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Dr Haroon Rashid Baloch

Assistant Professor
Department of Prosthodontics
Mouth preparation commonly necessary
Involve elimination of pathology and defects
Creates more favorable anatomical
environment
Conditions may involve the soft tissues and
bone

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Conditions that may involve oral mucosa
include
a) Denture stomatitis
b) Palatal inflammatory hyperplasia
c) Angular stomatitis/ Angular chelitis
d) Shallow sulci
e) Denture induced hyperplasia
f) Prominent freni

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Conditions that may involve the bone
include:
a) Pathology within the bone
b) Sharp and irregular bone
c) Undercut ridges
d) Prominent maxillary tuberosity
e) Presence of Tori

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Soft tissue conditions ..

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Appearance over the surface covered by the
denture may be:
a) Patchy
b) Diffused inflammation
Despite of bad appearance, patient usually does
not complain
Should not be termed denture soreness
Occurs usually in maxillary arch
Does not extend beyond denture coverage area
May occur alone or with:
a) Inflammatory hyperplasia
b) Angular chelitis
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Local factors include:
a) Candida Albicans
b) Bacteria
c) Poor denture hygiene
d) Denture trauma
e) Wearing dentures at night
f) Diet e.g. rich carbohydrate diet more
candida albicans
g) Non-microbial factors e.g. monomer, topical
agents and mouth washes (excessive use)
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Systemic factors include:
a) Immunodeficiency
b) Hormonal disbalance e.g. diabetes
c) Vitamin B deficiency
d) Vitamin C deficiency
e) Iron

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Denture stomatitis is asymptomatic
Should be treated before new dentures are
made because:
a) Swelling of the mucosa
b) Mouth may be a source of candida infection
spread into
1. Nail Beds
2. Pharynx
3. Larynx
(Nikawa et.al. 1998)

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Denture Hygiene Instructions:

a) Motivate the patient Encourage local cleaning


b) Laboratory cleaning when patients cannot clean
the dentures themselves
c) Denture disinfection By immersing the dentures
overnight in:
1. 0.08% hypochlorite solution
2. 0.1% chlorhexidine gluconate

Hypochlorite solution immersion may cause corrosion of


metal denture bases
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Correction of denture faults:

a) Occlusal faults correction by correcting


unbalanced occlusion
b) Impression surface faults by
1. Checking and correcting impression surface
faults
2. Soft reliner (temporary measure)
3. Replacing the denture where necessary
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Leaving dentures out at night:
a) Strongly recommended
b) Successful treatment not possible unless
patient conforms to this
c) The regime reduces:
1. Period of mucosal contact with the denture
2. Reduces intra oral population of candida
3. Provide opportunity for immersion into
disinfectants
4. Reduces the period of mucosal damage

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Systemic Therapy:

If conditions dont resolve in 2-3 weeks,


systemic condition may be present
Refer to a relevant medical practitioner
where appropriate

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Antifungal Agents:

Used topically as lozenges, mouthwashes or


ointments
Following antifungal agents may be used:
a) Nystatin
b) Amphotericin B
c) Fluconazole
d) Itraconazole
e) Miconazole

Rapid relapse if other factors are not controlled/corrected


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Also termed Hyperplastic Denture Stomatitis
Involves palatal mucosa
Bright red multiple elevations
Typical raspberry like appearance
No malignant transformation has been
reported
No cytological signs of dysplasia

(Kaplan et. al, 1998)


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Management of Inflammation:

Measures same for denture stomatitis


Antifungals reduce inflammation but
hyperplasia usually remains
Inflammation should be reduced before any
further management is carried out

(Salonen et.al, 1996)


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Prosthetic & Surgical Management:

Done once inflammation is treated


Pale colored, smaller sized nodules once
inflammation is reduced
Surgery or prosthetic relief may be provided
The decision will depend on:
a) The size of the lesion/nodules
b) The medical condition of the patient
c) The age of the patient
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If surgery not carried out:
a) Acrylic spicules may be polished
b) Acrylic spicules may be removed
c) Use a stainless steel denture
base

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Also known as angular cheilitis
Fissuring at the angles of the mouth
Erythematous, non erosive
Usually bilateral
Frequently painful
Rarely seen except in denture wearers
More common in females
If untreated, may result in permanent
scarring
May be seen with denture stomatitis
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Local:
a) infection
b) inadequate lip support
c) maceration of the skin
d) increased freeway space
Systemic:
a) iron deficiency
b) vitamin B and C deficiency.

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Treatment aimed at:
a) Elimination of local infection
b) Reduction of intraoral micro-organisms

This can be achieved by:


a) Denture hygiene
b) Anti-microbial agents
c) Denture modifications

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Denture hygiene instructions given to the patient
Immersion of denture in denture cleaning agents
Lesion cured in 2 weeks (mostly)

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Broad spectrum anti-biotic may be
administered i.e.
a) Miconazole oral gel
b) Tetracycline/Nystatin agent
Topical steroids not recommended (may
caused perioral dermatitis) may aggravate
the condition
Swab from the angle of lips (to exactly
identify the microbes)
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Freeway space may be decreased
OVD adjusted
Temporarily adjust with wax or self cure to
exactly identify
If problem identified, make new denture
accordingly

If condition not resolved due to measure


described above, systemic involvement should be
suspected and referral may be advised
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Shallow sulci may cause:

a) Compromised retention
b) Instability of dentures
c) Unfavorable load distribution

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May be:
a) Prosthetic
b) Surgical

Prosthetic: Aim at;


a) Correcting the existing denture
b) Obtaining more tissue coverage
c) Denture fabrication in muscular balance
d) Reduction of overloading
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Surgical:
Surgery may be beneficial
Cannot be performed in medically compromised
patients
Surgical procedures that may improve dentures
stability and retention are:
a) Alveolectomy
b) Frenectomy
c) Reduction of undercuts and tuberosities
d) Removal of bony prominences and tori
e) Sulcus deepening
f) Ridge augmentation
g) Dental implants

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Single or multiple flaps
Related to the borders of the denture
Found in 10% of the denture wearers

(Axell 1976; Budtz-Jrgensen 1981)

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Denture over extension is the main cause
Chronic irritation of the tissues
Slow progression of lesion alveolar
resorption denture borders dig into soft
tissues
Patient usually aware at very late stage

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Following sequence should be followed:

a) Elimination of denture trauma


b) Review after two weeks
c) Surgical excision if required

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May be present on buccal and labial side
Notch given in the denture to accommodate
May be difficult to achieve border seal if too
prominent
Surgical excision in extreme cases

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Conditions involving the bone ..

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Pathology within the bone:
a) Sinus
b) Swelling
c) Irregular shape of the ridge
(Seen in 30-40% of the edentulous patients)
Radiographs not to be taken in absence of
signs/symptoms
Panoramic radiography is indicated instead of
full mouth peri-apicals
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Leave unerupted tooth deeply embedded (if
not causing any pathology)
Surgical removal not necessarily indicated
causes loss of alveolar bone
Tooth lying close to the surface should always
be removed

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Bony Spicules:

May be painful for the patient


More common in mandibular arch
Occurs due to
a) Insufficient care during extraction procedures
b) Failure to compress the socket adequately
after extraction
c) Irregular bone resorption due to previous
periodontal treatment
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Temporary or permanent soft-reliner
Reliners usually dont work leads to
surgical correction
Conservative approach of bone removal is
recommended

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Mylohyoid Ridges & Genial Tubercles:

These become prominent after tooth loss


Projections become more prominent with
increasing age
Cause discomfort if denture is lying over

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1) Prosthetic Treatment:
a) Correction of denture design faults
b) Providing relief over the impression surface
c) Smoothening of the denture surface
d) Placing a soft-reliner

2) Surgical Treatment:
a) Surgical removal if prosthetic treatment fails
b) Always try a conservative approach
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Prominent Maxillary Tuberosities:
These may consist of fibrous tissue or
bone
May be very large in extreme cases
Complete extension of denture base
becomes difficult results in
compromised retention and support.

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a) Re-assessment of OVD:
If patient adapts increased OVD increased
inter-alveolar space may be given denture
fully extended
b) Accept under extension:
Successful if ridges are well developed
c) Use thin denture bases:
Use thin metal denture base in the area of
tuberosities
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Tori can be:
a) Maxillary
b) Mandibular

Developmental bony prominences


May adversely affect denture function

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Treatment:

a) Palatal relief over torus area


b) Relief over mandibular tori where possible
c) Large tori should be surgically removed

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any questions

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