Instructions to a complete denture Patient

| January 18, 2012 | 0 Comments

Instructions to a complete denture Patient

Limitations of Dentures
– Dentures are less efficient than natural teeth
– Some people can eat all foods easily, but these are the exception
– Generally the better the ridge form, the less problems are encountered. Patients with minimal ridges should be advised that their dentures will likely move (especially the mandibular) and their efficiency will therefore be reduced
– Patients with minimal ridges will likely encounter more sore spots than others
– It is wise to point out these limitations to patients prior to the delivery appointment so that it is viewed as an explanation, rather than an excuse
Adaptation to Dentures
– Because new dentures have usually been changed in some respects to the old dentures (otherwise there would be no need for new dentures), it will take time to adapt to them
– Studies show that it may take 6 to 8 weeks for patients to become optimally adapted to new prostheses (explain to patients)
– Adaptability is reduced in complete denture wearers because proprioceptors of the periodontal ligament have been lost and large areas of mucosal proprioceptors are covered in acrylic
– Adaptability is affected by:

1. Length of time wearing dentures
2. Amount of residual ridge remaining
3. Degree of changes made in new dentures
4. Individual variation (e.g. patients with more acute oral sensory perception have more difficulty adapting)

Adaptation to Chewing may be affected if:

1. CO has been changed to coincide to CR
2. Tooth positions (esp. incisors) have changed
3. Vertical dimension has changed

These patients may experience initial decreased efficiency, cheek or lip biting.

Adaptation may be improved by initially eating soft foods, increasing to hard foods, cutting food into smaller pieces, and placing food towards the corners of the mouth. Adaptation may be accompanied by an initial, transitory increase in saliva. Patients should be advised of the need to persevere while their neuromusculature adapts to the new prostheses.

Speaking may be affected by changes in:
1. Tooth position (esp. anteriors)
2. Tongue space (particularly if patients have been without dentures for some time)
3. Palatal contours
Initial speaking problems are usually transitory, since the tongue is very adaptable – tooth positions must be close at delivery, however).

Appearance may be changed in some individuals. These changes are usually due to:
1. Increasing length of incisors (worn)
2. Changes in vertical dimension
3. Improved lip support (not help with wrinkles)
In most instances these changes in appearance will be beneficial and not of concern to the patient. However, it may be of concern if appearance is radically changed. Patients may require reassurance during the period of adjustment to their new appearance.
Oral Hygiene
– Affects plaque retention, inflammation, fit and infections
– Provide proper instructions and demonstration
– Disclosing solution can be used to demonstrate plaque adherence for patients

a. Dentures:
– Brushing has been shown to be most effective method to remove plaque:
– Use non-abrasive cleanser (commercial pastes, dish detergents, not regular toothpaste)
– Patients are usually not vigorous enough around the denture tooth/base junctions
– Use soft brush with long bristles (less wear)
– Inner and outer surfaces must be cleaned
– Brush over a filled basin or face cloth (protection against damage if dropped)
– Brush after every meal, before bed

Chemical cleaners:
– Efferdent, Polident etc. must be used overnight to be effective (15-30 minutes is not
– Brushing is more effective (60-80% vs 20-30% plaque removal compared to soaking alone)
– Combine brushing with soaking for more efficiency
Ultrasonic cleaners:
– True ultrasonic cleaners work well
– “Sonic” cleaners are not effective without chemical cleaner (brushing is more effective)

b. Mucosa:
– Remove dentures at night
– Brush mucosa with a soft tooth brush and warm tap water, massage all of the tissue –
this will improve health for the next denture
– Stimulates tissue
– Alternatively use face cloth (less convenient, more pleasant feel, less plaque removed)

Continuing Care
– Most patients and many dentists don’t schedule yearly denture recall appointments
– Easier to correct small problems, wear, fractures, resorption, reinforce hygiene, etc.
– Can do something small – improved patient rapport
– Denture life expectancy is 5-7 years, but if tissues change, remakes may be required sooner
– It is better for dentures to wear out rather than the denture bearing tissues

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Category: Prosthodontics, WIKI

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