TUT 2 Flashcards
What is retching?
- physiological mechanism
- involuntary contraction of muscles of the soft palate or pharynx
- modified by medulla
What are the different types of retching?
- psychogenic
- somatic
Describe psychogenic retching.
Caused by sight, smell, sound or thought of ______
Describe somatic retching.
Touching of trigger zones causes retching
What are common trigger zones for retching?
- palatoglossal/palatopharyngeal folds
- base of tongue
- palate
- uvula
- posterior pharyngeal wall
How does retching impact prosthodontics?
- impressions
- jaw registration
- tolerating dentures
- denture retention (if extension reduced to accommodate reflex)
How do you manage a patient with a retching problem?
- relaxation (dim light, music, instruments out of sight, deep breathing)
- distraction (wiggle toes, salt on tongue, talking, close eyes)
- desensitisation
How can patients engage with desensitisation?
- brushing of anterior palate and tongue with toothbrush
- swallowing with mouth open
How can you modify the impression stage in a retching patient?
- modify stock trays
- lower trays in upper arch
- modify special tray to have palatal reduction
- rapid setting impression materials
How can the denture design be modified to accommodate a retching patient?
- SDA as an alternative?
- horseshoe palatal
- training plate
- multiple post dams (provide pressure which counteracts retching)
- must be well adapted, acrylic not too thick
What does ulceration in the sulcus indicate?
Overextended
What does poor stability indicate?
- under extended
- occlusal interference
- lack of support
How can you assess if there is enough freeway space?
- ask patient to say numbers 61-69
- ask patient to say days of the week
What key questions should you ask at initial assessment?
- how long ago were your teeth removed
- how many dentures have you had since your teeth were removed
- how old is the last denture you had made
- do you wear your most recent denture
What causes a flabby ridge?
Combination syndrome
How do you take an impression of a flabby ridge?
- open tray technique
- no EO handle with window 3-3 area
- take imp in alginate, then remove alginate in the window
- replace tray, fill window with silicone (fine type syringe) until set
What does pain on ridge palpation indicate?
- occlusal interference
- support problem
How does occlusal interference cause pain on ridge palpation?
- denture hits early on that side and denture tips
- additional force must be applied to get teeth to meet on opposite side
How does support cause pain on ridge palpation?
Inadequate support means that the alveolar crest receives all masticatory forces
Why should lower teeth be set on the ridge?
- neutral zone between muscles
- that is where the teeth were naturally (lower ridge resorbs downwards)
Why should upper teeth be set buccal to the ridge?
- the maxilla resorbs inwards and upwards
- so buccal to the ridge replicates where they would have been naturally
