Diagnosis for edentulous patients
-
Upload
dibya-falgoon-sarkar -
Category
Education
-
view
81 -
download
0
Transcript of Diagnosis for edentulous patients
Diagnosis for Edentulous
PatientsBy Dibya Falgoon Sarkar
( North Bengal Dental College & Hospital)
DiagnosisDefined as : The determination of the nature of a disease. (GPT-8)
In other words ,diagnosis is the examination of the physical state , evaluation of the mental or psychological makeup of the patient, and understanding the needs of each patient to ensure a predictable result.
Extraoral Examination
General appearance (healthy, signs of proper nourishment)
Facial symmetry Facial form & profile Skin: color, deep wrinkles Palpation of the head & neck (lymph
nodes & muscles)
Extraoral Examination
TMJ examination Lips: length,thickness,mobility
Classification of Frontal Face Forms (House, Frush & Fisher)
Square Square- Form Face Tapering
Tapering Ovoid
Classification of Lateral Face Forms Class I - Normal
Class II –Retrognathic
Class III - Prognathic
Temporomandibular Joint Examination The TMJ should be evaluated for pain by
palpation or mandibular movements. The muscles of mastication should be
examined for pain. Any deviations should be noted during
opening & closing the mouth. Any joint sounds such as clicking , popping,
crepitus should be noted Reasonably coordinated mandibular
movements are necessary for jaw relation.
TMJ Examination
Lips
LengthThicknessMobilitySmile line
Lip Length
Long Lip Short Lip
Lip (smile) line
High smile line Normal smile line
Intraoral Examination tongue color of the mucosa floor of the mouth maxillary tuberosity hard palate soft palate arch relationship arch form ridge contour residual ridge size inter-ridge space saliva undercuts
Residual Alveolar Ridge Size
Average Sized Ridge (Class I)
Resorbed Alveolar Ridge ( Class III )
Arch Form
Residual Alveolar Ridge (Cross Sectional Contour)
Inter-arch Distance
Class I Class II Class III
Ridge Parallelism
The Tongue Favorable tongue is average sized,
moves freely, covered by healthy mucosa Tongue contributes to denture stability
by controlling the dentures during speech, mastication & swallowing
Tongue provides peripheral seal to the dentures
In edentulous patients the tongue may become enlarged and powerful
Tongue SizeNormalMacroglossia - Difficulty in
impression taking is seen. Microglossia – Might
jeopardize a lingual seal.
Macroglossia Microglossia
Tongue Position (Wright’s Classification)
Class I Class II Class III
Frenal Attachments
Class I Class II Cass III
The Hard Palate Class I (U shaped)
Class II (V shaped)
ClassIII (Flat or shallow vault)
The Soft Palate(Palatal Throat Form)
House’s classification
Class I Class II Class III
Lateral Throat Form Examination
Class I
Class II
Class III
Saliva
Consistency: Thin serous Thick mucus Mixed
Amount: Normal Excessive Reduced
Drugs Causing Xerostomia Diuretics Antihistamines Atropine Anticholinergic Antihypertensive Antiparkinson (Norflex) Corticosteroids
Maxillary Tuberosity
If enlarged: the posterior
occlusal plane may be placed too low
not enough space to set all molars
Painful & difficult path of removal & insertion if an undercut is present
Radiographic Examination
A routine radiographic exam. must be ordered to rule out any bony conditions that could affect the treatment
Panoramic radiograph(OPG) is usually ordered for denture cases
Supplemental Radiographs: IOPA,Occlusal,etc.
Radiographic Examination
Pathologies to be watched during radiographic examination:
1.Retained roots2.Bony abcess 3.Bone Diseases: Paget’s
disease,Osteopetrosis,etc
Panoramic RadiographShowing extensive alveolar ridge resorption
Additional Tests & Medical Consultation Routine blood test, blood & urine
sugar (OGTT) levels Medical consultation Dental consultation
A good clinician is one who is able to diagnose potential problems during the initial
examination & suggest the best possible treatment plan compatible with the age,
physical, mental & financial status of the patient
ReferencesI. Complete Denture Prosthodontics, 1st
Edition, 2006 by John Joy Manappallil, Chapter 2.
II. Essentials of Complete Denture Prosthodontics by Sheldon Winkler.
III. Zarb. Prosthodontic Treatment for Edentulous Patients, 12th edition. Chapter7