Sabtu, 31 Desember 2011

Important Post Delivary instructions following Denture Delivary

Here in this post we would like to share, Important Post delivery instructions following Denture delivery.

Congratulation! You have just received your final prosthesis. We hope you will enjoy using it. There are a few things to keep in mind:

1. You may salivate more heavily for the next several days, until your mouth is accustom to the presence of the new prosthesis.
2. You may feel awkward when talking or speaking certain words, at first. With practice, your tongue will be trained to accommodate around the prosthesis and your phonic will become normal, again. Reading out loud may help expedite the process.
3. Sore spots are normal. Please give us a call to have your prosthesis adjusted, as necessary. We want to make sure that you will be able to use your new teeth, as comfortably as possible.
4. Occasionally, due to the morphology of the underlying jaw bone, the use of adhesive cream or paste may be required to attain satisfactory retention.
5. Keep your prosthesis soak in a water bath, with denture cleansing tablet, when not in use, especially during bed time.
6. Leave your new teeth out, during bed time, allowing your gum to breath regain normal circulation.
7. Clean your denture with a toothbrush and hand/liquid soap, over a half-filled sink or bucket of water, prior to each use.
8. Avoid chewing gum or eating sticky foods.

New full or partial Denture Instructions-in Detail

I believe that you will be very successful with your new full denture or removable partial denture. When you begin to wear your new prosthesis there is an adjustment period where your usual mouth functions may need to be relearned. These include chewing, speech, swallowing, appearance of lip posture, and ridge comfort. The following suggestions may help you in adapting to your new prosthesis and in maintaining it.

Avoid pain by starting with easy but nutritious food to eat. Examples of a softer diet can include fish, eggs, cottage cheese, cooked potatoes, oranges and apple sauce. If you have discomfort, remove the denture and massage the painful area with your finger. Let the gums rest and then replace the denture. Continue to use your prosthesis until your next visit. If you fail to wear the denture, no sore will be visible and precise adjustments will be very difficult.

Try to chew with food on both sides of your mouth. If food is bilaterally placed, the denture will be less likely to tip. Try not to bite with the front teeth as this may cause the back end of the denture to move off the gums. Biting with the side teeth will give better stability. Holding the top denture up with the tongue while chewing requires talent but this habit can be very useful.

Pain during swallowing may simply require a minor denture base adjustment.

With the stimulus of new dentures your mouth may have more or less saliva for a few days. Be patient and the flow will return to normal.

Speech is a very complicated and dynamic process involving all parts of the airway and mouth. Your denture has been constructed to meet the demands of stability and retention during speech. Fortunately, people are very adaptable and speech sounds very good at the time of delivery. If speech does not sound right to you, give it some time and normal body adaptation will resolve your concerns. Practice reading aloud. Do not focus undue attention on the process.

To remove food debris and bacterial plaque from your prosthesis, brush vigorously with a stiff denture brush. Use either soap and water, tooth paste or a commercially available denture cleaning agent. The effervescent soaking solutions are also useful. Follow the manufacturer’s instructions. Wash your denture over a basin of water or a cloth. If they are dropped on a hard surface, the acrylic portion may fracture and any metal may bend.

In general, take the dentures out or at least remove the lower denture for the night. This will allow the gums to rest. If this causes the jaw joints to hurt replace the dentures and use your best judgment for comfortable

Post delivery follow-up usually requires three visits. More are available as needed. After the first year, annual recall visits are useful to monitor changes in the shape of the ridges, wear of the teeth and general oral health. If there are problems with pain, chewing, or with wear or breakage of the base or teeth, please make an appointment with the office at your earliest opportunity.

Free Download Glossary of Prosthodontic Terms

Free Download Glossary of Prosthodontic
(Prosthetic Dentistry) Terms
Click Here

Kamis, 22 Desember 2011

Note on Necrotizing Sialometaplasia

It is spontaneous condition of an unknown cause usually of the palate in which large area of the surface epithelium underlying connective tissue and all the associated minor salivary glands become necrotic while the ducts under go squamous metaplasia. 

Clinical features:
Usually the location is at the junction of the hard and the soft palatebut it may also be present at tongue, retromolar pad and the nasal cavity.
NSM is characterized by deep seated ulceration it is punched out
With in its deep crater are the gray granular lobules which represents the necrotic minor salivary glands.
It is 2-3 cm in diameter.
It is asymptomatic but there may be numbness or burning pain.

In the palatal epithelium there is no zone of ulceration which replaced by fibrin granulation tissue.

The lobules of minor salivary glands undergo coagulation necrosis.
There scattered neurophils and foamy histocytes present in zone of necrosis.

No treatment is required once the diagnosis is confirmed by histological examination .
The ulcer area heals by its self with in 1-3 months.
Necrotizing Sialometaplasia

Necrotizing Sialometaplasia

Rabu, 14 Desember 2011

Notes on Sialolithiasis-Clinical features, Investigations, Histopathology and Treatment

There is presence of one or more round or oval calcified structures in the duct of the major or minor salivary glands( salivary stones)

How the stone is formed:
It is assumed that mucin proteins and desquamated ductal epithelial cells form a small nidus on which the calcium salts are precipitated, this nidus then allows concentric lamellar crystallizations to occur and thus sialolith increases in size as a layer by layer gets deposited on it

Clinical features of sialolithiasis:
About 80%of sialolith affects the major salivary glands and there is more predilections for the submandibular gland.
Stones are rare in children the average age is the 4th decade with no sex preference.

They are asymptomatic discovered on dental radiographs.
If symptomatic the chief complains are pain and swelling . Swelling is results as there is ductal dilatation caused by the ductal blockade.
The pain is described as pulling drawing or stinging.

Sialolithiasis Investigations:
Panoramic radiograph.
Ultra sound imaging

Histopathology of sialolithiasis:
Stone: On gross examination most stones are yellow or white in colour. they may be round to oval
  - some of the stones are nodular
  - after decalcification the stone shows concentric rings as of the annual rings of a tree trunk
   -The stone is acellular and amorphous in nature and may contain microbial colonies.
Ducts: the ductal lining that surrounds sialolith shows variety of reactive changes.
   - there is squamous and mucus cell
     metaplasia and changes to stratified squamous epithelium with numerous mucous goblet cells

Sialolithiasis treatment:
  • Many of the major salivary gland sialoliths can be removed by manipulation of the stone through major duct orifice
  • When manipulation fails then a surgical cut is made into the main duct
  • In triangular, or multiple stones and long standing obstructions removal of the stone and sialadenectomy is done.

Sabtu, 10 Desember 2011

Notes on Mucocele and Mucous Retention cyst-Etiology,Clinical Features,Differential Diagnosis and Treatment

Salivary glands react to injury or obstruction by under going atrophic degeneration and necrosis with replacement of the parenchyma by inflammatory cells and ultimately fibrous scar formation

It is a tissue swelling composed of pooled mucus that escapes into the connective tissue from several excretory ducts

When salivary duct is severed the acinar cells will continue to secrete saliva into the severed duct.
At the site of the cut/severance the secretory product escape into the connective tissue forming a pool of mucus that distends the surrounding tissue.

Minor glands of the lip are most prone to severance as a result of injury or biting the mucosa.
Intra oral minor salivary can also be effected as result of some irritation as well.

Clinical features
Mostly encountered in children and young adults.
Two third of the mucoceles occur in the 3rd decade of life.
Both males and females are effected equally.
Site: mucosal surface of the lower lip
              buccal mucosa
              floor the mouth
              ventral of the tongue and palate

Clinical appearance of the mococele depends on its location within the submucosa
More superficial zones of mucous extravasations presents a fluctuant mass with bluish translucent appearance.
Patient usually feels the mucocele and the fluctuation in its size
Pain is quite rare .
Initially the mucocels are well circumscribed but with repeated truma they become nodular ,more diffuse and firm on palpation.
The mucoceles have finely vascularized and distended, appearance often referred to as frogs belly that’s why they are also called Ranulas
When part of this ranula is deep seated in to the sumental or submandibular space then the term used is the” Plunging Ranula”

Differential diagnosis
  • Mucoepidermoid carcinoma
  • Cavernous hemangeoma (when there is hemorrhage)
  • Blisters seen in some bullous and desqumative disease.

Underlying pool of mucin distends the sarface epithelium.
The mucin is walled of by the rim of granulation tissue or in long standing cases by condensed collagen.
An epithelial lining is lacking
The mucinous material  basophilic or acidophillic and contains  neutrophils and large oval foam cells the histocytes .
The base of the mucocele will reveal feeder duct.
Long standing mucoceles will show acinar degeneration with fibrosis and minimal inflammation .

Minor salivary gland mucocele will not resolve on its own it must be surgically excised.
To minimize the chances of recurrence the feeder gland should also be removed.
Post surgical parasthesia might occur when the branches of the mental nerve are severed

Surgical Removal of Mucocele-Video

Mucus retention cyst
It is a swelling caused by an obstruction of a salivary gland excretory duct resulting in an epithelial lining cavity containing mucus. Mucus retention cyst is sometimes also referred as Sialocyst
The mucus retention cyst is lined by epithelium and rarely occur in the major salivary gland, when they do occur they are multiple i.e. poly cystic disease of the parotid gland
Clinical features:
Encountered in adults from 3rd -5th decade.
The lesion is painless and fluctuant and at times bluish in appearance.
Site: parotid cysts are located in the    superficial lobe as fluctuant well defined mass.
    -with in the oral cavity the floor of the mouth is the most common place.
    -this is followed by the lip and the buccal mucosa
The epithelium of the cyst is stratified cuboidal or columnar duct like epithelium.
The cytoplasm in the of these cells is either clear or eosinophlic and my show some features mucous differentiation
70% of these cyst are unilocular rest of the 30% have multilocular pattern.
Simple excision is the treatment of choice with caution of rupturing the cystic sacs.
Recurrence is rare.
However damage to the adjacent gland may result in a mucocele formation.