Diagnosis

The 1st Diagnostic Appointment Communicating The Patient Educating The Patient

The 1st Diagnostic Appointment   c)

d) e)

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Importance. Patient Interview: Gaining insight on patient psychological makeup. Obstacles to successful interview. Keys to successful interview.

Evaluating the effects of physical problems on dental& prosthodontic treatment. Evaluating the effects of drugs on dental& prosthodontic treatment

:Importance•

Provides the required data for -1• ttt Pt. interview, radiographs, oral) examination, mounting casts, preliminary survey& medical .)consultation Detect problems needs -2 .immediate attention .Dental prophylaxis -3

Pt. Interview:

))Boucher's 10th ed

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DrCarl Boucher -:said that → The 1st 5 minutes spent with a pt." represent the most important period of dentist-patient interaction. Pt. should feel that dentist is really interested in ."him& in help to solve dental problems DrM. M. Devan -:Said that → We should meet the mind of the pt." ".before we meet the mouth of the pt

Gaining insight on patient psychological makeup

DrM. M. House classifies the patients int

Philosophical

Exacting

Hysterical

Indifferent

Obstacles to a successful interview    

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Lack of attention Pt. body language Dentist choice of wards Pt. may hide information

Keys to successful interview 

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Dentist attitude& behavior Phrasing of questions

Evaluating the effects of * physical problems on Dental& : .Prosthodontic ttt          

1- Diabetes 2- Arthritis 3- Epilepsy 4- Cardio-Vascular Diseases 5- Cancer 6- Transmitted diseases 7- Pemphigus Vulgaris 8- Parkinson disease 9- Acromegaly 10- Paget's disease

Evaluating the effect of drugs on Dental& Prosthodontic ttt    

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Anticoagulants Antihypertensive Agents Endocrine therapy Saliva Inhibiting drugs

Communicating The Patient 

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A) Identification& Management of pt. B) Nutritional care of denture patients. C) Economics of ttt.

Pt. behavior characteristics during the Examination appointment that may indicate future Management problems 

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→ These patients have favorable prognosis but it is better not to proceed in ttt: 1- Disrupting your regular office routine 2- Over-reacting to normal examination procedure 3- Downgrading ttt provided by a previous dentist

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6- Dissatisfaction with existing denture that doesn't coincide with your evaluation of the denture 7- Numerous sets of dentures in short time )3 dentures in 2 years) 8- Unrealistic desires to change facial appearance 9- Recent major catastrophe in the immediate family 10- Crying during discussion of previous dental ttt. 11- History of severe gagging& inability to wear the denture 12- Evidence of excessive smoking

Nutritional care of denture patients ))Mary P. Faine 1986 

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→ Clinical symptoms of malnutrition are often appears first in the oral cavity )Rapid turnover in the oral cavity). → Long term inadequate nutrition may associated with: 1- Angular chelitis.2- Glossitis. 3- Slow tissue healing. → Adequate nutritional status will improve the tolerance of the oral mucosa to new denture& reduce it's rejection. → Denture construction needs:1- Series of appointments.

Alcohol abuse

aloric intake ↓

Xerostomia soft diet

Medications

Diabetes

Unhealthy oral tissues ↓ fiber intake

Nutritional needs& status of the elderly  

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→ The measure: RDA )Recommended Dietary allowance). - ↑ aging → body mass is replaced by fat leading to ↓ the metabolic rate and ↓ the calories. - RDA for 65 years old pt. = 1800 Kcal for men& 1400 Kcal for women. - RDA for Adult = 2400 Kcal for men& 1600 Kcal for women. → Denture patients who select food which are high in sugar& fat Should be advised of the importance of complex Carbohydrates because:1- Blood glucose level is often ↑ in older

Vitamins 

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1- Vitamin D: Calcium metabolism )Sunlight exposure 10:15 min 2 times weekly). 2- Vitamin B-complex: )Thiamine, riboflavin, niacin, pyridoxine, folic acid, and vitamin B12) → Burning sensation of the tongue& denture sore mouth. 3- Folic acid: R.B.C's formation. 4- Vitamin B12: Anemia& neurological damage. 5- Gastric I.F.: Vitamin B12 deficiency →

Minerals 1- Zn: → Tissue healing& Immune function.  2- Fe: → ↓ in menopause& ↓ in blood loss )Ulcers& gastric bleeding). 

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3- Ca& bone health:

→ Osteoporosis: History of fracture in vertebrae, wrist, or neck of femur may indicate osteoporosis. → Greater reduction in ridge height occurs among women than men. → Bone loss is ↑ in the first 6 months following tooth extraction. → Resorption much increased in mandible than the maxilla. → Denture pt. with excessive ridge resorption report ↓ Ca/Phosphorus ratios than normal edentulous pt. → ↓ serum Ca level → Ca is mobilized from bones → Demineralization of the skeleton [)-ve) bone/Ca balance]. → Recommended dietary Ca intake for

Possible oral signs of nutrient deficiencies Nutrient deficiency

Oral Symptom

Salivary glands

Protein Protein

Lips

Vitamin B-complex Vitamin B-complex& Iron Vitamin B-complex& Iron

Decrease salivary flow Enlarged parotid gland Cheilosis Angular stomatitis Angular scars

Tongue

Vitamin B-complex Vitamin B-complex Vitamin B-complex& Iron Vitamin B-complex, Iron,& Tryptophan

Edema Magenta tongue Atrophy of filiform papillae Glossitis

Gingiva

Vitamin C

Tender, Edematous, & bleeding tissue

Impact of wearing denture on dietary intake ♥ USDA )Human Nutrition Research Center) BOSTON: → Nutrient intakes of denture wearers ↓ than of dentate. → Male denture wearers have ↓ intake than the females. → Chewing efficiency of average denture wearer is about 20% than of an adult with complete natural dentition. → Because, of impaired chewing ability, texture, and hardness rather than taste and smell are what determine the acceptability of a food for many pt's. → The intake of harder food as: )Raw vegetables or fruits, fibrous meat, hard bread, seeds, and nuts) is reduced. While that of soft food as: 

Nutrition counseling 

Main objective:

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is to correct imbalances in nutrient intake that may interfere with maintenance of the oral tissues.

Applied if the pt. have any of the following risk factors:       

1- ↑ than 70 years of age. 2- Low income. 3- Physical isolation. 4- Oral lesions )Glossitis – Denture sore mouth). 5- Significant bone resorption. 6- Daily use of more than 3 prescription drugs. 7- Disease of the joints that limiting movement. 8- Using ↑ doses of dietary supplements.

Guidelines for nutrition counseling:       

1- Eat a variety of food. 2- Diet in complex carbohydrates, fruits, & vegetables. 3- Citrus fruit or juice containing vitamin C every day. 4- Select fish, lean meat& beans every day. 5- Obtain adequate Ca. 6- Limit intake of bakery products high in fat& simple sugars. 7- ↓ intake of processed foods high in Na& fat. 8- Consume 8 glasses of water daily.

Economics of the prosthetic service 

→ The fee should be determined on an individual bases for each pt. according to time& difficulties involved in the ttt.

Educating the patient

Understanding the pt. needs Instructing the pt.

Understanding the pt. needs     

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→ Dentist should find out why the pt. wants the denture? - Cosmetic factor. – Function. - Own decision. – Family stress. → Pt. must devote the responsibility & time necessary for the dental care. → Dentist must explain the nature of the procedure& must prepare the pt. for this new experience. → Before treatment dentist must discuss the specific requirements& evaluate them with the pt.

Instructing the pt 

→ It isn't advisable to oversimplify the instructions or to complicate it )according to the personality of the pt.)

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→ Pt. don't always remember the verbal instructions.

 *Why   

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we replace teeth:-

1- Speech. 2- Swallowing& mastication. 3- Facial support& Facial expression. 4- Esthetics. 5- Preservation of the remaining tissues.

 What

we expect from denture:-

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→ Pt. have artificial eye will expect the real function of the denture ) Superior denture efficiency 20% of normal arch ). → Withdraws in speech& fullness of the mouth may be noted but compensated by pleasant appearance& eating. → Pt. is educated to accept the positions that are consider more

 *How 

to use the denture:-

1- Speech:

a) Reading aloud. b) Repeat fallen wards. c) Practice pronouncing wards.    

2- Training of the tongue 3- Eating 4- Coughing& Sneezing 5- Seasickness, Airsickness& Vomiting

 *How  

to use the denture:-

1- Speech 2- Training of the tongue:

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The upper denture lower denture

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3- Eating 4- Coughing& Sneezing 5- Seasickness, Airsickness& Vomiting

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The

 *How   

to use the denture:-

1- Speech 2- Training of the tongue 3- Eating:

→ Type of food:- Hard& sticky food should be avoided as possible as the pt. can. → Food should be cut into small pieces& placed on the occlusal surface of posterior teeth. Food should chew slowly on the both sides at one time. → Eating on anterior teeth leading to:a) Resorption of the residual ridge. b) Unstable denture. 

4- Coughing& Sneezing

 *How    

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to use the denture:-

Speech Training of the tongue Eating Coughing& Sneezing:

→ Covering the mouth with hands to avoid embracement. 

5- Seasickness, Airsickness& Vomiting

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to use the denture:-

1- Speech 2- Training of the tongue 3- Eating 4- Coughing& Sneezing 5- Seasickness, Airsickness& Vomiting:

→ Denture should be put in water until the patient recovers.

How to care for denture:  

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A) Oral hygiene control. B) Denture hygiene control:-

1- Denture should be kept clean: Presence of deprise → pressure → bone loss. 2- Denture shouldn't clean in boiling water → cause distortion of base. 3- Denture should be hold above a container of water during cleaning → to act as a cushion. 4- Denture should be clean after each meal using a brush& Dentifrice → not abrasive powder. 5- When denture develops odor → Immerse in oxidizing sol. )Clorox 1 tea

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6- Denture should be removed at least 8 hours each 24hour for the reasons:

a) Pressure can interrupt blood supply to tissue → Bone resorption. b) Continuous pressure → soft tissue damage → loose denture. c) Best time during sleeping to aid in tissue& muscle relaxation. d) In waking hours )Somatic Nervous System Defense Mechanism) as the Chinese Women leading to tissue shrinkage. 

7- When soreness occur → Pt. should be return for examination → Soft liners are a temporary solution& cause an immediate relief.

:Preferences* 

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1- Boucher's Prosthodontic ttt. )10th edition),1995 2- Arthur )text book of complete denture),2000 3- Winkler, Sheldon,1988 )Essentials of Complete Denture Prosthodontics) 4- Stuart )R.P.D),2001 5- McCracken’s Removable Partial Prosthodontics )10th edition), McGivney& Carr, 2000