Pathology related to denture

Question 1

What is a very common problem with ill fitting dentures?

Answer 1

• Associated with heterogenous group of oral mucosal lesions
• Often due to
  - acute or chronic reactions to microbial plaque
  
  • Mechanical denture injury
  • Reaction to constituents of denture base materials

Question 2

What pathological changes can be seen with dentures?

Answer 2

• Ulcers
• Denture stomatitis
• Angular chelitis
• Denture induced hyperplasia
• Flabby ridges
• MRONJ/osteoradionecrosis
• Allergic reactions

Question 3

What are most ulcers due to in regard to dentures?

Answer 3

• Denture trauma leading to hyperkeratosis
• Ill fitting denture can lead to hyperplasia
• Usually due to overextension, sharp bits on denture, pressing too hard in one place, occlusal trauma

Question 4

Where are the most common sites for ulceration from dentures?

Answer 4

• Lingual fraenum
• Mylohyoid ridge
• Undercuts

Question 5

When you see an ulcer in the mouth you think is due to denture what is included in you clinical exam?

Answer 5

• Identify with pressure indicating paste or articulating paper
• Ease via occlusal adjustment, trimming or polishing base with acrylic bur
• Review in 2-3 weeks to see if ulcers has subsided

Question 6

When would you refer an ulcer via the urgent referral pathway?

Answer 6

• Non healing ulcer despite adjustments
• Suspicious lesion (hard etc)
• Unexplained ulceration or unexplained swelling/induration of oral mucosa persisting for >3 weeks
• Urgent referral to Max-FAc

Question 7

What clinically do we see in denture stomatitis?
What organism causes it?
What is the management?

Answer 7

• Oedema and erythema related to denture bearing area
• Often denture hygiene issue
• Due to candida albicans

Management
- Take denture out at night , clean with soft brush, steep denture, can use chlorhexidine but can cause staining
- Nystatin or miconozole antifungal
- new denture if poorly fitting

• Consider underlying issue e.g. diabetes, folate, B12 , ferriitn

Question 8

Why might angular cheilits occur?

Answer 8

• Overclosure due to old and ill fitting denture
• Gives loss of OVD, excessive FWS
• Need to replace dentures and give miconazole topical
• Xerostomia from pts meds may also contirbute
• Consider underlying issue; diabtes , folate , B12 , ferrtin, xerostomia

Question 9

What bacteria associated with angular cheilits?

Answer 9

• Candida albicans
• Staph.aureus
• Beta haemolytic streps

Question 10

What is the management of denture induced hyperplasia?

Answer 10

• Often due to old fitting dentures via chronic truama and hypeprlastic response
• Major ease of denture
• Use tissue conditioner like coe comfort
• Review and repeat until tissue shrinks and then can make new denture
• may need to refer to oral surgery to cut excess tissue but very rare

Question 11

Why do flabby ridges usually occur?
What does it cause?

Answer 11

• Trauma of denture hitting usually anterior ridge often when lower anteriors only present and no lower denture
• Causes bone resorption and fibrous replacement resorption

Question 12

What is the management of flabby ridges?

Answer 12

• New denture covering whole denture bearing area with good peripheral seal
• Also need opposing arch denture giving posterior support
• Occasionally need special impression techniques

Question 13

What can an ill fitting denture potentially cause in pts takign anti-restorative medications?
What can you do?

Answer 13

• Can be a factor to MRONJ or ORN
• See pts for reg oral health checks , prevention by well fitting dentures
• Refer promptly to max fac if diagnosis MRONJ or ORN as per SDCEP guidelines

Question 14

What is another diagnosis for denture stomatitis?
What denture is this usually seen in?

Answer 14

• Allergic reaction but very rare
• Erythema on denture bearing area
• Can also occur on lips and cheeks
• Occurs usually with Nickel containing Co/Cr or PMMA esp self cure relines as they have higher monomer