BRUNELLO AND MANDIKOS THE JOURNAL OF PROSTHETIC DENTISTRY

Construction faults, age, gender, and relative medical health: Factors

associated with complaints in complete denture patients
Demetrio L. Brunello, BDSc,a and Michael N. Mandikos, BDScb
Dental Clinic, Repatriation General Hospital Greenslopes, Brisbane,
Queensland, Australia

Statement of problem. Many practitioners will experience a situation, whereby a patient with newly
fabricated complete dentures continues to experience difficulty in adapting to them. This can lead to a
protracted period of discouraging “adjustment appointments” that may not result in the eventual resolu-
tion of the problem. Therefore it is often concluded that there is some patient factor, either age, gender,
medical, or psychologic status that is hindering the success of treatment.
Purpose. This study examined a group of 100 patients who experienced ongoing difficulties with their
new complete dentures, to determine possible underlying causes.
Material and methods. A retrospective study was conducted with information derived from patient
records. All patients were treated by the same prosthodontist after having been referred specifically for
their denture problems. Information regarding patient age, gender, medical and psychological histories,
and information pertaining to the dentures at the time of presentation was derived from patient records.
Results. Statistical analysis comparing age, gender, and medical and psychologic status with the number
or type of patient complaint failed to show any significant relationships. Significant relationships were
observed when denture design faults or the condition of a patient’s mucosa were compared with patient
complaints.
Conclusions. This study suggests that in most instances, complete denture patients present with com-
plaints only when there is a real design fault or a tissue problem. (J Prosthet Dent 1998;79:545-54.)

CLINICAL IMPLICATIONS
Although many complete denture patients are elderly and may suffer from a variety of
medical or mentally compromising conditions, these factors together with patient gen-
der are not frequently related to ongoing denture difficulties. The clinician is advised
to carefully determine the adequacy of the patient’s dentures before suspecting another
patient-related cause.

A major challenge in dental practice continues to

be the successful management of the complete denture
patient who experiences ongoing difficulty with his or
her dentures. Often there is not total agreement between
the patient and the dentist as to the adequacy of their
dentures.1-5 This differing perception of patient needs
makes management more difficult. The fact that a den-
ture of poor quality may be well tolerated in one person,
while a well-made one may be a failure in another has
been a frequent source of confusion and frustration.4,6,7 It
is our opinion that this has led many dentists away from
taking proper care in the construction and provision of
good quality dentures in the belief that the patient will
adapt to almost anything, irrespective of the quality.
Several authors cite the most frequent complaints with
complete dentures are those pertaining to retention and
a
Visiting Prosthodontist, Dental Clinic.
b
Postgraduate Student, Advanced Education Program in Prosthodon-
tics, State University of New York at Buffalo, Buffalo, N.Y.
stability, esthetics, comfort while eating, and the accu-
mulation of food under the appliance.5,11,14-16. The factor
that most often appears to have an impact on either the
success or failure of complete dentures is esthetics.14 A
patient may find it difficult to volunteer the fact that it is
the appearance of their dentures that prevents them from
wearing them. The way in which the patient believes he
or she should look is not always in accordance with the
clinician’s perception of a pleasing appearance.1,4,14,16,17
Some patients find it difficult to adequately manage
removable prostheses of any kind, especially complete
dentures.6,8-10 Moreover, systemic medical conditions and
local physical factors may make successful wearing of a
removable prosthesis difficult. Medication required for
systemic or local disease can adversely affect oral tissues
and the quantity and quality of saliva produced.9,11-13
The psychologic status of a patient also appears to
have great bearing on his or her ability to manage re-
movable prostheses.8,10 It has been reported that with
advancing age, both men and women experience diffi-

MAY 1998 THE JOURNAL OF PROSTHETIC DENTISTRY 545

THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 1. Patient age distribution.
culty in learning to adapt to and manage removable pros-
theses.6,9,11 Attention has been focused on women who
are experiencing menopausal changes. It is believed that
they are prone to experience more difficulty because of
the physical and emotional changes they undergo dur-
ing and after this time.2,7,9,18
Attention has also been focused on patient’s expecta-
tions of their dentures. Patients may have unrealistically
high expectations of their dentures, often believing that
the dentures will be comparable to their natural
teeth.3,4,7,14,19-21 It has been stated that these high expec-
tations of dentures are more prevalent in older age
groups.20 Fiske et al.21 stated that there is also a social
dimension to ongoing denture complaint in the elderly,
as visits to the dentist for adjustments provide these eld-
erly patients with something to do.
When assessing a patient who is experiencing diffi-
culty with his or her dentures, the clinician must criti-
cally assess the factors that influence denture acceptance.
These factors may provide an explanation as to why there
is often a difference between the perceptions of the den-
tist and the patient of where the difficulty lies.
The purpose of this study was to examine 100 com-
plete denture patients experiencing difficulties with their
prosthesis and determine: (a) the most frequent com-
plaints; (b) the age and gender distribution of these pa-
tients and how they may relate to complaints; (c) the
number of patients afflicted with chronic and debilitat-
ing medical conditions and how this relates to com-
plaints; and (d) the most frequently identified denture
faults and how these may relate to patient complaints.
The null hypotheses for this study were that there is no
relationship between patients’ age or gender and den-
ture complaints; no relationship between medical con-
ditions and denture complaints; and no relationship be-
tween denture faults and patient complaints.
METHODS
The charts of 100 patients were selected from a group
of more than 500 patients who had been referred to
546
BRUNELLO AND MANDIKOS
Fig. 2. Gender distribution of patients.
the Repatriation General Hospital Greenslopes,
Brisbane, because these patients were experiencing dif-
ficulty with their complete dentures. Each patient had
been referred to the hospital dental clinic for specialist
assessment and treatment of his or her complete den-
tures. The 100 charts selected were those of the first
and last five complete denture patients seen each year
for a period spanning 11 years and thus provided a ret-
rospective record of events.
There were 63 men and 37 women in the sample.
Their ages ranged from 43 to 90 years with a mean of
68.7 years. The patients were grouped into seven age
divisions: less than 60 years, 60 to 64 years, 65 to 69
years, 70 to 74 years, 75 to 79 years, 80 to 89 years, and
over 90 years (Figs. 1 and 2).
The patients were selected from a population that
comprised eligible male and female service veterans, their
spouses, and siblings. The same visiting prosthodontist
examined and treated each of the study patients for the
length of their treatment period. Notes on assessment
and subsequent treatment were recorded methodically
and systematically in their hospital files. Information
regarding the patients’ general medical condition, psy-
chologic health, or other ailments were also derived from
the records in the patient’s hospital files.
For purpose of comparison, patients whose medical
records revealed that they experienced a chronic or de-
bilitating condition were classified as having chronic ill-
ness. These conditions included respiratory disease, ad-
vanced coronary conditions, renal failure, endocrine dis-
orders, partial or hemiparalysis, or diagnosed emotional
or psychologic disorders (anxiety or depression).
In a similar manner, patients whose records showed
evidence that they experienced an illness or disease state
of which a symptom is chronic pain resulting in pro-
longed or constant periods of discomfort were classified
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BRUNELLO AND MANDIKOS THE JOURNAL OF PROSTHETIC DENTISTRY

Table I. Contingency table of patient’s age and type and num- Table II. Summary table of results of the chi-square testing of
ber of complaints gender and age against patient complaints
Type of complaint Complaints Gender Age
Age Eating Food Loose Pain Speech Total
Eating X X
<60 0 0 2 3 0 5 Food X X
60-64 16 7 14 16 4 57 Loose X X
65-69 27 6 24 24 6 87 Pain X X
70-74 9 2 9 10 2 32 Speech X X
75-79 4 0 4 9 2 19
80-90 5 2 5 4 1 17 ✓ = Significant relationship (p < 0.05).
X = Not significant.
>90 1 0 1 1 1 4
Total 62 17 59 67 16 221

palatal seal (either incorrect position anterior-posteri-

under the grouping of chronic pain. Most of these pa-
tients had degenerative or inflammatory bone and joint
disorders. There was crossover between these groups
such that many were classified under chronic illness and
chronic pain.
At the time of examination, the patients’ comments
regarding the adequacy of their dentures were recorded.
Five divisions were used to group the various complaints
the patients presented with. Those patients who stated
that they experienced pain and discomfort on inserting
or removing the dentures or pain while at rest or in func-
tion were grouped under “Pain.” Those patients who
experienced difficulties incising and masticating their
food or instability when in such function were grouped
under “Eating.” Complaints of loose dentures or drop-
ping dentures or complaints attributable to insufficient
retention were grouped under “Looseness.” Finally, pa-
tients whose complaints related to food accumulation
around or under the appliance and those whose com-
plaints related to lisping, whistling, or distorted pho-
netics were grouped under “Food” and “Speech,” re-
spectively. Patients with multiple complaints were listed
under more than one grouping.
The condition of the patient’s denture bearing tissues
was assessed at the initial appointment. The examina-
tion screened for ulceration, presence of infection, or
any other abnormalities such as hyperplasia or neoplasm.
Accordingly, patients were grouped as ulceration or in-
fection “Present” or “Not Present.”
Finally, an examination of the dentures was conducted
to determine the adequacy of the denture base and oc-
clusal scheme design according to the principles of base
design and complete denture occlusion established by
Rahn and Heartwell.22 The most frequently observed
inadequacies of the presenting dentures were then
grouped under “Retention,” “Jaw Relationships,” and
“Tooth Position.”
Retention incorporated perceived errors in base de-
sign (underextension or overextension of denture bases
in the maxilla and/or mandible), poor tissue contact
(observed in mandibular bases only or both mandibular
and maxillary bases), and inadequacies in the posterior
orly or inadequately formed).
The heading “Jaw Relationships” grouped together
errors in anteroposterior relationships (anterior prema-
ture tooth contact and posterior premature tooth con-
tact) and errors in occlusal vertical dimension (excessive
or inadequate). Tooth position involved errors in ar-
rangement and setting of either the anterior or poste-
rior teeth. These were errors in the buccolingual and
anteroposterior positioning of the teeth, and vertical
errors in tooth position involving the occlusal plane
height.
The information collected from patient files was sum-
marized by recording with a “tick the box” method onto
a standardized data sheet. The information was then
converted to numerical codes, and descriptive statistics
were obtained by processing this information on a
Packard Bell 386SX IIe computer (Packard Bell Elec-
tronics Inc., Chatsworth, Calif.) with the Statistical Pack-
age for the Social Sciences (SPSS, Chicago, Ill.). The
statistical tests used to investigate differences between
groups were the chi-square test, t test, Fisher’s exact
test, and the test for linear correlation. These tests were
performed by a statistician at the University of
Queensland. The level of statistical significance chosen
was α = 0.05.
RESULTS
Common complaints
All patients seen at the dental clinic had at least one
complaint; many patients had multiple complaints. It
was observed that 75% of patients complained of prob-
lems relating to pain and discomfort; 61% stated that
they had difficulty eating their food; 59% stated that their
dentures were loose; and only 17% complained of food
accumulating around or under their appliances. A total
of 16% of the patients in the sample said they had diffi-
culties with their speech while wearing their dentures
(Table I). A chi-square test was applied to determine
whether there was a relationship between the patient’s
gender and any particular complaint (Table II). No de-
pendence was observed between patient’s gender and
the type of complaint (χ2 = 1.7, df = 4, p = 0.791). The

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THE JOURNAL OF PROSTHETIC DENTISTRY BRUNELLO AND MANDIKOS

Table III. Summary table of results of the chi-square testing of Table V. Frequency and type of errors occurring in denture
the presence of chronic pain or chronic illness against patient construction
complaints
Type of fault Frequency Total
Complaint Chronic illness Chronic pain
Poor retention 88%
Eating X X (a) Base design
Food X X — Overextension of denture bases 2
Loose X X — Underextension of denture bases 86 88%
Pain X X (b) Poor tissue contact made
Speech X X — Lower denture base only 50
— Upper denture base only 0
✓ = Significant relationship (p < 0.05).
— Both upper and lower denture bases 36 86%
X = Not significant.
(c) Inadequate post dam 34%
Incorrect jaw relationships 94%
(a) Anteroposterior relationships
Table IV. Summary table of results of the chi-square testing of
the presence of ulceration and infection in the mucosal tis- — Posterior premature tooth contact 63
sues against patient complaints — Anterior premature tooth contact 9 72%
(b) Incorrect occlusal vertical dimension
Complaint Ulceration or infection Ulceration only — Too small 38
— Too large 30 68%
Eating X X
Error in tooth position 63%
Food X X
Loose X X
Pain ✓ ✓
Speech X X
fering with chronic illness and the type of complaint they
✓ = Significant relationship (p < 0.05). presented with (Table III). No significant relationship
X = Not significant.
was observed (χ2 = 0.859, df = 4, p = 0.930). The aver-
age number of complaints per patient was 2.17 for those
average number of complaints per male and female pa- suffering a chronic illness, and 2.22 for those not suffer-
tient were then measured with a t test. They were found ing chronic illness. These were not statistically different
to be not statistically different (t = 1.15, df = 98, when tested with the t test (t = 0.239, df = 98, p = 0.914).
p = 0.244). The average number of complaints from patients suffer-
The possibility of the presence of a relationship be- ing with chronic pain was 2.25, and 2.20 for those with-
tween patient’s age and the type of complaint was tested out chronic pain. No significant relationship was ob-
by a chi-square test (Table II). No dependence was found served when the t test was applied (t = 0.193, df = 98,
to exist (χ2 = 13.412, df = 24, p = 0.959). However, p = 0.971). Finally, a chi-square test was carried out that
many of the cells in the contingency table (Table II) failed to demonstrate a significant relationship between
contained counts of less than 5, which can invalidate the patients suffering from chronic pain and the type of com-
test. A test of linear correlation was then applied to de- plaint (χ2 = 0.983, df = 4, p = 0.912).
termine the existence of a relationship between patient’s
Condition of the denture bearing tissues
age and the number of complaints. No linear relation-
ship was observed. Examination of the oral lining mucosa of the denture
bearing tissues revealed that 31 patients in the sample
Chronic illness and chronic pain
exhibited ulcerative lesions in the mandible and 16 pa-
Twenty-eight patients in the sample suffered from a tients showed evidence of lesions in the maxilla. A gen-
condition that was categorized as a chronic illness, and eralized inflammatory appearance indicative of fungal
many experienced more than one disease state or sys- infection was seen in the maxillary edentulous arches of
temic disorder. This group also included patients with five patients. Evidence of infection was not observed in
diagnosed emotional or psychologic disorders. A ma- the mandibular arches of any patients and no other le-
jority of these patients (40%) had advanced cardiac sions were diagnosed.
or circulatory disorders. Twenty-four sample patients To determine whether there was a relationship be-
suffered from conditions relating to chronic or prolonged tween mucosal lesions and the type of denture complaint,
episodes of pain, and these conditions related mainly to a chi-square test was performed for each of the five com-
degenerative bone and joint disorders. Most patients plaint groupings against the presence of ulceration or
suffering with a chronic illness also had chronic pain infection in either of the mandible or maxilla (Table IV).
and were placed in both groupings. A significant relationship (p < 0.0l) was found when
Chi-square testing was conducted to determine comparing the patient complaint of pain with presence
whether there was a relationship between patients suf- of ulceration or infection in either dental arch

548 VOLUME 79 NUMBER 5

BRUNELLO AND MANDIKOS
Fig. 3. Impression of mandibular denture bearing area was
used to fabricate study cast and periphery of planned new
denture was marked.
Fig. 4. Existing denture reseated on cast illustrates
underextension of borders.
(χ2 = 7.244, df = 1, p = 0.007). This result was con-
firmed by performing a Fisher’s exact test (two-tailed),
which also revealed a significant relationship (p = 0.009).
The complaint of pain was then tested only against ul-
ceration of either dental arch only using both chi-square
(χ2 = 6.787, df = 1, p = 0.009) and two-tailed Fisher’s
exact tests (p = 0.007). A significant relationship was
thus observed at the p < 0.01 level.
The remaining four complaint groupings were tested
against the presence of ulceration or infection in either
arch with chi-square tests (Table IV). No significant re-
lationships were observed. (Ulceration or infection vs:
[a] Eating [χ2 = 2.554, df = 1, p = 0.110]; [b] Food
[χ2 = 3.964, df = 1, p = 0.06]; [c] Loose [χ2 = 0.028, df
= 1, p = 0.868]; and [d] Speech [χ2 = 0.608, df = 1,
p = 0.436]).
Denture faults
All of the dentures assessed were determined to have
some faults or errors (Table V). On initial examination,
88 patients had dentures that exhibited poor retention.
MAY 1998
THE JOURNAL OF PROSTHETIC DENTISTRY
Fig. 5. Gross underextension in primary denture supporting
area of retromolar pad demonstrated.
Fig. 6. Pressure disclosing cream applied to tissue surface of
denture base shows areas of high pressure over retromolar pad.
Of these patients, two had dentures whose bases were
overextended; the remaining 86 had underextended
denture bases (Figs. 3 through 5). Of these 88 patients,
86 showed poor tissue contact between denture base
and the load bearing areas (areas of high and low pres-
sure) (Figs. 6 and 7). Fifty patients showed this prob-
lem in the mandibular denture only, and 36 in both den-
ture bases. The posterior palatal seal was determined to
be inadequate in 34 of these patients.
Ninety-four patients had dentures that exhibited er-
rors in jaw relationships. Anteroposterior relationship
errors were slightly more prevalent with 72 patients who
have dentures with either posterior premature tooth
contacts (63) or anterior premature contacts (9) (Figs.
8 and 9). Incorrect occlusal vertical dimension was ob-
served in 68 of the 94 patients. It was observed that the
denture designs resulted in more patients being
overclosed with 38 patients who have too small a VDO,
whereas 30 patients had been provided with one too
large (Figs. 10 and 11).
Errors in horizontal and vertical positioning of either
549
THE JOURNAL OF PROSTHETIC DENTISTRY BRUNELLO AND MANDIKOS

Fig. 7. Intraoral examination reveals expected ulceration above Fig. 9. Harmonious tooth contact was established after den-
retromolar pad. tures were remade.

Table VI. Summary table of results of the chi-square testing of

the different denture faults against patient complaints
Complaint Retention Jaw relationships Tooth position

Eating X ✓ X
Food X X X
Loose ✓ X X
Pain X X X
Speech X X X
Age X X X
Gender X X X

✓ = Significant relationship (p < 0.05).

X = Not significant.

Fig. 8. Anterior premature tooth contact and posterior tooth

The patients in this study were drawn from a popula-
disclusion is seen when patient is guided back to centric rela-
tion position. tion of people who were Australian service veterans or
spouses. This sample may not be representative of the
edentulous population on a whole. One notable differ-
ence was the male to female ratio of 1.7:1, whereas other
anterior or posterior teeth were observed in the den-
studies have reported samples where the ratio was re-
tures of 63 patients (Fig. 12, A through C). A patient’s
versed with 1 male subject for every 1.6 to 4.0 female
dentures frequently displayed two or all three of these
subjects.2,8,10,16,18 Also, the mean patient age of this sample
errors and were counted as “yes” for each category.
was 68.7 years, which was higher than the mean ages
Contingency tables were prepared for chi-square test-
reported in other study samples (53 to 65 years)2,8,10,16,18
ing to determine the presence of a relationship between
possibly due to the fact that many patients in this study
each of the three faults observed, and each of the five
were World War II veterans. It is also possible that mili-
groupings of patient complaints. Only two significant
tary service-related conditions may be responsible for
relationships were observed (Table VI): (1) between
the medically compromised state of these patients more
faults relating to retention and the patient complaint of
than might be seen in the general population.
loose dentures (χ2 = 10.102, df = 1, p = 0.002), and (2)
Information was obtained retrospectively from patient
between faults relating to jaw relationships and the pa-
files in a manner similar to DePaola et al.12 The assess-
tient complaint of difficulty eating (χ2 = 10.072, df = 1,
ment of each patient by the same prosthodontist en-
p = 0.002). Both relationships were confirmed with a
sured standardization and consistency of observations,
Fisher’s exact test and determined to be significant
but may have introduced bias. However, in accordance
(p < 0.0l). Contingency tables were also prepared to test
with studies by Smith and Hughes,l5 Powter and Cleaton-
for relationships between observed denture faults and
Jones,8 and Cabot,23 observations by the prosthodontist
age, and faults and gender; however, no significant rela-
were accepted as the “Gold Standard” for assessment of
tionships were observed (Table VI).
denture faults. The prosthodontist’s involvement in col-
DISCUSSION
550 VOLUME 79 NUMBER 5
BRUNELLO AND MANDIKOS
A B
Fig. 10. A, Frontal and B, profile views of patient demonstrating overclosure and collapse of
nasolabial features due to VDO that is reduced.
lection and interpretation of notations in the patient files
ensured accuracy of data transcription.
The most common complaints of the complete den-
ture patients in this sample were Pain and Generalized
Discomfort (75%), Difficulty in Eating (61%), and
Looseness of the dentures (59%). This result supports
the findings of Kotin,16 (Pain 45%, Eating 40%, Loose-
ness 80%) and Smith and Hughes,15 (77% Pain, 55%
Looseness, 15% Eating). Interestingly, there were no
complaints from the patients in this sample regarding
the appearance of the dentures, which is in strong con-
trast to most other reports.1,4,14 This may be attributed
to an observed “easy going” and appreciative attitude
of many elderly service veterans in Australia toward the
providers caring for them.
Statistical testing in this study failed to identify any
relationship between patient age or gender and the num-
ber or type of complaints regarding their complete den-
tures. This conflicts with the accepted views that older
patients are more likely to experience difficulties with
their dentures and complain more frequently.6,11 Muller
and Hasse-Sander24 reported that oral motor abilities
and the capability of adaptation to new dentures are not
MAY 1998
THE JOURNAL OF PROSTHETIC DENTISTRY
clearly age related and concluded that aging is a bio-
logic process and not simply chronologic, which leads
to considerable individual variation in oral motor and
adaptation abilities.
Edwards and Bouchier25 stated that the median age
for onset of menopause occurs at 50.8 years. However,
only one woman in this study was below this age (43
years), so it could be assumed that the remaining women
in the sample were menopausal or postmenopausal. The
failure to observe a significant relationship between gen-
der and number or type of complaints would tend to
challenge the reports of Powter and Cleaton-Jones,18
Winkler,7 and Heartwell.9 However, the results of our
study supports the findings of Langer et al.2 and Berg,10
who observed no significant patient age or gender rela-
tionships on denture acceptance.
The significant relationship between the condition of
the mucosa of the denture bearing areas and the com-
plaint of pain and discomfort was anticipated. It is as-
sumed that denture patients who were medically com-
prised or being treated with medications that produce
oral side effects with intraoral manifestations will expe-
rience more difficulties with their dentures. DePaola et
551
THE JOURNAL OF PROSTHETIC DENTISTRY BRUNELLO AND MANDIKOS

Fig. 11. Autopolymerizing acrylic resin has been added to mandibular posterior denture teeth
(A) to reestablish esthetic (B) and physiologically (C) acceptable VDO.

al.12 further reported that all common medical condi-
tions except rheumatic heart disease and congestive heart
failure produced complications in their study. The re-
sults of our study revealed no such relationships between
the patient’s medical condition and the type or number
of denture complaints. Similarly, no significant relation-
ship was observed between the number of patients ex-
periencing chronic pain and the type or number of com-
plaints.
Finally, the various faults in denture construction and
the frequency of their occurrence were addressed. Al-
though the literature contains references that describe
how to identify construction faults and procedures for
their rectification,26,27 there are few reports describing
the commonly observed construction faults seen in ex-
isting complete dentures.
All patients in this study were referred from general
practitioner dentists who were unable to identify prob-
lems with the existing dentures, or unable to rectify
them sufficiently to overcome the patient’s complaints.

552 VOLUME 79 NUMBER 5

BRUNELLO AND MANDIKOS
Fig. 12. Anterior teeth have been set too far out into labial sulcus (A) resulting in incompetence
of the resting lips (B), and excessively full lip appearance (C).
This study found 88% of patients had dentures with
poor retention. The denture bases were either
underextended or overextended (86% and 2%, respec-
tively), formed poor tissue contact (86%), or displayed
an inadequate posterior palatal seal. Incorrect vertical
or horizontal jaw relationships were observed in 94%
of patients and errors in tooth positions were observed
in 63% of denture patients. Not surprisingly, signifi-
cant relationships were observed between the presence
of denture construction faults relating to retention and
patient complaints of loose dentures, as well as con-
struction faults relating to jaw relationships and com-
plaints of difficulty eating. These results are in accor-
dance with those of Smith and Hughes,15 who observed
universally present errors in denture base extension,
and generally poor retention. Jeganathan and Payne5
reviewed the literature and noted that underextension
of denture bases and vertical and horizontal jaw rela-
tionships were the most frequently observed faults.
Cabot23 identified that senior dental undergraduate stu-
dents and general practitioners experienced difficulty
in recognizing errors in base extension and occlusal
vertical dimension when compared with a control group
MAY 1998
THE JOURNAL OF PROSTHETIC DENTISTRY
of prosthodontists. The results of this study would tend
to support these findings.
CONCLUSIONS
This study found that complete denture patients ex-
periencing difficulties with their dentures most frequently
complained of pain and discomfort, difficulty with eat-
ing, and looseness of their dentures. There were no sig-
nificant relationships between the patient’s age, gender,
or general medical condition and the type or number of
complaints. A significant relationship was observed be-
tween an unhealthy denture bearing mucosa and com-
plaints relating to pain.
The most frequently observed faults in denture con-
struction related to retention, and vertical and horizon-
tal jaw relationships. There were significant relationships
between inadequate retention and improper intermaxil-
lary relationships and patient complaints of looseness
and difficulty eating, respectively.
The results of this study suggest that the dissatisfied
complete denture patient in most instances experiences
difficulties with his or her dentures due to an identifi-
able cause. This study would suggest that the clinician
553
THE JOURNAL OF PROSTHETIC DENTISTRY
carefully evaluate the denture for faults in denture base
extension and horizontal and vertical jaw relationships
before concluding that the patient’s complaint is related
to age, gender, or general medical condition.
In this study, age and physical illness did not affect a
person’s ability to manage a well-made denture pros-
thesis. It has been our experience that advancing age
and the presence of a debilitating illness can become
too much for some people. Chronically ill and
homebound patients often become depressed and may
give up with their dentures. In these circumstances, it is
the patient’s mental and emotional status and not that
he or she is old that is the factor. The development of an
ability to recognize an emotionally compromised or
depressed patient and manage them with concern and
empathy are invaluable skills that need to be encour-
aged and developed in the practicing clinician.
We thank Dr. Alan Gross, Department of Restorative Dentistry,
State University of New York at Buffalo, School of Dental Medicine,
for his advice; Mrs. Del Greenway for the statistical analysis; and
Miss Tania Nixon for her assistance in typing and proofreading this
manuscript.
REFERENCES
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VOLUME 79 NUMBER 5