Dental Appliances
By Mpano Theodat Uwizeyimana, BDS Student, University of Rwanda Class 2027, College of Medicine and Health Sciences
Teeth can be lost due to dental decay, gum disease, or injury, or they may need to be extracted if treatment is unsuccessful. Missing teeth may cause cosmetic, phonation, and occlusal problems and may allow movement of remaining teeth.
Types of dental appliance
Dental appliances include:
- Fixed bridges
- Removable partial dentures
- Removable complete dentures
- Osseo-integrated implants
A bridge also known as a fixed partial denture, consists of artificial teeth connected to crowns that are attached to natural teeth on each end. This dental restoration is securely cemented in place and cannot be removed once it is installed. Advances in technology now allow bridges to be created using computer-aided design and manufacturing methods. While bridges are smaller than removable partial dentures, they can replace multiple missing teeth within a dental arch.
A removable partial denture, dental appliance that can be taken out for cleaning and while sleeping. It usually has clasps that snap onto abutment teeth to hold it in place. This type of denture can distribute some occlusal stress to the soft tissues under the denture, which are typically located on both sides of the jaw. Removable partial dentures are often used when multiple teeth need to be replaced and when bridges or implants are not suitable or within budget constraints. They provide a more affordable option for restoring missing teeth compared to other dental treatments.
Complete dentures; artificial teeth sets that are removable and utilized when all natural teeth are missing. They aid in chewing, speech, and enhancing appearance, although they do not match the efficiency or sensation of natural teeth. With the absence of teeth, the jawbone can gradually shrink, leading to poorly fitting dentures that may need adjustments or replacement through procedures like reline or rebase. Other options include oral surgeries to improve the bony ridge supporting the teeth or opting for dental implants as a more stable and long-term solution for missing teeth.
An implant is typically a titanium cylinder or screw that replaces a tooth root. One or more implants are placed into the alveolar bone, where they integrate into the surrounding bone. Either immediately, or up to 6 months later, the artificial teeth (ranging from an individual tooth up to full arch dentures) are attached to the implants. Implants are not readily removable, although the prostheses they support can be. The potential for infection at these sites warrants scrupulous attention to oral hygiene.
Dental appliances and surgery
Generally, all removable dental appliances are removed before general anesthesia, throat surgery, or convulsive therapy to prevent their breakage or aspiration. They are stored in water to prevent changes in shape. However, some anesthesiologists believe that leaving appliances in place aids the passage of an airway tube, keeps the face in a more normal shape so that the anesthetic mask fits better, prevents natural teeth from injuring the opposing gingiva of a completely edentulous jaw, and does not interfere with laryngoscopy.
Denture problems
Occasionally, the mucosa beneath a denture becomes inflamed (denture sore mouth, inflammatory papillary hyperplasia). Contributing factors to this often painless condition include candidal infections, poor denture fit, poor hygiene, excessive movement of the denture, and, most frequently, wearing a denture 24 hours a day. The mucosa appears red and velvety. Candidal overgrowth may be indicated by adherent cottonlike patches or, more commonly, erosive lesions on the mucosa. The presence of Candida can be confirmed by the microscopic appearance of typical branching hyphae. There is still uncertainty in the possible role of Candida as a cause of inflammatory papillary hyperplasia.
A new well-made denture almost always improves the situation. Other treatments consist of improving oral and denture hygiene, refitting the existing denture, removing the denture for extended periods, and using antifungal therapy (nystatin rinses for the mouth and overnight nystatin soaks for the denture). Soaking the denture in a commercial cleanser is sometimes helpful. Other options for candidal overgrowth include applying nystatin suspension to the tissue surface of the denture and placing sublingual clotrimazole troches 10 mg 5 times a day. If Candida infection does not resolve with local oral measures, fluconazole 100 mg (2 tablets initially and 1 tablet each day thereafter until resolved) can be given. If inflammation persists, biopsy is indicated, and systemic conditions should be ruled out.