care of removable prostheses Flashcards
define edentulous - fully and partially
- Being without teeth or lacking teeth
- Fully edentulous: No teeth
- Partially edentulous: 2 quadrants with 4 teeth missing/quadrant OR 3 quadrants with 3 teeth missing per quadrant
define prosthesis
A fixed or removable appliance that is functionally and cosmetically designed to replace a missing natural tooth or teeth
DEMOGRAPHICS OF TOOTH LOSS
Changing patterns in __________, professional care, and attitudes toward healthcare have __________ the number of completely _______ people
~__% of American adults are edentulous
1 out of 5 adults aged ___ years or older are completely edentulous
Dental hygienists are likely to see edentulous
patients in practice due to ______ life spans and
growing “older adult” population
Changing patterns in ORAL DISEASE, professional care, and attitudes toward healthcare have DECREASED the number of completely EDENTULOUS people
~5% of American adults are edentulous
1 out of 5 adults aged 65 years or older are completely edentulous
Dental hygienists are likely to see edentulous
patients in practice due to LONGER life spans and a growing “older adult” population
what major risk factors contribute to a persons edentulous status (8)
- dental caries
- periodontal diseases
- oral cancer and treatment for it
- oral injury
- low socioeconomic status
- inadequate access to professional oral care
- low frequency of professional oral care
- poor daily oral hygiene
what are psychologic factors and physiologic factors
PSYCHologic factors: attitudes and values, insecurity, loss of self esteem, unrealistic expectations, fear of aging
PHYSIologic factors: residual ridge and alveolar bone resorption (4x faster/greater in the mandible), oral mucous membrane remodeling, loss of orofacial muscle tone
what human needs deficit is tooth loss associated with when it leads to loss of self esteem and insecurity
wholesome facial image
what other factors are associated with tooth loss
- mesial drift
- extrusion
what are the 4 types of prostheses
removable dentures: can be removed by the patient
fixed dentures: cannot be removed
partial dentures: replace some teeth
complete dentures: replaces the entire dentition
what are removable implant-supported overdentures
removable complete dentures designed to fit over implant fixtures
can be snapped onto implants using attachments or retained by magnets
increased stability and retention compared to traditional dentures
what is an obturator?
what could the opening be caused by?
obturator: a prosthesis that closes an opening between the nasal and oral cavity
the opening could’ve been caused by:
-oral cancer removal
-an accident
-congenital anomaly (cleft palate)
what 3 challenges are associated with the replacement of missing teeth
- physical appearance
- speech disturbance
- masticatory efficiency
when replacing missing teeth, how is physical appearance a challenge
- alveolar bone resorption
- judged most critically by the patient themselves
when replacing missing teeth, how is speech a challange
- if a speech disturbance lasts longer than a few weeks, the prosthesis may be ill-fitted and need to be reevaluated by a dentist
- encourage pt. to read/speak aloud in front of a mirror
when replacing missing teeth, how is masticatory efficiency a problem
- reduction in efficiency with the use of prosthesis due to a loss of periodontal support and stability as well as periodontal proprioception
- instruct pt. to increase chewing time, consume smaller pieces of food, and distribute the food evenly when chewing
what factors affect the oral mucosa of denture wearing individuals (5)
- systemic diseases/conditions
- xerostomia
- denture occlusion and fit
- oral hygiene; biofilm control
- continuous wear of dentures; should be removed overnight (or at least 6 hours/day)
the longevity of removable appliances depends on the:
the health of the natural teeth depend on:
The longevity of the removable appliance depends on the health of the supporting teeth
The health of the natural teeth depends on the cleanliness of the prosthesis
prostheses induced oral lesions
what are 2 examples of traumatic/reactive lesions
denture-induced fibrous hyperplasia - an abnormal increase in the volume of tissue as a result of irritation
ulcers
prostheses induced oral lesions
what are 2 examples of infectious lesions
denture stomatitis - inflammation under the dentures characterized by redness, pain, and swelling
angular cheilitis - fissures at the corners of the mouth with cracks, ulcerations, and redness
prostheses induced oral lesions
what is an example of mixed lesions
papillary hyperplasia - trauma and infection are causative factors, cobblestone appearance
DENTAL CARIES PREVENTION
__________ teeth are at increased risk for caries and periodontal disease.
________, _________, __________ may need modification to reduce caries risk
Caries and periodontal involvement involving any abutment tooth can lead to ___________ and the patient may have more limited options for __________
ABUTMENT teeth are at increased risk for caries and periodontal disease.
DAILY ORAL CARE, TOPICAL FLUORIDE USE, AND DIET may need modification to reduce caries risk
Caries and periodontal involvement involving any abutment tooth can lead to TOOTH LOSS and the patient may have more limited options for REPLACEMENT
What are the 3 types of dentures
interim - a denture for esthetics/function for a LIMITED time, them it should be replaced by a definitive prothesis
immediate - placed immediately following the removal of teeth
conventional
4 examples of denture deposits
- food debris
- pellicle and biofilm
- calculus
- stain
CARE OF DENTURES
removal of the denture:
professional cleaning of the denture:
removal: done by the patient
professional cleaning: place denture in a bag with tartar and stain remover, place bag in the ultrasonic for 5-10 minutes depending on calc/stain; rinse and brush with denture brush; scale calc from the teeth avoiding the soft tissue
how to prepare for the cleaning
rinse, remove any adhesive, brush exposed mucosa with soft denture brush or with a soft cloth
what are the advantages to cleaning by immersion
- solution reaches all areas of the denture
- prevents unnecessary handling
- attractive for caregivers (they don’t wanna do that shit)
ALKALINE HYPOCHLORITE
- mechanism of action
- advantages
- disadvantages
mechanism of action: dissolves mucins and organic substances from prostheses biofilm matrix
advantages: bactericidal cleanser, fungicidal cleanser, bleaches stains, may inhibit calc formation
disadvantages: CORRODES METALS (never clean partials with), odor and taste, may bleach the acrylic
ALKALINE PEROXIDE
- mechanism of action
- advantages
- disadvantages
Mechanism of action: mechanical cleansing effect is caused by the release of oxygen (bubbling)
advantages: antibacterial effect, removes stains
disadvantages: harmful to soft liners, not effective at removing calc
CHLORHEXIDINE GLUCONATE SOLUTION
- mechanism of action
- advantages
- disadvantages
mechanism of action: antimicrobial action caused by chemical agent
advantages: antibacterial cleanser, antifungal cleanser
disadvantages: provides temporary relief of denture stomatitis symptoms, stains denture teeth
ULTRASONIC CLEANSING DEVICE
- mechanism of action
- advantages
- disadvantages
mechanism of action: ultrasonic sound wave action creates a vibrating/bubbling effect
advantages: removes biofilm, enhances the effectiveness of chemical cleansers
disadvantages: commonly an in-office procedure, efficiency of the ultrasonic is uncertain
MICROWAVE RADIATION (IN OFFICE ONLY)
- mechanism of action
- advantages
- disadvantages
mechanism of action: electromagnetic waves kill microorganisms
advantages: bacterial cleanser, minimal negative effect on resilient liners
disadvantages: high temperatures can affect dimensional stability of a denture
which products are chemical and which are antimicrobial
CHEMICAL: alkaline hypochlorite and alkaline peroxide
ANTIMICROBIAL: chlorhexidine gluconate, ultrasonic cleansing, and microwave radiation
why is it important to maintain regular professional care (4)
- assess oral tissues
- denture irritation may be a cocarcinogenic factor in predisposed individuals
- oral tissue changes may go unnoticed by the patient
- loss of retention, stability, and support must also be assessed
what factors should we teach the patient (5)
- how to self-exam their tissues
- how to handle/clean the prosthesis (don’t assume they know how to)
- risks when missing teeth aren’t replaced
- need for a professional evaluation of existing prostheses
- review wearing/removing habits
how to clean the prosthesis
- fill sink with water and line with paper towel to prevent breakage if dropped
- use denture brush with denture cleaning creams/pastes
- creams/pastes are for EXTRAORAL use only
- do not use traditional toothpaste on the denture - soak in denture cleanser overnight or for 6-8 hours PER DAY
what nutritional considerations must we take into account for individuals with dentures
- lack of ___________ magnifies tissue irritability and diminishes repair potential
- ill-fitting dentures may result in _______ difficulties
- _________ can affect food choices by causing clients to shy away from foods that require a lot of chewing; this results from the increase in denture _______ or the rubbing of the denture in a dry mouth as well as the lack of _______ to moisten the food to soften it and make it easier to chew
- lack of essential nutrients magnifies tissue irritability and diminishes repair potential
- ill-fitting dentures may result in chewing difficulties
- Xerostomia can affect food choices by causing clients to shy away from foods that require a lot of chewing; this results from the increase in denture friction or the rubbing of the denture in a dry mouth as well as the lack of saliva to moisten the food to soften it and make it easier to chew
what to document for a client with dentures (5)
- chief complaint
- stability
- intraoral findings
- oral hygiene instructions
- cleaning of prosthesis if provided
