Individuals who present uncommon and abnormal denture&nbsp;problems require unusual and resourceful treatment. Because&nbsp;of the extreme complexity of their systemic illness, physical,psychogenic abnormalities, anatomic abnormalities and&nbsp;neurological disorders, these are the difficult denture birds. This&nbsp;article mainly describes about difficult denture birds and theirmanagement.&nbsp

Prasad, K Sitaram

Reddy, A Venkat

Srinath, HP

Yarlagadda, Siva Kiran Babu

English

Atharva Scientific Publications (E-Jounals)

Siva Kiran Babu Yarlagadda et al
102
REVIEW ARTICLE
Difficult Denture Birds: An Easy Psychological Assessment
Siva Kiran Babu Yarlagadda, HP Srinath, K Sitaram Prasad, A Venkat Reddy
ABSTRACT
Individuals who present uncommon and abnormal denture
problems require unusual and resourceful treatment. Because
of the extreme complexity of their systemic illness, physical,
psychogenic abnormalities, anatomic abnormalities and
neurological disorders, these are the difficult denture birds. This
article mainly describes about difficult denture birds and their
management.
Keywords: Denture birds, Management, Abnormalities.
How to cite this article: Yarlagadda SKB, Srinath HP, Prasad
KS, Reddy AV. Difficult Denture Birds: An Easy Psychological
Assessment. J Orofac Res 2013;3(2):102-105.
Source of support: Nil
Conflict of interest: None declared
INTRODUCTION
Difficult denture birds are described by Schultz1 as
‘individuals who present abnormal and uncommon denture
problems’. Because of the extreme complexities of their
symptoms and their physical and emotional handicaps, these
are difficult denture birds.
Characteristics of problem among denture patients are:2
1. They express dissatisfaction
2. They have pain
3. They are hostile
4. They exhibit regressive behavior
5. They are tense, anxious and appear unhappy
6. They often have systemic illness
7. They are inordinately preoccupied and conscious of
their dental problems
8. They have unrealistic fantasy regarding dentures
9. They often devious, deceptive and disarming
10. They are indefatigable and preserving in their efforts
to obtain satisfaction.
Complicating Factors in the Construction
of Dentures3
There are five factors that could complicate the construction
of complete dentures for a patient. The patient with only
one of these undesirable conditions could usually be treated
successfully, but when two or more of the factors exist in
the same patient. The first of these factors is general
debilitation. The second is abnormal jaw function. The third
is abnormal jaw relation with accompanying abnormal tooth
relationships. The fourth complicating factor is inadequate
space for denture bases, and bony protuberances and
undesirable undercuts, are also part of this complicating
factor. The fifth factor is the attitude of the patient, and
even though listed last, it is not the least important.
If the optimum result within the restrictions and
limitations presented is to be obtained, procedures for each
patient must be based upon observations and diagnosis.4
Examination and exploration are begun by the use of a
diagnostic chart to record the findings. The arrangement of
the chart encourages a systematic listing of conditions
because of its organized outline sequence.5
A fundamentally sound approach to this complex
problem is to divide the denture service into four stages:
(1) the preliminary stage, (2) the construction of ‘lend
dentures’, (3) the corrective functional refit procedure, and
(4) correction of postinsertion problems.
In preliminary stage, there is an opportunity to become
thoroughly familiarized with the patient. We gain an insight
into his emotions and tolerances, establish a rapport with
the patient, and gain his confidence The use of ‘bite’ splints
and occlusal pivots6 has merit in this preliminary stage. They
are used to provide relief from pain in the temporo-
mandibular joints or the muscles of mastication7 and
sometimes they seem to improve partially lost hearing. Often
bruxism can be controlled by the use of a bite splint which
is fabricated to fit over the teeth of the lower denture.
Consultation: The use of prosthetic consultation8 service
has great value with exceptionally difficult problem patients.
Consultation is especially important to justify the procedure
to be used when it is unusual. It is always advisable to call
in a prosthetic consultant if other than an acceptable standard
procedure is indicated or planned.
 Construction of lend dentures stage many hazards that
follow the insertion of completed dentures are avoided.
In order to build a corrective functional refit impression9
place wax which flows under pressure at mouth temperature
in the lower base and have the patient chew gum for an
hour or 2. This provides a functional adaptation of the
denture to the basal seat area. In addition, record an accurate,
functionally adapted border on the impression.
This corrective functional refit is used because after new
dentures have been used for a month or 6 weeks, the tissues
in the mouth undergo many changes. These are compensated
for with this functional refit impression in the tissue side of
the lower denture.
In the fourth stage should be corrected postinsertion
problems. An unsuccessful denture may be defined as one
10.5005/jp-journals-10026-1075
Difficult Denture Birds: An Easy Psychological Assessment
Journal of Orofacial Research, April-June 2013;3(2):102-105 103
JOFR
which fails to fulfill any or all of the above criteria to the
satisfaction of the doctor or his patient.10
Denture Birds2
1. Dodo Bird
Dodo bird was a large bird that was unable to fly. Dodos
are now extinct.
This type of denture bird will be 5% of denture
population. Some of them will become unhappy and
unmanageable at the first appointment; the difficulties will
begain at the try-in appointment; while the majority waits
until the dentures are completed before they begin their
perverse maneuvers. They may be as gentle and kind as
Whistler’s mother, or as aggressive as a politician a week
before polling time. Generally, the female of the species is
more colorful than the male.
 Tawkorchoo Gobbler: These are rare specimens who
use two separate lower dentures–one for speaking and one
for eating.
Management: For these denture birds, second stage that
is construction of lend dentures is crucial because this phase
allows prosthodontist to make adjustments and render
additional treatment.
 The species are very cooperative at the beginning of
the treatment; only after the denture is placed does the
trouble begin. This patient is so hostile, and is so strong
that she fractures porcelain denture teeth as though they
were peanuts. After 3 days, the balance of the posterior teeth
is destroyed, and the anterior teeth begin to crack away.
Management: Pay more attention to correction of the
postinsertion problems.
3. Hertz Bird
Also known as myway magpie. They are full of confidence
and energy. These generally appear with dentures worn in
the pocket or purse, one hand holds a suitcase which contains
a complete set of instruments for setting up teeth and waxing
a denture base, while other hand is a 25 years old-copy of
Swenson’s complete denture. First they agree to the fee,
and can hardly wait to get started, their pay is rarely paid
because they seldom complete their treatment. After the
preliminaries are over and when try-in begins, the hertz birds
take full change of esthetics and make comments like ‘its
wrong, they are too long or short, or they just do not feel
right’. Months may go by, and spouses or other supporting
relatives may be called in to support the contention that a
marriage is being ruined by the dentist’s inability to achieve
the proper esthetics for this person.
2. Karate Hawk
This is a large bird with a short, hooked beak, sharp claws,
and very good eye sight, while fighting using their hands
elbows, feet and legs. Female karate hawk is most difficult
to identify because she is very deceptive. One way to identify
this hawk is to engage her in conversation about her previous
dentists. It will then be observed that her eyes will turn fiery
red, and her face becomes flushed as she relates her tales of
conquest. This hawk is tiny and thin but she can easily crush
the hand of the dentist. This is an important identifying sign.
This species wears an upper denture made by one dentist
and a lower denture made elsewhere.
Siva Kiran Babu Yarlagadda et al
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Management: Make sure to get approval from the third
person, who is close to the patient at the time of approval of
lend dentures.
4. I Usta Duck
Also known as Minewere mallard. This type of bird is with
short legs, short neck and large flat beak. They are identified
by her habit of flying backward so that she can always see
where she has been. Her mode of dress may be described as
teen twentyish. Positive identification is achieved when this
beauty emits the shrill raucous call characteristic of the
species. Their physical limitations, she naturally becomes
disenchanted with her dentist. Her high hopes of regaining
many lost years are unrealized and she seeks remedies of
her own. It is not uncommon for these birds to place cotton
under their lower dentures, or to line their cheeks with
multiple sticks of chewing gum. These results are often
grotesque and harmful. The ‘do it yourself liners’ are the
final step for these poor creatures, who have run out of
dentists who will treat them.
Management: Corrective functional refit procedure.
5. Forever Flicker
Is a gentle creature with a chisel-shaped beak and heart full
of love. This hardy cousin of the woodpecker, also known
as sweet-lipped sapsucker. This bird is in search of a dentist
with a passion for order, the kind of man who likes to plan
his treatment carefully, make the denture, and complete a
case. Once the right man has been stopped this delicate
creature nests in for a long stay. Identification of these can
be made early if the dentist can hear this bird sing. If she is
left alone in the chair for a while one may hear a continuous,
clear, double-noted warble that sounds unmistakably like
till the end of time. There are no heartrending exclamations,
no threads of legal action and no comparisons with previous
dentures. It has no place in the lifetime liaison. The dentures
always need adjusting, cleaning, sharpening, refitting,
relieving, lighting or tightening.
Management: A good postinsertion denture service.
6. Martini Meadowlark/Junco
A common identification character is affinity for spirituous
liquids to the exclusion of other forms of nourishment. The
odor of alcohol accompanies every exhalation and makes
identification easy. Occasionally these birds will reek of
cologne or bay rum. One does not have to look hard for
these free spirits, because they are found everywhere. They
fly about on unsteady wings in search of a dentist who will
make dentures which can float on their booze-ridden, fragile
and undernourished oral tissues. These pathetic creatures
cannot tolerate dentures without the constant support of their
dentist, so that, unwittingly, he also become a part of their
pattern of addiction
Management: After denture insertion dentist should
remind the patient for periodical follow-up/correction of
postinsertion problems.
CONCLUSION
Patient satisfaction will play major key role in the prognosis
of the complete denture treatment. Hence, the dentist should
understand and read about the patient mental attitude to
give better service and make successful denture.
Difficult Denture Birds: An Easy Psychological Assessment
Journal of Orofacial Research, April-June 2013;3(2):102-105 105
JOFR
REFERENCES
1. Schultz AW. Management of difficult denture patients. J Pros
Dent 1961;11:4-8.
2. Koper A. Difficult denture birds. J Pros Dent 1967;17:532-39.
3. Brewer AA. Treating complete denture patients. J Pros Dent
1964;14:1015-30.
4. House MM. The relationship of oral examination to dental
diagnosis. J Pros Dent 1958;8:208-19.
5. Thompson MJ. Diagnostic chart of the odontic seminar 1939.
6. Sears VH. Occlusal pivots. J Pros Den 1956;6:332-38.
7. Schwartz L. Disorders of the temporomandibular joint.
Philadelphia: WB Saunders Company 1959:33.
8. Regan LJ. Doctor and patient and the law. St Louis: The CV
Mosby Company 1956:13.
9. Schultz P. Comfort and chewing efficiency in dentures. J Pros
Den 1951;1:38-48.
10. Koper A. Why dentures fail. Dent Clin North Am 1964:721-34.
ABOUT THE AUTHORS
Siva Kiran Babu Yarlagadda (Corresponding Author)
Reader, Department of Prosthodontics, St. Joseph Dental College, Eluru-
534003, Andhra Pradesh, India, e-mail: yarlagadda1428@gmail.com
HP Srinath
Professor and Head, Department of Prosthodontics, St. Joseph Dental
College, Eluru, Andhra Pradesh, India
K Sitaram Prasad
Senior Lecturer, Department of Prosthodontics, St. Joseph Dental
College, Eluru, Andhra Pradesh, India
A Venkat Reddy
Professor, Department of Prosthodontics, St. Joseph Dental College
Eluru, Andhra Pradesh, India


Difficult Denture Birds: An Easy Psychological Assessment

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Difficult Denture Birds: An Easy Psychological Assessment

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