Dental Prostheses and Oral Self-Care

• Chapter focuses on care of dental prostheses
• Highlights importance of oral self care

Learning Objectives

• Identify causes and prevention of tooth loss
• Describe anatomic features of an edentulous oral cavity
• Describes types and components of fixed and removal oral prostheses
• Explain methods for marking dentures with permanent identification
• Develop individual oral self-care regimen for fixed and removable prostheses
• Evaluate oral prosthesis, related soft tissue, and patient concerns during clinical examination
• Explain prevention and causes of denture-induced oral lesions
• List steps to provide professional cleaning of fixed/removal prostheses

Missing Teeth

• Inform patients of options and risk factors when missing teeth
• Common causes of tooth loss are poor self-care, lacking access to professional dental care and trauma
• Patient can be edentulous or partially edentulous
• Options include fixed/removal prostheses and complete/partial dentures

The Edentulous Mouth

• Bone structures to look out for are residual ridges, tori, and exostoses
• The oral mucosa layers include:
  • Masticatory: covers edentulous ridge and hard palate
  • Lining: covers the floor of the mouth, vestibule and cheeks
    • Specialized: tongue (filiform, fungiform, & circumvallate)
• Submucosa: connective tissue under mucous membrane
• Tension test helps to differentiate the attached gingiva over bony ridge and lining mucosa

Purpose of Wearing Fixed/Removal Prosthesis

• Benefits of replacing missing teeth with dentures
• Hygienists can explain choices, answer questions, and document any prosthesis
• Consequences of not replacing missing teeth include:
  • Migration of adjacent and opposing teeth
  • Loss of occlusal vertical dimension
  • Angular cheilitis

Types of Oral Prostheses

• Fixed:
  • Fixed partial denture
  • Implant-supported complete denture
• Removable:
  • Removable partial denture
    • Natural tooth supported
    • Implant supported
  • Complete denture
  • Overdenture
  • Obturator

Fixed Partial Denture Prostheses

• Commonly called bridges
• Fabricated from various materials
• Affixed to tooth or implants
• Not removable
• Can be natural tooth supported or implant supported
• Criteria to consider:
  • Biologically and esthetically harmonious with surrounding teeth and periodontium
  • Parts accessible for cleaning
  • Doesn't interfere with natural teeth cleansing
  • Doesn't traumatize tissues
  • Restores function of missing teeth

Removable Partial Denture Prostheses

• RPD replaces one or more teeth
• Denture base rests on oral mucosa
• Can be removed
• Framework made of chrome cobalt
• Framework engages abutment teeth or an abutment implant with clasp assemblies and seats
• Can be tooth-borne, implant-borne, or tissue-borne
• Base is made of plastic acrylic resin
• Teeth are made of porcelain, plastic resin, or metal

Complete Denture Prosthesis

• Types of dentures include
  • Tissue-supported complete denture
  • Implant denture
  • Overdenture
  • Interim denture
  • Immediate denture
  • Denture for primary teeth

Complete Overdenture Prostheses

• Complete denture supported by retained natural teeth, implants, and soft tissue of the residual alveolar ridge
• Root-supported overdenture
• Implant-supported overdenture

Obturator

• Closes congenital or acquired opening
  • Examples Cleft Palate or Trauma/oral cancer
• Clinical Applications
  • May be removed for radiographs or cleaning teeth
  • May need to stay in place for treatment involving water
  • Remove when scaling teeth
  • Denture Stomatitis if sleeping with it in place
  • Clean same as removable partial dentures
• Recommended professional care threee times a year
• Defects may change over time

Denture Marking for Identification

• Essential in forensics and emergencies for identification in long term resident facilities
• Criteria for an adequate marking system include:
  • No adverse effects on denture material
  • Inexpensive and durable
  • Fire and humidity resistance
• Inclusion Methods for Marking include
  • ID-Band
  • ID-Strip
  • Electronic microchip
  • Laser etching
  • Radio-frequency identification (RFID) tags
  • Bar codes
• Surface Markers Include
  • Permanent marker or pen
  • Engraving tool or dental bur
    • Cover with denture acrylic to provide smooth surface
• Information to include on a marker can include
  • Name or initials
  • Social security number or equivalent
• Other information suggested/ blood type, vital drug, or disease information

Professional Care Procedures for Patients with Fixed Prostheses

• Must take into account medical, dental, and psychosocial history Conduct Extraoral/intraoral examination
• Assess risk for oral disease
• Take radiographs
• Dental and periodontal examination should evaluate prosthesis margins for decay, monitor periodontal health for changes/mobility, and assess abutments for looseness and/or fractures.
• Perform a dental/dental hygiene diagnosis and create appropriate care plan.
• Oral hygiene education for natural dentition and prosthesis must be conducted
• Prophylaxis or periodontal treatment (S & RP) needed Preventive actions: Fluoride, Chlorhexidine, tobacco intervention & and dietary counseling
• Continuing care should be individualized with an emphasis on pontic/abutments
• Toothbrushing: Power/manual/methods

Cleaning the Prosthesis

• Follow the procedure below
• Spread a towel, washcloth, or rubber to act as cushion incase dropped in sink with water
• Secure grip, without squeezing
• Use warm water, cleanser, brush all surfaces, especially the ones touching oral topography
• Lastly, Rinse denture and brush under running water
• Cleaning prostheses can use
  • Rinsing
  • Brushing
• Cleaned via chemical denture cleansers by:
  • Sodium hypochlorite, soaking longer than 10 minutes may cause damage
    • Effective in killing MRSA (methicillin-resistant Staphylococcus aureus) and Candida
  • Peroxide must be Mix 1/2 cup of 3% peroxide with 1/2 cup water in a bowl and soak dentures for about 30 minutes.
• Enzymes are an option

Disinfection

• To loosen debris and light stains, use sodium hypochlorite
• Dilute Bleach for cleaning
• 1 Tablespoon to 1 Gallon of water for5 minutes Disadvantages of bleach:
  • Bleaching effect on denture materials -Scent
  • Pitting on surface
• May tarnish metal
• Will not remove heavy stains/calculus
• Tablet or poder form dropped/soaked in water for 10-15min
• Cleanser is efferdent, but does not remove calculus

Cleaning Denture via Immersion

• Fill the denture in container with distilled water.
• Use luke-warm water which encourages cleanser action.
• Ensure that the dentures are completely covered during the procedure.
• Remove water from denture before brushing to take off remaining debris.
• Clean container on a daily basis and maintain proper hygiene to avoid proliferation of hazardous microorganisms.

Complete Dentures Care

• Mucin and food debris
• Denture pellicle and biofilm
• Calculus
• Stains
• Patient can perform removal of denture. -Care of dentures during intraoral procedure can consist of a clinician who follows standard procedures. Position them at 11:00-12:00 if a right handed clinician. Use index finger for the palatal part, remove seals elevate upper lip. Manibular dentures can also follow similar procedure.
• Materials should be new toohbrush, paper towels and a cup to collect fluid. Patients name or info should be placed on labelled container.

Patient Self-Care Procedure: Complete Denture

• Give general education before placement
• Education for new user should mention to adjust to chewing, swallowing, takes 6-8 weeks
• Note that Taste may be affected by foods
• You cn reduce build up via biofilm and reduce oral lesions
• Patient recommendations include:
  • Soak well after daily brushing and and rinse well when storing
  • Store in water -Get annual dental exam
• Be sure reline or rebase as neede

Denture-Induced Oral Mucosal Lesions(OMLs)

• Denture induced OML are contributed to with many factors
• Common types consist of Dentures induced irritation with ulcers
• Denture stomatitis
• Angular cheilitis
• Tissue hyperplasia
• Some treatments include mouthwash can treat oral infections.
• Dentures must still be cleaned and maintained from stains and calculus.

Documentation of Denture

• Always review patient medical history, making sure to note all changes.
• Check for the patients complaints and evaluate their implanted teeth health to make sure they can function.
• Examine intra oral health for any change in tissue.
• The oral self-care must be personalized to the patient with their teeth well being being the goal.
• Check documentation for possible improvements.

Teaching Patients

• Help promote self examination of gums to eliminate problems that may arise.
• Teach cleaning of dentures and keep them sterile from infections such as bacteria such as Candida.
• Must remind patients that the tongue can contribue to complete health
• Should they arise patients should always consult a professional evaluate any issues.