Post insertion problems related to dentures.pdf

POST INSERTION PROBLEMS RELATED TO DENTURES Dr. Piriya Boonsiriphant Department of Prosthodontics Lecture Objectives Given the information regarding post insertion problems associated with dentures the student should be able to discuss accurately: 1. The importance of post insertion visits and de...

POST INSERTION PROBLEMS RELATED TO DENTURES Dr. Piriya Boonsiriphant Department of Prosthodontics Lecture Objectives Given the information regarding post insertion problems associated with dentures the student should be able to discuss accurately: 1. The importance of post insertion visits and denture adjustments 2. The symptoms and lesions associated with the post insertion phase of dentures 3. How to adjust the dentures to alleviate the symptoms associated with the dentures 4. The factors in managing the patient including the complete cooperation of the patient during the adjustment period. The 4 E’S (Earl Pound) • • • • Evaluate Educate Estimate Eliminate Important factors regarding patient acceptance of dentures • The patient’s attitude about wearing dentures • If the patient likes and respects the dentist as a human being • Establishment of a good dentist/patient relationship Preliminary precautions and explanations reduce the necessity for post-operative apologies Educate Before vs. Excuse After “You will feel increased salivary flow after you get your new dentures” “I’M DROOLING ALL THE TIME!!” Patient’s Level of Expectation vs. Your Level of Achievement The closer they match the better!!! Evaluation of Dentures • After returned from the lab • Delivery appointment • Post-insertion appt (adjustment) • Recall appointment Ask your patient “HOW DID YOU DO?” • Does it hurt anywhere? • How did it fit? • Are you satisfied with the way it looks? • How did you do with eating? • How did you do with speaking? Visually Look, and use an intra-oral mirror! Feel around, “Does it hurt when I press anywhere?” Patient expressed discomfort in one area but not the other… MUCOSAL IRRITATION • • • • • • • • • Sharp edges and blebs Overextension of border Impingement on frenum Unrelieved undercuts Isolated pressure areas Occlusal discrepancy Excessive vertical dimension Clenching and grinding teeth Insufficient saliva MUCOSAL IRRITATION • Sharp edges and blebs Round and polish • • • • Identify with PIP and relieve Overextension of border Impingement on frenum Unrelieved undercuts Isolated pressure areas MUCOSAL IRRITATION • Occlusal discrepancy Adjust occlusion chairside or clinical remount • Excessive vertical dimension Correct VDO on articulator or remake denture • Clenching and grinding teeth Educate patient • Insufficient saliva Prescribe artificial saliva Ex: The patient presented saying that they had a sore area… Armamentaria Pressure indicating paste (PIP) Indelible marker (Thompson’s marker) Corresponding pressure area Adjustment complete Alternative Technique: Mark ulcer with Thompson’s marker and reseat denture (not nearly as accurate) Alternative Technique: Mark ulcer with Thompson’s marker and reseat denture (not nearly as accurate) Patient stated that they felt that the denture was too full • New denture • Excessive flange thickness • Palate too thick • Improper tooth placement Patient stated that they felt that the denture was too full • New dentures No treatment until pt has had a chance to adapt to new dentures • Excessive flange thickness • Palate too thick Reduce • Improper tooth placement Reset teeth or remake dentures The patient had sore throat and difficulty in swallowing • Maxillary overextension posteriorly • Mandibular disto-lingual overextension • Excessive VDO • Insufficient saliva The patient had sore throat and difficulty in swallowing • Overextension in posterior of maxillary denture • Overextension of distolingual flange of mandibular denture Reduce overextension using PIP (Check relief for pterygomandibular raphe when mouth is open wide) Use PIP to locate overextension (Pt should place tongue to opposite side to check for overextension) • Excessive VDO Correct VDO on articulator or remake denture • Insufficient saliva Increase fluid or prescribe artificial saliva The patient complained of not being able to chew very well • Dentures are not as efficient, 1/10th that of natural teeth • “Front teeth are for looks and back teeth are for chewing” • Food preparation and selection • More important with the new denture wearer The patient states they have too much saliva or are drooling • Having new dentures will stimulate saliva glands • Insufficient vertical dimension Will subside in approx. one week after insertion Remake dentures to restore VDO “The denture is coming loose.” • Overextension Use PIP to locate border areas for reduction • Underextension (cause loss of seal) Add modeling compound around border If this corrects the problem, reline denture • Occlusal errors Adjust occlusion • Teeth improperly positioned Reposition teeth or remake dentures “The denture is coming loose.” • Inadequate posterior palatal Add posterior palatal seal area with acrylic seal • Buccal flange interfering with coronoid process Thin buccal flange of maxillary denture “The denture is coming loose.” • Atypical tongue position (loose lower denture) Educate pt to keep tip of tongue forward in mouth, behind the mandibular incisors Present in 33% of edentulous patients Slightly retracted Severely retracted Training device “I gag when the denture is in.” • Maxillary denture overextended posteriorly Shorten overextended posterior seal • Bulkiness of denture May need to reduce thickness and consider thin metal palate • Excessive vertical dimension Correct VDO on articulator or remake • Psychogenic rejection Educate pt The patient states that they are biting their cheek, lip or tongue • New denture No treatment until pt has had a chance to adapt to new dentures • Inadequate horizontal overlap Round lower buccal cusp or reset teeth • Teeth placed too far lingually Move teeth buccally or remake • Insufficient Vertical dimension Remake denture The patient states that they are biting their cheek, lip or tongue • Insufficient room posteriorly between tuberosity and retromolar pad Reduce acrylic thickness. May have to use metal base if too little room in these areas. Surgery may be indicated. The patient states that they are not able to speak or sound like they used to • Pt has no yet accommodated to new dentures No changes should be made for 6-8 weeks, as pt usually will adapt to new dentures • Excessive lingual flange thickness (doesn’t allow adequate room for tongue) Reduce thickness of lingual flange The patient states that they are not able to speak or sound like they used to • Incorrect placement of upper anterior teeth either vertically or horizontally (will make /F/ and /V/ sounds indistinct) Reposition anterior teeth or remake The patient states that they are not able to speak or sound like they used to • Loss of air through the palatal vault causes whistling (palatal vault lacks proper thickness) Place soft wax on palate to see if this corrects the problems. If it does, change wax to acrylic. Consider referral to speech pathologist if changes don’t correct speech difficulties. “My teeth are noisy” • Insufficient inter-occlusal distance ( = excessive VDO) • Loose dentures Reduce VD by equilibration of teeth on the articulator Reline or remake “I have an earache” “My jaw joint hurts” • Occlusion error • Vertical dimension is either opened (excessive) or closed too far • Bruxing and clenching Adjust occlusion Correct vertical dimension or remake Educate patient. Leave dentures out at night. “I can’t taste food as well as before I had dentures.” • New denture Educate patient • Coverage of palate Educate patient, possibly placing a cast metal palate would permit perception of temperature changes. • Atrophy of taste buds Educate patient The patient states that they are “getting food under denture” • Under-extension Correct under extension or reline • Inadequate adaption Reline or remake denture • Inexperienced denture wearer Educate patient Other areas to evaluate in denture patients to provide patient education and treatment… DRY MOUTH • • • • Medication Disease Radiation Anxiety ➢ Increase fluid ➢ Artificial saliva ➢ Referral to a physician ANGULAR CHEILITIS • Insufficient VDO Remake denture • Vitamin B deficiency Vitamin therapy • Candida Albicans infection Prescribe Mycostatin ointment BURNING PALATE OR LIP • Excessive incisive papilla pressure • Excessive mental foramen pressure Use PIP under function and relieve pressure area. If this doesn’t correct problem, mental nerve may have to be surgically lowered. BURNING TONGUE • Hormonal imbalance • Vitamin deficiency • Spicy foods • Caustic mouthwashes • Poor oral hygiene Refer to a physician Vitamin therapy Change diet Change mouthwash Instruct pt in correct oral hygiene Denture Recall • Yearly • Subjective evaluation by the patient • Objective evaluation by the dentist • Intra extra oral Examination • Oral Cancer Screening • Overall evaluation of tissue for disease or trauma • Evaluate each individual denture • Fit = retention, stability, extensions • Wear of the teeth • Evaluate occlusion Retention Stability Occlusion in CR RELINE AND REBASE INDICATIONS • Satisfactory Occlusion • Satisfactory Vertical Dimension • Satisfactory Esthetics • Previously fabricated by you If these criteria are not satisfied, then the denture should be re- made THANK YOU FOR YOUR ATTENTION