40
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Volume1 Issue2
S
upporting
Y
our
P
ractice
•
Whenwas the last timeyouhadadental professional
check theprosthesis?Didyouhaveadenturist or
someoneelseadjust it for you?Didyouadjust it
yourself?
•
Has yourmedicationchanged?Has yourmedical history
changed?
•
Whenyoucut yourself, does it takea long time for the
bleeding to stop?Doyoubruiseeasily?
•
Is thereanynumbness inyourmouthor face?
•
Describeyour diet.
•
Is yourmouthdry?
•
Haveyounoticedanywhiteor red spots inyourmouth?
Anyareasof roughness that donot goaway?
•
Doyou smoke?
2. Evaluate thepatient’smouthandprosthesis.
Before removing theprosthesis, look for, orask the
patient topointout, thebleedingarea.Withpermission,
manuallymove theprosthesis toattempt to stimulate
bleedingand/or elicitdiscomfort.
3. Evaluate theocclusion. Look for balancedpressure
with freedom incentric. Ensure that there is appro-
priate interocclusal space.
4. Remove theprosthesis and look for indents in the
tissues (assess for overseating).
5. Useapressure indicator paste (PIP) to identifyareas
of heavycontactwhenpassiveandactive.
6. Mark theareasof sorenesswithamarker and relieve
theprosthesis.
7. Look for sitesof thinmucosaover non-yieldingareas
suchas tori or sharpbony ridgeswhereadenture
basemayhave traumatized tissues. Assesspathof
insertionand see if insertion/removal by thepatient
or caregivermayhavedamaged tissues.
8. Clinicallyassess if theprosthesis is cleanandassess
theconditionof the relinematerial, if any.
9. Take radiographsof theareaandcomparewith the
contralateral side toassessanatomical changes.
Diagnosis
Basedon localizederythemaand/or edemawithina
relatively short perioddirectlyassociatedwithprosthesis
wear, adiagnosisof ill-fittingprosthesis canbeestablished.
DifferentialDiagnosis
•
Overextendedprosthesis
•
Occlusal interference (vertical andhorizontal
dimensions)
•
Inadequate relief onnon-yieldingareas
•
Sharp ridgesor projections in the resin
•
Clenchingor bruxism
•
Inadequatediet
•
Healthprofile (e.g., diabetes,menopause,medication)
•
Oral pathologies (e.g., erosive lichenplanus, carcinoma)
•
Xerostomia
Treatment
Common InitialTreatments
•
Localized relief of overextensions andheavycontact as
indicatedbyPIPandassessment
•
Relineof prosthesis
•
Education: careandmaintenance (for both thepatient
andcaregiver)
•
Prescriptionof chlorhexidine rinse
•
Referral for further assessment
Referral toSpecialist
If problemdoesnot resolveorworsendespitecooperation
from thepatient, refer toanoral pathologist or surgeon for
further evaluation.
•
Oral pathologist: further assessment of chronicarea.
Biopsyand specificdiagnosisof unknownetiology.
If further intervention isneeded, theoral pathologist
will refer toeither anoral surgeonor headandneck
surgeon.
•
Oral surgeon: further assessment of chronicarea. Biopsy
and specificdiagnosisof unknownetiology. If further
intervention isneeded, theoral surgeonmay refer toa
headandneck surgeon.
Advice toPatient
•
Document symptoms (e.g., timeof dayandmedications
taken).
•
Discontinueprosthesiswear at night.
•
Avoid sharp foods suchaspretzels, chips, popcorn, or
nuts thatmayworsen the symptoms. Keepadiet record
until thenext appointment.
•
Ifmedicationhasbeenprescribed, take it as instructed.
•
If the situationworsensbefore the follow-up
appointment, contact your dentist.
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