1
Q
SOFT TISSUE REACTION TO DENTURE WEARING (2)
A
Injury and inflammation
Fibrous tissue growth (flabby hyperplastic tissue)
2
Q
- If tolerance is low
A
. Injury and inflammation
3
Q
- If tolerance is high and trauma tolerable
A
Fibrous tissue growth (flabby hyperplastic tissue)
4
Q
CAUSES OF MUCOSAL IRRITATION (3)
A
- Mechanical irritation by denture
- Accumulation of microbial plaque on denture
- Toxic or allergic reaction to constituents of denture material
5
Q
what does local irritation of mucosa increase?
A
mucosal permeability to allergens or microbial antigen
6
Q
- Mild erythema or redness of the mucosa under the denture.
- Usually occurs in the maxilla
- Common in complete denture wearers
A
Denture Induced Stomatitis
7
Q
o Middle to old age
o More common in females
o Has been found in up to 70% of denture wearers
A
Incidence of Denture Induced Stomatitis
8
Q
o Wearing dentures at night
o Dry mouth
o Diabetes
o Increased carbohydrate diet
o HIV
A
Predisposing Factors of Denture Induced Stomatitis
9
Q
Etiology of Denture Induced Stomatitis (4)
A
o Changes in the oral environment related to presence of dentures or removable orthodontic appliance
o Poor oral and denture hygiene
o Candida is the main cause (70%)
o Can also occur because of mechanical irritation and bacterial infections
10
Q
localized simple inflammation or pinpoint hyperemia
A
Type I Denture Stomatitis
11
Q
- a more diffuse erythema ( redness) involving a part or all the mucosa which covered by the denture.
A
Type II Denture Stomatitis
12
Q
- inflammatory nodular/papillary hyperplasia commonly involving the central part of the hard palate and alveolar ridge.
A
Type III Denture Stomatitis
13
Q
Management of Denture Stomatitis: (3)
A
- Correction of ill-fitting dentures
- Efficient plaque control (oral & denture hygiene)
- Anti-fungal therapy
14
Q
- relining with soft tissue conditioner
- new denture when mucosa has healed
A
Correction of ill-fitting dentures
15
Q
A soft high-molecular material which is applied to the impression surface of the denture base, to release the distortion and indentation of mucosa
A
Soft tissue conditioner/liner
16
Q
- Remove and clean denture after meal
- Clean & massage mucosa with soft toothbrush
- Remove dentures at night
A
Efficient plaque control (oral & denture hygiene)
17
Q
o Ketoconazole
o Amphotericin B
o Miconazole
o Clotrimazole
A
Local therapy
18
Q
o Nystatin
o Fluconazole
A
Systemic therapy
19
Q
Other terms of Angular Cheilitis
A
à Angular Cheilosis
à Perleche
à Stomatitis
20
Q
- Often correlated with candida-associated denture stomatitis.
A
. Angular Cheilitis
21
Q
o Overclosure of jaw
o Nutritional deficiencies
o Iron deficiency anemia
A
- Predisposing Factors of Angular Cheilitis
22
Q
- 80% are associated with denture wearers.
A
angular cheilitis cases
23
Q
- Long term denture wearers:
o Attrition of teeth
A
o Attrition of teeth due to prolonged usage, and resorption of the residual ridges, results to decreased vertical dimension.
24
Q
- Long term denture wearers:
o Decreased vertical dimension
A
o Decreased vertical dimension results to deepening of the nasolabial groove, specially at the corners of the mouth, which leads to collection of saliva in this area resulting in skin being dry and fissured.
25
* Management of Angular Cheilitis: (5)
o Due to its varied etiology, unless the primary cause is corrected, the infection is not primarily cured.
o Antifungal, anti-inflammatory, or antimicrobial suspensions
o Corticosteroids
o Intralesional injections
o New dentures
26
* Due to replacement of bone by fibrous tissue.
Flabby Ridge
27
* Flabby Ridge is most common in _________
anterior part of maxilla when opposed by remaining anterior teeth in the mandible.
28
Flabby Ridge is caused by __________
excessive load of residual ridge and unstable occlusal condition.
29
* Management of flabby ridge (2)
Ø Remove surgically
- To improve stability & to minimize alveolar ridge resorption.
Ø In extreme atrophy, not totally removed because vestibule will be eliminated.
30
What does sequalae mean?
any complication or condition that results from a pre-existing illness, injury, or other trauma to the body
31
à Inflammatory fibrous hyperplasia,
à Denture-induced fibrous inflammatory hyperplasia,
à Denture injury tumor,
à Denture epulis,
à Denture induced granuloma, and
à Granuloma fissuratum
Denture Irritation Hyperplasia (Epulis Fissuratum)
32
* A benign hyperplasia of fibrous connective tissue which develops as a reactive lesion to chronic mechanical irritation produced by the flange of a poorly fitting denture.
Denture Irritation Hyperplasia (Epulis Fissuratum)
33
causes of Denture Irritation Hyperplasia (Epulis Fissuratum) (2)
o Chronic injury by unstable denture
o Thin, overextended denture flange
34
o Maybe single or quite numerous
o Composed of flaps of hyperplastic connective tissue
* Signs of Denture Irritation Hyperplasia (Epulis Fissuratum)
35
* Management of Denture Irritation Hyperplasia (Epulis Fissuratum) (3)
o Adjustment of denture
o Replacement of denture
o Surgical excision
36
Traumatic Ulcers (Sore spots) Causes (3)
o Overextended denture flange
o Unbalanced occlusion
o Nodules on the impression surface
37
* Management of Traumatic Ulcers (Sore spots)
Adjustment of denture
38
* The medical term for ongoing (chronic) or recurrent burning in the mouth without an obvious cause.
* This discomfort may affect the tongue, gums, lips, inside of your cheeks, roof of your mouth or widespread areas of your whole mouth.
* The burning sensation can be severe, as if you scalded your mouth.
Burning Mouth Syndrome (BMS)
39
o Burning sensation
o Oral mucosa appears healthy
o >50 yr. old females wearing denture
o Often appears for the first time in association with the placement of new denture
o Feeling of dry mouth with persistent altered taste perception
o Headache, insomnia, decreased libido, irritability, depression.
signs of Burning Mouth Syndrome (BMS)
40
Local Causes of Burning Mouth Syndrome (BMS)
Mechanical irritation
B. allergy
infection
oral habits
E. myofascial pain
41
Systemic causes of Burning Mouth Syndrome (BMS)
Vitamin deficiency (Vit B12, Folic acid)
Iron deficiency anemia
Xerostomia (radiation therapy)
Menopause
Diabetes
42
Psychogenic Causes of Burning Mouth Syndrome (BMS)
Anxiety
Depression
Psychosocial stressor
43
Management of Burning Mouth Syndrome (BMS)
Depends on the cause.
44
* A normal mechanism which prevents unwanted material from entering the pharynx, larynx or trachea.
* It occurs from an “involuntary contraction of the muscles of the soft palate or pharynx .
* Primarily controlled by the parasympathetic division of autonomic nervous system.
* Normally, the palatoglossal and palatopharyngeal folds, base of tongue, palate, uvula, and posterior pharyngeal wall are trigger points of gag reflex.
Gagging (Gag Reflex)
45
* Causes of gag reflex: (4)
1. Overextended borders
o Posterior part of maxillary denture
o Distolingual part of maxillary denture
2. Poor retention of maxillary denture
3. Unstable occlusal condition
4. Increased vertical dimension at occlusion
46
INDIRECT SEQUELAE OF WEARING DENTURE (2)
1. Atrophy of masticatory muscles (masseter and medial pterygoid)
2. Nutritional deficiency
47
o Reduce bite force and chewing efficiency.
Cause of Atrophy of masticatory muscles
48
Preventive Measures and Management of Atrophy of masticatory muscles
o Use of overdenture
o Use of implant supported denture.
49
o Ill-fitting denture
o Salivary gland hypofunction
o Altered taste perception.
Nutritional deficiency causes
50
Management of nutritional deficiency
o Mechanical preparation of food before eating.
51
Art of distinguishing one disease from the other, determination of the nature of a case of a disease, an evaluation of an existing condition.
DIAGNOSIS
52
The process of matching possible treatment options with the patient needs and systematically arranging the treatment in order of priority but in keeping with a logical or technically necessary sequence
TREATMENT PLANNING
53
An initial, tentative outline of therapeutic measures to be undertaken in accordance with diagnostic data and indications.
TREATMENT PLAN
54
Probable outcome of the treatment
PROGNOSIS
55
Adjunctive Care: (5)
1. Elimination of infection
2. Elimination of pathology
3. Preprosthetic surgery
4. Tissue conditions
5. Nutritional counseling
56
DATA COLLECTION AND RECORDING (7)
P Questions
P Records
P Visual Observation
P Radiographic Examination
P Palpation
P Measurement
P Diagnostic Cast
57
o Most important
o Prior to meeting, you should review general information
o Your confidence is as important as the treatment itself
o You should be a good listener
o Your communication should be simple and truthful.
THE FIRST MEETING
58
* General information, chief complaint, history of present illness, past history, systems review.
1) Case History
59
* General appraisal of the patient, detailed oral exam, special exam when indicated.
2) Clinical Examination
60
* Etiology and significance
* Prognosis
3) Diagnosis
61
* Ideal
* Alternative
4) Treatment Plan
62
CASE HISTORY
1. General Information
* Name (address by name to add a personal touch)
* Address & telephone number (contact)
* Birth or age (capacity to withstand stress, healing, diseases)
* Occupation (value on esthetic and quality of the denture, type of work, working schedule, financial status)
* Sex (women on appearance, men on comfort & function)
63
CASE HISTORY
2. Personal & Social History
* Marital status
o Duration, number of children, etc.
* Habits
o Alcohol, oral habits, tobacco
* Personality
o Moody, sociable, easygoing, complaining, etc.
* Weight
o Recent loss or gain of weight.
64
* A symptom or symptoms in the patient’s own words relating to the presence of an abnormal condition
* Why is he seeking treatment?
* Assess if the patient's expectation is realistic or not.
3. Chief Complaint
65
* A chronological account of the chief complaint and associated symptoms from the time of onset to the time the history is taken
* Include the date of onset of the chief complaint, type of onset, character, location, and relation to other activities.
4. History of Present Illness
66
o Patient’s general health prior to the onset of the present illness
o Medical conditions
o Medications
5. Past Medical History
67
Soreness of tongue and palate may occur.
In severe cases, pallor & breathlessness
1. Anemia
68
May lead to loss of use of muscles of the face.
2. Stroke
69
may rarely affect the TMJ.
Special trays are needed if unable to open mouth wide, jaw relation recording may be difficult.
Rheumatoid arthritis or osteoarthritis (3. Arthritic disease)
70
More susceptible to infection
Healing maybe slower
Rate of bone resorption may increase.
4. Diabetes
71
Danger of fracture of denture
5. Epilepsy & Blackouts
72
Loss of muscular coordination
6. Parkinson’s disease
73
Hypersensitivity to materials
7. Allergies
74
Short appointments with premedication (history of angina & heart attack)
Antibiotic prophylaxis
Increased blood pressure is not contraindicated if under medication.
8. Cardiovascular diseases and disorders
75
Diseases can be transmitted from patient to dentist and laboratory personnel.
Tuberculosis, AIDS, hepatitis, herpes, SARS
9. Transmissible diseases
76
Anxiety, depression or hysteria might be difficult patients.
10. Psychological disorders
77
* Suppress the inflammatory reaction
* Retard healing of mucosa after trauma
* Osteoporosis of jaw bones is likely
* Dryness of mouth
* Confusion
* Behavioral changes
1. Steroids
78
* Some supress salivary secretions
2. Antidepressants
79
* Dryness of mouth
* Change in the shape of the mucosa
3. Diuretics
80
* Mucosa is slow to heal
4. Immunosuppressants
81
* Dry mouth
* Postural hypertension
5. Anti-hypertensive
82
* Important considerations when preprosthetic surgery or deep scaling is planned.
6. Anticoagulants
83
* Dryness of skin and mucosa
* Confusion
* Behavioral changes
7. Antiparkinsonism
84
House’s Classification of Patients (4)
Philosophical
Exacting /critical
Hysterical /Skeptical
Indifferent
85
o Etiology of tooth loss
o Previous denture
o Existing denture:
Degree of wear
Cleanliness
Type of denture
Retention & stability
Occlusion
Fit
6. Past Dental History
86
* General health of the family
* History of mental disease
* Cause of death of parent if deceased
* Diseases in the family
7. Family History
87
8. Systems Review
- Head - (5)
- Cardiorespiratory - (3)
- Gastrointestinal - (3)
- Genitourinary - (3)
- Neuromuscular - (4)
headache, eyes, ears, nose, throat
chest pains, rheumatic fever, dyspnea
sore tongue, nausea & vomiting, diarrhea
polyuria, edema, menopause
paresthesia, arthritis, paralysis, tremors
