1
Q
which GDC standard is concerned with teamwork?
A
GDC standard 6.1 and 6.5
2
Q
how do technicians work?
A
Make dental devices to a PRESCRIPTION from a dentist.
3
Q
Can technicians ever work directly with the public without dental prescription?
A
YES, to REPAIR dentures when an impression is not required.
4
Q
5 ways to communicate with the laboratory?
A
- Laboratory prescription.
- In person.
- Over the phone.
- Email.
- Photographs.
5
Q
Which act mandates that there must be adequate security in the email system being used?
A
Data security act 2018.
6
Q
6 basic pieces of information that must be noted on all laboratory cards?
A
- Basic patient identified (name, DOB).
- Date the lab card.
- Clinician (your) name.
- Date of next appointment.
- What are you making.
- Indicate that lab work has been disinfected.
6
Q
4 types of instructions to include on laboratory prescription when prescribing SPECIAL TRAYS?
A
- Material (ex. shellac or light cure PMMA).
- Spacer
- Tray handle/ stops.
- Special instructions (ex. horseshow tray).
7
Q
3 things to include in laboratory prescription for record blocks?
A
- Do you need upper and/or lower (depends on index teeth).
- What material is the base (ex. wax, heat cured acrylic, shellac).
- Special instructions (ex. wire strengthener).
7
Q
what type of special tray can be used for patients that gag?
A
Horseshoe tray.
7
Q
What is the usual spacer for a special tray?
A
- Usually 3mm.
- Except in CLOSE FITTING TRAY in COMPLETE DENTURES for use with ZnO/Eugenol.
7
Q
What base would you have for a record block for the replica technique?
A
SHELLAC
8
Q
4 things to include in lab prescription of partial denture design?
A
- Prescribe for primary cast to be surveyed and articulated.
- Indicate design clearly on CARD and 1ARY CAST.
- Indicate MATERIAL OF BASE (ex. Co/Cr, acrylic).
- Special elements: clasps, rest seats etc.
9
Q
5 things to include in lab prescription of try in?
A
- Shade.
- Mould.
- Cusped/ cuspless.
- Setting/ arrangement.
- individual requirements (ex. diastema, no 7s etc).
10
Q
3 things to prescribe for post dam?
A
- Where?
- How deep?
- How many?
11
Q
5 things to include in lab prescription of finish?
A
- Post dams (where, how deep, how many).
- Relief areas (tori, overdentures).
- Soft lining.
- Type of acrylic (high impact, hear cured).
- Special requirements (ex. gum contouring).
12
Q
when is gum contouring used?
A
when the patient has a high lipline.
13
Q
5 examples of additional information you can include in a lab prescription.
A
- Clinical photographs.
- Family photographs.
- Photographs of old denture.
- Impressions of old denture.
- Odd clasp/ connector arrangements.
14
Q
Who must all dental laboratories be registered with?
A
MHRA.
15
Q
What must all patients be offered after being given a denture?
A
Statement of manufacture.
16
Q
What is a statement of manufacture?
A
gives details on the materials used in the device.
17
Q
Whose responsibility is the statement of manufacture?
A
- Laboratory –> PRODUCE.
- Clinician –> OFFER, NOTE IN RECORDS, KEEP A COPY.
18
Q
Do all devices require a statement of manufacture?
A
NO.
- NON MEDICAL DEVICES (ex. gumshields) do not.
19
Q
Do soft splints require SOM?
A
YES
20
Q
Do gumshields require SOM?
A
NO.
21
Define intercuspal position
COMPLETE INTERCUSPATION of opposing teeth INDEPENDENT OF CONDYLAR POSITION, sometimes referred to as the best fit of the teeth regardless of the condylar position.
22
Define retruded contact position
GUIDED occlusal relationship occurring at the MOST RETRUDED POSITION OF THE CONDYLES IN THE JOINT CAVITIES.
23
Define index teeth?
Contacting facets of teeth in the intercuspal position.
24
5 characteristics of ICP?
- Need sufficient index teeth.
- Stable occlusion.
- May vary through life (XLA, drifting, overuption etc).
- Depends on tooth relationships (XLA, drifting, overeruption).
- Sometimes more anterior than RCP.
25
5 characteristics of RCP?
- Insufficient index teeth.
- Unstable occlusion.
- Most reproducible position.
- Condylar position.
- Sometimes more posterior than ICP?
26
What do we want to do to the occlusion?
Where possible CONFORM to the occlusion.
27
Where does conforming to the occlusion work best? What must you ensure? ICP or RCP?
- Stable occlusion with sufficient index teeth.
- Ensure prosthesis doesn't alter the occlusion.
- Usually use ICP.
28
Where does changing the occlusion work best? ICP or RCP?
- Unstable occlusion and insufficient index teeth.
- Often use RCP.
- More challenging to record occlusion.
29
How to check if you have successfully CONFORMED to the occlusion?
Ensure index teeth are still meeting the same.
(check how they meet before and after inserting the appliance. Must be the SAME).
30
Do we always need to record the occlusion?
Not necessary when there is SUFFICIENT INDEX TEETH (can hand articulate).
31
What can be done when there is sufficient index teeth and teeth to increase accuracy of articulation?
MORE ACCURATE ARTICULATION BY OBTAINING AN INTER-OCCLUSAL RECORD.
32
3 ways to record an INTEROCCLUSAL RECORD?
- Bite registration paste (usually silicone).
- Wax wafer (modelling wax).
- Modified wax waver (ex. alminax - more stable than silicone - doesn't have spring).
33
4 steps to using alminax for interocclusal record?
1. Trim sheet to the rough shape of the arch.
2. Warm in warm water.
3. Put on occlusal surface of back teeth and ask patient to close.
4. Remove and cool in cold water.
34
When do we need to record the occlusion? How?
When there is INSUFFICIENT INDEX TEETH.
- Using RECORD BLOCKS.
35
4 types of record block materials?
- Wax.
- Wax with wire strengthener.
- Co/Cr base with wax.
- Shellac base.
36
What tools do we use to modify record blocks.
Heat (ex. hot plate/ bunsen burner) and wax knife.
37
What is the purpose of modifying the record blocks?
- If index teeth: ensure index teeth meet as normal.
- No index teeth: use OVD and FWS.
38
2 ways to do the occlusal registration with record blocks?
1. Melt wax of record block.
2. Bite registration paste.
39
Advantage of using melted wax over bite registration paste for recording the occlusal registration on record blocks?
Wax is less likely to come off the blocks in contrast to bite registration paste.
40
How can overdentures help patients with partial dentures with multiple saddles?
- Remaining natural teeth will have DIFFERENT OCCLUSAL PLANES.
- Cutting down some residual teeth can help EVEN OCCLUSAL PLANE + AESTHETICS.
41
What kind of support can overdentures provide?
- Tooth borne.
- Mucosa borne.
42
In which cases are overdentures an appropriate treatment method for tooth wear?
- Particularly where more than 2/3rds of crown height lost.
43
11 advantages of overdentures?
- Correction of occlusion and aesthetics.
- Support (tooth and mucosa).
- Tooth wear management (2/3rds of crown lost).
- Preservation of ridge form.
- Proprioception.
- Denture retention.
- Can be used with precision attachments.
- MRONJ and radiotherapy patients (avoid extractions).
- Psychological benefits.
- Useful in elderly patients.
- Eases transition to edentulism.
44
Why is preservation of ridge form advantageous (2)?
- Help denture retention.
- Preserves bone for implants.
45
How do overdentures help with proprioception?
- Retaining PDL.
- Allows them to sense food better in the mouth.
- Better chewing efficiency.
46
How do overdentures help with retention (2)?
- Undercuts around where the roots have been retained.
- Precision attachments on roots.
47
7 disadvantages of overdentures?
- Need for good oral health.
- Increased caries/ periodontal problems.
- Care homes.
- Denture fracture.
- Discomfort/ infection.
- Medical history.
- Potentially more traumatic extractions (if subalveolar).
48
Why are overdentures more prone to fracture?
- Tooth in denture takes up room, thus denture in area is THINNER and MORE PRONE TO FRACTURE.
49
4 steps to providing precision attachments for overdentures?
1. Root treat remaining roots.
2. Make post holes with pre fabricated drill.
3. Cement the female component of the precision attachment into the post hole in the tooth.
4. Male precision attachment (made of carbon fibre) would be COLD CURED in place with cold cure acrylic.
50
Where do the female and male components of precision attachments for overdentures go? Give a named example.
- Male: in the fit surface of the denture (cold cure).
- Female: in root treated root.
- Zest anker
51
How long to male components precision attachments for overdentures last?
12-18 months.
52
5 steps to replacing a worn out male component in overdentures?
1. Drill out old male component.
2. Place a new male component, attaching it to female component in the root.
3. Place some cold cure acrylic in the denture.
4. Seat the denture.
5. Wait until acrylic is set before removing it from the mouth.
53
4 points to caring for overdentures.
- Good oral hygiene.
- Denture hygiene.
- Fluoride toothpaste application to roots under an overdenture.
- Regular examinations and radiographs (PA and perio bone loss).
54
What is a problem dentures are associated with?
Dentures, particularly ill-fitting dentures, are associated with a heterogenous group of ORAL MUCOSAL LESIONS.
55
3 causes of oral mucosal lesions in denture wearers?
- Acute or chronic reactions to microbial denture plaque.
- A reaction to constituents of denture base materials.
- Mechanical denture injury.
56
7 pathological changes caused by dentures?
- Ulcers.
- Denture stomatitis.
- Angular chelitis.
- Denture irritation hyperplasia.
- Flabby ridges.
- MRONJ/ osteoradionecrosis.
- Allergic reactions.
57
What are mosr t ulcers caused by ind enture wearers?
Denture trauma.
58
3 particular site where ulcers are common in denture wearers?
- Lingual frenum.
- Mylohyoid ridge.
- Undercuts.
59
4 traumatic causes of trauma ulcers in denture wearers?
- Overextension.
- Sharp bits on denture.
- Pressing too hard.
- Occlusal trauma.
60
3 ways to identify what is causing a traumatic ulcer from dentures?
- Visually.
- Pressure indicating paste (if under denture).
- Articulating paper (if you think occlusal error).
61
3 steps to follow when you identify a traumatic ulcer in a denture wearer?
1. Identify cause.
2. Ease denture.
3. Review
62
3 ulcer-related indications for urgent referral? Where to refer?
- Non healing ulcer despite adjustments.
- Obviously very suspicious lesion (ex. large ulcer, rolled edge).
- Unexplained ulceration or unexplained swelling/induration of the oral mucosal for MORE THAN 3 WEEKS.
- **URGENT REFERRAL TO MAX-FAX NOT ORAL SURGEON**
63
Where is denture stomatitis often seen? What does it look like? What main thing causes it?
- Closely related to DENTURE BEARING AREA (footprint of denture).
- Often DENTURE HYGIENE issue.
- Looks RED - EDEMA & ERYTHEMA.
- May have superimposed CANDIDA ALBICANS infection.
64
6 ways to manage denture stomatitis?
- Take denture out at night.
- Clean denture with a soft brush and soap.
- Steep denture in DILUTED MILTON a couple times a week for 20 MINUTES.
- Chlorhexidine mouthwash.
- Use NYSTATIN (or other appropriate antifungal).
- New denture (if ill-fitting).
65
2 underlying issue that may be related to denture stomatitis?
- Diabetes.
- Folate, B12, ferritin (anemia).
- If it persists may wish to refer patient to GMP.
66
What other condition is denture stomatitis often related to?
Angular cheilitis.
67
What does angular cheilitis often co exist with? What causes it? How is it treated (2)?
- Denture stomatitis.
- OVERCLOSURE (ex. loss of OVD/ excessive FWS, old worn dentures).
- REPLACE DENTURES.
- Use of MICONAZOLE (int. coumarins).
68
What is miconazole and what does it interact with?
- Systemic antifungal.
- Drug interaction with coumarins.
69
3 pathogens implicated in angular cheilitis?
- Candida albicans.
- Staph aureus.
- Beta haemolytic strep.
70
3 underlying issues that may be contributing to angular cheilitis?
- Diabetes.
- Anemia: ferritin, follate, B12.
- Xerostomia (polypharmacy).
71
What usually causes denture irritation hyperplasia?
- Often very OLD, ILL FITTING DENTURES.
- CHRONIC trauma and HYPERPLASTIC response.
72
5 steps to treating denture induced hyperplasia
1. Major ease of denture.
2. Tissue conditioner (ex. coe comfort).
3. Review and repeat if required.
4. Wait for tissues to resolve (sometimes tissues don-t resolve fully and may have to refer pt to OS for removal of excess tissue - not common).
5. New denture.
73
Name an example of a tissue conditioner?
Coe comfort
74
Why apply a tissue conditioner after easing a denture due to denture irritation hyperplasia?
- Denture becomes very ill fitting due to major ease.
- Tissue conditioner helps denture fit better as well wait for the hyperplastic tissues to resolve before providing a new denture.
75
What causes flabby ridge?
- Trauma of denture hitting usually ANTERIOR RIDGE.
- Causes **BONE RESORPTION** and **FIBROUS REPLACEMENT RESORPTION**.
- Often when LOWER ANTERIORS only present and NO LOWER DENTURE (excessive force on upper anterior ridge causes bone resorption).
76
How to treat flabby ridges (2)?
- New denture covering WHOLE DENTURE BEARING AREA with GOOD PERIPHERAL SEAL.
AND
- OPPOSING ARCH DENTURE giving POSTERIOR SUPPORT.
77
Link between MRONJ/osteoradionecrosis and dentures?
- ILL FITTING dentures can result in MRONJ (if pt n anti resorptive drugs) or ORN (if radiotherapy to H and N).
78
3 ways of preventing MRONJ/ ORN in denture patients?
- Regular oral health checks.
- PREVENT by well-fitting dentures.
- Replace ill-fitting dentures.
79
What do to if you notice ORN/ MRONJ?
Refer promptly to maxfax.
80
How do denture allergic reactions present clinically? How to differentiate from another condition?
- Often REDNESS UNDER DENTURE BEARING AREA, mimicking DENTURE STOMATITIS so hard to diagnose.
- Can occur on **LIPS/CHEEKS**.
81
2 materials used in dentures that can induce allergies in patients?
1. NICKEL containing Co/Cr.
2. PMMA, especially SELF CURE RELINES as HIGH MONOMER.
Module 7
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