instructions to the patient

7/31/2019 Instructions to the Patient

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Mahinay, Marivic C.


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Outline:I. Problems that patients encounter when RPD is first worn

Soreness and discomfort

Coping with a prosthesis

Learning to speak distinctly

Learning to eat

Excessive Bulk

Increase in salivary flow

Increased oral perception

II. Maintenance of the oral tissuesIII. Methods of Dental Plaque control

A. Use of toothbrush

B. Use of dental floss

C. Use of four-ply knitting yarn

IV. Care of the soft tissues covered by the RPDA. Use of a toothbrush

B. Use of washclothC. Use of chewing gum

V. Care of the removable partial denture

VI. Methods of cleaning a removable partial denture

VII. Written instructions


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- provides the dentist ample opportunity to discuss with

the patient the many factors that contribute to successful

treatment.

- one of the best methods to establish patient-dentist

rapport, which is important to a successful prognosis.


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The reason the patient requires treatment with an RPD should be

discussed with the patient before treatment begins. This can best be

accomplished by means of:

Mounted diagnostic cast

Roentgenograms


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The patient must anticipate that there may be some soreness and

discomfort of the soft tissues or teeth during the few days. The patient should be reassured that the dentist will be available to

adjust the prosthesis during this annoying and sometimes difficult

time.


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The patient must acquire the skills necessary to cope with and

adjust to this seemingly large, bulky, foreign body in the mouth. Creates a forced learning period for the patient.


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Speech difficulties are usually transitory because the tongue has

considerable adaptability. Reading and speaking aloud will assist the patient to overcome this

problem.


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It is the most formidable task the patient must master, especially

with a mandibular bilateral distal-extension RPD. The process is usually accomplished through gradual, conscious

learning process.


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Feeling of fullness and crowding of the tongue because of the

increased bulk of the prosthesis. Patients should be reassured that this will be a temporary situation

because the tongue is a very adaptable organ.


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Stimulation of the sensory receptors of the mouth (gustatory,

thermal, and pain) characteristically induces increased salivarysecretion.

Highly polished acrylic resin denture base contributes to an

increased in salivary flow.


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RPD wearer who cannot tolerate a foreign object in his mouth for

whatever reason (physiologic or psychological).

Result of elevated level of oral perception that regards the

prosthesis as a foreign and obtrusive that is offensive to wear.


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1. The patient is given complete periodontal therapy before treatment

with an RPD.

2. The patient is placed on a strict oral hygiene regimen emphasizing

the need for effective dental plaque control, denture hygiene and

tissue rest (removal of the prosthesis for a specific period daily).

3. The patient can demonstrate effectiveness in maintaining low

levels of dental plaque.


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4. The patient is placed on a frequent, individualized, regular recall

program to detect early periodontal and prosthodontic changes.

5. The dentist provides the necessary periodontal and prosthodontic

therapy as well as dental caries control to maximize the longevity

of both the periodontal supporting apparatus and RPD.


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Patients should know that bacteria and their by products plus

fermentable carbohydrates and a susceptible tooth surface are the

prime etiologic factors in the production of dental caries.


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Dental plaque control is perhaps the single most important factor in

the success of any RPD.

It is a salivary precipitant that forms every 24 hours.

Uses carbohydrates for their growth, produce acids and enzymes

that precipitate dental disease.

Causes demineralization of the tooth surface that leads to dental

caries.


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It is the most universal method of effective dental plaque removal.

The patient should be given a toothbrush and requested to

brush in his or her customary amount of time.

The patient should be given a disclosing tablet or solution and

instructed in its use.

The patient should rinse his or her mouth with water to remove

any excess strain and should then be given a hand mirror.


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The dentist or dental hygienist should demonstrate any

remaining areas of dental plaque stained by disclosing solution.

A demonstration of the most effective methods of removal of

these areas of dental plaque is then performed.


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The toothbrush should be held at approximately a 45 angle to the

tooth at a level that allows the bristles to enter the gingival sulcus for

a distance of 2 to 3 mm.


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The floss should be gently inserted between the proximal surfaces

of the teeth by moving it back and fourth through contact areas of

the teeth.

The use of dental floss should not cause the interproximal gingival

tissues to hemorrhage or become irritated.

Use daily.


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Use because of its soft texture and slightly greater bulk, is an

excellent material for cleaning these inaccessible areas.

Used in a fashion similar to dental floss.


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To promote optimal and continuous health of the tissues covered by

the prosthesis and help prevent the formation of denture stomatitis,

patients should be instructed out leave the RPD out of their mouth

for a six-to eight-hour period each day.


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The most easiest and most convenient method of cleaning and

massaging the soft tissues covered by an RPD.

Soft nylon, multitufted toothbrush.


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This is used in patients who have difficulty holding or using a

toothbrush to properly brush the soft tissues may be able to clean

and massage them more effectively means of a moist washcloth.


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Can serve as adjunctive method to clean and massage the soft

tissues when the RPD is removed from the mouth.

Chewing gum for five to ten minutes a day usually provides

adequate stimulation for the soft tissues.


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Patients should be cautioned abut dropping the prosthesis

or carrying it in their purse or jacket pocket.

Correct method of insertion and removal of an RPD.

Correct insertion of an RPD:

Include the use of gentle finger pressure to seat the prosthesis on

the teeth.

Removal of an RPD:

direct retainers: the dislodging force should be applied only to the

shoulders of the clasp arms.


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Dental plaque that accumulates on the tissue surface of the RPD is

a contributing factor in the pathogenesis of denture stomatitis.

Plaque is also a major cause of the odor often found on an RPD.


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1. Mechanical denture cleansing with a denture brush or ultrasonic

agitation

Denture brush with soap and water or just plain tap water.

(effective in removing discoloration and denture plaque)

2.Chemical denture cleansing


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Soap and water or commercial dentifrice

Medium , synthetic toothbrush with long round-ended bristles of

small diameter or soft denture brush.

x Hard stiff bristle toothbrushes

Advantage:

Effective method of removing dental plaque, food debris, and

discoloration from the prosthesis.

Disadvantage:

Ineffective method of cleaning the inaccessible areas present on

most RPDs.


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This type of cleaning can serve as adjunct to the brushing method

and is often preferred by handicapped or geriatric patients who are

not able to clean their prosthesis adequately by brushing.


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1. Alkaline peroxides

2. The buffered alkaline hypochlorites3. Dilute organic or inorganic acids

4. Enzymes


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Most common type of commercial immersion cleaners used today.

Advantage:

Convenient to use.

Have a pleasant taste.

Do not harm or have a deleterious effect on the metallic or acrylic resin portion of the RPD.

Reduce surface tension.

Disadvantage:

Do not effectively remove stains or calculus from a prosthesis.

Indication:

Patients who have new RPDs and clean their dentures daily.


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Very effective denture-cleaning agents because of their ability to

dissolve mucin or other organic compounds associated with the

formation of dental plaque on an RPD.

Bactericidal and fungicidal because of hypochlorites.


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They will tarnish and corrode cast chromium alloy frameworks and

the gold-plated nickel pins or porcelain anterior denture teeth.

Solution: To overcome the corrosive effect of the hypochlorites

on the metal components of an RPD, phosphates such as

sodium hexametaphosphates must be added to buffer the

hypochlorite solution.

Remember: Prosthesis must never be placed in a hypochloritesolution unless a glassy phosphate has been added.


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Soaking of RPD in vinegar (5% acetic acid) for patients who

accumulate persistent stains and calculus deposits on their

prosthesis.

Hydrochloric 5% or 15% phosphoric acid will cause corrosion of

metallic portion of an RPD.


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A relatively recent approach to dental plaque control on an RPD.

Use of enzymes to breakdown the glycoproteins and mucoproteinsand the mucopolysaccharides of dental plaque.

15 minute immersion period


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Bactericidal and fungicidal

Non toxic

No harmful effects


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These units do not produce true ultrasonic waves that pass through

a specially prepared cleaning solution to produce a vibrating action.

Removes calculus, stains and odor from a prosthesis.


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Not an effective method to render an RPD plaque free.

Does not offer any great advantage over the combined brushing and

immersion method of cleaning an RPD.


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Most efficient method of cleaning an RPD.

Should be recommended as the method of choice for the majority of

patients treated with RPDs.

Brush prosthesis after each meal and before bedtime.

Soak the denture in a chemical cleaner while they are

asleep.


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Helps reinforce the patients responsibilities in caring for the oral

structures and the new RPD.

Provide the patient with a source of knowledge for future reference.

Should be concise and easily understood and should describe the

important points covered during the counseling sessions with the

patient.


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instructions to the patient

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