Sequalae of

Wearing Complete
Dentures

DIRECT SEQUALAE CAUSED BY

WEARING COMPLETE DENTURES
MUCOSAL REACTIONS
DENTURE STOMATITIS
DENTURE IRRITATION HYPERPLASIA
TRAUMATIC ULCERS

ORAL GALVANIC CURRENTS

ALTERED TASTE PERCEPTION
BURNING MOUTH SYNDROME
GAGGING
REIDUAL RIDGE REDUCTION
CARIES (ABUTMENTS)
PERIODONTAL DISEASE (ABUTMENTS)

DENTURE STOMATITIS
SYNONYMS
DENTURE SORE MOUTH, INFLAMMATORY PAPILLARY
HYPERPLASIA, CHRONIC ATROPHIC CANDIDOSIS

PREVALANCE

50% among complete denture wearers

DENTURE STOMATITIS
NEWTONS CLASSIFICATION

TYPE I
Localised Simple Inflammation or Pin Point Hyperemia

TYPE-II
Gen. Simple Inflammation, Erythematous type seen as diffuse erythema
involving part or the entire denture bearing mucosa.

TYPE-III (Granular Type)

Inflammatory papillary hyperplasia, involves part of hard palate and
alveolar ridges.
(type-I and type II are usually trauma induced, type-III is usually
associated with microbial plaque accumulation on the fitting surface or
underlying mucosa)

DENTURE STOMATITIS
DIAGNOSIS
CANDIDA ASSOCIATED DENTURE STOMATITIS
CONFIRMED BY :

FINDING OF MYCELIA OR PSEUDOHYPHAE IN A DIRECT

SMEAR
OR
ISOLATION OF CANDIDA SPECIES FROM THE LESION( 50
COLONIES)

DENTURE STOMATITIS
ETIOLOGY AND PREDISPOSING FACTORS
DIRECT PREDISPOSING FACTOR FOR CANDIDA ASSOCIATED LESIONS IS PRESENCE
OF DENTURES IN ORAL CAVITY
SYSTEMIC FACTORS:
Old age
Diabetes mellitus
Nutritional deficiencies (iron, folate or vitamin B12)
Malignancies (acute leukemia, agranulocytosis)
Immune defects
Corticosteroids, immunosuppressive drugs

LOCAL FACTORS:
Dentures (changes in environmental conditions, trauma, denture usage, denture

cleanliness)
Xerostomia (Sjogrens syndrome, irradiation, drug therapy)
High-carbohydrate diet
Broad-spectrum antibiotics
Smoking tobacco

Management and Preventive

Measures
Several options because of diverse possible origins
Efficient Oral and Denture hygiene/ correction of denture

wearing habits
Instruct pts to remove dentures after meals and scrub them
vigorously with soap before reinsertion
Keep mucosa in contact with denture clean
Discontinue denture wearing at night

Management and Preventive

Measures
Correction of Ill Fitting Dentures

Rough areas on fitting surface smoothed or

relined with tissue conditioner
Removal of

1 mm of internal surface

(penetrated by micro org.) and relined frequently

Polishing or glazing tissue surface to

facilitate denture cleansing by brushing

Management and Preventive

Measures
Antifungal therapy
Indications
In pts with clinical diagnosis confirmed by a mycological exam
In pts with associated burning sensations from oral mucosa
In pts where infection has spread to other sites in oral cavity or pharynx

Local antifungal therapy (preferred over systemic therapy)

Nystatin
Amphotericin b
Miconazole
Cotrimazole
Systemic antifungal therapy (resistance develops earlier)
Ketoconazole
Fluconazole

Management and Preventive

Measures
PRECAUTIONS TO PREVENT RISK OF RELAPSE
Rx with antifungals for 4 weeks
When lozenges are prescribed take out dentures before
sucking
Meticulous oral and denture hygiene
Wear dentures as seldom as possible and keep them dry
or in disinfectant solution of 0.2% to 2% chlorhexidine
during nights

Management and Preventive

Measures
Surgical Treatment
For elimination of deep crypt formation in type III
denture stomatitis
Achieved with cryosurgery

Flabby Ridge

Flabby Ridge
Definition
Mobile or extremely resilient alveolar ridge due to replacement
of bone by fibrous tissue

Commonest Site
Ant. Maxilla particularly where ant Mand teeth are present

Draw back
Provide poor support for the denture

Treatment
Should be surgically removed
Extremely atrophic ridges in maxilla shouldnt be totally
removed as vestibular area may be eliminated

Burning Mouth Syndrome

Definition

A possible sequela of denture wearing and

characterized by burning sensation in one or several
oral structures in contact with the dentures
Clinical Features
Oral mucosa is usually clinically healthy
Age gp affected: older than 50
Gender affected: females esp. postmenopausal
Common complaint : burning sensation from
supporting tissues or the tongue
Symptoms usually appear first time with placement

Burning Mouth Syndrome

Characteristics of Associated Pain
o
Gradual onset, often present in the morning and

becomes aggravated during day

o
Ususally a burning sensation with a feeling of dry
mouth and altered taste sensation
o
Associated symptoms may be headache,
insomnia,
decreased libido, irritability
depression
o
Aggravating factors: tension, fatigue, hot and spicy
foods
o
Relieving factors: sleeping, eating ,distraction

Burning Mouth Syndrome

Etiological Factors
Local factors
Mechanical Irritation
Allergy
Infection
Oral Habits and Parafunction
Myofascial Pain
Systemic Factors
Vitamin Deficiency
Iron Deficiency Anaemia
Xerostomia
Menopause
Diabetes
Parkinsons Disease
Medication

Burning Mouth Syndrome

Etiological Factors
Psychogenic factors
Depression
Anxiety
Psychosocial stressors

Burning Mouth Syndrome

Management
Systematic approach to identify the possible cause
Care is to be taken where no organic cause cant be
established for the complaints
Appropriate counseling to help pt. understand the benign
nature of the problem

Hyperplasia

Denture Irritation
Hyperplasia
Common sequela of wearing ill-fitting dentures
Occurs along overextended peripheries of

dentures
Results from chronic injury by unstable dentures
or thin overextended dentures
May occur right after placement of new dentures
and may not be associated with marked
symptoms
Lesions may be single or quite numerous and are
composed of flaps of hyperplasic connective
tissue

Denture Irritation
Hyperplasia
Inflammation is variable(in bottom of deep

fissures severe ulceration and inflammation

may occur)
Marked discomfort in pressure ulceration and
severe irritation from microbial products
Management
Replacement /adjustment of dentures
Following surgical excision and replacement
of dentures, lesions are unlikely to recur

Traumatic Ulcers

Traumatic Ulcers
These are sore spots most commonly develop

within 1 to 2 days after placement of new dentures

Clinical Features
Small and painful lesions
Covered by a gray necrotic membrane
Surrounded by an inflammatory halo with firm,
elevated borders
Direct Cause
Over extended denture flanges
Unbalanced occlusion

Traumatic Ulcers
Predisposing Factors

Suppress resistance of the mucosa to mechanical

irritation
Diabetes mellitis
Nutritional deficiencies
Radiation therapy
Xerostomia
Sore spots heal within a few days after correction of
dentures
If no treatment is rendered adaptation may lead to
denture irritation hyperplasia

Oral Cancer in Denture

Wearers
No definite proof exists for an association b/w

denture wearing and oral cancer

Other predisposing factors such as tobaccco,
alcohol, lower socioeconomic group and less
education and poor oral hygiene.

Gagging

Gagging
Definition

Normal healthy defense mechanism to prevent foreign bodies from entering

into the trachea
Trigger Zones

soft palate
fauces
posterior part of tongue
Primary Stimulus
tactile stimulation
Other Stimuli
sight
taste
noise
psychological factors
combination of t

Gagging
Afferent

glossopharyngeal
Efferent
vagus
Gagging associated with denture wearing
overextended borders
poor retention of maxillary dentures
unstable occlusion
increased vertical

Gagging
In old denture wearers may be a symptom of

GI disorders.
Adenoids
Alcoholism
Severe smoking

Residual Ridge Reduction

Residual Ridge Reduction

Alveolar bone is tooth dependant
Loss of teeth leads to continued bone resorption

as a result of alveolar remodelling due to altered

functional stimulation of bone
Aggressive resorption occurs in areas with thin
cortical bone
In 1st year after extraction reduction in residual
ridge height is 2-3 mm for maxilla 4-5 mm for
mandible in midsagittal plane
After healing of residual ridge, remodelling
process will continue but at slower rate

Residual Ridge Reduction

Proposed etiological factors for RRR

Anatomical Factors

More imp in mand vs the maxilla

Short and square face with increased masticatory
forces
Alveoloplasty
Prosthodontic Factors
Intensive denture wearing
Unstable occlusal conditions
Immediate denture treatment
Metabolic and systemic factors
Osteoporosis
Calcium and vitamin D supplements for possible
bone preservation

Caries and Periodontal

Disease