CD - Long Term Review

Question 1

When reviewing denture - what surfaces must you consider?

Answer 1

1. Denture
2. Soft tissues
3. Hard tissues

Question 2

What problems can affect soft tissue?

Answer 2

1. Infections - denture candidosis
2. Hyperplasia - denture granuloma
3. Neoplasia - dysplasia/ cancer

Question 3

What is candidiasis?

Answer 3

Fungal infection
Will see distinct boundary line - redness confined to denture 
Need good oral hygiene 
Asymptomatic most cases
Can see hyperplastic tissue 
Can get associated angular chelitis

Question 4

Management denture candidosis?

Answer 4

Identify cause

1. Poor oral and denture hygiene
2. Leaving denture in at night
3. Excessive face height - angular chelitis
4. Unretentive denture
5. Systemic disease - diabetes/ immunocompromised

Question 5

How to tx mild-moderate case of candidosis?

Answer 5

1. Improve oral and denture hygiene
2. Replacement denture
3. Antifungals - topical

Question 6

How would you give oral and denture hygiene advice?

Answer 6

1. Fill basin with water (avoid breaking denture)
2. Clean denture with soap and water using a normal toothbrush
3. Clean palate, tongue and ridges with soft toothbrush and water
4. Immerse denture in millions overnight (1% bleach)
5. Rinse before replacing in mouth

Question 7

How would you use antifungals?

Answer 7

Often when providing new denture - monitor oral and denture hygiene during fabrication stage 
Prescribe anti-fungals at try in stage
Use miconazole gel/ nystatin pastilles
Review
If not cleared - reconsider diagnosis

Question 8

What should you check if prescribing miconazole gel?

Answer 8

Warfarin status

Question 9

How to tx severe/ resistant cases of candidosis?

Answer 9

1. Protocol for mild-moderate
2. Bacteriological swab
3. Consider topical and systemic antifungals - liase w/ GP

Question 10

What is denture granulomata?

Answer 10

Mixture of hyperplasia and inflammation
Irritation = chronic inflammatory response

Denture may need to be adjusted/ overextension removed

Question 11

What to consider when thinking of neoplasia?

Answer 11

Significant ulceration in mouth - esp non-healing
Ulcers - if no obvious case - refer urgently
Ulcer - obvious cause (e.g trauma) - manage and review

Question 12

What problems should you look for in the hard tissues?

Answer 12

Pain/ insecurity

All related to alveolar resorption

Question 13

What is protrusive overclosure and how tx?

Answer 13

Due to combination of alveolar resoprtion and denture wear

Tx

1. Reline denture
2. Occlusal pivots - raised acrylic occlusal surface of teeth to prevent overclosurei
3. Replace denture - change jaw relationship

Question 14

What problems can be seen with denture it self?

Answer 14

1. Wear

2. Fractures - diagnose before repair

Question 15

Why can dentures become worn?

Answer 15

Unilateral chewing habit
Age
Identify cause

Question 16

What are different types of denture fracture

Answer 16

1. Impact
   - Isolated event –> repair and advice
   - Repeated –> reinforce w/ reinforced resin
2. Fatigue
   - Age –> replace
   - Hypochlorite solution - leach plasticiser - increase brittleness
   - Predisposing: space, weakness, lack labial flange

Question 17

What are other solutions for fractures of denture?

Answer 17

Cast metal base - problem w/ retention
Stainless steel mesh
Vulcanine - carbon fibres/ glass fibres