Systemic Health Aspects and Nutrition.pdf

Systemic Health Aspects and Nutrition Denture wearers more vulnerable to oral-systemic conditions and compromised nutritional health Dietary guidance is an integral part of overall management for denture pts Most oral-systemic conditions are: o Very difficult and challenging to manage o May require...

Systemic Health Aspects and Nutrition Denture wearers more vulnerable to oral-systemic conditions and compromised nutritional health Dietary guidance is an integral part of overall management for denture pts Most oral-systemic conditions are: o Very difficult and challenging to manage o May require alternative treatment interventions o such as osseointegrated implant prostheses Oral Systemic Considerations that may influence Adaptive Prosthodontic Experience Mucosal Conditions (Vesiculoerosive disorders, SLE, Burning mouth syndrome) Vesiculoerosive (VEC) Limit ability of oral tissues to withstand mechanical pressure from complete denture wear Often assc w quiescence and exacerbation periods, pain o Main disorders: § Oral Lichen Planus (OLP) § Erythema Multiforme (EM) § Mucous Membrane Pemphigoid/Pemphigus (MMP) o Disorders are inflammatory § OLP/MMP assc w autoimmunity in formation § EM: Viral or bacterial etiology o Treatment: Steroids, retinoids o Poor prognosis for denture therapy o Episodic in nature (time-dependent and fluctuant severeity) is a challenge Systemic Lupus Erythematosus More common in women (10:1) Autoimmune Type III hypersensitivity rxn Consequent to an environmental trigger (e.g EBV) Skin, hematologic, and musculoskeletal, other systems involved Similar to VEC: Has routine periods of remission, exacerbation o Subepithelial inflammation of the oral mucosa accompanies erosive lesions o Compromise in tissue tolerance to complete denture loading Osseointegrated prostheses may be indicated Sx may be indicated but some pts are on blood thinners due to stroke risk Burning Mouth Syndrome Diagnosis is subjective over pathological Most pts are postmenopausal women Cause/Symptoms: o Painful, burning sensation o Affects the oral mucosa o Most frequently affected site à tongue o May occur in the lips, buccal mucosa, and/or floor of the mouth o Intensity ranges from mild to severe May be assc with: o Sjogren’s Syndrome o Postradiation treatment in head and neck o Anti-psychotic meds o Other systemic diseases, drugs affecting salivary flow BMS assc w emotional disorders Burning that is distinguishable from BMS come from: o Systemic dz o Local factors Etiology: o Local: Candidiasis, erythema migrans, rxns to dental materials o Systemic: Nutritional defs (B12, iron), hormone disturbances, anemia, diabetes o Psychogenic: Anxiety, depression o Neurogenic: Alterations in peripheral nerves, dopamine lvls Salivary Alterations: o Xerostomia o Increased salivary viscosity o Altered taste BMS management is palliative à Pt education, encouragement is best approach Local Factors Mechanical Irritation Allergy Infection Oral habits Oral parafunctions Myofascial pain Causes of Burning Mouth Syndrome Psychogenic Factors Systemic Factors Depression Vitamin def Anxiety Iron def anemia Psychosocial stressors Xerostomia Menopause Diabetes Parkinson’s dz Medications Oral Movement Disorders Excess or diminished movement Uncontrolled jaw movement Clinical presentation: o Hyperkinetic: Bruxism, dystonia (involuntary contraction), dyskinesias (involuntary, erratic movements) o Hypokinetic: Parkinson’s dz Reduced muscular control impacts denture therapy prognosis Complications: o Pain o Compromised Function o Depression Systemic Dyskinesias: o Parkinson’s o Tourette’s o Huntington’s Ability to handle prosthesis w necessary dexterity and control may be limited Removable prostheses in pts w dyskinesias should be done AFTER reviewing pts limitations, capabilities Border Molding Border Molding Compound comes in green, red, brown Custom trays and wax also come in different colors, blue, pink, clear/white Border molding should be shaped like an ideal denture border Usually checked w relief wax present o Can be done if wax melted out tho Final impressions: o Wax in relief areas will be removed prior to impression o Space for impression will be left at relief areas so pressure wont be applied Tray should fit 2-3 mm short of vestibule depth Apply tray adhesive, add border mold material o Excess compound should be removed o Tray smoothed o Remove excess wax o Paint surface w tray adhesive Border will be molded twice o First w compound o Second w impression material o Stretch/pull pts cheeks, lips to make sure tissues, frenum attachments will not be imoinged on by final denture border