Patient Management in Pros

Question 1

what part of the brain controls retching?

Answer 1

higher centres in the medulla oblongata

Question 1

what is retching?

Answer 1

an involuntary contraction of the muscles of the soft palate or pharynx- it is a physiological mechanism

Question 2

what are the two types of retching?

Answer 2

psychogenic - may occur by sight, smell or sound of a dental surgery or thought

somatic- touching trigger zones, commonly palatoglossal and palatopharyngeal folds, base of tongue, palate, uvula, posterior pharyngeal wall

Question 3

how can a retching pt affect treatment in prosthodontics?

Answer 3

-impression taking
- jaw reg
-toleration of dentures
-denture retention due to recede post dam

Question 4

how do you manage a retching pt?

Answer 4

-identification of problem
- identify trigger zones
-anxiety reduction
- patience and empathy

Question 5

how would you distract a pt in order to attempt to reduce retching?

Answer 5

• talk to pt
• gen pt to concentrate on keeping their leg raised/wiggle toes
  -get pt to press or tap their temple
• put salt on tongue
  -ask pt to close eyes
  -rinse mouth with very cold water just before treatment

Question 6

how would you attempt desensitisation for a pt in order to help with retching?

Answer 6

repeated brushing or stroking anterior palate or tongue with finger/toothbrush
homework for the pt
ask pt to practice swallowing with their mouth open

Question 7

what modifications of impression taking can. you make to aide a retching pt?

Answer 7

modify stock tray with acrylic bur
use lower tray in upper arch
modify special tray (palatal reduction)
rapid setting impression material

Question 8

what modifications can you make to a denture to aid a retching pt?

Answer 8

-shortened dental arch
- use bridge or implant instead
- horseshoe palate
- buccal bar connector rather than lingual
-use CoCr rather than acrylic
-use of a training plate
-consider no 2nd molars
-palate not too thick
- cusps of posterior teeth may need rounded so do not stimulate dorsum of tongue

Question 9

what is the suggested % of patients who are dissatisfied with dentures?

Answer 9

10-30%

Question 10

what is the main cause of patient dissatisfaction for dentures?

Answer 10

retention and stability
usually the lower denture

Question 11

name causes of patient dissatisfaction of dentures other than retention and stability

Answer 11

-reduced self esteem
-aesthetic expectations unmet
-decreased chewing efficiency
-pt unaware of their anatomic limitations

Question 12

what is the best way to manage a patient’s expectations for a denture?

Answer 12

explain the intended treatment and possible problems BEFORE commencing treatment

Question 13

what % of communication is non-verbal?

Answer 13

55%