Examination, Diagnosis & Treatment Planning of the Edentulous Patient Flashcards
How to make a tx plan?
careful consideration of pt complaint
pt expectations must be determined
tx plan tailored to pt complaint, needs and abilities
presenting complaints
usual complaints from pt needing complete denture?
looseness of denture
pain/sores
unable to chew food
food packing under the denture
speech disturbance
damaged denture
unhappy with appearance
What are common causes for damaged denture?
burning out of the wax during the conversion of the denture to the acrylic base
or
processing of the fusing to the prosthetic teeth to the wax to acrylic base wax is not removed properly
= bond between acrylic teeth and denture base is affected
= denture might come off from denture base
Common cause of midline fracture?
shave back labial frenum extensively
midline fracture on palate
Why can a denture fracture if a pt has been wearing the denture for a long time?
resorption of the alveolar ridge
now a space has formed between the denture and new shape of alveolar ridge
make the denture flex
= midline fracture
Questions to ask pt about PC regarding first denture?
howlong since the teeth were lost
what was/were the reasons for tooth loss
if a long time ago, why was replacement not sought before
what is/are the reasons for change of mind to seek replacement now
was there any reason to not have dentures previously
ever used partial denture
do you know about complete dentures? family/friends?
Questions to ask pt about PC regarding current complete denture?
what is/are the problems with current denture
current problem longstanding or of recent origin
how long has current denture been in use for
has there been problems previously with the current denture
has repairs/adjustments been done to the current denture
has the current denture ever been comfortable
how many pairs of dentures have you has up till now
how long since the teeth were lost
what was/were the reasons for tooth loss
Cause of dry mouth?
diabetes
antihypertensive
salivary gland disease
diabetes and complete denture?
really need good dentition
need varied diet to help regulate glucose
bad dentition - eat softer foods. usually high in sugar
SH importance for complete denture?
logistics to attend for tx
- elderly, bus
motivation for treatment
- e.g. wedding
motivation for maintenance
habits
- nail biter
EO exam - what to focus on?
asymmetry
smile line
lower facial height and posturing
IO assessment full denture?
localised trauma
- ulceration in areas of high load
generalised damage due to incorrect vertical height of denture or occlusion
tissue overgrowth from trauma
- denture granuloma
chronic irritation
- denture induced stomatitis
angular cheilitis
- normally seen in deep folds in corers of mouth
- reduced OVD
irregular bine loss
thin atrophic tissues
surgical repair in denture base
restricted oral opening
- can appropriate imps be taken
bone replaced by fibrous tissue
- flabby ridge
denture hyperplasia
What is it called with tissue overgrowth from trauma?
denture granuloma
What causes denture granuloma?
The flange of a denture impinging on the vestibular mucosa may stimulate a reactive irregular hyperplasia
stomatitis?
inflammation of the mouth and lips. It refers to any inflammatory process affecting the mucous membranes of the mouth and lips, with or without oral ulceration.
usually caused by candida = oral thrush
Angular cheilitis
a common skin condition affecting the corners of your mouth. It leads to painful, cracked sores.
In F/F pt, why can they experience angular cheilitis?
recued OVD
CORNERS OF MOUTH DROOP DOWN - salva cannot be retained in the mouth
What has occurred here?
flabby ridge
Why has a flabby ridge occurred?
full upper denture
lower partial
- large occlusal load on upper
Flabby ridges occur when hyperplastic soft tissue replaces the alveolar bone, resulting in mobile, hypermobile, and frequently edematous tissue.
What is a flabby ridge?
Flabby ridges occur when hyperplastic soft tissue replaces the alveolar bone, resulting in mobile, hypermobile, and frequently edematous tissue.
What can cause denture hyperplasia?
overextension of the denture
What is shown?
tori/extostoses
What would you check in the oral environment for denture?
fissured tongue
dry mouth - enough moisture to keep denture in mouth
excessive resorption mandibular ridge
genial tubercles and mylohyoid ridge
genial tubercle?
genial tubercle in dentate vs edentulous pt?
dentate - lower down
edentulous - higher up due to resorbed ridge
effect of genial tubercle and/or mylohyoid ridge being higher up in edentulous pt?
hinderance to denture - think about design
compromise extension on denture
what is shown here?
mylohyoid ridge
What is shown here?
mucosa overlying thin bony prominence
Affect of thin bony prominence and denture?
can cause pain when biting/ when pressure is applied
not resistant to trauma
overdenture?
use of implants to support a mandibular complete denture
could also use retained roots and crowns
copy denture?
copy current denture
pt is happy with current denture and only needs minor adjustments e.g. teeth or extensions
transitional denture?
get pt use to a denture before moving to complete denture
immediate denture?
replacement of all extracted teeth with a completed denture immediately after extraction
