5. Denture Related Pathology Flashcards
- Occurs will almost all new dentures
- No big deal unless in a radiated pt susceptible to mucosal perforation –> osteonecrosis
Denture Sores
What is the cause of Denture Sore Mouth?
- ill fitting dentures
- Dirty dentures
- Wear them 24/7
What is the clinical appearance of Denture Sore Mouth?
- Diffuse red velvety area sharply defined by the area of coverage
What should all cases of DSM be checked for the presence of?
Candida
What are the 2 ways a pt can develop Papillary Hyperplasia?
- Long standing DSM –> granulation tissue develops and matures into fibrous papules (pink and firm) with a cobblestone appearance
- Pt w/o denture but has a high vaulted palate, that promotes candida, that causes PH
What pathology almost always has candida due to increased area for the fungus to hide?
Papillary Hyperplasia
What is the Treatment for Papillary Hyperplasia?
-
Early Lesions
- Denture remake/reline, OHI, antifungals
-
Mature Lesions
- once the collagen matures it will not resolve
- Surgically remove (Cautery or Laser)
Why is there PEH in the histology of Papillary hyperplasia?
- Inflamed palatal salivary gland ducts show reactive squamous metaplasia
What causes Epulis Fissuratum?
- Overextended denture flange - iatrogenic
- Ridge resorbed under old or temporary denture that the pt wore too long, and now the denture sits lower because of the ridge resporption
What is the clinical appearance of Epulis Fissuratum?
- Parallel flabby fibrous folds, on each side of the flange
- Seperated by a longitudinal fissure where the flange sits
- Central fissure is usually ulcerated
What is misdiagnosed as Epulis Fissuratum?
Cancer of the Vestibule
- Rare cancers have developed
What are the 3 possible causes of Angular Cheilitis?
- Candida (perleche)
- Deficiency of B-Complex Vit. or Iron
- Rarest
-
Overclosed VDO
- Biggest Cause!!!
How does Osseous and Chondromatous Metaplasia occur?
- Unstable denture rocks anteriorly on an atrophic ridge
-
Irritation of periosteum causes spurs of bone or cartilage to form
- Cartilage in the jaw is bad can be Chondrosarcoma
What are the clinical features of Osseous and Chondromatous Metaplasia?
- Usually Female
- Cause Pain
- Firm bumps in vestibule
- X-ray shows RO spurs
What is the pathogenesis of Sub-Pontic Osseous Hyperplasia?
- Crestal bone proliferation associated with irritating pontic
What is the radiographic presentation of Sub-Pontic Osseous Hyperplasia?
-
RO above the edentulous crestal bone, under a pontic
- Don’t want to see bone growing above the crest of the ridge aka Osteosarcoma
- So BIOPSY!
How does Frictional Hyperkeratosis present?
-
Many clinical white patches on ridges
- Represent benign hyperkeratosis resulting from Denture Irritation
What occurs in Florid Osseous Dysplasia?
- Dense masses of sclerotic bone and cementum form in the mandible for unknown reasons
- Remains stable until a denture is made
- Normal bone resporption that accompanies dentures exposes the sclerotic bone which becomes infected and sloughs
What population is Paget’s Disease seen in?
Elderly - bone expands and softens
What is the classic oral sign of Paget’s Ds?
Expansion of the Maxilla with pt complaint denture no longer fits
In what ways are Diabetes pts aftected by dentures?
- Excessive Ridge Resportion with lowered VDO causing Angular Cheilitis and the flange becomes pushed into the vestibule causing Epulis Fissuratum
- More susceptible to Candida
Where does Nicotine Stomatitis occur?
- Unexpected Soft Palate
- Denture protected the hard palate from the heat of the smoke and shunted it posteriorly
What types of diseases are aggravated by ill-fitting dentures and improved by well fitting dentures?
-
Sloughing Diseases
- Pemphigus
- Pemphigoid
- Cicatrical Pemphigoid
- SLE
- Lichen Planus
- ELP
- Lupus Eryth.
