Assessing patients and dentures Flashcards
what must be addressed before beginning patient examination
address the patient concerns and their reason for attending:
- why do they want a new denture, do they need one
- are they complaining of functional issues like pain, looseness, lack of retention, difficulty eating or speaking?
- are they complaining of their appearance ie tooth shade, amount of tooth showing
which problems should be identified regarding medical history before examining the patient
any issues which affect their treatment attendance, tolerance for treatment, and how they can live with dentures.
rheumatoid arthritis, stroke, mobility, mucosal disease, dry mouth etc
which elements of social history can affect if a patient can get dentures
are they living alone, in supported living or a carehome
how far do they have to travel to attend the appointment
do they have hobbies as musical instruments can impact the space they need in their mouths
do they drink or smoke
what is the diet like
which elements of prosthodontics treatment is relevant for a history taking prior to denture assessment
what type of denture is the patient wearing
how old is the denture
what materials have previous dentures been made from
do they have a favourite denture
which elements of a dental history are relevant for denture assessment
are they a regular attender or do they only come when they are in pain
how often do they clean their teeth
have they ever managed to wear dentures
how many dentures have they owned previously
how do they clean their dentures
do they take them out at night
what do you have to assess for a patient prior to dentures - extra oral assessment
look at the midline, is the incisal plane in line with the intrapupillary line, look at the aesthetics of the existing dentures,
what are the different lip positions
high - gummy smile
medium - normal smile
low - don’t see much tooth
what does the nasiolabial angle show
the facial support being provided by the teeth
what kind of nasio labial angle do people with teeth have
perpendicular
what to investigate regarding the soft tissues for denture examination
general exam, denture bearing areas, are they healthy, are they traumatised, are they clean and well looked after, are they red, is there any denture stomatitis.
why is intraoral access relevant for denture placement
does the patient actually have space to insert and remove the denture
why is plaque control important
the patient needs to have optimal oral hygiene before denture provision
why is dry mouth an issue for denturews
often this is medication related but an increase the chance of root caries
why would you want to leave retained roots when placing a denture
so there is no bone resorption
what to assess regarding the saddle areas for partial dentures
how atrophic is the bone
is there any displaceable tissue
what is the number, position, length etc
look for soft tissue undercuts that could be used for denture placement
what is the sulcus depth
frenum positions
what are some other special tests that can be used for denture assessments
electrical pulp tests
thermal tests
6 point pocket chart
clinical photography
what are the two classifications for the support and distribution of missing teeth
Kennedy classification
craddock classification
what regarding existing denture design should be assessed
draw it out and think about it, what is the condition of the teeth and the base, how is the hygiene
what are buccal corridors
space between the teeth and the cheeks, think of Wallace and Gromit who have small buccal corridors
what is denture retention
this means the retentive forces are exceeding the displacing forces so it stays in place
why is it important for the denture to be stable
it must move little in relation to the underlying bone during function, does it rock or move side to side, this can cause friction and wear and ulceration and be uncomfortable for the patient
what can over extension of the dentures lead to
discomfort
looseness in function
speech issues
impingement on frenal attachments
difficulty swallowing and gagging
what can under extension lead to
looseness in function, traumatic ulceration, food trapping under the denture
what is occlusion
the static relationship between masticatory surfaces of the upper and lower teeth
what to regard about occlusion for denture assessent
do the teeth meet when the denture is in place
is there space between the upper and lower teeth at rest
do any of the denture components interfere with occlusion\
are the denture teeth worn
is the lower face height restored when the denture is in place
what are index teeth
when the upper tooth meets the lower corresponding tooth to give the occlusal vertical dimension, the index teeth are these.
when assessing dentures, look at damage. which features can be damaged that you should look for
framework and clasps
acrylic components
how can framework and clasps of dentures be damaged
clasp fracture or removal
alterations to the major connector
fracture to major and minor connectors
how can the acrylic components of dentures be damaged
added teeth
wear on teeth
fractured teeth
fractures to base plate
repeated debone of acrylic components from the framework