Denture problems and their solutions
Denture problems plague most if not all dentists from time to time. This is a list of common issues and fixes. To see the step by step denture fabrication you can go to our denture page or for more detail click here.
Maxilla denture problems
Sore spots – Mark obvious sore spots with Thimpson stick and allow to transfer. Add PIP paste to check as well.
Difficulty swallowing and gagging, discomfort in soft palate, and speech issues – Over-extension onto soft palate. Check border hard and soft palate with Thompson stick and valsalva maneuverur then place denture and do same.
Loose during talking and yawning – PIP paste and have yawn and do denture movements. Watch as may not always remove PIP. Hamular notch needs to be checked with Thompson stick
Denture split down the middle – the teeth are either set too far buccal making the palate a fulcrum or the denture needs a tissue reline because the palate has become a fulcrum. From personal experience as seen below some people are just super hard on their denture and their bite force continually breaks it. Make a metal palate for those patients.
Mandible denture problems
- check genioglossus extension with PIP paste and tongue to roof mouth and out and side to side
- anterior overextension – ask to lift lower lip to edge of teeth
Denture lift from posterior towards anterior – mylohyoid and retromylohyoid
- PIP distal flange and tongue out and side to side
- Adjust the horizontal, maybe vertical (Vertical causes swallowing and gagging issues – slow adjust until patient comfortable)
Denture vertical dimension occlusion
Excessive VDO – Show too much teeth, TMJ pain, muscle pain, hard to swallow or gag, dentures click, hypersalivation, and general feeling of too full. Need to remake or rebase with a CR bite so don’t repeat issues.
Insufficient VDO – Show too little tooth, TMJ pain, gagging, instabilioty when not biting, and difficult to swallow. Need to remake or rebase.
For an upper denture flow 2mm band acrylic from tuberosity to tuberosity along the back of the denture. Once shine is gone seat and let set in the mouth. Remove when set and trim anything sharp or over flowing the original denture base and polish lightly. For the lower loose denture flow some fresh mixed jet acrylic on the lingual inside from cuspid to cuspid. Once starts to set, place in mouth to finish setting.
Add green stick to areas might be under-extended and see if helps – if does add to denture. Common in distal lingual flange lower denture
Evaluation of this with hydrocast or lynal and wear the denture for 24 hours
Sounds with dentures
There will usually be some issues with speech for awhile. Some we can help with some the patient adapts and adjusts to. One interesting study on this is that “s” sounds were more likely in a all on 4 type restoration than a removable denture. Meira JPD 2022
Problems with “S” sound
- Lisping – too narrow air space on anterior palate – seen if patient has thick rugae or large anterior ridge – thin out acrylic
- Whistle “s” – too thin acrylic in rugae or teeth too far forward
- Clicking when saying – not enough space between teeth.
Problem with “Th” or “T”
- Indistinct – teeth too far forward
Problems with “V” or “F”
- Indistinct – teeth too far lingual
Denture occlusal problems
Trouble after use but not on insertion or removal – check occlusion
- Soreness anterior hard palate and ridge
- Unilateral pain on ridge premolar to tuberosity
- Delayed gagging
- Muscle fatigue
- Discomfort chewing
Fix by doing CR bite with gothic arch tracer and Futar-D centric bite registration
Increase buccal overlap. Also ensure distal of last upper molar is distal to distal of last lower molar, this will prevent tissue wrapping around and getting bit.
Issues with gagging while wearing denture
Although the answers are above, we broke this topic out. There are two types of gagging. Immediately and hours later.
If immediately gagging it’s a fit issue. Step one is put just do a wash impression reline and see if stops. If does then it’s a fit issue. If continues it’s over extension, so remove until they stop gagging.
If they gag hours later, then it’s occlusion. To fix this it could mean getting a new VDO, see above, or just refining the bite.
Some great denture lab techs.
For more information you can check out our denture page as well.
Many of these issues and lots of others can be found in this nice denture problem article. McCord-Grant 2000-Prosthetics-Denture Problems
Partial denture issues
Needing a posterior reline because of ridge resorption will cause the lingual plate to lift and parts of the lingual plate to pinch the tissue. Tim Lane DT 2021