Complete Denture Problem Solving Flashcards
How do you clean dentures that are metal and acrylic?
- soak in alkaline peroxide for 15 mins or alkaline HYPCHLORITE for 10 mins in evening
- Rinse and soak over night in cold water
NO ACID CLEANER
How do you clean acrylic resin dentures?
Rinse denture after each meal and remove debris with a soft brush/soap/water
ALKALINE HYPCHLORITE for 10mins in the evening
Rinse with cold water and store in cold water over night
How do you clean the temporary soft linings?
Eg viscogel
Rinse denture after each meal with cold water and soak in water them rinse thoroughly in cold water
DO NOT a USE ALKALINE PEROXIDE
How do you clean the permanent soft linings?
Molloplast B
Rinse dentures after each meal and remove debris with a soft brush soap and water
Soak denture OCCASIONLLY in ALKALINE HYPOCHLORITE for 20mins
Rinse with cold water and soak over night
Name the solutions for denture cleaning and when they are used.
Acrylic: alkaline hypochlorite 10 mins
Metal and acrylic : alkaline HYPCHLORITE or peroxide: NO ACID 10mins
Temp soft linings: NO PEROXIDE
Perm soft linings: ALKALINE HYPOCHLROTE 20mins
What is an an example of the alkaline HYPCHLORITE cleaner?
Dentural
Milton
What is an example of the acid cleaner?
Denclen
What is an example of the peroxide cleaner?
Sterident
What can predispose to a broken denture?
Poor fit Previous repair Stress connector Thin or under extended flanges Tooth wear Absent flange Lack of adequate relief Poor clinical design
What are the two types of denture fracture?
Flexural fatigue
Impact fracture
What is Flexural fatigue?
Occurs when there has been repeated flexing of the material
Repeated small loads
What is impact fracture?
Occurs out of the mouth due to a sudden blow eg dropping
How can you reinforce dentures?
Chemical modification of PMMA
Addition of fibres to PMMA
Add metal strengthers to PMMA
What can cause a loose denture?
Denture related: Impression surface, Polished surfaces , Occlusal surface
Wearer: unstable foundation, poor NM control, inadequate saliva
What can go wrong with the impression surface?
Poor impression
Damaged to working model: handle carefully and consider sectional removal of the special tray, and careful trimming
Warped denture: need careful processing techqnie and dentures must be kept moist
Excessive Palatal relief chamber:
Absent or deficient most dam
When is a Palatal relief chamber needed?
Rarely indicated but sometimes for prominent maxillary tori
It can lead to uneven ridge compression and can epithelial hyperplasia beneath the chamber
What shape should you post dam be?
Bow shaped
Carved on working model
What can you do of there is a deficient post dam?
Add on at chair side or reline which is preferable
What are the problems arising from the polished surfaces?
Under extended borders in depth and width
Overextended borders in depth and width
Polished surfaces not in neutral zone
What can you do for under extend borders in depot hand width?
Exam the peripheries especially distal buccal of tuberosities and distolingual of the sulci of retro molar pad
Use careful trimmed special tray with good border moulding
What can you do for over extended peripheries?
Correct small areas by trimming and for gross over extension border mould or reline
What problems can arise from the occlusal surfaces?
ICP not equal to RCP
Premature occlusal contact
Locked occlusion
Occlusal plane incorrect
What can cause unstable foundation?
Flabby ridge
Atrophic lower ridge
Prominent mylohoyoid ridges
What can cause poor NM control?
Parkinson’s
Stroke
What can cause inadequate salva?
Sjorgen
Radiotherapy
Psychosomatic
What happens to the tongue once you have extracted molars?
The tongue spreads buccal
Where is the neutral zone technique applied?
The lower
What happens to the posterior teeth in the neutral zone techqniey?
They are narrowed to keep them in nutral zone
What is the purpose of a denture fixative?
Aids retention of the denture
When do you need to be cautious of using demure fixates?
Sometimes can mask underlying problems
What are the two types of denture fixatives?
Temporary and permanent
What happens to the temporary denture fixatives?
Eventually will be lost and swallowed
What happens to the permanent fixatives?
Preformed sheets which can be trimmed to the desired shapes
T/f permanent fixatives contain soluble products?
T
What is the life span of the permanent fixatives determined by?
The expertise of operator
What are the components of fixatives available?
Adhesive + antibac + flavouring + wetting agent + preservatives
Adhesive: gelatin, pectin, sodium carboxymethylcellulose
Antibac: sodium tetraborate + hexachlorphene + ethanol
Flavour: peppermint
Wetting: mineral oil
How can denture fixatives affect mastication?
There has been shown to be an increase in denture biting force with fixatives in place
How can denture fixatives affect OVD?
Shown to be an increase in OVD esp with preformed sheets
How do denture fixatives work? And how does thickness affect how it works?
Chemical and physical action
- Absorb water and swell: causes attraction between anions and an increase in viscosity of fix increases retention
- Forms a layer which blocks space between denture base and mucosa
Cannot be too thick since decrease in retention
What are the biological action of denture fixatives?
Over time fix is lot and swallowed along with food and drink
This will lead to a long term ingestion of components
Which key ingredient in denture fix is a problem with long term swallowing?
Karaya gum
Leads to
epigastric pain
angioneurotic oedema
Hives
What is the effect of the Antimicrobials on denture fix?
Influence microforms and inhibit growth so some organisms therefore must limit use in IMUNNOCOM
When are denture fixatives recommended?
Those with poor anatomical denture support and continued difficulty with retention
Poor NM control
Xerostomia
Obtuarators
After new dentures inserted until neuromuscular control is developed
When are eg denture fixes NOT used?
Following insertion of immediate dentures- use viscogel
For retention of clinically unacceptable dentures
What can cause the painful denture?
Denture related
Denture wearer
Generalised
Localised
What are the problems with the denture that can cause pain?
Impression surface Damaged fit surface Extension into undercuts Inadequate reflief Deep post dam
What can go wrong with the fit surface to cause pain? How do you mange this?
Blens or acrylic spurs
Faulty impression
Damaged working model
Poor processing
All of those!!!
Asses by running finger along surface or drag gauze and then remove
How can pain due to extension into deep boney undercuts present?
Localised pain on insertion and removal usually on upper labial anterior and distal tuberosity
Identify by direct lesions, may be ulcer, use pressure paste and adjust
How can inadequate reflief cause pain?
Need relieve areas where
1. Incompressible mucosa, boney prominences, Atrophic mucosa, muscle attactchement
Can be localised or generalise
Identity and relieve these areas and place soft lining where appropriate,consider pre prosthetic surgery
What do you do if the post dam is too deep and causing pain?
May cause pharyngeal pain
Minor adjustment and consider reline
What can happen if the teeth aren’t in the neutral zone?
Cheeck, lips or tongue biting
WHen does cheek and lip biting occur?
Associated with insufficient bucco lingual overjet
When does tongue biting occur?
Teeth too lingual and sharp
How do you correct problems arising from denture not in neutral zone?
- Use neutral zone technqie initially
- Correct overjet by adding wax and then reset teeth
- Reduce or smooth the teeth lingually or reset these
How common are allergies to denture materials?how would you manage this?
RARE
More likely due to chemical inflammation due to unreacted monomer
Patch test to diagnose and test denture in specialise central using gas liquid chromatography
May need further curing cycle to remove excess monomr
What unfavourable anatomy may cause pain?
Atrophic ridge
Prominent mental nerve
Tori
Make sure have relief and use soft lining material
What can cause pain other then dentures?
Buried roots Cyst Tumour Ulcer Lichen planus Herpes zoster Haematological def Xerostomia
T/F permanet soft linings directly bond to denture?
T
