Sequalae of Wearing Complete Dentures

Sequalae of Wearing Complete DenturesDIRECT SEQUALAE CAUSED BY WEARING COMPLETE DENTURESMUCOSAL REACTIONSDENTURE STOMATITISDENTURE IRRITATION HYPERPLASIATRAUMATIC ULCERS ORAL GALVANIC CURRENTS ALTERED TASTE PERCEPTION BURNING MOUTH SYNDROME GAGGING REIDUAL RIDGE REDUCTION CARIES (ABUTMENTS) PERIODONTAL DISEASE (ABUTMENTS) DENTURE STOMATITIS

SYNONYMSDENTURE SORE MOUTH, INFLAMMATORY PAPILLARY HYPERPLASIA, CHRONIC ATROPHIC CANDIDOSIS

PREVALANCE50% among complete denture wearers

DENTURE STOMATITISNEWTONS CLASSIFICATION

TYPE ILocalised Simple Inflammation or Pin Point HyperemiaTYPE-IIGen. Simple Inflammation, Erythematous type seen as diffuse erythema involving part or the entire denture bearing mucosa. TYPE-III (Granular Type)Inflammatory papillary hyperplasia, involves part of hard palate and alveolar ridges.(type-I and type II are usually trauma induced, type-III is usually associated with microbial plaque accumulation on the fitting surface or underlying mucosa)

DENTURE STOMATITISDIAGNOSISCANDIDA ASSOCIATED DENTURE STOMATITIS CONFIRMED BY :FINDING OF MYCELIA OR PSEUDOHYPHAE IN A DIRECT SMEARORISOLATION OF CANDIDA SPECIES FROM THE LESION( 50 COLONIES)DENTURE STOMATITISETIOLOGY AND PREDISPOSING FACTORSDIRECT PREDISPOSING FACTOR FOR CANDIDA ASSOCIATED LESIONS IS PRESENCE OF DENTURES IN ORAL CAVITYSYSTEMIC FACTORS:Old ageDiabetes mellitusNutritional deficiencies (iron, folate or vitamin B12) Malignancies (acute leukemia, agranulocytosis)Immune defectsCorticosteroids, immunosuppressive drugsLOCAL FACTORS:Dentures (changes in environmental conditions, trauma, denture usage, denture cleanliness)Xerostomia (Sjogrens syndrome, irradiation, drug therapy)High-carbohydrate dietBroad-spectrum antibioticsSmoking tobaccoManagement and Preventive Measures Several options because of diverse possible origins

Efficient Oral and Denture hygiene/ correction of denture wearing habits

Instruct pts to remove dentures after meals and scrub them vigorously with soap before reinsertion

Keep mucosa in contact with denture clean

Discontinue denture wearing at night

Management and Preventive MeasuresCorrection of Ill Fitting DenturesRough areas on fitting surface smoothed or relined with tissue conditionerRemoval of 1 mm of internal surface (penetrated by micro org.) and relined frequently

Polishing or glazing tissue surface to facilitate denture cleansing by brushing

Management and Preventive Measures Antifungal therapyIndicationsIn pts with clinical diagnosis confirmed by a mycological examIn pts with associated burning sensations from oral mucosaIn pts where infection has spread to other sites in oral cavity or pharynx

Local antifungal therapy (preferred over systemic therapy)Nystatin Amphotericin bMiconazoleCotrimazoleSystemic antifungal therapy (resistance develops earlier)Ketoconazole Fluconazole

Management and Preventive MeasuresPRECAUTIONS TO PREVENT RISK OF RELAPSERx with antifungals for 4 weeksWhen lozenges are prescribed take out dentures before sucking Meticulous oral and denture hygieneWear dentures as seldom as possible and keep them dry or in disinfectant solution of 0.2% to 2% chlorhexidine during nightsManagement and Preventive MeasuresSurgical TreatmentFor elimination of deep crypt formation in type III denture stomatitisAchieved with cryosurgery

Flabby RidgeFlabby RidgeDefinition Mobile or extremely resilient alveolar ridge due to replacement of bone by fibrous tissue Commonest SiteAnt. Maxilla particularly where ant Mand teeth are present Draw backProvide poor support for the denture TreatmentShould be surgically removedExtremely atrophic ridges in maxilla shouldnt be totally removed as vestibular area may be eliminated

Burning Mouth SyndromeDefinitionA possible sequela of denture wearing and characterized by burning sensation in one or several oral structures in contact with the denturesClinical Features Oral mucosa is usually clinically healthyAge gp affected: older than 50Gender affected: females esp. postmenopausalCommon complaint : burning sensation from supporting tissues or the tongueSymptoms usually appear first time with placement of new denturesBurning Mouth Syndrome Characteristics of Associated PainGradual onset, often present in the morning and becomes aggravated during dayUsusally a burning sensation with a feeling of dry mouth and altered taste sensationAssociated symptoms may be headache, insomnia, decreased libido, irritability depressionAggravating factors: tension, fatigue, hot and spicy foods Relieving factors: sleeping, eating ,distraction

Burning Mouth SyndromeEtiological FactorsLocal factorsMechanical IrritationAllergyInfectionOral Habits and ParafunctionMyofascial Pain

Systemic FactorsVitamin DeficiencyIron Deficiency AnaemiaXerostomiaMenopauseDiabetesParkinsons DiseaseMedicationBurning Mouth Syndrome Etiological Factors

Psychogenic factorsDepression AnxietyPsychosocial stressorsBurning Mouth SyndromeManagement Systematic approach to identify the possible cause Care is to be taken where no organic cause cant be established for the complaintsAppropriate counseling to help pt. understand the benign nature of the problemDenture Irritation Hyperplasia

Denture Irritation HyperplasiaCommon sequela of wearing ill-fitting denturesOccurs along overextended peripheries of denturesResults from chronic injury by unstable dentures or thin overextended denturesMay occur right after placement of new dentures and may not be associated with marked symptomsLesions may be single or quite numerous and are composed of flaps of hyperplasic connective tissueDenture Irritation HyperplasiaInflammation is variable(in bottom of deep fissures severe ulceration and inflammation may occur)Marked discomfort in pressure ulceration and severe irritation from microbial productsManagement Replacement /adjustment of denturesFollowing surgical excision and replacement of dentures, lesions are unlikely to recur

Traumatic Ulcers

Traumatic UlcersThese are sore spots most commonly develop within 1 to 2 days after placement of new denturesClinical FeaturesSmall and painful lesionsCovered by a gray necrotic membraneSurrounded by an inflammatory halo with firm, elevated bordersDirect Cause Over extended denture flangesUnbalanced occlusion

Traumatic Ulcers Predisposing FactorsSuppress resistance of the mucosa to mechanical irritationDiabetes mellitisNutritional deficienciesRadiation therapyXerostomia Sore spots heal within a few days after correction of dentures If no treatment is rendered adaptation may lead to denture irritation hyperplasia

Oral Cancer in Denture WearersNo definite proof exists for an association b/w denture wearing and oral cancerOther predisposing factors such as tobaccco, alcohol, lower socioeconomic group and less education and poor oral hygiene.

Gagging

GaggingDefinitionNormal healthy defense mechanism to prevent foreign bodies from entering into the trachea

Trigger Zones soft palate faucesposterior part of tongue Primary Stimulus tactile stimulation Other Stimulisight taste noisepsychological factors combination of tGaggingAfferent glossopharyngeal Efferent vagusGagging associated with denture wearing overextended borderspoor retention of maxillary denturesunstable occlusionincreased vertical

GaggingIn old denture wearers may be a symptom of GI disorders.AdenoidsAlcoholismSevere smoking

Residual Ridge ReductionResidual Ridge ReductionAlveolar bone is tooth dependantLoss of teeth leads to continued bone resorption as a result of alveolar remodelling due to altered functional stimulation of boneAggressive resorption occurs in areas with thin cortical bone In 1st year after extraction reduction in residual ridge height is 2-3 mm for maxilla 4-5 mm for mandible in midsagittal planeAfter healing of residual ridge, remodelling process will continue but at slower rate Residual Ridge ReductionProposed etiological factors for RRRAnatomical FactorsMore imp in mand vs the maxillaShort and square face with increased masticatory forcesAlveoloplasty Prosthodontic FactorsIntensive denture wearing Unstable occlusal conditionsImmediate denture treatmentMetabolic and systemic factorsOsteoporosisCalcium and vitamin D supplements for possible bone preservation

Caries and Periodontal Disease