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Complete dentures
DiRcult
denture
birds
Alex Koper,
B.S., D.D.S.*
Inglewood,
Calif.
D
enture patients are “special”
people because they have the problem of adapting
to a prosthesis which affects one of the most sensitive and emotionally
charged regions of the body. This must take place in full view of their friends, who, like baseball fans, are often opinionated
and voluble “experts,”
The problem is compounded
by the fact that in our North American
culture, with its emphasis on youth, virility
or femininity,
and apparent
immortality,
the individual
who lacks a normal and
attractive
dentition
is disadvantaged.
Therefore,
it takes an uncommonly
secure
individual
to accept dentures with equanimity.
During
the time their dentures are being made, and later while they are learning to use them, our patients are dependent,
frightened,
“less than whole”
people.
and in many instances, regress to infantile behavior. There are individuals
who have
so much difficulty with their dentures that they never make an acceptable
adjustment to them. Some wander from dentist to dentist in search of a solution to their
dental needs, while others isolate themselves from society. These people are called
problem
denture patients or dificult
denture patients.
Because American
standards
of function
and appearance
are so high, people
whose physical or emotional
limitations
prevent adequate
achievement
with dentures suffer much and seek help from dentists. In other parts of the world where
teeth are not looked upon as such a necessary and positive asset, these individuals
might suffer little as a result of this deficiency.
The difficult
denture
patient
is,
therefore,
a more common problem to American
dentistry, and is a product of ours
higher living conditions.
IDENTIFICATION
OF TtlE PROBLEM
DENTWtE
PATIENT
Difficult
denture patients have been described by Schultz’
present abnormal
and uncommon
denture problems.
Because
Read
before
the American
This article is being published
and the Journal
of the Southern
tween the editors.
*Co-director
of The Odontic
532
Prosthodontic
Society
in Chicago,
Feb.
as “Individuals
of the extreme
who
com-
3, 1967.
simultaneously
in the JOURNAL OF PROSTHETIC DENTISTRY
California
Dental
Association
by special arrangements
beSeminar,
Los
Angeles.
Difficult
denture birds
533
plexities of their symptoms and their physical and emotional handicaps, these are
difficult denture patients.”
It is conceded that what may be an abnormal and uncommon denture problem
for one dentist may be fairly routine to a more experienced practitioner.
Also, the
evaluation of the physical and emotional limitations
a patient presents varies with
the perception, observation, and experience of the dentist who treats him. It is also
true that there are individuals
who present severe challenges to all dentists who
a:te npt to treat them. This poses the questions: “What makes a problem denture
patient? Are there any criteria by which one may measure an edentulous patient
in order to determine whether or not he is or will be ‘difficult’?”
SOME CHARACTERISTICS
OF PROBLEM
DENTURE
PATIENTS
1. They complain.
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 illnesses.
7. They are inordinately
preoccupied
and conscious of their mouth and their
dental problem.
8. They have an unrealistic fantasy regarding dentures.
9. They are often devious, deceptive, and disarming.
10. They are indefatigable
and persevering in their efforts to obtain satisfaction.
While it may be true that some of these signs appear in patients needing types
of treatment other than dentures, difficult denture patients exhibit all or most of
these limitations, and often have additional handicaps which aggravate and intensify
their symptoms.
Many edentulous patients become problem patients because they lack the physical apparatus to wear dentures successfully. Some are frustrated in their attempts to
adapt themselves to a mechanical appliance which requires a rather high degree of
neuromuscular
skill and coordination.
This most often comes at a time in their lives
when they yearn for the comfort of familiar things and do not have the energy for
this difficult task.
FROM WHISTLER’S
MOTHER
TO THE KARATE
HAWK
Prosthodontic
literature is replete with many analyses of these problems. There
are certain individuals
who cannot wear dentures successfully. Most writers on this
subject attribute the causes for this lack of success to personality or emotional problems, physical problems, or failure of the dentist to provide the proper treatment for
his patient. Whatever the cause of their lack of success with dentures, these people
do not become problem denture patients unless they have had considerable experience as recipients of various kinds of dental therapy, and have thereby developed a
particularly
colorful and effective modus operandi which continuously
and successfully thwarts efforts to construct workable oral prosthetic devices for them.
Only occasionally does one come upon discussions of denture failures in the
literature.2
Brewer3 writes that he has no failures, just varying degrees of success.
It might be erroneously
surmised that the problem denture patient, the D~Ju~u~u
Calamitous
Amrricanus,
likr the dodo bird and the silver dollar. is brcornit~~!
extinct. Nothing could be farther from the truth. As vet. no statistics on the rlrm~t)~XI
and varieties of these birds are available.
but informed
observers rstimatc. thrir
number to be as hiah as 5 per cent of the denture-wearimg
population.
Ijentists wlrc;
have encountered
them are happy to disengage themselves from the clutchry (Ii
these predatory creatures, and forget their experiences as quickly as possible.
Problem denture patients do not wear wrist bands that would identify them.
and even well-trained
veteran observers often fail to spot them. There simply is no
ty$cal problem denture patient. They come younp and old, male and female. rich
and poor. They may be as gentle and kind as Whistler‘s mother. or as aggrrssi,t: a<
. . .
.
.
a pohtlclan a week before pollmg time. Generally. the female of the specit~ is man‘
colorful than the male.
Just as there is no stereotype of the problem denture patient, neither is the1.c.
a uniform pattern to his behavior. Some of them will become unhappy and un,manageable at the first appointment;
for others, the difficulties begin at the try-in
appointment;
while the majority wait until the dentures are completed before the
begin their perverse maneuvers. Most of them need this time to measure their prrs
and plan their tactics.
I have been in a particula,rly
strategic position to observe many exotic species
of these denture birds. My experiences with grievance committees of the Los Angrles
County Dental Society for the past fifteen years, plus a practice which is yuitt’
heavily populated
with many varieties of these creatures, has made an avid and
wary denture bird watcher of me. Although
I have never seen such rare specitnenh
as the l’awkorchoo
Gobblrr
(Fig. 1) who uses two separate lower dentures-- -on
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