post insertion and review Flashcards
How do you take a history of the past week?
Start with- I bet it’s been a tough week for you
Listen
Be sympathetic
What problems are encountered?
Pain/ulcers Insecurity (looseness) Chewing Speech Appearance Nausea
Why might pain occur?
At periphery of denture bearing tissues- over extensions
Centrally on denture bearing tissue- occlusal problems or fitting surface errors
Cheek or lip biting- neutral zone
Numbness- inadequate FWS
What are some common sites of pain?
Mylohyoid bone region (disto-lingual region)
‘Pain under tongue’
Use mirror to retract tongue
Hamular notch
‘Not sure if upper or lower denture’
Post dam/junction of hard/soft palate
‘back of mouth, difficult to swallow’
Around frenal attachments
- due to poor border moulding
Genial tubercles in atrophic mandibles
- due to mucosa being trapped
Lower labial region
-poor retraction of lower lip in secondary impression stage
What is a pick up technique?
- Dry surface of denture/ulcerated mucosa
- Mark ulcer w ZnO or dycal paste
- Transfer to denture
- Adjust denture accordingly
What is PSI?
Pressure spot indicator paste
Can pick up multitude of problems
What is central pain?
No ulcer
Palpate ridge and gradually move along
Ask patient to lift hand when they feel pain
Place cream on area and transfer onto denture
Why might cheek biting problems occur?
Check buccal fat pads
Often due to 7s or teeth not being in neutral zone (too far buccally)
There should be a slight space in retromolar region- should be anticipated in try in stage, better to leave out 7s
Why might numbness/shooting pain occur?
Inadequate FWS, teeth constantly in contact, creating load and pressure over mental nerves
Associated w numbness of lips
Why might tongue biting occur?
Teeth placed too far lingually or tongue cramping
What is a clue to lack of FWS?
Generalised tenderness along whole ridge
Lower ridge often tender to palpate and erythematous (red)
Why might a patient have TMJ or facial muscle pain?
Almost always FWS or occlusal problem
Does patient sleep w dentures in?
Check for general redness, palpate for tenderness
Often no discernible ulcers
What should be expected of the insecurity of dentures?
Maxillary- should eventually fit firmly
Mandibular- may never get tight fit due to anatomy
How should you investigate insecurity?
Ask when it occurs
Speaking- muscle interference at periphery/frenal attachment/muscle interference of polished surfaces (shape eg. convex)
Eating- occlusal interference (RCP not equal to ICP)/poor lower ridge form (can’t do much)
Why might there be a maxillary insecurity?
Usually posterior border
Due to under extensions
Small bead (autopolymerised acrylic) can be added to make a functional post dam- sets in mouth
Removed prior full setting to be trimmed w scalpel
Why might there be a mandibular insecurity?
~overextension of denture base
~lingual inclination of posterior teeth- cusps can be removed for tongue space
~occlusal discrepancies
~errors in placement of lower anterior teeth- outside of neutral zone
Why might the patient have chewing or eating problems?
Occlusal discrepancy- RCP not equal to ICP/incorrect OFH
Locked occlusion- worn dentures may be replaced by steep cusps
What is a precentric check record?
Uses wax/silicone
Guide patient into centric relation
Ask patient to stop when first tooth to tooth contact
Many operational errors
What is Gothic arch tracing?
- Upper- plate attached to denture using sticky wax
Coat GAT plate w crayon
Lower- stylus is mounted in same way - Placed in mouth, patient asked to slide forward/back and side to side etc, arrow shape occurs, tip of arrow signifies centric relation
- Sticky wax is used to secure a circular disc w a hole in it over the centric relation position
- The lower denture is placed back in mouth, stylus is manipulated so it locks into the hole
- Position captured with bite registration paste and denture is taken out
This can be remounted onto an articulator and can be accurately adjusted
Why might the patient have speech problems?
Tooth position
Shape of base
Lack of FWS
Excessive acrylic behind upper anteriors, palatal cusps of 4s too bulky, lingually tilted lower posteriors
Why might a patient have an issue w the appearance?
Complaint about position, shade, size and shape
Complaint about soft tissues and the way they’re supported
Why might a patient have nausea?
Patient never worn a denture before
Post dam region extended palatally for better suction
Thick posterior margin
Insecurity when talking- dropping onto tongue
Training plates may be needed- if can’t handle, they won’t handle so may need 3-3 (smaller denture)
Why might the patient have ulcers on labial and lingual surface- opposing side of ridge?
Patient was putting bonjela on overextending denture and sleeping with it in
Bonjela contains salicylic acid (component of aspirin)- causes burning
