Prosthodontic management of systemic disorders

1. Dr Ayesha Sadaf
HOD Prosthodontic Department / Associate Prof/Consultant Shifa
International Hospital
Shifa College of dentistry Islamabad

2.  Oral Health & Systemic health are inter-related
 Evaluation and consideration of overall health status prior to dental treatment
 Essential part of comprehensive health care system and better prognosis for
dental treatment
 Effect of un managed systemic disease on prosthodontic patients

3.  Direct or Indirect effects on oral tissue
 Drug interactions
 Immune system compromise
 Bacteremia
 Sensory and motor disturbances
 Decrease in patients’ tolerance to prosthodontic treatment
 Decrease in motivation towards oral health
 Regression towards invasive procedures
 Change in oral cavity which can effect treatment planning and prosthetic
procedures.

4. 8.50%
10.60%
24.80%
2.50%
1.30%
6.14%
0.63%
45.50%
Diabetes mellitus Chronic Kidney
Disorder
anemia leukemia Hyperthyroidism CVD Dementias tooth decay
Prevalence of systemic disorders in population Refrences
1. WHO global
report on DM
2. Hill NR et-all,
Plos one
2016;11:1-18
3. WHO
global(2015)
report on
anemia
4. World cancer
research
Journal
2018;5:1-7
5. Nature Reviews
Endocrinology
2018;14:1-16
6. JACC
2017;70:1-25
7. Lancet
Neurology
2019;18:88-106
8. WHO GOHSR

5. with systemic disease
65%
without systemic
disease
35%
A Survey of 4365 dental patients JADA 1979
with systemic disease
without systemic disease
with multiple
systemic
disorders
50%
with one systemic
disorder
50%
Multiple disorders prevalence in dental patients
with multiple systemic disorders with one systemic disorder

6.  At the end of this session student would be able to
 Identify various systemic disorders which affect oral cavity/ Prosthodontic
treatment
 Understand the affect of systemic disorders on prognosis of complete denture
treatment
 Apply the knowledge for prosthodontic management of systemic disorders

7. Removable Prosthodontics is not easy

8. Denture
market=
Age specific
population. x
Age specific
edentulism. x
10 year declining trend
towards edentulism x
Percent
utilization of
dentures
“Will there be a need of complete dentures in united states in 2020? “
By douglas et al, paper presented at greater new York meeting in 2002

9. AGE
 A GERIATRIC PATIENT WOULD BE HAVING POOR MUSCULAR CONTROL
 SYSTEMIC DISEASES + MEDICATIONS SIDE EFFECTS LIKE
XEROSTOMIA
 MORE RIDGE RESORPTION= INADEQUATE RIDGE SUPPORT
 HIGH EXPECTATIONS IN ELDERLY

10. GENDER
Male and Female will have different aesthetic and functional
requirements
Menopausal females have difficulty in adapatation to
dentures as compare to male due to harmonal changes
during and after menopause

11. The medical
evaluation of
patients seeking
prosthodontic
treatment is a vital
step in treatment
planning.

12. Bony
Disorders
Endocrinal
Disorders
Blood borne
disorders
Cvs disorders Autoimmune
disorders
Osteo
Arthritis
Diabetes
Mellitus
Anemia Hypertension/
angina
Sjogrens
Syndrome
Rheumatoid
Arthritis
Thyroid
disorders
Leukemia Myocardial
Infarction
Lupus
Ertheramatos
us
Osteoporosis Thrombocytop
enia
????

13. Systemic signs & symptoms Oral signs & Symptoms.
1. Polydipsia,
2. PolyUria
3. Polyphagia
1. Xerostomia
2. Tooth decay
4. Severe Fatigue 3. Fungal infection
4. Candidiais
5. Joint swelling
6. Increased blood/urine glucose
4. Periodontal Problems
5. Rapid Bone resorption
6.Mouth Ulcers
7. Taste Disturbances

14. Diabetes mellitus xerostomia • Affects retention
• Soreness+ulcers
• Denture stomatitis
Change in osmotic balance
leads to change in mucosal
surface

15.  Hypogycemia / Hyperglycemia
 Frequent Ulcerations
 Xerostomia
 Denture stomatitis
 Compromised Retention ?????????

16. RETENTION
SUPPOR
T
STABILIT
Y
THE GOLDEN TRIANGLE
An accurate record of the denture bearing tissues is needed to produce well supported, stable &
retentive dentures

17.  A thorough Medical History including drugs and prescriptions to bring at the day
of appointment
 Stress Reduction Protocoal.
 Morning and short appointments
 Eradication of any oral diseases
 Oral cavity should be in a healthy state prior to prosthodontic treatment

18.  Mucostatic / Selective pressure impression technique
 Simple hygienic designs
 Supragingival margins
 Minimal trauma from occlusion
 Salivary Reservoirs

20. Osteoporosis/Arthiritis Rapid bone resorption Knife edge ridges

22.  Mucostatic / Minimal impression technique
 Minimal trauma from occlusion
 Simple and self cleansable designs of prosthesis
 Frequent use of denture cleansers
 Meticulous maintenance of denture hygiene.

23. • Compromised
muscular Control

25. Neuromuscular
disorders
• Poor denture
control
• Lack of
retention
Lack of
stability

26.  Saliva pooling during impression taking , increased risk of impression choking.
 Poor muscular control
 Irregular muscle movements

27.  A thorough medical history
 Muscular examination
 Tmj examination
 Consultation with patients physician regarding drugs
 Mucostatic impression technique
 Minimal trauma from occlusion
 Simple designs
 Implant supported prosthesis are preferred

28.  Xerostomia
 Painful ulcers
 Limited mouth opening
 Impaired oral hygiene maintenance

29.  Sectioned impression trays/ Sectional Impressions
 Use of corticosteroid and antimicrobial therapy
 Simple design
 Less mucosal coverage
 Implant supported prosthesis

32.  Increased risk of medical emergencies
 Xerostomia
 Gingival enlargement
 Mucosal Ulceration
 Lichen planus
 Mucosal Ulceration

33.  A thorough Medical History including drugs and prescriptions to bring at the day of
appointment
 Stress Reduction Protocoal Non- Pharmacological ( Anxiolytics)/ Sedation
 Morning and short appointments
 BP Monitoring Throught long appointments
 Eradication of any oral diseases Prior taking impressions
 Oral cavity should be in a healthy state prior to prosthodontic treatment

34.  Salivary subsitutes
 Denture adhesives
 Polished dentures
 Salivary Reservoirs
 Meticulous maintenance of denture hygiene

35.  Impaired bone maturation & development in long term anemic patient
 Repeated Ulcertions
 Patients show disrupted & delayed healing
 Long time needed for implant osteointegration
 Progressive loading of implants to be followed
 Care needs to be observed while administrating pre and post OP antibiotics.

36.  Uncontrolled proliferation & release of immature blood cells
 Non irritating removable PD or CD can be used if patient maintains good oral
hygiene
 FPD with supra gingival finish lines recommended
 Implants are contraindicated in such patients:
 increased bleeding
 delayed healing
 risk of secondary infection
 Post OP discomfort

37.  Usually presents with
 Immunosuppression
 Polypharmacy
 Renal Osteodystrophy
 Bone loss
 Restriction of oral fluid intake
 May produce premature tooth loss and xerostomia
 All prosthodontic problems should be treated before “transplant”
 If implants are to be placed after transplant, postpone till health stabilizes and
transplant is accepted by the body
 Patients may have osteodystrophy while leads to bone demineralization and can cause
the bone to fracture after dental procedures. Treatment should be carefully monitored

38.  Hemodialysis patients:
 Implant surgery to be done 1 day after hemodialysis
 Long term implant stability should be measured using frequent radiographs
 Gingival enlargement
 In normal, crown and implant tooth is a common occurrence in patients who take
calcium channel blockers.
 Proper periodontal maintenance is necessary to avoid gingival enlargement
 Screw retained implant prosthesis are recommended for ease in maintainance