The Nature and Quality of the Delivery of Prosthodontic Care in the Kingdom of Bahrain.pdf (6.86 MB)

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

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posted on 25.01.2021, 14:58 by Talal Al-Alawi
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.

History

First Supervisor

Professor Christopher D. Lynch

Comments

A thesis submitted for the degree of Doctor of Philosophy from the Royal College of Surgeons in Ireland in 2019

Published Citation

Al-Alawi TA. The Nature and Quality of the Delivery of Prosthodontic Care in the Kingdom of Bahrain [PhD Thesis]. Dublin: Royal College of Surgeons in Ireland; 2020

Degree Name

Doctor of Philosophy (PhD)

Date of award

31/05/2020

Programme

  • Doctor of Philosophy (PhD)

Exports

Theses and Dissertations

Exports