1 Complete Removable Prosthodontics 12-7-2009 Sequelae of Denture earin! 1. Remember: the borders on the denture need to be rounded a.

If you leave it thin it will be sharp like a razor blade 2. Residual Ridge Resorption a. A physiologic process after teeth e tracted i. !he bone"s reaction to the denture is to disappear b. A variable process# dependent upon individual forces i. It depends on that individual patient and that individual denture ii. $ome people believe the process is inevitable and we can"t do anything about it iii. %thers believe that we not only can slow it down but we can stop it# we &ust don"t know how yet '. %ne method for slowing down the residual ridge resorption a. (e have discussed many methods to achieve this )probably 1* or 1+, i. %verdenture abutments ii. -inimize the resorption using the $nowshoe .rinciple / placing the denture on as much area as possible iii. %cclusion iv. !ooth location v. .utting the teeth somewhere other than where they came from vi. 0aving the anterior teeth out of contact 1. %verdentures a. !here are many options to affi the denture to the roots of the remaining teeth or to implants i. 2 ample: 2RA attachments or 3le i4overdenture b. If using implants you can cast a bar that will attach to all of them )typically ' or 1 implants, and then the denture will screw into that bar / I believe it is called a 0ater bar +. $e5uelae: -ucosal 6esions a. !raumatic 7lcers b. Inflammatory .apillary 0yperplasia c. Angular 8heilitis )aka 9perleche:, d. ;enture $tomatitis< ;enture $ore -outh e. 3ibrous 0yperplasia<2pulis 3issuratum f. 8andida albicans =. !raumatic 7lcers a. 8ommon with new dentures i. !hese are painful lesions b. If generalized on crest of ridge / suspect occlusal discrepancies i. 2very time the patient tries to bite or chew the denture tor5ues c. If in vestibule# suspect overe tended or sharp border >. Inflammatory .apillary 0yperplasia 9I.0: a. A reactive tissue growth usually developing under a denture i. It is because the patient wears the denture both day and night ii. !his is asymptomatic / so the patient does not feel it b. %ccurs on hard palate beneath denture base i. ?ot on the soft palate ii. If it has been there long enough it may migrate out to the crest of the ridge also )but it will start up in the palate, @. I.0 a. Asymptomatic red or pink nodules on mucosa of hard palate and occasionally the residual ridge i. 9.ebbly: b. ;irectly related to constant wearing of ill4fitting denture and poor oral hygiene c. 8andida fre5uently present i. -any people believe that it is caused by 8andida

2 ii. %ther articles have shown that it is not caused by 8andida but that 8andida is present 1. !he 8andida is there because the patient is constantly wearing the denture I.0 !reatment a. Remove denture at least @ hours<day# clean dentures well b. Reline# rebase or remake dentures for better fit c. R possible ?ystatin or other antifungals d. $mall nodules often improve with removal of denture e. If it has been there for years it will need surgery because it has collagen in it i. !he surgery will hurt Angular 8heilitis 4 about 1+B of denture wearers a. Inflammation of lips<lips with redness and fissures radiating from angles of mouth b. Candida albicans fungal infection c. ;ecreased %C; and vitamin deficiencies may contribute# but usually see poor4fitting denture and abused tissue i. !here are ' types: 1. !here is one form in institutionalized children with bad nutrition 2. !here is a form in alcoholics who are deficient in vitamins like Riboflavin and other D vitamins a. !hey were able to induce this in patients by making their diet deficient in Riboflavin '. !he last type occurs in patients with a decreased %C;# usually from a bad denture a. -ore than one thing can be going on / it could be a bad denture and riboflavin deficiency d. ! : antifungals E ?ystatin# Cioform cream# better denture Angular 8heilitis a. Red# fissured irritations at corners of mouth b. Associated with loss of %C; and Candida albicans and S. aureus ;enture $tomatitis a. 8hronic inflammation of denture4bearing mucosa b. -ay or may not be painful c. RednessF possible burning sensation d. 8ause uncertain: poor oral hygieneG 214hr wearG e. ! : tissue rest# improve oral hygiene# resilient liner in denture 9;enture $ore -outh: a. Dizarre symptoms: may be itching# may be burning# may be pain b. Cisual clinical signs often absent c. 8ause: may be metabolic# may be nutritional or psychologic d. ! : symptomaticE refer to physician for systemic evaluation i. 7sually seen in elderly patients so other things probably going onE 1. Dad diet 2. Immunocompromised '. ;eath in the family 3ibrous 0yperplasia<2pulis 3issuratum a. AHA Inflammatory 3ibrous 0yperplasia or ;enture 0yperplasia i. !here is a microscopic tension on the bone and on the tissue# the skin begins to enlarge itself in response to that b. $ingle or multiple fold)s, of hyperplastic tissue in vestibule c. Associated with the flange of an ill4fitting denture or flange is sharp<unpolished i. It may also be digging into the vestibule right there ii. Also asymptomatic 2pilus 3issuratum a. 7sually seen on facial<buccal b. .ronounced female predeliction / reason unclear E more denture wearingG i. -ore females wear dentures than males and they wear their dentures for longer periods of time

A.

1*.

11. 12.

1'.

11.

1+.

3 1=. 2pilus 3issuratum !reatment a. $horten denture border b. %ften re5uire surgical correction c. Reline# rebase# or remake dentures i. Iou really need smooth and round borders ii. If it is too thin you will really have to shorten it to make it anything but sharp 1>. 8andida / a yeast4like fungus a. A common oral microbe b. .redisposing conditions: 0IC )immunocompromised,# diabetes# )elderly, 1@. If you have calculus on one side of the denture but no calculus on the other side what causes thatG a. -alocclusion / it is in Jarb"s te t book