Medical Problems related to Dentures

Question 1

What conditions can affect denture treatment?

Answer 1

Xerostomia
Anaemia
Tremors
Anti-resorptive agents
Frailty
Dementia and capacity issues
vulnerable adult

Question 2

What is xerostomia?

Answer 2

dry mouth (<0.1 ml per min at rest- 0.2ml is normal)
- Increased risk of caries- lack of remineralisation, buffering, protective enzymes

Question 3

What are some of the causes of xerostomia?

Answer 3

anti-depressants

polypharmacy

sjogren’s

radiotherapy (head and neck- damage to parotid)

Chemotherapy

Question 4

What is the issue with xerosotmia in denture wearers?

Answer 4

Compromised retention- particularly in uppers, lack of suction with no moisture (lack of seal)

Patient discomfort- lack of lubrication in denture bearing area, inflammation

Question 5

What are the intra-oral effects of radiotherapy?

Answer 5

Dry mouth

Caries risk

Trismus

Mucositis

ORN

Question 6

What are the issues with patients who have anaemia and wearing dentures?

Answer 6

Often develop uncomfortable mucosal regions (pain when wearing dentures- aim to resolve before giving dentures)

Question 7

What conditions can cause a tremor?

Answer 7

CVA, Parkinson’s, Huntington’s

Question 8

What are the issues with tremor and production of dentures?

Answer 8

• Difficult to get jaw reg and impressions- RCP may change
• Keep dentistry simple- reorganising is not reproducible

Question 9

What are examples of anti-resorptive medications that are involved in MRONJ?

Answer 9

 Bisphosphonates- esp IV
 RANKL inhibitors
 Anti-angiogenics

Question 10

What may be done in terms of prosthodontics treatment to avoid risk of MRONJ

Answer 10

Consider keeping teeth and roots before extracting (root treatments, overdentures

Question 11

What is frailty?

Answer 11

A state of increased vulnerability to poor resolution of homoeostasis after a stressor event

Question 12

What are some of the signs of Frailty?

Answer 12

Low energy

Slow walking speed

reduced strength

Falls

Delirium

Question 13

What are the effects that frailty has on dentures?

Answer 13

• Falls- trauma of jaws, breaking dentures
• Care homes- difficult for denture maintenance (lost dentures, mixing up dentures, not cleaning)

Question 14

What can technician do to help prevent dentures getting mixed up in care homes?

Answer 14

Add name tags in acrylic

Question 15

What is dementia?

Answer 15

An umbrella term for diseases/ conditions characterised by a decline in memory, language, problem-solving and other thinking skills that affect ability to perform everyday activities

Question 16

What are the implications of dementia on dental treatment?

Answer 16

Issues remembering appointments

Issues remembering instructions

Dexterity problems

Capacity to consent

Question 17

What questions may you ask a patient to evaluate if they can consent?

Answer 17

How old are you?
What year is it?
What is your DoB?
Where are we?

Get patient to repeat back anything you say about treatment

Question 18

What is the criteria for capacity?

Answer 18

Understand the nature of treatment and why it is being proposed

Understand risks and benefits

Understand the alternatives

Understand the consequences of no treatment

Can retain information for long enough to come to a decision

Can communicate decision to others

Can hold decision consistently- doesn’t change

Question 19

What is a vulnerable adult?

Answer 19

Adults who are unable to safeguard their own wellbeing, property, rights or other interests and are at risk of harm
-> because they are affected by disability, mental disorder, illness or physical or mental infirmity, are more vulnerable to being harmed than adults who are not so affected

Question 20

Which services are available to help us in the care of vulnerable adults?

Answer 20

Adult Support and Protection Services
Social Services
General Medical Practitioner
Police
Indemnity Organisation

Question 21

How can MRONJ be prevented if extractions are required?

Answer 21

• CHX
• Rigorous adherence to post op instructions
• Atraumatic technique
• Suture sockets