GOOD AFTERNOON

POST-INSERTION INSTRUCTION,PROBLEMS & SOLUTIONS

SOLUTIONS

PATIENT’S EDUCATIO

N

Outline • Post-insertion instruction• Patient’s experiences &

discomfort• Problems occurring following

insertion & their solution

POST-INSERTIONINSTRUCTION

1. HABITUATION2. EATING HABITS3. SPEECH4. HOME CARE FOR THE DENTURES

LIST OF INSTRUCTIONS

1.HABITUATION

Initially the denture will feel strange & bulky in the mouth & will cause, fullness of lips & cheeks. Patient’s appearance with the denture will become more natural with time. Patient’s mouth & tongue has to get adjusted to the denture, also there will be increased salivation, which will be reduced subsequently.

1. It may be difficult to adjust as patient has been without teeth for a long period of time.

2. First few days pt is instructed not to chew hard food avoid sticky food

3. Pt is asked to try to chew on both side with the back teeth

4. Pt is asked not to drink water by lifting the tumbler but drinking by sipping.

2.EATING HABITS

1. Speaking with the dentures normally requires some practise.

2. Patient is asked to read aloud and repeat the words those which are difficult to pronounce.

3. With passage of time pt’s speech with denture will be better than without denture.

3. SPEECH

1. Pt is asked to clean the denture with soft brush, specially made for denture & keep cloth in the wash basin so, if denture will fall than it won’t break.

4. HOME CARE FOR THE DENTURES

2. Pt should rinse the mouth & denture after every meal.

3. Pt should never wear denture at night & should store denture in cold water.

4. Pt should not wash the denture with hot water.

5. It’s preferable if pt place denture in denture cleanser at night.

6. After removing the denture pt should massage the gums for few minutes with fingers.

7. Pt should not use any abrasive or detergents to clean the dentures.

8. Pt should not make any adjustment or repair by himself.

PATIENT’S EXPERIENCES& DISCOMFORTS

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 COMPARISION 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 FEELINGS

1. NATURE OF THE COMPLETE DENTUREGeneral introduction about the denture by

the mean of diagrams or models can be used to show the pt that what he wears in his mouth.

2. FULLNESS OF THE MOUTHa. Little change in the mouth is perceived as a big

change by the pt.b. Also dentist use as much area as possible.

2.RETENTION COMPARISION 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 thing enters in the mouth, it’s the normal reaction of the body.

Subsides in few weeks,Keep deglutition active.

4.SPEECH

PROBLEM 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.EATING

Pt’s compliancee.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 & tough foods in beginning, there is an ample variety of soft food is 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 solution

SEVERAL PROBLEMSDIRECT SEQUELAE

1. DENTURE STOMATITIS2. FLABBY RIDGE3. TRAUMATIC ULCER (sore spots)4. BURNING MOUTH SYNDROMS5. 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 candiasis

DENTURE STOMATITIS - 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.12 etc.

Local factors dentures • environmental factors• night wear of the dentures• denture cleanliness

xerostomia high carbohydrate diets:- causes

increased plaque accumulation

MANAGEMENT

SUPPORTIVE MEASURES

• cleanliness of the denture• denture & the mucosa should be cleaned

after the 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.

after the infection is conformed to be occurring because of the candida the topical anti-fungals are 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

• over extension of the denture• unbalanced occlusion.

ETIOLOGY

In normal pts, these ulcers heal within few days after correcting the dentures. If treatment is not administered, it may progress to denture irritation hyperplasia.

TREATMENT

4.BURNING MOUTH SYNDROMES

local factorssystemic factorspsychological factors

ETIOLOGY

mechanical irritation by ill-fitting denturesprolonged masticatory muscle activityconstant parafunctional movements of the

tongueconstant excessive friction on the mucosa

LOCAL FACTORS

vitamin or iron deficiencymenopausexerostomiadiabetes

SYSTEMIC FACTORS

anxietydepression

PSYCHOLOGICAL FACTORS

odoes not show any overt clinical features.

oMainly pain starts in the morning & aggrivates during the days.

oBurning sensation is usually accompanied with dry mouth & persistent altered taste sensation.

oAsso. Symptoms include head ache, insomnia, decreased libido, irritability, depression.

CLINICAL FEATURES

removal of local factorscompensation for systemic deficiency except for menopose.

Psychologic counselling

TREATMENT

5.RESIDUAL RIDGE RESORPTION

•Wherever there is pressure, bone resorbs due to activation of osteoclast.• 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 at 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 with age.Any part of the body which is out of function goes under atrophy.

2.NUTRITIONAL DEFICIENCIES

As masticatory muscles go under atrophy & also for any person masticatory muscles go under atrophy along with age their nutrition status also goes down.

CONCLUSIONPatient’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.

A WISH:- EVERYONE COULD INSERT FOUR OF THE DENTURES

REFERENCES

ZARB BOLENDERWINKLER

ANY DOUBT..,

THANK YOU