Teeth may be lost to dental caries, periodontal disease, or trauma or may be removed when treatment fails. 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 (fixed partial denture) is composed of false teeth cast or soldered to each other and, at each end, to a crown that is cemented to natural (abutment) teeth, which bear all the stress of biting. Bridges can now be made by milling using computer-aided design and manufacturing technology. Once cemented into place, a bridge is not removed. A bridge is smaller than a removable partial denture, but 1 or multiple bridges can be made to replace many of the teeth in a dental arch.
A removable partial denture, typically an appliance with clasps that snap over abutment teeth, may be removed for cleaning and during sleep. Part of the occlusal stress may be borne by the soft tissues under the denture, often on both sides of the jaw. This appliance commonly is used when many teeth have to be replaced and bridges or implants are not feasible or affordable.
Complete dentures are removable appliances used when no teeth remain. They help a patient chew and improve speech and appearance but do not provide the efficiency or sensation of natural dentition. When teeth are absent, the mandible slowly resorbs, resulting in ill-fitting dentures that require revision (called reline or rebase) or replacement. Alternatives are oral surgical procedures to enlarge the alveolar ridge or dental implants to replace 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.
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. If inflammation persists, biopsy is indicated, and systemic conditions should be ruled out.
Although there is some uncertainty about the role of Candida as a cause of inflammatory papillary hyperplasia, there is correlation between its presence and inflammation (1), and treatment is generally recommended. The presence of CandidaCandida
Reference
1. Poulopoulos A, Belazi M, Epivatianos A, Velegraki A, Antoniades D. The role of Candida in inflammatory papillary hyperplasia of the palate. J Oral Rehabil 2007;34(9):685-692. doi:10.1111/j.1365-2842.2007.01758.x
