pateint istruction, prob, solution-complete denture insertion
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GOOD AFTERNOON
POST-INSERTION INSTRUCTION,PROBLEMS & SOLUTIONS
SOLUTIONS
COMPLIED BY:-NIKUNJ PATEL
PATIENT’S EDUCATIO
N
Outline
• Post-insertion instruction
• Patient’s experiences & discomfort
• Problems occurring following insertion & their solution
POST-INSERTIONINSTRUCTION
1. HABITUATION2. EATING HABITS3. SPEECH4. HOME CARE FOR THE DENTURES
LIST OF INSTRUCTIONS
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.
1. It may be difficult to adjust as patient has been without teeth for a long period of time.
2. First few days pt is instructed not to chew hard food avoid sticky food
3. Pt is asked to try to chew on both side with the back teeth
4. Pt is asked not to drink water by lifting the tumbler but drinking by sipping.
2.EATING HABITS
1. Speaking with the dentures normally requires some practise.
2. Patient is asked to read aloud and repeat the words those which are difficult to pronounce.
3. With passage of time pt’s speech with denture will be better than without denture.
3. SPEECH
1. 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.
4. HOME CARE FOR THE DENTURES
2. Pt should rinse the mouth & denture after every meal.
3. Pt should never wear denture at night & should store denture in cold water.
4. Pt should not wash the denture with hot water.
5. It’s preferable if pt place denture in denture cleanser at night.
6. After removing the denture pt should massage the gums for few minutes with fingers.
7. Pt should not use any abrasive or detergents to clean the dentures.
8. 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.”
1. FIRST ORAL FEELINGS
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
Different experiences & discomforts
1.FIRST ORAL FEELINGS
1. 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.
2. FULLNESS OF THE MOUTHa. Little change in the mouth is perceived as a big
change by the pt.b. Also dentist use as much area as possible.
2.RETENTION COMPARISION BETWEEN NATURAL & ARTIFICIAL TEETH
NATURAL DENTITION
COMPLETE DENTURE
MODE OF ACTION Roots ( which have ability to bite tough food)
Wet slippery mucosa (which is not able to bite tough food)
BITING CAPACITY 80 pounds 11.7 pounds
SENSATION Proprioceptive mechanism
No such capacity
3.SALIVA
PROBLEM SOLUTION
Excess salivation :-As foreign thing enters in the mouth, it’s the normal reaction of the body.
Subsides in few weeks,Keep deglutition active.
4.SPEECH
PROBLEM SOLUTION Distortion of
speech, Affected fluency
(owing to initial feeling of bulk & the accompanying excessive saliva)
Difficult rapid conversation
Quietly read aloud at home (slow reading may not put up the pt’s concentration on how the sound is pronounced.)
5.EATING
Pt’s compliancee.g. ability to eat a steak or an apple is a mark of good denture.(Such things result in soreness of the mouth.)
Pt’s education In beginning pt is advised to eat soft/crispy
foods, as they are easy to comminuted.( 1st week)
Avoid fibrous & tough foods in beginning, there is an ample variety of soft food is available so, pt should not compromise with nutrition.
Pt is educated to eat methodically:- Pt is instructed to divide normal forkful of food in half & place each half bilaterally.
6. TONGUE POSITION & PROBLEMS WITH THE LOWER DENTURE IN CONTRAST WITH THE UPPER DENTURE
MANDIBULAR DENTURE MAXILLRY DENTURE
TONGUE tongue causes lifting of the lower denture
No tongue involvement
DENTURE BEARING AREAS
approx. 14cm2 Approx. 24 cm2
Muscle surroundings Buccal & lingual muscles Only buccal muscles
Problems occurring following insertion & their solution
SEVERAL PROBLEMS
DIRECT SEQUELAE
1. DENTURE STOMATITIS
2. FLABBY RIDGE
3. TRAUMATIC ULCER (sore spots)
4. BURNING MOUTH SYNDROMS
5. RESIDUAL RIDGE RESORPTION
6. DENTURE IRRITATION HYPERPLASIA
7. GAGGING
INDIRECT SEQUELAE
1. ATROPHY OF MASTICATORY MUSCLES
2. NUTRITIONAL DEFICIENCIES
DIRECT SEQUELAE
1.DENTURE STOMATITIS
• Denture induced stomatitis
• Denture sore mouth,
• Inflammatory hyperplasia,
• Chronic atrophic candiasis
DENTURE STOMATITIS - SYNONYMS
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.
after the infection is conformed to be occurring because of the candida the topical anti-fungals are given,,, e.g. nystatin, amphotericin B, micronidazole,
DRUG THERAPY
SURGICAL THERAPY
necessary in the type-III.
2.FLABBY RIDGE
Alveolar ridge may become mobile & extremely resilient due to replacement of the bone by the fibrous tissue.
DESCRIPTION
Surgical correction & relining of the denture base accordingly for re-adaptation of the tissue surface.
TREATMENT
3.TRAUMATIC ULCER (sore spots)
• 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.
DESCRIPTION
• over extension of the denture
• unbalanced occlusion.
ETIOLOGY
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.
TREATMENT
4.BURNING MOUTH SYNDROMES
local factors
systemic factors
psychological factors
ETIOLOGY
mechanical irritation by ill-fitting dentures
prolonged masticatory muscle activity
constant parafunctional movements of the tongue
constant excessive friction on the mucosa
LOCAL FACTORS
vitamin or iron deficiency
menopause
xerostomia
diabetes
SYSTEMIC FACTORS
anxiety
depression
PSYCHOLOGICAL FACTORS
odoes not show any overt clinical features.
oMainly pain starts in the morning & aggrivates during the days.
oBurning sensation is usually accompanied with dry mouth & persistent altered taste sensation.
oAsso. Symptoms include head ache, insomnia, decreased libido, irritability, depression.
CLINICAL FEATURES
removal of local factors
compensation for systemic deficiency except for menopose.
Psychologic counselling
TREATMENT
5.RESIDUAL RIDGE RESORPTION
•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.
ETIOPATHOGENESIS
•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.
PATTERN OF RESORPTION
MANDIBLE• initially=4-5mm
• Later=0.1-0.2mm
MAXILLA• Initially=2-3mm,
• Later=four times lesser than mandi.
RATE OF RRR
• The depth & width of the sulcus is reduced.
• Decreased vertical dimension at occlusion.
• Reduction of the lower facial height.
• Increased relative prognathism.
CLINICAL FEATURES
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.
CONCLUSIONPatient’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 BOLENDERWINKLER
ANY DOUBT..,
THANK YOU
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