Post insertion problems in complete denture: A review

Removable complete denture till date exists as one of the treatment modality of choice to the edentulous patients. Complaints that are associated after delivery of complete denture is more of actual type and very less frequent of psychological type. In most of the cases education to the patient prior to the start of the procedure will help the clinician as well as the patient to understand the limitations associated with the use of complete denture. The most important thing is to motivate the patient to overcome these limitations. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Introduction
Fabrication of complete denture is totally dependent over psychological and biological interplay between the patient and the dentist. Till date removable dentures plays an important role in the majority of the people of our country and thus one of the irreplaceable treatment option, because not every patient is financially sound that he or she will go for implants. The basic necessity of the patient for a complete denture is mastication, esthetics, phonetics and comfort while using the removable prosthesis. Although the complete dentures are very much compatible with the oral structures, but this requires a little bit time for tissue conditioning. Different authors classified the "post insertion denture problems". Once the problem associated with wearing of denture become evident, should be treated in a logical manner and should be treated satisfactory in a systematic way. Treatment should be started with adequate history taking along with careful examination of the oral cavity so that accurate diagnosis of the treatment should be made and based on the accurate diagnosis, the treatment plan should be made and should be follow appropriately. 5 The consistency of saliva is usually involved when, maxillary denture slowly looses its retention and if contraction occur at modiolous, dislodgement of denture occurs, if the flanges of the denture were not contoured properly.

Sore spots
One of the most common complaint, usually associated with use of new denture.

Feeling of space under maxillary denture
Might be due to shrinkage of the denture resin, due to processing error and if there is any history or anterior traumatic occlusion, which result in parasthesia of naso platine nerve.

Problems related to phonetics
When patient is having problem in speaking, may be a result from excessive vertical dimension of occlusion, too narrow air space on the anterior part of the palate, too broad air space on the anterior part of the palate, when upper anterior teeth placed too far lingually, when there is insufficient support to the lips provided, when there is improper vertical positioning of maxillary anterior teeth, when maxillary anteriors set too long or too far down, when maxillary anteriors set too short or too high up, when there is improper anteroposterior positioning of maxillary anterior teeth.

Treatment
Increase the passage of air (slowly) by removing some of the resin in increments behind the anterior teeth. If no improvement, try flowing some red carding wax in 1 mm increments, over the anterior and lateral palate to insure tongue contact.
If the air channel is blocked there may be a "shushing" or lisping sound. This is may be due to an excessive V.D.O.

Solution
Before considering a remake at a reduced V.D.O., increase the size of the channel by thinning the anterior portion of the palate.

Inability to eat food
Some of the edentulous patients come with a problem, that they are not been able to eat food with there complete denture. This could be due to poor muscular control, could be the one reason that patient wasn't able to chew/masticate the food. Other reason could be that the patient expectations were too high with the prosthesis delivered, that he/she want to eat every food that once they enjoyed when they have natural teeth.

Pain during swallowing
Mostly due to over extended disto lingual complete denture flange. This over extension produces slight to moderate sensation of pain during swallowing. It should be corrected by reducing the over extended denture flange with the use of disclosing agent and after than smoothened the denture flange.

Drooling of saliva at the corner of the mouth
1. Usually seen in patients with poor muscular control 2. When there is closed vertical dimension of occlusion 3. In cases of hypersalivation Treatment modality should be to treat the under line cause, if this occurs due to decreased vertical dimension of occlusion, new denture should be made with correct vertical dimension and an other attempt should be made to control the drooling of saliva at the corner of the mouth by making the denture flange a bit thicker at the modiolous area. 11

Cheek biting, lip biting or tongue biting
The most common cause of cheek biting is due to presence of inadequate overjet between the maxillary and mandibular anterior teeth. It can be corrected by increasing the over jet by reducing the buccal surface of lower posterior teeth.
Cheek biting is also due to loss of vertical dimension, because of this cheeks tend to occlude between the occlusal surface of the denture. 11 Tongue biting can be treated by reducing the palatal surface of maxillary posterior teeth, mostly the maxillary molars. Lip biting is mostly due to poor neuromuscular control in the old patients.

Halitosis
Usually associated with the bad oral hygiene when patient is not cleaning his/her denture for long period of time may lead to bad breadth or it may be due to medically compromised condition.

Xerostomia
Most of the elderly patients are on multiple medication for systemic diseases, and many of these drugs are capable of causing "xerostomia", which has adverse effects on the tolerability of complete denture. 12 These type of patients have problem/difficulty in masticating, swallowing of food. These patients are advised to drink water in between the meals, and should have plenty intake of water or water substitute. The use of artificial saliva or mouth rinses may be helpful to the patients suffering from condition of xerostomia. 13 One can also use a reservoir at palatal side which is filled with artificial saliva, surely overcome the quality of life of xerostomic patient. 14 Sialologues are the drug of choice in treating patient suffering from dry mouth condition, they stimulate the flow of saliva without affecting its ptyalin content. The main cause of dry mouth condition in old age patient are, some drugs such as antidepressants, geriatric degeneration, deficiency of vitamin A, chronic renal disease, and psychic tension. 15

Excessive salivation
In most of the cases, when patient start wearing denture for the very first time, reports problem of excessive salivation and this problem resolves with time as the oral structures become habitual to the denture. And secondly due to psychological tension.

Temporomandibular jaw problems
They occur mostly due to spasm of muscles of mastication, or injury to the muscles or to the surrounding structure. These types of problems usually seen in patients who were long term wearers of complete denture, that too with much amount of loss of vertical dimension of occlusion. If this problem not treated at time will lead to some other serious complications like referred pain to ear, tmj, muscles of mastication, clicking sound in tmj or crepitus, tinnitus in ear, pain during opening or closing of the jaw, midline deviation/ shift during opening.

Treatment
Primary goal of treatment is to treat the underlying cause of the problem. If related to vertical dimension, new set of complete denture with correct vertical dimension should be made again, patient should remain on soft diet for a specific time period, hot packs are advised over the area where the pain is persistent, and muscle relaxants should be advised to the patient.

Burning sensation
Most commonly due to ill fitted denture, poor denture occlusion, due to menopause in females. Treatment modality will stick to the underlying cause, patient is advised not to wear the denture for 2-5 days at least, do warm saline rinses two to three times a day, application of oral medication in case of candida infection or a new set of complete dentures are advised after the infection subsides.
And if the burning sensation is due to compression of nerve, oral surgical procedure is required.

Conclusion
A thorough knowledge of different factors required for the fabrication of complete denture is must before entering the post insertion checkup. A patient should always be recalled so that the remaining complaints can be eliminated.

Source of Funding
No financial support was received for the work within this manuscript.

Conflict of Interest
The authors declare they have no conflict of interest.