Effects of dental appliances on oral health

Unit 8 Dental Public Health and Preventative Dentistry

Do We Need to Replace all Missing Teeth?

The opinion of the patient and the dental

team regarding the nature of dental

treatment required can often differ. A

greater disparity is apparent the older the

patient, so many factors have to be

considered during treatment planning.

It is not always necessary to replace all

missing teeth any decision to do so

must be made with the goal of improving

function, appearance and comfort.

Consider the following

• Does the patient have any problems chewing food?

• Does the patient have any discomfort arising from the missing teeth?

• Does the patient have any appearance or cosmetic concerns arising from missing teeth?

• Is there any evidence of occlusal instability?

Biological Price

Does the potential benefit of providing a

prosthesis outweigh the potential damage it

may cause to the remainder of the natural

dentition?

Removable partial dentures in

particular are associated with high levels of

dental caries and periodontal disease,

particularly in patients who are unable to

maintain adequate oral hygiene.

Protect the patient!

One of the standards for DCPs as required

by the GDC.

Adults in particular have the capability to

adapt to the gradual loss of teeth and

patients who have adapted well are unlikely

to seek treatment unless anterior teeth are

lost

DENTURES

IIll fitting dentures can contribute to the decline of tissue health in the oral cavity.

This can be due to:

• An inaccurate impression or distortion during processing

• A breakdown in communication within the dental team and between the patient!

Effects

• Pain• Discomfort• Sensation• Retching• Gagging• Tissue reactions• Swelling• Disease

Epulis fissuratum where the partial denture rests

Hyper plastic folds of an epulis Fissuratum caused by irritation of a denture flange

What is Pathology?

Pathology is a varied field of science, one of

the oldest disciplines, which focuses on

the study of diseases.

It should be noted that a number of

conditions increase in prevalence with age.

Threatening oral health!

Tooth Supported dentures

Encroaching upon the gingival tissues with

components of the denture such as

Connectors and clasp tips, is a common fault

in the design of tooth supported dentures

Tooth damage & decay caused by a poorly designed dental prosthesis

This is particularly common in the

prescription of removable partial dentures

RPDs.

Threats of disease, can be

minimized, however, by following a few basic

guidelines

• Provide tooth support for the denture where possible – wrought rests can be incorporated into acrylic RPDs to provide tooth support.

• Chrome based dentures should have rests placed on the tooth surfaces adjacent to the saddles.

Keep it simple & self cleansing!

Regular inspection of the denture fit is

necessary to ensure it is not causing

damage – at least once a year!

Incorporating occllusal rests in partial dentures may prevent vertical movement!

Keep the RPD design as simple as possible,

Minimising coverage of the dental and

Gingival tissues

Connectors should not encroach on the

Gingival margins of the teeth, and clasps

should not cover exposed root surfaces

Tooth damage caused by vertical movement of denture

Solutions

As technicians involved in the design

process, we can utilize technology further to

eliminate future problems developing.

In the case of RPD design, tooth stops and

occlusal rests will act to prevent soft tissue

damage

Denture wearers need to avoid plaque build-

Up that can irritate tissues under the

dentures

Ill fitting dentures can increase the possibility

of oral cancer and denture wearers should

see a dentist once a year for screening.

• Reduced saliva flow• Increased sensitivity in changing and

tissue that becomes increasingly thin• Dentures that do not dimensionally change

in accordance with the changing shape of the mouth

• Are all factors that need to be considered in order to improve oral health.

Instruct the patient in cleaning techniques for

both the RPD and natural teeth.

This will include careful instruction in oral-

hygiene procedures, and encouraging the

patient to clean the denture after meals and

to use denture cleaners

Dentures need to be checked for proper fit to

Avoid irritation, increased bone loss and

Infections.

A change in the fit of a RPD could indicate

periodontal disease

Inflammatory papilomatosis/multiple

papilomatosis/papillary hyperplasia

A condition of unknown cause but associated

with the presence of dentures, characterized

by numerous red papilary projections on the

hard palate.

Staphylococcus

Dentures can harbour numerous pathogenic and opportunistic bacteria .

Streptococcus

A spectrum of microorganisms can be

found harboring in dentures.

These organisms can instantly adhere to the

denture surface and penetrate the pores left

during the release of gases from

polymerisation.

As at technician it is important to use a good

quality material and ensure processing and

finishing is of the highest standard in order to

eliminate these problems and prevent further

disease.

Denture surfaces should be smooth and well polished!

Dental Ceramics

Similarly, care has to be taken with

the production of ceramic restorations micro-

porosity can also harbour bacteria and micro-

organisms.

Fortunately as technicians, we can reduce

the likelihood of this occurrence by ensuring

a nice smooth finish to the material with no

processing faults – cracks/porosity and /or

using a glazing product

A Well Finished Restoration!

Rampant decay under

old improperly bonded

restorations

Avoidable!... with the application of correct preparation and appliance design.

Once again it is the breakdown in

communication within the dental team that

had led to a failure in this restoration

resulting from poor margin design with blame

being attributed to both the surgeon and

technician.

Effect on Bacteria on Oral Tissues

What are virulence factors?

Virulence factors assist bacteria in achieving

success to and colonising sites i.e. molecules

produced by a pathogen that specifically

cause disease.

Bacteria adheres to the acquired pellicle,

(a cellular film composed of glycoprotein that

closely and firmly adheres to tissues of the

oral cavity)

This bacteria can accumulate to the extent

That it is able to withstand the

Mechanical cleansing effects of the soft

oral tissues and salivary flow.

Certain species of bacteria have the ability to

invade soft tissues i.e. gingivae, delivering

toxic bacterial products to the tissues

Actinobaccilus

A bacteria that causes gum disease and has been linked to heart disease.

Latrogenic trauma

Components of poorly designed restorations

or appliances can cause direct local irritation

and trauma to the gingivae

Over contoured restorations may have serious health implications

Poorly contoured fixed restorations may be

More problematic rather than being a solution

Marginal discrepancies

Poor oral hygiene – accumulated food debris

from packing beneath open contact points in

furcations, beneath overhanging or leaking

restorations and associated dentures.

Factors that predispose to the accumulation

of plaque, include poorly designed

restorations with overhanging margins,

poorly contoured and deficient restorations

and dentures

Patients suffering from periodontitis

As part of a patients periodontal treatment, it may be necessary to allow access for cleaning. Long – term wear of properly fitting and contoured provisional restorations allows the health of the gingival margin to improve and it’s position to stabilize before impressions are taken for definitive restorations.

Overhanging margins and ill fitting furcations

(division of the tooth root) can also lead to

defects developing.