Physiological and social factors of importance for the older edentulous patient.
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Biomedical subjects
Publications and source records attributed to A Breustedt.
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The therapy of denture sore mouth which is induced by Candida albicans must take its bearings about the general and local disposition factors. The crucial points of stomatological treatment are pointed to. The problems related to local antimycotic therapy in the oral cavity are discussed. A new antimycotic dosage form, the nystatin-gelatin foil, for local application in denture wearers in presented. Its dosage and its use are described.
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The arteries of 22 mandibles injected with Kallocryl M were examined. The first group consisted of mandibles with the full complement of teeth. At the inner side, there were numerous anastomoses between the submental artery, the sublingual artery, the ascending palatine artery and the mylohyoid ramus. Furthermore, the dental rami branched into the periost. At the outside, the mental artery as well as the submental and inferior labial arteries contributed to the arterial supply. In the second group of mandibles (with intact incisors), these war a marked reduction of the anastomoses of the inferior alveolar artery in the middle region. The third group of mandibles (which were edentulous) showed anastomoses of the submental and sublingual arteries in the region of the incisors. The outside was supplied by the submental and inferior labial arteries. The mental artery exislar artery was demonstrated in 4 cases. The reduction of anastomoses concerned the inferior alveolar artery.
The successful use of technically unobjectionable plate dentures is a very complicated process that depends upon the patient's psychic attitude towards the removable prosthesis, the motivation, the ability of the sensory terminal organs in the oral cavity to get accustomed to the foreign body (the prosthesis), the adaptation and the learning of new sequences of reflex movements as a motor-muscular performance of perfection. These three factors, which the author regards as essential prerequisites of the incorporation (i. e., the untroubled mechanical use of the prostheses), are interpreted in the light of clinical experience and opinions from the most recent literature.
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The aetiology of denture sore is discussed from the aspect of changes in the keratinizing squamous epithelium of the oral mucosa that are caused by age and hormonal effects. An important rôle must be attributed to Candida albicans, the growth conditions for which increase in general with increasing age. Many cases of denture sore are, therefore, cases of candidiasis which may occur in a chronic, an acute and a pseudomembranous form. The improvement of oral hygiene and denture cleanliness is of prime importance to therapy.
Metal ceramics and ceramic bridges with aluminum-oxide profile components are optical solutions. The use of silanetreated "Keracetten" (mineral facets) avoids the disadvantages of plastic facing and has stood the test during a 5-year period of observation.
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The health and social policy of the German Democratic Republic as well as the programs of numerous medical specialties pay special attention to the problems of citizens advanced in years. But stomatology too must contribute to preserve or restore the well-being of citizens advanced in years. For this reason, a purpose-oriented research must realize the scientific advance which is necessary to preserve the functional performance of the masticatory organ till old age in spite of the incomplete dentitions which prevail at present. In the next few years, research should be focused on the prevention and control of diseases of the mucosa of the denture foundation and on the correction elimination of somatopsychic factors which are detrimental to the functional performance of dentures.
The majority of people of advanced age at present have either very many gaps in their dentures or they have no teeth at all. For this reason they can only wear broad-base plate-type bridged, which can lead to pathological changes of the mucous membrane. The author uses the complex etiology of prothetic stomatopathy, in which not only changes in the mucous membrane of the mouth associated with ageing but also hormonal changes (menopause), general diseases and oral candidiasis play a role, to illustrated the necessity of collaboration between stomatologists and geriatricians. Oral and prosthetic hygiene degenerates with increasing age. The average period of wearing prostheses also increases with the age and the danger of chronic mucous membrane damage also increases. But since old people seldom if ever consult a stomatologist, every geriatrician should also have a look at the mucous membrane of the mouth when examining old patients.
A 140% increase in the breaking strength of Keradens facings may be achieved by ion exchange, i.e., by substitution of the small sodium ions in soda feldspar by the larger potassium ions, which is done by melting the soda feldspar with potassium nitrate. The temperature and the time required for optimum exchange conditions are derived from the results of the present study.
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The present paper deals with first personal experience. The indications concern orthodontic space elimination and movement of single teeth in the anterior region. This method is a true rationalization in orthodontic practice.
Morphological changes in the mouth due to age, e.g. changes in the oral mucosa, the blood supply of the lower jaw, and the nervous system, make variations of prosthetical therapy necessary. By means of a classification of old-age patients, the significance of such variations for the prosthetical treatment of partially edentulous jaws is demonstrated.
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