Diagnosis in Fabrication of Complete Denture

Diagnosis:

Definition: The identification of the nature of an illness or other problem by examination of the symptoms.

Diagnosis is the evaluation of the existing condition, more specifically. It can also be described as

• The act or process of deciding the nature of a diseased condition by examination.
• A careful investigation of the facts to determine the nature of the Disease
• The determination of the nature, location and causes of the Disease.

Diagnosis for the prosthodontic care requires the use of general diagnostic skills and accumulation of knowledge from other aspects of dentistry and its supporting sciences.

Diagnosis in complete denture is a continuing process and is not accomplished in a short time. The dentist should be the first to recognize the problem and be ready to change the treatment plan to meet the new findings. These findings will be influenced mainly by:

• Gait
• Age
• Sex
• Complexion and Personality
• Cosmetic Index
• Patient’s mental attitude.
• Patient’s systemic status.
• Past dental history.
• Local oral conditions

Age:

The Decade which the patient belongs to is important to predicts the outcome of the Treatment. For example a patient in the Sixth decade of his life will have poor prognosis compared to a patient in the Fourth decade of life.

Sex:

This determines the main purpose of the dentures or for what they might be used, Males usually prefer comfort and function as compared to Females who prefer aesthetics over everything.

Complexion and Personality:

The Complexion of the patient determines the shade of the Teeth to be used and the personality of the patient determines the size and shape of the teeth.

Mental attitude (psychological factor)

The success of dental prosthesis is related to many factors, including functional, biological, technical, esthetic and psychological factors. Psychological factors include the preparedness of the patients and their mental attitudes towards dentures, their relationship with the dentist and their ability to learn how to use the dentures. Prosthodontists must fully understand their patients because such understanding predisposes the patient to accept the kind of the treatment they need.

De Van said “meet the mind of the patient before meeting the mouth of the patient”.

In the discussion with the patient, the dentist must seek an understanding of the patient’s health, particularly their attitude toward receiving new dentures.

House classified the patients into 4 categories:

1. Philosophical patients.
2. Exacting patients.
3. Indifferent patients.
4. Hysterical patients.

Philosophical patients

• These patients are rational, sensible, and calm and composed in a different situations.
• Their motivation is generalized as they desire dentures for the maintenance of health and appearance and feel that having teeth replaced is a normal acceptable process.
• These patients usually overcome conflicts and organize their time and habits; they eliminate frustrations and learn to adjust rapidly.
• The best mental attitude for denture acceptance is the philosophical type.

Exacting patients

• Exacting Patients have all the qualities of the Philosophical patients.
• But these patients have a bad quality of expecting each and every step of the procedure to be explained in detail
• And this requires extra hours spent prior to the treatment in patient education until an understanding is reached.

Indifferent patients

• These patients are apathic, uninterested and lack motivation.
• The do not care to their self image; they manage to survive without dentures and pay no attention to the instructions.
• They do not cooperate and mostly blame the dentists for their poor dental health.
• In most of them, questionable or unfavorable prognosis may be expected.
• For such patients, educational program in dental conditions and treatments is recommended before denture construction.

Hysterical patients

• These patients are excitable, apprehensive, emotionally unstable and hypertensive.
• They are neglectful of their oral health and unwilling to try to adapt to wear dentures.
• Additional professional help is required prior to and during treatment.
• Although these patients may try to wear the denture, they fail to use it as they expect it to look and function like the nature teeth.
• But these are the patients who if satisfied will be the best patients who will popularize your abilities to a lot of people

Social information

• Social Information is the establishment of patients identity.
• Personal information as the name, address, telephone number, work and hours of work might help the dentist in the primary estimation of the dental health and prognosis of the Denture.
• Social setting can help to understand the patient’s expectation and the dental status developed.
• Social information may clarify some habits, specifically those might contribute of their present conditions and those might help ensure success or failure for the treatment.

Systemic-medical status

• No prosthodontic procedure should be planned until the systemic status of the patient is evaluated.
• Many of the systemic diseases have local manifestations with no systemic symptoms and others have both local and systemic reactions.
• Some systemic diseases have a direct relation to the denture success even though, no local manifestations are apparent.

Debilitating diseases

These patients requires extra instructions in the oral hygiene and tissue rest, also frequent recall appointments should be arranged because the supporting bone may be affected to keep the denture bases adapted and the occlusion corrected. Debilitating diseases include, diabetes, tuberculosis, blood diseases… etc.

Cardiovascular diseases

Patients with cardiovascular diseases may require consultation with cardiologist as some denture procedures may be contraindicated.

Joint diseases

• Joint involvement, particularly osteoarthritis, presents different problems.
• If the disease involves the TMJ, alteration in the treatment plan may be essential.
• In extreme conditions, special impression tray and technique are often necessary because of the limited access from reduced ability to open the jaws.
• Furthermore, jaw relation records are difficult and occlusion correction must be made often because of the subsequent changes in the joints.