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Narvacan, Eunice M.

DDM-II Prostho 3 - Complete Dentures

Patient Education and Complete Denture Maintenance

PATIENT EDUCATION Help create a positive attitude by informing the patient about the special problems associated with wearing complete dentures, advising the patient on ways to overcome or compensate for these problems, informing the patient of proper oral and denture hygiene and warning the patient about drugstore dentistry Should establish the patients, as well as dentists, responsibility in complete denture service Thorough patient education program o Begin with the initial patient visit and interwoven throughout denture construction

PHASES OF PATIENT EDUCATION PROGRAM 1. FIRST PHASE Primarily verbal in nature Px should be encouraged to actively discuss any questions or misunderstandings Before denture insertion, Px expectations are probed carefully aligned with the expected result 2. SECOND PHASE Consists of a written summary of the expected problems and hygiene recommendation Complete Patient Education should include the following: 1) Nature of complete dentures 2) First oral feelings 3) Problem of excess saliva 4) Speech accommodation 5) Eating suggestions 6) Proper tongue position 7) Importance of tissue health 8) Warnings about over-the-counter denture products 9) Danger of do-it-yourself dentistry 10) Proper cleaning of complete dentures

1. NATURE OF COMPLETE DENTURES o First Concept to be discussed RETENTION o The dentist should point out that natural teeth have roots that are surrounded by bone o A denture sits on wet, slippery mucosa

o The patient should be active in this discussion and allowed to voice his or her conclusions o It should be pointed out that natural teeth and their embedded roots form an effective arrangement for the mastication of tough foods o Denture rests on bone with a delicate layer of mucosa between the denture base and the bone o Patients with natural tooth have an average biting force of 22kg (45lbs.) of force; have an acute proprioceptive system; able to detect minute variations in movement, as well as differences in sizes, location & texture o Patients with dentures are limited to approximately 7kg (14lbs.) of biting force; have lost their tooth guidance mechanism Comparisons should not be made to discourage the denture patient but to give him or her understanding of the physical and mechanical disadvantages that are present with complete dentures Complete dentures are not substitute for natural teeth, but only a prosthetic solution for no teeth Dentist must stress to the patient that these problems are insurmountable, but can overcome with patience, determination and skill Patient must be able to wear and to function with complete dentures; responsibility for denture success must be shared 2. FIRST ORAL FEELINGS Moment of insertion moment of truth for the patient Oral perception o Patients stereognostic ability o Notorious for EXAGGERATION Allow patient to view him/herself help assure the patient and counteract the patients overwhelming oral feelings forewarned that they will experience a temporary feeling of fullness 2 Reasons for this o First, the dentist wants to take advantage as much as tissue area as possible to aid in stabilization, retention, and the distribution of chewing forces o Second, any small changes in denture contour are perceived by the mouth as bulk Reassure patient that this fullness disappears with familiarization 3. EXCESS SALIVA New dentures interpreted as food by the oral sensory system leads to a stimulation of the salivary glands to produce saliva If salivary flow is excessive Px complain of floating dentures and a general excess of watery saliva normal reaction to new dentures and will slowly decrease over the next few weeks Deglutition necessary to evacuate the excess saliva & Px should be advised that compulsive rinsing or spitting should be avoided 4. SPEECH Distorted speech owing to the initial feelings of bulk and the accompanying excess of saliva; formation of the sibilant sounds Fluency of speech may also be affected; Px speaking becomes clumsy and uncoordinated during rapid conversations

5. EATING Each Px has its own food test Ability to eat a thick steak mark a good dentures Attempts result in soreness and frustration Patients o advised masticatory efficiency of their new dentures must be slowly developed and refined o Limit themselves to soft foods or crispy foods that are easily comminuted o Avoid tough, resistant foods that will overtax the capacity of their residual ridges o Liquid or powder foods supplements should be prescribed How to eat with dentures is more methodical than with natural teeth o Divide normal forkful of food in half and place each half posteriorly and bilaterally o Posteriorly placing the food in the area of the first molar increases the power of the masticatory stroke and places the occlusal load over the primary bearing area o Bilaterally aids in stabilization of the denture bases by distributing the force of mastication to both sides of the residual ridge; counteracts the potential tipping of the denture base Up and down chewing stroke helps to minimize lateral thrusts and stabilizes the mandibular denture base Factors uncontrolled by the dentists o Age o Degree of alveolar Resorption o Motivation o Natural coordination But dentist can bolster perseverance, encourage motivation and guide the Px through many complete denture problems with a careful education program 6. TOUNGUE POSITION Loose mandibular denture most common complaint of CD 3 handicaps associated with all mandibular dentures o First although the area of the mandibular denture basal seat is approximately one-third the areas of the maxillary denture, both are subjected to the same occlusal loads and thrusts o Second mandibular denture is surrounded lingually as well as buccally by muscles, all of w/c have a potential for denture base disruption o Third mandibular denture depends on proper position to maintain adequate peripheral seal and stability Determining normal tongue position and abnormal tongue position ask the Px to open the mouth wide enough to accept food o Dorsal surface of the tongue and occlusal surfaces of the teeth Tongue is in intimate contact with the lingual surface of the denture and the floor of the mouth is at a normal level mandibular denture should be stable and able to resist a gentle push on the mandibular incisors o Occlusal surface of the teeth, lingual surface of the denture and the anterior floor of the mouth

Tongue is in retracted position denture will be unstable, have no retention, and will easily be dislodged by a gentle push on the mandibular incisors denture is loose and it floats Diagnosis of a retracted tongue position (difficult Tx) o First step make the Px aware of the importance of tongue position o Second step demonstrate proper tongue position and the subsequent increase in denture retention and stability while the Px looks in the mirror; Px must practice opening and closing while the tongue assumes normal position No denture adjustment or relining procedure will not correct tongue movement and speech 7. MAINTAINING TISSUE HEALTH 3 Factors involved in the maintenance of healthy edentulous oral tissue o Adequate tissue rest o Proper nutrition o Cleaning of oral tissues Removing max and man dentures before sleeping o Provides a convenient time for soaking the dentures in a cleaning solution o Allows oral tissues to rest Adequate rest offset the daily stress placed upon them by denture wearing Px advised that the oral tissues were never intended to be covered or to support a hard denture base All occlusal forces are compressive to the soft tissues to recover from these forces may result in increased soreness and irritation Px Clench and Brux powerful movements that can severely damage the underlying foundation Cleaning and stimulation of the oral mucosa often neglected facet of tissue health; gentle brushing of the residual ridge with a soft polished tip toothbrush removes plaque and food debris and stimulates local circulation; followed by a vigorous rinsing with mouthwash or saline solution reduce the bacterial and fungal count and refresh the mouth 8. Over-the-Counter Denture Products all too often patients will come into the dental office after having prolonged the wearing of an ill-fitting denture by home relining, home repairing, or excessive use of an adhesive powder or paste Px, in their frustrations to cope with ill-fitting or unstable dentures, have turned to the drugstore self instead of securing professional help from their dentist What denture wearer would not like a plate so tight you can tackle the toughest foods or instant relief from rocking dentures and sore gums? The dentist views these claims as absurd, but Px sees a thread of hope in such treatment Manufacturer of these over-the-counter miracles are not going to inform the Px of the potential dangers of wearing ill-fitting dentures o Potential Danger of Do-It-Yourself Prosthetics Supported by the findings of Means study can induce or perpetuate pathologic changes in the oral tissues Induration and inflammation most common tissue change Acute reactions range from erythema to frank ulceration

Chronic reactions chronic inflammation leads to severe bone Resorption Most serious sequel to develop chronic denture irritation to oral mucosa carcinoma *create a dangerous discrepancy in the position of the denture increase vertical dimension and horizontal relationship of the denture leads to malocclusion o Home Repairs and Self-Adjustments Denture repair kits are available to Px 4 Basic Types of Denture Repairs a. A repair of an anterior tooth/teeth most benign repair b. A repair involving a posterior tooth/teeth c. A repair of a fractures denture flange most dangerous repair d. A repair of a fractured denture base most dangerous repair 9. DENTURE ADHESIVES Use of denture adhesive widespread among complete denture patients; according to Woelfel all denture adhesives occupies space More viscous adhesive pastes because of their reduced flow characteristics, produce greater errors in vertical dimension and denture positioning then do the finely ground powders It is recommended that if a patient finds it necessary to temporarily enhance the retention of the denture, that an adhesive powder be lightly sprinkled over the wetted tissue surface of the denture base 10. ANALGESIC OINTMENTS Increase the vertical dimension of the dentures and alter the proper positioning and subsequent occlusion of the prosthesis Small applications should be thinly spread over the area of the denture that corresponds to the mucosal soreness PROPER CLEANING OF COMPLETE DENTURES Many patients leave the dental office uninformed on how to properly care for their complete dentures Many patients learn to clean their dentures from news media advertisements Dental profession should make specific recommendations on the proper and hygiene care of oral prostheses 1. CHEMICAL CLEANING AGENTS **Effective Commercial Preparations 1 tablespoon (15cc) Sodium hypochlorite provides a bleaching when used in this conc. does not affect the color stability of the resin denture base or teeth; weak sodium hypochlorite also an effective germicidal agent 1 teaspoon (4cc) Calgon a weak softener; provides a detergent action that effectively softens and loosens deposits ***encourage patients to brush the dentures with a soft brush under running water after chemical soaking 4 Ounces (114cc) Water ***to effectively remove calculus, overnight soaking with 4 ounces white vinegar is recommended

***White vinegar provides safe concentration of acetic acid w/c decalcifies calculus deposits 2. CLEANING OF SOFT LINING MATERIAL Color changes, internal porosities, surface roughness and loss of resiliency after 2 weeks of normal daily soaking in commercial cleaner ***RECOMMENDED CLEANING PROCEDURE : i. gentle washing under cold running water with soft cotton; ii. external surface may be brushed in the normal matter; iii. if the denture is left out overnight it should be stored in plain water with the teeth down iv. denture should rest on teeth, not on the denture border 3. MECHANICAL CLEANING Use of brush, soap or cleaner and water very popular method of cleaning complete dentures; can lead to damaging abrasion if too stiff a brush or too harsh a cleaner is used. When recommending a cleaning program, Px should be given a soft denture brush and warned against using a toothbrush and toothpaste Gentle brushing with a soft denture brush and a nonabrasive detergent is an effective cleaning method, especially when combined with overnight soaking good for dentures and oral tissues Sonic Cleaners a relatively new denture accessory employ vibratory energy to clean the dentures Myers and Krol reported that the sonic-action denture cleaner was effective in removing calculus in a variety of cleaning situations Effective in helping to remove cigarette and coffee stains Nicholsom, Stark & Scott also demonstrated that the sonic-action cleaner and sodium hypochlorite solution were more effective than sodium hypochlorite solution alone ***Regardless of the method the Px choose to clean their dentures, it is important that it becomes a daily habit. The dentists responsibility is to inform the patient and to motivate the patient to form this daily routine. The following points may be offered to patients: 1. Daily cleaning of dentures removes the bacterial growth that forms on denture surfaces. These bacterial plaques are capable of acid formation and subsequent tissue irritation. 2. Daily Cleaning prevents stain and calculus build-up. 3. Unhygienic dentures can be a major cause of offensive mouth odor. 4. Vigorous oral irrigation and gentle brushing is not only stimulating and refreshing but promotes good tissue health. If the dentist can effectively communicate these ideas to his Px he will be promoting better oral health standards for denture wearers, increased denture comfort and personal acceptance.