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• Clinical risk


DEALING WITH DENTURES They may not be ideal but dentures are the only


option for many patients. Doug Hamilton offers some hints on managing expectations and more


D


ENTURES are not an alternative to having natural teeth. Dentures are an alternative to having no teeth. This well-worn advice reflects the fact that dentures, especially complete dentures, are normally


provided when all else fails. Many patients, especially those who are experienced denture wearers, appreciate that there are bound to be limitations in terms of retention, function and aesthetics once the natural dentition is lost. Unfortunately, there are others who still look forward to a life of effortless and comfortable toffee chewing and it is this radical divergence of reality and expectation which makes for disappointment and conflict. Obviously, the primary means of minimising


such problems is to provide well-planned treatment of a good standard. Clinical advice as to how this can best be achieved is beyond the scope of this author. (In fact, if there is any


reader who has discovered the secret of making “tight” full lower dentures – without resorting to implants – please feel free to drop me a postcard.)


Art of the possible It would seem logical to assume that prosthetic excellence would always lead to patient satisfaction. But the sad truth is that, regardless of operator skill, it can be difficult to realise the hopes of edentulous patients. Therefore, before treatment commences, there must be a comprehensive consenting process, including explanation of what is actually achievable. Experience tells us that practitioners who


take the time to effectively communicate this point in the first instance will encounter fewer problems later on. Needless to say, this advice should be imparted in an empathetic, professional manner. The use of visual aids


such as diagrams, together with accessible written advice upon which patients can reflect at their leisure, is often very useful and is strongly recommended by the GDC. The doctrine of valid consent dictates that


other subjects, such as treatment risks and alternatives, must also be discussed pre- operatively. This begs two obvious questions. Firstly, are there are any other risks of which the patient should be made aware when complete dentures are being considered (other than being entered into the 3 o’clock at Chepstow after the insertion stage)? In reality, denture provision is relatively safe and non-invasive. However, it would still be entirely reasonable to warn of potential complications such as traumatic ulcers or initial diction difficulties. Secondly, where implant retention is


beyond the patient’s means, are there any tangible options which can be offered to


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