Intro and Edentulous Problem Flashcards
What are the comorbidities with complete edentulism?
- Malnutrition
- Obesity
- Increased COPD events
- Increased pneumonia related hospitalizations
- Increased risk of head/neck cancer
- Decline in cognitive function
- Predictor of cardiovascular disease mortality
- Reduced, but nonreplaced dentition associated with increased risk of mortality
How many people in the USA are edentulous in at least 1 arch?
36 million
How many complete dentures are done each year in USA?
5.5 million
If you smoke, you are __x more likely to be edentulous
3 times
What percent of the gross salary of average general practice in the US is from partial or complete edentulism?
27%
What is the main problem with dentures?
In the edentulous state, there are few natural adapative mechanisms left. The dentures rest on tissues that will change progresively and irreversibly.
Almost all the principles of complete denture fabrication have been formulated to…
decrease movement
minimize the forces transmitted
More movement of the denture causes…
more soreness and more resorption
What are some basic causes of denture movement?
resiliency of tissue
instability of the dentures
What tissue do artificial teeth rest on in dentures?
mucous membranes
What are the supports in the natural dentition?
dentin
cementum
PDL
alveolar bone
What are the cm^2 area of PDL in each arch?
45 cm^2
What are the mean denture-bearing areas in the maxilla in cm^2?
23 cm^2 (1/2 of original)
What are the mean denture-bearing areas in the mandible in cm^2?
12 cm^2 (1/4 of original)
What is Wolff’s Law?
living bone responds to functional stress by depositing bone in areas of stress
What type of patients have very little adaptation to functional stress on alveolar bone?
edentulous patients
Wearing of dentures is almost always accompanied by an undesirable loss of _________
bone
In complete denture wearers, the mean reduction in anterior mandibular ridge is _____ times that of the maxillary ridge
4 times
How many hours a day should a patient remove the dentures?
at least 8 hrs/day
What are the proper impression techniques for a denture patient?
- record tissues at rest
- extend denture base to use max support area
- placement of pressure on those tissues besta ble to tolerate stress
What are some ways to reduce pressure on residual ridges?
- no contact of anterior teeth
- clinical remount and equailibration at delievery to reduce occlusal issues
The maxillary ridge is partly covered by a layer of _____________ after teeth extraction
cortical bone
The mandibular ridge crest remains _________ after teeth are extracted
spongy and trabeculated
- not resistant to resorption
What type of bone is more resistant to resorption?
cortical bone
What is the buccal shelf?
primary denture support area on the mandibular arch (compact bone)
What is the snowshoe principle?
decrease the pressure per unit area by extending the denture base to cover the maximum area with physiologic tolerance
More saliva contact =
more contact adhesion (retention)
Proper peripheral extension =
good border seal (retention)
What is retention?
resistance to dislodgement/resistance to movement away from the foundation
What challenges does xerostomia present to denture patients?
discomfort, ulcerations, retentnio loss, chewing problems
Quantity and quality of ______ affects denture retention
saliva
What medical conditions are associated with xerostomia?
- autoimmune and inflammatory conditions
- graft-versus-host disease
- immunoglobulin G4- related sclerosing disease
- degenerative disease
- granulomatous disease
- infections
- salivary gland aplasia
What medicines are associated with xerostomia?
- anticholinergic drugs
- antihistamines
- antihypertensive agents
- opioids
- psychotropic agents
- skeletal muscle relaxants
What is adhesion?
attraction of unlike molecules for each other
The amount of retention attributable to adhesion is directly proportional to…
the wettability of the denture base material, to the area covered by the denture base, and to the viscosity of the saliva
What is stability?
resistance to movement in the horizonal plane/resistance to rotation/resistance to lateral movement
What factors affect stability of the dentures?
- shape of alveolar ridges
- size of alveolar ridges/vestibular depth
- flange length and shape
- intimate fit of prosthesis
What percent of denture wearers had at least one problem with a denture (Redford 1996)?
60%
What are complete dentures often regarded as substitute treatment for?
expensive restorative therapy, periodontal therapy, or unesthetic dentition
What is the new trend of denturism?
lab technicians feel that they should be allowed to bypass the dentist and deal directly with the public
What are the steps of complete denures?
- diagnosis
- treatment planning
- denture fabrication
Dentures do not cure edentulism. They are not a substitute for natural teeth. They are a substitute for ______
no teeth
The patient’s _____________ _____ ____________ _______ ________ _____ play a substantial role in overall complete denture success
personality and relationship with the dentist
What are very important determinants of denture satisfaction?
psychological
social
interpersonal factors
What are the three categories of prosthodontics?
fixed (crown and bridge)
removable (RDP)
maxillofacial
What are the three big things to consider with compete dentures?
support
stability
retention
What are the important factors of retention?
adhesion
cohesion
interfacial surface tension
intimate tissue contact
border seal
atmospheric pressure
neuromuscular control
What is the resistance to displacement of the denture base away from the ridge?
retention
What is the resistance to horizontal or rotational movements?
stability
What is the resistance to vertical movement of the denture base towards the ridge?
support
What does adhesion mean?
attraction between unlike molecuels
What does cohesion mean?
force between molecules of same material
What is the thin fluid film between 2 closely contacting objects?
interfacial surface tension
What prevents ingress of air?
border seal
What is a learned phenomenon (external contour of denture bases promote this)?
neuromuscular control
What helps minimize residual ridge resorption?
- remove dentures at least 8 hrs/day
- proper impression techniques
- no contact of anterior teeth in centric relation
- ensure occlusal harmony
What are the 9 denture problems?
- dentures move in the mouth
- dentures creat pressure on supporting mucosa and bone
- pressure causes bone resorption
- bone resorption results in decreasing horizontal stability and decreasing retention
- retention of dentures requires saliva of good quality and quantity
- technical quality of dentures is not very high
- “Denturism”
- Not a substitute for natural teeth
- Life of dentures is 7-10 years
What are the steps in complete denture fabrication?
What are the four patient classifications?
- philosophical
- exacting/critical
- hysterical
- indifferent
What is important on an intraoral exam of a denture patient?
mucosa
basal seat
arch form
interarch space
What is border molding?
allows the intraoral soft tissues to form the length, width, and shape of custom tray borders prior to making the secondary impression
