GOOD AFTERNOON

POST-INSERTION INSTRUCTION, PROBLEMS & SOLUTIONS

SOLUTIONS PATIENTS EDUCATION

Outline
Post-insertion instruction
Patients experiences & discomfort Problems occurring following insertion & their solution

POST-INSERTION INSTRUCTION

LIST OF INSTRUCTIONS
1. 2. 3. 4. HABITUATION EATING HABITS SPEECH HOME CARE FOR THE DENTURES

1.HABITUATION
Initially the denture will feel strange & bulky in the mouth & will cause, fullness of lips & cheeks. Patients appearance with the denture will become more natural with time. Patients mouth & tongue has to get adjusted to the denture, also there will be increased salivation, which will be reduced subsequently.

2.EATING HABITS
1. It may be difficult to adjust as patient has been without teeth for a long period of time. 2. First few days pt is instructed not to chew hard food avoid sticky food 3. Pt is asked to try to chew on both side with the back teeth 4. Pt is asked not to drink water by lifting the tumbler but drinking by sipping.

3. SPEECH
1. Speaking with the dentures normally requires some practise. 2. Patient is asked to read aloud and repeat the words those which are difficult to pronounce. 3. With passage of time pts speech with denture will be better than without denture.

4. HOME CARE FOR THE DENTURES

1. Pt is asked to clean the denture with soft brush, specially made for denture & keep cloth in the wash basin so, if denture will fall than it wont break.

2. Pt should rinse the mouth & denture after every meal. 3. Pt should never wear denture at night & should store denture in cold water. 4. Pt should not wash the denture with hot water.

5. Its preferable if pt place denture in denture cleanser at night.

6. After removing the denture pt should massage the gums for few minutes with fingers.
7. Pt should not use any abrasive or detergents to clean the dentures. 8. Pt should not make any adjustment or repair by himself.

PATIENTS EXPERIENCES & DISCOMFORTS

ZARB BOLENDER STATES,.

Explanations provided after problems develop often are interpreted as excuses by the dentist for dentures that function less than satisfactorily.

Different experiences & discomforts

1. FIRST ORAL FEELINGS 2. RETENTION COMPARISION BETWEEN NATURAL & ARTIFICIAL TEETH 3. SALIVA 4. SPEECH

5. EATING
6. TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE

1.FIRST ORAL FEELINGS

1. NATURE OF THE COMPLETE DENTURE
General introduction about the denture by the mean of diagrams or models can be used to show the pt that what he wears in his mouth.

2.

FULLNESS OF THE MOUTH

a.
b.

Little change in the mouth is perceived as a big change by the pt. Also dentist use as much area as possible.

2.RETENTION COMPARISION BETWEEN NATURAL & ARTIFICIAL TEETH

NATURAL DENTITION Roots ( which have ability to bite tough food) 80 pounds COMPLETE DENTURE Wet slippery mucosa (which is not able to bite tough food) 11.7 pounds

MODE OF ACTION

BITING CAPACITY

SENSATION

Proprioceptive mechanism

No such capacity

3.SALIVA
PROBLEM Excess salivation :As foreign thing enters in the mouth, its the normal reaction of the body. SOLUTION

Subsides in few weeks, Keep deglutition active.

4.SPEECH
PROBLEM
Distortion of speech, Affected fluency (owing to initial feeling of bulk & the accompanying excessive saliva) Difficult rapid conversation

SOLUTION
Quietly read aloud at home (slow reading may not put up the pts concentration on how the sound is pronounced.)

5.EATING
Pts 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 In beginning pt is advised to eat soft/crispy foods, as they are easy to comminuted.( 1st week) Avoid fibrous & tough foods in beginning, there is an ample variety of soft food is available so, pt should not compromise with nutrition.

Pt is educated to eat methodically:Pt is instructed to divide normal forkful of food in half & place each half bilaterally.

6. TONGUE POSITION & PROBLEMS WITH THE

LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE

MANDIBULAR DENTURE MAXILLRY DENTURE

TONGUE tongue causes lifting of the lower denture No tongue involvement

DENTURE BEARING AREAS

approx. 14cm2

Approx. 24 cm2

Muscle surroundings

Buccal & lingual muscles Only buccal muscles

Problems occurring following insertion & their solution

SEVERAL PROBLEMS
DIRECT SEQUELAE

1. DENTURE STOMATITIS 2. FLABBY RIDGE

3. TRAUMATIC ULCER (sore spots)

4. BURNING MOUTH SYNDROMS 5. RESIDUAL RIDGE RESORPTION 6. DENTURE IRRITATION HYPERPLASIA 7. GAGGING

INDIRECT SEQUELAE

1. ATROPHY OF MASTICATORY MUSCLES

2. NUTRITIONAL DEFICIENCIES

DIRECT SEQUELAE

1.DENTURE STOMATITIS

DENTURE STOMATITIS - SYNONYMS

Denture induced stomatitis Denture sore mouth, Inflammatory hyperplasia, Chronic atrophic candiasis

CLASSIFICATION
Type-I (Localized simple infection) Type-II (erythematous type)- generalized type Type-III granular type

ETIOLOGIC FACTORS
systemic factors old age

diabetes mellitus
nutritional deficiency:- iron, folate, vit.12 etc.

Local factors dentures environmental factors night wear of the dentures

denture cleanliness
xerostomia high carbohydrate diets:- causes increased plaque accumulation

MANAGEMENT

SUPPORTIVE MEASURES
cleanliness of the denture denture & the mucosa should be cleaned after the meals. Store the denture in the 0.2-2% chlorhexidine during the night time. Polishing of the denture routinely. Not to wear the denture during night time.

DRUG THERAPY after the infection is conformed to be occurring because of the candida the topical anti-fungals are given,,, e.g. nystatin, amphotericin B, micronidazole,

SURGICAL THERAPY

necessary in the type-III.

2.FLABBY RIDGE

DESCRIPTION
Alveolar ridge may become mobile & extremely resilient due to replacement of the bone by the fibrous tissue.

TREATMENT
Surgical correction & relining of the denture base accordingly for readaptation of the tissue surface.

3.TRAUMATIC ULCER
(sore spots)

DESCRIPTION
It develops with 1- days after placement of new denture. They are small, painful lesions covered with a grey necrotic membrane surrounded by inflammatory halo with firm, elevated borders.

ETIOLOGY
over extension of the denture unbalanced occlusion.

TREATMENT
In normal pts, these ulcers heal within few days after correcting the dentures. If treatment is not administered, it may progress to denture irritation hyperplasia.

4.BURNING MOUTH SYNDROMES

ETIOLOGY
local factors systemic factors psychological factors

LOCAL FACTORS
mechanical irritation by ill-fitting dentures prolonged masticatory muscle activity

constant parafunctional movements of the tongue

constant excessive friction on the mucosa

SYSTEMIC FACTORS
vitamin or iron deficiency menopause

xerostomia
diabetes

PSYCHOLOGICAL FACTORS anxiety depression

CLINICAL FEATURES
odoes not show any overt clinical features. oMainly pain starts in the morning & aggrivates during the days. oBurning sensation is usually accompanied with dry mouth & persistent altered taste sensation. oAsso. Symptoms include head ache, insomnia, decreased libido, irritability, depression.

TREATMENT
removal of local factors compensation for systemic deficiency except for menopose. Psychologic counselling

5.RESIDUAL RIDGE RESORPTION

ETIOPATHOGENESIS
Wherever there is pressure, bone resorbs due to activation of osteoclast.

Its a constant sequel after extraction & continues even after inserting the complete denture.

PATTERN OF RESORPTION
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.

RATE OF RRR MANDIBLE

initially=4-5mm

Later=0.1-0.2mm

MAXILLA
Initially=2-3mm,
Later=four times lesser than mandi.

CLINICAL FEATURES
The depth & width of the sulcus is reduced.

Decreased vertical dimension at occlusion.

Reduction of the lower facial height. Increased relative prognathism.

MAXILLAE Resorption is centripetal (toward centre)

MANDIBLE Resorption is centrifugal

(away from centre)

6.DENTURE IRRITATION HYPERPLASIA

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.

7.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 & distolingual part of the mandibular dentures. In such cases it needs the correction.

INDIRECT SEQUELAE

1.ATROPHY OF MASTICATORY MUSCLES

Usually with age biting efficiency decreases with age.

Any part of the body which is out of function goes under atrophy.

2.NUTRITIONAL DEFICIENCIES

As masticatory muscles go under atrophy & also for any person masticatory muscles go under atrophy along with age their nutrition status also goes down.

CONCLUSION
Patients education only on a right time will lead to a successful denture.

If the annoying sequelae of denture wearing are not solved than they will lead to failure of treatment outcome. Patient should be educated & problems complained by them should be solved without FRUSTRATING them.

The denture fabricated even with all the normal criteria may lead to discomfort to the patient.

A WISH:- EVERYONE COULD INSERT FOUR OF THE DENTURES

REFERENCES
ZARB BOLENDER WINKLER

ANY DOUBT..,

THANK YOU