REM PROS pathological changes

Question 2

list the reasons why are ill-fitting dentures associated with a heterogenous group of oral mucosal lesions?

Answer 2

acute or chronic reactions to microbial denture plaque
a reaction to constituents of denture base materials
mechanical denture injury

Question 3

list the types of pathological changes that are related to ill-fitting dentures?

Answer 3

ulcers
denture stomatitis
angular cheilitis
denture irritation hyperplasia
flabby ridges
MRONJ/ ORN
allergic reactions

Question 4

how may dentures cause ulcers?

Answer 4

denture trauma from overextension: sharp bits, pressure too hard, occlusal trauma

Question 5

what sites are prone to ulceration if a denture is ill-fitting?

Answer 5

lingual fraenum
mylohyoid ridge
undercuts

Question 6

treatment is an ulcer is present with an ill fitting denture?

Answer 6

identify: pressure indicating paste, articulating paper
ease: occlusal adjustment, trim and polish base
review

Question 7

after adjustment, on review if the ulcer is still present, what do you do?

Answer 7

urgent referral to max-fac

Question 8

what part of the mouth would be related to denture stomatitis?

Answer 8

denture bearing area

Question 9

aetiology of denture stomatitis?

Answer 9

denture hygiene issue
candida albicans

Question 10

presentation of denture stomatitis?

Answer 10

red: oedema and erythema
will be related to the shape of the denture

Question 11

management for denture stomatitis?

Answer 11

take denture out at night
clean denture with soft brush
steep denture (in diluted milted x2/wk)
possible use of chlorhexidine
possible use of nystatin or other antifungals

Question 12

if a pt presents with denture stomatitis, what factors, other than denture hygiene, must we consider?

Answer 12

underlying issues - diabetes, folate, B12, feritin

Question 13

what other pathological disease is denture stomatitis related to?

Answer 13

angular cheilitis

Question 14

what are the causes of angular cheilitis?

Answer 14

overclosure; loss of OVD, excessive FWS, old worn dentures
use of miconazole (interacts with coumarins)
underlying issues: diabetes, folate, B12, ferritin, xerostomia (polypharmacy)

Question 15

what microbes are associated with angular cheilitis?

Answer 15

candida albicans
staph aureus
beta haemolytic streps

Question 16

what causes denture irritation hyperplasia?

Answer 16

very old ill-fitting dentures which induce chronic trauma and a hyperplastic response

Question 17

management for denture hyperplasia?

Answer 17

major ease of denture
tissue condition (coe comfort)
review and repeat if required
new denture

Question 18

if your local management doesnt resolve denture hyperplasia, what do you do?

Answer 18

refer to oral surgery for removal of excess tissue

Question 19

what causes flabby ridges?

Answer 19

trauma of denture hitting usually anterior ridge often when lower anteriors only present and no lower denture

this then causes bone resorption and fibrous replacement

Question 20

management for flabby ridges?

Answer 20

new denture covering the whole denture bearing area with a good peripheral seal and opposing arch denture giving posterior support

Question 21

what is the relation between MRONJ/ ORN and ill-fitting dentures?

Answer 21

an ill-fitting denture in a pt on anti-resorptive drugs can be a factor in MRONJ leading to necrosis of bone

Question 22

what do allergic reactions to dentures look like?

Answer 22

redness under denture bearing area
looks alot like stomatitis

can also occur on lips/ cheeks

Question 23

what components of dentures, even though uncommon, can cause allergic reactions?

Answer 23

nickel containing cocr
PMMA (self-cure relines); due to higher monomer