An investigation of complete denture teaching in the UK: part 2. The DF1 experience

Removable partial dentures: Part 1

The provision of removable partial dentures (RPDs) is an important skill for practitioners and it can often be challenging to make a successful prosthesis which the patient finds satisfactory. This three-part series has been designed to provide an overview of the clinical management of patients requiring RPDs. This first part provides a refresher of the aspects of the history and examination that are relevant to RPDs. We describe some key principles that are relevant to challenging denture cases. This will help the reader begin the treatment planning process and understand some of the factors which influence the prognosis of dentures.

Comparison of case-based learning combined with Rain Classroom teaching and traditional method in complete denture course for undergraduate interns

BACKGROUND

Complete denture, as an important restoration method for edentulism, is difficult to study for beginners, especially in linking the theory with clinical practice.

OBJECTIVE

This study was aimed to compare the teaching effects between case-based learning combined with Rain Classroom teaching and traditional lecture method in the clinical course of complete denture prosthesis for undergraduate interns.

METHODS

In a course called "Problems and treatment strategies of complete denture after wearing", interns were divided into two groups: one for traditional lecture-based teaching with PowerPoint slideshow (the control group, n = 28); and the other for case-based learning combined with Rain Classroom teaching, which published information before class, discussed specific clinic cases in class and got real-time interns' feedback via WeChat (the test group, n = 22). Both groups received the same exam and questionnaire survey after class. The Q&A participation of interns in class, theoretical test scores and questionnaire survey responses were used to evaluate the teaching effects. An independent sample t-test and the chi-square test or Fisher's exact test were used for statistical analysis in this study.

RESULTS

The Q&A participation of interns in the test group was much better than that of the control group. The average score on the theoretical test after class in the test group (72.14 ± 12.24) was significantly higher than that in the control group (61.29 ± 20.12) (P < 0.05). In the test group, 94.54% (21/22) of the interns preferred the new teaching mode.

CONCLUSION

Case-based learning combined with Rain Classroom teaching is helpful to enliven the classroom atmosphere, inspire studying enthusiasm, and achieve a good learning effect in both theory and clinical practice related to complete denture prosthesis.

Perception of Edentulous Patients and Dental Professionals towards Care and Maintenance of Complete Denture Prostheses

Methods

A descriptive qualitative study was conducted among 30 EDPs attending dental prosthetic clinics (DPCs) at the four centres in Fiji and 28 DPs at the four DPCs under purposive sampling. Semi-structured questionnaire with open-ended questions was used for in-depth interview (IDI) with EDPs via telephone and focus group discussion (FGD) with DPs virtually via Zoom. Participant responses were recorded and thematic analysis was used to manually analyze the verbatim transcripts.

Results

Five themes were identified as perceptions of EDPs towards care and maintenance of CDP in Fiji: patient perceptions towards CDP, CDP care and maintenance, communication between DPs and EDPs, challenges faced in CDP, and management strategies to CDP care and maintenance. Seven themes were identified as perceptions of DPs: CDP guidelines, post-denture insertion advice, care and maintenance, challenges while treating EDPs, management strategies to challenges faced, communication and teamwork, and recommendations to improving quality of CDP delivery in Fiji.

Conclusion

Patients' perception towards care and maintenance of CDP was low. It is highly recommended for EDPs to adhere to CDP advice given by DPs whilst for DPs, it had been recommended to provide written, oral, and visual forms of CDP care and maintenance advice to EDPs for effectiveness.

Complicating factors in complete dentures: assessing case complexity

This article aims to describe common complicating factors that impact on the success of complete denture treatment and present an overview of the challenges these pose in practice. The authors present a range of medical, oral and social factors to consider when providing treatment to edentulous patients, allowing the practitioner to identify cases which may require referral. The information is applicable to all dental practitioners, and is a useful aid to highlight complicating factors in individual patients and to make well-informed clinical decisions.

An investigation into the oral surgery curriculum and undergraduate experience in a sample of DFT's in the UK

AIM

There is conflicting evidence concerning the ability of recent graduates to meet the standards required in exodontia to be independent practitioners. In particular, there is a lack of confidence in surgical extractions. This study evaluated Foundation Trainee's confidence levels in their oral surgery experience and the teaching of oral surgery in UK dental schools.

MATERIALS AND METHODS

Two separate studies were carried out, and the first was a survey to all foundation trainees in the Yorkshire and Humber Deanary in 2019 which analysed their oral surgery experience and confidence levels. The second study surveyed all Dental Schools in the UK with regard to their contact hours, assessment methods, instruments taught and number of extractions in oral surgery for their undergraduate programmes.

RESULTS

There was a response rate of 52% for the foundation trainees which showed that they were confident in performing non-surgical extractions but lacked confidence with surgical extractions. There was a positive correlation between the amount of undergraduate experience and confidence levels in exodontia. The second survey which had a response rate of 71% showed variations in the numbers of hours taught for oral surgery, instruments taught and assessment methods, with the structured clinical operative test used more commonly. On average, 41 non-surgical extractions were performed by students before graduation and two surgical extractions.

CONCLUSION

There is a need to identify how oral surgery teaching can be improved in UK dental schools to ensure that foundation trainees are more confident and competent in both surgical and non-surgical exodontia. In addition, teaching and assessment methods need to be developed to reflect such requirements.

Complete dentures: an update on clinical assessment and management: part 1

The ability to provide high-quality complete dentures has been a key skill for general dental practitioners throughout the history of dental care. The prevalence of edentulism is becoming increasingly concentrated in an older patient cohort and general dental practitioners may more commonly face challenges associated with providing care for these patients. This two-part series explores various aspects of complete denture provision and is designed to act as a refresher on core aspects of managing these patients, while also covering common challenges associated with anatomical or patient factors. This first part will explore changes in the provision and teaching of complete denture care in the UK and will describe important aspects of patient examination. It will discuss the management of unstable lower dentures and fibrous replacement ridges. Part two will cover management of the gag reflex, tori, microstomia and copy dentures.

The standard of newly qualified dental graduates - foundation trainer perceptions

Background There have been anecdotal concerns that the skill mix of recently qualified graduates is very different to those qualifying several years ago, in particular that the clinical skills on qualification are less. If true, such changes may have ramifications for providers of undergraduate training, postgraduate training, particularly at foundation training level, and ultimately the public.Aim The aim of this study was to assess changes in perceived standards of newly qualified graduates as reported by foundation trainers.Method A cross-sectional survey was conducted using a self-completed internet-based survey tool sent to all foundation trainers (FTs) in England, Northern Ireland and Wales.Results A total of 312 responses were obtained covering all postgraduate deaneries. There was mixed opinion regarding standards of new graduates, with 51% reporting that the overall standard of those entering foundation training was 'unsatisfactory'. Standards in key clinical areas were considered unsatisfactory by large proportions of respondents. Eighty-five percent considered standards to be unsatisfactory in 'crown and bridge', 75% in 'extraction of teeth', 74% in endodontics, 67% in removable prosthodontics, and 62% in treatment planning. Experienced trainers identified a decline in standards in particular clinical areas.Conclusions A large proportion of foundation trainers consider the current standard of new graduates to be unsatisfactory for entering foundation training. There are a number of key clinical areas of concern and a perception of declining standards.

Learning effects of different training models for border molding from the perspective of dental students

BACKGROUND

The aim of this study was to investigate the effects of different practical training models on the comprehension and evaluation of practical training among dental students.

METHODS

The study subjects were all sixth-year dental students at our institute, and the study took place over three consecutive years (n = 58, 63, and 65, respectively). In practical training, all students learned border molding, and practical models were modified each year from plaster models to silicone models and then to silicone models mounted in mannequins. Immediately after completing clinical training, all students were asked to complete questionnaires consisting of 21 items regarding their overall practical training and their clinical comprehension of border molding. All items were rated on a five-point Likert scale, and in order to reduce the large number of interrelated questions, exploratory factor analysis was carried out using maximum likelihood estimation with promax rotation (κ = 4) and Kaiser normalization. The number of factors was chosen using the Kaiser-Guttman rule, which states that the eigenvalue should be larger than 1, and the scree plot criteria. Items that scored less than 0.25 in communality and exhibited factor loading greater than 0.35 for more than one item were excluded. The defined factors were analyzed for the plaster models, the silicone models alone, and the silicone models with mannequins using the Kruskal-Wallis test and follow-up tests using Bonferroni-corrected Mann-Whitney U tests. The significance level was set at p < 0.05.

RESULTS

Exploratory factor analysis identified the following three factors: "knowledge of border molding"; "contents of practical training"; and "personal learning attitude". The students who used silicone models and mannequins gave significantly better evaluations on the "knowledge of border molding" (p < 0.001, both) and "contents of practical training" (p = 0.046, p < 0.001, respectively) subscales than those who used plaster models. No significant differences were observed between those who used silicone models and those who used mannequins. Moreover, no significant differences were found on the "personal learning attitude" subscale among students for any model.

CONCLUSIONS

The change in practical training models from plaster to silicone improved student evaluations of border molding training.

Attitudes towards Prosthodontic Clinical Decision-Making for Edentulous Patients among South West Deanery Dental Foundation Year One Dentists

The aim of this study was to describe Dental Foundation year one dentists’ attitudes towards prosthodontic decision making for edentulous patients, and identify whether there are gender differences in these attitudes. All South West Deanery trainees were invited to take part in the study between May and June 2011 and a previously piloted questionnaire was administered to the trainees by their training programme directors. The questionnaire posed questions based upon a clinical scenario of discussing treatment options with patients. Seventy-two questionnaires were used in the analysis (91% overall response rate). Trainees perceived their own values to be less important than the patient’s values (p < 0.001) in decision making, but similar to the patient’s friend’s/relative’s values (p = 0.1). In addition, the trainees perceived the patient’s values to be less important than their friend’s/relatives (p < 0.001). Sixty-six per cent of trainees acknowledged an influence from their own personal values on their presentation of material to patients who are in the process of choosing among different treatment options, and 87% thought their edentulous patients were satisfied with the decision making process when choosing among different treatment options. Fifty-eight per cent of trainees supported a strategy of negotiation between patients and clinicians (shared decision making). There was no strong evidence to suggest gender had an influence on the attitudes towards decision making. The finding of a consensus towards shared decision making in the attitudes of trainees, and no gender differences is encouraging and is supportive of UK dental schools’ ability to foster ethical and professional values among dentists.