Treatment Planning: OR Multi-factorial: - patient experience - previous denture - what they like or don't like about it - patient request

- patient expectation - establish good vertical dimension so they don't get angular cheilitis - ODTP - especially for TMJ, OHI, PERIO, ongoing disease before doing prosthesis - study cast, facebow record, radiographic findings - teeth with disease and endodontic treatment, and feature abutement teeth - family history - level of history - general health - affect oral health - parafunctional habits - success of restorations and prosthetics - assessing abutement: sound, decay, disease, endodontic treatment, peridontal condition, bone level, root morphology, crown-root ratio - study casts: occlusion, where stress on teeth is there during function and rest, vertical dimension, stable occlusion? so need retruded position (because reproducible) - if not there will be TMJ probs - T(x) - reorganized approach (unstable icp), or conformed approach - multiple space, distal abutement - RPD - single tooth - bridge Stages: emergency preventive restorative - fillings, endo rehabilitation - replacement; RPD, CROWN, RBB, CONVENTIONAL, IMPLANT maintenance White Lesions: - clinically described as the appearance of lesions as white areas on the oral mucosa - it appears white because the thickened or abnormal keratin becomes hydrated as a result of being bathed by saliva, and then evenly reflects light - 'leukoplakia' (WHO definition) a white patch or plaque that cannot be characterized clinically or pathologically as any other disease Differential Diagnosis of White Lesions: Inflammatory: Infective Causes 1) Fungal (Candida albicans) - Candidosis: Predisposing factors Xerostomia, smoking, corticosteroids, borad spectrum antimicrobials, cytotoxic chemotherapy, irradiation involving the mouth/salivary glands, dental appliances;

systemic immune defects caused by malnutrition, immunosupprsesant drugs such as corticosteroids, t-lymph defects in HIV, leukaemias, lymphomas, and cancers, neutrophil leukocyte defects such as diabetes, anaemia D(x): gram-stained smear (hyphae), clinically, history, PAS stain - Management: nystatin/antifungal tablets, lonzenges ie) Denture Stomatitis - don't wear dentures overnight - may cause candidosis (esp if your immune is suppressed); gently dilute bleach 2) Viral ie) Hairy leukoplakia (Epstein-Barr Virus) ie) Human papillomavirus infection 3) Bacterial ie) syphilitic mucous patches and keratosis Inflammatory: Non-infective 1) Lichen Planus: - may be caused by antihypertensives (EC) 2) Lupus erythematosus Neoplastic and possibly pre-neoplastic Causes 1) Epithelial Dysplasia: 2) Leukoplakia 3) Keratoses 4) Carcinoma - SSC: floor of mouth, posterior buccal part, leukoplakia, erthryoplakia, nonhealing ulcers Local causes of white lesions [keratosis (hyperkeratosis)] - debris (from poor OH), burns from heat, radiation, chemicals (ie mouthwash), grafts and scars my appear pale or white - materia alba can usually be wiped off with gauze - frictional keratoses (cheek biting/lip biting) - denture wearing areas - smoker's keratosis - snuff-dipper's keratosis - skin graft - scars Histology of Hyperkeratosis: - thicker epithelium, elongated rete pegs; extra layer of keratin; ghost nuclei; inflammatory cells (lymphocytes) = chronic inflammation

Congenital Causes - Fordyce spots: ectopic sebaceous glands; yellowish; entirely benign and does not require any intervention; normal anatomy - leukoedema: whitish-grey filmy appearance of the mucosa; buccal mucosae bilaterally in African or Asian descent; white disappears if stretched; no t(x) available or required - inherited dyskeratoses (rare ie. white sponge naevus, dyskeratosis congenita, Darier's disease) - may run the risk of malignant transformation, specialist care indicated; family history and other lesions on mucosae and skin, and nails

- oral pathology: corson? Code of Conduct: - reversible or not - omission or act - actual dental decay