Pathology related to dentures

Question 1

Dentures, particularly ill-fitting dentures, are associated with a heterogenous group of oral mucosal lesions. Give 3 potential lesions why?

Answer 1

acute or chronic reactions to microbial dental plaque
a reaction to constituents of denture base materials
mechanical denture injury

Question 2

give examples of pathological changes related to dentures

Answer 2

ulcers
denture stomatitis
angular chelitis
denture irritation hyperplasia
flabby ridges
MRONJ/ORN
allergic reactions

Question 3

Common sites for denture-related ulcers

Answer 3

lingual frenum, mylohyoid ridge, undercuts

Question 4

causes of ulcers (denture related)

Answer 4

overextension; sharp bits on denture, pressing too hard, occlusal trauma

Question 5

denture related ulcers - management

Answer 5

identify
- pressure indicating paste
- articulating paper
ease
- occlusal adjustment
- trim and polish base

review

Question 6

denture stomatitis management

Answer 6

denture hygiene instructions
- take denture out at night
- clean with soft brush
- chlorhexidine mouthwash
- antifungals e.g. nystatin

consider underlying issues
- diabetes
- b12, folate

Question 7

angular chelitis causes and features

Answer 7

often co-exists with denture stomatitis
result of overclosure
- loss of OVD/excessive free way space , old worn dentures

Question 8

angular chelitis - management

Answer 8

miconazole gel (interaction with coumarins)
consider underlying issues
- diabetes
- folate
- xerostomia
- ferritin

Question 9

denture irritation hyperplasia - cause

Answer 9

often very old, ill-fitting dentures
chronic trauma resulting in hyperplastic response

Question 10

denture irritation hyperplasia, management

Answer 10

major ease of denture
tissue conditioner e.g. Coe comfort
review and repeat if needed
new denture?

Question 11

flabby ridges - cause

Answer 11

trauma of denture hitting usually anterior ridge
- often when lower anteriors present with no lower denture
causes bone resorption and fibrous replacement resorption

Question 12

flabby ridges - solution

Answer 12

new denture covering whole denture bearing area with good peripheral seal AND opposing arch denture giving posterior support

may occasionally need special impression techniques

Question 13

MRNJ/ORN cause (denture related)

Answer 13

and ill fitting denture in a patient on anti resorptive medication

Question 14

MRONJ/ORN management

Answer 14

refer promptly to maxfax

Question 15

denture allergic reactions - features

Answer 15

often redness under denture bearing area
- mimics denture stomatitis
can occur on lips/cheeks
uncommon but usually with nickel containing CoCr or PMMA
- especially self cure relines - higher monomer