The Nature and Quality of the Delivery of Prosthodontic Care in the Kingdom of Bahrain

The nature and quality of the delivery of prosthodontic care in the Kingdom of

Bahrain project is a comprehensive assessment of the standards and

practice which are currently undertaken in the delivery of prosthodontic care

in the Kingdom of Bahrain. The project consists of six investigations to

evaluate different aspects of prosthodontic care in Bahrain. The

investigations were completed during the period 2010-2018, and aimed: (i) to

assess the quality of prescription writing for different types of dental

prostheses, (ii) to investigate the delivery of prosthodontic care provided by

the general dentists in the private sector, (iii) to evaluate and improve the

nature of prosthodontic care provided by the dental laboratories and dental

technicians in the private sector, (iv) to investigate the costs involved in the

fabrication of dental prostheses, (v) to look at the treatment planning process

in general dental practice, and (vi) to evaluate the effect of training on

laboratory prescription writing and treatment planning of prosthodontic cases.

The findings of the assessment of the quality of 500 written laboratory

prescriptions (investigation 1) highlighted the difficulties that exist in the

communication between general dental practitioners and dental technicians

in the Kingdom of Bahrain within the field of removable dentures and fixed

dental prostheses. The results indicated inadequate communication between

general dental practitioners and dental laboratories. The results also

indicated there are dental practitioners who depend on dental technicians to

design the dental prosthesis without reference to clinical information.

Investigation 2 was a national survey of general dental practitioners in the

private sector including their approaches to treatment planning aspect of

prosthodontic cases. Eighty-three percent believed they need further training

in prosthodontics. The cost of prosthodontic services was the most frequently

mentioned by the participants that limits prosthodontic care in Bahrain.

Ninety-one percent of the participants prefer to provide a fixed dental

prosthesis (dental implants or bridge work) for the treatment of partial

edentulous cases. The problems experienced by general dentists in the

design of cobalt-chromium removable partial dentures were found to be

related more to educational factors than financial.

Investigation 3 was a national survey of dental laboratories in the private

sector to investigate the extent and range of prosthodontic laboratory support

available in the private sector of the Kingdom of Bahrain, the cost of the

dental laboratory work and the nature of the education and training of the

dental technicians. Ninety percent of dental technicians hold a diploma

qualification. Dental laboratories provide crowns, bridges, removable partial

dentures, removable complete dentures and implant-supported prostheses.

Most of the average monthly output is for crowns and removable partial

dentures (200 per month for each). Dental technicians reported that they

need further training for the following types of prostheses: crowns, bridges,

removable partial dentures, removable complete dentures and implant

supported prostheses. The production of veneers and cast partial dentures

were described by the majority of dental technicians as the most difficult

procedures.

The costs involved in providing prosthodontic care in the private sector was

researched in investigation 4. The average cost charged by the general

dental practitioners for Crowns= BHD 171.041, bridge (per unit) = BHD

152.270, removable partial denture (single tooth) = BHD 150.000, removable

complete denture= BHD 286.600 and implant-supported prosthesis (per unit,

excluding dental implant prosthetic components) = BHD 375.000. The Dental

laboratory average fees for crowns = BHD 30.000, bridge (per unit) = BHD

27.500, removable partial denture (Single Tooth) = BHD 40.000, removable

complete denture= BHD 55.000 and implant-supported prosthesis (per unit,

excluding dental implant prosthetic components) = BHD 40.000. [On

24.02.2020, 1 BHD = 2.65$, 2.45€, 2.05GB£, information taken from

www.xe.com]

Investigation 5 examined the quality of the treatment planning and the design

of cobalt-chromium removable partial dentures performed by the general

dental practitioners in the Kingdom of Bahrain. The participants were given

three partially dentate prosthodontic cases to design cobalt-chromium

removable partial dentures and they were asked to explain the reasoning

behind their decisions. The treatment planning and design for the cobaltchromium

removable partial dentures components (direct retainers, rests,

connectors, indirect retainers and denture base) was evaluated and the

results show a deficiency in the knowledge and training in this aspect and

indicate the need for further education and training in the design of the

cobalt-chromium removable partial dentures. Most of the participants

(92.4%) justified their treatment planning and design for the purpose of

providing the most retention possible for the removable denture. Seventyseven

percent justified their design for providing “better stability”. Twentyseven

percent based their design and components selection on obtaining

“strength and durability” for the dentures. Eight percent justified their

treatment planning for the purpose of “natural teeth protection”.

The effect of training in removable partial dentures prescription writing and

treatment planning on general dental practitioners in the Kingdom of Bahrain

was evaluated in investigation 6. The participants were invited to attend a

continuing professional development session, they were asked to design a

removable partial denture case before training, followed by a training session

in removable partial denture design and prescription writing, later they were

asked to design the same removable partial denture case after training and

finally evaluating the effect of training by comparing the answers before and

after the training based on 14 variables. The results show the average

percentage of improvement in the ability and confidence in designing

removable partial dentures on all participants was 32.4%.

General dental practitioners should provide a proper written dental laboratory

prescription based on acceptable international standards. A satisfactory

relationship between the dentist and dental technician is essential in order to

achieve a success dental prosthesis and contributes to an optimal treatment

outcome.

Dental technicians should have a valuable understanding and experience

regarding the dental laboratory procedures. Proper planning and the combination of dentist and technician expertise can ensure successful

treatment outcomes.

Continuing education and training are an important part of the continued

professional development process in the delivery of prosthodontic care.

The results revealed a number of concerns including inadequate

communication between the dental practitioners and dental technicians,

deficiencies in the knowledge and training for removable partial denture

design, and a lack of continuous education both in prosthodontics and dental

technology. Based on the study findings, recommendations are proposed to

improve the quality of the delivery of prosthodontic care in the Kingdom of Bahrain.