SND

CHITS -
Case 2
DDS3 Group 35: Sydney Shacklock, Simranpreet
Chohan, Yunxu He, Shile Ye, Kah Wee Chong, Roshine
Linus & Kunal Mehta

1
https://blog.dentalsky.com/the-importance-of-maintaining-
dental-equipment/
BACKGROUND

● 59 year old male

● Resides in supported accommodation
● Relies on primary carer

https://www.chartercollege.edu/news-hub/what-are-most-common-tools-dental-assistants-use

2
MEDICAL HISTORY
● Hypertension
● Hearing Difficulties
● Mild Intellectual Disability
● Depressive Anxiety Disorder
● Walking Difficulties

3
 Hypertension
Chronically elevated arterial blood pressure (BP).

High blood pressure = ≥140/90 mmHg

● Stage 1: Systolic BP ≥ 130mmHg and or/ diastolic BP ≥
80mmHg
● Stage 2: Systolic BP≥ 140mmHg and/or diastolic BP ≥ 90mmHg

Two main types:

● Primary: idiopathic (~95%)
● Secondary: as a result of other medical conditions (e.g. cushing’s
syndrome)
https://www.google.com/url?sa=i&url=https%3A%2F%2Fwww.mayoclinic.org%2Fdiseases-conditions%2Fhigh-blood-pressure%2Fdiagnosis-treatment%2Fdrc-20373417&psig=AOvVaw3SASND-
emhMFAWKWJYvqQW&ust=1620902552927000&source=images&cd=vfe&ved=0CAMQjB1qFwoTCNDQjuH6w_ACFQAAAAAdAAAAABAP

Prevalence:
● 10.6% of Aus population
● Increases with age: 42% of over 75 yr olds

4
Hypertension
Dental Implications:
Case 2 Relevance:
● In well controlled patients, no risks associated with dental
treatment.
● Patient is not administering
nonselective beta blocker or calcium
● Local Anaesthetic containing adrenaline can be used with little channel blocker.
risk:
○ Individuals with nonselective beta blocker, use adrenaline
cautiously (max 2 cartridges of 1:100,000) ● Confirm last BP reading

● Gingival hyperplasia common in individuals administering ● Confirm if the patient has had previous
calcium channel blockers
dental anxiety episodes.
● Elective dental treatment should be deferred in patients with BP
≥180/110mmHg (uncontrolled)

5
Hearing Difficulties
● Partial or complete loss of hearing in one or both ears
● Can be attributed to damage to the nerve or inner ear.
● Often associated with:
○ Age
○ Hypotension
○ Infection
○ Blockage e.g. ear wax
○ Long term exposure to loud noises
○ Intellectual Disabilities
● Prevalence:
○ Australian population-based study, 33% of participants aged ≥ 49
years had hearing loss.
http://www.clipartpanda.com/categories/ear-clip-art-free

6
 Hearing Difficulties Case 2 Relevance:

Dental Implications: ● At the start of the appointment, ensure

● Poor oral health and pronounced gingival in­flammation are common in adults hearing aids (if any) are adjusted so clinician
with hearing impairments, raising their risk for caries and periodontitis. can be heard.
● May need to repeat instructions
● Barrier to communication between patient and clinician ● Utilise simple gestures and lower mask to
allow lip reading
● Makes treatment difficult and longer e.g. asking patients to turn left/right ● Although patient has a carer to explain
instructions, still makes treatment difficult
(e.g. asking patient to open/close, turn
left/right)

7
http://www.clipartpanda.com/categories/ear-clip-art-free
Walking Difficulties
Case 2 Relevance
● Gait disorders are a predictor of functional decline, especially ● Single point walking stick less
in older patients. stable than tripod design
● Abnormal gaits can be painful and often multifactorial; some ○ More postural steadiness,
causes can be due to: ● Potential fall risk?
○ Impaired joint mobility ● Walking with single tip cane most
○ Muscle weakness efficient but least stable
○ Spasticity
○ Sensory/balance deficits
○ Impaired central processing
● A detailed history and associated experienced symptoms can
assist in understanding the extent of walking difficulty.

https://www.healthline.com/health/unsteady-gait

8
 Walking Difficulties
“Guidelines for Oral Health Care for People with a Physical Case 2 Relevance
Disability” (2000): ● Improve negative attitude to
● Pt’s with physical disabilities have lower dental attendance patient’s medical carer
primarily due to stairs or other physical barriers within building ● Design office in a way that
● Encourage higher frequency of dental visits by : minimizes physical barriers to
○ Parking spaces close to building entry
○ Sign posts for patients with sensory impairment
○ Use of ramps over steps
○ Surgery layout providing space for wheelchair
○ Unisex disabled toilet facilities

https://www.healthline.com/health/unsteady-gait

9
 Intellectual Disability Case 2 Relevance
● Communication barriers need to
be addressed
● An umbrella term describing disorders that:
○ Tell, show, do
○ Are usually present at birth - onset prior to age of 18
○ Negatively affect ○ Visual methods
■ intellectual functioning (learning, problem solving, ● Communication with support
decision-making) professionals & family members
■ adaptive functioning (every day social and
communication skills)
● Further information required regarding associated conditions
○ Down’s Syndrome
○ Cerebral palsy

https://www.netclipart.com/isee/ioxbxmT_gear-animated-film-brain-
clip-art-gear-template/

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Intellectual Disability
● Despite improvements in oral care provision, people with
intellectual disabilities showed poorer oral hygiene & plaque
control
● Compared to general population, patients with intellectual
disabilities have:
○ Higher periodontitis rates leading to extractions
○ Higher prevalence of caries & restorations
○ Higher rates of edentulism
○ Lower expressed need for dental prosthetics
○ Lower usage of prescribed dentures

https://www.netclipart.com/isee/ioxbxmT_gear-animated-film-brain-
clip-art-gear-template/

11
 Depressive Anxiety Disorder Case 2 Relevance:

● Remaining teeth in disrepair due to

neglect
● Depression
○ Group of psychological disorders characterized ● Medication - fluoxetine related
○ Xerostomia
by depressed mood and lost of interest or pleasure ○ Bruxism - contribute towards wear
○ Accompanied by:
■ Weight loss
■ Fatigue
■ Insomnia
■ Diminished ability to concentrate

Behavioural changes that lead to adverse oral health outcomes

https://www.psycom.net/depression.central.anxiety.html

12
 Depressive Anxiety Disorder
Review article by Cademartori et al. (2018):
● Depression is associated with higher rates of dental caries,
tooth loss & edentulism
● Mixed results about depression & periodontal disease
● Biological components of depression: reduction on salivary
flow, dry mouth, downregulation of immune system
● Yamamato et al. study showed adverse oral health outcomes
& mental disorders reinforce each other
Case 2 Relevance:
● Patient has depressive anxiety disorder,
coupled with edentulism on maxillary
arch, several restorations & RCT
● However, patient has a carer who may
not be affected by depression
● Considering impact of depression on
cognition, clinicians must have patience
and emphasize well structured messages
to carer about importance of oral hygiene
& undergoing regular dental checkups
13
 Depressive Anxiety Disorder Case 2 Relevance:

● Anxiety: ● Possible dental phobia

○ Need to address through gradual
○ Excessive worry and fear associated with a internal,
desensitization to dental
real or imagined threat that persists over 6 months environment
○ Associated behavioural disturbances
○ Accompanied by
■ Restlessness
■ Being easily fatigued
■ Sleep disturbance
■ Irritability

https://www.ihealthcareanalyst.com/global-anxiety-
disorders-depression-treatment-market/

14
 Hip Replacement

Image taken from orthoinfo.aaos.org - American Association of

Orthopaedic Surgeons

15
 Hip Replacement
Dental Implication Case 2 Relevance
● Routine/non emergency dental treatment should be delayed for 3-6
● Confirm if hip replacement due
months following prosthetic joint replacement
○ Use of anticoagulants - DVT prophylaxis to osteoarthritis or fall induced
● fracture - fall risk assessment
Use of antibiotic prophylaxis following THA is controversial
form
○ “neither the indication for prophylaxis nor the choice of
antibiotics regimen is altered by the presence of a joint
prosthesis” [2]
○ Recommended by Australian orthopaedic surgeons to prevent
bacteraemia and subsequent infection
● Bisphosphonates?
○ Bisphosphonates can reduce periprosthetic bone loss
○ Consult orthopaedic surgeon

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MEDICATIONS
● Fluoxetine
● Telmisartan
● Risperdal
● Valium

17
 http://clipart-library.com/medicine-cliparts.html

Fluoxetine (Antidepressant)

MEDICATIONS
Drug Class Indications Possible Side Possible Drug
& Dose Effects Interactions
Selective serotonin Major depression and ● Xerostomia, ● Drugs affecting platelet function (e.g.
reuptake obsessive compulsive ● Dysphagia NSAIDS, aspirin)
inhibitor (SSRIs) disorder ● Anxiety ● NSAIDS: Gastrointestinal bleeding.
● Insomnia ● Serotonergics e.g. SNRIs, SSRIs,
20mg/morning ● Fatigue tramadol, triptans
● Urinary infrequency ● Benzodiazepines (diazepam)
● ecchymosis ● QT prolonging drugs (macrolides)
● bruxism

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 http://clipart-library.com/medicine-cliparts.html

Telmisartan (Antihypertensive)

MEDICATIONS
Drug Class & Indications Possible Side Possible Drug
Dose Effects Interactions
Angiotensin 2 receptor Hypertension ● sinusitis ● corticosteroids
antagonist ● hyperkalaemia ● penicillin G Na
Prevention of mortality in ● bronchitis ● alcohol
40mg/morning patients >55 years ● sepsis ● NSAIDS
peripheral artery disease, ● back pain ● COX-2 inhibitors
stroke, diabetes with ● anxiety ● pressor amines e.g.
evidence of end organ ● hypersensitivity noreadrenaline
damage ● infections ● ACE inhibitors/ARN + anti-
● dry mouth inflammatory + thiazide

19
 http://clipart-library.com/medicine-cliparts.html

Risperdal (Atypical antipsychotic)

MEDICATIONS
Drug Class Indications Possible Side Effects Possible Drug
& Dose Interactions
Selective monoamine mental/mood disorders ● Dysphagia ● opioids
antagonist ● increased diabetic risk and heart ● fluoxetine
acute mania disease ● telmisartan
1mg/night ● infection ● macrolides
agitated patients with ● dry mouth ● benzodiazepines
dementia ● parkinsonism ● tramadol
● dizziness ● CYP3A4/P-gp
● tremor inhibitors
● photophobia ● drugs prolonging QT
● oedema
● drooling
● gait disturbances
● xerostomia

20
 http://clipart-library.com/medicine-cliparts.html

Valium (anti-anxiety drug)

MEDICATIONS
Drug Indications Possible Side Possible Drug
Class & Effects Interactions
Dose
Benzodiazepine Anxiety disorders or short term relief ● CNS disturbance ● CNS depressants (e.g.
of anxiety symptoms including impaired alcohol)
5mg/night alertness ● Azole antifungals
acute alcohol withdrawal ● fatigue ● Clarithromycin,
● drowsiness erythromycin, rifampicin
muscle spasm due to local trauma ● rebound anxiety ● Antacids e.g. omeprazole,
● dizziness esomeprazole, cimetidine
spasticity due to upper motor neuron ● tremor ● NSAIDS e.g. Ibuprofen
lesions e.g. cerebral palsy, paraplegia ● respiratory depression

21
FAMILY & SOCIAL
HISTORY
● Lives in supported accommodation
● Attends a day program
● Relies on carer for support with
ADLs (e.g. oral hygiene)
● Sister has medical Power of Attorney
● Full liquid Diet

22
 ● Under NDIS (National Disabilities Insurance Scheme), there is specialised
housing (shared supported accommodation or community residents) and
supported services

○ Supported Residential Services (SRS)

Supported ○ Supported Independent Living (SIL/ shared accommodation):

Accommodation ● Eley et al. (2009) found the prevalence of adults with ID in regional Australia
living in medium-sized residential facilities to be 15% (56% lived at home)
type of housing that provides higher
level care and support for people ● Positive impacts for living in supported accommodation and adult day programs
with particular needs include gaining independence, socialising and interacting with the community

https://www.nadrasca.com.au/older-adult-day-programs

23
 ● Carers help and support individuals that require assistance with activities of
daily living (ADLs)
○ Often responsible for dental related activities e.g. oral hygiene & dental
appointments.
○ Clinicians should provide written and verbal instructions to carers.

● Carers may not realize the importance of OH, particularly for people who are
Carers & OH edentulous or have few standing teeth
○ Reasons oral care may be omitted include: uncooperation, lack of
time/staff/equipment, forgetting, difficulty (e.g. flossing)

https://www.youtube.com/watch?v=vc4hG_8t9nA ● Lack of understanding of why we do oral care leads to people with ID not
accepting and cooperating with daily care

24
 ● Indications: difficulties swallowing or chewing, digestive system is in
distress, test or imaging procedures before certain medical procedures and
surgeries

● Foods: clear fluids, milk, fruit and vegetable juice, shakes, smoothies etc.

● Benefits: reduce risk of choking or aspiration, prevents food particles from

getting stuck in open wounds and extraction sites in the mouth, after surgery it
Full Liquid Diet can prevent complications and bowel obstructive

● Disadvantages: difficulties to get enough nutrients and calories each day

○ More than 3 standard meals a day, 6-8x throughout the day with a variety
https://www.couponraja.in/theroyale/how-to-lose-weight-with-
liquid-diets/
of liquids
○ Increase caloric intake by incorporating full fat dairy (butter and milk)

25
 ● Power of Attorney
- Can be a guardian who has the power to make medical treatment
Power of decisions on behalf of a person

Attorney & ● Legally incompetent patients for informed consent

- Impaired decision making processes
- Unable to consent for themselves
Informed - Will have a guardian appointed for them

Consent ● The primary carer of the person is able to make medical decision if the
guardian cannot be seeked

https://www.pinterest.com.au/pin/759982505849
26
845650/
DENTAL HISTORY
● Reason for presenting
● Past dental history
● Addition questions to ask patient

27
 Dental History
Additional Information Required
Reasons For ● “Pain and discomfort in ● Site: clarify if its mandibular/Maxillary
anterior region” ● Onset
Presenting ● Characteristics e.g. dull, sharp
● Does the pain radiate?
● How long it lasts?
● Exacerbating/alleviating factors
● Is it nocturnal?
● Severity of pain, scale 1-10

Past Dental ● “Neglected oral heal, full ● OH habits i.e. brushing & interdental brushes
liquid diet” ● Frequency of dental visits
Experience ● Living details (fluoridated water exposure)
● Reason for missing teeth (periodontal
disease/caries?)

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CURRENT DENTAL
STATUS
● Extraoral
● Intraoral
● OPG

29
 Dry lips Thin lip line

Intradermal naevus

Extra Oral

Bilateral angular cheilitis

30
Clinical features:
● Painful Erythema and fissuring of the corners of the
mouth

Aetiological factors
● Oral candidiasis
● Deep skin folds around the mouth Angular
● Ass. to Iron, folate or Vitamin B12 deficiency
● Drooling due to poor lip seal/medication. Cheilitis
Treatment
First line:
● Remove predisposing factors and barrier cream/ CHX
Symptom persist:
● OM specialist referral

31
Intra Oral

● Mouth breather
● Teeth 35 & 43 class III mobility
● Generalised bone atrophy
● Coated tongue
32
 Haziness - Maxillary
Edentulous sinuses
maxillary arch

OPG

Resorbed
Resorbed
ridges Q4 35-43 ridges Q3
33
 Potential frank
33 cavitation
32 restoration restoration

OPG

RCT

Apical
RCT radiolucency,
suggesting
pathosis
Apical radiolucency,
suggesting pathosis 34
● Teeth present: 35-43

● Potential frank cavitation 34 & 35.

● Potential periapical radiolucency: 35, 42 & 43

Dental Findings
● Restorations: 32 and 33 (determine clinically)

● Root Canal Treated (RCT): 34 & 42

35
 SPECIAL
INVESTIGATIONS
● Pulp (CO2) and Percussion (TTP) Testing
● Periodontal Charting
● Saliva Testing
● Plaque Index
● Diet Analysis
● Periapical Radiographs

36
 1.Palpation
Gingival sensitivity
Test all teeth
5.Diet Analysis
High sugar diet?

2.Percussion

6.Plaque Index
Periapical tissues
Test all teeth Special
Plaque stagnation
areas
3.Pulp Test (CO2,
Investigatio
EPT)

7.Saliva Test
Assess pulpal
sensibility
On all teeth not
ns
Salivary deficiency
endodontically treated

8.Periapical 4.Periodontal Chart

Radiographs Pocket depths and
Apical pathosis recession
BOP
Mobility
Furcation involvement
Test all teeth
37
DISEASE RISK
ASSESSMENTS
● Periodontal disease risk assessment
● Caries risk assessment

38
PRELIMINARY CARIES RISK
ASSESSMENT- HIGH CARIES RISK
RISK FURTHER INFORMATION FOR
FACTORS DEFINITIVE RISK ASSESSMENT
● Neglected oral health and poor oral hygiene ● Clinical examination (visual/tactile)

● Medications inducing dry mouth ● Saliva test

● Previous restorations, root canal ● Dietary analysis

treatments and periapical pathosis
● Fluoride history
● Potential active carious lesions
● Plaque index
● Potential exposed root surfaces

● Mouth breather - potential lower pH of

saliva

39
PERIODONTAL RISK ASSESSMENT-
HIGH RISK
● Bone loss present at all remaining teeth → Generalised

● Radiographic bone loss involving middle or apical third of the root; 42 most
severe ~60%; Less than 20 remaining teeth → Stage IV

● Rate of existing bone loss = %bone loss/age = 60/59 = >1 → Grade C

● Highlights future risk of periodontitis progression and patient may not

respond to periodontal therapy, high periodontal risk.

PROVISIONAL DX: GENERALISED STAGE IV GRADE C

PERIODONTITIS
40
PERIODONTAL RISK ASSESSMENT-
HIGH RISK
RISK FURTHER INFORMATION FOR
FACTORS DEFINITIVE RISK ASSESSMENT
● Neglected oral health and poor oral hygiene ● Full mouth survey of periapical radiographs
to determine radiographic bone loss
● Possible history of tooth loss due to
periodontitis (reason for missing teeth is ● Full periodontal charting
unknown)
● Plaque index & assessment of OH
● Potential genetic predisposition
● Familial history with periodontitis
● Unsatisfactory restorations (resulting in
increased plaque stagnation)

41
PROVISIONAL
DIAGNOSIS
● Caries
● Angular cheilitis
● Generalised, stage IV, grade C
periodontitis
● Apical pathosis? Apical periodontitis
or Perio-endo lesion
● Anterior pain

42
Provisional Diagnosis Risk/Aetiological Factors
● Caries ● Plaque accumulation, poor OH
● Poor diet (increased sugar
consumption with little
protection factors)
● Decreased quality/quantity of
saliva
● Medications- hyposalivation
● Mild intellectual disability-
disease knowledge & OHI
difficult
● Carer compliance to OHI

43
Provisional Diagnosis Risk/Aetiological Factors
● Caries
● Infection
● Angular cheilitis ● Loss of facial vertical
dimension due to lost teeth/ill-
fitting dentures
● Oro-facial granulomatosis
● Down Syndrome
● Medications
● Contact dermatitis

44
Provisional Diagnosis Risk/Aetiological Factors
● Caries
● Plaque accumulation, poor OH
● Angular cheilitis
● Mild intellectual disability-
● Generalised, stage 4, disease knowledge of
grade C Periodontitis Periodontitis and disease
specific OHI
● Smoking/Diabete
● Familial history of periodontitis
● Host Susceptibility

45
Provisional Diagnosis
● Caries
● Angular cheilitis
● Generalised, stage 4, grade C
Periodontitis
● Apical pathosis shown
radiographically (42,
43 & 35)
Risk/Aetiological Factors
● Apical periodontitis
○ Caries
○ Reduced marginal bone
level
○ presence/quality of coronal
restorations
○ Presence of root fillings
● Combined perio-endo lesion
○ Plaque accumulation
○ Unsatisfactory endo
treatment or restoration
○ Trauma
○ Resorption
46
Provisional Diagnosis
● Caries
● Angular cheilitis
● Generalised, stage 4, grade C
Periodontitis
● Apical pathosis shown
radiographically (42, 43 & 35)
● Anterior pain
Risk/Aetiological Factors
● Dentine hypersensitivity
● Gingival trauma
● Sinusitis
● Apical periodontitis
● Lesions on labial commissures
from Angular Cheilitis
47
PROVISIONAL PROGNOSIS
Individual Teeth Prognosis Full Mouth Prognosis
● 35 HOPELESS ● 8 teeth remaining
● 34 COMPROMISED ○ 2 teeth Fair
● 33 FAIR ○ 1 tooth Questionable
● 32 FAIR ○ 2 teeth Hopeless
● 31 N/A ○ 2 can’t be given a
● 41 N/A
prognosis
● 42 QUESTIONABLE
● 43 HOPELESS

https://www.shutterstock.com/video/clip-1009579913-cartoon-
gums-white-teeth-wearing-braces-new 48
TREATMENT
PLANNING
● Proposed treatment plan
● Ideal treatment plan
● Compromised treatment plan

49
MANAGEMENT CONSIDERATIONS
● Patient is in pain
● Communication barrier - how can it be improved?
● Assisted living
● Patients awaiting hip replacement surgery
● Comfort in dental chair https://www.smiletimedental.com.au/services/denture-dentist-

●
north-brisbane/

Denture wearing for those with IDs

● Mobility class 3 teeth presents a choking hazard, therefore should be extracted.
● Multidisciplinary healthcare approach

50
IDEAL TREATMENT PLAN
(Assuming the patient and carer are compliant & attends all dental appointments)

Emergency/Preliminary Phase

● Extract teeth with hopeless prognosis (35, 34 & 43)

● Fabrication of immediate mandibular and maxillary denture, denture care
● Remove predisposing factors of angular cheilitis and monitor OR if first line treatment failed Refer to OM

Short-term

Preventative and periodontal treatment

● Monitor Angular Cheilitis. Oral medicine/ Special need dentistry specialist referral if persistent.
● Saliva counselling to improve acrylic denture retention
● Carer education on denture care, OHI, diet counselling
● S/C of remaining teeth

Long-term

Advanced management
● Fabrication of upper full and lower partial acrylic dentures.
Recall and maintenance
● 3 monthly recall

51
Compromised Treatment Plan
If patient is non-compliant, consider if palliative options are more appropriate (e.g. prevention of pain & infection)

Emergency/Preliminary Phase
● Extract all teeth
● Remove predisposing factors of angular cheilitis and monitor OR if first line treatment failed Refer to OM

Short Term
Preventative and periodontal treatment:
● Educate patient and carer on OHI and diet counselling
● Monitor angular cheilitis. Oral medicine/Special Needs dentistry specialist referral if persistent

Restorative treatment: NA

Long Term
Recall & maintenance:
● 3 monthly recall
○ Assess soft tissues for trauma
○ Assess OHI

52
TREATMENT PLAN
CONSIDERATIONS Ideal Plan Compromised Plan

- Can reintroduce normal diet
- Relieves patient of pain and
discomfort
Advantages - Conservative approach
- Aesthetics restored
- VDO increased
- No dentures allows: better plaque control &
less soft tissue trauma
- More comfortable without denture since
patient has dry-mouth
- Less maintenance for carer
- Relieves patient of pain and discomfort
- Fewer appointments

- Compliance is key - requires a lot - Full liquid diet persists

of work - Unaesthetic: may affect confidence
- Denture stomatitis - Further decrease in VDO
Disadvantages - Multiple appointments required

53
TREATMENT PLAN
CONSIDERATIONS
DENTURE AS AN OPTION: Immediate denture vs. conventional denture
- Immediate denture helps with socket healing after
Advantages: extraction
- Restores VDO and may help resolve - Conventional denture has better fit
angular cheilitis
- Allows masticatory function and Partial denture vs. complete denture
reintroduction of solid food - Partial denture has more retentive features
- Complete denture prevents further complications
Disadvantages: with the remaining teeth
- Risk of further mucosal infection
- Choking risk
- Retention issues with reduced alveolar
ridge
- Compliance & adherence

https://www.pngitem.com/middle/TiiTxmh_smiling-
denture-tongue-position-front-hd-png-download/ 54
SUMMARY OF PROBLEMS &
RECOMMENDATIONS
Future recommendations:
Problems: ● Ensure accessible dental practice and patient comfort at
1. Bilateral angular cheilitis all appointments after hip recovery.
2. Missing teeth (Edentulism): Reduced masticatory
function influencing diet. ● Hearing can deteriorate with time, clinician should
3. Retained roots accommodate and speak louder.
4. Poor Oral hygiene
5. Dry mouth ● If pain persists post-treatment, consider non-odontogenic
6. Tooth mobility cause of pain; referral to Oral Medicine.
7. Periodontal disease
8. Periapical radiolucencies ● If Angular Cheilitis persists even after drug
9. Generalised bone atrophy: Unstable full denture administration, refer to Oral Medicine.
10. Mobility issues: higher fall risk, increasing risk of dental
trauma and dental chair discomfort. ● Emphasise to carer that ongoing dental care required even
after pain resolves.

55
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JPO Journal of Prosthetics and Orthotics. 2018;30(2):84-89.

Cademartori, M.G., Gastal, M.T., Nascimento, G.G. et al. Is depression associated with oral health outcomes in adults and elders? A systematic review and
meta-analysis. Clin Oral Invest 22, 2685–2702 (2018). https://doi.org/10.1007/s00784-018-2611-y

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Chen, E., & Abbott, P. V. (2009). Dental pulp testing: a review. International journal of dentistry, 2009, 365785. https://doi.org/10.1155/2009/365785

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Federico JR, Basehore BM, Zito PM. Angular Cheilitis. [Updated 2020 Sep 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021
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Gopinath, B, Rochtchina, E, Wang, JJ, Schneider, J, Leeder, SR, Mitchell, P. Prevalence of age-related hearing loss in older adults: Blue
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