To check a patient’s existing dentures effectively, you should perform a systematic review of the prosthesis both extra-orally and intra-orally. This process involves a combination of physical examination, functional testing (such as speaking or chewing), and direct communication with the patient.
Here is how to evaluate each characteristic based on the provided sources:
General History and Satisfaction
- Age: Determine the age of the dentures by asking the patient how many years they have been using them. Natural teeth and tissues change over time, and the age of the prosthesis can indicate the degree of wear or the need for a reline or replacement.
- Patient Satisfaction: Identify the patient’s chief complaints and any difficulties they have had adjusting to the dentures. Assess their perception of their dentofacial appearance and whether their expectations for treatment are realistic.
Physical Characteristics (Retention, Stability, and Extensions)
- Retention: This is the resistance to displacement in a direction opposite to that of insertion.
- How to check: Attempt to pull the denture away from the supporting tissues. For the maxillary denture, check the peripheral seal at the posterior palatal seal and buccal/labial flanges. For the mandibular denture, ensure the flanges are not over-extended, which could cause the denture to be displaced by muscle activity.
- Stability: This refers to the resistance against horizontal or lateral displacement.
- How to check: Apply lateral and anteroposterior (A-P) forces to the dentures to see if they shift or rock. Stability is enhanced by close tissue adaptation and appropriate relief of stress-bearing areas.
- Extensions: Evaluate the peripheral and posterior borders of the denture.
- How to check: Observe the denture flanges in the sulcus; they should be 1–2 mm clear of frena attachments to prevent irritation. Check the posterior maxillary extension by having the patient say “ah,” which identifies the vibrating line at the junction of the hard and soft palates.
Functional Characteristics (Occlusion and Phonetics)
- Occlusion (Centric, Lateral, and Protrusive):
- Centric: Ensure maximum intercuspation occurs simultaneously on the posterior path of closure. The contact should be bilateral and simultaneous.
Checking Centric With Articulating Paper
Instruct the patient to tap tap tap if you see a sliding pattern, it means that tooth is occluding too early
- Lateral and Protrusive: Check for eccentric interferences. In a “balanced” scheme, there should be simultaneous contact on both the working and balancing sides during lateral movements and posterior contact during protrusion to compensate for Christensen’s Phenomenon.
Lateral working and non working
For the working movements make sure to see that the cusps on the working side should contact simulatenously with those on the non-working side to maintain stability Articulating paper can also help: marks the inclines of teeth during movement. High spots will show long streaks, indicating interference
Correcting the Interferences
- centric prematurities
- adjust by deepening the fossae or increasing the incline of the cusps rather than grinding down cusp tips
- Working/Non-working
- grind the buccal of upper teeth and lingual cusp ridges of lower teeth
- Protrusive interferences:
- reduce the distal slopes of the upper teeth and mesial slopes of lower teeth
- Phonetics: Speech serves as a functional test for the position of teeth and the occlusal plane.
- “F, V, and Ph” sounds: The lower lip should make contact with the incisal edges of the maxillary anterior teeth.
- “S” sounds: Used to check the Occlusal Vertical Dimension (OVD). A whistle suggests insufficient tongue space, while a lisp indicates too much room between the bicuspids.
Aesthetics and Appearance
- Aesthetics: Evaluate the harmony between the teeth and the patient’s facial features.
- How to check: Check for lip support (the relationship of the lips to the nose and chin) and the midline, which should be within 2–4 mm of the facial midline.
- Appearance: Assess the shade, shape, and position of the teeth.
- How to check: Observe the incisal display at rest (typically 2–4 mm of maxillary incisors) and during a spontaneous smile (full crown exposure). Check for the presence of a buccal corridor (the space between the teeth and the corner of the mouth when smiling).
Summary Table for Clinical Check
| Characteristic | Primary Method of Assessment | Key Indicator of Success |
|---|---|---|
| Age | Patient History | Knowledge of wear/resorption timeline |
| Stability | Apply horizontal/lateral force | Minimal movement of denture base |
| Occlusion | Use articulating paper; observe closure | Bilateral simultaneous contact |
| Aesthetics | Visual inspection of lip support/midline | Harmony with facial proportions |
| Retention | Attempt vertical displacement | Resistance to “pulling” forces |
| Phonetics | Have patient repeat “S” and “F” sounds | Clear enunciation without whistling/lisping |
| Extensions | Visual check of sulcus and frena | Full coverage without impingement |
Are you looking for more detail on a specific part of this exam, such as how to troubleshoot specific speech problems or pain complaints?