UPPER DENTURE PROBLEMS – WONDERFUL WAYS TO FIX IT

UPPER DENTURE PROBLEMS – WONDERFUL WAYS TO FIX IT

UPPER DENTURE PROBLEMS

When coughing or sneezing

Occasionally a new denture wearer complains of his upper denture falls and his lower denture lifts whenever he coughs or sneezes.

Treatment

While coughing or sneezing the soft palate rises suddenly and the air pressure is considerable so that the peripheral seal of the upper denture is broken and it is liable to fall.

 The usual muscular movement causes the lower denture to lift.

There is no way of preventing these movements of the dentures, but covering the mouth with a hand or handkerchief is an obvious suggestion.

Upper denture drops while yawning

During the act of yawning the mouth is opened to its fullest extent, and the border tissues pull down against the borders of the denture.

If there is an area of irritation, the borders are overextended and should be reduced.

If there is no evidence of overextention, the patient should be cautioned to reframe from opening the mouth too wide.

Distobuccal flange of the denture may be too thick so that they interface with the action of ramus.

A side to side movement of the jaw will loosen the denture – If this occurs, reduction in the thickness of the distal ends of the buccal flanges of denture is to be done.

Denture is inadequate in posterior palatal seal – This leads to a poor palatal seal and air is permitted to enter under the posterior border of the denture.

Buccal surfaces of the teeth are placed too far towards the cheek. When this occurs, and the mouth has opened the muscles of the cheek pull against the buccal surfaces of teeth and tend to unseat the denture.

Denture is overextended in the pteregomixillary notch – When this occurs, the functional activity of the pterygomandibular raphae is interfered with and during jaw movements, the denture is unseated.

  • Upper denture drops while patient is talking
    • Poor border seal
    • Improper frenum relief in the denture.
      • Dislodgement of dentures on taking fluids

It is possible for him or her to experience a loosening of dentures while drinking when the dentures are delivered.

 During swallowing, the soft palate rises and the posterior palatal seal may be lost. The tongue and floor of the mouth are raised by the tongue muscles. The mandible is prevented from moving downwards by the suprahyoid muscles. So the lower denture rises during swallowing.

However, this will not persist when the tongue, lips and cheeks learn to manipulate the dentures.

Gagging

One of the most bewildering problems encountered in complete denture prosthodontics is that presented by the patient referred to as “gagger”.

“Gagging is an involuntary retching reflex that may be stimulated by something touching the posterior palatal region”.

 The etching may lead to actual vomiting and is accompanied by lacrimation, salivation and flushing. These symptoms are usually triggered by tactile stimulation of the soft palate by the upper denture, but may also be caused by virtually any intraoral procedure.

The upper denture of the gagging patient usually has either of the two characteristic contours.

It may have a posterior palatal margin that is so concave that it almost terminates on the hard palate, or it may have a palate which has a marked downward slope away from the soft palate. In either case, the dentures can exert only minimal pressure against the soft palate.

The most paradoxical feature found in almost every gagging patient is although the soft palate is extremely sensitive to the contact of the denture or any instrument; the patient seldom gags on foods and liquids of his diet which contact this same area during swallowing.

verage gagger can be separated into –

  1. Acute
  2. Chronic

Shortening of palatal margin does not decrease the tendency to gag but may actually increase it.

Even in a non-gagger light touch or pressure against the soft palate can cause a tickling sensation, whereas firm pressure is much less apt to do so.

A similar experiment can be performed by touching the back of one’s hand with the lightest possible pressure; this will usually cause a tickling sensation.

However, if the pressure on the same area is firm, no tickling is felt. And so, too, with the upper denture; it is much more apt to cause a tickling sensation if it exerts too little pressure against the soft palate than if it exerts too much.

So the consistent feature of the acute phase is an upper denture which feels “too long” and causes gagging which is not relieved by palate shortening.

Chronic phase

In this phase, the gaggers history resembles a simple conditioned reflex in that the gagging becomes so intimately associated with the denture that ultimately any procedure involving the denture, or the oral cavity, can set off the reflex. Even the thought of such contact may cause gagging.

Kovats and Krol mentioned that the gag reflex can be markedly diminished if the patient’s complete attention is diverted by having him maintain a leg in an elevated position.

Treatment

There are a number of methods of dealing with the problem.

It is important to give the patient a feeling of confidence of on the part of the dentist.

Prior to the impression making, the patient should be instructed to breathe through the nose slowly and audibly and at the same time to rhythmically tap his right leg on the floor.

 By doing so the patients attention would be diverted enough to allow the making of lower impression without incident.

The palate can be sprayed with surface anesthetic or ethylchloride prior to recording the impression. Posterior third of the tongue which is often implicated in the retching reflex can also do anesthetized.

It is wise to have the patients head upright and to record the lower preliminary impression first – an impression compound with minimal flow (Medium fusing compound) is recommended.

Either silicone or heavy bodied polysulphide is suitable for final impression.

For registration of centric relation, virtually the entire palate of the upper occlusal rim is removed in order to reduce to an absolute minimum the area of contact between rim and palatal tissue.

In addition, a thin film of adhesive is sprinkled onto the record base for retention, and an anesthetic is sprayed onto the palate.

 Patient followed instructions regarding breathing and foot tapping.

Prior to actual placing of new dentures, the patient is prepared for a temporary period of discomfort, but is assured that although initially uncomfortable, it would be short lived.

Lower denture should be placed first. The upper denture should then be placed and the patient is requested to close into centric occlusion in centric relation.

The patient should be made to nose-breathe in a deep slow fashion. Although initially very severe, the gagging will subside over a period of (4-5) minutes.

Hypnotheraphy is also used as are various types of behavior therapy. Barbiturates may be used to depress the CNS, antihistamines to lower the feeling of sickness or pararymphathetic depressants to reduce the salivary flow which increases at the outset of retching.

If your problem is still unsolved, and you are unable to correct upper denture problem then this article might be a solution to your problem. check out problems with a new delivered denture.

SUMMARY

The first consideration, when confronted with any failure or repair situation, is to ascertain the cause or suspected cause. If there is a cause that is correctable, it should be taken care of first. Care should be taken not to become involved in repairs that should have been remade. Repairs are usually the second best to the original in one or more ways. Imagination and innovation are key factors in successful repairs. Great satisfaction can be achieved in meeting a situation and solving it in an effective and economical manner. 

Never forget to give post insertion instructions. Check out our INCREDIBLE POST INSERTION EDUCATION GUIDE.



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