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Frequency of short term post-insertion complaints in conventional complete

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 Original Article

FREQUENCY OF SHORT TERM POST-INSERTION COMPLAINTS IN

CONVENTIONAL COMPLETE DENTURE WEARERS TREATED BY
UNDERGRADUATE STUDENTS
IRUM SIKANDER
1

2
MUHAMMAD AAMIR GHAFOOR CHAUDHARY
3
SALMAN AHMAD
4
MUHAMMAD FAROOQ KAMRAN
5
SARA AMIR KHAN
ABSTRACT
The objective of this study was to determine the frequency of various post-insertion complaints in
patients wearing complete dentures that had been fabricated by undergraduate students of the institute.
One hundred patients (66 males and 33 females) were included in the study who had been wearing
their prostheses for more than 6 months. Details of age, gender, medical history and denture history
were obtained. Post-insertion complaints, as reported by the patients, were recorded on a proforma. The
collected data was statistically analyzed using SPSS version 23. It was found that 60% of the subjects
had complaint of their dentures being loose; 20% denture ulceration, 10% had pain and generalized
discomfort, 25% reported that they had low masticatory efficacy, 8% of the patients had problems in
speech while only 3% patients had fracture of denture bases. It was concluded that on the basis of
frequency of occurrence, loss of retention, low masticatory efficiency and mucosal ulceration were the
main complaints of the complete denture patients being treated by the undergraduate students.
Key Words: Complete dentures, complaints, undergraduate students.

INTRODCUTION with anatomic and physiologic characteristics of the

Insertion of complete dentures should not be con-
sidered as the final step in the treatment of edentulous
patients because patients will continue to visit their
dentists long after this initial placement/treatment.1,2
Patients’ acceptance and satisfaction with their replace-
ment prosthesis is governed by different factors such
as number of corrections after insertion, psychological
characteristics of patients, self-evaluation of affective
state or quality of life, demographic and socioeconom-
ic factors, patient expectation of dentures, quality of
denture construction and factors that are connected
1
Irum Sikander, BDS, M. Phil Resident, Department of Dental
Materials, Islamic International Dental College, Riphah Interna-
tional University, Islamabad, Pakistan
2
Muhammad Aamir Ghafoor Chaudhary, FCPS (Prosthodontics),
Assistant Professor, Prosthodontics, Islamic International Dental
College, Riphah International University, Islamabad, Pakistan
3
Salman Ahmad, FCPS (Prosthodontics), Associate Professor, De-
partment of Prosthodontics, Islamic International Dental College
4
Muhammad Farooq Kamran, FCPS (Prosthodontics), Assistant
Professor, Prosthodontics, Rawal Institute of Health Sciences,
Rawalpindi.
5
Sara Amir Khan, BDS, House Surgeon, Lahore Medical &Dental
College, Lahore For Correspondence: Dr Muhammad Aamir
Ghafoor Chaudhary. House No. 333-C, Street No. 32, Sector
F-11/2, Islamabad Email: aamir.ghafoor@gmail.com
Cell: 0321-5162802
Received for Publication: October 28, 2016
Revised: November 26, 2016
Approved: November 28, 2016
patient.3
All denture patients routinely expect their new
dentures to fit and function better than their existing
ones, that is, most patients anticipate that their new
dentures will bring an improvement compared to their
previous dentures. However, they remain resigned to
understand that many a times some compromises may
be necessary.4 For the first-time denture wearers, the
experience can be totally unexpected and may need
an initial period of adaptation and learning to control
their prostheses in function. Likewise, all these patients
present with post-insertion complaints which have to
be managed on an as need basis.5
The most frequent short term complaints with
complete dentures are those pertaining to loss of re-
tention, poor esthetics, decreased chewing efficiency,
discomfort under the denture (the pain and generalized
discomfort), fracture of the denture bases.4 The most
crucial time for the patient’s perception of success or
failure of the dentures is the adjustment period.6
The present clinical study was designed to collect
information about various complaints associated with
complete dentures fabricated by undergraduate stu-
dents. This information may be used to improve upon
the clinical and laboratory training being imparted
to undergraduate students with an aim of ultimately
decreasing the post-insertion complaints of the denture

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 680
 Dentures post-insertion complaints

patients. In turn, it would be beneficial for both the had some complaints. In order of frequency of occur-
patient and the undergraduate teaching program. rence, the incidences of the post-insertion complaints
included in the study are presented in Table 3.
METHODOLOGY
TABLE 1: FREQUENCY OF PATIENTS
A descriptive study was conducted in the Depart- ACCORDING GENDER DISTRIBUTION
ment of Prosthodontics at a tertiary care dental hospital,
through the months of March 2015 to August 2016. Sr. No. Gender Percentage
A convenience non-probability purposive sampling
technique was used. The patients were thoroughly 1 Male 66.7%
screened at the OPD and after complete extra oral 2 Female 33.3%
and intra oral examination they were allocated to final
year undergraduate students. All the steps of complete TABLE 2: FREQUENCY OF PATIENTS ON THE
denture therapy were carried out by the undergrad- BASIS OF AGE
uate student to whom case was allocated. Only those
male and female patients were included who had been Age Range Total
wearing them for at least six months. Patients were 20-29 1
excluded if more than one operator was involved in
denture fabrication process. Patients presenting with 30-39 3
any medical condition such as diabetes or high blood 40-49 8
pressure were also excluded. 50-59 26
A verbal and written consent was obtained from 60-69 28
each patient before enrolling them in the study. It was
70-79 22
ensured that all clinical and laboratory steps of den-
ture fabrication were carried out by the same student 80-89 10
as part of their departmental quota. After insertion 90-99 1
of the prostheses, every patient was given a uniform Total 99
set of post-insertion instructions regarding denture
use and hygiene maintenance. They were additional- Mean Age: 64.74 ±16.44 (Standard deviation)
ly required to visit the department for at least three
regular intervals in which after complete intra oral TABLE 3: INCIDENCE OF POST-INSERTION
examination and denture examination all the com- COMPLAINTS IN ORDER OF DECREASING
plaints were addressed. After the first six months of FREQUENCY (N=99)
insertion in which patients complaints were addressed
until the patients were satisfied and pain free. In the Post-insertion Complaints Fre- Percent-
later six months; any patient coming back for review or quency age
adjustments were asked about the following six com- Loss of retention 60 60.60%
plaints on a self-designed proforma: loss of retention,
pain and/or generalized discomfort, denture ulceration/ Difficulty in chewing 25 25.25%
mucosal ulceration under the dentures, fracture of Mucosal ulceration under the 20 20.20%
the denture base, difficulty in eating and difficulty in denture
speech. Each item was to be answered as either present
or not present as per the response of the patients. The Pain and generalized discomfort 10 10.10%
patient complaints were corroborated with the intra- under the denture
oral examination as well as and remedial action was Difficulty in speech 8 8.08%
provided. The findings of the intraoral examination Denture base fracture 3 3.03%
and denture examination at the post insertion visits
were analyzed and denture corrections were carried
DISCUSSION
out. The study data was entered and analyzed in the
SPSS software version 23. Descriptive statistics were The present study was conducted as part of an un-
used to describe the data. dergraduate research competition/ within the institute
in an attempt to study the post-insertion complaints
RESULTS of complete denture wearers whose dentures had been
A total of 115 patients were enrolled at the start fabricated by the final year students. A total of 115
of the study. However, only 99 patients reported back patients were enrolled at the start of the study but
for regular follow up visits either voluntarily or when only 99 of them reported back for follow up. This meant
called upon. Therefore, these 99 individuals constitut- the response rate was 86% which was slightly more
ed the study sample. Hence the overall response rate than what had been expected at the onset of the study.
remained at 86%.The sample only constituted of those This relatively high response rate may have been due
patients who responded within six month to a year time to the fact that all patients were from within the city
after the denture has been inserted. limits and had agreed to revisit whenever called upon.
The final sample included 66 (66.7%) males and The patients who were dropped could not be contacted
33 (33.3%) females (Table 1) with a mean age of 64.74 successfully or were from surrounding rural areas.
years (Table 2). It was interesting to find that not a In the present study, the most common complaint
single patient was complaint free. All of the patients was looseness of the dentures, mostly of the mandibular

Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016) 681

complete dentures although some patients also com-
plained of looseness of the maxillary complete denture.
These complaints were addressed during the follow up
visits by establishing the cause and then taking reme-
dial measures. Most of the cases needed relining due
to extremely short flanges. Some dentures had to be
remade altogether due to multiple problems. A recent
survey has reported almost 54% patients complaining
of denture looseness or loss of retention after 6 months
of insertion.7 Most of these patients were also found to
be emotionally disturbed and generally dissatisfied with
life. However, in the present study, emotional status
of the patients was not taken into account and only
healthy and emotionally stable patients were included.
The second most common complaint was decreased
chewing efficiency especially while eating home-made
bread or chappati. It was mostly related to unstable
dentures secondary to loss of retention or incorrect
tooth set up. Remedial actions included improving the
denture retention and correcting the errors in tooth
arrangement and occlusal balancing. Shetty et al7 have
attributed this complaint to lack of patient education
mostly. They have recommended that dentists must
make their patients understand that the efficiency of
the prosthesis is related to their alveolar ridge condi-
tion and attitudes to adapt to the prosthesis. However,
Bilhan et al8 have actually used visual analog scores
to rate chewing efficiency and found negative effects
to it due to loss of retention, ulcerations and a high
vertical dimension. In the present study, vertical di-
mension problems were not included at all as we are
only concerned with the complaints as part of study
design. However, denture looseness and ulcerations
were present in all patients complaining of inefficient
chewing ability.
Ulceration of the denture-bearing mucosa was the
third most common complain encountered in the study
sample. It was mostly due to overextended flanges
which were adjusted in accordance to the peripheral
tissues. Discomfort under the dentures was also noted
in about 10% of the subjects. All of these patients also
had ulceration underneath the denture which was
probably the main cause of their discomfort. Shetty
et al7 reported discomfort values of upto 8% after 6
months of denture insertion, which are similar to our
own results. Many factors have been suggested to play
a role towards prosthesis comfort especially quality of
the residual ridges and previous denture experience.
Problems with speech were reported in almost
8% patients even after 6 months of denture insertion.
This may have been due to diminished ability of the
patients to adapt to intra-oral changes. This condition
may be explored through further research with a more
controlled study sample. Lastly, denture base fracture
was seen in 3% patients which were all due to dentures
CONTRIBUTIONS BY AUTHORS
1 Irum Sikander: Topic selection, study conception and design, data collection
2 M Aamir Ghafoor Ch: Statistical analysis and interpretation of data
3 Salman Ahmad: Discussion, editing and proof reading
4 M Farooq Kamran: Cross references and final review
5 Sara Amir Khan: Introduction
Pakistan Oral & Dental Journal Vol 36, No. 4 (October-December 2016)
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Dentures post-insertion complaints
falling to the floor on repeated occasions. These dentures
were repaired using self-cured acrylic resin and patients
instructed to be more careful in handling them. In their
study on various types of removable dentures, Bilhan
et al8 have reported upto 26% patients with denture
fractures which is a rather high number. This may
have been due to the initial inclusion criteria which
was limited to only healthy complete denture patients
in our study.
The present study cannot be considered as a rep-
resentative of the complete population of the region
in general as it was conducted in one of the dental
tertiary care hospital and only targeting patients being
treated by undergraduate students. The results of this
study can be helpful in inculcating a more supervised
and clinically oriented undergraduate teaching and
training program in order to reduce the dissatisfaction
of patients related to complete denture therapy and
improve the quality of treatment and services offered
at any tertiary care facility.
CONCLUSION
Within the limitations of the present study, it can
be concluded that the most common problems associated
with complete dentures fabricated by undergraduate
students are loss of retention, decreased chewing effi-
ciency and mucosal ulceration. These complaints may
influence other aspects of the denture function and
need to be addressed promptly.
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