Knowledge and Attitude Regarding Designing Removable Partial Denture Among Interns and Dentist; Dental Schools in Pakistan

Muhammad Farhan Khan                BDS, FCPS

Fatima Naseem Ahmed Khan         BDS

Muneeb Ahmed Lone                         BDS, FCPS

Muhammad Waqar Hussain           BDS, FCPS

Muhammad Ali Shaikh                     BDS

Irfan Ahmed Shaikh                          BDS, FCPS

INTRODUCTION

There are multiple options available in modern day restorative dentistry to restore partially edentulous arches.1
From simple removable options of restoration with fixed options with or without dental implants.1 While choosing between the options over all treatment cost, time and oral hygiene maintenance is mostly considered by the dentist.2
Removable partial denture (RPD) is one of the simple options available and if used scientifically and strategically could benefit the patient in restoration of function and esthetic and could be acceptable to the patient as well.2-3 There are different clinical and laboratory steps in the designing of an RPD such as surveying the primary cast and drawing a preliminary design and marking out the areas which need modification.3 After the tooth modification have been done the secondary cast is again reoriented on the dental surveyor and checked for the appropriate amount of tooth modification have been done in the mouth. Once satisfied the final design is drawn on the laboratory from and send to the laboratory technician to follow the design instructions.4-5 There are many components of an RPD which have some specific functions. Before designing an RPD for a particular patient the clinician must have a thorough knowledge about the design and functions of different parts and components of an RPD.5-6 Placing the components without knowing the reason or relaying on the dental technician for designing the RPD who is not trained for the task can end up in failure of the Prostheses and overall treatment8. Previous local and international literature have also documented that poor written prescription of cast partial denture to the dental laboratory and poor design principles for fabrication by the dentist have been in practiced which more than half of the practice.9-11 The objective of the study is to determine the attitude and knowledge of an intern, general dentist and specialist prosthodontist in providing service of an RPD to the patient. And if there are flaws, what changes should be made in the undergraduate curriculum so that the newly graduating student and the practicing dentist can benefit.

METHODOLOGY

A cross-sectional questionnaire-based survey was conducted in Karachi (Pakistan) at Baqai Dental College, Hamdard Dental College, Fatima Jinnah Dental College, Sir Syed Dental College, Jinnah Medical & Dental College (JMDC) and Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences (DIKIOHS) after the approval from ethical review
committee copy attached (BDC/ERB/2019/003. The survey was conducted through a questionnaire on Google form
(Copy attached) Sample size was calculated by using online sample size calculator formula. Written consent was taken from the participants before the questionnaire, those willing to participate in the study were included in the study others unwilling were excluded. The questionnaire comprised of questions about the participants attitude knowledge about designing an RPD and communication with the dental laboratory. The questions details are mentioned in the result section.

STATISTICAL ANALYSES

Data were entered using and analyzed using SPSS version 21. Mean and standard deviations were calculated for all continuous variables while frequencies and percentages were calculated for all categorical variables.

RESULTS

Of the total 573 study participants, the mean age of was 35.45±12.54 years. There was a female predominance in the study subject, (73% female’s vs 27% males). Figure 1 shows the experience distribution of the study participants.

Figure 1: Percentage distribution of experience of the study participants (n=573)

PRACTICES

The data in table 1 show that almost half (42%) of the study participants provided RPD services to partially edentulous patients once to twice a month whereas 174 (30%) of the study participants dealt with such cases more
than three times a month.

Table 1: Dentists responses to the questions related to the RPD practices among the participants

ATTITUDES

The data in Table 2 regarding the attitude of study participants on who should be responsible for designing the
RPD, half (51.3%) responded that dentist should be responsible while other half (48.7%) responded that dental

Table 2: Dentists responses to the questions related to the attitude of the participants towards RPD designing

Figure 2: Distribution of attitude regarding the designing of RPD based on experience.

laboratory technician should oversee the designing of the RPD. However, ironically only more interns believed that designing should be the job of dental laboratory technician as shown in figure 2.
Majority of the participants had an attitudinal belief that surveying is the job of both the dentists and the dental laboratory technicians. Unfortunately, almost 4% of the study participants believed that surveying is not required at all.

KNOWLEDGE

Only 81 (14%) of the study participants were fully aware of how to transfer the need of tooth modification in the
patients’ mouth. Whereas as high as 20% of the participants were not at all aware of the required knowledge. (table 3) Figure 3 shows the level of knowledge according to experience. Almost three percent of specialist with more than 5 years of experience revealed that they were not aware of the required knowledge at all.

Table 3: Dentists responses to the questions related to the knowledge of the participants towards RPD designing and practices

Figure 3: Distribution of the level of knowledge among study participants as per experience

DISCUSSION

Most of the previous studies in the literature have emphasized on the poor written laboratory communication between the clinicians and the dental Laboratory.8-12 Now a days the laboratory communication is being taught at the undergraduate level but in clinics and dental schools it is not being practiced regularly.9
This problem is globally present.11-12 According to the results of the present study (table 1) when the clinicians were asked about the method of communication with the laboratory about 50% of the clinicians didn’t mention about the laboratory communication document. Which is mandatory for the communication with the laboratory.11-12 To determine the path of insertion and removal surveying is mandatory.10 During the initial survey, need for the mouth preparation is identified for retention, reciprocation and support process of the prostheses.10 In the present study when the clinicians were asked about the need of survey about 40% of the participants gave negative feedback about surveying a cast on the dental surveyor by the clinician (table 2) When the clinicians were asked about their attitude about surveying a cast, is it the job of a dentist or a dental technician about 50% of the clinicians agreed that it’s the job of dentist. In the present literature there are strict guidelines available for the laboratory communication, designing an RPD and surveying of the dental cast by the clinicians.10-15 Tripoding is the method to reorient a cast on the dental surveyor, once the cast has been removed from the dental surveyor.16 It’s a mandatory process at the end of dental surveying.16 In the present study when the clinicians were asked about the method to reorient the cast on the dental surveyor only 14% of the clinicians showed full awareness about the knowledge to do so. (table 3) Within the limitations of this study it could be concluded from the results of the study that there is lack of written communication between the clinicians and the dental laboratory for designing an RPD. This problem could be rectified by emphasizing the need of written communication between the laboratory and the clinicians. This topic must be added in course learning outcomes at BDS level and licensing exams for newly graduate, also it should be added in continuing dental education courses. It is the dentist responsibility to survey and design the RPD as it is the dentist most aware of the clinical situation and health condition of the patient and his / her teeth influencing denture design and its insertion and the long term health of the oral tissues. The laboratory technician has to follow the dentist instructions.14-21

CONCLUSION

Despite the fact that almost half of the dental practitioners were involved in providing removable partial dentures (RPD), majority of the practitioners had insufficient knowledge and inadequate attitudes and practices regarding RPD. Within the limitations of the present study it could be concluded that emphasis must be given on principle of Cast Partial Denture designing and written laboratory communication at all levels of studies. We recommend the use of interactive software programs to train and evaluate the undergraduates about the RPD designing. Furthermore, continued dental education programs, workshops, and hands-on courses should be periodically conducted for the interns, general practitioners and specialists to reinforce the knowledge, attitude and practices related to RPD.

CONFLICT OF INTEREST

None declared

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1. Associate Professor, Department of Prosthodontics, Baqai Dental College, Baqai Medical University, Karachi.
2. Registrar, Department of Oral & Maxillofacial Surgery, Baqai Dental College, Baqai Medical University, Karachi.
3. Assistant Professor, Department of Prosthodontics, Dow University of Health Sciences, Karachi.
4. Associate Professor, Department of Prosthodontics, Bakhtawar Amin Medical and Dental College, Multan.
5. Senior Registrar, Department of Prosthodontics, Baqai Dental College, Baqai Medical University, Karachi.
6. Associate Professor, Department of Prosthodontics, Institute of Dentistry Liaquat University of Medical and Health Sciences, Jamshoro.
   Corresponding author: “Dr. Fatima Naseem Ahmed Khan” < fnaknlm@gmail.com >