1. Effects of dental appliances
on oral health
Unit 8 Dental Public Health
and Preventative Dentistry

2. Do We Need to Replace all
Missing Teeth?
The opinion of the patient and the dental
team regarding the nature of dental
treatment required can often differ. A
greater disparity is apparent the older the
patient, so many factors have to be
considered during treatment planning.

3. It is not always necessary to replace all
missing teeth any decision to do so
must be made with the goal of improving
function, appearance and comfort.

4. Consider the following
• Does the patient have any problems
chewing food?
• Does the patient have any discomfort
arising from the missing teeth?
• Does the patient have any appearance or
cosmetic concerns arising from missing
teeth?
• Is there any evidence of occlusal
instability?

5. Biological Price
Does the potential benefit of providing a
prosthesis outweigh the potential damage it
may cause to the remainder of the natural
dentition?
Removable partial dentures in
particular are associated with high levels of
dental caries and periodontal disease,
particularly in patients who are unable to
maintain adequate oral hygiene.

6. Protect the patient!
One of the standards for DCPs as required
by the GDC.

7. Adults in particular have the capability to
adapt to the gradual loss of teeth and
patients who have adapted well are unlikely
to seek treatment unless anterior teeth are
lost

8. DENTURES
Ill fitting dentures can contribute to the
decline of tissue health in the oral cavity.
This can be due to:
• An inaccurate impression or distortion
during processing
• A breakdown in communication within the
dental team and between the patient!

9. Effects
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Pain
Discomfort
Sensation
Retching
Gagging
Tissue reactions
Swelling
Disease

10. Epulis fissuratum where the
partial denture rests

11. Hyper plastic folds of an epulis
Fissuratum caused by irritation of a
denture flange

12. What is Pathology?
Pathology is a varied field of science, one of
the oldest disciplines, which focuses on
the study of diseases.

13. It should be noted that a number of
conditions increase in prevalence with age.
Threatening oral health!

14. Tooth Supported dentures
Encroaching upon the gingival tissues with
components of the denture such as
Connectors and clasp tips, is a common fault
in the design of tooth supported dentures

15. Tooth damage & decay caused by a
poorly designed dental prosthesis

16. This is particularly common in the
prescription of removable partial dentures
RPDs.

17. Threats of disease, can be
minimized, however, by following a few basic
guidelines
•
Provide tooth support for the denture where
possible – wrought rests can be incorporated into
acrylic RPDs to provide tooth support.
•
Chrome based dentures should have rests placed
on the tooth surfaces adjacent to the saddles.

18. Keep it simple & self cleansing!

19. Regular inspection of the denture fit is
necessary to ensure it is not causing
damage – at least once a year!

20. Incorporating occllusal rests in partial
dentures may prevent vertical
movement!

21. Keep the RPD design as simple as possible,
Minimising coverage of the dental and
Gingival tissues
Connectors should not encroach on the
Gingival margins of the teeth, and clasps
should not cover exposed root surfaces

22. Tooth damage caused by vertical
movement of denture

23. Solutions
As technicians involved in the design
process, we can utilize technology further to
eliminate future problems developing.
In the case of RPD design, tooth stops and
occlusal rests will act to prevent soft tissue
damage

24. Denture wearers need to avoid plaque buildUp that can irritate tissues under the
dentures
Ill fitting dentures can increase the possibility
of oral cancer and denture wearers should
see a dentist once a year for screening.

25. • Reduced saliva flow
• Increased sensitivity in changing and
tissue that becomes increasingly thin
• Dentures that do not dimensionally change
in accordance with the changing shape of
the mouth
• Are all factors that need to be considered
in order to improve oral health.

26. Instruct the patient in cleaning techniques for
both the RPD and natural teeth.
This will include careful instruction in oralhygiene procedures, and encouraging the
patient to clean the denture after meals and
to use denture cleaners

27. Dentures need to be checked for proper fit to
Avoid irritation, increased bone loss and
Infections.
A change in the fit of a RPD could indicate
periodontal disease

28. Inflammatory papilomatosis/multiple
papilomatosis/papillary hyperplasia
A condition of unknown cause but associated
with the presence of dentures, characterized
by numerous red papilary projections on the
hard palate.

29. Staphylococcus
Dentures can harbour numerous pathogenic
and opportunistic bacteria .

30. Streptococcus
A spectrum of microorganisms can be
found harboring in dentures.

31. These organisms can instantly adhere to the
denture surface and penetrate the pores left
during the release of gases from
polymerisation.
As at technician it is important to use a good
quality material and ensure processing and
finishing is of the highest standard in order to
eliminate these problems and prevent further
disease.

32. Denture surfaces should be
smooth and well polished!

34. Dental Ceramics
Similarly, care has to be taken with
the production of ceramic restorations microporosity can also harbour bacteria and microorganisms.
Fortunately as technicians, we can reduce
the likelihood of this occurrence by ensuring
a nice smooth finish to the material with no
processing faults – cracks/porosity and /or
using a glazing product

35. A Well Finished Restoration!

36. Rampant decay under
old improperly bonded
restorations

37. Avoidable!... with the application of
correct preparation and appliance
design.

38. Once again it is the breakdown in
communication within the dental team that
had led to a failure in this restoration
resulting from poor margin design with blame
being attributed to both the surgeon and
technician.

39. Effect on Bacteria on Oral
Tissues
What are virulence factors?

40. Virulence factors assist bacteria in achieving
success to and colonising sites i.e. molecules
produced by a pathogen that specifically
cause disease.

41. Bacteria adheres to the acquired pellicle,
(a cellular film composed of glycoprotein that
closely and firmly adheres to tissues of the
oral cavity)

42. This bacteria can accumulate to the extent
That it is able to withstand the
Mechanical cleansing effects of the soft
oral tissues and salivary flow.
Certain species of bacteria have the ability to
invade soft tissues i.e. gingivae, delivering
toxic bacterial products to the tissues

43. Actinobaccilus

44. A bacteria that causes gum disease
and has been linked to heart disease.

45. Latrogenic trauma
Components of poorly designed restorations
or appliances can cause direct local irritation
and trauma to the gingivae

46. Over contoured restorations may
have serious health implications
Poorly contoured fixed restorations may be
More problematic rather than being a solution

47. Marginal discrepancies
Poor oral hygiene – accumulated food debris
from packing beneath open contact points in
furcations, beneath overhanging or leaking
restorations and associated dentures.

48. Factors that predispose to the accumulation
of plaque, include poorly designed
restorations with overhanging margins,
poorly contoured and deficient restorations
and dentures

49. Patients suffering from
periodontitis
As part of a patients periodontal treatment,
it may be necessary to allow access for
cleaning. Long – term wear of properly
fitting and contoured provisional
restorations allows the health of the
gingival margin to improve and it’s position
to stabilize before impressions are taken
for definitive restorations.

50. Overhanging margins and ill fitting furcations
(division of the tooth root) can also lead to
defects developing.