Care of Dental Appliances and Prostheses

Dental Assistant Role in the Care and Cleaning of Appliances

1) Be familiar with different dental appliances 2) Carefully assess appliance with faculty input before attempting to clean 3) Look for soft liners, cracks, thin or fragile areas, loos teeth, etc. 4)Heavy buildup may mask damged appliances 5) May not withstand professional cleaning methods.

Soft liners and other non-ridgid dental materials

1) Can deteriorate or completely dissolve in the presence of enzymes and other soaking cleaners 2) Sensitive to heat of solution-coller is better 3) Do not use in ultrasonic cleaners unless specifically directed to do so. 4) Provide microscopic homes to Candida spp. 5) 0.5% bleach solutions most effective atmanaging Candida on soft materials -Not indicated for metal clasp/wire use -Can change color or increase brittleness of plastics if overused

Professional cleaning (cont.)

1) Check for calculus and debris 2) Brush obvious debris under running water 3) If no obvious damage, pace in doubled ziplock plastic bag w/stain and tartar remover (type 4) 4) Place sealed bag in ultrasonic and run for approx 5 mins

Oral Candidiasis

1) Common and naturally occurring oral yeast 2) Presence of anti-fungal proteins in saliva stabilizes Candida spp. in healthy mouths. 3) Candida thrives: -In oxygen deprived environments -Under continuously warn protheses/acrylic substrates -In immunocompromised systems -With plentiful glucose presence -Xerostomia -With use of antibiotics

Atrophic Candidiasis or 'Denture Stomatitis'

1) Edematous, red tissue (Usually palatal) that is in direct contact with a denture

Dental Appliances/Prostheses

1) Fixed/Removable Partial Dentures 2) Complete Dentures and Overentures 3) Mouthguards/Night Guards/ Snore guards 4) Orthodonitic Appliances

Professional cleaning of hard removable appliances

1) Follow the appliance through the cleaning process to ensure continuity of care. 2) Double check care plan for removable appliance with faculty 3) Faculty MUST assess prosthetic appliance before any cleaning is attempted.

Abutment Teeth at risk

1) Increased load on acnhoring abutments 2) Often have recession/exposed root surfaces. 3) Clasps readily retain plaque in the gingival third. 4) Ill-fitting appliances increase risk of periodontal breakdown and tooth mobility

Temporary appliances

1) May have to last longer than intended 2) Fluoride Carriers 3) Bleaching Trays 4) Postsurgical Stents 5) 'Flippers' (Temporarily replace missing teeth)

Erythema

1) Most common condition noted with appliance/prosthetic use. 2) Acute-may be painful and associated with edema, probably trauma etiology 3) Chronic-painless, suspicious of Candida spp. 4) Coincidental-consider possiblity of carcinoma lesion

Metal allergy

1) Nickel metal allergies most common 2) Used in denture frameworks, crowns/bridges, and also ortho wires and brackets 3) This patient was allergic to nickel, note the "footprint" of a metal-frame removable partial denture. 4) Documented allergies to other metals 5) Cobalt, chromium, and palladium

Natural vs. artificial surfaces

1) Post-cleaning biofilm formation in partially dentate mouths is more rapid and more complex on natural teeth than on denture teeth. 2) Oral gygiene becomes even more important for these patientse

Acute Hyperplastic Candidiasis or 'Thrush'

1) Raised white plaques-when wiped off w/wet 2x2-reveal a raw, bleeding surface underneath 2) Methacrylate resin surface textures and chemical properties are conducive to colonization by Candida spp.

Soft liners (cont)

1) Refer to treating dentist for obvious wear/repair issues/professional cleaning. 2) Clinic, limit cleaning to rinsing with water, or Cepacol/Plax (no ultrasonic) 3) For stain or fungal concern: 5-10 min soak in 0.5% bleach solution. Rinse well 4) Do not leave dry, seal in plastic bag

Types of Partials, Dentures, and Full Dentures

1) Removable Partial Denture 2) Complete or Full Denture 3) Overdenture

Professional cleaning (cont)

1) Remove remaining deposits with denture brush and curet. Do not scale on impression side of appliance 2) Rinse thoroughly with water 3) May polish with tin oxide to remove any surfaace stains (very low abrasive), rinse well. 4) Soak briefly in dilute mouthwash to freshen 5) Document findings and cleaning procedure in chart.

Dentures (F/F) and Removable Partial Dentures (RPD/RPD)

1) Replace an entire arch or missing teeth. 2) Aid in maintaining proper nutrition-adds chewing surface area 3) Improve appearance and aesthetics 4) Support facial muscles and structures

Denture ulceration from poorly-fitting dentures

1) Requires Dr. check with pressure indicator paste, adjust, or reline the denture

Desquamative lesion from trauma or chemical burn

1) Sloughing of damaged thin mucosal layer 2) Painful but resolves in 7-10 days w/o days w/o treatment 3) Failure to rise bleach-soakeddenture resulted in chemical burn in this situation

Implants as abutments

1) Use radographs to determin, if necessary 2) Implant post made of titanium which scratches easily -Use plastic instruments ONLY when probing and scaling around implants -Plaque can be removed with Superfloss -Be cautious recommending hoomecare aids with wire centers (eg Proxabrush)

Implant-borne prosthetics

1) Widely used in dentistry 2) Intergrity of screw attachments must be assessed 3) Report any concerns (movement, misplacement, fractures, etc) to dentist immediately 4) Close attention to implant abutments

Dental Appliances/Prostheses cont.

5) Splints 6) Fluoride Carriers 7) Bleaching Trays 8)Maxillofacial Prostheses 9) Sleep Apnea devisces 10) Implant-borne prostheses 11) Postsurgical Stents

Dentures vs. Partials Dentures

Dentures: 1) Replace entire arch 2) Usually removable 3) Porcelain, or plastic teeth 4) Can be supported by implants (Overdenture) Partials: 1) Replace some missing teeth 2) Removable or fixed 3) Porcelain, acrylic, composite, or plastic teeth 4) Metal or plastic framework use teeth for support

Temporary partials and 'flippers'

May not stand up to conventional or vigorus cleaning methods.

Chronic Hyperplasstic Candidiasis-'Palatal Hyperplasia'

Small rounded projections of epithelialized tissue grow into space between palate and ill-fitting maxillary denture