Common Problems in Complete Dentures: How to Identify and Fix Patient Complaints

Introduction

The successful delivery of a complete denture is a hallmark of clinical skill in prosthodontics. However, the post-insertion phase is often marked by patient complaints that require precise diagnosis and adjustment. A patient’s complaint of “the denture is loose” or “it hurts when I eat” can have multiple, distinct etiologies. Treating the symptom without identifying the root cause leads to repeated adjustments, patient frustration, and ultimately, prosthetic failure.

This article provides a systematic framework for diagnosing and resolving the most common problems encountered in denture wearers. By linking specific clinical signs to their underlying causes, clinicians can move from guesswork to targeted, effective interventions.

1. Complaints of Looseness and Dislodgement

A loose denture is one of the most frequent complaints. The timing and specific action that causes dislodgement are critical diagnostic clues.

• Loosening While Smiling: This is a classic sign of inadequate relief for the buccal frenum. The action of smiling lifts the frenum, which acts as a lever to unseat the denture if the border is not properly notched. The solution is careful identification and adjustment of the denture border in the frenum area to allow free movement without losing the peripheral seal.
• Loosening of Upper Denture While Opening the Mouth: This points directly to an issue in the distobuccal region. As the mouth opens, the coronoid process of the mandible moves forward. An excessive thickness of the distobuccal flange or a flange that extends too far laterally will interfere with this movement, displacing the denture. Correction involves reducing the flange in this specific area until the interference is eliminated.
• The Denture is Tight When Inserted But Becomes Loose During Function: This is almost pathognomonic for errors in occlusion. When the patient closes into a deflective occlusal contact, the denture base is shifted on its foundation, breaking the peripheral seal. This is not a border issue but an occlusal one, requiring a clinical remount and selective grinding to achieve harmonious, simultaneous contacts.

2. Complaints of Functional Difficulties: Swallowing, Chewing, and Speech

Problems that arise during essential functions often relate to denture extension or vertical dimension.

• Difficulty During Swallowing: This uncomfortable and alarming sensation is frequently caused by overextension of the lingual flange into the lateral throat form (the area of the retro-mylohyoid curtain). During swallowing, the tongue and pharyngeal muscles displace the overextended flange. A less common but serious cause is a significantly increased vertical dimension, which can prevent the lips from sealing comfortably and alter tongue position.
• Pain and Soreness During Chewing: Localized pain under the denture base during mastication is a key indicator of deflective occlusal contacts. These high spots cause the denture to pivot under load, creating focal areas of excessive pressure on the underlying mucosa. This requires occlusal adjustment.
• Clicking Noise During Teeth Contact: A clicking sound indicates that the teeth are contacting too abruptly. This is a direct result of an increased vertical dimension, which eliminates the minimal freeway space (interocclusal rest space). The mandible must force the teeth together from an unnaturally open position, creating the audible click.
• Cheek Biting: This occurs when there is insufficient horizontal overlap (overjet) of the posterior teeth. The buccal mucosa gets trapped between the maxillary and mandibular teeth during chewing. The solution is to increase the buccal overjet by rearranging or replacing the posterior teeth.

3. Complaints of Pain and Mucosal Pathology

Persistent pain and tissue changes signal chronic, unaddressed biomechanical issues.

• Mucosal Irritation and Soreness: Generalized or linear soreness along the denture border is a clear sign of overextension. The denture border is impinging on the movable mucosa beyond the denture-bearing area, which can be confirmed with a pressure-indicating paste like Pressure Indicator Paste (PIP).
• Soreness on the Slopes of the Ridge vs. Crest of the Ridge: The location of the soreness provides a vital diagnostic clue:
  • Slopes of the Ridge: Soreness here is typically caused by deflective occlusal contacts, which lead to a shifting or “rocking” of the denture base, putting lateral pressure on the ridge slopes.
  • Crest of the Ridge: Soreness directly on the crest is more commonly the result of an increased vertical dimension. This creates heavy, vertical, and concentrated forces that compress the crestal bone and mucosa.
• Burning Sensation in the Anterior Palate: A localized burning sensation in the area of the incisive papilla is due to inadequate relief for the nasopalatine nerve and vessels. Pressure on this area causes ischemia and neurovascular compression, leading to the characteristic burning pain. This is resolved by providing adequate relief in the denture base over the incisive papilla.
• Epulis Fissuratum: This is a reactive hyperplastic tissue response caused by chronic irritation from an ill-fitting or overextended denture flange. The flange creates a groove in the mucosa, and the tissue proliferates in response. Treatment involves surgical removal of the hyperplastic tissue followed by adjustment or relining of the denture to eliminate the source of irritation.

Conclusion: A Method for Diagnosis

When a denture patient presents with a complaint, a systematic approach is essential:

1. Correlate the Complaint with a Specific Function: Ask, “What were you doing when this happened?”
2. Inspect the Tissues: The location of inflammation or pathology directly points to the cause.
3. Evaluate the Borders: Use pressure-indicating paste to check for over- or under-extension.
4. Evaluate the Occlusion: Use articulating paper and a clinical remount to check for deflective contacts and correct vertical dimension.

By applying this knowledge, clinicians can transform post-insertion appointments from frustrating troubleshooting sessions into efficient, evidence-based procedures that ensure patient comfort, function, and long-term satisfaction with their prosthetic restoration.

References:

1. Zarb, G. A., Bolender, C. L., & Carlsson, G. E. (2013). Boucher’s Prosthodontic Treatment for Edentulous Patients (13th ed.). Elsevier Mosby.
2. Sharry, J. J. (1974). Complete Denture Prosthodontics (3rd ed.). McGraw-Hill.
3. Heartwell, C. M., & Rahn, A. O. (1992). Syllabus of Complete Dentures (5th ed.). Lea & Febiger.
4. The Glossary of Prosthodontic Terms (9th Edition). (2017). The Journal of Prosthetic Dentistry.