CASE HISTORY IN COMPLETE DENTURE

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CASE HISTORY IN COMPLETE DENTURE

PATIENTS

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Introduction

The successful complete denture therapy begins with thorough assessment of patients physical and

psychological condition and determining the treatment that will deliver a functional complete

denture.

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Definition

Case history:- A collected data about an

individual ,family ,environmental factors (including

medical/dental history) and other information that may be useful in analyzing and

diagnosing conditions and for instructional purposes ;best

termed as patient history.(GPT 8)

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Importance of Case History

• Obtaining a patient’s history and conduct a physical examination are requisities to establish diagnosis and treatment planning.

• To evaluate patient’s psycological behaviour.

• To understand expectations of patient regarding denture.

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Sequence of recording case history Personal data

 N

ame

 A

ge –

It is an indicator of the patients ability to wear and use dentures.

 Sex- Womens are more concerned about esthetics.

 Race- Critical factor in characterization of dentures

 Occupation- It is related to the design of the denture

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 Personality

^- According to M.M.HOUSE

 Philosophic- Easy going,mentally well adjusted,cooperative and has confidence in dentist

 Exacting- Precise,above average in intelligence,concerned in their dress and appearance,often dissatisfied

with past treatment

 Hyterical- Patients are often in poor health,are poorly adjusted,appear exacting but with unfounded complaints,have failed at past attempts to wear dentures and have unrealistic expectations

 Indifferent- Unconcerned with appearance often go without denture for years

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Medical history

As a health professionals,dentist are responsible for the well being of patients under care.

Systemic factors that may affect the complete denture therapy includes-

 Infectious diseases Hepatitis B

Tuberculosis

 Metabolic diseases

Diabetes mellitus-bone response prosthetic stress is poor and requires a pressure free impression tecniques.

Diseases of bone

Osteoporosis osteoarthritis pagets diseases

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 Diseases of bone

Osteoporosis Osteoarthritis Paget’s disease



Neuromuscular diseases

Parkinsonian disease- affects the stomatognathic system by

altering the functions of the jaws and tongue.Regular exercises,maintainence of prosthesis,adaptation and oral hygeine are to be

encouraged.

Bells palsy- partial support for the affected oral commisure is often possible with a

prosthesis a hook like device attached to denture.

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 Blood dyscrasias

Anemia

Leucopenia Leukemia

 Cardiovascular diseases

Angina pectoris

Myocardial infarction

 Diseases of skin

Pemphigus

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Oral malignancies

• Tissues chronically abused by poorly maintained

natural and artificial dentition ,alcohol and tobacco predispose the oral tissues to malignancy.

• Sharp borders of denture are avoided.

• In case of radiation therapy sufficient time has to be given for the tissues to recover before treatment is initiated.

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Nutritional status

• A complete denture prosthesis depends ultimately upon the health and integrity of the denture bearing tissues for successful function and comfort to the patient.

• The following nutritional factors should be considered-

 Xerostomia- Causes and effect of negative water balance.

 Negative calciuum balance-Causes and effects on alveolar bone.

 Nitrogen protein balance- Musle weakness tissue fragility.

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Dental history

 Chief complaint

“The dentist should meet the mind of the patient before he meet the mouth of the patient”-De Van

Importance-

 The chief complaint may be overlooked during therapy

 To access the patients expectations

 To determine patients psycological classification

 Expectations

 Years of edentulousness,max/man

 Reasons and sequence of teeth loss

 Previous dentures,max/man

 Existing or current dentures

 Denture success.

 Pre extraction records.

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Clinical evaluation

• Extraoral

 Facial form(frontal

)

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Facial form(profile)

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Muscle tone

• According to M.M.House

 Class 1- Normal muscle tone

 Class 2- Slight impaired muscle tone

 Class 3- Greately impaired muscle tone

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 Complexion

Hair, eye , skin colour provides useful guides in the shade selection.

 Lip

 Examined for cracking ,fissuring at th corner and ulceration.

 Lip support- adequetely supported unsupported

 Thickness- Thin thick

 Lip length- long normal

short

 Lip mobility- normal reduced

paralysis

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Temporomandibular joint

• Palpation

• Auscultation

• Mandibular movements- normal impaired

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Neuromuscular evaluation

 Speech- normal affected

 Coordination- patient with good neuromuscular coordination can be expected to learn to manipulate dentures

relatively quickly and likewise adapt readily to new dentures.

It can be classified as-

 Class 1-Excellent

 Class 2-Fair

 Class 3-Poor

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Intra oral examination

 Arch size

 Class 1-Large

 Class 2-Medium

 Class 3-Small

 Arch form-

 Class 1-Square

 Class 2-Tapering

 Class 3-Ovoid

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Ridge form

• Maxillary • Mandibular

Parallel walls

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Defects

• Ridge defects such as exostoses,sharp bony spicules should be noted that may pose problem for complete denture patients or may warrant preprosthetic

surgery.

• Tori may be classified as-

 Class 1-Tori are absent or minimal in size

 Class 2-Moderate in size

 Class 3-Large in size

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Inter arch space

• Class 1-Ideal

• Class 2-excessive

• Class 3-Insufficient

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Ridge parallelism

• Class 1

• Class 2

• Class 3

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Ridge relationship

• Class 1-Normal

• Class 2-Retrognathic

• Class 3-Prognathic

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Radiographic evaluation

Radiographic examination is an essential part of diagnosis and treatment planning for all dental patients.

The screening of jaws includes

 Retained tooth roots

 Unerupted teeth

 Foreign body

 Various pathosis of devlopmental,inflammatory or neoplastic origin

 Bone quatity and quality

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According to Branemark et al

Bone qantity Bone quality

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Lateral throat form

• According to Neil

 Class 1

 Class 2

 Class 3

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Palatal throat form

According to M.M.House

 Class 1

 Class 2

 Class 3

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Palatal sensitivity

• According to M.M.House

 Class 1-Normal

 Class 2-Subnormal

 Class 3-Supernormal

Mucosa thickness

 Class 1-Normal uniform density of mucosal tissue,investing membrane is firm.

 Class 2-Mucous membrane is thick,thin investing membrane.

 Class 3-Excessive thick investing membrane filled with redundant tissues.

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Mucosa condition

• 1According to M.M.House

 Class 1-Healthy

 Class 2-Irritated

 Class 3-Pathologic

Frenum attachments

 Class 1-High in maxilla or low in mandible

 Class 2-Medium

 Class 3-Freni encroach the crest of the ridge

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Saliva

 Class 1-Normal quality and quantity

 Class 2-Excessive saliva

 Class 3-Xerostomia

Tongue size

 Class 1-Normal in size,devlopnment and function

 Class 2-Teeth have been lost long enogh to permit a change in form and function of tongue

 Class 3-Exceesively large tongue

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Position of tongue

• According to Wright

 Normal

 Class 1-Retracted

 Class 2-Retracted

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Existing dentures

 Existing esthetics,phonetics,retention, stability,extensions and contours should be evaluated.

 Should be rated as-

 Good

 Fair

 Poor

 Centric relation and vertical dimensions of occlusion should be assesed and evaluated

 Occlusion plane orientation

 Midline

 Hygiene-good -fair -poor

 Wear

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Conclusion

A complete case history is presented for use in

evaluating and planning the treatment of patient for complete denture therapy. The treatment plan

devloped for a patient should reflect the dentist’s best efforts at interpreting the diagnostic findings and addressing the patient’s need in keeping with their appreciation for dentistry and their ability to accept the proposed treatment.

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References

• Robert L.Engelmeier,Rodney D.Phoenix:Patient evaluation and treatment planning for complete denture therapy,Dental Clinics of North

America:40,1-18,1996.

• Heartwell MC:Diagnosis. In Syallabus of Complete Dentures,ed 4,Charles M.Heartwell,Jr Arthur

O.Rahn,Varghese publishing house;Bombay;1992;106- 142.

• Douglas V.Chaytor:Diagnosis and Treatment Planning for Edentulous or Potentially Edentulous Patients. In Prosthodontic Treatment for Edentulous

Patients(Complete dentures and implant-supported prosthesis),Zarb,Bolender,Mosby;St.Louis

MO;2005;73-99.

• Robert L.DeFranco,Lance F.Ortman: Diagnosis and

Treatment Planning.In Essentials of complete denture prosthodontics,ed 2,Sheldon

Winkler;A.I.T.B.S;India;2000;39-55.