As a public health dental hygienist, I have seen many patients without teeth. Some hold it while they take care of me, others listen to it from the beginning. There are many reasons why a patient without teeth goes to a regular exam in a dental office. Many patients only intervene when their prosthesis causes pain or fractures. When patients are told that they have to come every six months to make sure that the prosthesis does not have to be adjusted, and to make sure that the oral cavity is healthy, they are usually surprised.
Many patients will argue and withdraw when I ask if I can look them in the mouth, "I have no teeth, so it is not necessary." You are surprised to learn why this is so important. Most of them have changed their mind about cleaning and examining dentures, while others simply do not want their mouth examined. Although this is something we have to respect, I always strive to educate them every time I see them. Over time, some resistant patients will wear off and allow me to take a look, but to a limited extent. My philosophy is that something is better than nothing, and every time I interact with them, I think that with regular exams, we will eventually get to where we need to be.
These are the five key points to consider when considering a patient without teeth, followed by some advice.
- Injuries (oral cancer test)
- dental injuries
- stomatitis
- Bad fit
- infection
The oral cancer test.
When I examine a patient's mouth, whether he has teeth or not, I do an oral cancer test! I feel extra and intraoral and create a baseline. I ask about the normal variations that I can see and document , and point out the measures and description of injuries or marks I can see. Then, at the next cleaning and testing, six months later, I can compare. In this test, it is important to ask questions. What does the patient feel with the prostheses? How does he / she eat? Does he / she go out at night? Is he cleaning his tongue? Do you have a dry mouth?
dental injuries
Whenever I see sores or aphthous ulcers, I need to ask the patient if he knew he was there, how long, and whether he remembers a self-inflicted trauma (with a brush). Teeth or fork, for example). Mostly patients tell me that they are ashamed to wear their prosthesis in front of their partner, or that they do not feel well without it when they sleep. At this point, I brief patients on how plastics that still cover tissues in the mouth can cause problems. I take the time to show you in the mirror the footprint of the prosthesis in the tissue and the stomatitis, if it occurs. Patients also feel that the pain is normal and can not be repaired. If we explain that dentures should be reloaded on a regular basis when the mouth changes, they are again surprised to wear dentures without pain or discomfort.
stomatitis
Patients do not like it when we recommend removing the prosthesis, unless they eat, so that the prosthetic wound can heal. This can be a difficult time. I explain that it is only temporary and that the adjustments made will solve the problem, but it is therefore important not to use them constantly. I think that patients simply do not know the information most of the time and that the situation will generally improve. Sometimes, no matter how many times we say it, patients do what they want.
Bad fit
If the prostheses do not fit properly, they usually tip over. I like that the patient stays in the prosthesis to feel if she is rocking and if there is a good pull when I try to remove it. I also want to see if the patient regularly uses glue. As soon as I retire, I finish my exam while I clean the prostheses. It is important that the patient knows how to clean the denture and when to remove it. I also recommend that you change and cover your toothbrush every six months and explain how bacteria grow inside, just like in our toothbrush.
infection
Finally, I look for infections such as candidiasis, thrush, gum disease and implant infections. In some patients, implants are used as anchors for prostheses. Patients with or without an implant should receive a panoramic x-ray or periapical x-ray of the implants each year. In this way we can protect the bones from diseases and infections. If patients do not remove their teeth daily, they may experience thrush, candidiasis, and / or gum disease. We can monitor and avoid this by organizing regular audits and training. I also like to look at the patient's tongue to see how much is covered and if there are cracks. It is important to talk about the importance of tongue brushing every day to remove bacteria that accumulate, especially if your mouth is dry.
Tips for teaching oral hygiene
Let the patients feel that they are leading the conversation. I would like to ask you if you have any concerns or complaints and solve your problems first. In this way, they feel that their concerns are being taken into account, and I can still provide some education to alleviate the problems. This increases the compliance of the patients and they will be interested to hear from you because they are worried. I also like to measure his personality. I like to feed with his atmosphere. I've found that they tend to work together this way. Finally, I always try to act as informally as possible so as not to offend patients or make them feel read. When patients feel initiated, few return. No one is ashamed or intimidated when he goes to the dentist, especially because it's a vulnerable area of his body.
Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. In 2016, she completed the Fones School of Dental Hygiene at Bridgeport University with an MSDH. He practices since 2009 dental hygiene.
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