The Review Appointment
Much research has been undertaken in an effort to explain why some patients have extreme difficulty in wearing complete dentures successfully. The technical quality of the dentures is of the utmost importance, but research is divided on the importance of
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The Review Appointment
History of the Complaint . . . . . . . . . . . . . . . . . . . 86 The Painful Denture . . . . . . . . . . . . . . . . . . . . . . . 86 Persistent Pain . . . . . . . . . . . . . . . . . . . . . . . . . . . . Occlusal Loading of the Oral Tissues and Resilient Lining Materials . . . . . . . . . . Properties of the Different Types of Resilient Lining Materials . . . . . . . . . . . . Other Causes of Persistent Pain . . . . . . . . . . .
89 90 91 91
Defective Speech . . . . . . . . . . . . . . . . . . . . . . . . . . 91 “Unable to Chew Food Properly” . . . . . . . . . . . . 92 Vague Symptoms . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Burning Mouth Syndrome . . . . . . . . . . . . . 93 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94
H. Devlin, Complete Dentures © Springer-Verlag Berlin Heidelberg 2002
86
The Review Appointment
Much research has been undertaken in an effort to explain why some patients have extreme difficulty in wearing complete dentures successfully. The technical quality of the dentures is of the utmost importance, but research is divided on the importance of medical and psychological factors (Brunello and Mandikos 1998; Beck et al. 1993). Older people take longer to adapt to new dentures, but questionnaires, in-depth interviews and personality assessments have all been unsuccessful in identifying any other consistent factor that may predict a patient’s inability to tolerate dentures. Various audit studies have been carried out of dentures constructed by dental laboratories in general dental practice. The main technical faults can be summarized as excessive reduction of the denture border and large changes in vertical dimension (Barsby et al. 1995). If too great an occlusal vertical dimension is provided, the patient may complain of continual clattering of the teeth or generalized pain which increases during the day (Jeganathan and Payne 1993). During mastication, the patient may find that there is not enough room for the food. Reduction of the interocclusal clearance can be prevented during processing of the denture by investing the trial denture in plaster with a stone matrix over the teeth. The stone matrix prevents tooth movement, but deflasking the denture can be more time consuming.
History of the Complaint Time spent obtaining a detailed history of the complaint can often prevent misdiagnosis, incorrect treatment and exacerbation of the patient’s problem. Therefore, typical questions to a patient about their loose dentures may include: 1. Are both upper and lower dentures loose or just one of them? 2. Are the dentures loose at rest or when eating? 3. Does movement of the lips, cheeks or tongue cause denture looseness? Looseness of dentures may also be associated with a host of other complications such as clicking of the teeth and pain. Patients may have too-high expectations of the function of their dentures, but this usually becomes obvious from the r
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