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Ethics & Law · patient case with 2 questions

Fifth set of dentures in fifteen years

Patient: 84-year-old man, complete denture wearer.

Chief complaint: I just do not like these dentures. I want the bite adjusted.

History: Four sets of complete dentures made over the past fifteen years, each by a different dentist. He cannot say specifically what is wrong with the current set.

Findings: Retention and stability are good. Borders are correctly extended. Occlusion is balanced with even bilateral contacts. Vertical dimension appears appropriate. No mucosal pathology.

Question 1

What is the MOST important thing to assess first?

  1. His expectations and psychological adaptation
  2. The occlusal vertical dimension
  3. Residual ridge form on a new radiograph
  4. The denture base extension
Show answer and explanation

Correct answer: A. His expectations and psychological adaptation

  • A. CORRECT. This is the classic exacting or philosophical patient in House's classification. Four prostheses in fifteen years with good retention and no demonstrable technical fault means the problem is unlikely to be mechanical. Explore what specifically he dislikes, what he expects a denture to do, and whether that is achievable. A fifth remake without this conversation fails identically.
  • B. Vertical dimension deserves evaluation, but nothing in the findings suggests it is at fault.
  • C. Ridge form informs prognosis but does not explain dissatisfaction with a well-fitting prosthesis.
  • D. Base extension is part of the technical check, and it is already reported as correct.

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Question 2

How should you respond to his request for an occlusal adjustment?

  1. Refuse and refer him back to the dentist who made the dentures
  2. Perform the occlusal adjustment as requested at this visit
  3. Take impressions for a fifth set of dentures
  4. Complete the full evaluation and discuss expectations before adjusting anything
Show answer and explanation

Correct answer: D. Complete the full evaluation and discuss expectations before adjusting anything

  • A. Sending him away without an evaluation abandons a patient with a legitimate complaint, even if that complaint turns out to be about expectations.
  • B. Irreversibly grinding a correctly balanced occlusion on request is treating the demand rather than the problem.
  • C. A fifth set built on the same unexamined expectations reproduces the same outcome.
  • D. CORRECT. Adjusting a balanced, correct occlusion because the patient asked will not resolve dissatisfaction and removes acrylic that cannot be replaced. Evaluate fully, identify whether a real fault exists, and align expectations before any irreversible step.

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