8-11-2021  Like TMJ, residual ridge (natira

kapag nawala yung ngipin)

COMPLETE DENTURE PROSTHODONTICS
***CD will not last very long due to resorption.
 By replacement of missing structure
(alveolar bone, teeth) by an artificial e. Patient’s comfort –
substitute.
 Replacement of the natural teeth in the arch
and their associated parts by artificial COMPONENT PARTS OF A COMPLETE
substitutes(denture) DENTURE
 Covering of mouth is already not a gingiva
but replaced with a mucosa. 1. Denture base – rest on oral mucosa in to
 The art and science of the restoration of which the teeth is attached;
an edentulous mouth.  Forms the foundation of the denture;
 Esthetics should always be  transfers force from the mastication
considered. to the teeth to the denture base to
 helps to distribute and transmit all
the forces acting on the denture
1. Complete denture teeth to the basal tissue (kasi kapag
 Dental prosthesis which replaces hindi nadistribute, iisang part lang
the entire dentition and associated mapupunta yung weight or stress
structures of the maxilla and that will cause fast resorption)
mandible (kasama lahat pati 2. Denture flange – vertical extension from
missing alveolar bone, gingiva, the body of the denture base going to the
teeth not only the missing teeth vestibule of oral cavity
kasi FPD yon)  FUNCTION: Retention and stability
 Because alveolar bone resorbs of the denture
and it is inevitable. Provides peripheral
 By complete denture, we slow seal and horizontal
down the bone resorption but if stability to the
you made a denture that is not denture
perfect fit, it will hasten the Also provides the
resorption. required cheek/lip
 As we grow older, alveolar bone fullness in
becomes smaller. edentulous patients.
 No denture flange on maxillary
***DENTURES were made for occlusion. lingual area because there’s no
vestibule in that part

OBJECTIVES OF COMPLETE DENTURE

 Always be realized to provide the following
during construction of denture:
a. To restore masticatory function
b. Restore contour and dimension
 facial dimension because there are a
lot of changes when teeth are gone
and affects the face.
c. To correct the speech and defect - 3. Denture border – margin of the denture
Labiodental words (fricatives)/ bilabial base at the junction of the polished surface
sounds because we need anterior teeth for and the impression surface.
sounds.  The edge of the denture
d. To preserve the remaining tissue – biologic
  The one that goes to the deepest c. Occlusal surface – surface of a denture or
part of the vestibule called dentition which makes contact or near
VESTIBULAR FORNIX contact with the corresponding surface of
the opposing denture or dentition.

8-16-2021

ANATOMY AND PHYSIOLOGY IN

4. Denture teeth – pontics RELATION TO COMPLETE DENTURE
 Artificial teeth CONSTRUCTION
 Made up of resin(widely used), Denture Bearing Areas
metal (unaesthetic) or porcelain
(has many disadvantages) Denture Limiting Structure
 Anatomic, semi-anatomic, non-
anatomic
 Pontic selection – kapag bilog yung EXTRAORAL LANDMARKS
mukha nung patient dapat pabilog
rin yung ngipin and not square 1. Interpupillary line – imaginary line drawin
para hindi maemphasize yung in your pupil; run horizontally between
round face pupils.
 Serve as Anterior Occlusal Plane
Surfaces of a Complete Denture Determination
 Not traight; parallel to the floor;
a. Intaglio – impression surface
assymetric
 Not polished
2. Ala Tragus Line – Ala of the nose to the
 Gets in contact with denture-bearing
tragus of the ear
area (residual ridge and others)
 For Posterior Occlusal Plane
 The portion of the denture surface Determination
which has its contour determined by 3. Naso-Labial Sulcus – becomes deeper
the impression with age and with loss of teeth particularly
 The surface of the denture that is in the permanent canine
contact with the tissues when the  makes the patient look older than
denture is seated in the mouth. their age.
b. Cameo – polished surface because the
 Lighten this groove specially the
fraction of mm is reduced
maxillary groove.
 Portion of a surface of a denture 4. Modiolus – located on first premolar area,
which extends in an occlusal posterior area of the corner of the mouth
direction from the border of the
 It gets hard when you pout your lips.
denture and includes the palatal
 A chiasma of facial muscles held
surface (lips, cheeks – more on sa
together fibrous tissue, located
outside)
lateral and slightly superior to each
 Part of the denture base which is
angle of the mouth.
usually polished and it includes the
 Become Flat with the loss of teeth
buccal and lingual surfaces of the
 Where Buccinator muscle and
teeth.
orbicularis oris meets
 External surfaces of the lingual,
5. Labiomental sulcus – horizontal
buccal, labial flanges, and the
depression between lower lip and chin.
external palatal surface of the
 Used to determine classes of jaw
denture.
relation
****MAKINTAB ang gingiva because of the
SALIVA
 INTRAORAL LANDMARKS
 Denture Bearing Areas – structures
covered by denture
a. Incisive Papilla – located lingual to the
maxillary incisors
 Pear shaped elevation in the
most anterior part of median
palatine raphe
 Thick part of the mucous
membrane covering the incisive
foramen.
 Found on the lingual between
the two Central Incisor in dentate
person
 In edentulous arch,, located at
the anterior end of the median
palatine raphe
 The nasopalatine nerves ad
**Nasolabial angle on Caucasian- 90 degree vessels pass through the incisive
foramen to supply the anterior
**For Filipinos = 45 degrees; mas makakapal 2/3 of the palate.
ang lips ng Pinoy  May lie on the crest of the ridge
due to excessive resorption.
 Reference in determining the
most anterior position of incisors.
 To locate where canines are.
**Anterior Occlusal Plane  The incisive papilla should be
should be parallel relieved to avoid pressure on the
nasopalatine nerves and
vessels.
Symptoms: Tingling
sensation,
hypersensitivity on
the area.
b. Palatine Rugae – irregularly shaped
Maxillary and mandibular
elevation of soft tissue extending
should be parallel
laterally from the midline in the anterior
part of the hard palate.
 Valleys of the rugae is also
important; in between the
elevations of rugae
 It serves as one of the
secondary stress bearing
areas in the palate.
c. Median Palatine Raphe - it can be very
elevated and you have to relieve this
area because it will cause over rocking
of the fulcrum and the denture may
fracture eventually (kasi manipis sa part
na yon)
  Covered by a thin layer of a  The denture in this area is in
mucoperiosteum covering the relation to the orbicularis oris and
median palatine suture. the superior incisive muscles
 The suture joins the right and left which limits the thickness and
halves of the hard palate. the length of the labial flange of
 Source of fulcrum when highly the denture.
elevated – provide relief to increase 3. Buccal Frenum – fold of mucous
denture stability by preventing its membrane (tendon of the buccinators
rocking movement. muscle varies in size in number and in
d. Residual Alveolar Ridge – will affect position.)
retention, support and stability.  A notch is made in the denture
 Remainder of what is left from flange opposite to its position to
extraction. facilitate its functional
 Adversely affect the construction movements.
of the denture. 4. Buccal Vestibule – denture in this area
e. Tuberosity – it is important for retention is related to buccinators muscle.
and support of the upper denture  Buccal flanges must extend in
against lateral movement. the deepest position of the
 The denture should cover it, buccal vestibule.
because it is one of the stress 5. Hamular Notch – posterior limit of the
bearing areas in the upper jaw. upper denture.
f. Hard palate – bony area of the palate  A straight line from hamular
g. Soft Palate – movable and non- notch on one side to the other
movable side determines the posterior
1. Immovable part – lies posterior to limit of the upper denture.
the hard palate (Blue part)

Palpate Position: visually

deceiving
***Junction between hard and soft  Must be captured during
***Junction of Movable and Immovable soft palate – impression
VIBRATING LINE; it is limiting structure so don’t  Over extension –
cover it. extreme pain
 Under extension – non-
retentive
6. Pterygomandibular Raphe – behind
 DENTURE LIMITING STRUCTURE – this is
hamular notches which is rarely
where you end; HINDI DAPAT I-COVER
significant.
NG DENTURE!
 Have patient open wide as
1. Labial Frenum – folds of mucous
possible
membrane
 Can displace if extended on the
 Must be relieved in the denture
area.
by making a V-shape notch in
7. Fovea palatina – two indentations
the labial flange opposite to its
located at the soft palate at the side of
position.
median palatine raphe
2. Labial Vestibule – reflection of the
mucosa of the lip to the mucosa of the
alveolar process in the labial vestibule.
  the posterior border of the upper MANDIBULAR
denture usually located 2 mm
 Less surface area for retention because
anterior to the fovea palatina
there will be no palate, the vibrating line
 you should locate this to know the
 Movable structures of the tongue and floor
vibrating line.
of the mouth can cause denture
displacement.

I. Denture Bearing area: Including residual

ridge (so there are 3)
a. Retromolar pad- you should cover it
8. Vibrating Line (Ah) because it is the primary stress bearing
 you can’t feel but you can see area.
this when you ask your patient to  Terminal border of denture base.
open his/her mouth and saying  Compressible soft tissue – affects
the word “AH” comfort and denture peripheral seal.
 Where you place the denture  Must be captured in impression –
border should always be.
 At junction of the movable and  A pear shaped area of mucous
non-movable portions of the soft membrane at the posterior end of
palate. the mandibular ridge and anterior to
 This line is arbitrary about 2mm the pterygomandibular area.
anterior to fovea palatina  Consists of mucous glands,
 This line determines temporal tendon, fibers of the
the posterior end of the buccinators and superior constrictor
upper denture. muscle.
 Identified when the
patients says “ah”
 Never place the
denture on a movable
tissue.
 If you put it on b. Buccal shelf of bone – flat, dapat
movable tissue, retention will nacocompress
be sacrificed.
 Lies between the crest of the
residual ridge (mesial boundary)
and the external oblique ridge
(distal boundary), Buccal frenum
(anterior boundary), Retromolar
pad (posterior border)
 Primary stress bearing area in the
Limiting structures lower arch providing good support
for the denture.
 Not subject for resorption kasi flat
** Peripheral seal will provide retention; where we
get the retention in maxillary
  Mylohyoid muscle- raises floor of mouth
during activity
6. Lingual Pouch – more posteriorly the
lingual flanges are related to the lingual
pouch with its boundaries which
are:
 Posteriorly – palatoglossus
BOUNDARIES:
muscle
1. residual ridge (mesial boundary)  Anteriorly – mylohyoid
2. external oblique ridge (distal boundary), muscle
3. Buccal frenum (anterior boundary),  Medially – tongue
4. Retromolar pad (posterior boundary)  Laterally – medial aspect of the
mandible
 it is just below the retromolar pad
7. Sublingual salivary gland area
 The lingual flanges of the lower
LIMITING STRUCTURES denture should not extend in this
1. Buccal/Lingual Vestibule area because with excessive
resorption of the mandible the
 Buccinator- contraction does not
gland may bulge superiorly above
displace the lower denture so
the body of the mandible.
flanges of the lower denture must
extend in the buccal vestibule.
 Masseter – affects the distobuccal
border.
 Fornix should be the end of the
denture border
 Check with minimal manipulation of
the lips 8-23-2021
2. Buccal Frenum
DIAGNOSIS OF EDENTULOUS PATIENTS
 A fold of mucous membrane in the premolar
area, movement of the lip and the cheek Objectives of Complete Denture:
may move the frenum.
 A notch is made in the lower denture to a. Always be realized to provide the following
accommodate the frenum. during construction complete denture:
3. Labial frenum – narrow 1. To restore masticatory function
2. To restore contour and dimension
***RESIDUAL RIDGE 3. To correct the speech defect
4. To preserve the remaining tissue
4. Lingual frenum – More anteriorly a fold of
(example: TMJ, residual ridge)
mucous membrane attach the mucosa of
5. To provide patient comfort
the tongue to mucosa of the floor of the
mouth.
 It moves with the movement of the
tongue so a notch is made to ESTABLISHING RAPPORT – it means getting
accommodate the frenum. familiar with the patient to gain his trust or win his
5. Retromylohyoid fossa- the undercut in this confidence.
area is where we get the retention
 Need to capture- especially when there is a
severely resorbed ridge A patient who perceives the dentist as caring,
 Severely resorbed – especially the understanding and respectful is more likely to
permanent first molar be cooperative.
COMMUNICATION: PSYCHOLOGICAL EVALUATION (House
Classification of Denture Patients)
1. Interview
 Know the personal information 1. Philosophical patient: well-motivated,
 Chief complaint and expectations cooperative, calm and composed even in
 Medical history difficult cases.
 Dental history 2. Exacting (Critical): likes each step in
2. Clinical exam detail, makes alternative treatment for
 Extraoral and intraoral dentist, and makes severe demands.
3. Evaluation of available diagnostic records 3. Indifferent: not very interested in treatment,
(cast, x-rays) blames the dentist for any mishap, not
 Making alginate impressions and follow instructions, been coerced to come
preparing mounted study models by friend, relative…*
 X-rays – if necessary only  There are a lot of costrains – you
4. Treatment planning – sequence of should be early in the appointment…
procedures that you do on your patients, 4. Hysterical: easily excited, highly
surgeries apprehensive, unrealistic expectations.
5. Presentation of treatment plan 5. Skeptical: bad experiences from previous
 Patient has to know the treatment plan treatment, almost the same with
HYSTERICAL
 Doubtful
 Referring for additional tests or medical  Most of them have severely resorbed
consultation ridges and poor health
Referring for second opinion  Might have psychological disturbances
 Discussion of diagnosis, treatment planning from recent personal tragedy
and prognosis with patient
Finalizing the fees and obtaining a signed
consent  Learn to detect patient attitudes and
reaction during diagnostic appointments and
modify their own attitude and reactions by
GENERAL/PERSONAL INFORMATION which mutual confidence can be
established.
1. Name  Must have a sense of real concern for the
2. Age health, comfort and welfare of their patients
 With advancing age: to establish the mutual confidence.
a. Decrease capacity of tissue to tolerate
stress
b. Tissue takes longer time to heal CHIEF COMPLAINT:
c. Many diseases are prevalent in older
age  Reason for dental consultations/treatment
d. Women at post-menopause may have  Patient’s own words
psychological disturbance (exacting or
HISTORY OF PRESENT ILLNESS
hysterical); it manifests on their attitude
e. Men at this age may be concerned with  Answers the question Why, how, when,
only comfort and function (indifferent) where
3. Race  Chronology of events leading to the present
4. Occupation condition.
5. Address and telephone No.
6. Previous dentist
 CURRENT MEDICATION
1. Insulin
2. Anticoagulants
3. Antihypertensive: dryness and postural
hypotension
4. Corticosteroids: dryness, confusion and
PATIENT’S EXPECTATION
behavioral changes
 Assess if patients expectations are realistic 5. Antiparkinson agents like Norflex and
or not. Akineton: dryness, confusion and behavioral
changes
Medical History
 Make efficient use of time
 Follow-up significant positive responses
 Note systemic conditions that has
relationship with the treatment (e.g. angina,
hepatitis)
 Obtain physician consultations where
appropriate
 Debilitating disease – discuss with patient to
ensure acceptability
a. Diabetes mellitus – can be treated as
long as it is controlled
b. Cardiovascular diseases
c. Diseases of joint: Osteoarthritis
d. Diseases of skin
DENTAL HISTORY
e. Neurological disorders (Bell’s palsy and
parkinson)  Previous dental treatment
f. Sjogren’s syndrome  Surgery
g. Radiation therapy  History of tooth loss:
a. CAUSE

RADIATION THERAPY vs DENTURES

a. Consequences of radiation therapy
b. Preprosthetic surgery
c. Wearing of previous denture
d. Denture fabrication

DENTURE FABRICATION IN RADIATION b. Time

THERAPY PATIENT  Edentulous period
 History of denture wear
 A void impression material that dry tissue
(impression plaster) or heavily flavored
materials (ZOE) DIAGNOSIS –
 Consider non-anatomic teeth
 Teeth set in neutral zone EXPECTATIONS
 Slight reduction in vertical dimension
 Soft liners are controversial die to porosity  Things patient likes and what they want
and possibility of candida changed
***Beware of patients who have a “BAG OF
DENTURES”
CLINICAL EXAMINATION
a. Extraoral - general health condition of the
patient

EXTRAORAL EXAMINATION
 General appearance (healthy, signs of
proper nourishment)
 Facial symmetry
 Muscle tonus
 Neuromuscular coordination
 TMJ Examination
LIPS
1. Length
Morphological Changes Associated with the 2. Position
Edentulous State 3. Thickness
1. Deepening of nasolabial groove 4. Mobility
2. Loss of labiodental angle 5. Smile line – high smile line, normal smile
3. Decrease in horizontal labial angle line

INTRAORAL EXAMINATION

 Specific Anatomical considerations:

CLASSIFICATION OF FRONTAL FACE FORMS  Examine systematically
 Note the significance that a finding
a. Square has to the treatment you are
b. Square tapering Tapering providing
 Visual and tactile examination (eyes,
finger, finger)
 Sometime auscultation
 General health tissue
 Attached mucosa/non-attached
 Color
 displaceability

CLASSIFICATION OF FACIAL PROFILE

1. Normal
2. Retrognathic
3. Prognathic
 1. lateral borders rest at level of mandibular
occlusal plane while dorsum is raised above
CHEEKS
it
- draping of the cheeks over the buccal 2. apex rests at or slightly below the incisal
flanges essential dor peripheral seal edges of mandibular anteriors
- opening of stensen;s duct (duct of parotid)/  retruded tongue position deprives patient of
- location for many many lesions (lichen border seal of lingual flange in sublingual
planus, submucosal fibrosis, leukoplakia, crescent and also may produce dislodging
malignancies as squamous cell carcinoma) forces on distal regions of the lingual flange
TONGUE MUCOSA

- the specialized mucosa covering the tongue

is said to be a “window” on systemic
Leukoplakia disease
FRENAL ATTACHMENTS

- fold of mucosa found at different locations

in the sulcus region of upper and lower
due to clasp or removable denture ridge

TONGUE CLASSIFICATION

 mobile 1. CLASS I – sulcal or low attachment

 favorable tongue is average sized, moves 2. Class II – midway between sulcus and crest
freely, covered by healthy mucosa of ridge
 normally, it should rest in a relaxed position 3. Class III – crestal attachment (needs
on lingual flanges, this will retain denture frenectomy)
and contributes to denture stability by
controlling it during speech, mastication and
swelling

MANAGEMENT OF LARGE TONGUE- it occurs

when chewing with maxillary denture only
LABIAL/BUCCAL VESTIBULE

 Check depth
a. lower the occlusal plane
- Flat ridge
b. use narrower teeth
 Use care in accurately registering
c. increase the intermolar distance
the vestibule to maximize retention
d. grind off the lingual cusp
e. avoid setting a second molar (widest area of
tongue)
FLOOR OF THE MOUTH
**maxillary lingual cusp- used for chewing
 If FOM is near the level of the ridge crest,
***Will tongue gets smaller again? YES, but it retention and stability of denture is less.
take several months/years  Hyperactive FOM reduces retention and
stability
 In severe ridge resorption, FOM in
Tongue position sublingual and mylohyoid regions spills on
the ridge.
  Patency of submandibular ducts  Class II – the soft palate turms downward at
about 45 angle from the hard palate.
MAXILLARY TUBEROSITY
 Class III – the palate turns downward
 If enlarged: sharply at about 70 angle to the hard palate
 No enough space to set all
molars
 The posterior occlusal plane
may be placed too low
 Undercuts may prevent
seating of denture.

Class II

 Palpate for undercuts – if extreme,

denture might not seat.

BONY PROMINENCES
 Midpalatal raphe
 Sharp ridge crest
THE HARD PALATE
 Sharp mylohyoid ridge
- Check for unusual features  Prominent genial tubercles
 Bony fragment and fractured root pieces
 Tori

CLASSIFICATION:
A. CLASS I - u-shaped, most favorable for
retention and stability
B. Class II – V-shaped; not favorable
C. Class III – flat or shallow vault; not very
favorable, accompanied by resorbed ridges,
poor resistance to lateral forces
Genial tubercle is very low in the base of mandible

SOFT PALATE (Palatal throat form)

HOUSE’S CLASSIFICATION

 Class I – almost horizontal; the soft palate

is almost horizontal curving gently
downwards
TORI
a. Palatal torus – you don’t need to remove
unless it is very big

Residual alveolar ridge

ARCH FORM (House’s Classification)
1. Class I – square
2. Class II – tapered (V-shaped), associated
with high arched palate, less retention and
b. Mandibular tori stability
3. Class III –ovoid (less common but more
UNDERCUTS
favorable)
 The contour of a cross section of a residual
Cross Sectional Contour
ridge that would prevent the placement of a
denture or other prosthesis a. U shaped – good stability
 Unilateral or bilateral; labial or lingual; mild, b. V-shaped – less stability
moderate or severe c. Knife edged
 Common locations: d. Flat – almost no residual ridge
a. Labial portion of maxillary anterior ridge e. Undercut
– as long as there is no posterior
undercuts
b. Buccal to maxillary tuberosity – as long
as it is unilateral
c. Retromylohyoid area of residual – for
retention; more common
d. Labial or lingual slopes of mandibular
anterior ridge
UNDERCUTS MANAGEMENT
1. Isolated anterior undercut – not present
any problem
2. Unilateral posterior undercut – may not
present much of a problem as path of
insertion is varied
3. Bilateral undercut – surgical removal of
the more severe one is indicated
 a. Thin serous – provides an insufficient
film for denture retention
b. Thick mucus - thick ropy saliva tens to
displace denture.
c. Mixed
 Amount
a. Normal: ideal for denture retention
b. Excessive: make denture consistency
messy
c. Reduced: reduced retention and
increase soreness; salivary substitutes
RESIDUAL RIDGE may be prescribed.
a. Size
DRUGS CAUSING XEROSTOMIA- lack of saliva
b. Interridge space
 Diuretics
SOFT TISSUE SUPPORT OF THE RIDGE
 Antihistamines – patients with rhinitis
 Firm and resilient – because there is  Anticholinergic
bone there  Antihypertensive
 Flabby and hypermobile: poor  Antiparkinson (Norflex)
support because denture base shifts  Corticosteroids
during masticatory function
 Management of flabby ridge ranges
from modified impression techniques EXAMINATION OF AN OLD DENTURE WEARER
to surgery.
 Traumatic ulcers
ANTERIOR ARCH RELATIONSHIP  Epulis fissuratum – sharp dentures, ill-fitting
dentures
 Angular cheilitis –
 Papillary hyperplasia – due to C. Albicans,
poor oral hygiene
 Flabby hyperplastic ridge
 Combination syndrome (Kelly’s syndrome)

Class III – more common to edentulous patients

 “Sunday bite?”

Large epulis fissuratum

inflammatory Papillary
Hyperplasia
SALIVA

 Consistency:
 Flabby hyperplastic ridge

RADIOGRAPHIC EXAMINATION
 Must be ordered to rule out any bony
conditions that could affect the treatment.
 Fractured roots or roots lying to the surface
should be removed
 Deep seated retained teeth or root fragment
may be left if they are asymptomatic
 Supplemental radiographs may be
prescribed if required such as periapical,
occlusal, and lateral cephalometric

Angular cheilitis ADDITIONAL TESTS AND MEDICAL

(Perleche) CONSULTATION
 Routine blood test, blood and urine sugar
levels
 Medical consultation
 Dental consultation

Reduced vertical dimension PRESCRIPTION, NUTRITIONAL SUPPLEMENT

AND TISSUE CONDITIONING

EXAMINATION OF AN OLD DENTURE WEARER  Assess for nutritional deficiency

 Recommend finger massage of oral tissues
 Esthetics, lip fullness, symmetry, amount of  If old denture wearer, tissue conditioner
display during smiling, phonetics, teeth placed to condition abused soft tissue
position, size, excessive wear  Instruct patient to discontinue wearing
denture 24-48 hours prior making final
impression.

 Fracture, cracks, porosity, denture hygiene DIAGNOSIS

 A specific evaluation of existing conditions
 Involves thorough examination of all factors
which are bound to affect the success of
treatment
  This includes both systemic and local A good clinician is one who is able to diagnose
factors and the mental condition of the potential problems during initial examination
patient. and suggest the best possible treatment plan
compatible with the age, physical, mental and
TREATMENT PLAN
financial status of the patient.
 The sequence of procedure planned for the
treatment of a patient following diagnosis.
 Explained to the patient in a simple and
straightforward manner including all of the
TISSUE RESPONSE TO COMPLETE DENTURE
factors that might complicate the treatment.
Sequelae caused by wearing of Denture
a. Direct sequale caused by wearing
removable prosthesis
1. Mucosal reactions
2. Altered taste perception
3. Burning mouth syndrome
4. Gagging
5. Residual ridge reduction
Interactions of Prosthetic materials and the oral
environment:
 Surface properties: Plaque Accumulation
ALTERNATIVE TREATMENT PLAN  Chemical stability
 Adhesiveness
 May be less than ideal but is often  Texture
necessary for various reasons.  Microporosities
- Diabetes mellitus with syphilis  Hardness
 Chemical properties
REFUSAL OF TREATMENT
 Toxic reactions
 The patient’s demand may be unreasonable  Allergic reactions
or against professional judgement or ethics.  Physical Properties
 We can refuse especially when the  Mechanical irritation
demands of the patients are unreasonable.  Plaque accumulation
 You have the right to refuse  Changes of environmental conditions
 If the treatment is a matter of life and death,  Plaque microbiology
you need to do it.
PROGNOSIS MUCOSAL REACTIONS
 Forecast to the probable result of disease or 1. DENTURE STOMATITIS
a course of therapy  Denture-induced stomatisi
 After considering all the factors, you should  Denture sore mouth
be able to predict the degree of success  Inflammatory papupplary
that can be expected and the patient should hyperplasia
know of what can and cannot be achieve.  Chronic atrophic candidosis
a. CANDIDA – direct cause of this
b. DENTURE – predisposing factor (condition
FEES AND SIGNED CONSENT increases the risk of getting the disease.)
 When patient agreed on treatment including TYPES:
fees, he must sign a written consent to
I. Pinpoint hyperemia
prevent later misunderstanding.
 Localized simple inflammation
  Trauma induced TREATMENT FOR DENTURE STOMATITIS:
II. Erythematous Type
a. Antifungal therapy
o More of general one
 Nystatin
o Microbial plaque accumulation
o Generalized simple inflammation  Amphotericin B
o More diffuse erythema involving  Miconazole
a part or the entire denture-  Clotrimazole
covered mucosa b. Correction of ill-fitting dentures
III. Granular type c. Efficient plaque control
 Inflammatory papillary  Meticulous oral and denture hygiene
hyperplasia commonly involving  Wear the dentures as seldom as
the central part of the hard palate possible.
and the alveolar ridges.  Keep them dry or in a disinfectant
 Microbial plaque accumulation solution made up of 0.2% to 2%
(bacteria and yeast) chlorhexidine during nights.
 Brush the denture

FACTORS PREDISPOSING TO CANDIDA-

ASSOCIATED DENTURE STOMATITIS 2. FLABBY RIDGE – not stable ridge
 Due to replacement of bone by
a. Systemic Factors fibrous tissue
1. Old age – lower immune response  Commonly in the anterior part of
against diseases, lesser ability to heal maxilla
2. Diabetes mellitus – very low turnover of  Sequela of excessive load of the
tissue; slow healing, prone to injury residual ridge and unstable
3. Nutritional deficiencies (iron, folate or occlusal conditions
Vitamin B12)  Must provide good support for
4. Malignancies (acute leukemia, the denture.
aganulocytosis)
 Anterior is used for chewing not
5. Immune defects
for biting.
6. Corticosteroid and immunosuppressive
 Tissue in anterior will
drugs – suppress immune system
resorb and will be
changes with fibrous
tissue.
b. Local Factors
1. Dentures – not the cause of problem; it ***PROVIDE GOOD POSTERIOR SUPPORT
just increases the risk
2. Xerostomia (Sjogren’s syndrome,
irradiation, drug therapy) 3. DENTURE IRRITATION
3. High-carbohydrate diet HYPERPLASIA/EPULLIS
4. Broad-spectrum antibiotics – because  Common sequela of wearing ill-
they don’t kill fungi, only bacteria like fitting dentures
staphylococcus.  Result of chronic injury by
unstable dentures or by thin,
**Mouth has millions of microorganisms and there
overextended denture flanges.
is a balance among those called MICROBIAL
FLOOR.  TREATMENT: reduce when it is
due to ill-fitting denture, relining
***Candida is a fungi (but it is just temporary)
5. Smoking tobacco – causes dryness of
mouth
 4. TRAUMATIC ULCER
 For newly installed dentures
 Sore spots most commonly develop
within 1-2 days after placement of
new dentures.
 Parang SINGAW
 Small and painful lesions, covered
by a gray necrotic membrane and
surrounded by an inflammatory halo
with firm, elevated borders
 Direct cause is usually overextended
denture flanges or unbalanced
occlusion
 Predisposing factors include:
A. Diabetes mellitus
B. Nutritional deficiency
C. Radiation therapy
D. Xerostomia

unbalanced
occlusion

overextended – when prolonged, it will

become epulis.