COMPLETE DENTURE : Problems and Solutions
Bone loss is one of the major denture problems.
Placement of removable prosthesis in oral cavity produces some changes that may have some adverse effect on the integrity of the tissues. Continuous wearing of denture has a negative effect on the residual ridge. The consequences of wearing complete dentures are usually loss of bone and changes in the oral mucosa.
This causes patient discomfort, destabilization of occlusion, insufficient masticatory function and aesthetics problems. Ultimately due to the consequences residual ridge reduction or any pathologic changes patient may not be able to wear dentures. Furthermore, poorly fitting dentures impairs the masticatory function and can result in nutritional deficiencies.
The denture problems can be classified into two categories:
1. Direct denture problems
2. Indirect denture problems
Direct denture problems:
1. Denture stomatitis
2. Burning mouth syndrome
3. Flabby Ridge
4. Irritation hyperplasia
6. Traumatic ulcer
7. Residual Ridge reduction
8. Overdenture abutments: Caries and periodontal disease
9. Oral cancer
Aka: Denture induced stomatitis, denture sore mouth, denture stomatitis, inflammatory papillary hyperplasia, amt chronic atrophic Candidiasis.
Among 50% of the population wearing complete denture often found with denture stomatitis.
Newton classified denture stomatitis into three types:
Type 1: Pinpoint hyperemia or localized inflammation
Type 2: Diffuse erythema involving entire denture covered mucosa
Type 3: Inflammatory papillary hyperplasia involving Central part of hard palate and alveolar ridges
Type 1 most often is trauma induced, whereas type 2 and type 3 are caused by microbial plaque accumulation.
Most of the times, denture stomatitis is caused by candida albicans. Denture stomatitis is often associated with angular cheilitis or glossitis.
Once the diagnosis is done by finding mycelia or pseudohyphae in a direct smear, treatment course of 4 weeks initiated immediately.
What causes denture stomatitis?
The infection prevails who wear dangers day and night and disappears if not worn.
Trauma from denture stimulates the turnover of epithelial cells thus reducing keratinization and there by facilitating fungal and bacterial antigen penetration.
Colonization of candida depends on-
Adherence a yeast cells,
Interaction with oral bacteria,
Redox potential of the site,
And the surface of acrylic resin.
Retention of denture plaque is enhanced by- poor oral hygiene, high carbohydrate diet, reduced salivary flow, continuous wearing of denture.
Also there are systemic factors predisposing to candida associated denture stomatitis- diabetes mellitus, nutritional deficiencies, corticosteroid therapy, immunosuppressive drugs, immune diseases and malignancies.
Although the major factors cause denture stomatitis is – unclean dentures and poor oral hygiene.
know how to clean dentures at home to reduce denture problems.
Solutions for denture stomatitis-
1. Antifungal therapy
2. Correction of ill fitting dentures
3. Plaque control
The most important is to clean the dentures and maintain hygiene. Instructing the patient to remove the dentures after meal and Scrub them with the soap or denture cleansers. The mucosa contacting the dentures should be kept clean and massage with finger or a soft toothbrush. Patient is instructed not to use dentures at night. Dentist should done routine step of polishing or glazing of the tissue surface of denture.
Local – Nysatin, Amphotericin B, Miconazole or Clotrimazole.
Systemic- Ketoconazole or Fluconazole.
Treatment with antifungals is continued for 4 weeks.
Dentures should be taken out while taking lozenges.
Wearing of complete dentures avoided during night time and to keep them dry or in a disinfectant solution of 0.02% to 2% chlorhexidine.
Cryosurgery (surgical elimination of deep crypts) is done for type 3 denture stomatitis.
Burning mouth syndrome(BMS):
BMS is defined as burning sensation in the mouth when the denture touches the oral structures.
It is relevant to differentiate between burning sensations and burning mouth syndrome. In burning mouth sensations- oral mucosa is often inflamed chemical irritation, infection or any drug allergy. While in burning mouth syndrome, mucosa appears healthy.
Postmenopausal women wearing complete denture often complaints of burning sensation in the tissues or tongue.
The characteristic pain is often present in morning and tends to aggravate during day. Pain may be present with the feeling of thirst and altered taste sensation.
The person might feel headache, insomnia, decreased libido, irritability or depression.
Aggravating factors are – tension, fatigue and Hot or spicy food.
Relieving factors are – sleeping, eating and distraction.
Solution for burning mouth syndrome-
It is important to counsel the patient and help understand the nature of denture problems and subsequent elimination of fears. The comprehensive prosthetic treatment is implant supported overdenture.
Flabby Ridge is defined as a mobile or extremely resilient alveolar Ridge due to replacement of bone by fibrous tissue.
It is often found in the anterior part of maxilla opposing remaining mandibular anterior teeth.
It is probably a consequence of excess of load on the residual Ridge and unstable occlusion.
Flabby Ridge provides poor denture support and should be removed surgically to minimise the ridge resorption. However with extreme atrophy of maxillary Ridge, flabby Ridge should not be totally removed as it would result in short vestibules. Indeed the resilient Ridge may provide some retention.
Denture irritation hyperplasia:
Long term wearing ill fitting dentures may result in occurrence of tissue hyperplasia contacting the denture border.
This is usually asymptomatic however severe inflammation and ulceration may occur.
Replacement or adjustment of dentures subside the inflammation and edema and produces improvement in the condition.
If left untreated due to negligence of Dentist or patient may stimulate neoplastic process.
Gag reflex is a normal defence mechanism to prevent foreign body entering the trachea.
Persistent complain of gagging may be due to overextended borders of the denture (posterior border of maxillary denture and distolingual flange of mandibular denture).
In sensitive patients, gag reflex stimulated after placement of new dentures but it usually disappears in few days patient is adapted to the new dentures.
Unstable occlusion or increased vertical dimension may trigger gagging reflex.
Gagging may be seen in gastrointestinal disorders, catarrh in upper respiratory passages, alcoholism or severe smoking.
aka: Sore Spots
Small painful ulcers develop within 1 to 2 days after placement of new dentures. Ulcer is covered by grey necrotic membrane and surrounded by an inflammatory halo with elevated borders.
The lesion is due to overextended denture flange or unbalanced occlusion.
In a non-compromised host, ulcer heals within few days after denture correction. If no treatment is instituted, it may develop into denture irritation hyperplasia.
Residual Ridge reduction:
After tooth extraction, there is a continuous loss of bone which continues even after placement of dentures. This is a progressive, irreversible course and a consequence of alveolar bone remodeling.
One year after tooth extraction, the residual ridge height (bone height) is reduced about 2 to 3 mm for maxilla and 4 to 5 mm for mandible. The annual rate of reduction is decrease after 1 year and is about 0.1 to 0.2 mm in mandible and is 4 times lesson maxilla.
Severe residual Ridge reduction of mandible results in marked mandibular base bend and posterior positioning of lower incisal edges.
As a manifestation of osteoporosis, women found with progressive bone loss under dentures, predispose to more Rapid residual Ridge reduction particularly in maxilla.
Severe atrophy is seen in day and night wearers of denture than in day wearer.
Consequences of residual Ridge reduction- loss of sulcus width and depth, displacement of muscle attachment closer to the crest of the Ridge, loss of vertical dimension, reduction in lower facial height, anterior rotation of mandible, increased prognathia.
The progression of ridge resorption is centripetal in maxilla and centrifugal in mandible.
Residual ridge reduction can be diminished with the use of implants.
Overdenture abutments: Caries and Periodontal disease:
Retention from remaining firm teeth to serve as abutment is an excellent choice for complete overdenture.
However, wearing overdenture associated with high risk of caries and progression of periodontal disease of abutment teeth. The principal aim is to prevent plaque accumulation. This can be done by regular follow up examination at 3-6 months interval and use of a drop of chlorhexidine fluoride gel at the abutment site insertion of denture once daily.
There is no definite proof existing between denture wearer and oral cancer. However case reports have details oral cancer in the patient wearing in fitting dentures.
Association appears with heavy alcohol and tobacco use, less education, social economic status predisposes to oral cancer as well as the poor hygiene and denture wearing.
To read book on complete denture problems, check out.
Solutions to denture problems:
Due to the consequences of wearing ill fitting complete denture for a long time, patient often complaints of discomfort, insufficient masticatory function esthetics problems. Ultimately the patient will not be able to wear the dentures.
To reduce the residual ridge resorption, following should be considered:
1. Effort should be made to retain firm teeth to serve as abutment for overdenture.
2. Patient with complete denture should be followed a regular schedule at yearly intervals.
3. Patient should be aware of the benefits of implant supported prosthesis.
Finally, it is important to educate explain to the patient that treatment with complete denture is not a definitive treatment and their collaboration is important to prevent the long-term risk dated with the denture problems.
check out our incredible post denture education guide