Boucher's prosthodontic treatment for edentulous patients. 10th Ed. George A. Zarb, Charles L. Bolender, Judson C. Hickey, Gunnar E. Carlsson, editors. BOUCHER's PROSTHODONTIC TREATMENT FOR EDENTULOUS PATIENTS. edited by J. C. Hickey and G. A. Zarb St. Louis. J. N. E. Connor · Search for more . Boucher's Prosthodontic Treatment for Edentulous Patients book. Read reviews from world's largest community for readers. This text has enjoyed a distingu.
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Book by Boucher, Carl O., Hickey, Judson C., Zarb, George A. Download Best Book Boucher's Prosthodontic Treatment for Edentulous Patients. Get this from a library! Boucher's prosthodontic treatment for edentulous patients.. [George A Zarb; Charles L Bolender; Gunnar E Carlsson; Carl O Boucher;]. Prosthodontic Treatment for Edentulous Patient 13 - Ebook download as PDF File .pdf), Text File .txt) or Download as PDF, TXT or read online from Scribd . This text is dedicated to the memory of Carl O. Boucher and Judson Hickey.
Since become maladaptive in the end. Nevertheless, we assert esthetic experience. In fact, it must be admitted that that this approach is clearly neither realistic nor the field of complete denture prosthodontic desirable for all patients because traditional com- research has been characterized by a lack of plete denture therapy has compellingly already methodological rigor in developing treatment out- proven its merits.
We also remain convinced that come measures. As a result, practical, useful results the clinical skills and judgment required to make from studies involving presumed determinants of complete dentures are essential to the osseointegra- prosthetic success underscore the unpredictability tion technique.
They are the two sides of the same of the complete denture service. Choosing the best form of therapy is not always thetic dentitions with endosseous anchorage went a clear-cut selection. The clinical decision should through numerous pioneering efforts. Biological, functional, per- research on the technique of osseointegration.
In sonality, and fiscal considerations may preclude the Toronto Conference on Tissue Integrated one option or the other. Admittedly, the complete Prostheses introduced the concept of inducing a denture option lends itself to more frequent appli- controlled interfacial osteogenesis between dental cation than a fixed implant-supported prosthetic implant and host bone to the dental academic com- one, with costs being a major determinant of patient munity.
The ability to safely locate alloplastic tooth choice. Complete dentures or Functional esthetic and B. Implant-supported overdentures or perceptual consequences C. Implant-supported fixed prosthesis that are encountered on a time-dependent and I. With a current history of B or C maladaptive denture-wearing experience Treatment choice is influenced by both patient and dentist-mediated concerns. Functional and esthetic requirements are better Osseointegration has ushered in a new scien- achieved and maintained, with the risk of time- tific era for the management of edentulous patients.
Zarb This ebook is uploaded by dentalebooks. Some authors actu- 2. Predictions from several surveys regarding a ally argue that tooth loss does not bear even a close healthy elderly population indicate that a high relationship to the prevalence of dental disease. Although the latter viewpoint is probably equally Therefore the effective demand for prosthetic inaccurate, research has demonstrated that several care for this population is likely to increase.
The impact of longevity on edentulism has not tal attendance, and characteristics of the health care been fully ascertained. Clinical experience sug- system play an important role in the decision to gests that the cumulative consequences of bio- become edentulous. In addition, a significant rela- logical and chronological aging will likely tionship exists between the edentulous state and confront dentists with a significant increase in fiscal concerns usually associated with low occu- the number of difficult edentulous mouths that pational levels.
It is therefore reasonable to con- require treatment. The heterogeneous etiology of edentulism has Most patients regard tooth loss as mutilation and been tackled on several worldwide fronts by the as a strong incentive to seek dental care for the dental profession, resulting in a reported decrease preservation of a healthy dentition and socially in the numbers of edentulous persons.
More recent acceptable appearance. Dentists, on the other reviews of tooth loss and edentulism in various hand, also regard tooth loss as posing the addi- parts of North American and European countries tional hazard of an even greater mutilation: the predict that treatment of patients with complete destruction of part of the facial skeleton with the dentures will continue to decline in the future while accompanying distortion of soft tissue shape, the needs for partial tooth replacement will likely together with varying degrees of functional dis- increase in the short term see Chapter 3.
Although these observations may suggest the need The edentulous state represents a compromise for a reduced dental educational commitment to in the integrity of the masticatory system. It is treatment of edentulous patients, some very com- frequently accompanied by adverse functional pelling points must be underscored: and esthetic sequelae, which are varyingly per- ceived by the affected patient.
Perceptions of the 1. Documented evidence reveals that despite pro- edentulous state may range from feelings of jections of declining edentulism, the unmet inconvenience to feelings of severe handicap 6 Chapter 2 Biomechanics of the Edentulous State 7 A B C D Figure Three female patients—young in A and B, middle-aged in C and D, elderly in E and F—whose edentulous state is reflected in a range of circumoral changes that are more overt as a result of both chronological and biological aging determinants.
Note the effect of well-designed dentures on varying degrees of recovery of soft tissue support with pleasing esthetic treatment outcomes.
Consequently, the lous state demands a comparison of the mecha- required treatment addresses a range of biome- nisms of both natural teeth and complete denture chanical problems that involve a wide range of support Figure The masticatory apparatus is involved in the This text seeks to provide an understanding of trituration of food.
Direct responsibility for this the effects of the edentulous condition and to task falls on the teeth and their supporting tissues. The suc- NATURAL DENTITION cess of this modification is indicated by the fact The natural or prosthetic dentition and its support- that it appears to have been rapidly adopted ing mechanism are the most visible and frequently throughout the many different groups of emerging managed parts of the masticatory system.
The mas- Mammalia. Teeth function properly only if ade- ticatory system is made up of closely related mor- quately supported, and this support is provided by phological, functional, and behavioral components.
It allows Chapter 2 Biomechanics of the Edentulous State 9 Functions and parafunctions physiological occlusal forces is their intermittent, rhythmic, and dynamic nature. Each mechanism of support thrust is of short duration, and for most people, chewing is restricted to short periods during the day.
Deglutition, on the other hand, occurs about Edentulous state without times a day, and tooth contacts during swal- a periodontal ligament lowing are usually of longer duration than those mechanism of support occurring during chewing. Loads of a lower order but longer duration are produced throughout the day by the tongue and circumoral musculature. Estimates of peak forces from the Figure Possible interactions among the various tongue, cheeks, and lips have been made, and lin- components of the masticatory system in the context of gual force appears to exceed buccolabial force dur- a change in the mechanism of occlusal support.
During rest or inactive periods, the total forces may be of similar magnitude. During mastication, biting forces are transmit- the teeth to adjust their position when under stress. These forces increase sues cementum and bone and soft connective steadily depending on the nature of the food frag- tissues the periodontal ligament and the lamina ment , reach a peak, and abruptly return to zero.
The periodontium is regarded as a thrusts differ among persons and depend on the functional unit and is attached to the dentin by consistency of the food, the point in the chewing cementum and to the jawbone by the alveolar sequence, and the dental status.
The direction of the process. The periodontal ligament and the lamina forces is principally perpendicular to the occlusal propria maintain continuity between these two hard plane in normal function, but the forward angula- tissue components. Upper to the bone that supports it. The two principal func- incisors may be displaced labially with each biting tions of the periodontium are support and posi- thrust, and these tooth movements probably cause tional adjustment of the tooth, together with the proximal wear facets to develop.
The patient who needs complete denture only during the functional movements of chewing therapy is deprived of periodontal support, and the and deglutition and during the movements associ- entire mechanism of functional load transmission ated with parafunction i. It has been calculated that the total time during The occlusal forces exerted on the teeth are which the teeth are subjected to functional forces of controlled by the neuromuscular mechanisms of mastication and deglutition during an entire day the masticatory system.
Reflex mechanisms with amounts to approximately Through normal function, the periodontal struc- Therefore the total time and the range of forces tures in a healthy dentition undergo characteristic seem to be well within the tolerance level of mechanical stress. The most prominent feature of healthy periodontal tissues. It happens usually, mandibular glands, are complicated further by the but not exclusively, in women after menopause, and biochemical interactions of multiple medications is discovered frequently when an older person Wu et al.
It has primary tion treatment also cause dry mouth. Food may and secondary forms that are difficult to diagnose. A change in the quality of saliva might obvious reason. Actually, the Type II form can not be obvious clinically, but it should be suspected develop as a consequence of any disease, such as as a cause of denture intolerance when a patient is hyperparathyroidism, and induce bone loss.
Management of Residual ridge resorption may be a manifestation hyposalivation is difficult, but recent evidence indi- of primary Type I osteoporosis, but there is very lit- cates that secretion of mucous saliva from the tle evidence to show that the two conditions are palate improves measurably after drinking 2 L of associated Esteves, Estrogen replacement water, when chewing or exercising vigorously, or therapy, bisphosphonates, or other systemic treat- when taking estrogen or pilocarpine Niedermeier ments for osteoporosis do affect the density and et al.
People chew more slowly as they get older. Although the duration of the total chewing cycle does not appear to change, it does seem that the Saliva vertical displacement of the mandible is shortened The role of saliva as a lubricant and as a chemical Karlsson and Carlsson, Movements of the buffer is central to the comfort and function of the mandible are governed by a generator in the brain mouth.
The electrolytes, glycoproteins, and stem influenced by proprioceptors in muscles, enzymes of mucous saliva lubricate, cleanse, and joints, and mucosa. Advancing age may delay the protect the mucosa, and they ease the passage of central processing of nerve impulses, impede the food around the mouth while contributing to the activity of striated muscle fibers, and inhibit sense of taste.
Inadequate quality or quantity of decisions. It can also reduce the number of func- saliva is particularly difficult for complete denture tional motor units and fast muscle fibers, and wearers because mucous saliva produced by the decrease the cross-sectional area of the masseter minor glands of the palatal helps to retain and and medial pterygoid muscles Newton et al.
We do not know whether the Consequently, older people tend to have poor quantity or quality of saliva in healthy individuals motor coordination and weak muscles. Older persons also have a less coordinated mended daily allowances for the various vitamins, chewing stroke close to maximum intercuspation, minerals, fats, carbohydrates, and proteins are probably because of a general deficit in the central probably inaccurate because most of the data on nervous system, and some individuals who assume intake of specific nutrients have been estimated for the characteristic stoop of old age experience pain young adults.
Nevertheless, the elderly population on swallowing because of osteophytes and spurs is at particular risk for malnutrition because of a growing on the upper spine adjacent to the phar- variety of factors that range from socioeconomic ynx.
A noticeable change in swallowing strongly stress to an overconsumption of drugs, and includ- suggests that there might be an underlying patho- ing, to some extent, the state of the dentition. Some edentulous per- in isolation, but results from the interaction of pro- sons with faulty dentures restrict themselves to a prioception, taste, and smell.
Texture is felt, chem- soft diet high in fermentable carbohydrates, ical constituents stimulate taste, and aromatic gases whereas others, even with uncomfortable and well- smell.
Bitter, sweet, sour, and salty tastes stimulate worn dentures, can eat nearly all of the food avail- receptors independently, so one may be damaged able to them Millwood and Heath, A recent without disturbing the others. Olfactory cells send population-based study in the United Kingdom projections directly to the brain so they can be trau- found that edentulous older persons, compared matized anywhere along the way.
Also, the preference for specific Sheiham and Steele, The three cranial nerves VI, IX, The scars of a lifetime are revealed dramatically on and X carrying sensations of taste can be dis- the skin as wrinkles, puffiness, and pigmentations, turbed and damaged by tumors, viruses e.
The leathery look characteristic of the older sun worshipper is caused by epidermal growths with large melanocytes—solar lentigines— NUTRITION that thicken in the epidermis. Gradually the dermis There is some evidence, largely from animal stud- thins, enzymes dissolve collagen and elastin, and ies, that diet influences longevity and aging, with wrinkles appear when layers of fat are lost. The relationship between diet and pro- upper lip, and it flattens the philtrum. The longed life in human beings is complex and, as yet, nasolabial grooves deepen, which produces a sag- inadequately explained.
Currently, the recom- ging look to the middle third of the face, whereas. Of course, much, if not more, than at any other stage of life. Unfortunately, the respect afforded occasionally to older people can be diminished by feelings of Teeth social rejection and physical collapse compounded The color of healthy, natural teeth ranges in hue by the stigma of inadequate dentures Goffman, from yellow to orange, with large variation in The chroma, and occasionally the hue, will plastic surgery and esthetic dentistry, and the pop- change as the enamel is abraded, exposing the ularity of the keep-fit industry, attest to a wide- underlying dentine to extrinsic stains.
Concealment of age has heavy metals. Ultimately, natural teeth take on the become a preoccupation of the Western world, a jagged brownish appearance of an aging dentition fixation that seems to disturb women more directly when the incisal edges break and the exposed den- than men.
The aging woman is considered unat- tine gathers extrinsic stains. It is not always easy to tractive and judged, even by other women, more reproduce this rugged appearance in artificial harshly than the aging man, whereas women in teeth.
Apparently, we admire clinician has a rational rather than a distorted view those who do not have to cover up their defects. Consequently, men are more furtive than women about seeking improvements to their appearance.
Furthermore, age concealment is acceptable for SUMMARY oneself but not for others, a clear indication that The need for complete dentures in the Western there are double standards operating on the public world will increase over the next quarter of a cen- image.
Healthy older persons fre- rary society. Management of edentulous elderly quently admit that they try hard to feel and look patients involves a constant sensitivity to the poten- young. A healthy person will accept the natural tial impact of a multitude of medical disorders.
For age Nicholson and Ballance, Unusual example, the edentulous mouth can suffer from a requests for alterations to appearance should be very painful attack of shingles involving sensory managed with caution and related directly to the nerves of the face, neck, and trunk, or display angu- psychosocial status of the patient. Indeed, expecta- lar cheilitis with a denture-induced stomatitis usu- tions that seem to be in any way unrealistic, partic- ally without symptoms.
Wounds heal more slowly ularly if the patient is depressed or deluded, should and possibly less effectively in old age because of be offered a very guarded prognosis. Actually, a decreased turnover of cells or poor blood circula- marked discrepancy between the assessment of the tion. Consequently, the mucosa and underlying clinician and the patient offers a valuable diagnos- bone supporting complete dentures heal more tic clue to a problem, assuming of course that the slowly from the trauma of ill-fitting dentures.
Publishing Service. Feldman HA. In Stephens T. MacEntee MI: Dentistry and distributive justice. MacEntee MI. Int Dent J Miller AJ. Spec Care Dent Stolar E: Systemic problems.
Life at MacEntee MI. National Oral Health Survey Australia Oral health and access to den- tal care— and Brown LJ. Bull Health and Human Services. The prevalence of edentulism and diseases related to dentures: Ainamo A.
Jette AM. Lakowski R: An instrumental colour analysis of ease patterns and treatment needs in the Scandinavian pop. Health Affairs J Dent Res Illness narratives: Sociol Health Illn Gerodontol Clinics Millwood J. Englewood Cliffs. Heath MR: Food choice by older people: Hill PM. Health and Welfare Canada. Burt BA: Epidemiology of dental diseases in the elderly. Main PA. Local inflammation of the Douglass CW. Goffman E: J Oral Rehabil 8: Mojon P. Shih A. Ostry L: Will there be a need for com- alveolar mucosa is caused usually by unhygienic plete dentures in the United States in Minister of Supply and Mojon P.
Olshan AF. Graham DF editors: Berkowitz J. Joshi A. J Public Health Dent Hussey PS: Community Dent Oral Epidemiol McGuire SM.
Soc Sci Med 55 4: Marcus SE. Locker D: Oral health status and treat- identity embedded visibly but inconspicuously in ment needs of Canadian adults aged 85 years and over. New dentures are not accepted easily by older Esteves APZ: The relationship between systemic metabolism patients.
Local Government and Community Services. Schoenbach VJ. Brunelle JA. Health Policy Bureau. Australian Government problems before attending to the design of den. Arbes SJ Jr. J Prosthet Dent and structurally defective dentures and can be cor. Mersel A: Prevalence of caries and of United States adults: Drury TF.
McKinlay JB: Oral health sta- quently complicated by inappropriate use of pre. Zion GR: Tooth retention and Symons MJ: Factors contributing to the poorer survival of tooth loss in the permanent dentition of adults: United black Americans diagnosed with oral cancer United States. Wong G. Stolar E. Fox CH. Changing demographic and oral dis. US Dept. Tennstedt SL. Slade GD. Journals of Gerontol British Columbia.
The University of dentures. Prentice Hall. J Oral Rehabil hallmark of successful aging. Glick N. Carlsson GE: Characteristics of mandibular masti- Overall. Glick N: Predicting concerns for oral health among institutional- References ized elders. Oral Dis 4: Carlos JP.
Ministry of Health and Welfare: Report on the survey of dental Charette A: Dental health. Karlsson S. The influence of age on the among industrialized countries.
Bury M. Nihtila A. Discrepancy between need for prostho- Services Canada. Oral health Bourgeois D. Caplan DJ. Anderson GF. Social inequality in Canada: United States. Guppy N. Meyer C. Steele JG: Geriatric oral health issues in the United College Cork. Newton JP. Gerodontics 3: Groome PA. Skarsgard DP. Lader D: Adult dental health United Kingdom.
Clinics Ship JA: Cross- quate intake in older adults. Wu AJ. Steele J: Does the condition of the mouth and teeth affect the ability to eat certain foods. Muller N. Sen A: Development as freedom. Sheiham A. Fox PC. Yemm R. Clinic Oral Investigat 5: Whelton H. Geriatric Med 8: Geriatric oral health issues in Germany. Hospital Med London Robertson EM.
Public Health Nutrition 4: Rhodus NL. Ballance E: Anorexia nervosa in later life: Hall SF. Hector MP: Significance of saliva for the denture. In Curtis J. Oxford Journals of Gerontol Fischer D. General and oral aspects of osteoporosis: Matthaeus C. Prentice-Hall Canada Inc. Schuler Todd JE. Holowaty EJ: Cancers of National Council of Welfare: Poverty in Canada. Niedermeier W. Brinninger A. Oral health Nicholson SD. Atkinson JC. Diepgen T. Brown J: The association of xerostomia and inade. Sonies BC: Oropharyngeal dysphagia in the elderly.
Fartasch M. J Amer Dietic Assoc Beier K. Oral Health Services Research Unit. Abel RW. Baum BJ. Changes in Statistics Canada: Canadian Statistics: The People: Huber M. Nutrition and chemosensory perception in the eld. Cancer Zhou S. Mackillop WJ. Rothwell D.
Gerodontol University Press. University Walls AWG. Dixon PF. On the con. There are several aspects of the interaction microbial antigens. Mucosal environment due to bacterial plaque may consti- reactions could result from a mechanical irritation tute an important cofactor in this process. The matter is further complicated by the may affect plaque formation on the prosthesis. For instance. The continuous wearing of dentures may often it is difficult to establish a definite causal have a negative effect on residual ridge form relationship because mechanical irritation or because of bone resorption.
Placement of a removable prosthesis in the oral The presence of different types of dental cavity produces profound changes of the oral envi. Thus a ing the surface area exposed to microbial colo. In the interface between a prosthesis and the trary. Most material. This makes it difficult to dis- cle function and nutritional status. Section guished. In the randomized popu- lations. Microbial plaque on the fitting denture tion. In the following sections.
Thus the infection prevails in type I or type II Figure Type III often is seen in association with cavity Box The colonization of the fitting denture surface by Candida species depends on several factors. This indi- Type II An erythematous or generalized simple cates that Candida residing on the fitting surface of type seen as more diffuse erythema involving a part the denture is the primary source of the infection. It is likely that bacteria.
Type I palatal epithelial cells. The pathogenicity of denture plaque can be enhanced by factors stimulating yeast propagation. The more important factors that can mod- ulate the host-parasite relationship and increase the susceptibility to Candida-associated denture stom- Figure Type II denture stomatitis showing ery.
Diagnosis The diagnosis of Candida-associated denture stomatitis is confirmed by the finding of mycelia or pseudohyphae in a direct smear or the isolation of Candida species in high numbers from Figure Pinpoint hyperemia. Type III A granular type inflammatory Etiology and Predisposing Factors The direct papillary hyperplasia commonly involving the predisposing factor for Candida-associated denture central part of the hard palate and the alveolar stomatitis is the presence of the dentures in the oral ridges.
The often relative association of Candida-associated denture stomatitis with angular cheilitis or glossitis indicates a spread of the infection from the denture- covered mucosa to the angles of the mouth or the tongue. In addi- because other causal factors exist such as bacterial tion.
Erythema of the soft palate. Median rhomboid glossitis. Type III denture stomatitis. Diffuse atrophic glossitis. Angular cheilitis. Evidence supports that unclean dentures and shows micropits and microporosities that harbor poor hygiene care are major predisposing factors microorganisms that are difficult to remove mechan- because healing of the lesions is often seen after ically or by chemical cleansing. Nutritional deficiencies iron.
Dentures changes in environmental condi. Systemic Factors that this infection results from local or systemic pre- Old age disposing conditions such as overclosure of the jaws. It must be Malignancies acute leukemia. Diabetes mellitus nutritional deficiencies.
Although denture stomatitis and angular cheili- tions. It seems. Culture on Oriculty: Broad-spectrum antibiotics Smoking tobacco Management and Preventive Measures Because of the diverse possible origins of denture stomati-. Angular cheilitis is often correlated to the pres- Factors Predisposing to ence of Candida-associated stomatitis.
Smear from the fitting denture surface yielded pseudomycelium. According to meticulous oral and denture hygiene is instituted. The patient should be instructed be used mainly in the following patients: In patients after the clinical diagnosis has been mucosa in contact with the denture should be kept confirmed by a mycological examination.
In patients with an increased risk of systemic dentures often may cause trauma because they are mycotic infections due to debilitating diseases. A new denture should be provided only resistance of Candida species to the latter drugs when the mucosa has healed and the patient is able to occurs regularly. In patients with associated burning sensations with recurrent infections should be persuaded not to from the oral mucosa.
Rough areas on the fitting surface should be smoothed or relined with a soft tissue conditioner. The 1. Treatment with antifungal agents should ence of the denture. Polishing or glazing of the tissue surface 2. The patient should be instructed in meticulous oral and denture hygiene. Treatment with antifungals should continue for venting colonization of the dentures by microor. There is no substantial evidence that harmless commercial denture cleansers are efficient in pre.
Local therapy with nystatin. Antifungal drugs could be used to remove The most important therapeutic and preventive Candida albicans residing on oral mucosa and the measures are the institution of efficient oral and den.
In patients in whom the infection has spread to exposed to air. In addition to suggesting appropriate antifungal treat- Figure Candida-associated denture stomatitis ment. There is evidence nosis and treatment of more serious and underlying of thrush on the hard palate. When lozenges are prescribed. The 4. This could prefer- ably be achieved with cryosurgery. Patients 2. Surgical elimination of deep crypt formations in type III denture stomatitis usually is a prerequisite for effective mucosal hygiene.
For a reduction in the risk of relapse. Traumatic Ulcers Traumatic ulcers or sore spots most commonly develop within 1 to 2 days after placement of new Denture Irritation Hyperplasia dentures.
If lym- situation with extreme atrophy of the maxillary phadenopathy is present. The lesions alveolar ridge is due to replacement of bone by may be single or quite numerous and are com- fibrous tissue. The proliferation mucosa to mechanical irritation are predisposing of tissue may take place relatively quickly after e.
Results of histological and histochemical studies the inflammation and edema may subside and pro- have shown marked fibrosis. The direct cause is usually Figure Flabby ridges After surgical excision of the tissue and replacement provide poor support for the denture.
Indeed the resilient ridge may provide some retention for the denture. Conditions that suppress resistance of the overextended denture flanges. After replacement or adjustment of the dentures. Flabby Ridge placement of new dentures and is normally not Flabby ridge i. It is seen most commonly in the posed of flaps of hyperplastic connective tissue.
After only a 2-week treatment with amphotericin B lozenges. The ulcers are small and painful lesions. Type III denture stomatitis showing modular hyperplasia with severe inflammation. When pressure ulcerations develop and irrita- cally to improve the stability of the denture and to tion from microbial products is severe. The lesions are the result of overextended denture flanges or unbalanced occlu- chronic injury by unstable dentures or by thin. A common sequela of wearing ill-fitting dentures covered by a gray necrotic membrane and sur- is the occurrence of tissue hyperplasia of the rounded by an inflammatory halo with firm.
When no treat- ment is instituted. Fibroma produced by the lingual denture flange. Oral Cancer in Denture Wearers An association between oral carcinoma and chronic irritation of the mucosa by the dentures has often been claimed. In the systemically noncompromised host. Case reports have detailed the devel- opment of oral carcinomas in patients who wear ill- Figure Flabby ridge or hyperplastic replace. The tissue reaction is caused by chronic irritation by the denture flange.
Soft tissue hyperplasia of the maxillary sulcus. In patients with BMS. Patients inflamed because of mechanical irritation.
BMS is older than 50 years of age. Carcinoma involving the alveolar ridge and the vestibule. In the edentulous A B Figure A. Chronic ulcer produced by the lingual denture flange. Basocellular carcinoma of the floor of the mouth. It should be The vast majority of those patients affected by recognized that the prognosis is poor for oral carci. This characterized by a burning sensation in one or underlines the necessity of strict and regular recall several oral structures in contact with the den- visits at 6-month to 1-year intervals for comprehen.
BMS could be a sequela of denture wearing and is including tooth extraction and denture wearing. Acute ulcer produced by the maxillary denture in the hamular notch region distal to the tuberosity arrows. The opinion is still valid that ing mouth sensations and BMS. It is relevant to differentiate between burn- sive oral examinations. In the former if a sore spot does not heal after correction of the group. Thus the oral discomfort repressed. Vitamin B Xerostomic conditions induced by radiation mucosa and the tongue.
In denture wearers in. Aggravating factors include Xerostomia tension. Box tions from the supporting tissues or the tongue are common complaints. Other associated symptoms may Vitamin deficiency include headache. It is not quite clear. Documented Possible Causes of menopausal women. Candidal infections or allergic reactions may pro- duce the symptoms related to burning mouth sen.
Management A priori. Iron deficiency anemia tability. Mechanical irritation Characteristically. Diabetes sity. The Oral habits and parafunctions Myofascial pain quality of pain is a burning sensation associated with a feeling of dry mouth and persistent altered Systemic Factors taste sensation. The causative factors could therapy.
As a conse- BMS. Local In denture wearers. Psychogenic With the use of objective psycho- sations but seldom to BMS. During the the gag reflex is easily released after placement of first year after tooth extraction. After healing of the residual ridge. Its function is to prevent foreign bodies ulus of the bone tissue. Residual Ridge Reduction should be carried out only as a collaborative effort Longitudinal studies of the form and weight of the of psychiatrist and prosthodontist.
The process of remodeling is However. The reduction is a sequel of The gag reflex is a normal. In the mandible. Gagging can be trig. It follows a chronic pro- from entering the trachea. In sensitive patients. Note the location of the mental foramina near the top of the residual ridge. Severe residual ridge reduction—a sequela of wearing complete dentures over several years. The situation may be further compli.
In wearers of old have received. Persistent 2 to 3 mm for the maxilla and 4 to 5 mm for the complaints of gagging may be due to overextended mandible. It is important. In this simple method.
Thus a corre- is not well understood Box Short and square face associated with elevated by performing ridge augmentation procedures. For example. Intensive denture wearing Unstable occlusal conditions Overdenture Abutments: Caries and Immediate denture treatment Periodontal Disease Metabolic and Systemic Factors The retention of selected teeth to serve as abut- Osteoporosis ments under complete dentures is an excellent Calcium and vitamin D supplements for possi.
It is assumed lation exists between the years of denture wearing that the degree of residual ridge reduction results and the severity of atrophy. Women are particularly are apparent loss of sulcus width and depth. Apart from these observations. Prosthodontic Factors which is discussed in Part 4.
B and C. This could explain why it is difficult increase the risk of technical failures such as den. Another outstanding fea- wearing of overdentures is often associated with a ture of denture plaque flora is its high proportions high risk of caries and progression of periodontal of lactobacilli and Streptococcus mutans.
The faces. The principal aim of the preven- denture plaque are well known for their major con. One reason is that the species of effective prevention of caries and periodontal dis- Streptococcus and Actinomyces predominating in eases is necessary.
The inflamma- exposed root surface and canal are filled with tory potential of these species is illustrated by the amalgam or a composite restoration. The dentures have been in place for 25 years.
In this way. Complete overdentures in a patient with multiple aplasia. There is no evidence of a similar benefit after Atrophy of Masticatory Muscles a preprosthetic surgical intervention to improve It is essential that the oral function in complete the anatomical conditions for wearing complete denture wearers is maintained throughout life.
As a conse- overdenture wearers. The dentures. One of the consequences is The introduction of adequate denture-wearing that wearers of conventional complete dentures need habits e. Patients were denture wearers often find that their chewing abil- instructed to put a drop of the gel in the prosthesis at ity is insufficient and that they are obliged to eat the abutment site and to insert the prosthesis for at soft foods.
The placement of copings that cover the with overdentures has particular relevance in view exposed dentin and root surface is indicated only of the increasing numbers of older people who are where caries is more deeply penetrating.
With the fluoride gel. This improve- ment may persist in a long-term perspective. The preventive measures masticatory function depends on the skeletal mus- include mechanical and chemical plaque control cular force and the facility with which the patient is and introduction of adequate denture-wearing able to coordinate oral functional movements dur- habits.
Periodontal pockets greater than 4 to 5 mm ment of implants is usually followed by an should be eliminated surgically because they pres. This indicates that reduced bite force Despite these efforts. Therefore treatment rent caries. There is little evidence that The effect of daily application of gels containing the placement of a new denture significantly fluoride or fluoride plus chlorhexidine has been improves masticatory efficiency.
Preventive Measures and Management To Treatment of superficial caries of the overden. Diagnosis Direct measurement of the capacity to pared with the placebo gel and no effect on peri. Maximal bite forces tend to Longitudinal studies indicate that it is generally decrease in older patients.
This is retaining a part of their natural dentition later in life. Reduced skinfold thickness plete dentures or that replacement of ill-fitting den- tures with well-fitting new dentures will cause. In Loss of appetite Reduced serum albumin level healthy individuals there is no evidence that the Reduced body mass index nutritional intake is impaired in wearers of com. The is to improve masticatory function. Dependent Older Persons tion of coffee and a lower intake of ascorbic acid Reduced Stimulated Salivary Flow Rate compared with dentate subjects within the same Associated with: Mechanical preparation of food before eating will help mastication and reduce its Masticatory Ability and Performance One of influence on food selection.
This reeducation of elderly denture patients nutritional deficiencies are frequent. As Box previously mentioned. Severe nutritional deficiencies are rare among For the improvement and maintenance of the healthy individuals. The principal causes of protein energy malnutri- However. Denture Wearing. As a conse. In this context.
In wearers may be very difficult because their dietary these patients. Complaints of xerostomia Chewing difficulties Nutritional Status and Masticatory Function Complaints related to wearing complete den- Four factors are related to dietary selection and the tures nutritional status of wearers of complete dentures: Increased number of chewing cycles before masticatory function and oral health.
In institutional- Epidemiology see Chapter 6 Aging is often ized patients. There is no striking Impaired Masticatory Function. The patient should be motivated to practice medically compromised. This associated with the consequences of wearing com- often results in poor patient comfort, destabiliza- plete dentures. Ultimately, the patient may not be able to wear dentures and will receive a Bibliography diagnosis of prosthetically maladaptive.
Oral mucosal lesions associated with the For the adverse sequelae of residual ridge wearing of removable dentures, J Oral Path Prognosis of overdenture abutments in the resorption to be reduced, the following should be aged: Oral Epidemiol Prognosis of overdenture abutments in eld- 1. Restoration of the partially edentulous patient erly patients with controlled oral hygiene: Ecology of Candida-associated denture this is the only alternative as a result of poor stomatitis, Microb Ecol Health Dis Successful aging—the remaining teeth, and economic limitations.
In case for prosthetic therapy, J Publ Health Dent Oral Candida: J Dent Res 74 5: The mainte- , Ten-year longitudinal study of larly important. The patient with complete dentures should fol- Prosthodont 7: Gerodontology The gagging problem in prosthodontic 3.
Edentulous patients should be aware of the bene- treatment. Part I: Description and causes, J Prosthet Dent Factors associated with the 4.
In young patients, the primary advantage presence of denture related stomatitis in complete denture would be reduced residual ridge reduction. In eld- wearers: Grushka M: Insights into burning mouth syndrome, PhD thesis, comfort and maintenance of masticatory function.
Toronto, , University of Toronto. Guggenheimer J, Hoffman RD: The importance of screening The following precautions should be taken to pre- edentulous patients for oral cancer, J Prosthet Dent clude development of soft tissue disease: Hillerup S: Preprosthetic surgery in the elderly, J Prosthet Dent Current perspectives in ural roots or implants should follow a program residual ridge remodeling and its clinical implications: Treatment of denture-induced stomatitis: Patients complaining of a burning patient every 3 to 4 months.
Mercier P, Vinet A: Factors involved in residual alveolar ridge Tallgren A: The continuing reduction of the residual alveolar atrophy of the mandible, J Can Dent Assn 5: Overdentures with roots or implants for elderly nal study covering 25 years, J Prosthet Dent Newton AV: Denture sore mouth, Br Dent J Changes in human jaw mus- microflora of plaque on removable dentures in patients with cles with age and dental state, Gerodontology Skeletal osteopenia and Electron microscopic study of Reichart PA: Oral mucosal lesions in a representative cross- denture plaque, J Biol Buccale 8: Burning mouth syndrome, Oral Surg Epidemiol Temporomandibular disorders or TMDs is a col- subjects, but it is certainly not of the epidemic pro- lective term that is used to designate a group of portions reported in earlier studies.
The term TMDs was introduced by notions that tooth loss is a predisposing factor to Dworkin and LeResche and replaces mandibular dysfunction. This association has been numerous misleading terms that were previously further reinforced by reports that the severity of used. This Viklund, The wide discrepancies observed is clearly not the case, and in the last decade are largely due to differences in the criteria, or the numerous reports have refuted this assumption lack of specific criteria, that were used to define Bibb, Atchison, Pullinger et al.
In addition, the lack of cor- an appraisal of the epidemiological literature on relation between the number of remaining teeth and TMDs and related symptoms from different popu- the prevalence or severity of TMDS has been lation-based studies reveals consistently that it is repeatedly reported Bibb, Atchison, Pullinger et primarily a condition of young and middle-age al.
These observations suggest that is a well-known fact, whether in the TMJs per se TMDs are encountered in elderly and edentulous Pereira, Lundh, and Westesson, or in other. Therefore because tion in arthritic pain and inflammation in the TMJs edentulism is most prevalent among older persons, has received increasing attention Kopp, However, the data either were not Booker et al.
In the case of muscle-related substantiated by statistical analysis Tervonen and TMDs, sensitization of peripheral tissues, neuro- Knuuttila, , or group differences failed to plasticity in pronociceptive and antinociceptive cir- reach statistical significance Harriman, Snowdon, cuits, and behavioral sensitization associated with Messer et al.
There are also compelling data increased emotionality and with pain-specific neu- that TMD-related signs and symptoms are mild in roendocrine and autonomic responsivity have been edentulous subjects Bergman and Carlsson, ; also been reviewed Stohler, Some newer Lundeen, Scruggs, McKinney et al.
One such example is the interaction wear dentures Wilding and Owen, A lack of between estrogen and neuroactive agents implicated correlation between the severity or presence of in both peripheral and central pain processing TMDs and edentulism-related factors duration, mechanisms Dao, Knight, and Ton-That, ; age, quality and number of complete prostheses, Dao and LeResche, Moreover, the use of centric occlusion—centric relation coincidence, and exogenous hormones e.
The role of female hormones in the patho- ation between the clinical signs of dysfunction and physiology of TMDs is an exciting research area; occlusal instability or denture quality. In their however, it must be recognized that the etiology of search for etiological factors for TMDs in edentu- TMD conditions is still unclear.
This is still a valid approach been eclipsed by biological variables, which to the adjunctive management of the TMDs.
Management of TMDs should primarily mechanisms of joint diseases. Chronic orofacial and be directed toward palliation of the condition. The muscle pains as unique foci for study have emerged guidelines for management are well summarized in from the related clinical and basic science research.
Based on the evidence from clinical trials [of patient education, medications, oral splints , the TMDs]. While no specific therapies have Dworkin, Huggins, Wilson et al. For acute pain states, dentists most com- tion and until development of specific therapies, monly prescribe medications with analgesic prop- correct and prudent conservative symptomatic erties, as well as muscle relaxants, nonsteroidal management of TMDs in denture wearers should anti-inflammatory drugs NSAIDs , and the be similar to the management strategies prescribed recently introduced selective cyclooxygenase-2 for most TMD patients.
This includes patient edu- COX-2 inhibitor. These medications are particu- cation and reassurance about the benign nature of larly useful for the treatment of arthritic conditions the condition, self-care, short-term pharmacother- involving the TMJs. Patients should be followed apy Dionne, , physical modalities Feine and closely for the titration of the medication, to ensure Lund, , and cognitive and behavioral inter- adequate pain control and minimize unwanted side vention Dworkin, As for other Although patients should be informed about the medications that are prescribed on a long-term limited knowledge of etiological factors, together basis, however, the balance between their therapeu- with reassurance about the relative frequent occur- tic benefit and toxicity should be carefully rence of TMDs in the population, the good progno- weighed, and their administration should be sup- sis of the condition, and the merits of prudent ported and coordinated with the family physician management strategies.
In addition, the patient or a pain specialist. The dentist should additionally should be instructed to follow a home care program be aware of the potential interactions of the pre- to promote tissue rest and self-healing that includes scribed medications with other drugs that are used the following: Encouraging patients to gested to patients, including the use of heat and actively participate in the control of their condition cold therapies, ultrasound, massage, joint mobiliza- should be an integral part of the management tion, and passive stretching, and can be adminis- strategies because committed patients usually do tered either by the patient or by a clinician.
This is sup- Although local heat application is widely used for ported by recent evidence showing that when pain relief, its benefit has been questioned because patients who participated in tailored self-care pro- raised temperature increases tissue inflammation.