Medical Problems related to Dentures Flashcards
What conditions can affect denture treatment?
Xerostomia
Anaemia
Tremors
Anti-resorptive agents
Frailty
Dementia and capacity issues
vulnerable adult
What is xerostomia?
dry mouth (<0.1 ml per min at rest- 0.2ml is normal)
- Increased risk of caries- lack of remineralisation, buffering, protective enzymes
What are some of the causes of xerostomia?
anti-depressants
polypharmacy
sjogren’s
radiotherapy (head and neck- damage to parotid)
Chemotherapy
What is the issue with xerosotmia in denture wearers?
Compromised retention- particularly in uppers, lack of suction with no moisture (lack of seal)
Patient discomfort- lack of lubrication in denture bearing area, inflammation
What are the intra-oral effects of radiotherapy?
Dry mouth
Caries risk
Trismus
Mucositis
ORN
What are the issues with patients who have anaemia and wearing dentures?
Often develop uncomfortable mucosal regions (pain when wearing dentures- aim to resolve before giving dentures)
What conditions can cause a tremor?
CVA, Parkinson’s, Huntington’s
What are the issues with tremor and production of dentures?
- Difficult to get jaw reg and impressions- RCP may change
- Keep dentistry simple- reorganising is not reproducible
What are examples of anti-resorptive medications that are involved in MRONJ?
Bisphosphonates- esp IV
RANKL inhibitors
Anti-angiogenics
What may be done in terms of prosthodontics treatment to avoid risk of MRONJ
Consider keeping teeth and roots before extracting (root treatments, overdentures
What is frailty?
A state of increased vulnerability to poor resolution of homoeostasis after a stressor event
What are some of the signs of Frailty?
Low energy
Slow walking speed
reduced strength
Falls
Delirium
What are the effects that frailty has on dentures?
- Falls- trauma of jaws, breaking dentures
- Care homes- difficult for denture maintenance (lost dentures, mixing up dentures, not cleaning)
What can technician do to help prevent dentures getting mixed up in care homes?
Add name tags in acrylic
What is dementia?
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
What are the implications of dementia on dental treatment?
Issues remembering appointments
Issues remembering instructions
Dexterity problems
Capacity to consent
What questions may you ask a patient to evaluate if they can consent?
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
What is the criteria for capacity?
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
What is a vulnerable adult?
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
Which services are available to help us in the care of vulnerable adults?
Adult Support and Protection Services
Social Services
General Medical Practitioner
Police
Indemnity Organisation
How can MRONJ be prevented if extractions are required?
- CHX
- Rigorous adherence to post op instructions
- Atraumatic technique
- Suture sockets
