An 84-year-old has had four sets of complete dentures made in fifteen years. Retention and extension are clinically good, but he states simply that he does not like them. What is the MOST important thing to assess before beginning any new treatment?

Correct answer: C. The patient's expectations and psychological adaptation

• A. Vertical dimension is worth checking, but four consecutive technically adequate prostheses point away from a purely technical cause.
• B. Ridge form matters, but it does not explain repeated rejection of prostheses judged clinically adequate.
• C. Correct. A history of MULTIPLE dentures that are technically satisfactory but subjectively unacceptable is the hallmark of the patient whose EXPECTATIONS, not whose prostheses, are the problem. In House's classification this is the 'exacting' or 'hopeless' patient. Making a fifth denture without addressing expectations simply reproduces the failure. The correct step is a frank conversation about what complete dentures can and cannot achieve, exploration of what specifically dissatisfies him, and consideration of implant-retained overdentures where indicated.
• D. Base material is rarely the cause of generalised dissatisfaction with well-fitting dentures.