cd insertion lecture 02 jan 2012

8/3/2019 CD Insertion Lecture 02 Jan 2012

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Outline:Post-insertion instruction.

Patients experiences & discomfort.Post-insertion Problems & their solution.

INSTRUCTIONS:

LIST OF INSTRUCTIONS:

HABITUATION.

EATING HABITS.SPEECH.

HOME CARE FOR THE DENTURES.



HABITUATION:

Initially CDS will feel strange & bulky in mouth.

Feeling of bulky lips and cheeks.

Appearance with CDs will become more natural

with time.

Initially Eating will be difficult.

Patients should avoid using the Cds for eating in

the fist week.

Then start eating soft foods should be taken.

Biting & Incising food should also be avoided.

Small pieces of food place b/w posterior teeth on

both sides.



SPEECH:

Initially Speaking will also be difficult with the new

CDs.Patient Will also feel speaking difficulty.

He should be advised to persevere and try speaking

aloud with CDs in privacy.

However, CDs should be evaluated for any faults that:

- Bring changes in Appearance of the patient.

- Makes Eating difficult With the CDS.

- Alter the patients speaking ability.



HOME CARE FOR THE DENTURES



EXPERIENCES & DISCOMFORTS WITH

CDs:

1. FIRST ORAL FEELINGS..2. RETENTION COMPARISION BETWEEN NATURAL

& ARTIFICIAL TEETH.

3. SALIVA.4. SPEECH.

5. EATING.

6. TONGUE POSITION & PROBLEMS WITH THELOWER DENTURE IN CONTRAST WITH THE

UPPER DENTURE.



FIRST ORAL FEELINGS:1. NATURE OF THE COMPLETE DENTURE

General introduction about the denture by the mean of diagrams ormodels can be used to show the pt that what he wears in his mouth.

2. FULLNESS OF THE MOUTH

a. Little change in the mouth is perceived as a big change by the pt.b. Also dentist use as much area as possible.



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



SALIVA

PROBLEM SOLUTION

Excess salivation :-

As foreign thing enters in

the mouth, its the normal

reaction of the body.

Subsides in few weeks,

Keep deglutition active.



SPEECH

PROBLEM SOLUTION

y Distortion of speech,

y Affected fluency (owing to

initial feeling of bulk & the

accompanying excessive saliva)

y Difficult rapid conversation

Quietly read aloud at home (slow

reading may not put up the pts

concentration on how the sound

is pronounced.)



EATING

Patients compliance

e.g. ability to eat a steak

or an apple is a mark of

good denture.

(Such things result in

soreness of the mouth.)

Pts education

y In beginning pt is advised to eat soft/crispy foods, as

they are easy to comminute.( 1st week)

y Avoid fibrous & tough foods in beginning, there is an

ample variety of soft food available so, patient should

not compromise with nutrition.

y Patient is educated to eat methodically:-Pt is instructed to divide normal forkful of food

in half & place each half bilaterally.



TONGUE POSITION & PROBLEMS:

WITH THE LOWER CD IN CONTRAST WITH THE

UPPER CD:MANDIBULAR CD MAXILLRY CD

TONGUE tongue causes lifting of the

lower CD

No tongue involvement

DENTURE BEARING AREAS approx. 14cm2 Approx. 24 cm2

Muscle surroundings Buccal & lingual muscles Only buccal muscles



Problems occurr ing f ollowing inser tion

& their solution:

SEVERAL PROBL EMS:

DIRECT SEQUELAE:1. DENTURE RELATED STOMATITIS (DRS).

2. FLABBY RIDGE.

3. TRAUMATIC ULCER (sore spots).

4. BURNING MOUTH SYNDROME.

5. RESIDUAL RIDGE RESORPTION.

6. DENTURE IRRITATION HYPERPLASIA.

7. GAGGING.

INDIRECT SEQUELAE

1. ATROPHY OF MASTICATORY MUSCLES

2. NUTRITIONAL DEFICIENCIES



DIRECT SEQELAE:

DENTURE RELATED STOMATITIS:

Synonymous With:

Denture induced stomatitis

Denture sore mouth,

Inflammatory hyperplasia,

Chronic atrophic candiasis

Calssification:

Type-I (Localized simple infection)

Type-II (erythematous type)- generalized type

Type-III granular type



Systemic Factors:

Old age

Diabetes mellitusNutritional deficiency:- iron, folate, vit.12 etc.

Local Factors:Dentures

Environmental factors

Night wear of the dentures

Denture cleanlinessXerostomia

High carbohydrate diets:

- causes increased plaque accumulation



Management:

Supportive Measures:

Cleanliness of the dentureDenture & the mucosa should be cleaned after the meals.

Store CDs in 0.2-2% chlorhexidine during night time.

Polishing of the denture routinely.

Not to wear the denture during night time.DRUGS:

After the infection is confirmed to be due to candida

infection, topical anti-fungals are given:

Nystatin, Amphotericin B, Miconiazole.

Surgical:

Necessary in Papillary Hyperplasia (Type-III).



Flabby Ridge:

Alveolar ridge may become mobile & extremely resilient

due to replacement of the bone by the fibrous tissue.

Management:

Surgical correction.

CD relining to improve its adaptation to the tissue surface.

New CD Making: Use special impression Techniques avoiding tissue distortion /

displacement.



TRAUMATIC ULCERS:

Develop within a day after placement of new denture.

They are small, painful lesions covered with a grey necrotic

membrane surrounded by inflammatory halo with firm, elevatedborders.

Etiology:

Over extension of the denture base.

Unbalanced occlusion.

Management:In normal pts, these ulcers heal

within few days after correcting

the dentures.

If treatment is not administered,

it may progress to dentureirritation hyperplasia.



Burning Mouth Syndrome:

Local factors.

Systemic factors.Psychological factors.

Local Factors:

Mechanical irritation by ill-fitting dentures.

Prolonged masticatory muscle activity.

Persistent parafunctional movements of 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 & aggravates during the day.

Burning sensation usually accompanied with dry mouth & persistent altered taste .

Associated Symptoms: Include head ache, insomnia, decreased libido, irritability,

depression.

Treatment:Removal of local factors,

Compensation for systemic deficiency except for menopose.Psychiatric counselling.



RESIDUAL RIDGE RESORPTION:

Wherever there is pressure, bone resorbs due to activation of osteoclast.

Its a constant sequel after extraction & continues even after inserting CDs.



Pattern of RRR:

More rapidly in first 6 months and slows in later 6 months.

Its more rapid in females than in males.

Its precipitated by certain systemic diseases & ill-fitting dentures.

MANDIBLE: Initially = 4-5mm, Later = 0.1-0.2mm.

MAXILLA: Initially = 2-3mm, Later = four times lesser than mandible.

Clinical Features:

The depth & width of the sulcus is reduced.

Decreased vertical dimension at occlusion.

Reduction of the lower facial height.

Increased relative prognathism.

Maxilla: RRR is Centripetal.

Mandible: RRR Centrifugal



Denture Irritiation:

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.



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.

cd insertion lecture 02 jan 2012

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