Date post: | 18-Jan-2017 |
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POST-INSERTION COMPLETE DENTURE COMPLAINTS & THEIR
SOLUTIONS
BY Dr. MARYAM ARBAB
Outline
• Patient’s experiences & discomforts
• Problems occurring following insertion & their solutions
ZARB BOLENDER STATES …
“Explanations provided after problems develop often are interpreted as excuses by the dentist for dentures that function less than satisfactorily.”
1. First Oral Feelings2. Retention Comparison Between Natural &
Artificial Teeth3. Saliva4. Speech5. Eating6. Tongue Position & Problems With The Lower
Denture In Contrast With The Upper Denture
Different Experiences & Discomforts
1. First Oral Feelings1. NATURE OF THE COMPLETE DENTURE
General introduction about the denture by means of diagrams or models can be used to show the pt that what he is going to wear in his mouth.
2. FULLNESS OF THE MOUTH Little change in the mouth is perceived as a big change by the pt.
2. Retention Comparison Between Natural & Artificial Teeth
NATURAL DENTITION
COMPLETE DENTURE
MODE OF ACTION Roots ( which have ability to bite tough food)
Wet slippery mucosa (which is not able to bite tough food)
BITING CAPACITY 80 pounds 11.7 pounds
SENSATION Proprioceptive mechanism
No such capacity
3. SALIVA
PROBLEM SOLUTIONExcess salivation :-As foreign object is placed inside the mouth, it’s the normal reaction of the body.
Subsides in a few weeks,Keep deglutition active.
4. SPEECHPROBLEMS SOLUTION
Distortion of speech Affected fluency
(owing to initial feeling of bulk & the accompanying excessive saliva)
Difficult rapid conversation
Quietly read aloud at home (slow reading may not put up the pt’s concentration on how the sound is pronounced.)
5. EATINGPt’s compliance
e.g. ability to eat a steak or an apple is a mark of good denture.(Such things result in soreness of the mouth.)
Pt’s education In beginning pt is advised to eat soft/crispy
foods, as they are easy to comminuted.( 1st week)
Avoid fibrous & hard food in beginning, there is an ample variety of soft food available so, pt should not compromise with nutrition.
Pt is educated to eat methodically:- Pt is instructed to divide normal forkful of food in half & place each half bilaterally.
6. TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE
MANDIBULAR DENTURE MAXILLRY DENTURE
TONGUE tongue causes lifting of the lower denture
No tongue involvement
DENTURE BEARING AREAS
approx. 14cm2 Approx. 24 cm2
MUSCLE SURROUNDINGS
Buccal & lingual muscles Only buccal muscles
Problems Occurring Following Insertion & Their Solutions
SEVERAL PROBLEMSDIRECT SEQUELAE
1. DENTURE STOMATITIS2. FLABBY RIDGE3. TRAUMATIC ULCER (sore spots)4. BURNING MOUTH SYNDROME5. RESIDUAL RIDGE RESORPTION6. DENTURE IRRITATION HYPERPLASIA7. GAGGING
INDIRECT SEQUELAE
1. ATROPHY OF MASTICATORY MUSCLES2. NUTRITIONAL DEFICIENCIES
DIRECT SEQUELAE
1.DENTURE STOMATITIS
• Denture induced stomatitis• Denture sore mouth• Inflammatory hyperplasia• Chronic atrophic candidiasis
SYNONYMS
CLASSIFICATION
• Type-I (Localized simple infection)• Type-II (erythematous type)-
generalized type• Type-III granular type
ETIOLOGIC FACTORS
Systemic factors Old age Diabetes mellitus Nutritional deficiency:- iron, folate,
vit B12 etc.
Local factors Dentures • environmental factors• night wear of the dentures• denture cleanliness
Xerostomia High carbohydrate diets:- causes
increased plaque accumulation
SUPPORTIVE MEASURES• Cleanliness of the denture• Denture & the mucosa should be
cleaned after meals.• Store the denture in the 0.2-2%
chlorhexidine during the night time.• Polishing of the denture routinely.• Not to wear the denture during night
time.
MANAGEMENT
After the infection is confirmed to be occurring because of the candida, the topical anti-fungals should be given. e.g. nystatin, amphotericin B, micronidazole,
DRUG THERAPY
SURGICAL THERAPY
necessary in the type-III.
2. FLABBY RIDGE
Alveolar ridge may become mobile & extremely resilient due to replacement of the bone by the fibrous tissue.
DESCRIPTION
Surgical correction & relining of the denture base accordingly for re-adaptation of the tissue surface.
TREATMENT
3.TRAUMATIC ULCER (sore spots)
• It develops with 1- days after placement of new denture.• They are small, painful lesions covered with a grey necrotic membrane surrounded by inflammatory halo with firm, elevated borders.
DESCRIPTION
• Overextension of the denture• Unbalanced occlusion
ETIOLOGY
In normal pts, these ulcers heal within a few days after correcting the dentures. If treatment is not administered, it may progress to denture irritation hyperplasia.
TREATMENT
4.BURNING MOUTH SYNDROMES
Local factors Systemic factors Psychological factors
ETIOLOGY
Mechanical irritation by ill-fitting dentures Prolonged masticatory muscle activity Constant parafunctional movements of the
tongue Constant excessive friction on the mucosa
LOCAL FACTORS
Vitamin or iron deficiency Menopause Xerostomia Diabetes
SYSTEMIC FACTORS
Anxiety Depression
PSYCHOLOGICAL FACTORS
o Does not show any overt clinical features.
o Mainly pain starts in the morning & aggrivates during the days.
o Burning sensation is usually accompanied with dry mouth & persistent altered taste sensation.
o Asso. Symptoms include headache, insomnia, irritability and depression.
CLINICAL FEATURES
Removal of local factors Compensation for systemic deficiency except for menopause.
Psychological counselling
TREATMENT
5. RESIDUAL RIDGE RESORPTION
• Whenever there is pressure, bone resorbs due to activation of osteoclasts.• It’s a constant sequel after extraction & continues even after inserting the complete denture.
ETIOPATHOGENESIS
• More rapidly in first 6 months and slows in later 6 months.• It’s more rapid in females than in males.• It’s precipitated by certain systemic diseases & ill-fitting dentures.
PATTERN OF RESORPTION
MANDIBLE• Initially=4-5mm• Later=0.1-0.2mm
MAXILLA• Initially=2-3mm,• Later=four times lesser than mandi.
RATE OF RRR
• The depth & width of the sulcus is reduced.• Decreased vertical dimension of occlusion.• Reduction of the lower facial height.• Increased relative prognathism.
CLINICAL FEATURES
MAXILLAE Resorption is
centripetal(toward centre)
MANDIBLE Resorption is centrifugal
(away from centre)
6.DENTURE IRRITATION HYPERPLASIA
• It is a hyperplastic reaction of the mucosa occurring along the borders of the denture. These lesions result from trauma due to unstable denture flanges.• The lesions usually subside after surgical excision of the tissues & correction of the dentures.
• Symptoms are very mild with single or numerous lesions showing flaps of hyperplastic connective tissue. Deep ulceration, fissuring & inflammation may occur at the depth of the sulcus.
7. GAGGING
• The gag reflex is a normal defence mechanism, which functions to prevent foreign bodies from entering the trachea.• It may occur due to over extension of the denture borders at posterior palatal seal of the maxillary dentures & disto-lingual part of the mandibular dentures.• In such cases it needs the correction.
INDIRECT SEQUELAE
1. ATROPHY OF MASTICATORY
MUSCLES
• Usually with age, biting efficiency decreases.
• Any part of the body which is out of function goes under atrophy.
2. NUTRITIONAL DEFICIENCIES
As masticatory muscles undergo atrophy with age, their nutrition status also goes down.
CONCLUSION Patient’s education only on a right time will lead to a successful denture.
If the annoying sequelae of denture wearing are not solved than they will lead to failure of treatment outcome.
Patient should be educated & problems complained by them should be solved without FRUSTRATING them.
The denture fabricated even with all the normal criteria may lead to discomfort to the patient.
REFERENCES
ZARB BOLENDER WINKLER
THANK YOU