Patient Examination

Question 1

What are questions that should be asked upon presenting complaint?

Answer 1

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

Question 2

Before you even put on your gloves, what should be asked and identified?

Answer 2

Routine medical history

Identify problems which could affect

Attending for treatment
Procedure tolerance
Living with dentures

Question 3

What questions should be asked in the social history

Answer 3

Social History

Live alone/supported living/care home
Distance travelled / Ability to attend
Accompanying person?
Hobbies – musical instruments
Smoking
Alcohol
Diet

Question 4

What should be asked in the prosthodontic history?

Answer 4

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?

Question 5

What should be asked in the dental history?

Answer 5

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

Question 6

What are the main parts that need to be assessed?

Answer 6

patient
denture

Question 7

What should be examined in the extra-oral examination?

Answer 7

Midline
incisal plane
Lip Position (smile line)
Aesthetics of existing dentures

Question 8

What are types of lip position?

Answer 8

-High (gummy)
-Medium (normal)
-Low (don’t see much tooth)

Question 9

What are the facial supports that need to be assessed?

Answer 9

Nasio-labial angle
Lower face height (index teeth)

Question 10

What exams should be taken on the soft tissues?

Answer 10

General exam
Denture bearing area (healthy, trauma, denture stomatitis)

Question 11

What is the nasio-labial angle for patients with their own teeth?

Answer 11

perpendicular

Question 12

What is the nasio-labial angle for patients with dentures?

Answer 12

obtuse

Question 13

What is the lower face height for people who have dentures?

Answer 13

distance from nose to chin much less than nose to forehead

Question 14

What does the intra-oral assessment include?

Answer 14

chart the teeth (if not done recently)
BPE

Question 15

What are relevant questions to the denture assessment beforehand?

Answer 15

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)

Question 16

How should the residual ridges/saddle areas be assessed?

Answer 16

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

Question 17

How can you assess potential abutment teeth?

Answer 17

caries
bone support
peri-apical pathology
root length
angulation of long axis
long term prognosis

Question 18

What are other special tests?

Answer 18

electric pulp test
thermal
6-point pocket chart
clinical photography

Question 19

How should you assess the denture?

Answer 19

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

Question 20

What are the parts of denture assessment?

Answer 20

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

Question 21

What are buccal corridors?

Answer 21

spaces on either side of your upper teeth when you smile (the negative space)

Question 22

What is retention?

Answer 22

the retentive forces exceed displacing forces e.g it stays in place

how easy it is to remove it?

Question 23

What is stability in regards to dentures?

Answer 23

stable denture moves little in relation to the underlying bone during function (antero-posteriorly/mesio-lateraly)

Question 24

What does over-extension cause?

Answer 24

discomfort, looseness in function, speech issues, impingement on frenal attachements, difficulty swallowing and gagging

Question 25

What does under-extension cause?

Answer 25

looseness in function, traumatic ulceration, food trapping under denture

Question 26

What is occlusion?

Answer 26

static relationship between the mastication surfaces of the upper/lower teeth

Question 27

What is important in occlusion that dentures should have?

Answer 27

free-way space between upper and lower teeth when the mandible is in the physiologic rest position

Question 28

What are index teeth essential for?

Answer 28

occlusion vertical dimension

Question 29

Where does denture damage commonly occur?

Answer 29

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

Question 30

Denture stomatitis was classified by Newton in 1962. How does Newton’s type 3 denture stomatitis present?

Answer 30

Inflammatory papilliary hyperplasia on the hard palate and alveolar ridge

Question 31

What is commonplace amongst partial denture wearers?

Answer 31

poor oral hygiene

Question 32

What other features are associated with denture stomatitis?

Answer 32

Angular cheilitis
Incorrect occlusal vertical dimension
Soft tissue hyperplasia
Traumatic ulcers

Question 33

Denture stomatitis was classified by Newton in 1962. How does Newton’s type 2 denture stomatitis present?

Answer 33

Diffuse erythema involving part, or all, of the denture-bearing area

Question 34

What is the chronic exposure of the soft tissues underneath dentures to ‘denture plaque’ most associated with?

Answer 34

Inflammatory changes in the soft tissues

Question 35

In denture stomatitis, which species of Candida is most prevalent?

Answer 35

Candida albicans

Question 36

Denture stomatitis was classified by Newton in 1962. How does Newton’s type 1 denture stomatitis present?

Answer 36

Localised inflammation or pinpoint erythema

Question 37

How many microbes is the denture surface capable of carrying?

Answer 37

10^11

Question 38

What is the difference between the rest vertical dimension (RVD) and the occlusal vertical dimension (OVD)?

Answer 38

free way space