consqeuences of tooth loss and challanges managing older patients

Question 1

phyical problems with dental treatmetn and older people

Answer 1

1) do we visit in own hmes
2) do we provide taxi/ambulance
3) do we rely on their own capability (car grt parking problems, bus pass restrictions with public transport)
4) do we rely on their ability to get neighbours or family bring them in?

Question 2

domicicillary dentistry

Answer 2

Where dentists go out to the community

• easy for patient but more difficult for clinician
• need chaperone (eg nurse)
• take all the equipment necessary including light an take all clinical waste away
• cant do many complex treatments

Question 3

how to make dental visit easier

Answer 3

seating
noise
confusion(ie reduced speed, less instruction)
timing

Question 4

improving change in denture

Answer 4

make small changes to exisitng denture

or copy exisitng detures with few alteratios

Question 5

what does tooth loss affect (Dentures)

Answer 5

• impression taking
• jaw registration
• retention and stability of the denture
• ability to wear the denture

Question 6

tooth loss and alveolar resorption

Answer 6

After loss of teeth the remaining alveolar bone forms the alveolar ridge
- gives support to a denture
- part of denture bearing area
Following tooth loss
- alveolar bone resorbs
- rapidly at first but decreases with time

Question 7

patterns of bone loss in mx and tooth

Answer 7

• Around an individual tooth, resportion is greater where the cortical plate is thinner
  In maxilla
• greater loss of the thinner buccal cortical plate with gradual reduction in the width and length of the residual ridge

Question 8

patterns of loss in md

Answer 8

1) anteriorly
- buccal plate is thinner
- residual ridge moves slightly lingually (towards the tongue)
2) premolar
- buccal and lingual plates are equal thickness
- residual ridge maintains its position
3) molar
- buccal plate is reinforced by external oblique ridge
- resorption of the thinner lingual plate occurs and there is apparent movement of the residual ridge buccally

Question 9

clinical effects of alevolar resorption

Answer 9

1) Too little resorption
- bulky alveolar ridges with little space to place dentures (adequate interalveolar space)
- leads to either frequent denture fracture (as it is thin and also there is lots of pressure on the denture) or excessive face height
2) irregular
- bone may be sharp and soft tissues may get traumatised under the denture leading to ulcers and discomfort (when the denture moves)
- surgical reduction of the knife edge ridge may be needed
3) excessive
- normal relationship of the posterior teeth may be changed
- enough room for denture but may struggle with stability and retention of denture
- With increase in width of the mandible posteriorly a posterior corss bite is produced
- anterioally, edge to edge incisal relationship of prominent mandible may occur (where maxilla buccal resportion predonicates)

Question 10

retained roots are known as

Answer 10

denture abutments

Question 11

what if lower anterior teeth not in neutral zone

Answer 11

lower denture moves in function

will flip out

Question 12

oral surger

Answer 12

1) implants
- usually in areas of lower 3s
- denture clips in
2) Sulcus deepening
3) Ridge augmentation
- if we want more height and width for lower ridge

Question 13

how can you try and get neutral zone correct

Answer 13

Anterior section of mandibular registration rim placed by impression material
- technician uses this as a template for sitting the lower anterior teeth

Question 14

why may you get pain on denture wear

Answer 14

• atrophy of the alveolus causes the mental foramen to become superficial
• Mylohyoid ridge on lingual aspect of mandible becomes sharp and prominent