Complete dentures - long term review

Question 1

Problems encountered

Answer 1

Soft tissue
Hard tissue
Denture

Question 2

Soft tissue problems

Answer 2

Infection - denture candidosis
Hyperplasia - denture granuloma
Neoplasia - hysplasia/ cancer

Question 3

Denture candidosis - signs

Answer 3

• Red palate defined by denture bearing area
• Asymptomatic in most cases
• Hyperplastic tissue may also be apparent
• Often also associated with Angular cheilitis

Question 4

Management of candidodis

Answer 4

Identify the Cause:
1. Poor oral & denture hygiene
2. Leaving denture in at night
3. Excessive FWS – Angular cheilitis
4. Unretentive dentures – rocking
5. Systemic disease: Diabetes, Immunocompromised,
other…

Question 5

Management of candidosis - mild to moderate cases

Answer 5

1. Oral & Denture Hygiene
   -fill basin with water
   -clean denture with soap and water using a
   normal toothbrush
   -clean palate, tongue and ridges with soft
   toothbrush and water
   -immerse denture in Miltons overnight (1% Bleach)
   -rinse before replacing in mouth
2. Denture Replacement
   -provide new dentures
   -monitor oral and denture hygiene during
   fabrication stages
   -prescribe anti-fungals at try-in stage (Miconazole gel – Check Warfarin status, Nystatin pastilles)
3. Antifungals – Topical
   -start antifungals on day of fit stage (use oral & dental hygiene protocol prior to
   application, use antifungals with denture out of mouth)
   -review at one week, two weeks and one
   month
   -if not cleared up - reconsider diagnosis
   and manage appropriately

Question 6

Management of candidosis - severe to resistant

Answer 6

1. Protocol for Mild-Moderate
2. Bacteriological swab
3. Consider topical and systemic
   antifungals – Liase with GMP or specialist services

Question 7

Denture granulomata

Answer 7

Mixture of hyperplasia and inflammation

-where denture is digging in

Question 8

Neoplasia

Answer 8

Be aware of significance of ulcers in the mouth
If suspicious or worrying with no obvious cause - refer urgently
If apparent cause obvious - manage and review in one week
If not healed - refer

Question 9

Hard tissue problems

Answer 9

All related to alveolar resorption

• pain
• insecurity

Question 10

Protrusive overclosure

Answer 10

Combination of alveolar resorption and denture wear

Question 11

Treatment of protrusive overclosure

Answer 11

• Reline dentures
• Occlusal pivots
• Replacement or denture duplication with moderate changes in jaw relations

Question 12

Denture problems

Answer 12

Wear
Fracture
-diagnose before repairing

Question 13

Abnormal wear

Answer 13

Wear due to unilateral chewing habit
Wear due to sewer’s habit of breaking threads against incisor teeth
Wear of base*

Question 14

Diagnosis and management of denture fracture

Answer 14

Impact
• Isolated Event – Repair and advice
• Repeated – Reinforce
Fatigue
• Age of denture ? – Replace
• Predisposing factors – Space, weakness

Question 15

Impact: isolated event

Answer 15

Give warning about cleaning the repair

Question 16

Impact: repeated fracture

Answer 16

Can use ‘reinforced’ resin

Question 17

Fatigue: consider predisposing fractures

Answer 17

1. Insufficient space
2. Pronounced maxillary torus
3. Lack of labial flange

Question 18

Other solutions

Answer 18

Polycarbonate
Injection-moulded
Tooth bonding

Question 19

Cast metal base

Answer 19

Bonding between metal and acrylic

Post dam

Question 20

Stainless steel mesh

Answer 20

**

Question 21

Vulcanite

Answer 21

Carbon fibre
Glass fibre
Aramid etc.

Question 22

Leaf fibroma

Answer 22

Possible soft tissue problem

Will need removing