Pros Tutorials Flashcards by Sanjana Chahal

what is the main cause of denture stomatitis?

candida albicans

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what are local risk factors for denture stomatitis?

denture trauma
poor denture hygiene
nocturnal denture wear

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what are systemic risk factors for denture stomatitis?

smoking
diabetes
nutritional deficiencies
immune deficiencies
broad spectrum antibiotics
corticosteroid therapy
high carb diet
xerostomia
radiotherapy

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denture stomatitis is generally asymptomatic but what can it give rise to?

bleeding of affected area of mucosa
burning sensation
halitosis
bad taste
xerostomia

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why does denture stomatitis rarely affect the lower arch?

due to washing effect of saliva and cleansing action of tongue, whereas peripheral seal in upper arch creates microenvironment

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what is newtons classification of inflamed mucosa?

type 1: localised areas of inflammation (possibly caused by trauma). simple localised inflammation
type 2 - generalised erythema covering the denture bearing area. simple diffuse inflammation
type 3 - inflammatory papillary hyperplasia usually affecting the hard palate or alveolar ridges. granular inflammation

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what is type 1 denture stomatitis associated with?

long term tissue trauma from poorly fitting/unstable dentures, pt with parafunctional habit,s dentures with surface roughness

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what is type 2&3 denture stomatitis associated with?

denture hygiene

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how does c albicans cause denture stomatitis?

acrylic resin is suitable for fungi to colonise (can adhere and proliferate). also applies to soft linings (as have relatively high surface porous texture).

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how do the risk factors relate to the increased incidence of denture stomatitis?

Patients who wear implant-supported prostheses have a greater distribution of occlusal loads compared to conventional prostheses have been shown to have significantly decreased occurrence of denture stomatitis
Rough fitting surface of denture facilitates retention of micro-organisms and may act as a reservoir
Surface irregularities may shield micro-organisms from physical oral hygiene measures
Poor denture hygiene allows increased growth of pathogenic microorganisms on fit surface
Wearing denture at night increases risk:
Relatively anaerobic environment with decreased pH favours candida growth
Saliva is not able to cleanse denture-bearing area
Unclear why smokers are predisposed to denture stomatitis, although thought that aromatic hydrocarbons in smoke cause localised epithelial alterations
High sugar diet means there is more glucose to stimulate candida growth and increase adhesion of fungi
just as significant a risk factor as poor denture hygiene!!

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What is treatment for denture stomatitis?

Treat the cause!!:
- management of underlying systemic disease - eg smoking cessation, salivary substitute, dietary advice
- improve fit of poorly fitting dentures - smooth rough areas, tissue conditioners
- improve denture hygiene
- use of topic and systemic antifungals - miconazole, fluconazole, nystatin

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what denture hygiene can be done to improve denture stomatitis?

improved brushing of denture, cleansing of palate
leaving denture out at night
use of sonic bath
soak dentures in hypochlorite (Miltons, no more than 15mins)

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how does brushing the palate reduce palatal inflammation?

removal of palatal biofilm leads to reduced keratinisation, reduced infiltration of inflammatory cells and increased proliferation of fibroblasts and collagen synthesis
brushing away hyphae, increases blood flow to area, stimulates healing

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what is the most likely complaint from a denture stomatitis patient?

the denture not fitting properly

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What are the advantages of overdentures?

preservation of alveolar bone
enhanced proprioception
improved prosthesis stability/support
improved retention (precision attachments)
benefits psychologically

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common causes of overdenture failure?

periodontal disease
caries
periapical infection
vertical root fracture

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How to care of abutment teeth?

regular maintenance/topical fluoride use/OHI

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What precision attachments are there for overdentures (in order of retentiveness most to least)?

Bars
Studs
Magnets

what are the advantages of magnets?

easy to clean
self-locating
good for poor manual dexterity
less sensitive path of insertion

disadvantages of magnets

susceptible to corrosion
requires changing every year

what might precision attachments do?

may transmit damaging lateral forces to abutment teeth during function

what is a vertical space of 2.5mm required for?

keeper
magnet
denture base
prosthetic tooth

how much vertical space do bars require?

6mm

what features should magnet abutment teeth need?

caries free
periodontally sound
sound root filling

(dont discount mobile teeth, prep will reduce crown-root ratio, mobility will be eliminated as a result)

advantages of copy dentures

aim to copy general shape of polished surfaces allows for changes to fit surface renovation of occlusal surface simple clinical technique fewer clinical visits

how can you manage a free end saddle area?

shortened dental arch simple rigid design RPI equipoise

why is mandibular arch free end saddle more problematic than maxillary arch?

maxilla has more denture bearing area upper has less soft tissue displaceability

what is the issue with free end saddle?

mucosa offers less support/more displaceable

what is a simple, rigid design?

mandibular free end sadles - extend onto anterior 1/3 of retomolar pads reduced occlusal table: narrowing post teeth, shortening, omitting posterior teeth wrought clasps mesial rests indirect retention

what happens as the saddle is pressed into the mucosa (RPI)

denture rotates about a point close to mesial rest on the distal abutment tooth distal guide plate and I bar disengage

what is equipoise?

modification of RPI. opposite effect. mesial rest, lingual cusp arm - extends into distal undercut from rest. tooth held in rigid manner. design protects, preserves, strengthens abutment teeth - directs all masticatory forces down the long axis of the abutment tooth

indications neutral zone impressions

highly atrophic ridge (atwood 5/6) history of lower denture instability

what is the neutral zone?

An area in the mouth where, during function, forces of tongue pressing outwards are neutralised by forces of cheeks and lips pressing inwards

what are the aims of neutral zone impressions?

construct denture shaped by muscle function - in harmony with surrounding oral structures

what are advantages of neutral zone impressions?

improved stability and retention posterior teeth correctly positioned to allow tongue space reduced food trapping adjacent to molars good aesthetics due to facial support

what are the functional anatomy - main displacing forces on lower denture?

tongue, lower lip, modiolus

what are the functional anatomy - major muscles involved?

buccinator, modiolus, orbicularis oris, tongue

what is the main retentive/stabilising factor during function of the atrophic mandible?

muscular control over denture

timeline of neutral zone impressions

primary imps secondary imps jaw reg assessing upper wax try-in and OVD neutral zone imp wax try-ins finish and check record review

what is the lower base-plate construction for a neutral zone impression?

heat-cured acrylic base plate. acrylic provides better stability.

what is the function of the heat cured acrylic base plate?

even occlusal stops at correct OVD provide support for neutral zone imps

what is the neutral zone technique?

ensure pt sat upright assess baseplate - check stability and ensure stops do not interfere with muscle function insert upper wax try in insert lower base plate - check desired OVD-adjust occlusal stop in necessary remove baseplate - place viscogel onto base plate, manipulate to form approximate rim reinset lower base plate ask pt to perform functional movement remove after 10mins once set and send to lab

how do you ask pt to perform functional movement?

swallow, take sips of water talk aloud smile, grin, lick lips, purse lips actions will mould material via muscle activity