Tissue changes/ fixed orthodontics courses

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Indian Dental Academy: will be one of the most relevant and exciting training center with best faculty and flexible training programs for dental professionals who wish to advance in their dental practice,Offers certified courses in Dental implants,Orthodontics,Endodontics,Cosmetic Dentistry, Prosthetic Dentistry, Periodontics and General Dentistry.

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Tissue changes/ fixed orthodontics courses

  1. 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  2. 2. CONTENTS  Introduction  Microscopic anatomy of the mucous membrane in oral cavity  Sequelae of wearing complete denture www.indiandentalacademy.com
  3. 3. www.indiandentalacademy.com
  4. 4. www.indiandentalacademy.com
  5. 5. Microscopic anatomy of the mucous membrane in oral cavity  Has thinner horny layer than skin.  Sigmund and Weber et.al.: claimed that mucosa has no horny layer.  Spreng(1945) : demonstrated horny layer in palatine mucosa and claimed that hornification is a reaction to the wear and tear produced by the denture.  Orban(1953) : first to state positively that oral mucosa has horny layer. www.indiandentalacademy.com
  6. 6. EPITHELIUM  Its thickness is not more than 0.20mm  Consists of several differentiated cells covered by stratum corneum  Important as a protective mechanism www.indiandentalacademy.com
  7. 7. Stratum corneum  It has a mean thickness of 13.2micron  Appears as homogenous band stained red  Consists of closely packed cells which appear to have no nuclei.  Scrapings from palatal mucosa shows cells appearing as fried egg with nucleus in centre as yolk www.indiandentalacademy.com
  8. 8. Stratum granulosum  Characterized by granulation in cytoplasm  Kerato-hyaline granule: located in basal parts of the layer as single granules  Number of cells increase as they approach the surface www.indiandentalacademy.com
  9. 9. Stratum spinosum  cells are polygonal/rounded connected to each other by protoplasm in the form of fibrillar structure called tonofibrils  In the mesh b/w the fibrils, tissue fluid facilitate the metabolism of the cells  Metabolism is facilitated by extension of the papillae of connective tissue into the epithelium www.indiandentalacademy.com
  10. 10. Stratum basale  Formed by thin layers of amorphous materials and of reticular fibers  Demonstrated using PAS  Under EM : seems to have 1. basal lamina 2.reticular lamina www.indiandentalacademy.com
  11. 11. Functions  Provide adhesion on one side to epithelial cells and other side to connective tissue  Act as barriers to the diffusion of molecules  Play role in cell organization  May influence the regeneration of peripheral nerves after injury  May play a role in re- establishing of neuro- muscular junctions www.indiandentalacademy.com
  12. 12. Lamina propria  Characterized by collagenic and elastic fibers  Fibers run parallel to the surface of epithelium and extend in papillae perpendicular to their main course  This wavy course provides the tissue with high degree of elasticity www.indiandentalacademy.com
  13. 13. sub mucosa  Constitutes major bulk of the mucous membrane  Contains :  Other components (blood vessels, lymphatic vessels and nerves)  Fatty tissues  Glands  Muscles fibers www.indiandentalacademy.com
  14. 14. SEQUELAE OF WEARING COMPLETE DENTURES  DIRECT SEQUELAE  Denture stomatitis  Flabby ridge  Denture irritation hyperplasia  Traumatic ulcers  Oral cancer  Burning mouth syndrome  Gagging  Residual ridge reduction  Caries and periodontal disease www.indiandentalacademy.com
  15. 15. Indirect sequelae  Atrophy of masticatory muscles  Nutritional deficiencies www.indiandentalacademy.com
  16. 16. Denture stomatitis  Prevalence: 50% among the complete denture wearers  Synonyms : denture sore mouth, denture-induced stomatitis, inflammatory hyperplasia, and chronic atrophic candidosis  Classification: 3 types  By –Newton's www.indiandentalacademy.com
  17. 17. Newton’s classification  Type I : localized simple inflammation or pinpoint hyperemia Cause: trauma induced www.indiandentalacademy.com
  18. 18.  Type II :  Diffuse erythema involving a part or entire denture covered mucosa www.indiandentalacademy.com
  19. 19.  Type III :  Granular type of inflammatory hyperplasia  Cause:  Presence of microbial plaque ( bacteria/yeasts) www.indiandentalacademy.com
  20. 20. Candida associated denture stomatitis www.indiandentalacademy.com
  21. 21. Colonization of the fitting denture surface by Candida species depends on several factors  Adherence of yeast cells  Interaction with oral commensal bacteria  Redox potential of the site  Surface properties of the denture resin www.indiandentalacademy.com
  22. 22. Predisposing factors  Systemic factors  Local factors Denture properties Environmental factors  Oral hygiene www.indiandentalacademy.com
  23. 23. Systemic factors  Age  Diabetes mellitus  Nutritional deficiencies  Malignancies  Immune disorders www.indiandentalacademy.com
  24. 24. Local factors Denture properties favoring Candida growth  Surface irregularities  Micro porosity  Improper Design of prosthesis  Mechanical irritation  Texture www.indiandentalacademy.com
  25. 25. Environmental factors  Health of adjacent mucosa  Composition of saliva  Salivary secretion rate xerostomia sjogrens syndrome  High carbohydrate diet  Broad spectrum antibiotics www.indiandentalacademy.com
  26. 26.  Smoking tobacco  Oral hygiene maintenance  Denture wearing habits www.indiandentalacademy.com
  27. 27. Associated with  Angular chelitis  Diffuse atrophic glossitis www.indiandentalacademy.com
  28. 28.  Median rhomboid glossitis  Erythema of the soft palate www.indiandentalacademy.com
  29. 29. Diagnosis  Confirmed by finding of mycelia/pseudohyphae in a direct smear or the isolation of Candida in high numbers from the lesions. www.indiandentalacademy.com
  30. 30. HISTOLOGICAL FINDINGS Thinning of stratum corneum or absence of keratinization. Epithelial atrophy & hyperplasia Intraepithelial infiltration by leucocytes. Lymphocytic infiltration in underlying connective tissue. www.indiandentalacademy.com
  31. 31. Management and preventive measures www.indiandentalacademy.com
  32. 32.  Because of diverse possible origin, several treatment procedures are used like:  Antifungal therapy  Correction of ill-fitting dentures  Efficient plaque control  Surgical care www.indiandentalacademy.com
  33. 33. Antifungal therapy  Local therapy > nystatin, amphotericin B, miconazole, clotrimazole  Systemic therapy > ketoconazole , fluconazole  Used mainly in following patients:  After the clinical diagnosis has been confirmed by a mycological examination  Associated with burning sensation in oral mucosa  When infection has spread to other sites of oral cavity or the pharynx  Patients with high risk of systemic infections www.indiandentalacademy.com
  34. 34. Precautions to reduce the risk of relapse  Treatment should continue for 4 weeks www.indiandentalacademy.com
  35. 35.  When lozenges are prescribed > patient is instructed to take out the denture during sucking  Meticulous oral and denture hygiene instructions www.indiandentalacademy.com
  36. 36. Correction of ill-fitting dentures  Rough surface > smoothened and polished  Relining > soft tissue conditioner classification: 1) short term a) tissue conditioner b) functional impression materials 2) long term heat cure silicone cold cure www.indiandentalacademy.com
  37. 37.  B) acrylic based resins heat cure cold cure 3) others: polyvinyl chloride polyvinyl acetate polyurethane hydrophilic acrylates www.indiandentalacademy.com
  38. 38. COMPOSITION In general they are supplied in powder and liquid form.  POWDER – poly (ethyl methacrylate)  LIQUID – A mixture of aromatic ester and ethyl alcohol.  The ester behaves as a plasticizer and the alcohol is penetrated which speeds up the process. www.indiandentalacademy.com
  39. 39. On mixing the two together a slurry is formed. The liquid then penetrates between the molecules of the powder, a process accelerated by the ethyl alcohol present and the whole material becomes stiffer until a gel is formed, the setting therefore is a physical process, there being no chemical reaction involved. www.indiandentalacademy.com
  40. 40. PREFORMED SHEETS OF ACRYLIC GEL ARE ALSO AVAILABLE WHICH CAN BE ADAPTED TO THE SURFACES OF THE DENTURE. www.indiandentalacademy.com
  41. 41. www.indiandentalacademy.com
  42. 42. www.indiandentalacademy.com
  43. 43. Method to condition the tissues traumatized by ill-fitting dentures  Ask the patient not to wear the dentures for days – week period  Stimulate the diseased tissue with a gauze dipped in warm saline > 3 times a day  Tissue side of the denture should be clean www.indiandentalacademy.com
  44. 44. Adjust and perfect the occlusion and the vertical dimension Adjust the periphery www.indiandentalacademy.com
  45. 45. Relieve the tissue side of the denture > about 11/2 mm of relief is given Coat the denture base with tissue conditioning material and insert. www.indiandentalacademy.com
  46. 46. BEFORE CONDITIONING www.indiandentalacademy.com
  47. 47. AFTER CONDITIONING www.indiandentalacademy.com
  48. 48. Effective plaque control  Oral hygiene instructions  Denture and partial clasp brushes  Denture cleansing solutions www.indiandentalacademy.com
  49. 49. Surgical care  Deep crypt formations in type III : electro surgery / cryosurgery www.indiandentalacademy.com
  50. 50. DETURRENCE / PREVENTION > Educating the patient about the oral health care. > Instructing the patient to take their dentures out atleast 8hrs a day. > Mechanical plague control & appropriate denture wearing habits are important measures. www.indiandentalacademy.com
  51. 51. Angular chelitis a painful inflammation at the corners of the mouth. Synonyms: angular stomatitis, perleche, angular cheilosis www.indiandentalacademy.com
  52. 52. Predisposing factors  Reduced vertical dimension  Secondary to denture stomatitis  Riboflavin and thiamine deficiency www.indiandentalacademy.com
  53. 53. CLINICAL FEATURES epithelium at the corner of the mouth appears wrinkled, macerated, one or more deep fissures, cracks which appear ulcerated & tends to bleed. www.indiandentalacademy.com
  54. 54. Treatment Elimination of the primary cause. Antifungal treatment & supplement antifungal ointment at the lesion site www.indiandentalacademy.com
  55. 55. FLABBY RIDGE  It is due to the replacement of bone by fibrous tissue  Common in maxillary anterior region (when mandibular anteriors are remaining)  They offer poor support to the denture www.indiandentalacademy.com
  56. 56. Mechanism Direction of applied force of mastication causes slight rotation of the denture around the anterior maxillary alveolus. Pressure of the distally rotating anterior flange against the labial plate of bone causes resorbtion. www.indiandentalacademy.com
  57. 57. The shearing force applied to the periosteum by friction with the base during rotation results in fibrous hyperplasia . When the patient incises the pad, fibrous tissue is compressed & upward movement of the maxillary denture causes downward displacement posteriorly ,with loss of retention in the post dam area & development of fibrous maxillary tuberosity. www.indiandentalacademy.com
  58. 58. TREATMENT  SURGICAL: i) surgical removal to improve stability of denture ii) Augment the alveolar ridge with biocompatible bone substitutes iii) In extreme atrophic condition, flabby ridges should not be totally removed because the vestibular area will be limited. www.indiandentalacademy.com
  59. 59.  Conservative :  judicious selection of impression materials and technique.  3 technique has been advocated as follow : www.indiandentalacademy.com
  60. 60. A  Special tray made with a window cut in the region of displaceable tissue www.indiandentalacademy.com
  61. 61.  Border molding done www.indiandentalacademy.com
  62. 62.  Wash impression made with ZOE paste www.indiandentalacademy.com
  63. 63. Tray re-inserted, impression plaster syringed over displaceable tissue www.indiandentalacademy.com
  64. 64. Completed impression www.indiandentalacademy.com
  65. 65. Technique – B www.indiandentalacademy.com
  66. 66. Special tray with window cut www.indiandentalacademy.com
  67. 67. Medium- bodied / monophase elastomer is loaded www.indiandentalacademy.com
  68. 68.  Light body material is syringed in the cut window and then stabilized by syringing the plaster over the set elastomer www.indiandentalacademy.com
  69. 69. Technique – c www.indiandentalacademy.com
  70. 70. Special tray with no window and border molding done www.indiandentalacademy.com
  71. 71.  Impression made using ZOE / Monophase elastomer  When set , impression material corresponding to the displaceable tissue is removed  Tray is perforated www.indiandentalacademy.com
  72. 72.  Impression plaster / light body elastomer syringed over displaceable tissue  Tray is reinserted and the impression is complete www.indiandentalacademy.com
  73. 73. Denture irritation hyperplasia www.indiandentalacademy.com
  74. 74. cause  Chronic irritation by ill- fitting dentures  Overextended flanges www.indiandentalacademy.com
  75. 75.  Lesions may be single or numerous  Composed of flaps of hyper plastic connective tissue  Severe inflammation and ulceration in deep fissures  Asymptomatic www.indiandentalacademy.com
  76. 76. HISTOLOGICAL FINDINGS  Excessive bulk of fibrous connective tissue covered by a layer of stratified squamous epithelium  Connective tissue shows coarse bundle of collagen fibers with few fibroblast & blood vessels. www.indiandentalacademy.com
  77. 77. Management  Correction of over extended flanges  Surgical excision if its fibro tic or if the hyperplasia does not fully subside on correction of over extended flanges. www.indiandentalacademy.com
  78. 78. Traumatic ulcers  Commonly develop within 1 to 2 days after placement 0f new dentures  Lesions are painful, small, and ulcerated  Lesion is covered by a grey necrotic membrane , surrounded by inflammatory halo with firm and elevated borders www.indiandentalacademy.com
  79. 79. Direct cause  Overextended denture flanges  Unbalanced occlusion  Predisposing factors  Diabetes mellitus  Nutritional deficiency  Radiation therapy/xerostomia www.indiandentalacademy.com
  80. 80. HISTOLOGICAL FINDINGS  Loss of continuity of the surface epithelium with the fibrous exudates covering exposed connective tissue.  Infiltration of leucocytes into the connective tissue www.indiandentalacademy.com
  81. 81. Treatment  Management includes correction of local irritant factors in the denture.  Not treated > subsequently may develop into denture irritation hyperplasia www.indiandentalacademy.com
  82. 82. Oral cancer in denture wearers  Associated with chronic irritation of the mucosa by the dentures  Case reports > detailed development of oral carcinomas in patients who wear ill-fitting dentures www.indiandentalacademy.com
  83. 83. Predisposing factors  Heavy alcohol and tobacco use  Lower socioeconomic status  Less education  Prevention regular recall visits > 6 months – 1 year interval for comprehensive oral examinations www.indiandentalacademy.com
  84. 84. Burning mouth syndrome  Characterized by a burning sensation in one or several oral structures in contact with the dentures  Commonly seen at the age of 50 years  Females are affected more  The oral mucosa appears clinically healthy  Clinical signs: absent  Symptoms : gradual in onset associated with pain www.indiandentalacademy.com
  85. 85. Characters of the pain Gradual in onset Often present in morning Aggravated during the day / absent at night www.indiandentalacademy.com
  86. 86. Quality of pain  Burning sensation associated dry mouth and persistent altered taste sensation  Associated symptoms : headache, insomnia, decreased libido, irritability , depression  Aggravating factors : tension, fatigue, hot or spicy food  Reducing factors : sleeping, eating, distraction www.indiandentalacademy.com
  87. 87. Site of occurrence  Anterior two third of the tongue  Anterior hard palate  Mucosa of the lower lip www.indiandentalacademy.com
  88. 88. Etiology www.indiandentalacademy.com
  89. 89. Management Systematic approach is necessary to identify the possible causes. symptomatic treatment should be given. - Mucosal disease -diagnosis & treat the mucosal condition. -Dry mouth - high fluid intake & sialagogue Any systemic disease present should be identified & treated. -Menopause-hormonal replacement -Nutritional deficiency -oral supplementation. www.indiandentalacademy.com
  90. 90. if no organic basis is found, proper counseling of the patient, help the patient to understand the benign nature of the problem & with subsequent elimination of fears. comprehensive prosthetic treatment should be carried out as collaborative effort of psychiatrist & prosthodontist www.indiandentalacademy.com
  91. 91. Gagging  Normal , healthy defense mechanism  Functions to prevent the entry of foreign bodies in to the trachea www.indiandentalacademy.com
  92. 92. Gagging problem in prosthodontic treatment. Part I : Description and causes, JPD ; 1983:49  FAIGENBLUM’S CLASSIFICATION  Mild :  Experiences nausea with mild stimulus  Will be able to control the stimulus  Severe : > responds in an exaggerated manner to physical or psychological stimuli www.indiandentalacademy.com
  93. 93. Five trigger zones identified producing gag reflex  Fauces ( tonsils )  Base of the tongue  Palate  Uvula  Posterior pharyngeal wall www.indiandentalacademy.com
  94. 94. Clinical behavior ( by khan ) - Intraoral  Puckering of the lips or attempting to close the jaws  Elevating and furrowing the tongue  Elevation of the soft palate and hyoid bone  Fixation of the hyoid bone  Contraction of anterior and posterior pillars of the fauces (tonsils)  Elevation, contraction and retraction of larynx and closure of the glottis  Simultaneous and uncoordinated respiratory muscle spasm  vomiting www.indiandentalacademy.com
  95. 95. Extra oral  Excessive salivation  Lacrimation  Coughing  sweating www.indiandentalacademy.com
  96. 96. Causes of gagging  SYSTEMIC FACTORS  Psychological FACTORS  PHYSIOLOGIC FACTORS  IATROGENIC FACTORS www.indiandentalacademy.com
  97. 97. SYSTEMIC FACTORS  Deviated septum  Nasal polyps or sinusitis  Inflammation of pharynx  Chronic gastritis  Carcinoma of stomach  Peptic ulcer  Psychological FACTORS  Active  passive www.indiandentalacademy.com
  98. 98. PHYSIOLOGIC FACTORS  Extra oral stimuli  Visual  Auditory  Olfactory  Intraoral stimuli  Inadequate post-dam  Over-extended posterior borders  Disharmonious occlusion  Poor retention  Surface finish of acrylic resin  Inadequate free-way space www.indiandentalacademy.com
  99. 99. Management – Daniel J. conny and Lisa A. 1983; 49  Clinical techniques  Prosthodontic management  Pharmacologic measures  Psycho logic intervention www.indiandentalacademy.com
  100. 100. Clinical techniques  Surgical ( Leslie ):  Removal of uvula  Shortening of soft palate  Prosthodontic  Impression technique > BORKIN  Provides greater control of setting time  Discrepancies can be easily corrected www.indiandentalacademy.com
  101. 101. Technique  Primary impression > stock tray and red modeling compound  Secondary impression > by pouring “Kerr impression wax”  Flexible nature of the wax allows reseating of the tray and border molding until desirable results are obtained www.indiandentalacademy.com
  102. 102. Marble technique > SINGER  First visit :  Patient asked to place 5 marbles in his/her mouth > 1 at time at leisure  Further instructed to keep the marbles continuously for 1 week, except while sleeping and eating  Second visit :  Patients ability to tolerate the marbles was evaluated  Reassured that patient would be able to tolerate the denture www.indiandentalacademy.com
  103. 103.  Third visit :  Primary impression made  Special tray fabricated  Fourth visit :  Lower tray was inserted with 3 marbles in the mouth  Training bead placed on the lingual aspect of the tray to maintain proper tongue position  Fifth visit :  Use of marbles discontinued www.indiandentalacademy.com
  104. 104.  Sixth visit :  Fabrication of bite rims  Jaw relation  Seventh visit :  Wax – try in made  Eighth visit :  Final denture insertion  This technique admits patient motivation  Has definite risk in aspiration of marbles by the patient during the procedure www.indiandentalacademy.com
  105. 105.  Radiographic > RICHARD’S  use of high – speed film  Preset the timer  Moisten the film pack  Ask the patient to rinse in cool water  Psycho logic > LANDA  Engage the patient in conversation  Make the patient count rapidly from 50 – 100  Have the patient to read aloud www.indiandentalacademy.com
  106. 106. Prosthodontic management  Obtaining proper post – dam  Correcting over – extended borders  Correcting the occlusion  Proper retention  Mattel surface finish  Increasing the free – way space www.indiandentalacademy.com
  107. 107. Pharmacologic measures  Approached when clinical and prosthodontic measures are ineffective  Their efficacy, however is not universally accepted  Classification peripherally acting drugs centrally acting www.indiandentalacademy.com
  108. 108.  peripherally acting drugs  Topical and local anesthetics  Centrally acting drugs  Antihistamines  Sedatives and tranquilizers  Parasympathocytics  Central nervous system depressants Psycho logic intervention • Hypnosis • Behavioral therapy www.indiandentalacademy.com
  109. 109. RESIDUAL RIDGE REDUCTION  A term used for the diminished quality & quantity of the residual ridge after the teeth are removed.(GPT-7)  A continuous loss of the bone tissue after tooth extraction & placement of the complete denture  the reduction is the sequelae of alveolar remodeling due to altered functional stimulus of the bone tissue. www.indiandentalacademy.com
  110. 110.  Follows a chronic progressive & irreversible course that often results in severe impairment of prosthetic restoration & oral function.  First year after tooth extraction ,the reduction of the residual ridge in the midsagittal plane maxilla:2-3mm mandible:4-5mm  After healing remodeling takes place in decreased intensity www.indiandentalacademy.com
  111. 111. Etiological factors of reduction of residual ridges  Anatomical factors :  Short and square face associated with elevated masticatory forces  Alveoloplasty  Prosthodontic factors :  Intensive denture wearing  Unstable occlusal conditions  Metabolic and systemic factors :  Osteoporosis  Calcium and vitamin D deficiency www.indiandentalacademy.com
  112. 112. CONSEQUENCE OF RR REDUCTION  Apparent loss of sulcus width & depth  Displacement of muscle attachment  closer to the crest of the ridge  Loss of vertical dimension of occlusion www.indiandentalacademy.com
  113. 113.  reduction of lower facial height  Anterior rotation of mandible & increase in relative prognathism  Sharp, spiny, uneven residual ridge & location of mental foramina closer to the ridge www.indiandentalacademy.com
  114. 114. Treatment  Preprosthetic surgical initiation such as vestibuloplasties  Severe situations > ridge augmentation procedures www.indiandentalacademy.com
  115. 115. PREVENTVE MEASURES  Dietary / nutrition intervention, estrogen therapy when indicated, maintenance of teeth & placements of implants.  Supplement of calcium & vit D to reduce the rate of post extraction remodeling of RR in immediate denture wearers (Wical & Bruser 1979)  Retaining the tooth as for the over denture abutments.RRR was found to be 0.6mm in over denture wearers compared with 5mm in complete denture wearers( Crum & looney,1978).  Osseo integrated implants as abutment, reduces rate of resoption of RR than conventional complete denture( Sennerby et al 1988) www.indiandentalacademy.com
  116. 116. OVERDENTURE ABUTMENTS: CARIES & PERIODONTAL DISEASE  Wearing of over denture are often associated with high risk of caries & periodontal disease of the abutments when oral hygiene measures are not adequate. www.indiandentalacademy.com
  117. 117. Etiology  Bacterial colonization beneath the close fitting denture due to poor oral hygiene  Streptococcus and actinomyces > gingivitis and periodontitis  streptococcus mutans and lactobacilli > caries www.indiandentalacademy.com
  118. 118. Treatment  Maintain good oral hygiene  Motivate the patient with regular recall visits at 3 – 6 months intervals  Superficial caries > application of fluoride- chlorhexidine gel and polishing  Deep caries > placement of copings  Periodontal pockets greater than 4 to 5 mm > surgically eliminated www.indiandentalacademy.com
  119. 119. Indirect sequelae www.indiandentalacademy.com
  120. 120. Atrophy of masticatory muscles  Computed tomography study > masseter and medial pterygoid muscle demonstrated greater atrophy in complete denture wearers  Maximal bite forces tend to decrease in the old age.  Chewing efficiency decreases as the number of natural teeth is reduced.  Reduced bite force & chewing efficiency are sequelae caused by wearing the complete denture , resulting in impaired masticatory function www.indiandentalacademy.com
  121. 121. Diagnosis  Capacity to reduce the test food particles  It has been verified > chewing efficiency as the number of natural teeth is reduced  Worse for subjects wearing complete denture  Complete denture wearers need approximately 7 times more chewing strokes than subjects with natural dentition www.indiandentalacademy.com
  122. 122. Management  Retention of small number of teeth used as over denture abutments > role in maintaining the oral function  Completely edentulous patients > placement of implants www.indiandentalacademy.com
  123. 123. Nutritional deficiencies  Nutrition the science of how the body utilizes food to meet requirements for development, growth, repair and maintenance  Essential nutrients to maintain good health are  Carbohydrates  Fat  Protein  Vitamins  Minerals  Water www.indiandentalacademy.com
  124. 124. Nutritional deficiencies  Primary > faulty selection of food  Lack of knowledge what to eat  Fat diets  Poor food habits  Food like n dislikes  Poverty  Physical incapacities  Emotional prejudices www.indiandentalacademy.com
  125. 125.  Secondary> systemic disorders  Factors that interfere with food intake  Conditions that interfere with digestion  conditions that interfere with absorption  Factors that interfere with metabolism  Conditions that interfere with utilization  Factors that increases nutrition requirements  Factors that cause excessive excretion www.indiandentalacademy.com
  126. 126. Risk factors for malnutrition in patients with dentures  Eating less than two meals/day.  Difficult chewing and swallowing  Unplanned weight gain or loss of more than 10lb in the last 6 months.  Undergoing chemotherapy or radiation therapy.  Loose denture or sore spots under denture  Oral lesions(glossitis,cheliosis,or burning tongue)  Severely resorbed mandible  Alcohol or drug abuse www.indiandentalacademy.com
  127. 127. NUTRITION & THE DENTURE BEARING TISSUE Nutritional deficiency (Proteins, vitamin C & D, Ca) Alveolar ridge resorption Thin friable mucosa ILL-Fitting denture Poor force tolerances www.indiandentalacademy.com
  128. 128. ALCOHOLISM, SMOKING & DENTURE Decrease in food intake Multiple nutrient def Dehydration (Vit B & C) Thinning of oral mucosa Friable oral mucosa Abrasion of the denture bearing mucosa www.indiandentalacademy.com
  129. 129. NUTRITION & OVER DENTURE Cariogenic diet Ca++ deficiency Vit A & C def Caries of abutment Ridge resorption Poor periodontal health Failure of abutment FAILURE OF OVER DENTURE www.indiandentalacademy.com
  130. 130. Providing nutrition care for denture wearing patients  Obtain a nutrition history and an accurate record of food intake over a 3-5 day period or complete a food frequency form  Evaluate the diet: assess nutritional risk  Teach about the components of a diet that will support the oral musosa,bone health, and total body health  Help patient establish goals to improve the diet  Follow-up to support patient in efforts to change food behaviors. www.indiandentalacademy.com
  131. 131. Dietary counseling for Denture wearers  Diet for the first day after denture insertion :  liquid diet www.indiandentalacademy.com
  132. 132.  Diet for the 2nd and 3rd day after denture insertion: Pureed diet to soft diet  Diet for the fourth day and later: Soft diet to regular diet as tolerated www.indiandentalacademy.com
  133. 133. CONTROL OF SEQUELAE WITH USE OF COMPLETE DENTURES  Every effort should be made to retain some teeth in good positions to serve as over denture abutments.  Proper patient education & good oral hygiene practices.  Patient should be motivated to practice proper denture wearing habits.  Patients wearing complete dentures should follow a regular control schedule at yearly intervals so that acceptable fit & stable occlusal condition to be maintained.  Patients wearing over dentures should follow a program of recall & maintenance for continuous monitoring of the denture and the oral tissues www.indiandentalacademy.com
  134. 134. REFERENCE  Prosthodontic treatment for edentulous patients-BOUCHER.  Essentials of complete denture prosthodontics-WINKLER.  Textbook of complete denture-HEARTWELL.  Complete denture-sharry.  Problems & solution in complete denture prosthodontics-DAVID J.LAMB.  Clinical dental prosthetics-FENN.  Principles & practise of complete denture-IWAO.  Prosthodontics for elderly-BUDTZ-JORGENSEN.  Txtbook of oral pathology-SHAFER.  Oral lesions of interest to prosthodontics JPD1961.  Oral conditions associated with dentures JPD 1958.  Trouble shooting in CD prosthesis JPD 1960.  Candida associated denture stomatitis Aus DJ 1998. www.indiandentalacademy.com
  135. 135. For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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