ClassifIcation of complete denture patients/ hands on courses in dentistry


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ClassifIcation of complete denture patients/ hands on courses in dentistry

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education
  2. 2. Do we need to categorize our complete edentulous patients Guidance: Dr. M. Vasanthakumar (Prof. & HOD) Dr. B. Muthukumar (Prof.) Presenter: Dr. G. Uday Raghav Reddy Post Graduate
  3. 3.
  4. 4. EDENTULISM; the state of being edentulous ,without natural teeth.
  5. 5. Our patients can be First timers with no knowkedege of our treatment procedures or patients who have undergone much treatment.
  6. 6. They can be rich…or poor
  7. 7. Highly educated or uneducated
  8. 8. Highly co-operative /non-co-operative…
  9. 9. Patients who may sue us if there is any professional negligence
  10. 10. So don’t you think we should treat each one in a different manner
  11. 11. An earlier concept states patients can be classified as per their attitudes.
  12. 12. Philosophical   They anticipate the need for  treatment with complete dentures and   are willing to rely on dentists advice for  diagnosis and treatment. a.   .
  13. 13. Exacting Poor oral health a seriously concerned about appearance and efficiency of artificial dentures, Reluctant to accept the advice of the physician and are unwilling to submit to the removal of their natural teeth. They doubts the ability of the operator and insists on a written guarantee or expects the dentist to make repeated attempts to please them.
  14. 14. Hysterical   Bad oral health with neglected mouth conditions and had come to the dentist as a last resort. Have attempted to wear artificial dentures but failed. They are of a hysterical,nervous &exacting type and will demand efficiency .
  15. 15. Indifferent          They are unconcerned about their appearance feel  very  little  or  no  necessity  for  teeth  for  mastication.  They  have very little appreciation for the dentist.                     This classification helps the dentist to understand patient’s attitudes & helps in assessing the ways in which they may react to the dentist.
  16. 16. A new classification is proposed. Based on 2 factors: 1. The level and quality of the engagement or involvement of the patient toward the dentist 2. The level of willingness to submit (trust) to the dentist
  17. 17. Ideal Reasonably ENGAGED(+++) and reasonably WILLING to submit (trust) (+++) to the dentist. They seek explanations to understand the situation and arrive at a final decision regarding treatment. Neither overly suspicious nor blindly accepting of the dentist’s recommendations.
  18. 18. Submitter ++++ Engagement ++++ willingness to submit (trust). They lack discrimination and tend to idealize the dentist, which results in a high degree of engagement and utter surrender. Therefore he/she cannot be an active partner in the treatment
  19. 19. Reluctant This patient rates ++ on engagement and ++ on willingness to submit (trust). They are often leery of the dentist and skeptical of the treatment plan.
  20. 20. Indifferent This patient rates + on engagement and + on willingness to submit(trust). Usually forced into seeing the dentist by a concerned family member or friend. This patient is minimally engaged and indifferent to the dentist to the extent ,that willingness to submit (trust) is not an issue.
  21. 21. Resistant This patient is paradoxically, very engaged with the dentist but in an adverse way. Rather than being dependent , they challenge the dentist and there is no trust. This patient rates ++++ on engagement and + on willingness to submit (trust).
  22. 22. Patients with medical problems; Uncontrolled diabetes
  23. 23. Diabetes Should be controlled by medical treatment. Impression technique must be physiologically compatible. Masticatory load to the supporting tissues should be controlled. Careful occlusal correction to remove interferences. Food table should be small.
  24. 24. Arthritis Limited movement of the mandible – necessitates modification of trays and technique during impression making. DDifficult to get proper jaw relation registrations. OOcclusal corrections must be made often because of arthritic changes in the TMJ.
  25. 25. Bells palsy Retention difficult to achieve – denture adhesives necessary Paralyzed musculature – affects both function & aesthetics – explain to the patient. Patient education on mastication and oral hygiene
  26. 26. Parkinsonism Control of patient movement during denture fabrication accomplished with sedatives. Retention is difficult – adhesive is necessary. To eliminate denture swallowing – remove dentures when not in use.
  27. 27. Radiation necrosis Dentures to be used only after 2 years from the radiotherapy treatment. Abrasion and irritation avoided, because an open lesion may provoke Osteoradionecrosis.
  28. 28. Pagets disease   Is a chronic osseous disturbance Continued  enlargement  and  change  in  form  of  the  supporting  structures  especially  the  maxillary  tuberosities,  necessitates  frequent  re-fabrication  and  adjustments of the denture.
  29. 29. Hypothyroidism Decreases  salivary  flow  and  increases  mucosal  inflammation. Treated systemically. Salivary substitutes
  30. 30. Hyperthyroidism Increase the rate of resorption Treated systemically Denture base should take advantage of the maximum  basal seat coverage.
  31. 31. Acromegaly Condition necessitates a periodic  check up of the prosthesis to determine  whether  the  denture  requires  changes  due  to  continued  growth  of  the  mandible and the maxilla.
  32. 32. CONCLUSION As we have seen that our patients can be from different economic classes, different education levels, different psychological attitudes, and present different clinical picture we have to carefully asses them and categorize them according to the above mentioned conditions before treating them there by rendering better service.
  34. 34. Thank you For more details please visit