REM PROS REVISION LEC CARDS Flashcards
Why make the mouth healthy before starting dentures? (3)
Dentures more comfortable if tissues healthy
Dentures can make dental disease worse
Dentures last longer (tx e.g. XLA can change the fit surface of the denture
What oral structures are we making healthier (pre-denture)? (3)
Oral mucosa
Teeth
Periodontal tissues
What is denture stomatitis? List KEY facts to do w/ denture hygiene? (6) (Pre-tx; oral mucosa)
Definition: ‘Denture sore mouth’ localised non-communicable oral candida infection affecting the palate + gingiva (acute or chronic)
Caused by candida albicans
Key causes 1) poor denture cleaning 2) keeping denture in overnight
Assoc w/ angular chelitis
Tx: nystatin oral suspension OR miconazole gel
(Consider immunosuppression, pt risk suspectibility/ referral tests)
ORAL ULCERS - non-denture + denture related? (2) (Pre-tx; oral mucosa)
Mouth ulcers COMMON + should resolve in 2-3w (arrange review + urgent referral to OM for persistant ulcers of unknown cause)
Denture related = TRAUMATIC ULCER from poor fitting denture (remove cause e.g. over-extension of denture)
What is BRONJ? + how do we manage? (Pre-tx; oral mucosa)
Bisphosphonate related osteonecrosis of the jaw
Management = Referral
How do identify/manage denture if causing trauma / trauma rx ulcers? (3) (Pre-tx; oral mucosa)
- Assess if denture border too long for sulcus
- Identify area causing trauma w/ pressure paste + trim back w/ acrylic bur
- Temporary soft lining may help
How do you use pressure paste to identify area of trauma? (2) (Pre-tx; oral mucosa)
Apply pressure paste to edge of denture
Trim pink acrylic showing through w/ paste still there
How do you use soft linings to ease area of trauma? (3) (Pre-tx; oral mucosa)
Mix + apply to fit surface
Place in mouth to mould to shape
Trim excess (lasts weeks/months + allows tissues to recover)
What is denture granuloma? Management? (4) (Pre-tx; oral mucosa)
Definition = chronic inflammation (of upper arch that is denture rx
Management:
Remove cause (usually denture rx)
Review to see if reduced in size (several months)
Surgery (last resort)
Why manage caries + perio disease before starting dentures?(2) ; state tx (3) (Pre-tx; oral mucosa)
Dentures attract plaque (any plaque rx diseases made worse)
So, **dentures fit the teeth in their final form **
THEREFORE
Complete all direct + indirect restorations before
Plaque score < 20%
XLA of poor prognosis + allow healing (6-8w)
Key considerations re tooth-wear before making dentures? (3) (Pre-tx; oral mucosa)
Decide what to do about worn teeth before making dentures (tx plan for worn teeth)
Restore before making dentures usually (eg. Composite or indirect restorations)
Tx will result in increased OVD (so, new OVD established before denture = better denture success)
Reasons for using articulated casts? (6) (;Articulated cast)
Easier to view incisal relationship from palatal aspect
To observe occlusion for denture design purposes (positioning of rests and assess interocclusal space)
Examine static and/or dynamic occlusion
Plan changes in OVD (wear cases)
Make diagnostic changes prior to irreversible treatment (composite build-ups/indirect restorations)
Use as a visual aid when discussing treatment options with patient
What material is used for primary impressions?
Alginate
How/tips on selecting stock tray? (5)
Use imprint of teeth on a sheet of wax for tray selection
Be able to insert tray into the mouth w/o discomfort + comfortable when seated
Tray should touch occlusal surfaces on both sides to indicate it is seated
Tray covers all the teeth + soft tissues that you wish to record (or can be modified easily if under-extended e.g. using pink wax)
Be able to move tray sideways showing enough space for alginate between tray & tissues
How to get accurate reading of sulcus area?(8) -primary + secondary imps
1.Check tray extends to full height of the sulcus (2mm gap between tray + sulcus)
- Add double layer of wax to extend borders if tray too short in sulcus area
- Ensure frenal attachments not squashed (cut grooves in wax if too long)
- Pre-load some sulcus areas with alginate to avoid trapping air (esp labially)
- Ensure sufficient impression material where you need it (enough in the stock tray?)
- Seat tray correctly so that impression material can flow over tray borders correctly
- Border moulding (by pt +/ operator) whilst impression material setting
- Ensure detachable handle does not interfere with lip movement (is it fitted correctly?)
How do you manage gagging pt during impressions? (4)
Correct tray size - ensure impression tray (+ extensions) not too large
Impression material – right amount of impression material (not XS)
Impression material – fast-setting where possible
Distract patient during impression (deep, steady breathing, wiggle toes etc)
List 4 instructions for correct disinfection + storage of impressions (Alginate or silicone) (2)
Rinse – with water under the tap to remove debris
Rinse – low in sink/away from you to prevent splash back
Disinfect – soak for required time (10 mins proform)
Rinse again - to remove chemicals
Alginates keep moist – wrap completely in damp gauze/tissue. Store in sealed bag to prevent drying out
Elastomeric impression materials (silicones) store dry and protect with paper or bubble wrap
List 6 ways to reduce errors when casting? (6)
Cast ASAP + within 24 hrs (alginate ASAP, silicone not as urgent)
Ensure no debris/excess liquid inside impression when casting
Remove excess alginate from impressions borders where it might distort impression when sitting on the bench
Ensure plaster or stone mixed correctly + of correct consistency (not too thick or watery)
Run a thin layer of mix over teeth area first to avoid air getting trapped in teeth
Use vibrating table to eliminate air bubbles in mix
Leave stone in impression to set properly first before turning over to base the cast
Remove impression once cast is based (this prevents interaction of materials + surface damage)
What is meant by jaw relation? (2) (;jaw reg stage)
3D spatial relationship between the upper + lower jaws (or teeth)
Both a VERTICAL + HORIZONTAL component
What is meant by horizontal jaw relationship? (3) State rationale (1) (;jaw reg stage)
- Two positions are intercuspal position (ICP) and retruded contact position (RCP) (aka centric relation)
- Use ICP – when there are sufficient opposing pairs of posterior teeth to record a reproducible ICP
- Use RCP/centric relation – if insufficient natural teeth to record ICP, or if the patient’s OVD is to be increased (typically wear cases)
Rationale = choose an occlusal rx that is reproducible + so kept the same throughout all stages of making a denture
What horizontal rx do we use in wear cases and why?
even if someone has stable ICP, in wear cases you are increasing OVD so you are loosing stable ICP
therefore we use RCP
Give the full definition of RCP
Retruded Contact Point
A bilateral, unstrained position of the mandible in which the condylar disc assembly(CDA) is in the most anterior superior position (ASP) within the glenoid fossa. (GF)
In this position, the initial 20mm of incisal opening is a pure ”hinge” movement around the hinge axis.
If natural teeth are present, RCP is the point of initial tooth contact as the jaw closes around the hinge axis.
What is the ideal occlusion for partial dentures?
For partial dentures use natural teeth as a guide to denture position WHERE POSSIBLE i.e. ICP where it is reproducible
Where the vertical dimension is determined by natural teeth but there are NOT enough inter-cuspating posteriors to determine horizontal jaw position RCP is used.
When do we need occlusal rims? (2)
To support casts when articulating
Hand articulation not possible without rim (or interocclusal record alone not sufficient)
(regardless of occlusal rims being needed we always need the intraocclusal record which relates the horizontal position between upper + lower jaws)
What ways can you articulate a study cast when using ICP? (2)
Hand articulated casts
OR
Facebow to articulate
Ways/process of articulating a study cast when using RCP?
(These casts cannot be hand articulated)
Therefore to mount on an articular, you need:
- occlusal rims
- interocclusal record
- facebow
What is the purpose of occlusal rims?
provide a shape to whoever is making denture on where to set teeth + to indicate where the lip support is and incisal edges etc
Why use a facebow? (4)
- is used to record the 3D rx between the upper occlusal plane and the terminal hinge axis in the patient
The facebow then transfers this relationship onto the articulator
This enables the articulator to simulate the patient’s jaw movements better
If the articulator simulates the patient better, then any restorations made on the articulator (eg. dentures) are more likely to conform to the patient’s occlusion + be more acceptable to the patient
What is the purpose of a face bow? (3)
To record the relationship between upper occlusal plane + terminal hinge axis in the patient
Then use facebow to transfer this onto the articulator
Use facebow to articulate upper cast
State 3 considerations for jaw reg of edent pt
No guide of where pt’s previous teeth were, so need occusal rims + inter-occlusal record for Jaw relationship
Jaw relationship recorded in RCP
Occlusal rims for e.dent pt can be made in wax, self-cure acrylic or heat- cure acrylic
(Note for partially dentate pt heat-cure acrylic not used)
How do we measure freeway space for an edentulous patient? (5)
Ideally 2 - 4 mm for an edentulous patient
Use a Willis gauge as a measuring tool
Measure occlusal vertical dimension (OVD) w/ both dentures in
Measure rest vertical dimension (RVD) w/ at least one denture out
Calculate RVD- OVD = FWS
What could happen if there is not enough freeway space (FWS)? (4) (;edent pt)
- Might get soreness under one/both dentures (trauma may be visible on soft tissues)
- Aching jaw muscles (OVD too excessive or not enough freeway space and no room to move)
- Patient wants to leave dentures out because uncomfortable to wear. Patient may say “dentures feel too big or they feel like a mouth full”
- Appearance may not be unacceptable - showing too much tooth/ or patient’s lips become incompetent because mandible & maxilla are too far apart
What could happen if there is too much freeway space (FWS)? (6) (;edent pt)
Might see deep creases at the corners of the patient’s mouth (both sides usually)
Might see infection/redness/soreness at corners of the mouth (possibly angular cheilitis)
May also have denture stomatitis on palate (possibly same time as angular cheilitis, because both can be candida related)
Patient may complain of poor appearance (i.e.. poor lip support or reduced denture tooth height)
Patient may have jaw/muscle ache because they are over- closed (OVD too small)
Patient may show very worn denture teeth/and also have difficulty chewing food if occlusal surfaces flat or misshapen
Positioning artificial upper anterior teeth in denture patients? (6)
Match denture teeth midline to midline of face (nose and between the eyes when smiling or incisive papilla)
**Incisal edges near (or 1-2 mm below) lower border of upper lip at rest. **
** Lip support favourable** (approx. 90-degree angle between lower border of nose and upper lip profile looking from the side)
Match long axes of upper denture teeth with patient’s sagittal plane/midline (symmetry and converging slightly inwards + downwards ideal)
**Look at denture gingival margins + lower border of upper lip when smiling **(to see how much pink wax/acrylic is showing)
Compare denture tooth position against natural teeth (eg. anterior overjet & overbite, or arch shape)