Removable Prosthodontics

Question 1

When completing lab prescription forms, what act must be adhered to?

Answer 1

The Data Protection Act 2018

Question 2

How many mm would you normally prescribe for a spacer on a special tray?

Answer 2

3mm

Question 3

When would you not not prescribe for a spacer on a special tray?

Answer 3

In complete dentures when the tray is close fitting

Question 4

What material is normally used for special trays?

Answer 4

Light cured acrylic

Question 5

What other features can you prescribe for special trays to have?

Answer 5

Tray handle and/or stops

Question 6

If the patient is a gagger, what special tray might you prescribe for?

Answer 6

A horseshoe tray

Question 7

What type of acrylic can be used for the dentures if the patient has a high risk of fracture?

Answer 7

High impact acrylic

Question 8

What are the clinical stages in the construction of a partial denture?

Answer 8

1. 1st imps
2. Occlusion
3. Denture Design
4. 2nd imps
5. Try-In
6. Retry
7. Fit

Question 9

What are the advantages of overdentures?

Answer 9

1. Correction of occlusion and aesthetics
2. Support (tooth and mucosal)
3. Tooth wear management
4. Preservation of the ridge form
5. Proprioception - due to maintenance of the PDL
6. Denture retention - undercuts and precision attachments can be added
7. Avoids extractions - beneficial in MRONJ and radiotherapy cases
8. Psychological benefits
9. Useful in elderly patients
10. Eases transition to edentulism

Question 10

What are the disadvantages of overdentures?

Answer 10

Require good OH
Increased caries/perio problems
Care homes - more challenging to maintain OH
Denture fracture - thinner denture so more prone to fracture
Discomfort/infection
Medical history
Potentially more traumatic extractions further down the line

Question 11

What pathological changes can occur as a result of ill-fitting dentures?

Answer 11

1. Ulcers
2. Denture stomatitis
3. Angular cheilitis
4. Denture irritation hyperplasia
5. Flabby/fibrous ridge
6. MRONJ/Osteoradionecrosis

Question 12

What is the most common cause of oral ulcers in patients that have dentures?

Answer 12

Trauma

Question 13

List 3 common sites to find ulcers in a patient that has dentures?

Answer 13

Lingual frenum
Mylohyoid ridge
Undercuts

Question 14

List some common causes of denture related trauma that results in the formation of ulcers?

Answer 14

1. Overextensions
2. Sharp bits on denture
3. Pressing to hard
4. Occlusal trauma

Question 15

When should you refer a non-healing ulcer to the nearest maxillofacial department?

Answer 15

When a non-healing ulcer has persisted for >3weeks

Question 16

What is often a found issue in patients that have denture stomatitis?

Answer 16

Poor denture hygiene
Angular chelitis

Question 17

What does denture stomatitis look like?

Answer 17

Redness of the mucosa related to the denture bearing area - oedema and erythema.

Question 18

Which yeast species is related to denture stomatitis?

Answer 18

Candida

Question 19

How do you manage denture stomatitis?

Answer 19

Take denture out at night
Clean denture with soap and soft brush
Steep denture in milton
Possible use of chlorhexidine mouthwash
Use of nystatin or other appropriate antifungal
New denture
Consider underlying issues (diabetes, folate, B12, ferritin.)

Question 20

What causes angular cheilitis in denture wearers?

Answer 20

Often co-exists with denture stomatitis

Associated with over-closure of the mouth - due to loss of OVD/excessive FWS (e.g. old worn dentures)

Question 21

Which microbes are often associated with angular cheilitis?

Answer 21

Candida albicans, staph aureus, beta-haemolytic steps

Question 22

How is angular cheilitis treated?

Answer 22

1. Treat tissues - prescribe miconazole (drug interacts with coumarins)
2. Replace denture - less FWS
3. Consider underlying issues that could be causing/contributing to the angular cheilitis - diabetes, folate, B12, ferritin, xerostomia (polypharmacy)

Question 23

What might be the cause of denture hyperplasia?

Answer 23

Very old ill-fitting dentures causing chronic trauma and a hyperplastic response.

Question 24

How can you manage denture hyperplasia?

Answer 24

1. Major denture ease
2. Tissue conditioner - Coe comfort
3. Review and repeat if required until tissues have resolved
   - if tissues don’t resolve may require referral to oral surgeon to remove excess tissue (this doesn’t happen often)
4. New denture

Question 25

What is the usual cause of a flabby ridge?

Answer 25

Often caused by trauma of the denture hitting anterior ridge

Question 26

How does a flabby ridge form?

Answer 26

Repeated trauma to ridge resulting in bone resorption in the area and fibrous replacement resorption.

Question 27

How can you manage a flabby ridge?

Answer 27

1. New denture covering whole denture bearing area with good peripheral seal and opposing arch denture giving posterior support.
2. Occasionally require special investigation techniques

Question 28

How might an ill-fitting denture contribute to MRONJ/Osteoradionecrosis?

Answer 28

By causing trauma to the tissues

This can exaggerate the effects of MRONJ in a patient that is on anti-resorptive drugs

Similarly this can exaggerate the effects of ORN in patients that have had radiotherapy to the head an neck region.

Question 29

How might you mange a patient with an ill-fitting denture that is at risk of MRONJ/Osteoradionecrosis?

Answer 29

1. See patient for regular check-ups
2. Prevent MRONJ/ORN by providing well fitting dentures
3. Refer promptly to the maxillofacial surgeon at the local maxillofacial department if MRONJ or ORN is observed (SDCEP)

Question 30

Name an oral presentation that may mimic denture stomatitis:

Answer 30

An allergic reaction to denture material

• Often seen as redness under the denture bearing area
• Uncommon but usually occurs with nickel containing CoCr or PMMA especially self-cure relines due to higher monomer content