Diagnosis for edentulous patients
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Discussion about diagnosis of edentulous patients requiring removable complete dentures
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Diagnosis for edentulous patients
- 1. Diagnosis for Edentulous Patients By Dibya Falgoon Sarkar ( North Bengal Dental College & Hospital)
- 2. Diagnosis Defined as : The determination of the nature of a disease. (GPT-8) In other words ,diagnosis is the examination of the physical state , evaluation of the mental or psychological makeup of the patient, and understanding the needs of each patient to ensure a predictable result.
- 4. Extraoral Examination General appearance (healthy, signs of proper nourishment) Facial symmetry Facial form & profile Skin: color, deep wrinkles Palpation of the head & neck (lymph nodes & muscles)
- 5. Extraoral Examination TMJ examination Lips: length,thickness,mobility
- 6. Classification of Frontal Face Forms (House, Frush & Fisher) Square Square- Form Face Tapering Tapering Ovoid
- 7. Classification of Lateral Face Forms Class I - Normal Class II –Retrognathic Class III - Prognathic
- 8. Temporomandibular Joint Examination The TMJ should be evaluated for pain by palpation or mandibular movements. The muscles of mastication should be examined for pain. Any deviations should be noted during opening & closing the mouth. Any joint sounds such as clicking , popping, crepitus should be noted Reasonably coordinated mandibular movements are necessary for jaw relation.
- 11. Lip Length Long Lip Short Lip
- 12. Lip (smile) line High smile line Normal smile line
- 13. Intraoral Examination tongue color of the mucosa floor of the mouth maxillary tuberosity hard palate soft palate arch relationship arch form ridge contour residual ridge size inter-ridge space saliva undercuts
- 14. Residual Alveolar Ridge Size
- 15. Average Sized Ridge (Class I) Resorbed Alveolar Ridge ( Class III )
- 16. Arch Form
- 17. Residual Alveolar Ridge (Cross Sectional Contour)
- 18. Inter-arch Distance Class I Class II Class III
- 20. The Tongue Favorable tongue is average sized, moves freely, covered by healthy mucosa Tongue contributes to denture stability by controlling the dentures during speech, mastication & swallowing Tongue provides peripheral seal to the dentures In edentulous patients the tongue may become enlarged and powerful
- 21. Tongue Size Normal Macroglossia - Difficulty in impression taking is seen. Microglossia – Might jeopardize a lingual seal.
- 23. Tongue Position (Wright’s Classification) Class I Class II Class III
- 24. Frenal Attachments Class I Class II Cass III
- 25. The Hard Palate Class I (U shaped) Class II (V shaped) ClassIII (Flat or shallow vault)
- 26. The Soft Palate(Palatal Throat Form) House’s classification Class I Class II Class III
- 27. Lateral Throat Form Examination Class I Class II Class III
- 29. Drugs Causing Xerostomia Diuretics Antihistamines Atropine Anticholinergic Antihypertensive Antiparkinson (Norflex) Corticosteroids
- 30. Maxillary Tuberosity If enlarged: the posterior occlusal plane may be placed too low not enough space to set all molars Painful & difficult path of removal & insertion if an undercut is present
- 31. Radiographic Examination A routine radiographic exam. must be ordered to rule out any bony conditions that could affect the treatment Panoramic radiograph(OPG) is usually ordered for denture cases Supplemental Radiographs: IOPA,Occlusal,etc.
- 32. Radiographic Examination Pathologies to be watched during radiographic examination: 1. Retained roots 2. Bony abcess 3. Bone Diseases: Paget’s disease,Osteopetrosis,etc
- 33. Panoramic Radiograph Showing extensive alveolar ridge resorption
- 34. Additional Tests & Medical Consultation Routine blood test, blood & urine sugar (OGTT) levels Medical consultation Dental consultation
- 35. A good clinician is one who is able to diagnose potential problems during the initial examination & suggest the best possible treatment plan compatible with the age, physical, mental & financial status of the patient
- 36. References I. Complete Denture Prosthodontics, 1st Edition, 2006 by John Joy Manappallil, Chapter 2. II. Essentials of Complete Denture Prosthodontics by Sheldon Winkler. III. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th edition. Chapter7
Editor's Notes
- * Pts with poor neuromuscular coordination (CVA, pakinson, paralysis) may find it difficult to adapt to new dentures. The pt is asked to perform various mandibular movements to determine neuromuscular coordination.
- This is important for selection of tooth shape.
- Short lips show more of the denture base when pt smiles or talks, longer teeth may have to be selected. Long lips would hide the denture base and most of the teeth during facial expressions. Tooth visibility as a guide to anterior teeth positioning would be impractical Thin lips are very sensitive to small changes in anterior teeth position.
- *the greatest height to which the inferior border of the upper lip is capable of being raised by muscle function.
- U shaped: Good prognosis, large U shaped ridges supported by firm keratinized mucosa are favorable for good retention and support V shaped or tapered: favorable prognosis, common in mandible Knife edged: poor prognosis, common in mandible, the crest of ridge has to be relieved to avoid soreness. Flat: poor prognosis Inverted: poor prognosis
- *An edentulous pt who has not been wearing a mandibular denture often will use the tongue as an antagonist for the maxillary arch in mastication.. It may slowly regain its normal size after a period of wearing complete dentures.
- *slight movement of denture will break seal and cause loss of retention, may be associated with tapered arch
- Class I: most favorable as more surface area for retention, as well as allowing for a wider seal area. The muscular activity is minimal. Class III: usually seen along with deep V shaped palate. Because of the greater movement of soft palate during function and the narrower seal area, the class III is the least favorable.
- Saliva is an important factor in denture retention as well as the health of tissues. You should note the amount and consistency of saliva.
- Xerostomia is also caused by radiation therapy in head and neck region and by Sjogren’s syndrome. Aging is no longer considered to be a primary factor in diminished salivary flow.
- Maxillary tuberosity can present problems if it is enlarged and undercut. An undercut maxillary tuberosity can make denture removal and insertion difficult and painful. Management: from radiograph, it is determined if the enlarged tuberosity is bony or fibrous or a combintion, then removed surgically.
- The radiograph is useful in the following instances: bone pathosis, cysts, tumors, retained roots or teeth, bone fractures, to study soft tissue thickness and extent of bone resorption, to locate mandibular canal and its proximity to ridge crest, to locate maxillary sinuses, to determine thickness of body of mandible, to plan surgeries, as treatment records, and for pt education.