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Assistant Professor
Department of Prosthodontics
Mouth preparation commonly necessary
Involve elimination of pathology and defects
Creates more favorable anatomical
environment
Conditions may involve the soft tissues and
bone
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Conditions that may involve oral mucosa
include
a) Denture stomatitis
b) Palatal inflammatory hyperplasia
c) Angular stomatitis/ Angular chelitis
d) Shallow sulci
e) Denture induced hyperplasia
f) Prominent freni
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Conditions that may involve the bone
include:
a) Pathology within the bone
b) Sharp and irregular bone
c) Undercut ridges
d) Prominent maxillary tuberosity
e) Presence of Tori
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Soft tissue conditions ..
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Appearance over the surface covered by the
denture may be:
a) Patchy
b) Diffused inflammation
Despite of bad appearance, patient usually does
not complain
Should not be termed denture soreness
Occurs usually in maxillary arch
Does not extend beyond denture coverage area
May occur alone or with:
a) Inflammatory hyperplasia
b) Angular chelitis
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Local factors include:
a) Candida Albicans
b) Bacteria
c) Poor denture hygiene
d) Denture trauma
e) Wearing dentures at night
f) Diet e.g. rich carbohydrate diet more
candida albicans
g) Non-microbial factors e.g. monomer, topical
agents and mouth washes (excessive use)
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Systemic factors include:
a) Immunodeficiency
b) Hormonal disbalance e.g. diabetes
c) Vitamin B deficiency
d) Vitamin C deficiency
e) Iron
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Denture stomatitis is asymptomatic
Should be treated before new dentures are
made because:
a) Swelling of the mucosa
b) Mouth may be a source of candida infection
spread into
1. Nail Beds
2. Pharynx
3. Larynx
(Nikawa et.al. 1998)
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Denture Hygiene Instructions:
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Systemic Therapy:
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Antifungal Agents:
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Also known as angular cheilitis
Fissuring at the angles of the mouth
Erythematous, non erosive
Usually bilateral
Frequently painful
Rarely seen except in denture wearers
More common in females
If untreated, may result in permanent
scarring
May be seen with denture stomatitis
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Local:
a) infection
b) inadequate lip support
c) maceration of the skin
d) increased freeway space
Systemic:
a) iron deficiency
b) vitamin B and C deficiency.
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Treatment aimed at:
a) Elimination of local infection
b) Reduction of intraoral micro-organisms
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Denture hygiene instructions given to the patient
Immersion of denture in denture cleaning agents
Lesion cured in 2 weeks (mostly)
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Broad spectrum anti-biotic may be
administered i.e.
a) Miconazole oral gel
b) Tetracycline/Nystatin agent
Topical steroids not recommended (may
caused perioral dermatitis) may aggravate
the condition
Swab from the angle of lips (to exactly
identify the microbes)
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Freeway space may be decreased
OVD adjusted
Temporarily adjust with wax or self cure to
exactly identify
If problem identified, make new denture
accordingly
a) Compromised retention
b) Instability of dentures
c) Unfavorable load distribution
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May be:
a) Prosthetic
b) Surgical
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Single or multiple flaps
Related to the borders of the denture
Found in 10% of the denture wearers
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Denture over extension is the main cause
Chronic irritation of the tissues
Slow progression of lesion alveolar
resorption denture borders dig into soft
tissues
Patient usually aware at very late stage
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Following sequence should be followed:
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May be present on buccal and labial side
Notch given in the denture to accommodate
May be difficult to achieve border seal if too
prominent
Surgical excision in extreme cases
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Conditions involving the bone ..
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Pathology within the bone:
a) Sinus
b) Swelling
c) Irregular shape of the ridge
(Seen in 30-40% of the edentulous patients)
Radiographs not to be taken in absence of
signs/symptoms
Panoramic radiography is indicated instead of
full mouth peri-apicals
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Leave unerupted tooth deeply embedded (if
not causing any pathology)
Surgical removal not necessarily indicated
causes loss of alveolar bone
Tooth lying close to the surface should always
be removed
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Bony Spicules:
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Mylohyoid Ridges & Genial Tubercles:
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1) Prosthetic Treatment:
a) Correction of denture design faults
b) Providing relief over the impression surface
c) Smoothening of the denture surface
d) Placing a soft-reliner
2) Surgical Treatment:
a) Surgical removal if prosthetic treatment fails
b) Always try a conservative approach
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Prominent Maxillary Tuberosities:
These may consist of fibrous tissue or
bone
May be very large in extreme cases
Complete extension of denture base
becomes difficult results in
compromised retention and support.
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a) Re-assessment of OVD:
If patient adapts increased OVD increased
inter-alveolar space may be given denture
fully extended
b) Accept under extension:
Successful if ridges are well developed
c) Use thin denture bases:
Use thin metal denture base in the area of
tuberosities
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Tori can be:
a) Maxillary
b) Mandibular
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Treatment:
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any questions
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