Gupta R et al. Post denture instructions.

International Journal of Research in Health and Allied Sciences

Journal home page: www.ijrhas.com
Official Publication of “Society for Scientific Research and Studies” [Regd.]

ISSN: 2455-7803

REVIEW ARTICLE
Post Insertion Denture Instructions, Problems and Its Management In
Complete Denture Patients -A Review

Renu Gupta1, Priyanka Singh2, Divya Vashisth3, Niyati Arora2, Vijay Chib2
1
Professor & Head, 2PG student, 3Professor, Department of Prosthodontics HPGDC, Shimla (HP)

ABSTRACT:
Complete-denture therapy involves a complex interplay between the biologic and technical limitations. Fabrication of
successful complete dentures is dependent on technical, biological, and psychological interplay between the clinician and the
patient. The overall success of complete denture therapy depends on patient’s comfort and acceptance of the dentures
interplay between the clinician and the patient. Identification of post insertion complaints in different types of prosthesis
would be very supportive to developing strategies to prevent and manage these more effectively by reducing all negative
factors associated with these complaints. Hence, this article reviews about post insertion instructions, problems and
management in denture patients.
Key words: Denture, Management, Insertion

Received: 12 September, 2020 Accepted: 16 October, 2020

Corresponding author: Dr. Priyanka Singh, PG student, Department of Prosthodontics HPGDC, Shimla (HP)

This article may be cited as: Gupta R, Singh P, Vashisth D, Arora N, Chib V. Post Insertion Denture Instructions,
Problems and Its Management In Complete Denture Patients -A Review. Int J Res Health Allied Sci 2020; 6(6):61-68.

INTRODUCTION
“Fitting the personality of the aged patient is often The overall success of complete denture therapy
more difficult than fitting the denture to the mouth” depends on patient’s comfort and acceptance of the
-Jamieson dentures.6
The elderly population is remarkably increasing Complete denture is essential to rehabilitate the
world-wide.1 The fast-growing segment of population stomatognathic system by improving masticatory
are in increased need of special care and attention to efficiency, phonetics and aesthetic appearance of
maintain a reasonable quality of life in the face of completely edentulous patients. Hence, the follow-up
disability and growing frailty in this group. This might care of complete denture is an important step and it
result in an increased demand for health and social helps to correct minor problems and complaints, as
services over the next quarter century.2Tooth loss has wearing complete dentures with problems and
a direct influence on reduced masticatory function and complaints may have adverse effects on the health of
a shift towards a poorly balanced diet. This in turn denture supporting tissues.4 Satisfaction with dentures
will result in an increase in oral diseases due to a is impacted by factors such as denture quality,
deficiency in various micronutrients, leading to a available denture-bearing area, the quality of the
uncompromised immune status. Ill-fitting dentures dentist-patient interaction, previous denture
will worsen this situation and patients may avoid experience, the patient personality and psychological
certain social activities like speaking, smiling, eating well-being.
etc. in the presence of another person.3 Fabrication of Hence, this article reviews about post insertion
complete dentures is dependent on technical, instructions, problems and management in denture
biological, and psychological interplay between the patients.
clinician and the patient. Paramount to the patient are Patient Education -The concept of “difficult denture
factors as esthetics, comfort, and masticatory ability. birds” was described by Koper (1988) which is

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 Gupta R et al. Post denture instructions.

defined as a problem denture patient with much b. Denture cleansers should only be used to clean
experience as a recipient of various kind of dental dentures outside of the mouth.
therapy. They are individuals who complain, have c. Dentures should always be thoroughly rinsed
pain, are hostile, tense, anxious, and unhappy people. after soaking and brushing with denture cleansing
They often exhibit regressive behaviour and transfer solutions prior to reinsertion into the oral cavity.
many of their fear and frustrations to their mouth and Always follow the product usage instructions.
face. 3. Dentures should be cleaned annually by a dentist
 Patient education at impression and jaw relation or dental professional using ultrasonic cleansers
recording procedures12-13 to minimize biofilm accumulation over time.
Considerable instruction may accompany impression 4. Dentures should never be placed in boiling water.
making and brief concise explanation of the 5. Dentures should not be soaked in sodium
impression technique should be given with proper hypochlorite bleach, or in products containing
emphasis on the role of the patient in that procedure. sodium hypochlorite for more than 10 minutes as
Diagnostic casts, facial measurements, old and recent it will damage the denture.
photographs, profile records and the patient’s old 6. Dentures should be stored immersed in water
dentures if available can be employed to illustrate the after cleaning, when not replaced in oral cavity to
discussion. avoid warping.
 Patient education at the try-in12-13 7. Denture adhesives can improve the retention,
At the try-in stage, the dentist should instruct the stability of dentures, quality of life,mastication
patient carefully that denture teeth should be shaded function and help seal out the accumulation of
and have embrasures and diastemas to simulate food particles beneath the dentures, even in well-
natural appearance. Dentist should explain that the fitting dentures.
denture will seem to be bulky at the try-in stage. The 8. Extended use of denture adhesives should not be
patient should be given a mirror and instructed to considered without periodic assessment of
speak and count. Each patient should be accompanied denture quality and health of the supporting
by a close friend or relative at the try in. It is tissues by a dentist, prosthodontist, or dental
absolutely necessary to obtain the complete consent professional.
and satisfaction of the patient before proceeding with 9. Improper use of zinc-containing denture
the construction of the dentures. adhesives may have adverse systemic effects.
 Patient education at the denture insertion stage12-13 Therefore, zinc-containing denture adhesives
The denture insertion appointment represents a should be avoided.
marked transition in complete denture treatment. 10. Denture adhesives should be completely removed
From this point forward, the here to fore dentist- from the prosthesis and the oral cavity on a daily
directed care becomes patient-directed as the patient basis.
experiences new sensations and reports those that are 11. If increasing amounts of adhesives are required,
unexpected or intolerable to the dentist for remedy. patient should see a dentist or dental professional
For this reason, at the insertion appointment, the to evaluate the fit and stability of the dentures.
dentist must employ both technical and interpersonal 12. It is recommended that dentures should not be
skills in order to place the patient on a trajectory worn continuously (24 hours per day) in an effort
toward success. to reduce or minimize denture stomatitis.
13. Patients who wear dentures should be checked
INSTRUCTIONS TO THE PATIENT annually by the dentist for maintenance of
REGARDING DENTURE CARE optimum denture fit and function, for evaluation
Guidelines for the care and maintenance of for oral lesions and bone loss and for assessment
complete dentures1 of oral health status.
In 2009, the American College of Prosthodontists 14. Patient should not wear the old dentures during
(ACP) formed a task force to establish evidence the 12–24 h before insertion to allow the insertion
based guidelines for the care and maintenance of of the new dentures on supporting tissues without
complete dentures. compression.
1. Careful daily removal of the bacterial biofilm
present in the oral cavity and on complete PERIODIC RECALL APPOINTMENTS
dentures is of paramount importance to minimize /FOLLOW-UP FOR ORAL EXAMINATION7
denture stomatitis and to help contribute to good Patients must be educated that annual recall
oral and general health. appointments are important to ensure the sustained
2. To reduce levels of biofilm and potentially optimal fit and function of their new prosthesis as well
harmful bacteria and fungi, patients who wear as for the maintenance of mucosal health. In many
dentures should do the following: cases, the period of postinsertion adjustment is crucial
a. Dentures should be cleaned daily by soaking for denture success rather than failure, and the
and brushing with an effective, nonabrasive professional is responsible for providing patient care
denture cleanser. during this period as adaptation is specific for each

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Gupta R et al. Post denture instructions.

patient, and may require several months to be

achieved.8 POST INSERTION PROBLEMS IN COMPLETE
Boucher has advised recall appointments immediately DENTURE
24 hour post insertion and periodic checkup phase. Loss of natural teeth and subsequent alveolar
Sharry has advised four recall appointments after 10 resorption has a significant impact on appearance &
days, 3 weeks, 6 weeks and 3months consequently function.Problems and their causes with respect to the
from denture placement. Allen and McCarthy advised post insertion recall visits at an interval of a stipulated
appointment within 1 to 2 days of delivery of the period of time of 24 hours , 72 hours , one week and
denture with annual recall is recommended. three weeks are:- 5

Table 1: Problems after 24 hours of denture insertion:

Problem Cause Treatment

Use disclosing agent , an area of wipe off

Trauma at the peripheral Sharp edge of acrylic or an acrylic would be seen, remove the sharp edge and
area pearl smoothen out the denture periphery

i)Overextended maxillary denture. i)Check for proper extension in the

ii)Decreased stability of the maxillary posterior palatal seal area.ii)Check for
Gagging denture. Occlusal prematurities iii)Check for the
iii) Overextended mandibular denture over extension in the retromylohyoid area
iv)Over polished maxillary denture and correct accordingly.
i)Overextended mandibular denture in the
Difficulty in swallowing retromylohyoid area Check for over extension and correct
ii)Increased vertical dimension of occlusion accordingly

Pain or ulceration in the

area of the labial or buccal Freni not relieved properly Use disclosing media and correct accordingly
freni in either the
maxillary and mandibular
denture
Check for the sounds while patients speak
This problem could range from lisping or words containing a lot of the “s” alphabet and
whistling sound while speaking due to the correct the palatal contour. If the problem is
Difficulty in speech. incorrect contour of the palate of the difficulty in getting used to new dentures,
maxillary denture, to a difficulty in getting educate the patient
adapted to the new dentures

Table 2: Problems which the patient presents with 72 hours after denture insertion
Problem Cause Treatment
 Locate the prematurity using articulating
Pain or area of ulceration  Usually a result of occlusal papers and correct accordingly.
present at the crest of the prematurity.  No alterations to be done to the intaglio
ridge surface if it is found to be smooth.

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Gupta R et al. Post denture instructions.

i)If the shift from the centric is very minimal, it

This is usually due to incorrect can be corrected using selective grinding.
Soreness or ulceration recording of the centric relation ii)However if gross amount of movement of the
present at lingual part of which results in shifting of the mandibular denture base is seen, at least one of
the slope of the anterior mandibular denture base resulting in the dentures have to be remade
part of the mandibular trauma.
ridge

This results when the retentive Use disclosing agent and provide relief to the
Soreness at the area of the qualities of the denture holds it in buccal frenum as required.
buccal frenum of the place, while enough relief is not
maxillary denture provided at the area of the buccal
frenum.

i)If the increase is slight, correct it using selective

Dentures making clicking This is the result of increased grinding.
sound when the patient tries vertical dimension of occlusion. ii)If the increase is gross, remaking of the dentures
to speak may be required

This is usually due to a sharp edge of i)Check for the cramping of the tongue by asking
a tooth or too much lingual tilting of the patient to protrude the tongue slightly, if the
Ulcerations on the lateral the occlusal surface of the lower mandibular denture lifts dentures have to be
borders of the tongue teeth leading to cramping of the remade.
tongue ii)However, if the cause is a sharp cusp of a tooth,
round it off.

Pain at posterior aspect of Flange at the buccal aspect of the Use disclosing agents to locate the area of excess,
upper denture on opening tuberosity too thick relieve and repolish.

Table 3: Complaints presented by the patient after about a week of denture insertion
Problem Cause Treatment
i)If excess is less than 1.5 mm -grind ii) If the
Pain about periphery of dentures Excessive vertical excess is more than 1.5 mm. remake dentures
dimension of occlusion at a new VDO

Appearance-Complaints may arise from i)Patient failed to i)Accurate assessment of patient’s aesthetic
patient or relatives. Common complaints comment at trial stage, or requirements.ii)Ample time for patient
include: shade of teeth too light or dark; has subsequently been comments at trial stage.iii) Use any available
mould too big/small; arrangement too swayed by family or evidence to assist - photographs, previous
even or irregular or lacking diastema. friends. dentures
ii)Perhaps the change
from the old denture to
the replacement denture

Table 4: Complaints reported by the patient after 3 weeks of denture insertion

Problem Cause Treatment
Cannot open Can remove up to 1.5 mm from occlusal plane by
mouth wide Excessive VDO grinding, but if more is required, remake dentures
enough for food’.

Dentures move over supporting tissues Construct dentures to maximise retention and
Eating minimize displacing forces.
difficulties.

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Gupta R et al. Post denture instructions.

 Broad posterior occlusal surfaces Where non-anatomical teeth used, careful

which replaced narrow teeth on explanation of rationale is required, may be possible
‘Blunt teeth’ previous denture. to reshape teeth, Routine use of narrow tooth
 Non- anatomical type teeth used moulds recommended.
where cusped teeth previously used.

i)Check for vertical dimension accuracy, and that

Speech vertical incisor overlap not excessive.ii) Palatal
problems- Cause may not be obvious. May be contour should not allow excessive tongue contact or
May affect sibilant unfamiliarity - check that problem not air leakage iii) patient’s speech is assessed at trial
(eg s), bilabial (eg present with old dentures. insertion visit,recommended
p,b), labiodental
(eg f.v)

i)Check for proper extension and seal at the posterior

This complaint could be the result of food palatal seal area ii)Addition at the area with self -cure
Gagging getting under the maxillary denture base acrylic resin could be done to achieve a better seal.
and causing the denture base to dislodge
and irritate the dorsal surface of the tongue,
leading to gagging.

COMMON COMPLAINTS14 8. Fractured tooth from denture

The most frequent complaints of patients wearing
complete dentures are:- 1. Mucosal irritation
1. Mucosal irritation The mucosa should be free from irritation, otherwise
2. Loosening of Denture the functions will be impaired. Mucosal irritation
3. Food accumulation under the dentures occur due to- i) Compression beyond physiological
4. Difficulty in speech limits ii) Movement of denture during function- Often
5. Difficulty in mastication seen at the freni, muscular attachment regions, the
6. Unattractive appearance hamular notch area, mandibular retromylohyoid area
7. Fractured denture and buccal area. iii) Faulty jaw
relations -decreased or increased vertical dimension, intermittently, 10 times a stretch. Then hold it there
instability caused by incorrect centric relation, for two minutes. Repeat this 10 times in a session for
premature contact in centric occlusion iv) Faulty four sessions a day. ii) Bohnenkamp and Garcia
arrangement of teeth, v) Overextended borders suggested a phonetic training technique to use the
Management i) Use of a disclosing medium on the tongue and buccinator muscles to retain and stabilize
intaglio surface of the denture determines the area and the mandibular denture by pronouncing the long “e”
extent of correction. ii) An inside-out approach is sound. iii)Retention of prostheses can be improved by
recommended iii)Occlusal correction and proper jaw use of denture adhesives, relining and rebasing.iv)
relation. iv) Denture stomatitis being multifactorial, it Use of endosseous dental implants.v) Patient should
may be associated with both local and systemic rinse out the ropy saliva about every two to three
factors. Its management includes antifungal therapy, hours with a mouthwash.
correction of ill-fitting dentures, and efficient plaque
control. 3. Food accumulation under the dentures
The less adapted the patient is in stabilizing the
2. Loosening of Denture prosthesis during function, greater the denture
If the patient complains of looseness always, there movement and greater the quantity of food particles
may be an obvious retention fault, whereas if the that would collect beneath the dentures. Food
patient complains of looseness but the dentures resist accumulation under the mandibular dentures could be
a direct pull, lack of stability may be suspected, this minimized by- i)Correct position of the tongue by the
could be caused by-i)Faulty occlusal contacts patient,
ii)Insufficient motivation iii)Faulty tongue position Wright and co-authors suggested that the ideal resting
iv)Thick and ropy saliva interferes with the overall position of the tongue ii)Unilateral chewing causes
adaptation of denture. Management:- i)Levin greater denture movement, so bilateral chewing is
advocated placement of a groove in the anterior recommended.
lingual flange of the mandibular denture to train the
patient and instruct the patient to touch the groove
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Gupta R et al. Post denture instructions.

4. Difficulty in speech occurred.Fracture may be of two kinds :-i)

Although the majority of patients adapt to new Accidental,ii)Stress induced. Causes:-i)Porosity in
dentures within weeks, some patients report denture base. ii)Lack of adhesion of artificial teeth to
difficulties during speech because of- i)Length, form denture base. iii)Presence of tori and undercuts.
and thickness of denture base ii)Improper position of iv)Large frenum requires large notches,to
the maxillary anterior teeth.iii)Improper tongue accommodate such frenum large notches are
position. Management-i) Phonetics may be evaluated considered a “cleavage point”. Therefore, are
by palatography ii)Kong and Hansen demonstrated responsible for fracture of dentures. v)Buccally placed
the need to personalize the palatal contour of a teeth vi)Resorption pattern vii)Failure to relieve
maxillary denture in relation to tongue as this palatine raphe viii)Single complete dentures are more
procedure can reduce the period for adaptation to the susceptible for fractures.
prosthesis. iii)Adaki et al showed that there was Management:-
relative improvement of speech with rugae i)Reducing the need for a deep frenal notch by a
incorporated dentures. Among these, customized frenectomy.
rugae dentures showed better results than arbitrary ii)Incorporation of a metal mesh and higher strength
rugae dentures. iv) Repositioning the of anterior teeth. polymers, will reduce the tendency to fracture.
iii)Constructing dentures with metal palates for
5. Difficulty in Mastication patients with heavy occlusions has the dual advantage
A period of 6-8 weeks is necessary to establish new of providing greater strength and better thermal
memory patterns for the masticatory muscles. Koshino stimulation of the underlying mucosa.
et al., concluded that the basal area of the denture iv)Relieving palatine raphe, tori and undercuts.
foundation greatly influenced the masticatory
efficiency and was limited by their own residual 8. Fractured tooth from denture19
ridges Causes:-
Instructions to patient:-i)Patients should be advised i)Wax remaining between the surface of the artificial
to chew simultaneously on both sides to aid in the tooth and the denture base acrylic resin forming an
stability of the dentures.ii)Have light, non-sticky insulating layer during acrylic resin pressing.
foods and gradually shift to more resistive food ii)Insufficient pressure during packing.
substances.iii)Chew with their posterior teeth, iii) Excessive trimming of the teeth while arrangement
especially those who had to chew with a few anterior to accommodate heavy ridges.
natural teeth before going for the complete denture. Management:-Removal of wax between artificial
iv) Patients should be informed about the limitation of tooth and denture base and Sufficient application of
the recovery of masticatory ability before the pressure and avoid excessive trimming.
beginning of denture treatment.
UNCOMMON COMPLAINTS
6. Unattractive appearance15 Patients register an amazing variety of complaints
Patients generally want teeth which are lighter in against complete dentures, but some of the complaints
shade and smaller in size and should be educated are not as common as others. These include whistling,
regarding good dental aesthetics. swallowing difficulty, loss of taste sensation, altered
Complaints: -i)Dissatisfied with the degree of taste, dislodgment of dentures on having fluids,
visibility of teeth ii)Drooping of the lips iii)Presence drooling at the corners of the mouth, cheek biting,
of folds and creases near the lips and mouth. iv) dryness of mouth (xerostomia), nausea and gagging
Excessive lip fullness. and tingling of the lower lip.9-11
Management- i) Increased visibility can be achieved
by incorporating large overbite but this may present a 1. Whistling17
problem in the stability of the dentures.ii)Increasing When the patient wears the denture for the first time,
the occlusal vertical dimension to get rid of drooping the patient may complain of whistling while talking
of lips and facial wrinkle. iii)Careful contouring of the which could be because of:-
labial flange and the inclination of the maxillary i)Increased palatal vault depth
central incisors will preserve the contour of the ii)Compressed arch form.
philtrum and the tubercle of the upper lip by providing iii)Failure to duplicate the rugae could also lead to this
adequate support. iv)For lip fullness- the width of the problem.
peripheral roll and the labial flange can be modestly iv)Lowering the palatal contour and duplicating rugae
reduced from the facial aspect without compromising should help the condition.
retention or esthetics.
2. Swallowing difficulty18
16
7. Fractured denture Pain during swallowing is often caused by :-
The cause of fracture should be determined first when i)Overextended peripheral extensions-such as an
a patient arrives with a complaint of fractured denture overextended posterior palatal seal area or
to know the condition under which fracture overextended retromylohyoid flange. ii)Compression

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Gupta R et al. Post denture instructions.

on the superior constrictor. iii)Increased vertical ii) Use of artificial saliva and frequent mouth rinses
dimension. iv)Reducing the overextension or the particularly during meals.
vertical dimension should solve the problem. iii)Palatal reservoir filled with artificial saliva will
enhance the quality of life of xerostomic denture
3. Loss of taste sensation wearing adults.
This is a common complaint with elderly edentulous iv)Sialagogues, can be prescribed to the patient if
patients probably because their taste buds begin to some glandular function still is present.
atrophy at about the same time that dentures are first
worn. 9.Nausea and gagging
The patient should be told that most of the taste buds Cause:-
are on the tongue and are not covered by the dentures i)Patients with an exaggerated gag reflex.
and placement of a denture base that decreases the ii)Overextended posterior extent of the maxillary
stimulation and temperature sensations to the palate denture and the distolingual part of the mandibular
may partially account for a loss of taste. denture.
iii)Unstable and poorly retained dentures.
4. Altered taste iv Unstable occlusal contacts or increased vertical
Common etiology of altered taste is poor oral hygiene. dimension of occlusion because the unbalanced or
Patients should clean the dentures daily by soaking frequent occlusal contacts may prevent adaptation and
and brushing with a nonabrasive denture cleanser. trigger gagging reflexes
One should follow the guidelines on the daily and Management:-
long term care and maintenance of complete denture i)In case of overextended borders, denture should be
prostheses. Tongue brushing is important for reduced posteriorlyto the posterior palatal seal area.
increasing taste acuity in geriatric patients. ii)Stable occlusal contacts.
iii)Decrease vertical dimension.
5. Dislodgement of dentures on having fluids18
This problem may occur when the dentures are first 10.Tingling sensation
worn by the patient. Patient should be informed that it Cause:-
is possible to experience loosening of dentures while i)In mandible- It may be seen in ACP (American
taking fluids. Patient may get used to it when the lips, College of Prosthodontists) Class IV patients when
cheeks and tongue learn to manipulate the dentures. excess resorption has led to mental foramen to be
located near the crest of the mandibular residual ridge,
6.Drooling at the corners of the mouth 18 then tingling and mild paraesthesia of the lower lip
Cause:- may occur.
i)Decrease vertical dimension. ii)In maxilla- pressure on the incisive papilla due to
ii)Decrease thickness of flange. compression on the nasopalatine nerve, patient may
Management:-Correct the vertical dimension. and complain of burning or numbness in the anterior part
Increase the thickness of the flange in the modiolus of the maxillae.
area. Management:-Providing relieve in mandibular and
maxillary denture base in these regions.
7.Cheek biting 18
Cause:- PREVALENCE OF POST INSERTION
i)Lack of horizontal overlap in the posterior teeth. COMPLAINTS IN REMOVABLE PARTIAL
ii)Decrease in vertical dimension. DENTURE PATIENTS
Management:-Reducing the buccal surface of the
offending mandibular tooth to create additional
horizontal overlap, thus providing an escape for the
buccal mucosa and increasing the vertical dimension.

8.Dryness of Mouth (Xerostomia)

i)Many elderly patients take multiple medications and
many of these drugs can cause xerostomia which
negatively affects the patient’s ability to tolerate
complete dentures and have difficulty masticating and
swallowing, particularly dry foods.
ii)Lack of lubrication at the denture-mucosa interface
can produce denture sores.
Instructions:-
i)Patient should be advised to drink plenty of water (a
minimum of eight glasses) and fluid daily.

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POST INSERTION COMPLAINTS IN REFERENCES

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International Journal of Research in Health and Allied Sciences |Vol. 6|Issue 6|November – December 2020