3. Examination of PE Patients

Question 0

Initial Consultation - Medical History

Initial consultation follows the same steps as you would with all other patients. However, some additional information is required for improved patient management.

Answer 0

Medical History
We pay more attention to conditions that may impact to both oral health and RDP use:
- Xerostomia (MUSATRIADS)
- Epilepsy (may cause RDP fractures)
- Neurological conditions (e.g. Parkinson’s disease)
- Intellectually or physically handicapped patients
- Lack of motivation
- Impaired manual dexterity
- Paget’s disease/Arthritis
- Smoking

Question 1

Initial Consultation - Dental History

Initial consultation follows the same steps as you would with all other patients. However, some additional information is required for improved patient management.

Answer 1

We assess:

• Reasons of tooth loss
• How long patient has been edentulous?
• Patient’s attitude to tooth loss/edentulous
• Level of masticatory function
• Expectations of patient of prosthodontic treatment

Question 2

Initial Consultation - Denture History

Initial consultation follows the same steps as you would with all other patients. However, some additional information is required for improved patient management.

Answer 2

We take note of:
- Any success or failures in previous RDPs
- Dissatisfaction or success of current RDPs
- Is RDP design appropriate? Retentive? Hygienically designed?
- Any evidence of traumatic changes in oral epithelium due to denture
impingement
- Any angular cheilitis?
- Take note of patient’s attitude to their RDPs
- Any discrepancies between satisfaction and quality of their RDP

Note: for patients that have become recently E or PE, and if there will be a long delay in the issuing of denture, during this time, the pt may learn new mechanisms or get used to new motions of the tongue which may lead to complication when denture is issued.

Question 3

Prosthodontic Assessment

Oral Examination

Initial consultation follows the same steps as you would with all other patients. However, some additional information is required for improved patient management.

Answer 3

Anatomy of PE spaces

Any loss of occlusal stability, occlusal vertical dimension or interrupted occlusal plane

Evidence of TMD

Periodontal and restorative status of abutment teeth

Quality of Oral Mucosa
- Keratinized attached mucosa is the remainder of the attached gingiva
after removal of teeth
- The more KAM, the better the support and tolerance of occlusal load

Question 4

Prosthodontic Assessment

Oral Examination

Answer 4

Muscle Attachment
- Frenulum (folds of mucous membrane abundant in fibrous CT) can:
> Limit denture extension
> Difficult to achieve seal
> Affect retention of maxillary denture
- Tongue position affects stability and retention of mandibular denture
- Buccal shelf extension depends on buccinator muscle and resorption
of alveolar bone in that area.

Saliva
- Low salivary flow causes:
> Reduced tolerance to denture due to increased friction
> Difficult to achieve & maintain peripheral seal esp of max denture
due to reduce intersurface surface tension
> Increased risk of fungal and bacterial infection/diseases

Question 5

Prosthodontic Assessment

Oral Examination

Answer 5

Neuromuscular Control
- May affect patients ability to manipulate their lower denture and
control bolus simultaneously
- Note that patients with good neuromuscular control can overcome
unfavourable bearing surfaces and contours

Bone Contour

• Mylohyoid ridges
• Alveolar ridge resorption
• Palatal vault
• Hamulus notch
• Maxillary tuberosity

Question 8

Prosthodontic Assessment

What do we look at during denture assessment?

Answer 8

Posterior teeth
- Assess tooth forms, materials and wear of teeth.
Retention
- Maxillary: apply tipping force to incisors to attempt to break seal
- Mandibular: apply unilateral force to posterior occlusal surfaces
Stability
- Apply unilateral force to posterior occlusal surfaces of denture
Vertical Dimension of Occlusion
Occlusal Stability
Aesthetics