Medical Problems Related to Dentures Flashcards
What medical problems commonly affect denture wearing patients?
- xerostomia
- anaemia
- tremors
anti-resorptive agents - frailty
- dementia and capacity issues
- the vulnerable adult
In what patients is xerostomia commonly seen?
- many medications cause xerostomia
- antidepressants
- poly pharmacy
- Sjogren’s
- often grossly carious teeth
- plaque accumulation increased by denture
How can xerostomia affect denture wearing?
- caries
- often more teeth affected
- poor oral clearance
- reduced prognosis of abutments
- retention difficulties
- lack of saliva
- poor suction
- lack of saliva
- pain and discomfort
- lack of saliva
- poor lubrication
- lack of saliva
- associated oral mucosal problems
- candida
- angular cheilitis
How can anaemia affect denture wearing?
- associated oral mucosal problems
- atrophy of oral mucosa
- acute candidiasis
- white slough around redness
- angular cheilitis
- pain and discomfort
- denture bearing area not strong enough
- occlusal forces produced by dentures
- especially lower arch
In what patients are tremors more frequently experienced?
- Parkinsons disease
- stroke
- Huntington’s disease
How can tremors affect denture construction?
- all stages are more challenging
- sudden involuntary movement
- involving jaws and arms
- sudden involuntary movement
- jaw registration
- hard to get patient in occlusion
- occlusion often end up inadequate
- requires re-registration
- simple treatment plans
- no precision attachments for partial dentures
What anti-resorptive agents can be taken by denture wearing patients?
- bisphosphonates
- e.g. alendronic acid
- RANKL inhibitors
- e.g denusomab
- anti-angiogenic
- e.g bevacizumab
How can taking anti-resorptive agents affect denture construction and denture wear?
- risk of MRONJ
- ill fitting dentures increase risk
- teeth and roots kept
- usually would be extracted
- denture design compromised
- altered occlusion and aesthetics
- due to retained teeth and roots
What is frailty?
a state of increased vulnerability to poor resolution of homeostasis after a stressor event
What are the signs of frailty and what scale is it measured on?
- low energy
- slow walking speed
- reduced strength
- can be associated with long term conditions
- old age
- poly pharmacy
- ECOG Performance Status Scale
- 0 is least frail
- 4 is most frail (bed bound)
How can frailty affect denture construction and denture wearing?
- increased hospital admission
- falls
- delirium
- care home admission
- affects techniques which can be used to construct dentures
How can dementia and capacity issues affect denture construction and denture wearing?
- difficulty remembering appointment
- increased FTA
- aid of carer or relative
- difficulty remembering instructions
- care of dentures
- seeking help if problems arise
- aid of carer or relative
- dexterity
- CoCr are especially hard to insert
- capacity to consent
- patient may be unable to consent to treatment
What 4 questions can be asked to quickly assess whether a patient has capacity or requires further investigation?
- How old are you?
- What is your date of birth?
- Do you know where you are today?
- What year is it?
When determining a patient does not have capacity, what details must be included?
- the lack of capacity
- can be intermittent
- the proposed intervention
- who has been consulted
- general principles of AWI Act have been observed
What is a vulnerable adult according to the Adult Support & Protection (Scotland) Act 2007?
- adults who are:
- unable to safeguard their own wellbeing property, right or other interests…
- …and are at risk of harm…
- …and 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
