1- common complaint - Pharos University in Alexandria

Prof.Dr. Ahlam El-Sharkawy 

Professor of prosthodontics. 

Pharos university. 

prpp

Denture patients can be classified 

into three groups: 

• The first group : Accept anything even badly 

constructed denture. 

• The second group: Hard to please even with 

well constructed denture 

• . 

• The third group : Easily pleased and satisfied 

with well constructed denture.

Complaints 

Common 

Uncommon

Common Complaints 

1.Pain 

2. Esthetics 

3. Inefficiency 

4.Poor Retention 

5. Instability 

6. Clattering of teeth 

7. Nausea 

8. Discomfort 

9. Altered speech 

10. Bitting the cheek and 

tongue 

11. Food under the denture

Uncommon Complaints 

1. Allergy 

2. Whistling 

3. Lisping 

4. Ear ache 

5. Loss of taste sensation 

6. Peculiar taste 

7. Defensive tongue 

8. Burning of mouth

A) PAIN

Causes of pain 

• 1- Over extended periphery. 

• 2- poor fit. 

• 3- Insufficient relief. 

• 4-Incrrect centric relation. 

• 5- Other occlusal error. 

• 6-Teeth outside the ridge. 

• 7- Retained root or un-erupted tooth. 

• 8- V shaped ridge.

Causes of pain. 

• 9- Mental foramen. 

• 10-Irregular resorption. 

• 11- Pathological conditions. 

• 12- Rough fitting surface. 

• 13- infection with monilia. 

• 14- Swallowing and sore throat. 

• 15- Undercuts.

1- Overextension of the periphery 

• Most common cause of pain. 

• Incorrect molding of the impression . 

• Visible in the mouth as a red line, an area of 

hyperemia or an ulcer.

Visual &digital 

examination 

Indelible 

pencil 

Disclosing 

wax

1- Overextension of the periphery 

• Treatment: mark with indelible pencil or use 

disclosing wax.

2- Poor fit 

• The movement of denture rubbing the 

mucosa causing pain and patches of redness.

2- Poor fit 

• Treatment: new denture, relining using soft 

liner or rebasing

3- Insufficient relief 

Poor base adaptation 

Fulcrum on bony structures 

Treatment: apply PIP and 

relief pressure areas.

4- Incorrect jaw relations 

a. Wrong antero-posterior relationship 

Treatment: If slight not more than ¼ of cusp it 

can be corrected by grinding the mesial planes 

of the upper cusps and distal planes of lower 

cusps. 

- If gross, new dentures will be required.

B- Uneven pressure. 

• Treatment: 

• If detectable with a spatula, a new lower 

denture. 

• If detectable with celluloid strips, selective 

grinding using articulating paper

Increased Vertical Dimension 

Excessive VD 

• Sorness over entire ridge . 

• Muscle/joint pain 

• Denture teeth clatter during 

eating and talking. 

• Esthetic complaints:

Decreased Vertical Dimension 

Effects of excessively reducing the 

vertical dimension: 

1-Inefficiency. 

2- Cheek biting. 

3- appearance. 

4- soreness at the corners of the 

mouth(Angular cheilitis) 

5- Costen’s syndrome

Costen’s syndrom

Costen’s Syndrom 

1- Vestibulo – cochlear Nerve ( 8 th cranial nerve) 

2- Chorda Tympani Nerve(Branch from Facial Nerve-7th c.n) 

3-Auriculo-Temporal Nerve(Branch from Mandibular n. 

which is Branch from Trigeminal n. 5th c.n)

I – Otological Symptoms : 

Pressure on Vestibulo-Cochlear nerve. 

1- Vertigo. 

2-Tinnitus 

3- Mild Catarral Deafness

II – Oral Symptoms 

Pressure on Chorda Tympani 

1- Burning Sensation in the ant. 2/3 of 

the Tongue 

2- Metalic Taste 

3- Xerostomia

III – T.M.J and Peri auricular Symptoms 

Pressure on Auriculo-temporal n. 

1- Pain in T.M.J 

2-Pain in the Ear 

3-Pain in the Periauricular Region 

4- Xerostomia.

5- other occlusal errors 

• Cuspal interference 

• Disharmony between centric relation & centric 

occlusion 

• 1-Dragging of mucosa with retentive denture 

• 2-Instability with un-retentive denture 


• Articulating paper &selective grinding 

• Grinding paste 

• Remounting 

• New denture

6- Teeth outside the ridge 

• 1-Occlusal contact not 

centered over ridge 

• 2-Tilting forces cause 

displacement. 

3-Abrasion, ulceration 

in the buccal sulcus 

• 4-Cheek biting

7- Retained root or unerupted tooth 

• Well fit denture will stimulate eruption of 

unerupted teeth 

• Treatment: relief or extraction and reline

8- V- shaped ridge 

• Usually associated with lower denture… 

pressure during mastication pressing m.m. 

against a sharp ridge of bone. 

• Treatment: relief or alveoplasty & reline

9- Mental foramen 

• Pressure on the mental foramen 

the foramen. 

Relief over

10- Irregular resorption 

• Sharp spicules of bone 

• Treatment: alveolectomy & relining

11- Pathological condition 

• Usually diagnosed & treated before new 

denture construction

12- Rough fitting surface 

• Small pimples where material forced into 

small air bubbles of model 

• Treatment: remove the roughness

13- Infection with monilia albicans 

• Acute red inflammation terminating at 

borders of denture 

• Low protein & vitamin diet 


• fungicide such nystatine 

• Remove denture at night 

• Diluted hypochlorite

14- Swallowing & sore throat 

• Overextension on soft palate 

• Excessive pressure in hamular notch 

• Overextension disally in lingual pouch

15- Undercuts 

• Inserting & removing denture is getting 

painful 


• Insert this side first 

• Cut away from fitting surface but not height 

• Use of resilient liner or alveoplasty

B) ESTHETICS

1- Nose & chin approximation 

• Reduce vertical dimension with excessive 

freeway space 

• Treatment: reline one or both dentures or 

new one

2- Cheeks & lips falling in 

• Lack of tone of facial muscles 

• Lack of support by teeth & alveolar ridges 


building out of upper denture to compesate for 

the loss muscular tone.

3-Angular cheilitis 

• Loss of vertical dimension 

• Secondary infection 


• Increase vertical dimension 

• Correct position of anterior teeth 

• Provide sufficient support for angles of mouth 

by denture flanges

4- colour, size & position of anterior 

teeth 

a- Colour and size 

b- position. 

• Too dark or yellow, too large or small teeth 

• Irregularities pt wishes to reproduce

5- Amount of tooth showing 

• Too much or too little showing 

• Treatment: remake

6- General dissatisfaction 

• Middle aged women 

• Both pt & dentist should participate activities 

• Satisfy pt during try in stage

C) INEFFICIENCY

1- Inability to eat anything 

• Denture wearer for first time 

• Impatient 

• Psychological approach

2- Inability to eat meat 

• Flattening of cusps 

• Cuspless posterior teeth 

• Overclosure with decresed muscle efficiency 

• Unbalanced occlusion 


• Inexperience

3- Denture dislodged by eating 



• Upper teeth outside the ridge. 

• Treatment. 

• remake

4- Insufficient tongue space 

• Lower denture move during eating 

• Remake, allowing more tongue space, using 

narrower posterior teeth 

Tongue

Tongue and cheek biting 

Tongue biting may be due to; 

1. the artificial teeth positioned too far lingually. 

2. the occlusal plane is too low. 

3. enlarged hypertroghic tongue.

Tongue and cheek biting 

Cheek biting may be due to; 

1. setting of teeth buccally. 

2. lack of posterior overjet. 

3.loss of tone of cheek 

musculature with age.

5- Periphery overextended 

• Commonest place is region of lingual pouch 


• Reduce overextension.

6- Inexperience 

• Biting : function of anterior teeth 

• Chewing: function of posterior teeth 

• careful Explanation to the patient.

D) POOR RETENTION

1- When opening mouth 

a. Overextension 

b. Tight lips 

c. Tongue cramped 

d. Underextension 

e. Lack of peripheral seal 

f. Lack of saliva or a very 

thin watery saliva

1- When opening mouth 

Tight lips. 

A. Remake with the lower anterior teeth set 

more lingually, with a labial concavity on the 

denture & with maximum extension in 

the region of the retromolar pad.

2- When coughing or sneezing 

• Explain that there is a movement when 

pressure of air in mouth is greater than 

atmospheric pressure 

• Peripheral seal broken 

• Unusual movement

E) INSTABILITY

Causes of instability 

• Poor retention 


• High occlusal plane 

• Teeth outside ridge 

• Teeth not in neutral zone 

• Unrelieved median raphe

f) Clattering teeth 

• Too great a vertical height 

• Gross cuspal interference

G) NAUSEA 

Light or intermitted contact on soft palate or back 

of tongue

1- Denture slightly overextended 

• Intermittent contact with denture 

• Observe relation of posterior border to 

vibrating line 

• Remove excess

2- Denture underextension 

• Intermittent contact: denture moving owing 

to inadequate air seal 

• A palpable ridge: the edge detected by 

dorsum of tongue 

• Extend denture to vibrating line & post dam

3- thick posterior border 

• Dorsum of tongue irritated by thick edge 

• Thin down post. border

h) discomfort 

• Careful comparison with the old denture will 

give a clue to the cause 

1. Cramped tongue space 

2. Altered vertical height 

3. Altered occlusal plane 

• Pt should be encourage to preserve several 

weak

i) Altered speech 

• Temporarily 

• Overcome by reading loud 

• Remake with concern thickness of palate & 

anterior teeth position

1- labial Sound 

2- Dental Sound 

3-Labio-dental Sound 

4-Linguo-dental Sound 

5- Linguo Palatal Sound

-It results from contact between upper 

and 

-lower Lips to pronounce-: [ B,P,M]

-Result from Relation Between 

Incisal Edge Of Upper ant. Teeth 

and Lower ant. Teeth to 

Pronounce ( S )

Result from Contact Between Lower 

Lip and Incisal Edge of Upper ant. 

Teeth to Pronounce ( F , V )

Result from Contact Between Tip 

of Tongue and Incisal Edge of 

Upper anterior Teeth to Pronounce 

( Th )

-Results from : 

A- Contact Between Tip of the Tongue 

and ant. Part of the palate to 

Pronounce ( T , D ) 

B- Contact Between Tip of the Tongue 

and Middle Part of the Palate to 

Pronounce ( H )

Lisping 

Premature contact between tongue & ant. 

Teeth 

1. Increased vertical dimension 

2. Increased denture thickness 

3. Narrow arch space 

4. Anterior teeth too palatally 

Reduce intraoral air volume

Whistling 

. 

Failure of contact between tongue and 

anterior teeth 

1-Decreased vertical dimension 

1. -Increased overjet 

2. -Posterior teeth buccally 

3. Increase intra oral air volume

j) Biting the cheek & tongue 

a) Insufficient overjet 

b) Reduced vertical height

k) Food under denture 

• Maximum covering & adequate peripheral 

seal

2- Uncommon complaint

Allergy 

• Burning sensation 

• Mucosa slightly inflamed & red in color 

• New denture in another material

Ear ache 

• Pain in TMJ 

• traumatic occlusion

Loss of taste sensation 

• Pecular taste 

• Poor oral hygient 

• Saulty taste from drainage of cyst or 

haemorrhage

Burning of mouth 

• Large doses of vitamin B complex 

• A Piece of ice held in mouth 

• Leave denture out of mouth as possible

Commonest causes of denture failure 

1. Incorrect anteroposterior relation 

2. Uneven & locked occlusion 

3. Open vertical dimension 

4. A cramped tongue 

5. Poor retention 

6. Failure to copy existing denture

1- common complaint - Pharos University in Alexandria

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