Complete Denture Problem Solving Flashcards by anisah h

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

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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

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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

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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

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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

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What is an an example of the alkaline HYPCHLORITE cleaner?

Dentural

Milton

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What is an example of the acid cleaner?

Denclen

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What is an example of the peroxide cleaner?

Sterident

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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

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What are the two types of denture fracture?

Flexural fatigue

Impact fracture

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What is Flexural fatigue?

Occurs when there has been repeated flexing of the material

Repeated small loads

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What is impact fracture?

Occurs out of the mouth due to a sudden blow eg dropping

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How can you reinforce dentures?

Chemical modification of PMMA

Addition of fibres to PMMA

Add metal strengthers to PMMA

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What can cause a loose denture?

Denture related: Impression surface, Polished surfaces , Occlusal surface

Wearer: unstable foundation, poor NM control, inadequate saliva

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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

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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

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What shape should you post dam be?

Bow shaped

Carved on working model

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What can you do of there is a deficient post dam?

Add on at chair side or reline which is preferable

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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

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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

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What can you do for over extended peripheries?

Correct small areas by trimming and for gross over extension border mould or reline

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What problems can arise from the occlusal surfaces?

ICP not equal to RCP
Premature occlusal contact
Locked occlusion
Occlusal plane incorrect

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What can cause unstable foundation?

Flabby ridge
Atrophic lower ridge
Prominent mylohoyoid ridges

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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?

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 1. Absorb water and swell: causes attraction between anions and an increase in viscosity of fix increases retention 2. 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?

1. Use neutral zone technqie initially 2. Correct overjet by adding wax and then reset teeth 3. 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?