Consequences of tooth loss and challenges managing older patients Flashcards

1
Q

Percentage of edentulous adults 1968, 2008 and 2018

A

30%
8%
5%

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2
Q

What increases with age of px?

A

Problems relating to treatment and patient management

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3
Q

Why is getting to know who needs treatment a problem?

A
  • Elderly may be reluctant to seek treatment until absolutely necessary
  • Medical health issues might take priority so dental health is ignored
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4
Q

What pathologies do elderly patients have? Is this why they attend dentist?

A

-Denture stomatitis (red raw under denture)
-Oral cancer
-Denture granuloma (fold in tissue)
-Lichen planus
-Oral infections
Rarely, only if there is pain involved

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5
Q

What are the problems with physically providing treatment?

A
  • Visit in homes? (difficult - equipment)
  • Provide ambulance / taxi to bring them to surgery? (expensive)
  • Could they drive? Parking
  • Use bus? (pass restrictions)
  • Neighbour or family could bring them? (difficult)
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6
Q

What are the problems with having them in the dental surgery?

A

Easier for clinician but is surgery suitable for the elderly? E.g. calm enough, enough time, bright light, access

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7
Q

How to improve dental experience for elderly in surgery

A

Seating: keep upright or slowly alter position
Noise: low tones, reduce noise and speed
Confusion: reduce speed, less instruction, call GP first
Timing: medication, convenience

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8
Q

How to help elderly adapt to change

A
  1. Make small changes to existing dentures (reline / adapt existing denture)
  2. Copy existing dentures with alterations
  3. Make new dentures similar
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9
Q

What would tooth loss affect in the appointment?

A

Impression taking
Jaw registration
Retention and stability of denture
Ability to wear denture

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10
Q

What happens after tooth loss?

A

Remaining alveolar bone forms alveolar ridge
-gives denture support
-part of denture-bearing area
Bone resorbs very quickly after tooth loss

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11
Q

Does mandible or maxilla resorb faster?

A

Approx. 4 times as much resorption of mandible as maxilla

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12
Q

General pattern of bone loss around individual tooth

A

Resorption greater where cortical plate is thinner

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13
Q

General pattern of bone loss in the maxilla

A

Greater loss of thinner buccal cortical plate with gradual reduction in wifth and length of residual ridge

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14
Q

General pattern of bone loss in mandible

A

Anteriorly: buccal plate slightly thinner so residual ridge apparently moves slightly lingually
Premolar region: buccal & lingual plates are of = thickness and residual ridge maintains position
-Molar: buccal plate reinforced by external oblique ridge, resorption of thinner lingual plate occurs, apparent movement of residual ridge buccally

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15
Q

Clinical effects of too little resorption

A

-Bulky alveolar ridges with little space in which to place dentures (inadequate interalveolar space)
Leads to frequent denture fracture or excessive face height

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16
Q

How can frequent denture fracture be prevented?

A

By increasing size of denture but this

  • compromises appearance
  • encroaches the free way space
  • compromises function (speaking, eating)
17
Q

What is the free way space?

A

Space between occluding surfaces of maxillary and mandibular teeth when mandible is in physiologic resting position

18
Q

What are clinical effects of irregular resorption?

A

Bone may be sharp, soft tissues may get traumatised under denture

  • Leads to ulcers & discomfort
  • Surgical reduction of knife-edge ridge may be needed
19
Q

Clinical effects of excessive resorption

A

Relationship of posterior teeth may be changed
> of mandible posteriorly produces ‘posterior crossbite’
-Edge-to-edge incisor relationship or prominent mandible may occur anteriorly, where buccal resorption of maxilla predominates

20
Q

Effects on mandible from excessive resorption

A

-atrophy of alveolus –> superficial mental foramen
-mylohyoid ridge on lingual aspect becomes sharp & prominent
Pain (& numbness) during denture wear

21
Q

Clinical effects of normal resorption

A
  • Resorption occurs a few months after extraction

- Dentures start to feel loose. Must be relined or replaced

22
Q

Useful clinical techniques to help prosthetic treatment

A
  • Check record
  • Windowed trays
  • Neutral zone impression technique
  • Retained roots
  • Polycarbonate
  • Soft liners
23
Q

What is check record?

A

Take occlusal impressions with silica on working model

24
Q

What are windowed trays used for?

A

For anterior flabby ridges
Windowed tray constructed on primary impression
-when impression is in mouth window is filled with fluid impression material e.g. silicone with syringe

25
What is neutral zone?
Space in oral cavity where forces exerted by tongue are equal to forces exerted by buccinator of cheek laterally and orbicularis oris anteriorly -Determines horizontal location of teeth
26
What is neutral zone impression technique?
- Anterior section of mandibular registration rim from old dentures replaced by impression material - Ask px to gurn - This used as template for siting lower anterior teeth
27
Why are retained roots useful for dentures?
They preserve alveolar bone
28
What is polycarbonate (or stainless steel) used for in prosthetics?
To reduce likelihood of midline fracture (stronger)
29
What are soft liners used for in prosthetics?
- More comfortable base over irregular ridges - Processed onto denture in lab - Doesn't last long (6m - 3y) - Harbours bacteria
30
Which oral surgeries may be necessary for difficult cases?
``` Implants (if some bone left) Sulcus deepening (not really recommended) Ridge augmentation (put extra HAP on ridge) ```