Treatment of an Edentulous Patient With a Dry Mouth


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Treatment of an Edentulous Patient with a Dry Mouth Kenneth Shay, DDS, MS Continuing Education Units: 4 hours This continuing education course is intended for general dentists and hygienists. The primary learning objective for this course is to increase your general knowledge of and skills in the dental management of the complete denture patient with a dry mouth. Overview Dental health professionals are being asked to care for a growing number and range of medically compromised patients living
  1 Crest ® Oral-B at Continuing Education Course, Revised August 5, 2010This continuing education course is intended for general dentists and hygienists. The primary learningobjective for this course is to increase your general knowledge of and skills in the dental management of thecomplete denture patient with a dry mouth. Overview Dental health professionals are being asked to care for a growing number and range of medicallycompromised patients living with chronic health problems. Although tooth loss overall has declined in theUnited States, millions of persons, particularly those of more advanced age, still require treatment for theedentulous condition. Particular challenges are faced when this oral state is combined with a complexmedical history. The primary learning objective for this case is to increase your general knowledge of andskills in the dental management of the complete denture patient with a dry mouth. Learning Objectives Upon the completion of this course, the dental professional will be able to:ã Be able to describe the various ways in which a dry mouth complicates the management and success ofcomplete denture treatment; and be able to describe approaches to address these challenges;ã Be able to describe the oral and dental findings likely to be encountered in a patient with rheumatoidarthritis, Sjogren’s syndrome, or both;ã Be able to describe the likely oral findings and complications to dental therapy likely to be encounteredin patients taking one or more of the following prescription medications: prednisone, salsalate, ormethotrexate;ã Be able to describe the factors involved in denture retention and suggest how these are affected in apatient with one or more of the following: dry mouth, severely resorbed ridges, a metal-base denture; andã Be able to describe the mechanism, application, removal, indications, contraindications, advantages, anddisadvantages of the use of denture adhesive. Kenneth Shay, DDS, MS Continuing Education Units: 4 hours Treatment of an EdentulousPatient with a Dry Mouth  2 Crest ® Oral-B at Continuing Education Course, Revised August 5, 2010 Course Contents ã General Informationã Chief Complaintã Patient Historyã Clinical Examinationã Treatment Planã Medicationsã Reumatoi Artritisã Sjögren’s Syndromeã Denture Retentionã Use o Denture Adhesivesã Course Testã Referencesã About the Author General Information JJ is a 71 year old, Caucasian male currentlyresiing in a nursing ome wile recoveringfrom a recent leg amputation. Prior to hishospitalization and convalescence he lived alonein a rural region, several hundred miles rom anyurban area. He is a former insurance claimsadjuster who retired on disability six years ago.e currently receives ocial ecurity, modestveteran’s benefits, and a small company pension.He smoked a pipe for 30 years but stopped 15years ago. He reports only social use o alcohol. Chief Complaint JJ desires to use upper and lower dentureswithout discomfort. He recognizes fromexperience and from the counseling of a previousdentist that certain features of his oral anatomywill compromise te egree to wic cewingforces can be generated. Patient History Medical History Form for Patient JJ edical history orm completed by patient JJ.Positive answers are in OLDFACE Please inicate any conition tat you ave ain the past or have now by circling either YESor NO and fill in blank space when indicated.Answers to the following questions are for ourrecords only and will be considered confidential.Are you currently under the care of a physician? YES NOPhysician’s name: George BrownPhone number: 222-3333Address: 444 Oak Street, Any town, DE CARDIOVASCULAR  Heart failure YES NO Heart disease or attack YES NO Angina pectoris or chest pains YES NOig loo pressure YES NHeart murmur or click YES NO Mitral valve prolapse YES NO heumatic ever YES NCongenital heart defect or lesion YES NO Heart surgery or transplant YES NO rtificial heart valve YEIrregular heartbeat (arrhythmia) YES NOHeart pacemaker or defibrillator YES NO Other heart problem YES NO HEMATOLOGIC  Blood transfusion YES NO Anemia YES NO Sickle cell (anemia) disease YES NO Tendency to bleed longer than normalYE NO Hemophilia YES NO Leukemia YES NO NEURAL Stroke or TIA YES NO ision problems YEGlaucoma or cataract YES NO Earaches, ringing in ears YES NO Hearing loss YES NO Severe headaches, migraines YES NO Fainting or dizzy spells YES NO Epilepsy, seizures, convulsions YES NO Nervousness YES NOPsychiatric treatment YES NO ENDOCRINE  Diabetes YES NOThyroid disease YES NO DERMAL/ORAL/MUSCULOSKELETAL Allergy to latex (rubber) YES NO kin rash or hives YErtritis, reumatism or gout YES NOArtificial joint YES NO Fever blister YES NO Mouth Ulcers or canker sores YES NO GASTROINTESTINAL Stomach or intestinal ulcers YES NO Gastritis or esophageal reflux YES NO Colitis YES NO Persistent diarrhea YES NO  3 Crest ® Oral-B at Continuing Education Course, Revised August 5, 2010 artificial tears prnmethotrexate .75 mg, M & T Have you ever been hospitalized? YES NIf yes, then please describe when and why: Recent leg amputation due to septic knee.Two years ago hosptalzed wth chest pans. Have you ever had an operation or surgery? E NIf yes, then please describe when and why:See abovere you allergic to any oods, preservatives,clothing, animals, etc? YES NO ave you taken cortisone, prenisone or otersteroids in the past 12 months? YES NOen you walk up stairs or take a walk, o youever have to stop because of pain in your chest,shortness of breath, or feeling tired? YES NDo your ankles swell during the day?YEDo you need to sleep on two or more pillows?YES NO Have you unintentionally lost or gained more than0 pounds in the past year? YES NOAre you on a special diet? YES NO as your occupation ever rougt you in contactwith blood, blood products, or needles?YES NO DENTAL HISTORY  Do you make regular (non-emergency) visits tothe dentist? YEDo your teeth feel loose? YES NODo your gums bleed when you brush you teeth?YES NO re any o your teeth painul to biting or chewing? YES NOHepatitis or yellow jaundice YES NO Cirrhosis YES NO Other liver problem YES NO RESPIRATORY  Hay fever YES NO Sinus trouble YES NO sthma YE NO Persistent cough YES NO Bronchitis YES NO Emphysema YETuberculosis (TB) YES NO Breathing difficulties YES NO ENITO-URINARY  Urinate more than 6 times/day YES NO Kidney or bladder problems YES NO Dialysis YES NO SEXUALLY TRANSMITTED DISEASE  (syphilis, gonorrhea, chlamydia, herpesYES NO OTHER CONDITIONS  Enlarged lymph node or “gland” YES NO Persistent or unexplained fevers YES NO IV-positive/AID YEse toacco YES NOUse alcohol YES NO Drug addiction YES NO Tumor or cancer YES NO X-ray or radiation treatment YES NO Chemotherapy YES NO ALLERGIES  Are you allergic to:local anesthetics (“Novocain”) YES NO penicillin or other antibiotics YES NO aspirin YES NO codeine or other pain medicine YE NO any other drug or medicine (list below)re you taking (or supposed to be taking) anymedicine, drugs, or pills of any kind? YES NOIf yes, what kind and dose? prednsone 20 mg TDheparin 5000u mg SQ BIDibuprofen 400 mg q6h prnpropoxyphene 100 mg/ acetaminophen 325 mg 2 q6h prnsalsalate 1000 mg TID  4 Crest ® Oral-B at Continuing Education Course, Revised August 5, 2010 Consultation with the patient’s physician confirmsno contrainications to enture treatment, altougthe recency of his amputation has left the patientextremely anxious about transferring out of theental cair. Dental History y is own amission, JJ as een a sporaicdental patient all of his adult life. He wore amaxillary removable partial denture for over tenyears. ixteen years ago his remaining maxillaryteet were extracte an e receive an upperimmediate complete denture. He thinks that theupper teeth needed to be removed because ofdecay. Ater the maxillary denture was placed, hebegan to experience severe dental caries in hismandibular teeth. This ultimately necessitatedremoval o his remaining dentition twelve yearsago. A mandibular complete denture fabricatedsubsequent to that time was never wholly toleratedecause it move an cause soreness unerfunction. For this reason, the patient stopped usingthe mandibular denture about three years ago, andte ten sortly stoppe using te upper enture aswell because he was traumatizing his mandibularedentulous ridge. He has tired of his oral condition,owever, an wises to again attempt reailitation. Radiographic History There were no pre-existing radiographs available fornspecton. Clinical Examination A. General impression ã Cachectic older male in wheelchair; rightleg amputated above the knee with gauzeanages in place over stumps.ã Prominent disfigurement of hands due torheumatoid arthritis.ã Prominent rheumatoid nodules o the elbows.ã Prominent chin; long mustache obscuringmouth.ã Disevele; poor general ygiene.ã Patient wears glasses (need cleaning) andblinks frequently and forcefully.ã Patient requests not to be transferred intoental cair. B. Head and neck examination ã Head and neck: within normal limits (WNL)ã Face: no skin lesions note. Patientnoticeably tanned.ã Lymph Nodes: WNLDo you ever have pain, or experience clicking,popping or grining wen you open an closeyour mouth? YES NO o you grind or requently clench your teeth?YES NO oes your mouth requently eel dry? YES NOave you ever worn braces or alse teeth? YES NODo you gag easily or do you have a problem withgagging during dental treatment? YES NOHave you ever fainted or had a bad experiencerelated to dental treatment? YES NO WOMEN ONLY:  Is there a possibility you may be pregnant?YES NOre you nursing? YES NAre you taking birth control pills? YES NOo you ave any oter isease, conition, orproblem not listed on this form? YES NOIf yes, then please explain below:In order to best treat your dental health needs,please explain why you came to the dental oicetoday. Need new dentures _______________________________________Patient’s Signature Medical History JJ suffers from rheumatoid arthritis. He displaysdeorming osseous changes in his toes, hands,nees an elows ue to te isease. He recentlyhad to undergo an amputation above the rightknee because of a septic knee joint. In addition hesuffers from hypertension, cardiovascular disease,and blurred vision due to very dry eyes.JJ is meicate wit prenisone, eparin,ibuprofen, darvocet, salsalate, artificial tears, andmethotrexate.
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