Manuals_files/CD Manual 12.pdf - Removable Prosthodontics

Troubleshooting Pain & Looseness -76
Diagnosing Denture Pain & Looseness: Principles and Practice
General Principles for Diagnosing Denture Problems
Clinicians can save time and minimize repeat visits for patients with complete or removable
partial denture problems by employing five strategies for eliminating etiological factors: 1)
establishing a differential diagnosis, 2) identifying variations from normal 3) having denture
patients demonstrate their problems, 4) always using an indicating medium when making
adjustments to prostheses, and 5) having the patient rate how much better they feel after
adjustments.
Establishing a Differential Diagnosis
To effectively eliminate denture problems, one must correctly identify the etiology of the
problem. Take a good history and perform a thorough clinical exam. Establish a list of
potential causes (a differential diagnosis), rank them as to which ones occur most commonly,
and begin by eliminating the causes that could most likely be causing the problem. If the
cause of a problem is removed, the pain, ulceration or other related signs and symptoms
should normally resolve in 10-14 days 1 . Biopsy is mandatory in any lesion that fails to heal
within 14 days of onset 2 , particularly when a denture has been ruled out as the source of the
ulcer. Work down the list of differential diagnoses until the problem is eliminated 2 .
Looking for Normal
Many denture problems can be identified by inspecting dentures critically for variations from
normal (Fig. 1-5). Unusual extensions, contours, tooth position, thickness and finish can all
be sources of denture problems. Intraoral inspection for anatomical or tissue abnormalities or
variants may also give clues to the cause of some denture problems (Fig. 6-8). If an
abnormality is found, attempt to ascertain if it is related to patient signs and symptoms by
correcting the denture. If the source of the problem is eliminated, there should be resolution
of signs and symptoms within 10-14 days.
Have a Patient Demonstrate the Problem
Many times asking the patient to demonstrate how the problem occurs will help a clinician
identify the source of the problem. If the problem occurs only when the patient chews, cut a
small piece of a cotton roll, dampen it and let the patient demonstrate the location where the
bolus causes the symptom (Fig 9). If a problem occurs during speaking, singing, drinking, or
opening wide have the patient replicate the circumstances. Have the patient describe what
they feel is happening and watch carefully to determine the cause of the problem. Attempt to
eliminate the cause and recall the patient in 10-14 days to ensure the problem has resolved.
Never adjust without using diagnostic media
Clinicians normally check occlusion of restorations using an indicator such as articulating
paper or shim stock. Similarly, denture adjustments are more accurate and effective, when
made using an indicating medium. Pressure or fit checking medium, indelible markers and
articulating paper can all be used to aid in the location and the determination of the degree of
adjustment that is required.