Three Weeks Into New Complete Dentures

Correct answer: B. Candida-associated denture stomatitis

• A. Incorrect. Nicotinic stomatitis is a smoker’s lesion of the hard palate, appearing as diffuse white keratosis with red punctate duct openings. She is not described as a smoker, and the color pattern is opposite.
• B. Correct. Erythema conforming exactly to the denture-bearing area, in a patient wearing the prosthesis continuously, is the defining presentation. Continuous wear creates a warm, anaerobic, low-oxygen microenvironment that favors Candida colonization. Diabetes adds further susceptibility.
• C. Incorrect. Erythroplakia is a solitary, well-defined red velvety patch that cannot be attributed to any other cause. It carries a very high risk of dysplasia. The distribution here matches a prosthesis exactly, which explains it fully.
• D. Incorrect. True acrylic monomer allergy is rare, and would produce symptoms almost immediately after delivery rather than developing over 3 weeks. Testing would be needed to confirm it, and it remains a diagnosis of exclusion.

Note: Treatment is threefold: remove the denture at night, disinfect the prosthesis itself since it harbors the organism in its porosities, and use antifungal therapy. Skipping denture disinfection is the most common reason for recurrence.

Correct answer: D. Reposition the maxillary anterior teeth more posteriorly

• A. Incorrect. Excessive vertical dimension produces clicking teeth during speech, difficulty with the “s” sound, and a strained facial appearance. Increasing it would not correct a labiodental problem.
• B. Incorrect. Reduced vertical dimension causes an aged appearance, angular cheilitis, and cheek biting. It does not cause fricative distortion.
• C. Incorrect. The posterior palatal seal governs retention of the maxillary denture. Reducing it would loosen the prosthesis without any effect on speech articulation.
• D. Correct. The labiodental fricatives “f” and “v” are produced when the incisal edges of the maxillary anterior teeth contact the wet-dry line of the lower lip. When the teeth are set too far anteriorly, that contact cannot be made properly and the sounds are distorted. Moving them posteriorly restores the relationship.

Note: Speech sound checklist: “f” and “v” test anteroposterior position of the maxillary anteriors. “s” tests vertical dimension and the anterior palatal contour. “th” tests the anteroposterior position of the anterior teeth as a group.

Correct answer: D. 10%

• A. Incorrect. Eighty percent approaches natural dentition performance and is not attainable with any removable prosthesis.
• B. Incorrect. Fifty percent is well beyond what conventional complete dentures achieve and approaches implant-supported fixed prosthesis territory.
• C. Incorrect. Thirty percent overstates conventional denture performance. It is closer to what is achieved with an implant-retained overdenture.
• D. Correct. Complete denture wearers generate a small fraction of natural masticatory force, commonly cited as roughly one-sixth or less. Of the choices offered, 10% is the closest. The prosthesis is mucosa-borne rather than bone-anchored, and the absence of periodontal mechanoreceptors removes the feedback that permits high, controlled force.

Note: Flagged for precision. The published range is broader than the single figure suggests: masticatory performance in complete denture wearers is generally reported at 10–25% of natural dentition, with maximum bite force sometimes as low as 15%. “Less than one-sixth” is the phrase used in much of the prosthodontic literature. Given the options offered, 10% is the intended answer, but recognize the range.

Correct answer: A. Normal mucosa overlying normal bone — mandibular tori

• A. Correct. Mandibular tori are developmental bony exostoses on the lingual aspect of the mandible above the mylohyoid line, typically bilateral, covered by normal thin mucosa. Their longstanding presence and their stability confirm the diagnosis; no treatment is needed unless they interfere with a prosthesis.
• B. Incorrect. Peripheral ossifying fibroma is a reactive gingival growth arising from the interdental papilla. It requires a tooth to be present, and she is edentulous.
• C. Incorrect. Osteosarcoma is a rapidly enlarging, often painful destructive lesion with paresthesia and radiographic bone destruction. A lesion stable over decades excludes it.
• D. Incorrect. Pleomorphic adenoma presents as a soft to rubbery, mobile submucosal mass, most commonly on the palate. It would not be bony hard or immobile against the alveolus.

Note: Relevance to her prosthesis: mandibular tori sitting above the mylohyoid line can undercut the lingual flange and cause soreness. If they interfere with denture design and cannot be relieved, surgical reduction before impressions is appropriate.