Patient Examination Flashcards
What are questions that should be asked upon presenting complaint?
Why does the patient want a new denture?
Is the patient complaining of functional problems?
Pain
Looseness/lack of retention
Difficulty eating/speaking
Is the patient complaining of appearance?
Tooth shade/size
Amount of tooth show
Before you even put on your gloves, what should be asked and identified?
Routine medical history
Identify problems which could affect
Attending for treatment
Procedure tolerance
Living with dentures
What questions should be asked in the social history
Social History
Live alone/supported living/care home
Distance travelled / Ability to attend
Accompanying person?
Hobbies – musical instruments
Smoking
Alcohol
Diet
What should be asked in the prosthodontic history?
What type of denture is the patient currently wearing?
How old is the denture?
What materials have previous dentures been made from?
Do they have a “favourite” denture?
What should be asked in the dental history?
Regular attender or when just in pain
How often do they clean their teeth
Have they never/ever managed to wear dentures
How long have they been wearing dentures
How many dentures previously
How do they clean their dentures
Do they take them out at night
What are the main parts that need to be assessed?
patient
denture
What should be examined in the extra-oral examination?
Midline
incisal plane
Lip Position (smile line)
Aesthetics of existing dentures
What are types of lip position?
-High (gummy)
-Medium (normal)
-Low (don’t see much tooth)
What are the facial supports that need to be assessed?
Nasio-labial angle
Lower face height (index teeth)
What exams should be taken on the soft tissues?
General exam
Denture bearing area (healthy, trauma, denture stomatitis)
What is the nasio-labial angle for patients with their own teeth?
perpendicular
What is the nasio-labial angle for patients with dentures?
obtuse
What is the lower face height for people who have dentures?
distance from nose to chin much less than nose to forehead
What does the intra-oral assessment include?
chart the teeth (if not done recently)
BPE
What are relevant questions to the denture assessment beforehand?
intra-oral access (have you got space to insert/remove a denture)
plaque control (OH must be optimised before denture provision)
tooth mobility and PD disease (are there suitable abutments, is there likely to be further tooth loss?)
gag reflex (can you take an impression? will the patient tolerate a denture?)
trauma/ulceration (is there trauma from an existing denture?)
dry mouth (often medication related in denture patients - increased risk of root caries)
retained roots (can they be left as overdenture abutments to retain alveolar bone)
compromised teeth (toothwear, caries)
How should the residual ridges/saddle areas be assessed?
feel the ridges with your finger-assess ridge form
-how atrophic is it
-any displacement tissue
-number/position/ length
-possibly bone resorption
look for soft tissue undercuts
sulcus depth
frenum positions
How can you assess potential abutment teeth?
caries
bone support
peri-apical pathology
root length
angulation of long axis
long term prognosis
What are other special tests?
electric pulp test
thermal
6-point pocket chart
clinical photography
How should you assess the denture?
Support and distribution of missing teeth
kennedy classification
craddock classification
existing design (draw out existing design, what do you think of it?)
what is the condition of teeth and base in existing dentures
What are the parts of denture assessment?
tooth position
tooth shade/mould
amount of tooth shown
condition of existing teeth (are they worn)
midline
incisal plane
lip position (smile line)
buccal corridors
retention
stability
occlusion
What are buccal corridors?
spaces on either side of your upper teeth when you smile (the negative space)
What is retention?
the retentive forces exceed displacing forces e.g it stays in place
how easy it is to remove it?
What is stability in regards to dentures?
stable denture moves little in relation to the underlying bone during function (antero-posteriorly/mesio-lateraly)
What does over-extension cause?
discomfort, looseness in function, speech issues, impingement on frenal attachements, difficulty swallowing and gagging
What does under-extension cause?
looseness in function, traumatic ulceration, food trapping under denture
What is occlusion?
static relationship between the mastication surfaces of the upper/lower teeth
What is important in occlusion that dentures should have?
free-way space between upper and lower teeth when the mandible is in the physiologic rest position
What are index teeth essential for?
occlusion vertical dimension
Where does denture damage commonly occur?
framework and clasps
-clasp fracture or removal
-alterations to major connector
-fracture to major and minor connectors
acrylic components
-added teeth
-wear on teeth
- fractured teeth
- fractures to baseplate
-repeated debond of acrylic components from framework
Denture stomatitis was classified by Newton in 1962. How does Newton’s type 3 denture stomatitis present?
Inflammatory papilliary hyperplasia on the hard palate and alveolar ridge
What is commonplace amongst partial denture wearers?
poor oral hygiene
What other features are associated with denture stomatitis?
Angular cheilitis
Incorrect occlusal vertical dimension
Soft tissue hyperplasia
Traumatic ulcers
Denture stomatitis was classified by Newton in 1962. How does Newton’s type 2 denture stomatitis present?
Diffuse erythema involving part, or all, of the denture-bearing area
What is the chronic exposure of the soft tissues underneath dentures to ‘denture plaque’ most associated with?
Inflammatory changes in the soft tissues
In denture stomatitis, which species of Candida is most prevalent?
Candida albicans
Denture stomatitis was classified by Newton in 1962. How does Newton’s type 1 denture stomatitis present?
Localised inflammation or pinpoint erythema
How many microbes is the denture surface capable of carrying?
10^11
What is the difference between the rest vertical dimension (RVD) and the occlusal vertical dimension (OVD)?
free way space
