Denture related oral pathology

Question 1

What is the aetiology of the mouth?

Answer 1

Trauma
    - Physical/chemical
    - Chronic/acute
Infection
Autoimmune
Neoplasia (new growth - cancer)

Question 2

Name 3 examples of traumatic aetiology.

Answer 2

Traumatic ulcer
Inflammatory hyperplasia (denture granuloma)
- Callus of the mouth
(Extreme alveolar atrophy)

Question 3

How can a traumatic ulcer form in a patient with dentures?

Answer 3

Overextension of flange
Sequestration of bony spicule (Necrotic bone that works its way through the gingiva)
Rough fitting surface
Foreign body beneath denture (fruit pip)

Question 4

How do you manage a traumatic ulcer?

Answer 4

Correction of underlying cause
Review
If no resolution consider referral
Be suspicious!! (if stays over 2 weeks)!!

Question 5

How can a proliferative inflammatory rolled margin form?

Answer 5

By over-wearing dentures when gum trying to heal from traumatic ulcers

Question 6

How is denture granuloma treated?

Answer 6

• Relieve affected area
• Encourage patient to leave denture out
• Surgery rarely indicated

Question 7

What is a leaf fibroma?

Answer 7

Pink, fibrous, pedunculated lesions that have been flattened against the palate by a denture

Question 8

How is extreme alveolar atrophy described in appearance? and how does it affect the denture?

Answer 8

Flabby ridge

As it is flabby, the tissue is mobile and the denture therefore is also mobile

Question 9

What infective bacteria predominantly affects the mouth?

Answer 9

Candida Albicans

Question 10

Who is affected by acute pseudomembranous candidiasis?

Answer 10

5% newborns
10% elderly debilitated
AIDS

Question 11

Who is affected by acute atrophic candidiasis?

Answer 11

Patients with prolonged steroid or br spectrum antibiotics (antibiotic sore mouth)

Question 12

What develops from chronic hyperplastic candidiasis?

Answer 12

Candida leukoplakia

Question 13

What percentage of denture patients suffer from Chronic Atrophic Candidosis-Denture Induced Stomatitis (DIS)?

Answer 13

24-60%

Question 14

What do females suffer from Chronic Atrophic Candidosis-Denture Induced Stomatitis (DIS) more than men?

Answer 14

Females don’t take them out at night as much and bacteria grows

Question 15

What are the symptoms of Females don’t take them out at night as much and bacteria grows?

Answer 15

Frequently symptomless, but, mucosal bleeding, swelling, burning, halitosis, unpleasant taste, dryness

Is on the palatal mucosa

Question 16

Describe the 3 types of Frequently symptomless, but,

Mucosal bleeding, swelling, burning, halitosis, unpleasant taste, dryness.

Answer 16

Type I
-Pin point hyperaemia and diffuse inflammation (limited area)
Type II
-Diffuse erythema of most of the denture bearing area
Type III
-Granular inflammation or inflammatory papillary hyperplasia

Question 17

What is the aetiology of DIS?

Answer 17

• Xerostomia
• Poor host defences
• Candida albicans
• Continuous denture wear
• Denture plaque
• Denture trauma

Saliva; reduces adherence of c.albicans
Low (acidic pH) favours colonisation of candida species. Low pH observed in denture plaque in patients with sucrose or glucose rich diets.
Denture plaque (bacteria) may contribute to colonisation.
Defects in cellular immune system predispose as T-cell and macrophage mediated activation of the immune system is critical. Malnutrition in association with high carbohydrate diets, iron, folate, B12 def), hypoedocrine states, diabetes, blood disorders e.g. leukemia, HIV

Question 18

What are other predisposing factors of DIS?

Answer 18

Malnutrition
   - Fe deficiency, excess CHO
Oral antibiotics
   - In the presence of inflammation
Hormonal imbalance
   - Tolerance of the oral tissues trauma decreased

Question 19

How is DIS managed?

Answer 19

• Denture hygiene advice
• Leave dentures out at night
• Tissue conditioners
• Correction of denture faults
• Diet advice
• Microwave dentures
• Antifungal agents
• Type II/III – topical use best
  
  • -> Miconazole Oral Gel (DAKTARIN) - 2% gel, TDS, 14 days
  • -> (Nystatin or amphotericin B)
  • -> Fluconazole Capsules (DIFLUCAN) - 50mg/day, 7-14 days
• Systemic anti-fungals
  
  • -> Fluconazole Capsules (DIFLUCAN) - 50mg/day, 7-14 days
  • -> Amphotericin B

Question 20

How should dentures be washed?

Answer 20

• Can easily use a soft nail brush and soap
• Can use sterilising solution (steradent/milton) but can be complex and expensive
• No toothpaste as it is too abrasive
• Put towel or water into sink so denture doesn’t break

Question 21

What are the side effects of Amphotericin B?

Answer 21

Nausea, vomiting, diarrhoea, plus renal, bone marrow, cardiovascular or neurological toxicity

Question 22

Who are more prone to DIS?

Answer 22

“The disease of the diseased”

• Elderly
• Frail
• Prone to opportunistic infections
• Social considerations

Question 23

If there is an allergy to the denture base with a positive patch test what alternative materials can be used?

Answer 23

Pro-flex (vinyl)