The forgotten patient in maxillofacial prosthetics.
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Some of the conditions of the soft tissues related to complete dentures encountered during a period of 25 years at a university clinic were presented and discussed from the standpoint of the clinical prosthodontist. During this time, over 1,000 denture patients were treated each year. For some conditions, a method of management was offered with treatment by sound prosthodontic principles rather than unneccessary medication. That denture fabrication involves much more than mere mechanical procedures is an understatement. Complete dentures are foreign objects in the oral cavity that are accepted and tolerated by the tissue to a degree that is surprising. As prosthodontists, we can gain satisfaction from the realization that the incidence of oral cancer due to dentures is less than extremely low. At the same time, we must be ever mindful of the statement by Sheppard and associates. "Complete dentures are not the innocuous devices we often think they are." Every dentist must remember that one of his greatest missions is to serve as a detection agency for cancer. The information discussed indicates (1) the need for careful examination of the mouth, (2) the value of a rest period of 8 hours every day for the supporting tissues, and (3) the importance of regular recall visits for denture patients. Robinson stated that while the dental laboratory technician can be trained to aid the dentist in the fabrication of prosthetic devices, his lack of knowledge of reactions and diseases of the oral tissues limits him to an auxiliary role. Complete prosthodontics is a highly specialized health service that greatly affects the health, welfare, and well-being of the patient. It can be rendered only by the true professional who is educated in the biomedical sciences.
Many edentulous patients are "sick patients." Often geriatric considerations are involved, as well obesity and postmenopausal problems. These patients have deficient tissues on which to build dentures. The degenerative processes which initiate the loss of teeth continue after extraction and cause further shrinkage of supporting tissues. Repeated relining and rebuilding of dentures can be avoided and happier and healthier patients maintained by (1) saturating patients with therapeutic dosages of vitamins and minerals prior to surgical intervention, (2) using scientifically evaluated liquid and semisolid diets containing the maximum quantities of nutrients and the minimum number of calories during the preoperative and postoperative periods, and (3) thereafter maintaining the patient on a high-protein, high-vitamin, high-mineral diet.
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A study was conducted to compare tissue displacement resulting from different techniques and impression materials for distal-extension ridges. Impression techniques used were Applegate's functional fluid wax and a single-impression technique with mercaptan rubber. A mucostatic impression technique using irreversible hydrocolloid served as control. The results showed a statistically significant difference in tissue displacement between the casts made from the functional fluid wax technique and the single-impression technique with mercaptan rubber and the casts in the control group.
Four hundred patients with oral cancer were studied to determine if there appeared to be a risk related to denture wearing. Forty-three percent of the group wore dentures, and there seemed to be no correlation between the wearing of dentures and any specific cancer site. Furthermore, there was no difference between denture and nondenture wearers relative to age, sex, time from first signs or symptoms to diagnosis, tumor stage, or tobacco use. In addition, a large number of individuals in the general population wear dentures, and carcinomas occur infrequently in denture-bearing sites. Other studies have shown no difference between denture wearers and control groups in the occurrence of oral cancer. Therefore, it does not seem plausable at this time to consider denture irritation as a significant carcinogenic aggravating factor.
A technique has been described whereby a physiologic registration of the attached and unattached tissues of the denture-bearing areas can be attained. A low-fusing impression wax in conjunction with modeling compound is used for this purpose.
In 39 denture-wearing patients in whom anterior maxillary flabby ridge tissue (prosthesis fibroma) was excised, 15.4% contained cartilaginous nodules within this tissue. The chondrometaplasia may arise due to mechanical irritation activating pluripotential mesenchymal cells; but the possibility that the cartilaginous nodules represent remnant embryologic tissue cannot be excluded.
The systemic delivery of peptides and proteins from the nasal, rectal, vaginal, and buccal mucosae has been the subject of active investigation. The objective of this study was to determine the pathway and rate of hydrolysis of methionine enkephalin (TGGPM), leucine enkephalin (TGGPL), and [D-Ala2] met-enkephalinamide (TAGPM) in homogenates of these non-oral mucosae relative to the ileal mucosa. Aminopeptidases appeared to contribute over 85% to the hydrolysis of TGGPM and TGGPL, while dipeptidyl peptidase and dipeptidyl carboxypeptidase contributed much less. Overall, TGGPM was somewhat more susceptible to hydrolysis than TGGPL but was 10 times more so than TAGPM. These enkephalins were most rapidly hydrolyzed in the rectal and buccal homogenates, followed by the nasal and then the vaginal homogenates, but the differences in hydrolytic rates were small. Indeed, these rates did not differ substantially from the ileal mucosa, suggesting that the same enzymatic barrier to enkephalin absorption possibly exists in both the oral and the non-oral mucosae.
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