post insertion and review

Question 1

How do you take a history of the past week?

Answer 1

Start with- I bet it’s been a tough week for you
Listen
Be sympathetic

Question 2

What problems are encountered?

Answer 2

Pain/ulcers
Insecurity (looseness)
Chewing
Speech
Appearance 
Nausea

Question 3

Why might pain occur?

Answer 3

At periphery of denture bearing tissues- over extensions

Centrally on denture bearing tissue- occlusal problems or fitting surface errors

Cheek or lip biting- neutral zone

Numbness- inadequate FWS

Question 4

What are some common sites of pain?

Answer 4

Mylohyoid bone region (disto-lingual region)
‘Pain under tongue’
Use mirror to retract tongue

Hamular notch
‘Not sure if upper or lower denture’

Post dam/junction of hard/soft palate
‘back of mouth, difficult to swallow’

Around frenal attachments
- due to poor border moulding

Genial tubercles in atrophic mandibles
- due to mucosa being trapped

Lower labial region
-poor retraction of lower lip in secondary impression stage

Question 5

What is a pick up technique?

Answer 5

1. Dry surface of denture/ulcerated mucosa
2. Mark ulcer w ZnO or dycal paste
3. Transfer to denture
4. Adjust denture accordingly

Question 6

What is PSI?

Answer 6

Pressure spot indicator paste

Can pick up multitude of problems

Question 7

What is central pain?

Answer 7

No ulcer
Palpate ridge and gradually move along
Ask patient to lift hand when they feel pain
Place cream on area and transfer onto denture

Question 8

Why might cheek biting problems occur?

Answer 8

Check buccal fat pads
Often due to 7s or teeth not being in neutral zone (too far buccally)

There should be a slight space in retromolar region- should be anticipated in try in stage, better to leave out 7s

Question 9

Why might numbness/shooting pain occur?

Answer 9

Inadequate FWS, teeth constantly in contact, creating load and pressure over mental nerves
Associated w numbness of lips

Question 10

Why might tongue biting occur?

Answer 10

Teeth placed too far lingually or tongue cramping

Question 11

What is a clue to lack of FWS?

Answer 11

Generalised tenderness along whole ridge

Lower ridge often tender to palpate and erythematous (red)

Question 12

Why might a patient have TMJ or facial muscle pain?

Answer 12

Almost always FWS or occlusal problem
Does patient sleep w dentures in?
Check for general redness, palpate for tenderness
Often no discernible ulcers

Question 13

What should be expected of the insecurity of dentures?

Answer 13

Maxillary- should eventually fit firmly

Mandibular- may never get tight fit due to anatomy

Question 14

How should you investigate insecurity?

Answer 14

Ask when it occurs

Speaking- muscle interference at periphery/frenal attachment/muscle interference of polished surfaces (shape eg. convex)

Eating- occlusal interference (RCP not equal to ICP)/poor lower ridge form (can’t do much)

Question 15

Why might there be a maxillary insecurity?

Answer 15

Usually posterior border
Due to under extensions
Small bead (autopolymerised acrylic) can be added to make a functional post dam- sets in mouth
Removed prior full setting to be trimmed w scalpel

Question 16

Why might there be a mandibular insecurity?

Answer 16

~overextension of denture base
~lingual inclination of posterior teeth- cusps can be removed for tongue space
~occlusal discrepancies
~errors in placement of lower anterior teeth- outside of neutral zone

Question 17

Why might the patient have chewing or eating problems?

Answer 17

Occlusal discrepancy- RCP not equal to ICP/incorrect OFH

Locked occlusion- worn dentures may be replaced by steep cusps

Question 18

What is a precentric check record?

Answer 18

Uses wax/silicone
Guide patient into centric relation
Ask patient to stop when first tooth to tooth contact
Many operational errors

Question 19

What is Gothic arch tracing?

Answer 19

1. Upper- plate attached to denture using sticky wax
   Coat GAT plate w crayon
   Lower- stylus is mounted in same way
2. Placed in mouth, patient asked to slide forward/back and side to side etc, arrow shape occurs, tip of arrow signifies centric relation
3. Sticky wax is used to secure a circular disc w a hole in it over the centric relation position
4. The lower denture is placed back in mouth, stylus is manipulated so it locks into the hole
5. Position captured with bite registration paste and denture is taken out

This can be remounted onto an articulator and can be accurately adjusted

Question 20

Why might the patient have speech problems?

Answer 20

Tooth position
Shape of base
Lack of FWS

Excessive acrylic behind upper anteriors, palatal cusps of 4s too bulky, lingually tilted lower posteriors

Question 21

Why might a patient have an issue w the appearance?

Answer 21

Complaint about position, shade, size and shape

Complaint about soft tissues and the way they’re supported

Question 22

Why might a patient have nausea?

Answer 22

Patient never worn a denture before
Post dam region extended palatally for better suction
Thick posterior margin
Insecurity when talking- dropping onto tongue

Training plates may be needed- if can’t handle, they won’t handle so may need 3-3 (smaller denture)

Question 23

Why might the patient have ulcers on labial and lingual surface- opposing side of ridge?

Answer 23

Patient was putting bonjela on overextending denture and sleeping with it in
Bonjela contains salicylic acid (component of aspirin)- causes burning