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Unit 8


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Unit 8

  1. 1. Effects of dental appliances on oral health Unit 8 Dental Public Health and Preventative Dentistry
  2. 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. 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. 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. 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. 6. Protect the patient! One of the standards for DCPs as required by the GDC.
  7. 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. 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. 9. Effects • • • • • • • • Pain Discomfort Sensation Retching Gagging Tissue reactions Swelling Disease
  10. 10. Epulis fissuratum where the partial denture rests
  11. 11. Hyper plastic folds of an epulis Fissuratum caused by irritation of a denture flange
  12. 12. What is Pathology? Pathology is a varied field of science, one of the oldest disciplines, which focuses on the study of diseases.
  13. 13. It should be noted that a number of conditions increase in prevalence with age. Threatening oral health!
  14. 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. 15. Tooth damage & decay caused by a poorly designed dental prosthesis
  16. 16. This is particularly common in the prescription of removable partial dentures RPDs.
  17. 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. 18. Keep it simple & self cleansing!
  19. 19. Regular inspection of the denture fit is necessary to ensure it is not causing damage – at least once a year!
  20. 20. Incorporating occllusal rests in partial dentures may prevent vertical movement!
  21. 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. 22. Tooth damage caused by vertical movement of denture
  23. 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. 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. 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. 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. 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. 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. 29. Staphylococcus Dentures can harbour numerous pathogenic and opportunistic bacteria .
  30. 30. Streptococcus A spectrum of microorganisms can be found harboring in dentures.
  31. 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. 32. Denture surfaces should be smooth and well polished!
  33. 33. 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
  34. 34. A Well Finished Restoration!
  35. 35. Rampant decay under old improperly bonded restorations
  36. 36. Avoidable!... with the application of correct preparation and appliance design.
  37. 37. 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.
  38. 38. Effect on Bacteria on Oral Tissues What are virulence factors?
  39. 39. Virulence factors assist bacteria in achieving success to and colonising sites i.e. molecules produced by a pathogen that specifically cause disease.
  40. 40. Bacteria adheres to the acquired pellicle, (a cellular film composed of glycoprotein that closely and firmly adheres to tissues of the oral cavity)
  41. 41. 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
  42. 42. Actinobaccilus
  43. 43. A bacteria that causes gum disease and has been linked to heart disease.
  44. 44. Latrogenic trauma Components of poorly designed restorations or appliances can cause direct local irritation and trauma to the gingivae
  45. 45. Over contoured restorations may have serious health implications Poorly contoured fixed restorations may be More problematic rather than being a solution
  46. 46. Marginal discrepancies Poor oral hygiene – accumulated food debris from packing beneath open contact points in furcations, beneath overhanging or leaking restorations and associated dentures.
  47. 47. Factors that predispose to the accumulation of plaque, include poorly designed restorations with overhanging margins, poorly contoured and deficient restorations and dentures
  48. 48. 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.
  49. 49. Overhanging margins and ill fitting furcations (division of the tooth root) can also lead to defects developing.