Intro and patient assessment Flashcards
Which patients are more prone to be edentate?
- Older population
- Compounding effects of co-morbidities
What are the limitation of complete dentures?
Functional – smile, eat, drink, etc
Aesthetic
Feedback
What is the history taken for a complete denture assessment?
Presenting complaint/Reason for attendance
- Paying attention to what the patient is saying at this stage is important it will start to guide your thoughts on the diagnosis and prognosis
HPC
- Write in patient’s own words
- Denture patients speak a different language (“I have a mouth full of marbles)
Denture history
Medical history
Social history
When carrying out an extra oral exam on a denture patient what would you observe?
Considering this at the outset as much of what you identify you will do so whilst talking to the patient and taking the history
- Look at the lip support, any asymmetry
- Skeletal profile – whilst this is not an absolute indication for the relationship of the teeth it is useful to note
- Soft tissue support
- Face height
- Biological age vs chronological age
As you are talking with the patient – notice how much of the denture teeth are visible – at rest, during speech, when smiling –visible at all?
Listen to the speech - phonetics
When carrying out an intra oral exam on a denture patient what would you observe?
Do both WITH and WITHOUT denture!
Look and feel
- Any abnormalities
- Describe the ridge form – height, firmness, irregularity, mobility, sulci
- Limiting anatomy –bony exostoses, tori – undercuts
- Muscle attachments - frenal attachments,
- Line where previous denture
Sulcal depth – functional depth
What about saliva? – Worth noting
What to record when assessing the denture?
Ask patient to reinsert their dentures and gently open only a few mm
- Record what you see: do the dentures stay in place, are the maxillary dentures displaced vertically (i.e. drop down), is there any visible displacement of the mandibular denture
Retention is the capacity of the denture to resist displacement away from the tissues
- Assess the vertical displacement (attempt to remove the dentures along their long axis)
Stability is the capacity of the dentures to resist movement whilst in contact with the tissues
- This can be checked by applying lateral finger pressure to the dentures and looking for any movement (rocking or rotational movement)
Do the dentures move when the patient speaks
- Look
- Attempt to displace along the vertical axis and by attempting to tip anteriorly
Tactile feedback is important when assessing dentures
How is the base extension of the denture ill fitted?
Is there a gap?
Does it displace easily in function when moving the cheeks around the sulcus can mean the denture is over extended
Can the denture be moved by border moulding
Look closely at the areas causing displacement
Look at the base extensions in relation to the frenal attachments
When recording dental occlusion what is the RCP and ICP?
Retruded contact position
Intercuspal position
What should you look at on the dentures in relation to the occlusal contacts?
Even or worn, look at lateral and protrusive movements
How to assess occlusal plane against reference points?
- Incisal plane measured against the interpupillary line
- Antero-posterior plane measured against the alar-tragal line
- A Foxs bite plane will help measure these
What do you need to be looking for when assessing or reviewing implants supported overdentures (ISODs)?
- Specifically for the implants need to complete a 6-point periodontal chart NOT a BPE
- Will need to assess whether the inserts for locator abutments need changing
- Radiographs may be needed but this will be will based on clinical assessment
Why are ISODs good fitting dentures?
ISODs gain retention and stability from implant attachments located within the fitting surface of the denture
When should treatment be carried out?
All treatment should be based on a diagnosis – shouldn’t be completing treatment without a diagnosis
What is the prognosis of a patient?
- Aligning patient expectations and your own
- Do the best you can but know when you have done all you can
When making dentures for a patient what would be good to consider before hand about their previous dentures?
- Consider previous successful or unsuccessful denture wear
- Number of sets of teeth may be useful to consider after assessing the current set of dentures
