One of the time consuming appointments for a dentist is adjusting appliances. You can be a big help to your dentist by taking on the average appointment.
First, review the folder before the client arrives. How many adjustments have they had? What comments have been made during these appointments?
When your client is seated, listen to what they say. Is it just a sore spot or are they angry, discouraged, etc. If there is an emotional problem, go ahead and adjust the appliance and then have the doctor examine after your client is comfortable.
Use a mirror to examine the mouth. Locate the sore area. If you can’t see it, have your client put a finger on it. Next, you put your finger on it. When the client agrees that you have found the spot, mark it with an indelible stick or an artist’s ink pencil, and seat the dried denture. Clients are not very accurate at telling you where the sore spot is. They will often point to the periphery of the flange when the area is really more centrally located. Have your client carefully bite down and chew around. The purple mark will be transferred to the denture. Now take the denture to the lab and grind 1 mm away. At first, you will be too shy and careful you won’t remove enough denture. After cutting some away, ask your client to seat the denture and ask if it feels better. It will still be sore, but if you’ve relieved enough it will feel better. Don’t worry about removing too much acrylic. If you do, we’ll add some back on. This is easier than having the client get upset by having to return to readjust the same sore spot.
Reinforce with your client that we want to correct these spots as the denture settles. They should call again if another sore spot develops.
1. Loneliness- older clients will sometimes use a visit to the dentist as an excuse for a social outing where s/he is the center of attention. If tissues and dentures look fine, just roughen an area a little, have him/her try it in, talk for a little, make sure it feels good, polish the area, and wish them well. Make sure your client hears the grinding and sees the roughened area
2. Sore spots – developed in a denture that was recently seated, use pressure indicating paste.
a. Remove the paste with a tongue blade dispenser so you don’t have to dip back into the container.
b. Dry the denture.
c. Apply the paste with a cotton tip applicator. Spread it evenly.
d. Have your client wear the denture at least three minutes so the pressure areas will be clearly visible.
3. Constant sore mouth after a new appliance is seated – Even with repeated adjustments, the soreness remains. This is a sign that the client either has too great a vertical dimension or s/he is clenching or grinding. This can be corrected by reducing the vertical at least 2 mm.
When the denture is comfortable, repolish the areas you have adjusted.
1. Wash the denture thoroughly with soap and water using a scrub brush.
2. Soak in a 10:1 dilation of Chlorox for 1 minute.
3. Rinse thoroughly.
We now have a denture adjusting kit that avoids using the rag wheels. The adjusting burs are well shaped. The yellow polisher should only be used at 1/2 the speed of the green final polisher.
4. Denture is loose – we are going to recommend a reline, but always mention that implants are available if the client wants even better comfort.
5. Biting cheek, tongue-
a. upper posterior teeth set not set out far enough
c. all posterior teeth set too far in (tongue) or out (check)
6. TMJ pain
b. centric off
7. Dentures not stable
a. when teeth apart
1. over extended or under extended
2. post dam wrong
a. on hard palate
b. post dam through hamular notch
c. not heavy enough
b. during chewing
1. inadequate post dam
2. anterior teeth too far labially
3. flabby anterior tissue
4. lack of control by client
5. lower posteriors set off the ridge
c. when biting
1. occlusion off
2. denture rides on hard palate
a. whistle or “S” sounds
1. not enough room for tongue between bicuspids
2. space between upper centrals
b. lisping on “S” sounds- too much space between bicuspids for tongue
c. “Th” and “T” sounds indistinct
1. tongue needs more room in palate
2. anteriors too lingual
d. “F” and “V” sounds indistinct- upper anterior- adjust anteriors vertically or horizontally