibilities in the treatment effort.The functional demands of the prosthesis are entirely controlled by the patient. The patient should not expect to use the prosthesis efficiently during the first few days or even the first weeks following its insertion. Effective and efficient use comes through the patients persistent practice to master these skills.The patient can enhance the stability of the prosthesis by centering the functional forces on the posterior teeth, and can further minimize the functional demands by minimizing the power stroke during mastication and by avoiding habits or parafunctions that increase functional demands and or concentrate the functional forces in an isolated area. ORAL AND DENTURE HYGIENEThe patients oral and denture hygiene play a dominant role in the maintenance of oral health. Complete dentures will move during function.The greater the movement, the greater the quantity of food particles that will collect beneath the dentures.Many foodstuffs decompose quickly into substances that are irritating to the oral mucous membranes. Prolonged retention of these irritants resulting from poor denture hygiene excites tissue irritation, reduces tissue tolerance, and indirectly increases functional demands. A self-perpetuating cycle of tissue abuse may be established.

OBSTACLES TO PATIENT EDUCATIONTwo of the main obstacles in presenting a comprehensive patient education are time and competition.Time in the dental operatory involves economics. Many patients are given a comprehensive patient education booklet in an effort to minimize time in the operatory. This has proved to be an ineffective method of patient education.POST-INSERTION DENTURE PROBLEMSEven when utmost care is taken in the fabrication of complete dentures, there are always unforeseen problems that arise when the patient is attempting to adjust to the new prosthesis. These problems may be classified under four major headings: ( 1) Comfort (2) Function (3) Esthetics (4) Phonetics.p

POST INSERTION INSTRUCTIONS WEARING OF DENTURES:Within 24 hrs of wearing dentures, little discomfort will be their leading to soreness and their will be excessive salivation, which has to be swallowed.If any pain , ulceration or burning sensation after wearing denture occurs consult dentist.Before sleeping soak the denture overnight in fresh clean water.Dentures should not be soaked in hot water ; this can cause thermal changes and can distort dentures. SPEECHSpeaking with new dentures requires practice so read out loud and repeat the words those which are difficult to pronounce.With time speech will be better with dentures.While sneezing , coughing or yawning , keep hands close to mouth to prevent denture from coming out. DENTURE HYGIENERinse mouth properly before wearing dentures.Dentures must be cleaned properly before and after meals , using denture brushes.Clean tongue and skin over the bone properly and massage the skin over bone gently using clean finger.Inside surface of dentures must be cleaned delicately using clean finger, wet cotton.

EATING:

For 2-3 weeks take soft food and chew small bites simultaneously from both sides.Avoid sticky food.Food must be chewed from back teeth.Biting from front teeth should be avoided as will dislodge the denture.Cut fruits into small pieces and then eat.Drink water by sipping and do not lift glass for drinking water , this will dislodge the denture.

GAGGING

vomiting sense is a rare , but normal healthy reaction when any foreign object is placed in mouth.In old denture wearers it may be symptom of a disease or disorder of intestinal tract , respiratory tract , excess alcoholism and severe smoking.In case gagging persist for long time , causing discomfort to wear the denture , consult the dentist. SUMMARY AND CONCLUSIONS1.The problems encountered in complete denture treatment are numerous and come from many sources.

2.One of the greatest single sources of avoidable problems stems from insufficient, inadequate, ineffective, or adverse patient education.3. Patients must be made aware that they are purchasing a health service, and not a commodity that is continuous, and that this health service, if properly maintained through the cooperative efforts of dentist and patient, will assure him of maximum comfort, esthetics, chewing efficiency, and preservation of oral structures commensurate with the conditions peculiar to his oral environment, general health index, level of expectation, level of oral hygiene, and adeptness in the use of the prosthesis.

REFERENCES1. Gehl, D. H.: Investment in the Future, J. PROS. DENT. 18: 190-201, 1967.2. Devan, M. M.: The Nature of the Partial Denture Foundation: Suggestions for Its Preservation,J. PROS. DENT. 2: 210-218, 1952.