Patiens if they are uncomfortable or do not aid in function.

Once dentures are constructed, a

denture brush and chemical immersion cleaners should be used regulary to avoid plaque
accumulation. Annual dental visits are often recommended to assess fit and function.
Persons with dentures frequently experience oropharyngeal pain, which may be due to
dentureinduced stomatitis, hypersensitivity to denture materials, or trauma from poorly-fitting
appliances. Patients should be encouraged to remove dentures at night to avoid infections
such as candidiasis, the major cause of denture stomatitis. Overuse of dentures may cause
damage to mucosal structures and loss of underlying bone. These changes may alter the fit of
dentures causing discomfort and difficulty chewing and may lead to mucosal ulceration and
superinfection.
Perioperative Considerations
Physicians may be asked to examine a patient in advance of a dental procedure and to advise
on issues such as antibiotic prophylaxis and management of anticoagulation. Prophylactic
antibiotics have been used for many years in patients with cardiac abnormalities to reduce the
incidence of infective endocarditis after dental procedures. The link between dental treatment
and infective endocarditis in patients with valvular disease has recently been challenged in a
case-control study. However, the current recommendation of the American Heart Association
is to use prophylaxis for patients with high risk cardiac conditions such as prosthetic heart
valves and moderate-risk conditions such as valvular disease, ventricular septal defect, and
mitral valve prolapsed with regurgitation. The presence of an atrial septal defect, implanted
defibrillator, or pacemaker does not require prophylaxis.
Single oral doses of amoxicillin, clindamycin, cephalexin, or azithromycin are appropriate for
most dental procedures that require prophylaxis. Prophylaxis against endocarditis is
recommended for procedures such as dental extractions, periodontal surgery, and teeth
cleaning.
Antibiotic prophilaxis is not needed for dental procedures in persons with orthopedic pins,
plates, and screws and is needed only for those with total joint replacements in certain
situations. According to the American Dental Association and the American Academy of
Orthopaedic Surgeons, prophylactic antibiotics in patients with total joint replacements
should be considered when (1) a high-risk procedure such as an extraction is planned, (2) the
patient is within 2 years of joint replacement, (3) the patient has had previous prosthetic joint
infections, or (4) the patient has diabetes or is otherwise immunocompromised.
The nature of the planed procedure, the risk of bleeding, and the risk of thromboembolism
during a period without anticoagulation should be considered when choosing a preoperetavie
management strategy for patients receiving long-term anticoagulation. If it is necessary to