3. Fully edentulous patient Flashcards
Define fully edentulous patient (2)
- Individual (usually an adult) without erupted teeth nor tooth buds in its jaws.
- lost all of his/her teeth or never has had any
Define edentulism
state of being edentulous; without natural teeth
What was the prevalence of edentulism in 1975 in the US
11% of population
What was the prevalence of edentulism in 2000 in the US
10% of the population
Avg age for edentulism?
70-80
What decreases the prevelence of edentulism? (2)
prevention and conservative dentistry
What increases the prevalence of edentulism?
increased life expectancy
Etiology of edentulism? (4)
- Periodontal disease ( most common cause)
- Caries
- Traumatisms
- Anodontia
What is anodontia? (2)
- congenital absence of teeth
- Usually due to hereditary syndromes, like ectodermal dysplasia
What is the most common Etiology of edentulism?
• Periodontal disease
What changes when a patient is edentulous? (5)
Personality • Facial changes • Intraoral changes • Extraoral changes • Functional changes
What personality changes occur with edentulism?
-shyness
First appointment with an edentulous patient should not be…
very through
What facial profile changes occur with edentulism? (5)
- Decreased VD
- Loss of bone support for perioral muscles.
- Lip alterations
- Pseudoprognathism
- Deepened facial furrows
What lip alterations occur with edentulism? (3)
- Lip collapse.
- Loss of lip expressivity.
- Widening of the mouth
What deppened facial furrows occur with edentulism? (2)
- Nasolabial furrow.
- Corners of the mouth:
Due to loss of VD » angular cheilitis.
Edentulism: What intraoral changes occur with oral mucosa ? (3)
• Two kinds: masticatory mucosa (attached gingiva)
and lining mucosa (alveolar mucosa).
• Muco-gingival junction.
• Atrophic mucosa
Edentulism: What happens with atrophic mucosa ? (4)
- Slimming of mucosa.
- Retraction.
- Loss of elasticity.
- Fragility.
Edentulism: Bone reabsorption factors? (4)
• Anatomical factors: previous quantity and density of bone.
• Metabolic factors: bone metabolism (PTH, TSH,
calcitonin)
• Prosthetic factors: bad fit of the prosthesis.
• Surgical factors: careless tooth extraction
• Functional factors
Edentulism: what are the functional bone reabsoprtion factors? (3)
- Pressure (Bose’s law & Jore’s law)
- Vascularization
What is Bose’s law? (5)
- functional bone reabsorption factor
-Intensity of pressure
§ Strong pressure: high resorption
§ No pressure: high resorption
§ Mild pressure: least resorption
What is Jores’ law? (5)
- functional bone reabsorption factor
- Frequency
Constant pressure: resorption
§ Discontinuous pressure with short resting
times: resorption.
§ Discontinuous pressure with long resting
times: least resorption.
Vascularization and bone reabsorption? (2)
- functional bone reabsorption factor
- Too much or too little can
promote bone resorption
Edentuluism: What intraoral changes can occur? (5)
- Oral mucosa
- Bone reapsorotion
- morphology of alveolar ridge
- tongue
- saliva
edentulism:
What type of resorption occurs for the upper alveolar ridge?
Centripetal - more from the vestibule
edentulism: What happens to the upper alveolar ridge? (2)
- Alveolar ridge loses height and rounds off. Usually height is no more than 1-1’5 cm.
- Reduction of the radius of the curve of the ridge
Edentulism: What are the possible shapes of the upper alveolar ridge? (3)
- U shape
- V shape
- C shape
Describe the U shape of the upper alveolar ridge (2)
The best. More retention and
stability
Describe the V shape of the upper alveolar ridge (3)
- Typical of the long-term edentulous patient.
- The edge is an area of trauma.
- Less retention and stability.
Describe the C shape of the upper alveolar ridge (3)
- Drop shape
- Convex sides.
- Trauma while placing and removing the denture if the
denture base is overextended.
Edentulism: What happens to the lower alveolar ridge? (3)
- Increase of the radius of the curve of the ridge.
- Up to 4 times higher resorption than in the upper ridge
- High resorption highlights chin, coronoid process, gonion
What type of resorption occurs with the lower alveolar ridge?
Centrifugal - more resorption of the lingual bone
Edentulism: What is the height of the lower alveolar ridge? (2)
- 3-0.5 cm.
- Can even be 0 cm or even negative
Edentulism: What is the shape of the lower alveolar ridge? (2)
- “V” shape in the anterior ridge
- “U” shape in the posterior with flat occlusal portion.
Edentulism: What intraoral changes does the tongue go through? (3)
- General atrophy of epithelium and filiform papillae
- Macroglossia » Tongue invades teeth space.
- Decreased taste sensitivity. Taste buds.
Edentulism: What intraooral changes occur with saliva? (2)
• Decrease in the amount of saliva. • Affects minor salivary glands, which produce mucous saliva (therefore worse retention for dentures)
Edentulism: What extraoral changes occur? (3)
- TMJ.
- Masticatory muscles.
- Nerve sensitivity changes.
Edentulism: What extraoral changes occur with the TMJ? (2)
- Dysfunction.
* Osteoarthrosis.
Edentulism: What extraoral changes occur with the masticatory muscles?
Atrophy due to hypofunction
Edentulism: What extraoral changes occur with nerve sensitivity? (3)
- Decrease in proprioception.
- Decrease in coordination and neuromotorcapability.
- Decrease in adaptation capability to carry a denture.
Edentulism: What extraoral changes occur with proprioception nerve sensitivity ? (3)
- Epicritic touch (pressure, vibration, location of stimuli).
- Loss of peridontal propioceptors.
- Loss of taste sensitivity.
Edentulism: What functional changes occur? (3)
- Masticatory function
- Deglutition function
- Phonation function
Edentulism: What functional phonation changes occur? (2)
- difficulties with interdental and labiodental sounds
* Prosthetic dysglossia.
What is prosthetic dysglossia? (2)
- Prosthetic teeth are located differently than natural teeth
- Tongue changes its movement pattern (direction, speed and pressure)
Edentulism: What functional deglutition changes occur? (2)
- Use perioral muscle and tongue to help swallowing
- Choking: Lack of mandibular stablility frequently implies diffculty in hypopharynx elevation
What occurs during normal deglutition? (2)
- tooth contact occurs
- stabilizes mandible
Edentulism: How does a denture help deglutition changes? (4)
-recovers physiologic swallowing pattern for correct hyoid bone movement:
- tooth contact
- tongue pressure against front palate
- mandible stabilization
Edentulism: What functional masticatory changes occur? (4)
- Decrease in food chewing/ grinding
- Oral mucosa adapts to friction from food.
- Neurosensory changes
- Decrease in muscle strength - 5x less
Edentulism: What functional masticatory NEUROSENSORY changes occur ? (4)
- Less capability to detect food b/w occlusal surfaces.
- Produces an increase in muscular tonus » ↓VD.
- No slowing down of teeth before tooth contact.
- Adaptation period before
patient can learn new neuromuscular patterns.
Edentulism: What functional masticatory changes occur when the patient has a denture? (2)
similar to that of the dentate patient, but they get modified
when there is a denture
