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Denture Pain: Infection

Denture Pain: Infection. Poor denture hygiene Localized (lack of tissue contact) Generalized. Denture Pain: Infection: Localized. Porous denture surface Palatal relief chamber Voids from chairside relines If denture cleanser not rinsed, also get inflammation.

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Denture Pain: Infection

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  1. Denture Pain:Infection • Poor denture hygiene • Localized (lack of tissue contact) • Generalized

  2. Denture Pain:Infection: Localized • Porous denture surface • Palatal relief chamber • Voids from chairside relines • If denture cleanser not rinsed, also get inflammation

  3. Denture Pain:Infection: Generalized • Patient debilitated • diabetes, leukemia, AIDS, etc. • Drugs • chemotherapy, steroids, antibiotics • Poor nutrition • Xerostomia • drug/radiation induced • systemic condition (Sjogren’s)

  4. Denture Pain:Infection: Generalized • Denture Stomatitis(Denture Sore Mouth) • Usually Candida albicans • Bright red, often no white plaques • Usually maxilla • Generalized pain

  5. Denture StomatitisTreatment 1. Remove source of infection • Tissue rest • Remove surface acrylic, soft reline • Reline frequently • Clean with: • 2% Sodium Hypochlorite

  6. Candidal Infections • Remove gross calculus or debris (scalers, lathe wheel) • Clean denture in ultrasonic • Soak in sodium hypochlorite redness disappears

  7. Denture StomatitisTreatment 2. Eliminate infection from tissues • Fluconazole 100mg • 200mg on 1st day then 100mg, once a day • minimum of 2 weeks to prevent relapse • Topical Nystatin ointment (less effective) • Nyaderm (15, 30 g tubes , 454g jar) • Apply 1-4 x per day • Oral suspension • Nyaderm (24, 48 ml bottle)

  8. Denture StomatitisTreatment • Sometimes very persistant • May need to change drug • May need to use systemic medication

  9. Denture Pain:Infection: Generalized Before Medicating: • Improve hygiene • Consult: present medications • Address nutrition

  10. Drug Induced Xerostomia • Antiarrhythmics, Anticonvulsants, Antidepressants, Antihistamines, Diuretics, Hypotensives, Muscle Relaxants, Narcotics and others • Health history is important

  11. Importance of Saliva • Retention • Lubrication • Removal of debris • Anti-bacterial, -fungal, -viral • Taste & digestion

  12. Burning Mouth Syndrome • Burning mouth (palate) • Burning tongue, lips • No clear cut cause • No uniformly successful tx

  13. Denture PainCD & RPD • Occlusion • Denturebase (fit & contour) • Vertical dimension • Infection • Systemic disease/condition • Allergy (rare)

  14. Systemic Disease or Condition Comfort/Retention Diabetes, Ectodermal Dysplasia, Sjogren’s Syndrome, Neoplasm, Vesiculo-Bullous Diseases, STD,etc. Coordination Stroke, Muscle or Neurologic Disorders

  15. Denture PainCD & RPD • Occlusion • Denturebase (fit & contour) • Vertical dimension • Infection • Systemic disease/condition • Allergy(rare)

  16. Denture Base Allergies • Extremely rare • Generalized reaction, wherever base touches tissues • Usually reaction to free monomer leaching out • Patch test, as last resort

  17. Denture Base Allergies • Use porcelain teeth • Other material for base • Triad - Urethane dimethacrylate • Non-Nickel containing framework alloy

  18. Denture LoosenessCD & RPD • Occlusion • Denture base (fit & contour) • Poor anatomy

  19. Denture LoosenessCD & RPD: Occlusion Typical History Adequate retention initially Gets worse with time Clinically: No discomfort when press firmly on 1st molars

  20. Denture LoosenessCD & RPD: Occlusion Perpetually Loose Maxillary Denture • Heavy anterior interferences can cause loosening at posterior • Tuberosity mucosa grows into space • Space develops under midline of denture base

  21. Denture LoosenessCD & RPD: Occlusion Tuberosity Tilting Growth Loss of retention

  22. Lip Inclined Residual Ridge Denture LoosenessCD & RPD: Occlusion • Incisors placed too far labially • Denture displaces lingually. • Inclined ridge provides no resistance.

  23. Denture LoosenessCD & RPD: Occlusion Tilting/jiggling caused by: • Contacts not centered over ridge • Contacts on inclined portion of ridge

  24. Denture LoosenessCD & RPD: Occlusion Check for looseness in excursions with fingers on canines

  25. Denture LoosenessCD & RPD: Occlusion • Check centric position (articulating paper) • even, stable contacts both sides • stop patient upon initial contact

  26. Denture LoosenessCD & RPD • Occlusion • Denture base (fit & contour) • Poor anatomy

  27. Denture LoosenessCD & RPD: Denture Base Typical History Loose/discomfort immediately on insertion Clinically: Discomfort when press firmly on 1st molars Pressure up/outward from lingual of canine causes looseness

  28. Denture LoosenessMandibular lingual flange too thick “Eyes in Your Fingers” Blanchard, JPD 2:36 Tongue Flange bulges into tongue space, lifts denture during function. Flange is not too long.

  29. Denture LoosenessCD & RPD: Denture Base Short flange • PIP streaks • Looks short of vestibule • Often displaces easily

  30. Denture LoosenessCD & RPD: Denture Base Long flange • PIP burnthrough • Retentive until speaking, eating • Watch when seating denture • Flange touches vestibular depth, denture continues to seat

  31. Denture LoosenessCD & RPD: Denture Base • If flange too thick • Seal may be maintained at rest • Pulls during function - drops • If flange is short or long • Displacement as lips or cheeks move • Allows air to break vestibular seal

  32. Denture LoosenessCD & RPD: Denture Base Principle Always have the patient demonstrate how a denture loosens

  33. Denture LoosenessCD & RPD: Denture Base Lack of post dam/ retrozygomal seal • Pull upward and outward on canine • Test hypothesis: add compound/functional wax -opposite side

  34. Denture LoosenessCD & RPD: Denture Base • Poor base adaptation • Fulcrum on bony structures • Test hypothesis: PIP

  35. Denture LoosenessCD & RPD: Denture Base Periphery terminates on bony structures • Hard palate • Zygoma • External oblique ridge • Before retromolar pad • No seal, discomfort • Eventual resorption Dry Mucosa

  36. Denture LoosenessCD & RPD: Denture Base Principle Denture peripheries always terminate on displaceable soft tissues Retromolar pads, Vestibular tissues, Vibrating line (nonmoveble soft palate), Hamular notches

  37. Gagging with Dentures • Usually not soft palate contact • Denture contact with tongue : • thick posterior border rubs on tongue • posterior border drops onto tongue: • Occlusal interferences • Terminates on hard palate (no seal)

  38. Denture LoosenessDenture Base: Coronoid Interference • Thick flange in retrozygomal area • Coronoid gets closer to tuberosity as patient opens or moves jaw to side • Dislodges maxillary denture

  39. Denture LoosenessDenture Base: Pterygomandibular Raphe • Raphe from area of hamular notch • Very tight in some patients • Easily displaceable, but raphe can displace denture opening wide

  40. Denture LoosenessDenture Base: Palatal Cleft • In some patients midline soft palate fissure • Can “tent” during function • Allows air to leak under denture

  41. Denture Looseness or Pain CD & RPD Principle Always have the patient rate improvement (0-100) after adjustment. If below 90%, more diagnosis/adjustment is required

  42. Denture LoosenessCD & RPD • Occlusion • Denture base (fit & contour) • Poor anatomy

  43. Denture LoosenessCD & RPD: Poor Anatomy • Many sets of dentures • Use articulator • More involved/precise impression & jaw relation procedures • Implants • Refer

  44. Overview • Deal with denture problems systematically • Use a differential diagnosis • Address probable causes until problem eliminated • If can’t identify problem, refer

  45. Phonetic Problems Lisping: • too much overjet • triangular spaces between max. & mand. teeth • palatal contour too constricted • insufficient tongue space

  46. Difficult Denture Patients • Anatomic Problem • Diagnosis Problem • Adaptive Problem • Psychologic Problem

  47. Difficult Denture Patients Principle If you can’t determine the problem using indicating medium: 1. Tell the patient 2. Don’t adjust 3. Refer

  48. Difficult Denture Patients Principle Never pretend to adjust a denture Reinforces maladaptive behaviour - harder for the next guy

  49. Difficult Denture PatientsAdaptive Problem • Elderly take more time to adapt • More teeth missing, less adaptation (loss of PDM receptors) • Better perception - less adaptive

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