!Financial agreement COST / RISK / BENEFIT

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Cory Powell
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1 COMPLETE DENTURES 1 2 Oral Examination, Diagnosis and Treatment Planning Initial Appointment! Get to know your patient! Personally, experiences, expectations! Past medical history! Past dental history! Oral examination! Treatment plan!financial agreement COST / RISK / BENEFIT Very important! medical history! dental history Helps determine! diagnosis! prognosis! fee Records 3 4 The House Classification!Dr. Milus House!General classification based on extensive clinical experience of complete denture patients mental attitudes. The House Classification! The Philosophic Patient! Accepting of dentist, oral condition! Ideal attitude for successful treatment provided the bio-mechanical factors are reasonable! The Indifferent Patient! Little concern oral health, dentist! Treatment insisted on by a significant other! Give up easily 5 6 1

2 The House Classification! The Critical Patient! Find fault with everything! They direct treatment! Usually have poor health leading to poor personality! Medical consultation advisable before treatment The House Classification! The Skeptical Patient! Previous bad experience with dentist/dentures and doubtful anyone can help them! Poor health and unfavorable oral conditions for fabrication of dentures! Often have a series of personal tragedies! A lot of TLC 7 8 Observations Affecting Diagnosis! Age!Young - more adaptable,esthetics very important, good health, high tolerance levels! Middle - be more aware of psychological and physiological changes! Advanced - less tolerant of change, reduced coordination, communication may be more difficult, soft and hard tissue changes, drug regimen Observations Affecting Diagnosis! Gender! Female- may be more demanding than males! Males- indifferent towards appearance and place more emphasis on comfort and function 9 10 General Health! May or may not correlate with patients age! Observe patients posture and entrance into office! Communication/ listening! Friendly questioning usually stimulates patient to readily volunteer information! Consultation with Physician!!! Medical History! Medical Condition! Diabetic, psychological state, hypertension, heart problems, allergies, chronic diseases! Medications! Anti-depressants, anti-anxiety, antiinflammatory, diuretics, antihypertensive, vasodilator

3 ! View overall facial appearance! Lip support! Lip thickness! Lip length! Lip fullness! Facial profile and tone! Vertical face length! Lip support! If tissues around the mouth are wrinkled and the rest of the face is not, improvement may be made to decrease the wrinkles.! If the lips appear collapsed the anterior teeth may be set to far lingually ! Lip thickness! Thin lips will not tolerate much change in labiolingual tooth position! Any slight change will make changes in the appearance of the lip! Thick lips will give the dentist more leeway in tooth position and arch form before changes are noted.! Lip length! Short upper lip will expose all of the maxillary teeth and labial flange of the denture base! Pay special attention to tooth size, shape and shade along with the denture base shade 15 16! Lip fullness! Directly related to the support it gets from the teeth and mucosa/denture base! Do not confuse this with lip thickness which involves the intrinsic structures of the lip 17! Facial profile and contour Gives an indication of the relative jaw size and vertical jaw relations! Convex profile Maxilla is larger than the mandible. (occlusion that is characteristic of a Class II)! Concave profile Maxilla is smaller than the mandible (occlusion that is characteristic of a Class III) 18 3

4 ! Tone of facial tissues! Age and health affect intrinsic structures of facial tissues! Poor tone indicates limitations on what can be done (we are not plastic surgeons)! Facial tissues can only be supported to their original position! Vertical face length! Directly related to the vertical height of the dentures! Decreased vertical dimension= lower facial height will not be adequate, difficult to function, soft tissue problems! Increased vertical dimension= lower facial height will be extensive, difficult to function, soft tissue problems Oral Examination! Electronic! MRI, Radiographic (CAT, Imaging)! Visual! Eyes, Magnification, Photography! Palpatory!Sense of structure (not radiopaque) Radiographic Examination! Should always be done prior to Tx! 30-40% will have a positive radiographic finding retained root tips unerupted teeth radiopacities radiolucencies 21 foreign bodies 22! Pathoses! Maxillary and Mandibular arches! Oral tissues! Saliva

5 25 26 Exam Form! PREVIOUS DENTURE EXPERIENCE! ORAL EXAM! RADIOGRAPHIC! ESTHETICS! PROGNOSIS! FEE ESTIMATE Previous Denture Experience! Length of time patient has been edentulous?! How old are current dentures?! What is the patient s chief complaint?! This will help you determine if you can help the patient, how successful you will be, and your fee for the service. LISTEN Previous Denture Experience! Evaluation!Esthetics!Vertical Dimension!Mandibular Tissue Coverage!Maxillary Tissue Coverage!Retention!Stability! Oral tissues! Mucosa, tongue, soft/hard palate, cheeks, floor of mouth, throat! Abrasion, ulcerations, tori, cuts, malignancies, hyperplasia, epulis fissuratum, papillary hyperplasia, lichen planus, leukoplakia! Mucosal health is determined by its color, pink! MUST be healthy prior to impressioning procedures

6 Variety of Maxillary Arches. Variety of Mandibular Arches The good The good The ugly The ugly The bad 31 The bad 32! Uniform layer of soft tissue over bone which is firm but resilient! Well defined tuberosities and hamular notches, low frenum attachments! Broad U-shaped arches are ideal! Ideal Palatal vault form is of medium depth with well defined rugae! Normal tongue size! Saliva of moderate flow and serous content is ideal! Ideal muscle tone and coordination! Free flowing jaw movements! Lack of pathological TMJ dysfunction! Lack of severe gag reflex Treatment Planning! After obtaining all information pertaining to your initial examination, a treatment plan is devised.! Is treatment indicated considering the patients present medical and/or psychological health?! Will treatment improve or maintain health?! Do you as the dentist feel comfortable with the patient and the proposed treatment? Treatment Planning! After obtaining all information pertaining to your initial examination, a treatment plan is devised.! Is treatment indicated considering the patients present medical and/or psychological health?! Will treatment improve or maintain health?! Do you as the dentist feel comfortable with the patient and the proposed treatment?

7 Treatment Planning Treatment Planning IF NOT! CONSULTATION OR REFERAL! Discuss with the patient the length of time to complete the procedures and any unforeseen difficulties that may arise.! Also cost of treatment and expected outcome

PREPARATION OF MOUTH FOR REMOVABLE PARTIAL DENTURES Dr. Mazen kanout

PREPARATION OF MOUTH FOR REMOVABLE PARTIAL DENTURES Dr. Mazen kanout Mouth preparation includes procedures in four categories: 1. Oral Surgical Preparation. 2. Conditioning of Abused and Irritated Tissue.