Denture Problems

Dentures remain a widely used and effective form of prosthetic rehabilitation for partially or completely edentulous patients. While modern dental materials and fabrication techniques have significantly improved comfort, function, and longevity, denture users still frequently present with a variety of complaints. Understanding these issues is essential for clinicians providing comprehensive care, as symptoms often have multifactorial causes related to denture design, oral anatomy, patient adaptation, or systemic health.

Pain and Discomfort Associated With Dentures

Pain is one of the most common complaints presented by denture wearers, and it can arise from numerous mechanical, anatomical, and pathological factors. A thorough assessment is essential because symptoms do not always originate from the areas where patients perceive discomfort.

Mechanical Causes of Pain

1. Poor fit or roughness of the denture base

Even small imperfections on the fitting surface can create localized pressure areas. Acrylic resin can develop sharp edges during finishing or become rough from wear, leading to irritation or ulceration of the mucosa.

2. Occlusal errors

Improper occlusion can cause trauma by concentrating chewing forces in specific areas. High spots, uneven occlusal contacts, or an incorrect jaw relationship can displace the denture, often causing soreness along the ridge or in the retromolar and buccal shelf areas.

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3. Incorrect freeway space (FWS)

Too little FWS (i.e., increased vertical dimension) may lead to constant pressure on tissues, muscle fatigue, temporomandibular discomfort, and burning mouth symptoms.

4. Bruxism and parafunction

Patients who clench or grind their teeth exert excessive forces on their dentures. This can lead to chronic mucosal irritation or denture movement, increasing the risk of generalized soreness.

5. Premature contacts & denture displacement

Premature contact during function can displace the denture forward or laterally, inflaming the ridge. Lateral displacement particularly causes irritation on the lingual or buccal slopes.

Anatomical and Biological Causes of Pain

1. Bony prominences caused by resorption

As residual ridges resorb over time, underlying bone becomes increasingly exposed and sensitive. Prominent areas such as the genial tubercles or mental foramen may become painful under pressure from ill-fitting dentures.

2. Retained roots or pathology

Root fragments left beneath the mucosa, cysts, or undiagnosed oral pathology can mimic denture soreness. These require radiographic evaluation.

Pain From an Individual Tooth in Partial Dentures

In partial dentures (P/P), pain associated with a single tooth often indicates:

  • Excessive occlusal load on abutment teeth
  • Instability of the denture, causing leverage or rotational forces
  • Over-tightened clasps, which can damage the periodontal ligament and cause mobility or sharp discomfort during insertion/removal

 

Timely adjustment of clasp tension, occlusion, and stability is critical to prevent long-term damage.

 

Denture Looseness (Instability and Poor Retention)

Denture looseness is particularly common in mandibular dentures due to smaller denture-bearing areas, tongue movement, and faster resorption of the mandibular ridge compared with the maxilla.

Denture-related causes of looseness

  • Incorrect peripheral extension: Over-extension causes displacement; under-extension reduces suction and support.
  • Teeth not positioned in the neutral zone: If teeth are placed outside the zone of muscle balance, the tongue or cheeks will destabilize the denture.
  • Unbalanced articulation: Lack of even occlusal contacts results in tipping of the denture during mastication.
  • Poorly contoured polished surfaces: These surfaces guide muscle forces; irregularities can impair stability.

 

Patient-related causes

  • Inadequate saliva volume: Saliva provides lubrication and surface tension that help maintain retention. Xerostomia significantly affects denture stability.
  • Poor ridge form: Flabby ridges, knife-edge ridges, or severe resorption reduce support.
  • Reduced neuromuscular control: Elderly patients or those with neuromuscular disorders often struggle to adapt to dentures.

 

Burning Mouth and Oral Sensitivity

Burning mouth syndrome (BMS) or burning sensations under dentures can stem from both local and systemic factors.

Local causes include:

  • Increased occlusal vertical dimension (OVD)
  • Allergic sensitivity to acrylic monomer
  • Irritative mouthwashes or denture cleaners
  • Localized infections such as candidiasis

 

Systemic causes include:

  • Menopause (due to hormonal changes affecting oral mucosa)
  • Nutritional deficiencies (particularly B vitamins, iron, folate)
  • Xerostomia or salivary gland dysfunction
  • Psychological factors such as anxiety or depression

 

A multidisciplinary approach is often necessary for persistent symptoms.

 

Cheek Biting and Soft-Tissue Trauma

Cheek biting is commonly caused by improper tooth positioning or occlusal discrepancies.

Key management principles:

  • Ensure teeth are positioned in the neutral zone where muscular forces balance.
  • Reduce buccal overjet by trimming buccal surfaces of lower posterior teeth when necessary.
  • Evaluate and correct occlusion if premature contacts exist.

 

Speech Difficulties With Dentures

Speech articulation depends heavily on tooth position, palatal contours, and denture thickness. Complaints are common when dentures are newly delivered but should improve within days as patients adapt.

Common speech issues and their causes

1. Difficulty with f and v sounds

Usually caused by maxillary incisors being too far palatally. These sounds require contact between the lower lip and the incisal edges.

2. Difficulty with s, d, t

Often associated with altered palatal contour or incorrect overjet/overbite.

3. Whistling

Resulting from excessive space between the anterior palate and tongue due to a vault that is too high.

4. “S” becoming “th”

Occurs when incisors are set too far palatally, causing altered phonetic pathways.

5. Clicking sounds

Usually due to:

  • Increased OVD
  • Inadequate freeway space
  • Poor retention

 

Correcting tooth position and adjusting palatal thickness solves most speech issues.

 

Retching (Gagging) and Dentures

Gagging is a significant barrier to denture use for some patients and can be psychological, physiological, or mechanical.

Mechanical causes

  • Over-extension onto the soft palate
  • Excessive denture thickness
  • Incorrect occlusal plane

 

Mapping the gag reflex area helps determine necessary adjustments.

Potential solutions

  • Palateless or reduced-palate dentures: Useful but may compromise retention.
  • Training dentures: Gradually increase palatal coverage, starting with small plates and adding teeth incrementally.
  • Hypnosis or behavioural therapy: Beneficial for psychogenic gagging.
  • Implant-supported prostheses: Provide excellent function without palatal coverage and are an ideal solution when gagging persists.

 

The Grossly Resorbed Lower Ridge

Ridge resorption is an inevitable, progressive condition following tooth loss. The mandible resorbs at a faster rate than the maxilla, often leading to severely compromised denture retention and support.

Challenges associated with severe resorption

  • Reduced surface area for denture support
  • Loss of anatomical landmarks
  • Increased denture mobility
  • Greater discomfort due to thin mucosa
  • Psychological distress from functional limitations

 

Strategies to improve lower denture performance

1. Maximize denture base extension

Ensures the denture fully covers primary and secondary support areas.

2. Optimize teeth number and width

Broader occlusal tables increase stability but must be balanced against occlusal loading and ridge capacity.

3. Increase freeway space (FWS)

Reduces muscle overactivity and denture displacement.

4. Lower the occlusal plane

Brings the denture teeth closer to the tongue and cheek musculature, enhancing stability.

5. Neutral zone impression technique

Captures functional movements to position the denture within the optimal muscular envelope, improving retention dramatically.

6. Surgical interventions

Includes vestibuloplasty or ridge augmentation when appropriate.

7. Implant-assisted dentures

The gold standard for severely resorbed ridges, providing markedly improved retention, comfort, and chewing efficiency.

 

Recurrent Denture Fracture

Fracture of denture acrylic can occur due to material fatigue, occlusal discrepancies, or anatomical conditions.

Common causes of fracture

  • Flexing of dentures over flabby or uneven ridges
  • Thin acrylic bases caused by undercuts or fraenal notching
  • Excessive occlusal forces (e.g., from bruxism or incorrect occlusal planes)
  • Repetitive small stresses during chewing
  • Poor handling or dropping the denture

 

Management

  • Identify and correct occlusal faults
  • Relieve stress around frenal areas without excessively thinning the base
  • Strengthen areas prone to flexure
  • Incorporate a metal denture base or reinforcement plate when fractures recur
  • For persistent anatomical problems, consider implant-supported options

 

Candida and Dentures

Candida species, particularly Candida albicans, are common commensal organisms in the oral cavity. Under certain conditions, they proliferate and become pathogenic.

Why dentures promote Candida growth

  • The fitting surface provides a warm, moist anaerobic environment
  • Rough acrylic surfaces allow microbial adhesion
  • Plaque accumulation increases carbohydrate availability
  • Reduced salivary flow diminishes natural cleansing mechanisms
  • Denture wearing at night gives continuous contact, limiting oxygen exposure

 

Denture Stomatitis

Denture stomatitis—often called denture sore mouth—is a highly prevalent inflammatory condition associated with denture wear, especially complete maxillary dentures.

Clinical presentation

  • Typically asymptomatic
  • Reddened mucosa under the denture
  • Petechiae or small whitish patches may be observed
  • Usually limited to the upper denture-bearing area
  • Occasionally accompanied by angular cheilitis

 

Epidemiology

  • Occurs in 30–60% of complete denture wearers
  • More common in women (ratio 4:1)
  • Strongly associated with overnight denture wear

 

Aetiology

Local factors

  • Candida infection
  • Poor denture hygiene
  • Continuous denture wear
  • Trauma from ill-fitting dentures
  • Faulty orthodontic appliances

 

Systemic factors

  • Nutritional deficiencies
  • Steroid use
  • Immune suppression
  • Endocrine disorders
  • Xerostomia-inducing medications

 

Dietary factors

  • High sugar intake enhances Candida proliferation

 

Management of Denture Stomatitis

Management involves eliminating predisposing factors and treating the infection.

1. Improve denture hygiene

  • Brush dentures thoroughly, especially fitting surfaces
  • Soak nightly in hypochlorite solutions (where safe for acrylic)
  • Mechanically clean to reduce microbial load

 

2. Remove denture at night

This is one of the most effective measures and significantly reduces recurrence.

3. Fabricate new dentures

If old dentures are porous, ill-fitting, or heavily colonized, replacement may be required.

4. Reduce dietary sugar

Reduces substrate for fungal growth.

5. Antifungal therapy

  • Topical miconazole gel applied to denture fitting surface before insertion
  • Systemic fluconazole may be used for resistant or recurrent cases

 

6. Treat contributing systemic conditions

  • Evaluate nutritional status
  • Manage xerostomia
  • Refer to general medical practitioner when systemic involvement is suspected

 

7. Manage coexisting papillary hyperplasia

Severe cases may require surgical reduction.

8. Angular cheilitis

Often associated with denture stomatitis and frequently caused by Candida or secondary bacterial infection; treat accordingly.

 

Conclusion

Denture problems are common and multifactorial, affecting comfort, function, speech, and oral health. Proper diagnosis relies on careful assessment of both prosthetic and biological factors. Understanding the interplay between denture design, patient anatomy, oral hygiene, and systemic health allows clinicians to provide targeted solutions that significantly enhance patient satisfaction and quality of life.

Equally important is recognizing the role of Candida in denture-related lesions. Through improved hygiene practices, appropriate antifungal therapy, and, when necessary, new or implant-supported dentures, denture stomatitis can be effectively managed and often prevented.

A comprehensive, individualized approach ensures long-term success, enabling patients to enjoy comfortable, functional dentures that support oral and systemic well-being.

 

References

  1. Zarb, G., Hobkirk, J., Eckert, S., & Jacob, R. (2013). Prosthodontic Treatment for Edentulous Patients (13th ed.). Mosby/Elsevier.
  2. Taylor, T. D., & Wiens, J. (2015). Clinical Maxillofacial Prosthetics. Quintessence.
  3. McCord, J. F. & Grant, A. A. (2000). Complete Dentures: A Clinical Manual. British Dental Association.
  4. Watt, D. M., & MacGregor, A. R. (1986). Designing Complete Dentures (2nd ed.). W. B. Saunders.
  5. Shillingburg, H. T., et al. (2012). Fundamentals of Fixed Prosthodontics (4th ed.). Quintessence Publishing.
  6. Wilson, N. H. F., Lynch, C. D., & Fung, D. E. (2018). Essentials of Complete Denture Prosthodontics. Wiley-Blackwell.
  7. Budtz-Jørgensen, E. (2002). Materials and methods for cleaning dentures. Journal of Prosthetic Dentistry, 88(2), 143–151.
  8. Emami, E., de Souza, R. F., Kabawat, M., & Feine, J. S. (2013). The impact of edentulism on oral and general health. International Journal of Dentistry, 2013, Article ID 498305.
  9. Pietrokovski, J., & Massler, M. (1967). Residual ridge resorption in immediate dentures. Journal of Prosthetic Dentistry, 17(4), 380–385.
  10. Felton, D. A. (2009). Complete edentulism and denture quality in the elderly. Journal of Prosthodontics, 18(2), 87–90.
  11. Baran, I., & Nalçacı, R. (2009). Self-reported denture hygiene habits and oral health–related quality of life. Gerodontology, 26(3), 193–199.
  12. Gendreau, L., & Loewy, Z. G. (2011). Epidemiology and etiology of denture stomatitis. Journal of Prosthodontics, 20(4), 251–260.
  13. Ramage, G., Tomsett, K., Wickes, B. L., López-Ribot, J. L., & Redding, S. W. (2004). Dentures as reservoirs for Candida albicans. FEMS Yeast Research, 4(5), 461–469.
  14. Webb, B. C., Thomas, C. J., Willcox, M. D., Harty, D. W., & Knox, K. W. (1998). Candida-associated denture stomatitis. Australian Dental Journal, 43(3), 199–206.
  15. British Society for Restorative Dentistry (2018). Guidelines for the Management of Complete Denture Patients.
  16. American College of Prosthodontists (ACP). (2020). Clinical Practice Guidelines for the Care and Maintenance of Complete Dentures.
  17. NICE Clinical Knowledge Summaries (2021). Oral Candidiasis.
  18. Neill, D. J. (1968). The neutral zone in complete dentures. Dental Practitioner and Dental Record, 19(5), 157–164.
  19. Kapur, K. K. (1967). A clinical evaluation of denture adhesives. Journal of Prosthetic Dentistry, 18(6), 550–558.
  20. Basker, R. M., & Davenport, J. C. (1986). Prosthetic Treatment of the Edentulous Patient. Macmillan Publishing.