SEQUELAE OF WEARING COMPLETE DENTURE Dr Muhammad Rizwan

SEQUELAE OF WEARING COMPLETE DENTURE Dr Muhammad Rizwan Memon B. D. S, R. D. S, (F. C. P. S)

Direct Sequelae Denture Stomatitis l Flabby Ridges l Denture Irritation Hyperplasia l Traumatic Ulcers l Oral Cancers l Burning Mouth syndrome l Gagging l Residual Ridge Resorption l

DENTURE STOMATITIS Denture Induced Stomatitis l Denture Sore Mouth l Inflammatory Papillary Hyperplasia l Chronic Atrophic Candidosis l

The pathological reactions of the denture bearing palatal mucosa Findings from several studies suggest that denture stomatitis develops in as many as 3550% of persons who wear complete dentures (Cumming, 1990; Frenkel, 2000).

Classification Newton’s (1962) Type-1: Pinpoint hyperemia or localized simple inflammation (Trauma induced)

Type-2: Diffuse erythema confined to the mucosa in contact with the denture base (Microbial plaque induced)

Type-3: Granular surface or inflammatory papillary hyperplasia of the palate (Microbial plaque induced)

Etiology and Predisposing Factors l Systemic factors Old age l Diabetes Mellitus l Nutritional deficiencies (Iron, Vitamin B 12) l Malignancies (Acute leukemia, Agranulocytosis) l Immune Defects (Corticosteroids, Immunosuppressive drugs) l

l Local Factors l l Fungal Infections Dentures l l l Xerostomia l l l Changes in environmental conditions Trauma Denture usage Denture cleanliness Sjogren’s syndrome Irridiation Drug therapy High Carbohydrate Diet Broad Spectrum Antibiotics Smoking Tobacco

Diagnosis Presence of Mycelia or Pseudohyphae in direct smear from the lesions

Management and Preventive Measures l General therapy Efficient Plaque Control l Denture Usage l Trauma from Denture l l Antifungal therapy Local (Nystatin, Amphotericin B, Miconazole) l Systemic (Ketoconazole, Fluconazole) l l Surgical (Cryosurgery)

FLABBY RIDGE Mobile or extremely resilient alveolar ridge l Provide poor support for denture l Special Impression techniques l Remove surgically l

TRAUMATIC ULCERS Develop within 1 to 2 days l Overextended flanges l Unbalanced occlusion l Heal after correction of denture l If not corrected can lead to Denture irritation hyperplasia l

DENTURE IRRITATION HYPERPLASIA Tissue hyperplasia in contact with denture borders l Symptoms subside after correction of borders l If not than Surgery l

ORAL CANCER l Association between chronic irritation of mucosa and oral cancer is claimed without proof l Heavy alcohol l Tobacco use l Less education l Poor socioeconomic status l Refer to pathologist

BURNING MOUTH SYNDROME Burning sensation in one or several oral structures in contact with denture without any inflammation of mucosa

Etiology l Local l Mechanical irritation l Allergy l Infection l Parafunctional l Myofacial pain habits

l Systemic factors l Vitamin deficiency l Iorn deficiency anemia l Xerostomia l Menopause l Diabetes l Medication l Psychogenic factors l Depression l Anxiety l Psychosocial stressors

Management Appropriate counseling of the patient

GAGGING Normal healthy defense mechanism l Triggered by stimulation of soft palate and posterior part of tongue. l Usually disappears in few days after adaptation with new denture l Persistent gagging may be due to poor retention or overextended borders.

RESIDUAL RIDGE RESORPTION A term used for the diminishing quantity and quality of the residual ridge after teeth are removed (GPT-2005).

Continuous loss of bone tissue after extraction of teeth l During 1 st year (2 to 3 mm for maxilla & 4 to 5 mm for mandible) l Annual rate of RRR is 0. 1 to 0. 2 mm for mandible and 4 times less for maxilla l Women are affected more l

Clinical features Centripetal in maxilla and Centrifugal in mandible l Loss of sulcus width and depth l Muscle attachment closer to ridge l Loss of VD of occlusion l Reduction of lower facial height l Anterior rotation of mandible l Prognathia

Prevention Periodic recalls l Overdentures l Implant supported dentures l

Management l Surgery l Vestibuloplasties l Ridge augmentation