2. • Introduction
• Terminology
• General information
• Chief complaint
• Medical history
• Personal history
• Dental history
• Examination- Extra-oral
Intra- oral
• Radiographic examination
• Diagnosis
• Prognosis
• Treatment plan
• Conclusion
3. Case history- anamnesis (historically)
(abbreviated hx or Hx)
It is information gained by a physician by asking
specific questions, either to the patient or the
accompanying person.
SYMPTOMS- complaints reported by the patient or
others familiar with the patient.
SIGNS- ascertained by direct examination on the
part of medical personnel.
It helps to form a diagnosis and formulate
a treatment plan
4. 'Listen to your patient; they are telling you the
diagnosis' is a much quoted aphorism.
Basis- good communication between doctor and
patient.
It is important for doctors to acquire good
consultation skills.
A good history is one which reveals the patient's
ideas, concerns and expectations as well as any
accompanying diagnosis.
The art of history taking
5. Listening is at the heart of good history taking.
Often the history alone does reveal a
diagnosis. Sometimes it is all that is required
to make the diagnosis.
It takes practice, patience, understanding and
concentration.
The history is a sharing of experience between
patient and doctor.
6. • It is the examination of the physical
state, evaluation of the mental or
psychological makeup, and
understanding the needs of each patient
to ensure a predictable result. (Winkler)
• Determination of the course of the
disease (GPT 8)
7. • It is the act or
process of deciding
the nature of a
diseased
condition by
examination, a careful
investigation of the
facts to determine the
nature of a thing. Or
the determination of
the nature, location
and cause of disease.
(Heartwell)
8. The sequence of
procedures planned for
the treatment of a
patient after diagnosis.
(GPT)
It means developing a course
of action that encompasses the
ramifications and sequela of
treatment that serve the
patient’s need. (Winkler)
9. A forecast as to the portable result of a
disease or a course of therapy. (GPT 8)
11. NAME
• The dentist should always address the patient by
his/her name.
• It creates some confidence in patient and
psychological security.
• To maintain the medico legal records.
Information of the Patient
12. Age is an indicator of the
patient’s ability to wear
dentures.
THROUGH 4th DECADE
• Tissues heal rapidly.
• Tissues are resilient.
• They give more
importance to esthetics
• They adapt to new
conditions rapidly.
• Bone quality is good.
• They are more demanding.
THROUGH 5th DECADE
• Muscular coordination
decreases
• Learning capacity decreases.
• Tissues are less resilient.
• Loss in tissue tone.
• Mucosa and sub mucosa above
the bone are thinner. Therefore
more susceptible to trauma.
• Adaptability to the new
prosthesis is less.
15. .
OCCUPATION
A patient’s job and social standing often determine the value he/she
places on oral health, as well as esthetics as well as other qualities desired
in a denture.
16. MENTAL ATTITUDE of a patient was classified by
House as: -
Philosophical
Exacting
Indifferent
Hysterical
Mental Attitude
• The successful prosthodontic treatment depends
on both technical skill & patient management
according to mental attitude.
17. Exacting : precise,
above average - intelligence,
immaculate in dress and appearance
doubt the ability of the practitioner
Once satisfied -greatest supporter
Philosophic: easygoing,
mentally well adjusting,
cooperative and
confident in the dentist.
prognosis - good
18. • INDIFFERENT PATIENT
• Patient presents a questionable or
unfavorable prognosis.
• Uninterested and lacks motivation.
• No attention to instructions,
will not cooperate.
• Blame the dentist for poor dental health.
HYSTERICAL PATIENT
Negative attitude
Poor oral health
Poorly adjusting
Previous denture attempts- Failed
Unrealistic expections
19. Chief Complaint
De Van “The Dentist should meet the mind of the patient
before he meets the mouth of the patient”
• Obtained by asking the patient to describe
the problem.
• Should be recorded in patient’s own words
as much as possible.
20. મારા દાાંત નથી
ચોકઠાં જરૂરી
ખાવા માટે અસમથથ
મારો દેખાવ સારો નથી
1) Uncomfortable
2) Inability to chew
3) Inability to speech
4) Looseness
5) Gagging
6) Biting the check or tongue
7) Food under the denture,etc
23. Neurological disorders
Parkinson’s disease
• C/f –expressionless face with staring look
soft rapid speech,
fixed posture,
impaired balance,
Altered gait,
muscle rigidity,
impaired fine movements,
tremors in mandible, tongue, fingers, hands.
• Difficulty in making impression , jaw relation recording
• Patient should be educated about the difficulty in eating, speech &
retaining mandibular denture
24. Diabetes
• Impaired carbohydrate metabolism because of insulin
deficiency or resistance.
Pt suffering from DM will show– Osteoporosis,
Residual alveolar boneresorption
Delayed wound healing.
Prone infection.
• Patient education regarding maintenance of denture
cleanliness oral hygiene. Need for regular check up
• Appointment scheduling- Morning appointment
• Mucostatic impression technique. Avoid surgical
intervention.
25. Osteoarthritis:
Characterized by deteriorations of articular
cartilage remodeling of underlying bone.
C/f:-Pain &crepitaion
Restricted movements
Muscles of mastication tender. -
Advanced stage joint disability & atrophy of
associated muscles.
Difficulty in wearing and cleaning of denture.
Difficulty in impression making & recording jaw
relation.
Frequent occlusal corrections should be made.
26. Cosmetic Index (CI)
Classified as:
Class I- High CI
More concerned,
Exacting personality
The aesthetic expectations of the patients.
Class II- Moderate CI
Nominal expectations
Class III- Low CI
Least bothered,
Indifferent personality
28. DENTAL HISTORY
Period of edentulism
-Gives information about the amount and
pattern of bone resorption
29. Reason for loss of teeth:
• Periodontal: implies the reduced potential ridge structure available
for denture support
• Caries :one may be spared and optimal bone support may be
expected if caries did not cause complications like alveolar abscess.
• Congenital: congenital absence of teeth, impaired bone supported
ectodermal dysplasia
• Trauma: it may cause complications in prosthetics because of
a) Bone loses b) scar tissue c) irregular ridges or
shortened ridges, d) maxillo -mandibular ridge relationship
30. SEQUENCE OF LOSS OF TEETH
• Loss of lower posterior teeth →→
supraeruption of the upper posterior bringing
the maxillary alveolar ridge down along with it
→→ overhanging tuberosity of posterior ridge
when the upper teeth are lost at a later time.
31. • Also if all posteriors were extracted some years before
the anterior ones and no partial dentures were worn in
the meantime, then a habit of eating with the front teeth
will have been formed which, if persisted in, will have a
pronounced unstabilizing effect on full dentures.
32. PREVIOUS DENTURE
HISTORY
• Duration
• Denture care
• Stability
• Retention
• Esthetics
• Vertical dimension of occlusion
• Phonetics
• Denture hygiene
• Occlusion.
38. To determine the facial profile, observe the
relative straightness or curvature of the
profile.
3 points are noted -
o The forehead
o The base of the
nose
o The point on the
chin
40. Concave/ Prognathic:
The two reference lines
form an angle with the
convexity towards the
tissue.
Associated with a
prognathic mandible or
a retrognathic maxilla.
41. Convex/ Retrognathic:
The two lines form an angle
with the concavity facing
the tissue.
This profile occurs as a
result of a prognathic
maxilla or a retrognathic
mandible.
42. Facial symmetry
• Determine disproportions in transverse and
vertical plane.
• Some degree of asymmetry is accepted as normal
Gross asymmetries can be due to -
Congenital defects
Hemi facial atrophy
Unilateral condylar ankylosis and hyperplasia
44. Gross asymmetries can be due to -
Congenital defects
Hemi facial atrophy
Unilateral condylar ankylosis and hyperplasia
45. Facial complexion
A guide to tooth selection.
Fair complexions – Teeth with less color range and color
saturation thus, the teeth are darker and in harmony
with the colors of the face.
Dark complexions- lighter teeth
Skin color can also reveal disease and pathology.
Pale, anemic looking patients may have underlying
systemic diseases and may require longer adjustment
periods.
46. Facial muscle tone
• Depends on the age &
health of the patient
• Classified by House as:-
Class I- Normal tone and
function.
Class II- Normal
function but decreased tone.
Class III- Decreased tone
and function
48. The lip is examined for
1.Support
2.Thickness
3.Mobility
4.Color
5.Health
49. Lip support
-Classified as adequately supported or
‘unsupported’.
-Unsupported lips results when the
patient has been edentulous for a number
of years.
50. Insufficient support of lips is characterized by-
A drooping and deepening of the nasolabial
grooves.
A reduction in the visible part of the vermilion
border.
A reduction in the prominence of the philtrum
Small vertical line or wrinkles above the
vermilion border.
A drooping or turning down of the corners of
the mouth.
51. LIP THICKNESS
Thin and tight lips
o Thin and tight lips make
impressions difficult, as
the insertion and removal
of the impression trays
may cause discomfort.
o Thin lips rely on the
appropriate labiolingual
position of the teeth for
their fullness and
support.
52. Full and relaxed lips
o The extra fullness of
the lower lip may be
the result of too
broad a dental arch or
the elimination or
reduction of
mentolabial sulcus.
o Thick lips need lesser
of support from
artificial teeth and the
labial flange.
53. LIP MOBILITY:
It is classified as:
o Normal
o Reduced mobility
Stroke patients may have paralysis of half of
the lip leading to unilateral mouth droop and
facial asymmetry.
54. LIP LENGTH:
The average lip length at rest is
measured from subnasale to the
most inferior portion of the
upper lip at the midline.
- 24mm - 20mm
• Affect how much tooth will be
exposed.
55. Short lip- any expression will express most
of the teeth and may be even part of the
denture base.
Long lip- hide the denture base and most of
the tooth.
Lip length to be classified as:
Long (26mm & above)
Normal (24mm- 26 mm)
Medium (21-24mm)
Short (10-15mm)
56. HEALTH OF THE LIPS
• The lips should also be examined for cracking fissuring at
the corners and ulcerations.
• These changes could be caused by vitamin B complex
deficiency, infections from organisms such as candida albicans,
an excessive over closure of an existing denture could be
neoplastic in nature. The cause of the situation should be
determined before denture construction.
57. T.M.J.
• Pain on opening/ closing movements
of mandible.
• Tenderness
• Clicking sound, crepitations
• Deviation of mandible on opening
• Muscle tenderness
• Limitation of mandibular movement
63. • Quality of mucoperiosteum may vary in different
parts the arch.
• Variation in thickness of mucosa make it difficult
to equalize the pressure under the denture and to
avoid soreness
Thickness of mucosa
64. Classification by House-
• Class I: Normal uniform
density (approximately
1 mm thick). Investing
membrane is firm but not
tense and forms an ideal
cushion for the basal seat
of the denture.
65. • Class II: Soft tissues have
been investing
membranes and are
highly susceptible to
irritation under
pressure. The mucous
membrane is twice the
normal thickness.
66. • Class III: Soft tissues have
excessively thick investing
membranes filled with
redundant tissue.
• At the very least, this
requires tissue treatment.
Such conditions may
require surgical
correction.
67. Condition of the Mucosa
Class I- Healthy mucosa
Class II- Irritated mucosa
Class III- Pathologic mucosa
70. Viscocity of saliva should be determined.
Saliva can be classified as-
Class I- Normal quality and quantity
Class II- Excessive saliva
Class III- Xerostomia
A consultation can allow a patient to unburden himself or herself. They may be upset about their condition or with the frustrations of life and it is important to allow patients to give vent to these feelings. The importance of the lament and how it may be transformed from the grumbles of a heartsink patient, to a useful diagnostic and therapeutic tool for both patient and physician, has been discussed in an excellent paper.[4]
women can be more demanding
People like beauticians, who open bobby pins with their teeth, might place leverage on the front of the CD and cause problems of function; i.e. retention.
A complete denture diagnosis based only on oral biophysical condition is incomplete unless the psychological factor is also evaluated.
A- philosophical
. Those who have presented themselves prior to the extraction of their teeth, have had no experience in wearing artificial dentures, and do not anticipate any special difficulties in that regard.
b. Those who have worn satisfactory dentures, are in good health, are a well-balanced type, and are in need of further denture service.
Class II - Exacting
a. Those who, while suffering ill health, are seriously concerned about appearance and efficiency of artificial dentures. They are reluctant to accept the advice of the physician and the dentist and are unwilling to submit to the removal of their artificial teeth.
b. Those wearing artificial dentures unsatisfactory in appearance and usefulness, and who so doubt the ability of the operator to render a service which will be satisfactory that they often insist on a written guarantee or expect the dentist to make repeated attempts to please them.
Class III - Hysterical
a. Those in bad health with long neglected pathological mouth conditions who dread dental service and submit to the removal of their teeth as a last resort and who are positive in their minds that they can never wear artificial dentures.
b. Those who have attempted to wear artificial dentures but failed and are thoroughly discouraged. They are of a hysterical, nervous, very exacting temperament and will demand efficiency and appearance from the artificial dentures equal to that of the most perfect natural teeth.
Class IV - Indifferent
a. Those who are unconcerned about their appearance and feel very little or no necessity for teeth for mastication. They are therefore non persevering and will inconvenience themselves very little, if any at all, to become accustomed to dentures.
The most imp. Fact the dentist should get to know is the chief complaint.
Once this is known, the dentist should get to know the individual, arrive at some understanding of what the patient really wants and whether the pts. Goals are realistic or not.
Angina pectoris: it is a severe ischeamic pain aggravates on exertion relieved with rest.
Avoid anxiety, exertion
Physician consultation .
Emergency drugs.
Hypertensions:
Myocardial infarction:
Pt with h/o MI avoid treatment for 6 mts.
Physician consultation & reassurance of pt to reduce anxiety.
Infective bacterial endocarditis:
Pt with artificial heart valves, valvular heart disease prone to develop.
Prophylactic Ab therapy prior to surgical procedures.
Patients of PD have difficulty in controlling and retaining the dentures due to tremors, rigidity of the orofacial musculatures and drooling of saliva.
Impressions should be recorded with quick setting impression materials especially in severe form of PD
Patients being treated for complete denture, wax or compound should be used for recording jaw relations (as it registers instantaneously) after proper training
If the teeth in one side of the mouth are extracted, the patient has to chew to the side to which teeth are present. This may lead to jaw deviation towards the extracted side. Jaw physiotherapy should be given before the jaw relations are taken in order to get an accurate recording.
Combination syndrome-There may be seven characteristics associated with this syndrome: 1. Bone loss in the premaxilla. 2. Dropping of the posterior maxilla (tuberosities). 3. Extrusion of the lower anterior teeth. 4. Posterior bone loss in the mandible under the RPD. and 5. Papillary hyperplasia of the maxilla. 6. Decreased Occlusal Vertical Dimension. and 7. Facial aesthetics often altered dramatically
If the teeth in one side of the mouth are extracted, the patient has to chew to the side to which teeth are present. This may lead to jaw deviation towards the extracted side. Jaw physiotherapy should be given before the jaw relations are taken in order to get an accurate recording.
Duration – clinical observation of the ridge
Denture care and hygiene- clean
Dental knowledge
HNF Region should be examined for any pathology
Facial color, tone, symmetry, neuromuscular activity to be noted.
Facial examination, examination of muscle tone and development and tmj examination.
Examining the facial form helps in teeth selection
Three points are noted
The patient should be up right and comfortable one with the head supported by the spine, wet the lips, place the lips into light contact and relax. It is determined by an imaginary line joining the forehead, nasion, and menton.
Forehead- nasion
Gnathion
menton
In most patients, the right and left sides are not identical which is also termed as normal asymmetry. Some degree asymmetry is accepted as normal whereas gross asymmetries are recorded.
Hue-color
Saturation- chroma
Saturation is the purity of a color.
Value:(also called brightness or luminosity)
Value is the lightness or darkness of a color
Facial muscle tone:
it can be classified in to 3 classes
Class I: muscles are normal in tone and function. There are sufficient teeth properly distributed to retain the normal mandibular position and furnish normal tension, tone, and placement of the muscles. They’re in no degenerative changes in the muscles of facial expression or mastication. Except in instance of immediate restoration, edentulous patients do have this muscle tone.
Class II: Approximately normal function, tone and tactile senses have been preserved by wearing of denture with restoration of correct vertical dimensions.
Class III: sub normal function, tone and tactile sense results from ill health, loss of natural teeth, or the wearing of grossly inefficient dentures. Frequent over closures produces wrinkles and a droopy mouth, protrusion of the mandible and loss of muscle power.