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pateint istruction, prob, solution-complete denture insertion
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pateint istruction, prob, solution-complete denture insertion - Presentation Transcript
GOOD AFTERNOON
POST-INSERTION INSTRUCTION,PROBLEMS & SOLUTIONS
SOLUTIONS
PATIENT’S EDUCATION
COMPLIED BY:-NIKUNJ PATEL
Outline
Post-insertion instruction
Patient’s experiences & discomfort
Problems occurring following insertion & their solution
POST-INSERTIONINSTRUCTION
LIST OF INSTRUCTIONS
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. Patient’s appearance with the denture will become more natural with time. Patient’s mouth & tongue has to get adjusted to the denture, also there will be increased salivation, which will be reduced subsequently.
2.EATING HABITS
It may be difficult to adjust as patient has been without teeth for a long period of time.
First few days pt is instructed not to chew hard food avoid sticky food
Pt is asked to try to chew on both side with the back teeth
Pt is asked not to drink water by lifting the tumbler but drinking by sipping.
3. SPEECH
Speaking with the dentures normally requires some practise.
Patient is asked to read aloud and repeat the words those which are difficult to pronounce.
With passage of time pt’s speech with denture will be better than without denture.
4. HOME CARE FOR THE DENTURES
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 won’t break.
Pt should rinse the mouth & denture after every meal.
Pt should never wear denture at night & should store denture in cold water.
Pt should not wash the denture with hot water.
It’s preferable if pt place denture in denture cleanser at night.
After removing the denture pt should massage the gums for few minutes with fingers.
Pt should not use any abrasive or detergents to clean the dentures.
Pt should not make any adjustment or repair by himself.
PATIENT’S 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
FIRST ORAL FEELINGS
RETENTION COMPARISION BETWEEN NATURAL & ARTIFICIAL TEETH
SALIVA
SPEECH
EATING
TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE
1.FIRST ORAL FEELINGS
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.
FULLNESS OF THE MOUTH
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
3.SALIVA
4.SPEECH
5.EATING
6. TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE
Problems occurring following insertion & their solution
SEVERAL PROBLEMS
DIRECT SEQUELAE
DENTURE STOMATITIS
FLABBY RIDGE
TRAUMATIC ULCER (sore spots)
BURNING MOUTH SYNDROMS
RESIDUAL RIDGE RESORPTION
DENTURE IRRITATION HYPERPLASIA
GAGGING
INDIRECT SEQUELAE
ATROPHY OF MASTICATORY MUSCLES
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 re-adaptation 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
does not show any overt clinical features.
Mainly pain starts in the morning & aggrivates during the days.
Burning sensation is usually accompanied with dry mouth & persistent altered taste sensation.
Asso. 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.
It’s 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.
It’s more rapid in females than in males.
It’s 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 & disto-lingual 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
Patient’s 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
nikunj999 + Follow
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