after care in complete dentures

KAMINENI INSTITUTE OF DENTAL SCIENCES

DEPARTMENT OF PROSTHODONTICS

AFTER CARE OF COMPLETE DENTURE PATIENT

J SUJANA I MDS

Journal of Prosthodontics 18 (2009) 688–693

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


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) 688–693

Speaking with new dentures.

Maintaining tissue health.

Educational material for patients.

Periodic recall for oral examination.


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.


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


• 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

perceptionJournal of Prosthodontics 18 (2009) 688–693

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.


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


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.


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


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.


Denture cleansers:

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

and solutions

• Commercially available denture cleansers use various active agents

—including 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 denturesJournal of Prosthodontics 18 (2009) 688–693

• 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) S1–S12

• 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) 688–693

• 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


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.


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


Impression surface

Discrete painful areas

Reduction of sharp edges

Pain on insertion and removal

Relieved in the region of undercuts

Pain on pressure

Locate the area and relieve it


Impression surface

Lifting of denture on tongue protrusion

Mark extension of overextension and

relieve it

Generalized pain over denture

supporting area

Extend denture to optimal denture

bearing area

Sore throat causing difficulty in swallowing

Adjustment of post dam



Pain on eating

Adjust occlusion by selective

grinding

Pain lingual to alveolar ridge

Mark deflecting inclines of posterior

teeth and adjust them

Pain labial to alveolar ridge

Reduce incisal vertical overlap



Pain at periphery of

dentures

If <1.5mm grind to provide

VDOIf >1.5mm

perform new VDO

Cheek biting Tongue biting

Restore functional width

of sulcus

Remove lower lingual cusps


In association with systemic conditions

Burning sensation of the

tongue

Correction of denture faults, multivitamin

therapy, antidepressant

therapy

Glossodynia – beefy red tongue

Multivitamin therapy

Frictional lesions related

to the dentures

Surgical removal of the lesions


In association with systemic conditions

Allergy to denture material

Remaking denture using

polycarbonate resin

Painful click on opening and

closing the mouth

Careful correction of

denture faults


Factors resulting in looseness of the dentures

Decreased retentive forces

Increased displacing 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



Xerostomia

Design dentures to maximize retention

Gap between the periphery of the flange and the

ridge

Reline the denture if it is satisfactory

or remake the denture as required



Overextension in depth

Overextension in width

Reduce overextension

Check borders of record rims

and reduce them

cautiously



Poor fit to supporting

tissues

Reline or remake

Denture not in optimal space

Perform denture adjustments or

remake if required



Noise on eating or speaking

Eating difficulties

Blunt teeth

Reassurance or correction of specific faults

Proper construction of

dentures

rEshape the teeth



Speech problems

Gagging

Unnatural color of

denture base material

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

Reduce overextension

of dentures

Remake using suitable denture

base material


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.

after care in complete dentures

Documents

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mdsjournal of prosthodontics

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