Consequences of tooth loss and challenges managing older patients Flashcards
Percentage of edentulous adults 1968, 2008 and 2018
30%
8%
5%
What increases with age of px?
Problems relating to treatment and patient management
Why is getting to know who needs treatment a problem?
- Elderly may be reluctant to seek treatment until absolutely necessary
- Medical health issues might take priority so dental health is ignored
What pathologies do elderly patients have? Is this why they attend dentist?
-Denture stomatitis (red raw under denture)
-Oral cancer
-Denture granuloma (fold in tissue)
-Lichen planus
-Oral infections
Rarely, only if there is pain involved
What are the problems with physically providing treatment?
- 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)
What are the problems with having them in the dental surgery?
Easier for clinician but is surgery suitable for the elderly? E.g. calm enough, enough time, bright light, access
How to improve dental experience for elderly in surgery
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
How to help elderly adapt to change
- Make small changes to existing dentures (reline / adapt existing denture)
- Copy existing dentures with alterations
- Make new dentures similar
What would tooth loss affect in the appointment?
Impression taking
Jaw registration
Retention and stability of denture
Ability to wear denture
What happens after tooth loss?
Remaining alveolar bone forms alveolar ridge
-gives denture support
-part of denture-bearing area
Bone resorbs very quickly after tooth loss
Does mandible or maxilla resorb faster?
Approx. 4 times as much resorption of mandible as maxilla
General pattern of bone loss around individual tooth
Resorption greater where cortical plate is thinner
General pattern of bone loss in the maxilla
Greater loss of thinner buccal cortical plate with gradual reduction in wifth and length of residual ridge
General pattern of bone loss in mandible
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
Clinical effects of too little resorption
-Bulky alveolar ridges with little space in which to place dentures (inadequate interalveolar space)
Leads to frequent denture fracture or excessive face height
How can frequent denture fracture be prevented?
By increasing size of denture but this
- compromises appearance
- encroaches the free way space
- compromises function (speaking, eating)
What is the free way space?
Space between occluding surfaces of maxillary and mandibular teeth when mandible is in physiologic resting position
What are clinical effects of irregular resorption?
Bone may be sharp, soft tissues may get traumatised under denture
- Leads to ulcers & discomfort
- Surgical reduction of knife-edge ridge may be needed
Clinical effects of excessive resorption
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
Effects on mandible from excessive resorption
-atrophy of alveolus –> superficial mental foramen
-mylohyoid ridge on lingual aspect becomes sharp & prominent
Pain (& numbness) during denture wear
Clinical effects of normal resorption
- Resorption occurs a few months after extraction
- Dentures start to feel loose. Must be relined or replaced
Useful clinical techniques to help prosthetic treatment
- Check record
- Windowed trays
- Neutral zone impression technique
- Retained roots
- Polycarbonate
- Soft liners
What is check record?
Take occlusal impressions with silica on working model
What are windowed trays used for?
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
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
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
Why are retained roots useful for dentures?
They preserve alveolar bone
What is polycarbonate (or stainless steel) used for in prosthetics?
To reduce likelihood of midline fracture (stronger)
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
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)
