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sequelae of complete dentures

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by

Sana Aziz

on 13 May 2016

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Transcript of sequelae of complete dentures

Sequelae Caused by Wearing Complete Denture
Traumatic Ulcers
" Small painful lesions covered by a gray necrotic membrane & surrounded by an inflamatory halo with firm elevated borders"
Traumatic Ulcers
They usually occur if pressure areas or overextension of flanges are not identified & relieved or if there are errors in occlusion
occur within days after placement of new dentures
Correction:

Lesion marked intraorally with a thompson color transfer stick, followed by careful insertion of the denture & then relieving the area on denture where the marking has been transferred.
Once corrected the lesion usually heal within few days
If left untreated ,it can lead to
Denture Irritation Hyperplasia.
Introduction
Oral cavity is not a static biologic entity.
Time - dependant changes occur, particularly at the interface between prosthesis and their supporting & surrounding tissues. Long term denture wearing is accompanied by consequences in local morphology plus functional & esthetic changes.
Mucosal Reactions

Oral Galvanic Currents

Altered Taste Perception

Burning Mouth Syndrome

Gagging

Residual Ridge Reduction

Periodontal Disease

Caries
Direct Sequelae
Indirect Sequelae
Interaction of Prosthetic Material & Oral Environment
Surface Properties:
Chemical stability
Adhesiveness
Texture
Microporosities
Hardness
Chemical Properties:
Corrosion
Toxic reactions
Allergic reactions
Physical Properties:
Mechanical irritation
Plaque accumulation
Cheek Biting
may be due to posterior denture teeth being in violation of the neutral zone concept.
commonly corrected by selective recontouring of the prosthetic teeth or even having to reset them.
Denture Irritation Hyperplasia
"Mucosal hyperplasia that develops slowly from chronic low grade trauma, typically inducted by unstable dentures or an overextended denture flange"
Denture Irritation Hyperplasia
It is also known as
Epulis Fissuratum
.
Patients who wear ill fitting dentures for a prolonged period of time may develop this condition.
The fibrous tissue formed in such a case is usually inflammatory yet asymptomatic.
It is in the form of folds that proliferate over the denture flange.
Single or multiple lesions of variable sizes are usually observed.
Site: anterior regions of either the maxilla or mandible.
more common in Men.

Treatment Therapy:
Adjustment/ Replacement of ill fitting dentures
Surgical excision of Hyperplastic tissue.
Denture Irritation Hyperplasia
Denture Stomatitis

" A common condition where mild inflammation and redness of the oral mucous membrane occurs beneath a denture"
It is also known as:
Denture Sore Mouth
Chronic Atrophic Candidiasis
Candida-associated Denture Induced Stomatitis
Denture-associated Erythematous Stomatitis
Classification Of Denture Stomatitis
It is based on the extent & severity of a diagnosed stomatitis.

Type I :
a localized inflammation or pinpoint hyperemia

Type II:
a more generalized erythmatous area involving either a portion of or the entire surface of denture covered mucosa.

Type III:
a composite of types I & II in addition to a granular, inflammatory hyperplasia usually involving the midline of hard palate & the alveolar ridges.
Candida-Associated Denture Stomatitis
most prevalent & clinically important lesion of denture wearers.
high prevalance in maxillary rather than mandibular dentures.
Clinical Apperance:

Erythematous soft tissues with areas of mild edema sharply localized to areas where the denture contacts the gum rigde.
Diagnosis:

confirmed by the finding of "Mycelia" or "Pseudohyphae" in a direct smear or the isolation of "Candida Species" in high numbers from the lesions.
Factors Predisposing to Candida-Associated Denture Stomatitis
Management of Candida-Associated Denture Stomatitis

Remove the dentures after each meal & wash them gently but vigorously with soap & rinse with water before reinserting them.

The mucosa in contact with the denture should be kept clean & massaged with a soft toothbrush.

Dont use dentures at night.

Rough areas on the fitting surface should be smoothed or relined with a soft tissue conditioner.

Approx 1mm of the acrylic surface of denture should be removed & relined frequently.

A new denture should be provided only if the mucosa has healed & the patient is able to achieve good denture hygiene.
Preventive Measures:
Treatment of Candida-Associated Denture Stomatitis
Drug Therapy
(for Type I & II)
Local :
It includes topical application of any of the following antifungal agents:
Nystatin
Amphotericin B
Miconazole
Clotrimazole

Systemic :
It includes the use of Ketoconazole or Fluconazole.
To prevent the risk of Relapse:
Treatment with antifungals should continue for no more than 4 weeks.
If antifungals are in the form of lozenges, dentures should be removed when lozenges are in mouth.
Dentures should be worn as little as possible
keep them dry or in a disinfectant soltion of 0.2% to 2% clorhexidine at night.
Surgical Management
In case of Type III denture stomatitis, surgical elimination of deep crypts formations may be necessary for effective mucosal hygiene.
This is prefferably done by cryosurgery.

Atrophy of masticatory muscles

Complaints of xerostomia

Chewing difficulties

Increased numbers of chewing cycles before swallowing

Loss of apetite

Reduced serum Albumin levels

Reduced body mass index

Reduced skinfold thickness
By Dr. Sana Aziz
Kelly's Syndrome
An upper complete denture & only anterior mandibular teeth remaining.
Bone resorption of Premaxilla
Hypertrophy or downward growth of maxillary tuberosities
Papillary hyperplasia of hard palate
Extrusion of mandibular anterior teeth in a labio incisal direction
Posterior bone loss in the mandible under a Kennedy class I removable partial denture.
Loss of vertical dimension of occlusion
Altered facial esthetics giving rise to a "witch's chin"
Features:
Excessive growth of fibrous tissue where there would otherwise be bone is due to :
excessive occlusal loading on the residual maxillary ridge.
unstable occlusal reationship elsewhere in oral cavity.
Cause:
Management:

Surgical intervention may be required in such cases in order to improve the stability of maxillary denture and to minimize alveolar ridge resorption
Residual Ridge Reduction
It is a sequence of alveolar remodeling due to altered functional bone stimulus. It follows a chronic progressive & irreversible course that often results in severe impairment of prosthetic restoration and oral function.
Buccal and labial parts of maxilla & lingual parts of mandible are the areas with thin cortical bone.
During first year after extractions ,reduction in mid-saggital plane is about 2-3mm for maxilla & 4-5mm for mandible.

In mandible,annual rate of reduction in height is about 0.1mm to 0.2mm, which is four times less in edentulous maxilla.

The pathogenesis of residual ridge resorption is not well understood.
Etiologial Factors of Residual Ridge Reduction
Anatomical factors:
More important in mandible versus the maxilla
Short & square face associated with elevated masticatory forces
Alveoloplasty
Prosthodontic treatment:
Intensive denture wearing
Unstable occlusal conditions
Metabolic factors:
Osteoporosis
Calcium & Vit D supplements for possible bone preservation
Consequences:
apparant loss of sulcus width & depth
displacement of muscle attachmnts closer to crest of residual ridge
loss of VDO
reduction of lower face height
an anterior rotation of mandible
an increase in relative prognathic appearance
sharp spiny and uneven residual ridges
new location of mental foramen close to top of residual ridge.
Treatment:
permanant soft liners
temporary soft liners
preprosthetic surgical treatments like vestibuloplasties
Osseointegration techniques & bone augmentation.
Conclusion
The time- dependant changes that occur at the interface between prosthesis & their supporting
& surrounding tissues must be examined during patient's regular dental visits. Applied strategies to minimize the risk of such changes need to be followed in order to prolong optimal use of dental prosthesis.
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