CASE HISTORY IN COMPLETE DENTURE

PATIENTS

Introduction

The successful complete denture therapy begins with thorough assessment of patients physical and psychological condition and determining the

treatment that will deliver a functional complete denture.

Definition

Case history:- A collected data about an individual ,family ,environmental factors (including medical/dental history) and other information that may be useful in analyzing and diagnosing conditions and for instructional purposes ;best termed as patient history.(GPT 8)

Importance of Case History

• Obtaining a patient’s history and conduct a physical examination are requisities to establish diagnosis and treatment planning.

• To evaluate patient’s psycological behaviour.

• To understand expectations of patient regarding denture.

Sequence of recording case history

Personal data

Name

Age – It is an indicator of the patients ability to wear and use dentures.

Sex- Womens are more concerned about esthetics.

Race- Critical factor in characterization of dentures

Occupation- It is related to the design of the denture

Personality- According to M.M.HOUSE

Philosophic- Easy going,mentally well adjusted,cooperative and has confidence in dentist

Exacting- Precise,above average in intelligence,concerned in their dress and appearance,often dissatisfied

with past treatment

Hyterical- Patients are often in poor health,are poorly adjusted,appear exacting but with unfounded complaints,have failed at past attempts to wear dentures and have unrealistic expectations

Indifferent- Unconcerned with appearance often go without denture for years

Medical history

As a health professionals,dentist are responsible for the well being of patients under care.

Systemic factors that may affect the complete denture therapy includes-

Infectious diseasesHepatitis B

Tuberculosis

Metabolic diseasesDiabetes mellitus-bone response prosthetic stress is poor and requires a pressure free impression tecniques.

Diseases of bone Osteoporosisosteoarthritispagets diseases

Diseases of bone OsteoporosisOsteoarthritisPaget’s disease

Neuromuscular diseases

Parkinsonian disease- affects the stomatognathic system by altering the functions of the jaws and tongue.Regular exercises,maintainence of prosthesis,adaptation and oral hygeine are to be encouraged.

Bells palsy- partial support for the affected oral commisure is often possible with a prosthesis a hook like device attached to denture.

Blood dyscrasias

Anemia

Leucopenia

Leukemia

Cardiovascular diseases

Angina pectoris

Myocardial infarction

Diseases of skin

Pemphigus

Oral malignancies

• Tissues chronically abused by poorly maintained natural and artificial dentition ,alcohol and tobacco predispose the oral tissues to malignancy.

• Sharp borders of denture are avoided.

• In case of radiation therapy sufficient time has to be given for the tissues to recover before treatment is initiated.

Nutritional status

• A complete denture prosthesis depends ultimately upon the health and integrity of the denture bearing tissues for successful function and comfort to the patient.

• The following nutritional factors should be considered-

Xerostomia- Causes and effect of negative water balance.

Negative calciuum balance-Causes and effects on alveolar bone.

Nitrogen protein balance- Musle weakness tissue fragility.

Dental history Chief complaint

“The dentist should meet the mind of the patient before he meet the mouth of the patient”-De Van

Importance- The chief complaint may be overlooked during therapy To access the patients expectations To determine patients psycological classification Expectations Years of edentulousness,max/man Reasons and sequence of teeth loss Previous dentures,max/man Existing or current dentures Denture success. Pre extraction records.

Clinical evaluation

• Extraoral

Facial form(frontal)

Facial form(profile)

Muscle tone

• According to M.M.House

Class 1- Normal muscle tone

Class 2- Slight impaired muscle tone

Class 3- Greately impaired muscle tone

Complexion

Hair, eye , skin colour provides useful guides in the shade selection.

Lip

Examined for cracking ,fissuring at th corner and ulceration.

Lip support- adequetely supportedunsupported

Thickness- Thinthick

Lip length- longnormalshort

Lip mobility- normalreducedparalysis

Temporomandibular joint

• Palpation

• Auscultation

• Mandibular movements- normal

impaired

Neuromuscular evaluation

Speech- normalaffected

Coordination- patient with good neuromuscular coordination can be expected to learn to manipulate dentures relatively quickly and likewise adapt readily to new dentures.

It can be classified as- Class 1-Excellent

Class 2-Fair

Class 3-Poor

Intra oral examination

Arch size Class 1-Large

Class 2-Medium

Class 3-Small

Arch form- Class 1-Square

Class 2-Tapering

Class 3-Ovoid

Ridge form

• Maxillary • Mandibular

Parallel walls

Defects

• Ridge defects such as exostoses,sharp bony spicules should be noted that may pose problem for complete denture patients or may warrant preprosthetic surgery.

• Tori may be classified as-

Class 1-Tori are absent or minimal in size Class 2-Moderate in size Class 3-Large in size

Inter arch space

• Class 1-Ideal

• Class 2-excessive

• Class 3-Insufficient

Ridge parallelism

• Class 1

• Class 2

• Class 3

Ridge relationship

• Class 1-Normal

• Class 2-Retrognathic

• Class 3-Prognathic

Radiographic evaluation

Radiographic examination is an essential part of diagnosis and treatment planning for all dental patients.

The screening of jaws includes Retained tooth roots Unerupted teeth Foreign body Various pathosis of devlopmental,inflammatory or

neoplastic origin Bone quatity and quality

According to Branemark et al

Bone qantity Bone quality

Lateral throat form

• According to Neil

Class 1

Class 2

Class 3

Palatal throat form

According to M.M.House

Class 1

Class 2

Class 3

Palatal sensitivity

• According to M.M.House Class 1-Normal Class 2-Subnormal Class 3-Supernormal

Mucosa thickness Class 1-Normal uniform density of mucosal

tissue,investing membrane is firm. Class 2-Mucous membrane is thick,thin investing

membrane. Class 3-Excessive thick investing membrane filled

with redundant tissues.

Mucosa condition

• 1According to M.M.House

Class 1-Healthy

Class 2-Irritated

Class 3-Pathologic

Frenum attachments Class 1-High in maxilla or low in mandible

Class 2-Medium

Class 3-Freni encroach the crest of the ridge

Saliva

Class 1-Normal quality and quantity Class 2-Excessive saliva Class 3-Xerostomia

Tongue size Class 1-Normal in size,devlopnment and function Class 2-Teeth have been lost long enogh to permit a

change in form and function of tongue Class 3-Exceesively large tongue

Position of tongue

• According to Wright Normal

Class 1-Retracted

Class 2-Retracted

Existing dentures

Existing esthetics,phonetics,retention,stability,extensions and contoursshould be evaluated.

Should be rated as- Good Fair Poor Centric relation and vertical dimensions of occlusion

should be assesed and evaluated Occlusion plane orientation Midline Hygiene-good

-fair-poor

Wear

Conclusion

A complete case history is presented for use in evaluating and planning the treatment of patient for complete denture therapy. The treatment plan devloped for a patient should reflect the dentist’s best efforts at interpreting the diagnostic findings and addressing the patient’s need in keeping with their appreciation for dentistry and their ability to accept the proposed treatment.

References• Robert L.Engelmeier,Rodney D.Phoenix:Patient

evaluation and treatment planning for complete denture therapy,Dental Clinics of North America:40,1-18,1996.

• Heartwell MC:Diagnosis. In Syallabus of Complete Dentures,ed 4,Charles M.Heartwell,Jr Arthur O.Rahn,Varghese publishing house;Bombay;1992;106-142.

• Douglas V.Chaytor:Diagnosis and Treatment Planning for Edentulous or Potentially Edentulous Patients. In Prosthodontic Treatment for Edentulous Patients(Complete dentures and implant-supported prosthesis),Zarb,Bolender,Mosby;St.Louis MO;2005;73-99.

• Robert L.DeFranco,Lance F.Ortman: Diagnosis and Treatment Planning.In Essentials of complete denture prosthodontics,ed 2,Sheldon Winkler;A.I.T.B.S;India;2000;39-55.