Patient examination and assessment of previous dentures Flashcards
ILO 2.6d: be familiar with the design and choice of materials used in the production of partial dentures, along with laboratory procedures
what may be a patient’s complaint when attending for dentures?
- pain
- looseness / lack of retention
- difficulty eating/speaking
- tooth shade / size
- amount of tooth on show
what are you looking for in the medical history? give examples of conditions that may affect these
identify problems that could effect:
1. attending for treatment
2. procedure tolerance
3. living with dentures
* rheumatoid arthritis
* neuromuscular problems
* stroke
* mobility
* mucosal disease
* osteoporosis / bisphosphonates
* limited mouth opening
* dry mouth
* dementia
what in the social history affects people with dentures?
- do they live alone/supported living/care home?
- distance travelled / ability to attend
- accompanying person?
- hobbies? - musical instruments?
- smoking
- alcohol
- diet
what are some important questions to ask in the dental history?
- regular attender or just in pain?
- how often do they clean their teeth?
- have they 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 you assessing in the extra-oral assessment?
- midline
- incisal plane
- lip position (smile line) - high (gummy), normal, low
- aesthetics of existing dentures
- naso-labial angle
- lower face height
what are you assessing in an intra-oral assessment?
- general exam
- healthy denture bearing area?
- any trauma?
- denture stomatitis
- chart the teeth
- BPE
what is of relevance when making a denture intra-orally?
- intraoral access - enough space to insert/remove a denture
- plaque control - OH must be optimised before denture provision
- tooth mobility and periodontal disease - suitable abutments? likely further tooth loss?
- gag reflex - can you take an impression? will pt. tolerate a denture?
- trauma/ulceration - trauma from existing denture?
- dry mouth - medication related - increased chance of root caries
- retained roots - can they be left as overdenture abutments to retain alveolar bone?
- compromised teeth - toothwear, caries - all teeth must be restored
what are you looking for with the residual ridges / saddle areas?
- how atrophic is it? (decrease in size)
- any displaceable tissue?
- number? position? length?
- soft tissue undercuts
- sulcus depth
- frenum positions
what are you looking for in a radiographic assessment?
- assess potential abutment teeth
- caries
- bone support
- periapical pathology
- root length
- angulation of long axis of tooth
- long term prognosis
when designing a denture, what are you assessing?
- retention - retentive forces exceeding displacing forces
- stability - stable denture moves little in relation to the underlying bone during function - antero-posteriorly / mesio-laterally
- extension - look at labial, buccal and posterior denture borders, esp. saddle areas
- over extension - discomfort, looseness in function, speech issues, impingement on frenal attachment, difficulty swallowing
- under extension - looseness in function, traumatic ulceration, food trapping under denture
- occlusion - static relationship between the masticatory surfaces of the upper and lower teeth
what are you assessing when looking at occlusion?
- do the teeth meet when the denture is in place
- is there space between the upper and lower teeth at rest
- do any of the denture components interfere with the occlusion
- are the denture teeth worn
- is the lower face height restored when the denture is in place
what are index teeth?
when a maxillary tooth meets against a mandibular tooth
where can there be damage in a denture?
framework and clasps
* clasp fracture or removal
* alterations to major connector
* frature to major and minor connector
arcylic components
* added teeth
* wear on teeth
* fractured teeth
* fractures to base plate
* repeated debond of acrylic components from framework
