The Nature and Quality of the Delivery of Prosthodontic Care in the Kingdom of Bahrain
Creators: name: Al-Alawi, Talal
Publisher: name: Royal College of Surgeons in Ireland
Year: 2021
Subjects: subject: 110599 Dentistry not elsewhere classified
subject: FOS: Clinical medicine
subject: FOS: Clinical medicine

description: The nature and quality of the delivery of prosthodontic care in the Kingdom ofBahrain project is a comprehensive assessment of the standards andpractice which are currently undertaken in the delivery of prosthodontic carein the Kingdom of Bahrain. The project consists of six investigations toevaluate different aspects of prosthodontic care in Bahrain. Theinvestigations were completed during the period 2010-2018, and aimed: (i) toassess the quality of prescription writing for different types of dentalprostheses, (ii) to investigate the delivery of prosthodontic care provided bythe general dentists in the private sector, (iii) to evaluate and improve thenature of prosthodontic care provided by the dental laboratories and dentaltechnicians in the private sector, (iv) to investigate the costs involved in thefabrication of dental prostheses, (v) to look at the treatment planning processin general dental practice, and (vi) to evaluate the effect of training onlaboratory prescription writing and treatment planning of prosthodontic cases.The findings of the assessment of the quality of 500 written laboratoryprescriptions (investigation 1) highlighted the difficulties that exist in thecommunication between general dental practitioners and dental techniciansin the Kingdom of Bahrain within the field of removable dentures and fixeddental prostheses. The results indicated inadequate communication betweengeneral dental practitioners and dental laboratories. The results alsoindicated there are dental practitioners who depend on dental technicians todesign the dental prosthesis without reference to clinical information.Investigation 2 was a national survey of general dental practitioners in theprivate sector including their approaches to treatment planning aspect ofprosthodontic cases. Eighty-three percent believed they need further trainingin prosthodontics. The cost of prosthodontic services was the most frequentlymentioned by the participants that limits prosthodontic care in Bahrain.Ninety-one percent of the participants prefer to provide a fixed dentalprosthesis (dental implants or bridge work) for the treatment of partialedentulous cases. The problems experienced by general dentists in thedesign of cobalt-chromium removable partial dentures were found to berelated more to educational factors than financial.Investigation 3 was a national survey of dental laboratories in the privatesector to investigate the extent and range of prosthodontic laboratory supportavailable in the private sector of the Kingdom of Bahrain, the cost of thedental laboratory work and the nature of the education and training of thedental technicians. Ninety percent of dental technicians hold a diplomaqualification. Dental laboratories provide crowns, bridges, removable partialdentures, removable complete dentures and implant-supported prostheses.Most of the average monthly output is for crowns and removable partialdentures (200 per month for each). Dental technicians reported that theyneed further training for the following types of prostheses: crowns, bridges,removable partial dentures, removable complete dentures and implantsupported prostheses. The production of veneers and cast partial dentureswere described by the majority of dental technicians as the most difficultprocedures.The costs involved in providing prosthodontic care in the private sector wasresearched in investigation 4. The average cost charged by the generaldental practitioners for Crowns= BHD 171.041, bridge (per unit) = BHD152.270, removable partial denture (single tooth) = BHD 150.000, removablecomplete denture= BHD 286.600 and implant-supported prosthesis (per unit,excluding dental implant prosthetic components) = BHD 375.000. The Dentallaboratory average fees for crowns = BHD 30.000, bridge (per unit) = BHD27.500, removable partial denture (Single Tooth) = BHD 40.000, removablecomplete denture= BHD 55.000 and implant-supported prosthesis (per unit,excluding dental implant prosthetic components) = BHD 40.000. [On24.02.2020, 1 BHD = 2.65$, 2.45€, 2.05GB£, information taken fromwww.xe.com]Investigation 5 examined the quality of the treatment planning and the designof cobalt-chromium removable partial dentures performed by the generaldental practitioners in the Kingdom of Bahrain. The participants were giventhree partially dentate prosthodontic cases to design cobalt-chromiumremovable partial dentures and they were asked to explain the reasoningbehind their decisions. The treatment planning and design for the cobaltchromiumremovable partial dentures components (direct retainers, rests,connectors, indirect retainers and denture base) was evaluated and theresults show a deficiency in the knowledge and training in this aspect andindicate the need for further education and training in the design of thecobalt-chromium removable partial dentures. Most of the participants(92.4%) justified their treatment planning and design for the purpose ofproviding the most retention possible for the removable denture. Seventysevenpercent justified their design for providing “better stability”. Twentysevenpercent based their design and components selection on obtaining“strength and durability” for the dentures. Eight percent justified theirtreatment planning for the purpose of “natural teeth protection”.The effect of training in removable partial dentures prescription writing andtreatment planning on general dental practitioners in the Kingdom of Bahrainwas evaluated in investigation 6. The participants were invited to attend acontinuing professional development session, they were asked to design aremovable partial denture case before training, followed by a training sessionin removable partial denture design and prescription writing, later they wereasked to design the same removable partial denture case after training andfinally evaluating the effect of training by comparing the answers before andafter the training based on 14 variables. The results show the averagepercentage of improvement in the ability and confidence in designingremovable partial dentures on all participants was 32.4%.General dental practitioners should provide a proper written dental laboratoryprescription based on acceptable international standards. A satisfactoryrelationship between the dentist and dental technician is essential in order toachieve a success dental prosthesis and contributes to an optimal treatmentoutcome.Dental technicians should have a valuable understanding and experienceregarding the dental laboratory procedures. Proper planning and the combination of dentist and technician expertise can ensure successfultreatment outcomes.Continuing education and training are an important part of the continuedprofessional development process in the delivery of prosthodontic care.The results revealed a number of concerns including inadequatecommunication between the dental practitioners and dental technicians,deficiencies in the knowledge and training for removable partial denturedesign, and a lack of continuous education both in prosthodontics and dentaltechnology. Based on the study findings, recommendations are proposed toimprove the quality of the delivery of prosthodontic care in the Kingdom of Bahrain.