1. How long will my new denture last, do I need to come back? Codey Pilgrim, Dave Ropson, Kyle Nield, Mattie Paradise, Matthew Quinlan, David Patch

2. Things to consider Longevity Proper Care Oral care

3. Longevity Dentures are typically expected to last 5-7 years Have to consider: – Changes in the denture Staining Fracture/damage to denture/wear – Changes in the Patient Tissue changes Bone resorption

4. Proper Care Should schedule yearly recall visits with the dentist when you have a denture Need to make sure the denture still fits and the tissue is healthy Easier to correct small problems – Small fractures/wear – Reinforce oral hygiene

5. Key Point – Better for Dentures to wear out than the tissues

6. How to clean a denture Dr. MacAdam’s Group: Sean Eckstein David Gagnier Liz Girgulis Shane Huish Melissa Jeans Joe Joudrey

7. Basic Concepts Remove dentures after eating Brush minimum 1x/day – Brush both mucosa & denture. Rinse before returning to mouth Regular denture check-ups are necessary! Don’t wear dentures 24 hours/day Want to give the tissue time to heal Soak overnight in water or mild cleanser

8. What not to do Do not use toothpaste – abrasives can harm denture Keep away from stiff bristled toothbrushes No bleach containing cleaning products Stay away from dishwashers and hot water Avoid using solutions with chlorine if you have metal components on the denture

9. Ideal Denture Cleanser Non-toxic and easy to remove Harmless to patient and denture Should dissolve all the denture deposits (calculus) Antimicrobial effect Long shelf life Inexpensive Ex. Efferdent, Polident, ex.

10. Limitations of Dentures Team Raftus

11. Eating Complete denture is not fixed in the mouth completely so may unseat while eating Difficulty with chewing (dislodgement) Change in sensation Function less effectively than normal teeth in chewing (force generation) Not able to eat all of the same foods (biting into an apple, corn on the cob)

12. Patient Sensitivity Coverage of tissues (palate) will cause problems with sensation of temperature and potentially taste

13. Patients’ Anatomy Residual ridge is different for different patients Residual ridge is constantly changing so may adapt differently over time May lead to differences in comfort and fit of the denture for the patient Higher risk of sore spots Saliva is acting as a primary adhesive. Patients with dry mouth will have a hard time with denture fit.

14. Phonetics Adaption to some sound production because of movement of the tongue against the denture

15. Tyler Nelson Megan Mews Kim Mahoney Kyle MacPherson Saida Mershati Severely Resorbed Ridge What To Expect Compared To A Good Ridge

16. An Ideal Ridge Adequate bone support for retention – Broad U shaped alveolar ridge with buccal and lingual cortices as parallel to each other as possible Adequate firm soft tissue coverage – Firm, keratinized mucosa No bony or soft tissue undercuts No sharp ridges No high muscle or frenal attachment No intra or extra oral pathology

17. Resorbed Ridges What do we see? – Little to no alveolar bone – More prone to ulcers – Soft tissue overgrowth (compressible tissue) – Altered lip support – Reduced facial height (due to reduction in vertical occlusal dimensions) – Tend to be worse in the mandible

18. Resorbed Ridges How does this affect treatment? – Decreased or inability to wear a denture Pain and retention – Negatively affects retention of the denture – Compromised lateral stability – Harder to treat in the maxilla Gravity Large sinuses

19. Management of Severely Resorbed Ridges What can we do about this? – Localized or generalized hyperplastic replacement of resorbed ridges (surgery) – Implants for abutments (depending) Avoid nerve damage or fracture – Use of long- term soft liners as a therapeutic measure (increased discomfort) Frenum can be atop of the ridge Closer to the nerves

20. Why Do Patients Take Time To Adapt To Chewing? Dr. Boran’s Squad

21. Changes due to new denture Vertical changes in occlusion Changes in the incisal guidance Changes in centric occlusion Loss of proprioception for new denture patient (loss of PDL attachment alters proprioception during mastication) This applies to new denture patients and patients that have already had dentures

22. Changes DUE TO NEW DENTURE Muscles will be hyperactive at first Cheeks, lips, and tongue must be trained to maintain the denture in position during mastication This is a moving prosthesis, so there is a learning curve relating to how to chew so that you don’t get tipping of the denture, etc. It is a new sensation

23. Patients may experience Pain Decreased efficiency Cheek or lip biting, initially Discomfort Muscle fatigue Changes in salivary flow

24. EDUCATION Placing food towards corners of mouth Cutting food into smaller pieces Initially eating soft foods (crackers, soft toast, chopped meat) Avoid hot foods Eat more slowly Encourage chewing on both sides Encouraging them to wear dentures

25. Why do patients take time to adapt (Speech) Group: Dr. Christie

26. Denture Quality Denture fits and retention is good, thickness of denture (increases rapidly after 1mm) Important for landmarks Correlation between denture quality and speech quality Speech test: should be made after esthetics (No impingement on soft tissue (some impingement but no undo) Position of post-palatal seal important for sound production

27. Phonetics Phonetics: The branch of linguistics that deals with the sounds and speech and their production, combination, description and representation by written symbols The alterations in positions and relationships of the incisors had a strong influence on phonetics

28. Tongue movement and lips Numerous muscles involved in sound production but primary is tongue and lips Tongue, lips, palate, teeth and mandible play a very important role

29. Mechanisim of speech production: Neuromuscular and mechanical Sound is produced in the larynx Resonators Lisping: Palatolingual sounds formed by tongue and hard palate Words like S, T, D, N and L belong to this caterogy

30. Why patients take time to adapt For new dentures they might take time to pronounce certain words Possible mechanical interferences with muscles if denture is improper Position of teeth affects speech Fine tune system: mm matters (thickness of dentures) Changing the paramaters of the mechanics of the landmarks that the tongue looks for to create a lip seal and tongue seal