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KAMINENI INSTITUTE OF DENTAL SCIENCES

AFTER CARE OF COMPLETE DENTURE PATIENT


Journal of Prosthodontics 18 (2009) 688693

DEPARTMENT OF PROSTHODONTICS
J SUJANA I MDS

CONTENTS
INTRODUCTION RATIONALE FOR AFTER CARE OF COMPLETE DENTURE PATIENT.

EDUCATION AT DENTURE APPOINTMENT.


POST INSERTION PROBLEMS CRITICAL EVALUATION CONCLUSION.

INTRODUCTION
Success of complete denture begins with the first appointment

itself , continued in the treatment followed by regular denture


maintenance by the patient, combined with the periodic consultation with the prosthodontist.

Thus the patient must be educated from the first appointment


itself till the placement appointment regarding proper maintenance of the complete denture. This article attempts to highlight the points to be considered in the after care of complete denture patient.

RATIONALE
Lack of after care of complete denture patient Damage to support tissue mucoperiosteum and underlying bone

Increased ridge resorption


Damage to facial musculature and TMJ Long term wear of the dentures
Journal of Prosthodontics 18 (2009) 688693

Education at denture appointment


During the insertion of the complete denture the following

points must be considered :


Individuality of the patient Appearance with new dentures Mastication with new dentures Tasting and swallowing

Nutritional support
Tongue position.
Journal of Prosthodontics 18 (2009) 688693

Speaking with new dentures. Maintaining tissue health. Educational material for patients.

Periodic recall for oral examination.

Journal of Prosthodontics 18 (2009) 688693

Individuality of the patient: Anatomic, psychological, tissue tolerance and oral conditions. Compare the progress of dentures Appearance with new dentures: Appearance - More natural with time Restoration of facial dimension and contour

Repositioning of facial muscles.

Journal of Prosthodontics 18 (2009) 688693

Mastication with new dentures: Learning to chew satisfactorily - 6 to 8 weeks. New memory patterns facial muscles and muscles of

mastication.
Time for adjustment in long term edentulous patient is Salivary flow initially is increased but becomes normal after few days. Deglutition is necessary to swallow excess saliva and spitting

should be avoided
Efficiency of artificial teeth 1/3 natural teeth
Journal of Prosthodontics 18 (2009) 688693

Eat relatively soft foods little mastication


Place the bolus of food on both sides of the mouth. The corner of the mouth rather than between anterior teeth.

Divide the food into half and place each half posteriorly and
bilaterally in the first molar area . Tasting and swallowing: Major part of hard palate is covered by the denture taste sensitivity reduced

Due to reduced salivary flow there is negative effect on taste


perception
Journal of Prosthodontics 18 (2009) 688693

Nutritional support:

Nutritional support will improve the tolerance of the mucosa to


new dentures Five essential principles of nutrition: 1. Food choice 2. Attention to food selection and preparation. 3. Dietary supplementation 4. High quality protein diet.

5. Adequate hydration.

Journal of Prosthodontics 18 (2009) 688693

Tongue position: The most common complaint of the patient at the recall appointment is loose mandibular dentures.

Three points to be considered:


area of the mandibular denture basal seat 1/3 area of maxillary denture basal seat, Surrounding musculature - potential for denture base disruption. Proper tongue position helps in maintaining mandibular denture

stability and adequate peripheral seal


Retracted tongue position stability of denture is lost
Journal of Prosthodontics 18 (2009) 688693

Speaking with new dentures:


During the first few weeks after placement of the dentures patient will have difficulty in speaking with the new dentures. Patient must be advised to read aloud and repeat words in front of the mirror.

The adaptability of the tongue to compensate for the changes


is so great that the patient masters the speech with in a few days.

Journal of Prosthodontics 18 (2009) 688693

Maintaining tissue health:


Three factors are involved in maintaining healthy edentulous oral tissues TISSUE REST : Removing the dentures before sleeping allows adequate rest to

the oral tissues.


It provides convenient time for soaking the dentures in cleansing solution Nocturnal habits prevent damage to the denture
Journal of Prosthodontics 18 (2009) 688693

COMPLETE DENTURE HYGIENE: Prevent malodor, poor esthetics, and the accumulation of plaque and biofilm.

Adverse effects such as denture stomatitis, inflammatory


papillary hyperplasia, and chronic candidiasis are minimized. Brush the dentures with a soft brush after every meal and soak them in cleansing solutions for about 30 minutes for effective killing of microorganisms.

Journal of Prosthodontics 18 (2009) 688693

Denture cleansers:

Denture cleansers are available in the form of creams, pastes gels


and solutions Commercially available denture cleansers use various active agentsincluding hypochlorite, peroxides, enzymes, acids and disinfecting agents.(Journal of prosthetic dentistry Dec 1979 vol42 number 6) Sodium hypochlorite is superior to all the commercially available denture cleansers. Alternative to these mechanical denture cleansing other methods are

Ultrasonic cleaning of dentures


Microwave irradiation of dentures
Journal of Prosthodontics 18 (2009) 688693

Mode of action of ultrasonic devices cavitation BioSonic Enzymatic (Colt`ene/Whaledent, Cuyahoga Falls, OH), which contains nonionic detergents, protease enzymes

and 400 parts per million isopropyl alcohol, Ultra-Kleen


(Sterilex, Hunt Valley, MD)

Microwave irradiation of dentures immersed in sterile water at


650 Watts for three minutes sterilizes dentures without causing surface degradation of the prosthesis

o The characteristics of an ideal denture cleanser should include the following Minimum anti biofilm activity.

Increased antibacterial and antifungal


Nontoxic Compatible with denture materials Short acting Easy to use

Acceptable taste.
Cost effective.
Journal of Prosthodontics 20 (2011) S1S12

Meliodent - PMMA denture base material. Wirobond C Co-Cr alloy Efferdent EDTA 240 dihydrate,FD&C blue no 2,FD&C

green no 3,polytetrafloroethylene,potassium monopersulfate,


sodium bicarbonate, sodium lauryl sulfoacetate, sodium perborate monohydrate, sodium saccharin USP,sodium sulfate anhydrous, sodium tripolyphosphate, spearmint flavor. Polident subtilisin, citric acid, sodium carbonate, potassium

peroxymonosulfate, sodium perborate monohydrate.


Clorox sodium hypochlorite 5.25%
Journal of clinical and dental research vol 15 issue 3 pg 145 - 153

TISSUE HYGIENE AND MASSAGE

Mucosal surfaces of the residual ridges and dorsal surface of


the tongue should be cleaned with soft brush. increase the circulation

It remove plaque and debris which prevents irritation to soft


tissues. DENTURE ADHESIVE: The patient should be advised regarding proper use of denture adhesive

Use the minimum amount necessary to achieve the desired


result.
Journal of Prosthodontics 18 (2009) 688693

Distribute the adhesive evenly over the tissue-bearing surfaces. Apply or reapply when necessary.

Always apply denture adhesive to a clean tissue-bearing


surface. Schedule periodic professional oral evaluations

Journal of Prosthodontics 18 (2009) 688693

Education material for the patients: People remember less of what they hear than of what they see

Printed information care and cleaning of dentures


Periodic recall for oral examination:

After 24 hours of placement of dentures corrections.


One week and one month additional adjustments.

Journal of Prosthodontics 18 (2009) 688693

o INSTRUCTIONS : Initially new dentures feel strange and bulky in the mouth and there is feeling of fullness, over a period of time dentures get

accustomed to the patients.


Patient should be asked to read aloud and repeat phrases in front of mirror. Patient is asked to eat relatively soft foods by placing on both sides of the mouth, rich in minerals and vitamins

Patient is asked to clean the dentures after each meal and place
them in cleansing solutions. Recall after every six months.

Post insertion problems


The problems which arise subsequent to complete denture insertion may be grouped into Factors resulting in discomfort associated with dentures

Factors resulting in looseness of the dentures


Factors associated with problems of adaptation

British dental journal, volume 189, no. 3, august 12 2000

Factors causing discomfort to the patient

Impression surface

Occlusal and polished surface

In association with systemic conditions

British dental journal, volume 189, no. 3, august 12 2000

Impression surface

Discrete painful areas

Pain on insertion and removal

Pain on pressure

Reduction of sharp edges

Relieved in the region of undercuts

Locate the area and relieve it

British dental journal, volume 189, no. 3, august 12 2000

Impression surface

Lifting of denture on tongue protrusion

Generalized pain over denture supporting area

Sore throat causing difficulty in swallowing

Mark extension of overextension and relieve it

Extend denture to optimal denture bearing area

Adjustment of post dam

British dental journal, volume 189, no. 3, august 12 2000

Occlusal and polished surface

Pain on eating

Pain lingual to alveolar ridge

Pain labial to alveolar ridge

Adjust occlusion by selective grinding

Mark deflecting inclines of posterior teeth and adjust them

Reduce incisal vertical overlap

British dental journal, volume 189, no. 3, august 12 2000

Occlusal and polished surface

Pain at periphery of dentures

Cheek biting

Tongue biting

If <1.5mm grind to provide VDO If >1.5mm perform new VDO

Restore functional width of sulcus

Remove lower lingual cusps

British dental journal, volume 189, no. 3, august 12 2000

In association with systemic conditions

Burning sensation of the tongue

Glossodynia beefy red tongue

Frictional lesions related to the dentures

Correction of denture faults, multivitamin therapy, antidepressant therapy

Multivitamin therapy

Surgical removal of the lesions

British dental journal, volume 189, no. 3, august 12 2000

In association with systemic conditions

Allergy to denture material

Painful click on opening and closing the mouth

Remaking denture using polycarbonate resin

Careful correction of denture faults

British dental journal, volume 189, no. 3, august 12 2000

Factors resulting in looseness of the dentures

Decreased retentive forces

Increased displacing forces

British dental journal, volume 189, no. 3, august 12 2000

Decreased retentive forces

Lack of peripheral seal

Inelasticity of cheek tissues

Add tracing compound along impression surface of posterior border and replace compound with acrylic resin

Repeated treatment may be required as the elasticity progresses British dental journal, volume 189, no. 3, august 12 2000

Decreased retentive forces

Xerostomia

Gap between the periphery of the flange and the ridge

Design dentures to maximize retention

Reline the denture if it is satisfactory or remake the denture as required British dental journal, volume 189, no. 3, august 12 2000

Increased displacing forces

Overextension in depth

Overextension in width

Check borders of record rims and reduce them cautiously

Reduce overextension British dental journal, volume 189, no. 3, august 12 2000

Increased displacing forces

Poor fit to supporting tissues

Denture not in optimal space

Reline or remake

Perform denture adjustments or remake if required

British dental journal, volume 189, no. 3, august 12 2000

Factors associated with problems of adaptation

Noise on eating or speaking

Reassurance or correction of specific faults

Eating difficulties

Proper construction of dentures

Blunt teeth

rEshape the teeth

British dental journal, volume 189, no. 3, august 12 2000

Factors associated with problems of adaptation


Assessment of patients speech at trial visit and check for any discrepancies Reduce overextension of dentures

Speech problems

Gagging

Unnatural color of denture base material

Remake using suitable denture base material British dental journal, volume 189, no. 3, august 12 2000

Critical evaluation
Ideal characteristics of denture cleansing solutions. Newer methods of cleansing dentures. Post insertion problems treatment.

Conclusion
Complete denture service cannot be adequate unless the patients are cared for after dentures are placed Caring for the complete denture and the oral tissues needs

special attention, and patients need to be educated regarding


this fact.

References
AFTER CARE OF COMPLETE DENTURE PATIENT - Journal of

Prosthodontics 2009 vol 18 pg 688-693.


MATERIALS AND METHODS FOR CLEANING DENTURES. Journal of Prosthetic Dentistry Dec 1979 vol42 number 6. IDENTIFICATION OF COMPLETE DENTURE PROBLEMS : A SUMMARY British Dental Journal, volume 189, no. 3, august 12 2000. EVIDENCE BASED GUIDELINES FOR THE CARE AND MAITAINENCE OF COMPLETE DENTURES. Journal of Prosthodontics

vol 20 2011 S1 S12.


PSYCHOLOGICAL PREPARATION OF COMPLETE DENTURE PATIENTS. Journal of Dental sciences and Research vol 1 issue 2 September 2010.

COMMON FAULTS IN COMPLETE DENTURES : A REVIEW.

Quintessence International Volume 24, Number 7/1993.


FACTORS INFLUENCING SATISFACTION OF COMPLETE DENTURES IN GERIATRIC PATIENTS. Journal of prosthetic dentistry

nov dec 1961 vol 11 num 6 1019- 1031.


NUTRITIONAL ISSUES FOR DENTURE PATIENTS. Quintessence International vol 36 num 8 September 2005

Factors causing problems may be grouped,essentially into four causes. Adverse intra-oral anatomical factors eg atrophic mucosa. Clinical factors eg poor denture stability. Technical factors eg failure to preserve the peripheral roll on a master cast. Patient adaptional factors.

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