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