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complete denture patients? It might be that a variety of materials or designs could be considered. However, the most likely choice would probably be between NHS and private standard dentures. NHS practitioners must ensure that this discussion complies with their terms of service which, amongst many other things, do not allow patients to be misled


offending denture on the worktop and invited the patient and the entire student group to gather round. “Watch this denture”, he insisted. “Apparently, it moves”. We stood for some time in respectful silence gazing upon the inert denture, finally agreeing that it must be the patient and not the denture which was moving. One simply wouldn’t get away with that nowadays.


“ Many patients will have valid concerns that should be addressed through careful discussion and further treatment “


regarding the quality or availability of NHS treatment. If, having been accurately advised, the patient selects private treatment this must be recorded and signed for on a form GP17DC or equivalent.


Respecting patient concerns Regardless of the quality of treatment, consenting and management of expectations, there will inevitably be patients who are disappointed with the outcome. It is critical that any such expressions of dissatisfaction are dealt with professionally and in accordance with NHS (where appropriate) and GDC requirements. For an example of precisely what not to do, I


need to reach back several decades to my student days. During one of the prosthetic teaching clinics, my undergraduate tutor was berated by an edentulous patient whose mandibular ridge resembled a billiard table and who had returned to the clinic to complain that her lower complete denture “moved”. My tutor could have re-explained that a period of perseverance and adaption would be required if the transition to this denture was going to be successful. Instead, however, he placed the


Clearly, in this instance, the complaining


patient, while genuinely disappointed and deserving of a respectful explanation, was being unrealistic. However, many patients will return with concerns which are valid and require to be addressed, not only through careful discussion, but also by further treatment. For example, mucosal discomfort under new dentures may seem like quite a trivial problem, but can be severe and always requires early and careful relief of the denture. Leading on from this point, it is vital to satisfy yourself that the lesion is definitely of traumatic origin. As a rule, you should review these cases and, if the ulcer persists despite an appropriate amount of denture adjustment there should be an increased index of suspicion that it may be sinister. Learning to recognise malignancy is a


gradual process which will hopefully be expedited by the GDC’s recommendation that oral cancer awareness should now form an integral part of all registrants’ CPD. Even for an experienced practitioner, however, attempting to reach a definitive diagnosis without biopsy is fraught with dangers. Therefore, where there are concerns regarding any lesion,


including persistent ulcers, the safest route is to make an urgent, documented referral. Other soft tissue conditions, possibly


caused by advancing years or long-term prescription medicines, are perhaps more prevalent in complete denture patients. Some, such as xerostomia, may have a profound effect on the prosthetic success. Therefore, as with every patient, scrutiny of a current, signed medical history followed by thorough examination of extra and intraoral tissues must be carried out, analysed and documented before treatment commences.


Goodbye old friend With advancing years comes not only the increased likelihood of pathology and poly- pharmacy but also the circumstance that a patient’s existing dentures will date back to circa 1970 and will therefore have acquired the familiarity and comfort of a favourite pair of slippers. Introducing new prostheses at this stage can be a thankless task and, in some instances, the best treatment is no treatment. However, where the old denture has been


worn to the point it has begun to resemble a polo mint, its replacement is probably unavoidable. While replica techniques assist this process, it is important to remember that new dentures, quite possibly with some degree of increased vertical dimension, will present enormous challenges, especially for the older wearer. Patience and empathy must be the prevailing approach. Despite your best efforts, there may be


occasions when a reproachful patient returns wearing his or her old dentures and hands you a bag containing the ones which you have lovingly constructed. Try not to be offended. Most practitioners have a small collection of orphaned dentures tucked away in some darkened recess of the surgery. It’s character building.


Doug Hamilton is a dental adviser at MDDUS


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