Attitudes and practice in the provision of removable partial dentures

It's not just about the money: recruitment and retention of clinical staff in general dental practice - part 2: dental care professionals

As described in the first paper of this two-part series, increasing difficulties in recruitment and retention of dentists and dental care professionals (DCPs) in general dental practice in the UK is affecting delivery of NHS dental services. There is a significant risk to the future dental workforce supply which will affect access to dental care and worsen oral health inequalities. Understanding what factors contribute to job satisfaction and prevent job dissatisfaction of dental professionals would be useful in managing recruitment and retention issues. The aim of this literature review was to identify factors which contribute to job satisfaction of DCPs in general dental practice. Database searching was conducted systematically through PubMed/Medline, Scopus, Ovid, and the National Grey Literature Collection. Eleven relevant articles were identified, which were qualitatively analysed using Herzberg's motivation-hygiene theory as an analysis tool. Unfair remuneration is a major contributor to dissatisfaction of DCPs, but job satisfaction could be promoted through increased recognition, variety of work, and opportunities to progress. Dental contract reform in the UK should aim to minimise factors contributing to dissatisfaction and increase factors which increase satisfaction, including the development of an acceptable remuneration model for NHS dentistry that facilitates skill mix.

Evaluation of the Empower model of care for partial denture clients in a public oral health care setting

OBJECTIVE

To evaluate the effectiveness of the Empower model of care (EMC) on reducing the addition of teeth to removable partial dentures (RPD).

METHODS

Data reports were generated through the Titanium electronic database to retrieve all clients at Monash Dental Services (MHDS) who participated in the EMC or received an RPD prior to the implementation of EMC was assessed over a two-year period to determine if they had additional teeth added to their partial dentures (PD). A logistic regression was performed testing whether a combination of socio-demographic and clinical variables, provided a multivariate explanation of the EMC outcome.

RESULTS

Prior to EMC, 2034 patients attended MHDS requiring RPDs with 363 returning to have teeth added. From 2018 to 2020, 38 of 584 participants in EMC returned to have teeth added to their PDs. Those in the 'High' risk group were two times more likely to return requiring additional teeth (OR = 1.99; 95%CI:1.31-3.02); each additional year of age increased the odds of requiring additional teeth (OR = 1.03; 95%CI:1.02-1.04). Participants of the EMC were more than two times less likely to require additional teeth (OR = 0.42; 95%CI:0.29-0.59). The variance in requiring additional teeth accounted for using the full model was 9.1% (η2  = 0.091).

CONCLUSIONS

This analysis confirms the effectiveness of the EMC. This approach assists denture wearers to maintain good oral health and provides an effective way of managing public health funds by reducing denture repairs and additions. © 2023 Australian Dental Association.

Alveolar ridge augmentation for implant placement in a growing patient

BACKGROUND

Partial edentulism in growing children due to aplasia or trauma poses a difficult situation to manage. We present a case of horizontal ridge augmentation in a growing patient who had trauma in childhood when it was too early to place implants.

METHODS AND RESULTS

This patient had a history of trauma, at age 13, that resulted in mandibular fracture and loss of teeth #23-27. The definitive restorative treatment plan was postponed due to the patient's continued growth. At age 18, horizontal bone augmentation was performed in a severely resorbed anterior mandible. After 7 months of healing, 7-8 mm ridge augmentation was achieved, and three implants were placed. Soft tissue augmentation by free gingival graft was performed at implant second stage surgery 4 months later.

CONCLUSIONS

When considering the timing of implant placement in adolescents, the clinician walks a fine line between waiting as long as possible to place the implants and racing against continued resorption of the edentulous alveolar ridge. 70/30 mineralized/demineralized cortical bone allograft and injectable platelet-rich fibrin mix combined with tenting screws and resorbable membranes are useful measures for horizontal ridge augmentation in growing patients.

KEY POINTS

Why is this case new information? There are insufficient data available when considering implant treatment in younger patients. The present case was managed with a variation of the sausage technique described by Urban. The use of allograft, I-PRF, and tenting screws replaced the use of autogenous bone and resulted in exceptional results. What are the keys to the successful management of this case? Delaying treatment until after the critical growth period has passed. Adequate flap release, tension-free primary flap closure, and space maintenance through the use of tenting screws and tacking the membranes using tacking pins provided support for the grafted site. What are the primary limitations to success in this case? The continued growth may cause infra occlusion of the implant-supported bridge.

Understanding the impact of removable partial dentures on patients' lives and their attitudes to oral care

Introduction Due to a rising prevalence of removable partial denture (RPD) use, there is an unmet need to explore the psychological impact on patient wellbeing.Aim To assess the psychological effects of consumers losing teeth and receiving partial dentures to better manage their needs.Design Four market research surveys, undertaken on behalf of GlaxoSmithKline Consumer Healthcare, are described.Setting Surveys were conducted across the US, Japan, Malaysia, Colombia, Brazil, Poland and Italy.Materials and methods Quantitative/qualitative methods were used to gain knowledge regarding patients' experiences living with partial dentures.Results In a global market research survey involving 3,952 RPD wearers (RPDWs), 54% said that losing teeth was difficult to accept, 40% were concerned about their appearance, 32% were embarrassed about wearing dentures and 62% wished that more oral care education was available when they were younger. In another survey of >1,000 RPDWs, self-esteem was negatively impacted in 51% of respondents and 57% reported anxiety around dental visits.Conclusions Global market research confirmed that RPDWs can have emotional and practical needs that are not well understood/documented by dental healthcare professionals (HCPs). Consumer research can enhance understanding of patients' needs by dental HCPs and provide suggestions about how they may address them.

Clinical Oral Disorders in Adults Screening Protocol (CODA-SP) from the 2019 Vancouver IADR Consensus Symposium

BACKGROUND

The Clinical Oral Disorder in Elders (CODE) index was proposed in 1999 to assess the oral health status and treatment needs of older people who typically were edentate or had few natural teeth. Since then, more people are retaining natural teeth into old age and have oral disorders similar to younger adults. In addition, there has been further guidance on screening for disease that includes changes to the clinical indicators of several oral disorders and greater sensitivity to people's concerns about their oral health and care needs.

METHODS

Experts in dental geriatrics assembled at a satellite symposium of the International Association of Dental Research in June 2019 to revise the objectives and content of the CODE index. Before the symposium, 139 registrants were asked for comments on the CODE index, and 11 content experts summarised current evidence and assembled reference lists of relevant information on each indicator. The reference lists provided the base for a narrative review of relevant evidence supplemented by reference tracking and direct searches of selected literature for additional evidence.

RESULTS

Analysis of the evidence by consensus of the experts produced the Clinical Oral Disorders in Adults Screening Protocol (CODA-SP).

CONCLUSIONS

The CODA-SP encompasses multiple domains of physical and subjective indicators with weighted severity scores. Field tests are required now to validate its effectiveness and utility in oral healthcare services, outcomes and infrastructure.

Nonmetal clasp dentures: What is the evidence about their use?

The aim was to discuss the indications, contraindications, advantages, and disadvantages of Nonmetal clasp dentures (NMCDs), as well as the most relevant properties of its constituent materials. A search was conducted using the keywords: “nonmetal clasp dentures,” “thermoplastic resin,” “flexible resin removable partial denture,” “polyamide,” and “nylon” in databases PubMed/Medline, Lilacs, SciELO, and textbooks between 1955 and 2020. Theses and texts without reliable sources of publication were excluded. Once the analysis instruments were determined, the data were analyzed and discussed. NMCDs present high flexibility, easy adaptation to the abutments, color compatibility and biocompatibility with the oral mucosa, and absence of visible metal clasps. However, they need laboratory relining, grinding, and polishing, do not have criteria for its planning, become rougher and stained over time, and are able to traumatize supporting tissues. The association with metal components seems to be an alternative to increase the success of NMCDs by combining esthetics and biomechanical principles of conventional removable partial dentures. The lack of long-term clinical studies makes the professionals to rely solely on previous experiences or on the manufacturers' recommendations. It suggested that NMCDs must be indicated with caution when not used temporarily.

Attitude of dental professionals toward cast partial denture: A questionnaire survey in India

Aims:

The use of cast partial dentures (CPDs) has been decreased and its importance has been declined in the teaching curriculum. The purpose of this survey was to evaluate the attitudes of dental professionals toward conditions using CPDs in private practice in India.

Settings and Design:

Descriptive survey

Materials and Methods:

This survey consists of eight close-ended questions concerning the use of CPD by dental professionals practicing in India. The URLs of the questionnaire were shared via E-mail to dentists practicing throughout India, to obtain a response of 384 which is a predetermined sample size.

Statistical Analysis Used:

Statistical analysis was done using counts and percentages and the results were further analyzed statistically by the Chi-square test.

Results:

Nearly 42.79% of general dental practitioners (GDPs), 47.26% of prosthodontists, and 9.95% of other specialist dentists responded to the questionnaire. GDPs mostly preferred removable partial dentures (RPDs) (71.87%) and fixed partial dentures (57.22%), whereas prosthodontists preferred mostly implant (60.91%). GDPs mostly preferred flexible dentures (62.42%), whereas prosthodontists preferred CPDs 62.84%. Almost 52.50% of the GDPs mostly raised a cost issue and 63.11% of the prosthodontists had difficulty in adjustment with CPDs. Nearly 63.46% of the dentists told that implant-supported restorations are better options compared to CPDs; still, majority of the dentists (53.23%) were in favor that more importance for teaching CPDs in graduation curriculum should be given.

Conclusions:

This survey shows that in India a significant proportion of GDPs (71.87%) preferred RPDs, mostly flexible dentures (62.42%) due to their low cost compared to CPDs. Prosthodontists mostly preferred implants (60.91%) because they are more confident and better trained in these. It is recommended that more importance be given in teaching implants along with CPDs in graduation curriculum so that practitioners can better educate their patients about implants and their advantages over flexible dentures and their utilization in cases where patients are not willing for CPDs.

The association between denture care and oral hygiene habits, oral hygiene knowledge and periodontal status of geriatric patients wearing removable partial dentures

Purpose:

This study aims to evaluate the association of the denture care with oral hygiene habits, knowledge and periodontal status geriatric patients wearing removable partial denture (RPD) and to compare the relationship between denture cleaning and tooth brushing frequency.

Patients and methods:

In total, 553 participants wearing RPD for at least 6 months and aged 65–86 years were asked to complete a questionnaire following the clinical examination. Chisquare analysis and Fisher’s exact test utilized to analyze the data.

Results:

A significant relationship was found between the frequency of smoking, denture age, overnight denture wearing, denture stomatitis and denture cleaning (p<0.05). 54.10% of the participants reporting that they did not have information about denture care had poor denture cleaning. Among patients brushing once per day, 26.34% had a good level of denture cleaning; whereas, this was 39.40% for those brushing three times in a day.

Conclusion:

The type of advice (verbal or written) and oral hygiene habits demonstrated a more significant impact on the cleaning level of dentures than the socioeconomic level, smoking, overnight use, denture age. The success of denture maintenance might depend on the patients’ knowledge of denture care and hygiene habits and geriatric patients’ motivation.

The removable acrylic partial denture in primary care: the experience and satisfaction of dental surgeons

Abstract Introduction The guidelines of the National Politics of Oral Health have led to the inclusion of elemental prostheses in the list of Primary Care procedures. Objective This paper aimed to evaluate the performance and satisfaction of dental surgeons with the implementation of Acrylic Partial Dentures. Metodology The sample was composed by 159 dental surgeons (sample calculation), in Belo Horizonte, MG, Brazil, selected via raffle (simple random sampling). A structured questionnaire was built with 72 questions on the daily practice of the performance of dental surgeons, using the SurveyMonkey platform. Result The results showed that for most of dental surgeons, the inclusion on the list of primary care procedures was a positive initiative and they have enjoyed the experience of using Acrylic Partial Dentures. Dental surgeons who had graduated in private institutions reported to have had more failures than those who had graduated in public institutions. The better prepared dental surgeons reported less difficulties and failures, and the more satisfied professionals with the performance of Acrylic Partial Dentures related had also experienced fewer failures. Considering the indication, the majority of participants did it according to the protocol of the institution (only for anterior teeth) but many revealed the use of dentures also for premolars. Conclusion Acrylic partial dentures have been a reality in the Brazilian social context even before their inclusion in the list of Primary Care procedures. Such inclusion indicates their relevance; however, it is necessary to have their confection systematized by a protocol in public services.

Determination of occlusal vertical dimension for complete dentures patients: an updated review

Determination of the occlusal vertical dimension (OVD) is an integral part of complete dentures fabrication. Due to the lack of teeth, the clinician faces the challenge of how to accurately establish the OVD of the new denture. Therefore, the purpose of this review article was to present, discuss and critique the available methods used in determining the OVD for complete dentures patients. This review identified two main streams to determine the OVD: (i) pre-extraction methods and (ii) post-extraction methods. For the pre-extraction methods, the OVD of the natural dentition is transferred to the new dentures mainly by intra-oral measurements, profile tracing and cephalometric analysis. The post-extraction methods rely on mandibular rest position, facial aesthetic appearance, swallowing pattern, craniofacial landmarks measurements, cephalometric analysis, phonetics and existing dentures. In general, all the available techniques have merits and are helpful for routine clinical use. However, they are empirical in nature, controversial and lack the scientific support. Further, there is no single accurate method for OVD determination. To overcome the limitations of the techniques, the clinician will benefit from applying combination of techniques to approximate the OVD.

Retention of Teeth and Oral Health–Related Quality of Life

The authors aimed to critically review the literature regarding the relationship between retention of teeth and oral health–related quality of life (OHRQoL) and the extent to which tooth retention can ensure OHRQoL among adults. The authors investigated studies that assessed the relationship between number of teeth and OHRQoL and how the position, type, and/or pattern of the teeth is related to OHRQoL. Relevant papers published in English from January 2004 to September 2015 were searched via PubMed and EMBASE. Twenty-nine papers—including cross-sectional, longitudinal, clinical trial, and case-control studies—were included and categorized according to 4 subthemes to achieve the stated aim: 1) number of teeth or missing teeth and OHRQoL, 2) occluding pairs or functional units and OHRQoL, 3) position of remaining or missing teeth and OHRQoL, and 4) shortened dental arches (SDAs) and OHRQoL. The main findings for each subtheme were as follows: 1) A significant association between number of teeth and OHRQoL was shown in most studies; however, those studies found different cutoff points regarding the number of teeth that affect OHRQoL, after adjusting for other factors in the analyses (e.g., age, sex, cultural background, and study locations). 2) The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. 3) Having fewer anterior occluding pairs had a greater negative impact on aesthetics and thus affected OHRQoL. 4) Two randomized clinical trials on SDAs indicated that people with SDAs do not show worse OHRQoL than do those with removable dentures. The only 2 population-based studies on SDAs showed that adults with SDAs have no impaired OHRQoL when compared with those having more natural teeth. To conclude, this review found evidence that retention of teeth is associated with better OHRQoL. The number of occluding pairs and the location of remaining teeth have great impacts on OHRQoL. People with SDAs maintain an acceptable level of OHRQoL.

Failures in the rehabilitation treatment with removable partial dentures

BACKGROUND

Despite being functional and having aesthetic benefits, the acceptance of patients regarding the use of removable partial dentures (RPDs) has been low. In part, this is due to the deleterious effects that causes discomfort to the patient. Success depends not only on the care expended by the patient, including daily care and oral hygiene, but also on common goals set by their professional and clinical staff, aiming beyond aesthetics, to incorporate issues of functionality and the well-being of patients.

METHODS AND RESULTS

For rehabilitation treatment with RPDs to reach the desired level of success without damaging the support structure, all the steps (diagnose, cavity preparation, adaptation of the metal structures, functional of distal extension and posterior follow-up) in the rehabilitative treatment should be carefully developed. A literature review was carried out, searching through MEDLINE (PubMed) articles published between 1965 and December 2012 including clinical trials and reviews about the use of RPDs.

CONCLUSIONS

This study describes factors that lead to failures and complications in oral rehabilitation through the use of RPDs and suggests possible solutions.

Partial edentulism and removable partial denture design in a dental school population: a survey in Greece

OBJECTIVES

To investigate the pattern of partial edentulism and the most frequent designs of cobalt-chromium removable partial dentures (RPDs), constructed at the Dental School of Athens, Greece.

METHODS AND MATERIALS

Five hundred and fifty-three patients, between 42 and 81 years old, mostly males, treated by undergraduate dental students, were included. The survey was based on visual evaluation of master casts and work authorisation to dental technicians. Aspects examined were: Kennedy Classification, modification areas, major connectors, clasping, placement of rest seats and indirect retention.

RESULTS

Kennedy Class I was the most common encountered in the maxilla (50.5%) and in the mandible (70%). The most frequent major connectors were the lingual bar (92.6%) and the U-shaped palatal strap (54%). The most common clasp was the Roach (69.2%) in Class I and Class II. In Class III and IV, the most common was the occlusally approaching clasp (55% and 70%). The most frequent location of the rest was mesial of abutment teeth. On the average, 39.5% of Class I RPDs and 58.6% of Class II RPDs had indirect retainers.

CONCLUSION

A combination of the two major philosophies of RPD design (biomechanical and hygienic) was evident in the RPDs examined in our study.

Efficient resource use in simplified complete denture fabrication

PURPOSE

Conventional dentures will remain the only treatment available to most edentulous people for the foreseeable future. In this study, we compared the efficiency of two methods of making complete conventional dentures-the traditional academic standard (T) and a simplified technique (S) used in private practice. We have previously shown that they produce similar levels of patient satisfaction and denture quality.

MATERIALS AND METHODS

Data were gathered during a randomized controlled clinical trial of 122 subjects from initial examination until 6-month follow-up. For this report, the direct costs of providing one set of conventional complete dentures by T or S techniques were estimated. All materials used were recorded and their cost was calculated in Canadian dollars (CAN$). The costs of fabrication in an outside laboratory were added. Clinician's labor time was recorded for every procedure. Between-group comparisons for each clinical procedure were carried out with independent t-tests. The number of patients in each group who needed postdelivery treatment was compared with Chi-square tests. The effect of group assignment and of treatment difficulty on outcomes was analyzed with multiple regression analysis.

RESULTS

The mean total cost of the T method was significantly greater than S (CAN$166.3; p < 0.001), and clinicians spent 90 minutes longer (p < 0.001) on clinical care. The difficulty of the case had no significant influence on outcomes.

CONCLUSIONS

The results indicate that the S method is the more cost-efficient method and that there are no negative consequences that detract from the cost savings.