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Chapter 1 Introduction

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1. Introduction
Part A:
Part B:

Trends in removable prosthodontic dentistry

Consequences of tooth loss

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PATIENT DEMOGRAPHICS

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Average lifespan
Average Age

100 80 60 40 20 0 38 47 75

90

Average Age

1800 1900 1996 2050 Year

Average lifespan has increased dramatically. We are living longer.

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Trends in tooth loss

Vital & Health Statistics 14 13 60

Percent Edentulous 18+ yrs old

50

Percent Edentulous 65+ yrs old

Percent

12

40
11

10 1960

1970

1980

1990

30 1960

1970

1980

1990

Since the 1960s there has been a dramatic decrease in the rate of tooth loss in our population.
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Estimates of U.S. total adult & edentulous adult population Vital & Health Statistics
350
300

Millions

250
200 150 100

< 18 yrs.
Adult

50
0

Edentulous Adults

1970 1980 1990 2000 2010 2020 However, due to the exponential growth of our population the actual number of edentulous patients is slightly increasing over time. Because the age at which patients are becoming edentulous is older, they may have greater adaptation difficulties.
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Estimates of U.S. total elderly (65+yrs.) & elderly edentulous in one or both jaws
60 50

Vital & Health Statistics

Dentate

Millions

40
30 One Arch 20 10 0 1970 1980 1990 2000 2010 2020 Edentulous

Both Arches

By the year 2020 approximately 30 plus million elderly adults will be edentulous in one or both arches.
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Denture users in the adult population

Redford et al(1996) NHANES Data

This chart reveals all the possible combinations of completely edentulous and partially edentulous prostheses in our present population.
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Trends in the laboratory industry

Cornerstone Research & Marketing 2002 study of 601 laboratories

Answers to the question, what is your lab specialty? 1999 8% 18% 2% 2002 24% 23% 3% % change +16% +5% +1%

Type Partial Dentures Complete Dentures Orthodontics

Implants
Full Service Crown & Bridge

3%
16% 51%

3%
16% 49%

0
0 -2%

Trends in the laboratory industry are showing a significant increase in the demand for complete and partial removable services. In fact the increase in removable is outpacing the growth patterns of the other restorative areas.
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Will there be a need for complete dentures in the United States in 2020? Douglas et al., J Prosthet Dent 2002

Complete dentures will increase from 33.6 million adults in 1991 to 37.9 million adults in 2020. The 10% decline in edentulism experienced each decade for the past 30 years will be more than offset by the 71% increase in the adult population older than 55 years.

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Future needs for fixed and removable partial dentures in the United States Douglas et al., J Prosthet Dent 2002

The number of people in the United States who need complete dentures will increase over the next 20 years.

Dental education programs and practitioners should consider the implications of these continuing patient needs.

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Denture use and the technical quality of dental prostheses among persons 18-74 years of age: United States, 1988-1991 Redford et al., J Dent Res 1996 Analysis of prosthodontic evaluation data indicate that approximately 60% of denture users have at least one problem with the denture.

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Complete dentures in the prosthetic rehabilitation of the elderly persons; five different criteria to evaluate the need for replacement. Nevalainen et al., J Oral Rehabil 1997 This study evaluated the complete dentures of 144 patients over 75 years old. They found that depending on the criteria used, between 10% and 80% of the dentures were in need of replacement.

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Despite all the shortcomings edentulous patients are quite satisfied with their complete dentures, only 5-20% of them are not. Van Waas, 1990 Denture satisfaction is influenced by various factors, including denture quality, the denture bearing area available, the quality of dentist-pt. interaction, previous denture experience and the patients personality & psychologic well being. Berg, 1991

Outcome from the patients point of view is only in part related to technical aspects of the treatment modality Vervoorn, 1988; Van Waas, 1990

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Dissatisfied 7.7 %

Moderately Satisfied 25.6 % Fully Satisfied 66.7 %

Berg E (1998); Smedley TC et al (1989); Kapur KK et al (1997)

Patient satisfaction also depends upon expectations and some patients may have very unrealistic expectations. For this reason it is important to guide and educate the patient.
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ESTHETIC AWARENESS

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Increase in esthetic awareness has prompted an increase in patient demand for quality removable prosthodontic restorative treatment.
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ESTHETIC AWARENESS

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Increase in esthetic awareness has prompted an increase in patient demand for quality removable prosthodontic restorative treatment.
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IMPLANT TREATMENT

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Out of 33 million edentulous patients only 2-4% have received implant treatment.

Dr. Lydon Cooper

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GERIATRIC PATIENT

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Specific Management Problems

Elderly patients require special considerations due to their compromised oral anatomy, medical & nutritional status, reduced physiologic reserves and adaptive capacity.

Denture support area Neuromuscular control Chewing force Salivary flow due to medication(s) Healing capacity Quality of denture bearing tissues

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CONSEQUENCES OF TOOTH LOSS

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Residual Ridge Resorption (RRR)

Physiologic levels of tension results in apposition (such as that transmitted by loading the PDL through natural dentition)
Non-physiologic compression (as may occur under denture bases) results in resorption

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CONSEQUENCES OF TOOTH LOSS

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CONSEQUENCES OF TOOTH LOSS

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Maxillary loss is in vertical and palatal direction

Atrophy of supporting structures Residual Ridge Resorption Mandibular loss is vertical and oriented along cross-sectional shape of mandible

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CONSEQUENCES OF TOOTH LOSS

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Maxillary loss is in vertical and palatal direction

Mandibular loss is vertical and oriented along cross-sectional shape of mandible

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CONSEQUENCES OF TOOTH LOSS

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Maxillary loss is in vertical and palatal direction (0.1 mm/year sustained) Initial loss in first year greater but variable

Mandibular bone resorption is 4x maxillary (varies)

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CONSEQUENCES OF TOOTH LOSS

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Changes in Intraoral Structures

Atrophic changes in the residual ridge leading to unfavorable changes in vestibular attachments Atrophic changes in the mucosa compromising the bearing surface Loss of teeth as fulcrums for function and tissue support Affect quality of support and stability Affect ability to manipulate dentures during function
Denture wearers are in a sense oral invalids.

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CONSEQUENCES OF TOOTH LOSS

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Loss of Facial Support and Muscle Tonus

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CONSEQUENCES OF TOOTH LOSS

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SUMMARY Tooth loss results in

Residual Ridge Resorption (RRR) Changes in intraoral structures Decreased masticatory function Loss of facial support and muscle tonus Psycho-social effects

The goals of complete denture treatment are to help minimize the affect of these functional, aesthetic and psychological compromises.
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CONSEQUENCES OF TOOTH LOSS

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D E N T I S T

Technical ability Interpersonal management skills Understanding of denture function and denture limitations

The technical details of denture fabrication are only one aspect of treatment. Of equal importance is the dentist-patient interactions or rapport. A dentist must understand denture function and its limitations and be able to guide the patient through the treatment and adaptation process.
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CONSEQUENCES OF TOOTH LOSS

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Elderly are not simply old adults . . . They vary widely in their physiologic and psychosocial characteristics and in the number and severity of diseases that they contract.
Rowe, New England J of Medicine 1985

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Proceed to Chapter 2: History and Exam

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