Complete dentures

DiRcult

denture

birds

Alex Koper,
B.S., D.D.S.*
Inglewood,
Calif.

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.
2.
3.
4.
5.
6.
7.

They complain.
They have pain.
They are hostile.
They exhibit regressive behavior.
They are tense, anxious, and appear unhappy.
They often have systemic illnesses.
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 WHISTLERS

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 Whistlers 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 lawkorchoo
Gobblrr
(Fig. 1) who uses two separate lower dentures-- -on<
for speaking and one for eating, I can readily identify five of the more colorful
varieties which migrate from dentist to dentist in these United States.
COOKIES,

SWEET TALK, AND BRASS KNUCKLES

The most deadly is the Karate Hazek (Fig. 2) He is a freyuently

observed
predator whose insatiable need for new dentists to destroy compels him to fly in
ever-widening
circles. Forced by his reputation
to seek out new and unsuspecting
dentists to conquer, his hunting range is limited only by the amount of distance he
can afford to travel. Most often discovered in the offices of recent graduates, this
carnivorous
species has a particular
love for the flesh of new enthusiastic
dentists
who are full of knowledge and the confidence of youth. The female Karate Hawk
is most difficult to identify because she is very deceptive. This bird successfully disarms her prey by continuous flattery and gifts of home-baked cookies.
Generally, she dresses conservatively,
often refers to her activities as a devoted
mother, her community
achievements,
and her pious dedication to home and husband. Concealed under a demure hair-do are two sharp horns, which are apparen,
only to the most wary observer. Hanging from her belt, and concealed in the folds
of her clothing, are a pair of brass knuckles and a rubber truncheon.
One way to identify
this hawk is to engage her in conversation
about her
previous dentists. It will then be observed that her eyes will turn fiery red, and her
face becomes flushed as she relates her tales of conquest. Generally,
this species

Vcllume 17
Number fi

Dificult

denture

birds

535

Fig. 2

Fig. I

wears an upper denture made by one dentist and a lower denture made elsewhere.
In her purse she carries other trophies of previous kills. Another revealing clue is
her handshake. This hawk, tiny and thin as she may be, can crush the hand of the
average greeter. This is an important
identifying
sign, which I shall soon exain.
Pl
Generally this species is very cooperative
at the beginning
of treatment,
and
will so lull the dentist that he will wonder why anyone with such excellent coordination and healthy ridges should ever have difficulty with artificial
teeth. Only after
the dentures are placed does the trouble begin. This patient has so much hostility,
and is so strong, that she fractures porcelain denture teeth as though they were
peanuts. After three days, all semblance of balance of the posterior teeth is destroyed,
and the anterior teeth begin to crack away. If gold occlusal surfaces are used, the
upper denture base soon splits under the stress of the extraordinary
strength of this
sweet, quiet-spoken,
but deadly creature.
GOING

MY WAY?

The Myway Mug@

(Fig. 3)) also known as the Hertz Bird, wears the feathers
of a hard working solid citizen whose occupation, if a male, might be an examiner
for the Internal Revenue Service; the female is generally the president of the local
chapter of the League of Women Voters.
The Myway Magpie generally appears with dentures worn in the pocket or
purse. One hand holds a suitcase which contains a complete set of instruments for
setting up teeth and waxing a denture base, in the other hand is a 25-year-old copy
of Swensons Complete Dentures (in a plain wrapper, of course), and coiled over
one shoulder at a jaunty angle is a large whip of the type used by lion tamers.
At first an amiable creature, the Hertz Bird readily agrees to the fee, and can
hardly wait to get started. This is because having dentures made is an engrossing

Fig. 3

avocation for this bird, and the fee is rarely paid because the dentist seldom completes his treatment.
As its name implies, this bird must be in the drivers seat. It should be pointed
out that, at all times, this creature maintains a sporting attitude. In his conversations with the dentist, he will occasionally use phrases like balanced occlusion or
incisal clearance,
and now and then he will chirp out the word centric.
If he
does not feel he has given the dentist enough warning, he may casually mention
the fact that he was a navy dental corpsman for three weeks during World War II.
The preliminaries
are over when the try-in begins. Now the Myway Magpie
takes charge of all aspects of the construction.
No set-up is satisfactory. The teeth
must be changed. Their color is wrong, They are too long or short, or they just do
not feel right. Months may go by, and spouses or other supporting relatives may be
called in to support the contention that a marriage is being ruined by the dentists
inability
to achieve the proper esthetics for this person. Often, if the dentist lasts
long enough, the patient will take over completely. The following is an excerpt from
a grievance committee
case; the dentists reply to a patients complaint.
IIere, in
part, is the chronicle of his experiences with a Myway Magpie:
She threw her hands up in despair and said: You just wont set them the way I tell
you. If you will just give me an instrument 111 show you how I want them. I thought-What
have I to lose in humoring her? Ive tried everything
else without being able to satisfy her.
So I lit the fire in the lab, set out a wax spatula and wax, and invited her to be my guest. I
thought she meant to shift a tooth or two. That was where I was mistaken.
At 5 P.M., Mrs. B. was still setting teeth. Words cannot describe the results! This,
she
said, is the way I want them. I asked her repeatedly,
Mrs. B, are you sure that is what

Volume 17
Nutiber 6

Dificult

denture

birds

537

you want ? I asked her to assure me that she would be satisfied if we completed the case thus.
She said that she would. That wax was a mess, to put it mildly. I assured her that we would
not shift a tooth.
The completed denture was to be delivered on Monday. . . etc., etc.

It goes without saying that this patient

this dentist to fly to the next encounter.
MAKE

won again,

and was soon released by

ME LIKE I NEVER WAS

The Minewere
Mallard
(Fig. 4)) also known as the I Usta Duck, or the
Younger
Than Springtime
Buflehead,
is one of the most frequently
encountered
species of the Denturus Calamitous Americanus family. This feather-brained
creature
is generally a female who achieves full maturity during, or shortly after her menopause. Flush with insurance money gained from a recently buried husband, or full
of the freedom and lust for further adventure that a substantial divorce settlement
affords, this bird descends upon the prosthodontist
full of heady visions of herself
with new dentures.
The Minewere Mallard may be identified by her habit of flying backward-so
that she can always see where she has been. Her mode of dress may be described as
teen twentyish
or more accurately, nineteen twentyish.
Positive identification
is
achieved when this beauty emits the shrill raucous call characteristic
of the species.
This is the Minewere
or I Usta sound, as in <Minewere always very white and
small and perfect, or I Usta look fuller in the face than this, or Mine Usta fit
tighter, Doctor!
This creature harbors an image of herself which never existed, and can never
be restored. Completely
oblivious to the reality of her physical limitations,
she
naturally becomes disenchanted with her dentist. Her high hopes of regaining many
lost years are unrealized and she seeks remedies of her own. It is not uncommon for
these birds to place cotton under their lower dentures, or to line their cheeks with
multiple sticks of chewing gum. The results are often grotesque and harmful. The
do-it-yourself
liners are the final step for these poor creatures, who have run out
of dentists who will treat them. They spend their remaining
days trying new nostrums, and busily changing the liners and plumpers on their dentures, as their ridges
slowly shrink away.
ETERNALLY

YOURS

Not all species of the Denturus Calamitous Americanus

exhibit aggressive behavior. The Forever Flicker (Fig. 5) is a gentle creature with a chisel-shaped beak
(for breaking through locked doors) and a heart full of love. This hardy cousin of
the woodpecker,
also known as the Sweet-Lipped
Sapsucker, has an affinity for
the dentist who has chronic duodenal ulcers and a short temper. Some instinct sends
this bird in search of a dentist with a passion for order: the kind of man who likes
to plan his treatment carefully, make the dentures, and complete a case. Once the
right man has been spotted, this delicate creature nests in for a long stay. Generally
she moves within walking distance of the office to save bus fare, but it is not uncommon
for this species to make regular visitations over the years from quite a
distance. This is the Pilgrimage
Variant of the species.

538

.I. Pros. Dent.

.Junr. 1967

Koper

Identification
of the Forever Flicker can be made early if the dentist can hear
this bird sing. If she is left alone in the chair for a while, one may hear a continuous,
clear, double-noted
warble that sounds unmistakably
like Till the End of Time.
Without this clue, it is only possible to identify the bird after it is too late to matter.
This species is strictly a low pressure operator. There are no heartrending
exclamations, no threats of legal action, and no comparisons with previous dentures.
Ill will has no place in this lifetime liaison. Instead, there is an endless series of
gentle complaints
(say one per week) forever. The dentures always need adjusting.
cleaning, sharpening,
repairing,
refitting,
relieving,
lightening,
or tightening.
Specific instructions
not to return, or extra charges fomr additional
services are
accepted with sweet tolerance and a patient smile by this persevering bird, because
she knows something the dentist does not: only death will sever their relationship.
It is simply a matter of who goes first.
THE GUMMY

RUMMIES

The next group of difficult denture birds is an often-encountered

species. Because they vary so much in behavior and appearance,
they are known by many
names. Some of the more familiar are. the Tipsy Pipit, the Hollow-Legged
Tanager,
the Rummy Robin, and the Martini
Meadowlark
(Fig. 6). These feathered chasacters, together with their cousins (the Heroin, Marijuana,
or LSD Juncos [Fig. 71)
form a colorful group whose numbers appear to be growing.
These playboys and girls display a wide variety of bizarre songs and markings.
noted in all but the J~ncos, is an affinity for
A common identifying
characteristic,
spiritous liquids to the exclusion of other forms of nourishment.
The odor of alcohol
and makes identification
easy. Occasionally,
these
accompanies
every exhalation,
birds will reek of cologne or Bay Rum. One does not need to look hard for these
free spirits, because they are found everywhere. They fly about on unsteady wings
in search of a dentist who will make dentures which can float on their booze-ridden.
fragile, and undernourished
oral tissues.

FolQVETL

LSD

FtiCK=
Fig. 5

Fig. 6

JUWO
Fig. 7

??kz
6
Unfortunately,
these pathetic creatures cannot
constant support of their dentist, so that, unwittingly,
pattern of addiction.

Difficult

denture

birds

539

tolerate dentures without

the
he also becomes a part of their

THE WOODS ARE FULL OF THEM

These descriptions of a few species of the Denturus Calamitous Americanus are
intended to sharpen the eyes of difficult denture bird watchers everywhere. There
are many varieties yet to be described. The Gagging Grackle or the Bruxing Booby
are often sighted. The Ridgeless Firemouth
Raven is not an uncommon sight, and
the Whittling
Denture Dove has always been with us.
The woods are full of these unfortunate
suffering individuals.
They confound,
frustrate, and antagonize us, but their needs are so varied, and their problems so
intense, that they stimulate and challenge us to seek new ways to help them.

References
1. Schultz, A. W.: Management
of Difficult
Denture Patients, J. PROS. DENT. 11: 4-8, 1961.
2. Koper, A.: Why Dentures Fail, D. Clin. N. America 721-734, 1964.
3. Brewer, A. A.: Treating Complete Denture Patients, J. PROS. DENT. 14: 1015-1030, 1964.
645 E. AERICK STREET
INOLEW~~D,
CALIF. 90301