Dental CPD Australia

Denture Difficulties - Patient Attitude

It is a common attitude of the elderly that they do not adapt as well or as willingly to the new, be it in the environment, society, in their home, and in particular, their own body. dPatients who have been wearing the same set of dentures for many years, will be used to the feel and fit, making the new dentures difficult to accept. Some patients may also request the practitioner copy their

old set of dentures because they feel like it fits them perfectly. As professionals we have all encountered this at some time and will need to explain to the patient that their mouth has altered and the denture no longer fits, and show them how the teeth have worn so they are no longer effective for their needs. The old dentures will have decreased vertical dimension and probable incorrect occlusion when true centric relation is sought. Although it is common for adjustments to be made after initial completion of the denture, the practitioner may encounter patients that return frequently for adjustments because they claim to still feel discomfort or pain.

Dealing With The Difficulties

The presented difficulties that a practitioner may encounter in the edentulous elderly patient should not be contraindications to providing good denture care that will benefit their health and quality of life. The practitioner may choose to be creative in treating these patients and use methods that are unconventional.

In edentulous elderly patients, it is common to find an unfavourable remaining alveolar ridge size and shape where the denture is fitted. Surgical methods to reshape the alveolar ridges, to augment the bone, or to place implants are all options for patients in good health. These methods may provide a better anchor where a denture may be seated and retained. In cases where surgical methods are not possible, the practitioner can attempt to increase denture retention through other methods. These may include the retention properties contributed by saliva, the retention provided by recording correct centric relation and ensuring balanced occlusion, and the retention from properly positioning the dentures within the neutral zone. This ensures placement of the denture in an area where the forces from the surrounding musculature, the tongue on the lingual surface, and the cheeks and lips on the labial/buccal surface, will not dislodge the denture during function due to neutralization or balance between them.

Patients with microstomia have a limited mouth opening that make conventional methods for fabricating a denture become difficult and challenging, making it inevitable to use modifying techniques. Some recommended techniques for modifying the standard impression include the use of stock trays or custom-made trays for each half of the arch. This creates sectional impressions that are connected extra orally after impression taking. Another method is the use of flexible impression trays made of silicone putty that can be bent during insertion and removal from the mouth, enabling the tray to pass through the mouth opening with ease for both practitioner and patient. Primary impressions can also be taken inside the patients existing dentures, with the intention of fabricating a custom tray for secondary impressions.

Case studies and reports have shown several modifications in denture design for patients with microstomia. Methods that can be used are as follows 1/ Sectional and collapsible dentures with swing-locks or hinges to connect two segments of a collapsible denture. 2/ The use of a metal framework with clasps to hold sections of a complete denture together, 3/ The use of a post connected to one section of a denture that slides into a stainless steel tubing. This is used in conjunction with a magnetic attachment system to connect sectional dentures. The choice of design modification will depend on the practitioner and the patient, based on comfort and ease.

Metabolic changes may be expected in elderly patients, particularly those with a decreased health status. Although Xerostomia is a common condition in the aged population, it is not assumed to be present in all elderly patients. In those that have Xerostomia, the professional must educate the patient and provide appropriate treatment depending on the cause. The practitioner may suggest an increase in water intake, chew on sugarless gum and avoid dehydrating substances such as alcoholic beverages. It is also suggested to use ethanol-free mouth rinses that contain aloe or lanolin and apply water-soluble lubricating gels to the oral tissues. For patients where xerostomia is due to an auto-immune disorder or to radiation exposure, oral pilocarpine may be prescribed. In elderly patients with sensitive oral mucosa, using a less rigid material as a denture base may be advised

In dealing with the flabby or fleshy type of mucosa, custom trays can be made for selective pressure impression taking. This simply means modifying the impression tray so more pressure can be is applied to areas that can withstand. A modification that can also be implemented is the placement of holes in selected areas of the tray to relieve the pressure applied on the tissues in that particular area.

Finally, it is important to have patience and perseverance when treating an edentulous elderly patient. As a professional, make an effort to understand the patients needs, give them the time, effort and guidance they deserve and allow for them time to adapt and accept the new dentures.

In choosing to persevere and take extra steps to modify procedures and denture design for the edentulous elderly patient, you will provide an ideal treatment plan to benefit the patient’s health and quality of life.

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