19 Appliance-related problems
Leanne, a 12-year-old girl, presents for a routine check of her upper retainer. You notice a reddened palate (Fig. 19.1A). What is your diagnosis and what management would you institute?
Leanne has been wearing the upper removable retainer for the past 10 weeks. were absent and she had removed to provide space for relief of upper arch crowding. She was offered upper fixed appliance treatment to produce the best occlusal result but she was not keen for this. Instead, she opted for upper removable appliance therapy. She has worn one previous appliance. The current appliance has been getting progressively looser over the past month.
Leanne has a Class I skeletal pattern with average FMPA and no facial asymmetry. Her lips are competent, with the lower lip just covering the incisal third of the upper anterior teeth. There are no temporomandibular joint signs or symptoms.
Acrylic allergy. This, however, is unlikely as a ‘burning’ sensation of the mucosa underlying the baseplate would have been reported early after insertion of the first upper removable appliance and there would be erythema of all of the soft tissues adjacent to the acrylic.
Candida is the principal cause. Although a normal oral commensal, proliferation of Candida is facilitated by local environmental or systemic factors, thereby allowing it to become pathogenic (Table 19.1).