As a dental hygienist working in public health, I have seen my fair share of edentulous patients. Some transition to being endentulous while in my care, and others I have known as edentulous from the beginning. There are many reasons for a patient who has no teeth to come to a dental office for a regular checkup. Many patients will only come in if their dentures cause pain or break. When patients hear that they should be coming every six months to make sure the dentures don’t need to be adjusted, and to make sure the oral cavity is healthy, they are usually surprised.
Many patients will argue and wave me off when I ask if I can take a look in their mouths: “I have no teeth, so there’s no need for it.” Well, they are quite shocked as to why it is so important. Most end up changing their minds about the denture cleaning and exam, while others just don’t want their mouths looked at. While this is something we have to respect, I still strive to educate them each and every time I see them. Over time, some resistant patients will get worn down and allow me to take a look, but on a limited basis. My philosophy is that something is better than nothing, and each time I engage with them, I like to think that we will eventually get to where we need to be with regular exams.
Here are the top five things to look for when examining an edentulous patient, followed by some tips.
- Lesions (oral cancer exam)
- Denture sores
- Poor fit
The oral cancer exam
When I examine a patient’s mouth, whether they have teeth or not, I do an oral cancer exam! I will palpate extra- and intraorally and create a baseline. I ask questions about variants of normal I might see and document, marking down the measurements and description of any lesion or mark I might see. This way, at the next cleaning and exam six months later, I can compare. It is important that when you are performing this exam, you ask questions. How does the patient feel with the dentures in? How is he/she eating? Is he/she taking them out at night? Does he/she brush his/her tongue? Does his/her mouth feel dry?
If I see any sores or apthous ulcers, I make sure to ask if the patient knew it was there, how long it’s been there, and if he/she remembers self-inflicted trauma (e.g., with a toothbrush or fork). Most of the time, patients will tell me they are embarrassed to take their dentures out in front of their partner or don’t feel comfortable sleeping without them. This is when I educate patients about how plastic always covering tissues in the mouth can create issues. I use this time to show them in the mirror the indentation of the denture on the tissue and the stomatitis, if it presents. Patients also have this feeling that pain is normal and it can’t be fixed. When we explain that dentures need to be relined regularly as the mouth changes, again they are shocked that they can wear dentures and not experience pain or discomfort.
Patients don’t like when we recommend to remove the denture except when they are eating, so the denture sore can heal. This can be a challenging time. I explain that it is temporary and with the adjustment, it hopefully will resolve, but this is why it is important to not wear them all the time. I find most of the time, patients just don’t know the information and generally things will improve. Sometimes, no matter how many times we say it, patients will do what they want.
When dentures don’t fit correctly, they usually rock back and forth. I like to have the patient keep in the denture, so that I can feel if it does rock and if there is good suction when I try to remove it. I also like to see if the patient is using adhesive regularly too. Then, once it is removed, I will finish my exam while the dentures are being cleaned. Reviewing how to clean the denture and when to remove it is important for patient compliance. I will also recommend they replace their denture brush and case every six months, and I explain how bacteria grows on them, just like on our toothbrush.
Lastly, I look for infections such as candidiasis, thrush, gum disease, and Implant infection. Some patients will have implants placed as anchors for the dentures. Patients with or without implants should be getting a panoramic x-ray or periapical x-rays of the implants every year. This will help us monitor the bone for disease and infections. If patients aren’t removing their dentures daily, they can get thrush, candidiasis, and/or gum disease. We can monitor and help avoid this by regular exams and education. I also like to look at the patient’s tongue to see how coated it is and if it’s fissured. Discussing the importance of brushing the tongue daily to help remove the bacteria that collects there is important, especially if he/she suffers from dry mouth.
Tips for oral hygiene instruction
Let patients feel that they are guiding the conversation. I like to ask if they have any concerns or complaints and address their issues first. This way they feel that their concerns are being addressed and I’m still able to do education to help reduce issues.This will increase patient compliance and they will be interested in hearing you because they are concerned. I also like to gauge their personality; I like to feed off their vibe. I have found they are more inclined to be cooperative this way. Last, I always try to act as casual as possible in effort to not offend or make patients feel like they are being lectured. If patients feel like they have been lectured, few will return. No one likes to feel embarrassed or intimidated when going to the dentist, especially since it is such a vulnerable area of their body.
Katie Melko, MSDH, RDH, is a public health hygienist at Community Health Center Inc. She graduated from Fones School of Dental Hygiene at the University of Bridgeport in 2016 with an MSDH. She has practiced dental hygiene since 2009.