History, Examination, Diagnosis, and Treatment Plan  

 

Medical History 

  • Make efficient use of time, and perform the exam systematically e.g. posterior to the anterior, palate, etc.

  • Follow-up significant positive findings Note systemic conditions that impact therapy (e.g. angina, diabetes, etc)

  • Obtain physician consultations where appropriate 

  • If some debilitating disease - discuss prosthesis with the caretaker/instructor – to ensure acceptability

 

Denture History 

  • How many dentures,

  • How long patient has worn dentures - Satisfaction/dissatisfaction with dentures -

  • Things patient likes - What do they want to change?

  • Be brief

 

Clinical Exam – routine clinical exam Intraoral Exam - Examine one arch at a time – inspect, then record findings

  • General tissue health - Attached mucosa / non-attached - Colour - Character - Displaceability

  • Specific anatomical considerations  - Examine systematically, e.g. posterior to the anterior, palate, etc.

  • Note the significance that a finding has to the therapy being provided - Visual and tactile exam. 

 

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Instructions to Patients 

Limitations of Dentures

  • Dentures are generally less efficient than natural teeth - Some people can eat all foods easily, but these are the exception

  • Generally, the better the ridge form, the fewer problems are encountered. Patients with minimal ridges should be advised that their dentures will likely move (especially the mandibular) and their efficiency will therefore be reduced - Patients with minimal ridges will likely encounter more sore spots than others

  • It is wise to point out these limitations to patients prior to the delivery appointment so that it is viewed as an explanation, rather than an excuse

Adaptation to Dentures

  • Because new dentures have been changed in some respects from the old dentures, it will take time to adapt

  • Studies show that it may take 6 to 8 weeks for muscles to become optimally adapted to new prostheses (explain to patients)

  • Adaptability is reduced in complete denture wearers because proprioceptors of the periodontal ligament have been lost and large areas of mucosal proprioceptors are covered with acrylic

  • Adaptability is affected by:

    1. Length of time wearing dentures  

    2. Amount of residual ridge remaining  

    3. Degree of changes made in new dentures

    4. Individual variation (e.g. patients with more acute oral sensory perception have more difficulty adapting)

  • Adaptation to Chewing may be affected if:  

    1. Centric occlusion (CO) has been changed to coincide with the centric relation (CR)

    2. Tooth positions (esp. incisors) have changed

    3. Vertical dimension has changed

These patients may experience initial decreased efficiency, and cheek or lip biting. Adaptation may be improved by initially eating soft foods, increasing to firmer foods, cutting food into smaller pieces, and placing food toward the corners of the mouth. Adaptation may be accompanied by an initial, transitory increase in saliva. Patients should be advised of the need to persevere while their neuromuscular adapts to the new prostheses.

 

Speaking may be affected by changes in: 

  1. Tooth position (esp. anterior teeth)

  2. Tongue space (particularly if patients have been without dentures for a while)

  3. Palatal contours

 

Initial speaking problems are usually transitory since the tongue is very adaptable – tooth positions must be close at delivery

 

Appearance may be changed for some individuals, usually due to:

  1. Increasing length of incisors (if previous teeth were significantly worn)  

  2. Changes in the vertical dimension

  3. Improved lip support (do not promise to eliminate wrinkles)

In most instances, these changes in appearance will be beneficial and not of concern to the patient. However, it may be of concern if appearance is radically changed. Patients may require reassurance during the period of adjustment to their new appearance.

 

Oral Hygiene - Affects plaque retention, inflammation, fit and potential infections - Provide proper instructions and demonstration

  • Dentures: - Brushing has been shown to be the most effective method to remove plaque: - Use non-abrasive cleanser (commercial pastes, dish detergents, NOT toothpaste) - Patients often need more attention to the denture tooth/base junctions - Use a soft brush with long bristles (less wear) - Inner and outer surfaces must be cleaned - Brush over a filled basin or face cloth (protection against damage if dropped) - Brush after every meal and before be

    • Chemical cleaners: - Efferdent, Polident etc. must be used overnight for optimal effectiveness (15-30 minutes is not sufficient) - Brushing is more effective (60-80% vs 20-30% plaque removal compared to soaking alone) - Combine brushing with soaking for more efficiency

    • Ultrasonic cleaners (Professional Cleaning): - True ultrasonic cleaners work well - “Sonic” cleaners are not effective without chemical cleaner (brushing is more effective)

  • Mucosa: 

    • Remove dentures at night 

    • Brush mucosa with a soft toothbrush and warm tap water, and massage all of the tissue - this will improve health for the next denture 

    • Alternatively use a face cloth

Continuing Care

  • Patients should schedule yearly denture recall appointments

  • Easy to correct small problems, occlusion, pressure, reinforce hygiene, etc.

  • Can do something small - improve patient health and rapport

  • Denture life expectancy is 5-7 years, but if tissues change, remakes may be required sooner

  • If continued care, dentures might last longer than average

  • It is better for dentures to wear out rather than for changes in fit and occlusion to cause resorption of the residual ridge