Understanding Palatal Obturators and How They Can Address Openings in the Roof of the Mouth

Palatal obturators are a type of prosthetic appliance worn in the mouth. This device is specifically used to close openings on the roof of the mouth which can be congenital such as a cleft palate or acquired as a complication from surgery, trauma to the oral cavity, or maxillectomy from cancer removal [1].

Palatal obturators cover the opening on the roof of the mouth to protect it and allow it to heal correctly, then later restore oral function. The prosthesis can compensate for any missing teeth and will be custom-made to fit.

How exactly do palatal obturators address openings in the roof of the mouth? Here is what you need to know about this prosthetic device and when it is necessary.

What a Palatal Obturator Does and How It Works

A palatal obturator is designed to close, or obturate, a defect on the roof of the mouth in the hard or soft palate. Such a defect involves communication of the sinuses and/or nasal cavity with the oral cavity which can affect speech, breathing, and eating. Palatal obturators are used when defects cannot be corrected surgically. Then, the obturator prosthesis is a valid treatment option in cases of large defects and in medically compromised patients where surgery is not indicated.

It is important to distinguish between a palatal obturator and a palatal lift. A palatal lift is a different type of prosthesis that supports the soft palate to improve speech and swallowing. However, depending on the patient a maxillary prosthesis can incorporate both obturation and palatal lift features.

When Are Palatal Obturators Needed?

Palatal obturators are necessary when trauma, a congenital defect, or surgery results in a palatal defect, ie. an opening on the roof of the mouth. As such, palatal obturators are appropriate in patients who are:

• Recovering from cleft palate surgery
• Have had surgery to remove a benign or cancerous tumor
• Are otherwise healing from trauma to the roof of the mouth

These prosthetic devices are used throughout treatment phases to protect the surgical wound, restore function of the mouth, and improve speech [2].

Different Types of Palatal Obturators [3]

There are three types of maxillary obturators, of which surgical and interim prostheses can be optional depending on the treatment plan:

• Surgical obturator. This type of obturator is most often indicated when the defect is acquired. It is used to support the surgical packing placed in the resection cavity. By restoring continuity of the palatal structures, this prosthesis enables the patient to speak and take oral nutrition immediately post-operatively. Prosthesis is usually in service for 5 – 10 days. The division between surgical and interim obturator prosthesis is not well defined, but both have the same objective of maintaining the patient’s comfort and function until the definitive prosthesis can be fabricated.
• Interim obturator. Used post-surgery, these obturators help protect defects while they are healing. This prosthesis can be maintained until the definitive obturator is constructed. A definitive prosthesis is not indicated until the surgical site is healed and dimensionally stable, and the patient is prepared physically and emotionally.
• Definitive obturator. A definitive obturator is fabricated once healing is complete and site dimensionally stable, typically 3 – 4 months after surgery[4].

Caring for Your Palatal Obturator

Maintenance of an obturator is much like that of a denture. It is recommended that the prosthesis is removed at night time, and using a large denture brush all debris is cleaned. It is imperative that toothpaste is not used, rather use the brush under running water. Toothpaste contains abrasive particles, often used for tooth stain removal, which scratch and wear the plastic teeth used in dentures and obturators. Use of denture cleanser tablets, in addition to brushing, is recommended to remove bad odor and keep the prosthesis fresh.

What makes obturators different from conventional dentures is the bulb extensions that closes the defect. The bulb extension can be one of two designs: open vs. closed top. When the bulb is in an open top configuration as seen in fig. 1, nasal and/or sinus fluids may accumulate throughout the day. This is normal; however, the patient has to clean the bulb. Sometimes an open top bulb may have a drainage tract which means that the patient has to also make sure the tract is kept clean every day as to not cause fluids to dry and create blockage.

Removing plaque, food particles, and bacteria by brushing the prosthesis and adjunctive use of cleanser tablets keeps the tissues healthy and prosthesis clean.

Work With an Prosthodontist for Your Palatal Obturator

As with any prosthetic device, proper fit is essential to maximize comfort and effectiveness. If you need a palatal obturator, it is imperative to work with an experienced prosthodontist to get a device that will properly fit your smile and support healing. Contact Elite Prosthetic Dentistry today to schedule a consultation for your palatal obturator needs.

Sources:

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4082538/
2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4402688/
3. Beumer, J., Marunick, M. T., & Esposito, S. J. (2011). Maxillofacial rehabilitation: Surgical and prosthodontic management of cancer-related, acquired, and congenital defects of the head and neck. Quintessence Pub.
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6162668/