Download - CD Insertion Lecture 02 Jan 2012
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Outline:Post-insertion instruction.
Patients experiences & discomfort.Post-insertion Problems & their solution.
INSTRUCTIONS:
LIST OF INSTRUCTIONS:
HABITUATION.
EATING HABITS.SPEECH.
HOME CARE FOR THE DENTURES.
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HABITUATION:
Initially CDS will feel strange & bulky in mouth.
Feeling of bulky lips and cheeks.
Appearance with CDs will become more natural
with time.
Initially Eating will be difficult.
Patients should avoid using the Cds for eating in
the fist week.
Then start eating soft foods should be taken.
Biting & Incising food should also be avoided.
Small pieces of food place b/w posterior teeth on
both sides.
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SPEECH:
Initially Speaking will also be difficult with the new
CDs.Patient Will also feel speaking difficulty.
He should be advised to persevere and try speaking
aloud with CDs in privacy.
However, CDs should be evaluated for any faults that:
- Bring changes in Appearance of the patient.
- Makes Eating difficult With the CDS.
- Alter the patients speaking ability.
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HOME CARE FOR THE DENTURES
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EXPERIENCES & DISCOMFORTS WITH
CDs:
1. FIRST ORAL FEELINGS..2. RETENTION COMPARISION BETWEEN NATURAL
& ARTIFICIAL TEETH.
3. SALIVA.4. SPEECH.
5. EATING.
6. TONGUE POSITION & PROBLEMS WITH THELOWER DENTURE IN CONTRAST WITH THE
UPPER DENTURE.
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FIRST ORAL FEELINGS:1. NATURE OF THE COMPLETE DENTURE
General introduction about the denture by the mean of diagrams ormodels can be used to show the pt that what he wears in his mouth.
2. FULLNESS OF THE MOUTH
a. Little change in the mouth is perceived as a big change by the pt.b. Also dentist use as much area as possible.
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RETENTION COMPARISION BETWEEN
NATURAL & ARTIFICIAL TEETH
NATURAL DENTITION COMPLETE DENTURE
MODE OF ACTION Roots ( which have ability
to bite tough food)
Wet slippery mucosa
(which is not able to bite
tough food)
BITING CAPACITY 80 pounds 11.7 pounds
SENSATION Proprioceptive
mechanism
No such capacity
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SALIVA
PROBLEM SOLUTION
Excess salivation :-
As foreign thing enters in
the mouth, its the normal
reaction of the body.
Subsides in few weeks,
Keep deglutition active.
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SPEECH
PROBLEM SOLUTION
y Distortion of speech,
y Affected fluency (owing to
initial feeling of bulk & the
accompanying excessive saliva)
y Difficult rapid conversation
Quietly read aloud at home (slow
reading may not put up the pts
concentration on how the sound
is pronounced.)
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EATING
Patients compliance
e.g. ability to eat a steak
or an apple is a mark of
good denture.
(Such things result in
soreness of the mouth.)
Pts education
y In beginning pt is advised to eat soft/crispy foods, as
they are easy to comminute.( 1st week)
y Avoid fibrous & tough foods in beginning, there is an
ample variety of soft food available so, patient should
not compromise with nutrition.
y Patient is educated to eat methodically:-Pt is instructed to divide normal forkful of food
in half & place each half bilaterally.
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TONGUE POSITION & PROBLEMS:
WITH THE LOWER CD IN CONTRAST WITH THE
UPPER CD:MANDIBULAR CD MAXILLRY CD
TONGUE tongue causes lifting of the
lower CD
No tongue involvement
DENTURE BEARING AREAS approx. 14cm2 Approx. 24 cm2
Muscle surroundings Buccal & lingual muscles Only buccal muscles
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Problems occurr ing f ollowing inser tion
& their solution:
SEVERAL PROBL EMS:
DIRECT SEQUELAE:1. DENTURE RELATED STOMATITIS (DRS).
2. FLABBY RIDGE.
3. TRAUMATIC ULCER (sore spots).
4. BURNING MOUTH SYNDROME.
5. RESIDUAL RIDGE RESORPTION.
6. DENTURE IRRITATION HYPERPLASIA.
7. GAGGING.
INDIRECT SEQUELAE
1. ATROPHY OF MASTICATORY MUSCLES
2. NUTRITIONAL DEFICIENCIES
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DIRECT SEQELAE:
DENTURE RELATED STOMATITIS:
Synonymous With:
Denture induced stomatitis
Denture sore mouth,
Inflammatory hyperplasia,
Chronic atrophic candiasis
Calssification:
Type-I (Localized simple infection)
Type-II (erythematous type)- generalized type
Type-III granular type
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Systemic Factors:
Old age
Diabetes mellitusNutritional deficiency:- iron, folate, vit.12 etc.
Local Factors:Dentures
Environmental factors
Night wear of the dentures
Denture cleanlinessXerostomia
High carbohydrate diets:
- causes increased plaque accumulation
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Management:
Supportive Measures:
Cleanliness of the dentureDenture & the mucosa should be cleaned after the meals.
Store CDs in 0.2-2% chlorhexidine during night time.
Polishing of the denture routinely.
Not to wear the denture during night time.DRUGS:
After the infection is confirmed to be due to candida
infection, topical anti-fungals are given:
Nystatin, Amphotericin B, Miconiazole.
Surgical:
Necessary in Papillary Hyperplasia (Type-III).
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Flabby Ridge:
Alveolar ridge may become mobile & extremely resilient
due to replacement of the bone by the fibrous tissue.
Management:
Surgical correction.
CD relining to improve its adaptation to the tissue surface.
New CD Making: Use special impression Techniques avoiding tissue distortion /
displacement.
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TRAUMATIC ULCERS:
Develop within a day after placement of new denture.
They are small, painful lesions covered with a grey necrotic
membrane surrounded by inflammatory halo with firm, elevatedborders.
Etiology:
Over extension of the denture base.
Unbalanced occlusion.
Management:In normal pts, these ulcers heal
within few days after correcting
the dentures.
If treatment is not administered,
it may progress to dentureirritation hyperplasia.
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Burning Mouth Syndrome:
Local factors.
Systemic factors.Psychological factors.
Local Factors:
Mechanical irritation by ill-fitting dentures.
Prolonged masticatory muscle activity.
Persistent parafunctional movements of tongue.
Constant excessive friction on the mucosa.
Systemic Factors:Vitamin or Iron deficiency.
Menopause.
Xerostomia.
Diabetes.
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Psychological Factors:
Anxiety.
Depression.
Clinical Features:Does not show any overt clinical features.
Mainly pain starts in the morning & aggravates during the day.
Burning sensation usually accompanied with dry mouth & persistent altered taste .
Associated Symptoms: Include head ache, insomnia, decreased libido, irritability,
depression.
Treatment:Removal of local factors,
Compensation for systemic deficiency except for menopose.Psychiatric counselling.
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RESIDUAL RIDGE RESORPTION:
Wherever there is pressure, bone resorbs due to activation of osteoclast.
Its a constant sequel after extraction & continues even after inserting CDs.
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Pattern of RRR:
More rapidly in first 6 months and slows in later 6 months.
Its more rapid in females than in males.
Its precipitated by certain systemic diseases & ill-fitting dentures.
MANDIBLE: Initially = 4-5mm, Later = 0.1-0.2mm.
MAXILLA: Initially = 2-3mm, Later = four times lesser than mandible.
Clinical Features:
The depth & width of the sulcus is reduced.
Decreased vertical dimension at occlusion.
Reduction of the lower facial height.
Increased relative prognathism.
Maxilla: RRR is Centripetal.
Mandible: RRR Centrifugal
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Denture Irritiation:
It is a hyperplastic reaction of the mucosa occurring along the borders of the
denture.
These lesions result from trauma due to unstable denture flanges.The lesions usually subside after:
Surgical excision of the tissues.
Correction of the dentures.
Symptoms are very mild with single or numerous lesions showing flaps of
hyperplastic connective tissue.Deep ulceration, fissuring & inflammation may occur at the depth of the sulcus.
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Gagging:
The gag reflex is a normal defence mechanism, which functions to prevent foreign
bodies from entering the trachea.
It may occur due to over extension of the denture borders at posterior palatal seal
of the maxillary dentures & disto-lingual part of the mandibular dentures.In such cases it needs the correction.