|Year : 2018 | Volume
| Issue : 1 | Page : 16-20
Assessment of the perceived communication competence of senior undergraduate dental students: A study of the quality of data and orders written in prosthodontics' laboratory forms
Manal R Alammari1, Roaa Albagar2
1 Department of Oral and Maxillofacial Prosthodontics, King Abdulaziz University, Jeddah, Kingdom of Saudi Arabia
2 General Dentist, Jeddah, Kingdom of Saudi Arabia
|Date of Web Publication||26-Feb-2018|
Dr. Manal R Alammari
Department of Oral and Maxillofacial Prosthodontics, King Abdulaziz University, Dental Hospital, P.O. Box: 80209, Jeddah 21589
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Background: Although principled responsibilities are on dentists to prescribe and communicate prosthodontics information and requirements to dental technician, studies reveal a lack of communication. Moreover, skills and techniques that students develop during their clinical education are profoundly become attitudes. Aim: The aim of this cross-sectional study was to inspect and observe the quality of prosthodontics instructions and information submitted for both fixed and removable prosthodontics cases immediately at the end of each students' clinical session. Methods: Research ethical committee approved this study. A paper-based examination designed to find out the quality of instructions and nature of information. A self-structured questionnaire was constructed which included general data; year of study, age and gender of the dental student, information of the case type itself, and the clarity and correct instructions. Written instructions and the drawings were categorized as satisfactory and clear, a guide, unsatisfactory and poor, and none, outcome of treatment recorded at the delivery/cementation appointments. Results: Only 36.5% of the whole study samples were satisfactory and clear. Moreover, 37.4% were considered as a guide, 22.8% were unsatisfactory and poor, and 3.3% were without instructions. There was a statistical significance difference between the groups. Results showed that only 42.3% of prosthodontics cases approved on the intended day for delivery and/or cementation with minor adjustments. Nearly 14.6% rejected and unapproved (Redo). Only 9.75% of written information indicated disinfection. Conclusion: This study indicates weakness in communication between senior dental students (SDSs) and the laboratory dental technicians. SDSs are not competent in writing prosthodontics forms. The significance of acceptably completing the forms must be stressed throughout students' education.
Keywords: Dental students, dental technicians, fixed, laboratory form, prosthodontics, removable
|How to cite this article:|
Alammari MR, Albagar R. Assessment of the perceived communication competence of senior undergraduate dental students: A study of the quality of data and orders written in prosthodontics' laboratory forms. J Int Oral Health 2018;10:16-20
|How to cite this URL:|
Alammari MR, Albagar R. Assessment of the perceived communication competence of senior undergraduate dental students: A study of the quality of data and orders written in prosthodontics' laboratory forms. J Int Oral Health [serial online] 2018 [cited 2018 Mar 24];10:16-20. Available from: http://www.jioh.org/text.asp?2018/10/1/16/226175
| Introduction|| |
There is a moral and authorized commitment that places precise necessities on dentists to deliver acceptable written orders and information when a dental prosthodontic work is being made.
A number of studies from different parts of the world exist which reveal a deficiency in communication and worries about the quality of the data provided by dentists.,,,,,,,, Instructions have been known as “the most often used and abused form of message between the dentist and laboratory dental technician.”
The explanations for the poor communication found in these studies were usually either financial or educational.
Due to the improvements in dental patients' alertness about their dental treatment requirements, a positive dental treatment requires not only an active but also a collaborative rapport between all associates of the dental team.
Moreover, there is a reliable indication in the dental literature presenting the damaging effects of improperly planned removable dental prosthesis (RDPs)., Therefore, there is a general agreement that dentists should deliver a thorough instruction for prosthodontics work to dental laboratories. The European Union introduced the “Medical Devices Directive,” which places legal and ethical guidelines on dental practitioners when a prosthesis is to be manufactured. The British Society for the Study of Prosthetic Dentistry has similar guidelines, which clearly states that the design of the RDP is the responsibility and obligation of the dentists. Yet, nothing introduced in Saudi Arabia.
The skills and techniques that students develop during their clinical education are profoundly become attitudes. Although faculty are really leading to produce high-quality learning environment in the dental school, clinical supervisors in dental schools are asking questions about the effectiveness of clinical teaching strategies to improve and modify current strategies or to implement new tactics.
The aim of this clinical cross-sectional study was to inspect and observe the quality of written prosthodontics instructions and information for both fixed and removable prosthodontics immediately at the end of each clinical session to check if dental students are competent in this key prosthodontics' skill. The study was including senior undergraduate dental students from University Dental hospital in the city of Jeddah, Saudi Arabia.
The null hypothesis was that the senior dental students (SDSs) are capable to write a complete, clear, and efficient instructions and information in prosthodontics laboratory forms to produce a satisfactory quality dental prosthesis in an educational environment, Western district of Saudi Arabia.
| Methods|| |
King Abdulaziz University dental Hospital Research Ethics Committee (No. 056-16) approved this cross-sectional, observational study, over a period of 8 months from October 2016. A paper-based investigation aimed to find out the nature of instructions, and information was required about the quality of written orders and the drawing of the prosthodontics design.
A self-structured questionnaire was constructed in comprehensive care clinics for 5th and 6th-year undergraduate dental students who received training and education over 3 years about leading the dental team in prosthodontics and how to communicate with dental technicians with sufficient understanding of clinical and laboratory steps and stages.
The questionnaire contained four parts: first part is about general data; year of study, age and gender of the dental student. Second part was about information of the case itself: if it was cobalt-chromium removable partial denture (RPD), acrylic RPD, complete denture, fixed partial denture (FPD), porcelain-fused-to-metal crown, or not specified, if they did not specify the case. Then, the third part is checklists consist of student name, patient file number, date written, supervisor name and signature, the last thing was about the clarity and correct instructions. Then, if the case was removable or FPD, then detailed checklists were developed for each division following the prosthodontics laboratory forms available in the clinic for the students to use by the Prosthodontic Department [Table 1]. Information was also sought relating to the “disinfection status” of the supplied prosthodontics work. Written instructions and the diagrams were categorized as satisfactory and clear – the instructions are complete and clear. A guide – minor judgment making has been left to a dental technician. Unsatisfactory and poor – some information was missing and major judgment making has been left to dental technician. None – no information, instructions, and/or design have been transferred.
This study was analyzed using IBM SPSS version 22 (IBM Corp. Released 2013. IBM SPSS Statistics for Windows, Version 22.0., IBM Corp., Armonk, NY, USA). A simple descriptive statistic was used to define the characteristics of the study variables through a form of counts and percentages for the categorical and nominal variables, whereas continuous variables are presented by mean and standard deviations. To establish a relationship between categorical variables, this study used Chi-square test. While comparing two group means, an independent t-test was used. These tests were done with the assumption of normal distribution. Finally, a conventional P < 0.05 was the criteria to reject the null hypothesis.
| Results|| |
The majority of the sample were 6th-year dental students which represent 78.9%. Moreover, in 70.7% of the cases, the date at which the case is required was missing and not written on the form in its specified area. Supervisor's name and signature were missing in 22% of the cases. Nearly 49.6% of the cases were removable dentures cases whereas 50.4% of the cases were fixed prosthodontics cases.
Unexpectedly, 91.8% of removable prosthesis design were not drawn on the form, 95.1% were not drawn on the cast itself and just left to the technicians' imagination and experience. SDSs failed to communicate the type of the opposing dentition, clasps type, the location of rests, retention, bracing, and tissue stops as shown in [Table 1].
Regarding the instructions written in the laboratory form for fixed cases, there was no information about the type of metal, ginigival shade and incisal shade. However, 87.8% of the study samples selected the overall percaline shade.
The results showed that younger students produce more removable prosthodontics work whereas older dental students produce more fixed prosthodontics cases; this was statistically significant (P = 0.012) in comprehensive care clinics course.
Regarding the quality of the written instructions, only 36.5% of the whole study samples were satisfactory and clear. Moreover, 37.4% were considered as a guide, 22.8% were unsatisfactory and poor, and 3.3% were without instructions. There was a statistically significant difference between the groups as shown in [Table 2].
Results showed that only 42.3% approved on the intended day for delivery with minor adjustments. Almost 43.1% approved after major adjustment and delayed delivery as a consequence. Regrettably, 14.6% rejected and unapproved (redo) as shown in [Table 3].
|Table 3: The outcome (quality of the prosthesis) based on approval for delivery to patients|
Click here to view
For removable prosthodontics, 32.8% of the cases approved for delivery with just minor adjustments on the same day and 49.2% approved after major adjustments and rescheduled delivery appointment. Finally, 18% were unapproved (redo). However, in fixed prosthodontics, 51.6% of the cases approved for cementation with just minor adjustments on the same day. Though, 37.1% of the cases approved for cementation after major adjustments were done which required rescheduled appointments for try-in. Finally, 11.3% were unapproved (redo) as shown in [Table 4].
Unexpectedly, only 9.75% (n = 12) of written instructions indicated disinfection of the prosthodontics work.
Unexpectedly, only 9.75% (n = 12) of written instructions indicated disinfection of the prosthodontics work.
| Discussion|| |
Dental students are expected to develop many skills in prosthodontics with all its clinical and laboratory techniques. Despite the progress in dental education in Saudi Arabia with the multinational clinicians and supervisors who came from different schools from all around the world, the results of this study were substandard. Poor communication addressed many years ago, and it is unacceptable that it is still present these days. Results showed a shortage in following the correct approach to write and fill the prosthodontics laboratory form as required and as taught since only 36.5% of the whole study samples considered satisfactory and clear in SDS clinics. This is the first study conducted in Saudi Arabia from the clinic with dental students unlike previous and recent studies which depends on a survey to dental technicians only. Moreover, in this study, researchers followed up the cases to observe the outcome of the prosthesis until the day of delivery and/or cementation; therefore, limited data are available to compare with our results.
Female dental students produce more prosthodontics work and prosthesis as the female in the study was 60.2% since female seek higher grades more than male and they are considering getting bonus by doing more difficult and complex cases.
Many studies in diverse parts in the world described the poor transferring of prosthodontics data between dentists and dental technicians.,,,
Moreover, in 70.7% of the cases, the date at which the case is needed was missing and not written on the form in the specified area. Supervisor's name and signature were missing in 22% of the sample. Unexpectedly, 87% of removable prosthesis design is not drawn on the form and just left to the technicians' imagination and experience. In addition, 86.2% of the cases sent without design drawn on the casts. In removable prosthodontics, the absent data were almost all the information regarding the design itself, the teeth, or the restoration type. This might be due to the difficulty of designing encountered by dental students or limitation of time in the clinic due to lack of time management and planning of the next step. In 89.4% of the cases, student did not mention the type of the opposing dentition. In 87.8% of the cases, students did not specify the type of the clasps, and in 89.4%, they did not mention the location of rests, retention, bracing, and tissue stops. Moreover, in fixed prosthodontics cases, 100% missing information regarding the type of metal, gingival shade, and incisal shade. However, 87.8% of the study sample selected the overall porcelain shade.
In the United Arab Emirates, Reem Haj-Ali and her group concluded that the responsibility of RPD design appeared to be largely delegated to dental technician which is similar to what we found in this study.
From all RPD cases examined in this study, only one single case found to be completed with all the information about the RPD and the design was completely drawn on the laboratory form. Because the design is mostly ignored and left to the technician, the number of remakes will increase, as it was shown in our results. Our results were nearly similar to Stewart in 2011, which was 18% of prosthodontics forms were poor and in our results were 22.8%. In addition, the patients may complain from periodontal diseases and difficulty in function as a result of ignoring the important details by the dentist. Another way to make the students' complete prescriptions is to make it simple and includes a lot of guides and model example for removable and fixed prosthodontic cases.
More focus should be given to the correct and complete way in writing a laboratory prescription paper by training. Courses to the undergraduate students by the prosthodontists and by dental technicians are important to improve dentist–technician interaction and communication. Dickie et al. mentioned in their audit that they found better prescriptions and completed forms after providing education about this issue including an examination questions on prescription writing in undergraduate objective structured clinical examination well make the students more competent.
Additional worrying finding from this study relates to the decontamination approach of the students of the prosthodontics items delivered to the dental laboratory. In only, 9.75% of the cases were technicians informed clearly about the decontamination status that is similar to the finding reported in 2012 which surveyed dental laboratories in Riyadh, Saudi Arabia. An incompetently disinfected appliances or dental casts can cause the spread of infections to all dental team. It is important in educational dental environment to have consistent and standardized instructions and feedback from the clinical supervisors to overcome confusion and dependence on others. Finally, the instruction and orders have to be wholly compliant before initiation the prosthodontics appliance. The null hypothesis that the SDSs are capable to write a complete, clear, and efficient instructions and information in prosthodontics laboratory forms to produce a satisfactory quality dental prosthesis in Jeddah, Saudi Arabia, was rejected. Furthermore, efforts should be made to form accountable policies and guidelines for prosthodontic treatment procedures. Specific ethical and legal guidelines should be introduced to prosthodontic courses in early years. The significance of acceptably completing instruction and prosthodontic orders needs to be emphasized throughout dental students' training. Likewise, the planning of faculty development programs for clinical supervisors, mainly the new comers of faculty who will take part in teaching will help to achieve improvements in this aspect. Implementing a quality assurance program intended to rise reliability and quality for staff and students is recommended. Finally, a new development in uploading and downloading information and dental drawings helps transmitting information to dental laboratory, and it could be made with restrictions and allowed to submit it only if all the vital fields completed according to the type of the prosthesis selected. The strengths of this study came from the design as it permits immediate collection of data from the students at the end of each clinical session and follow-up the case till the delivery and/or cementation.
| Conclusion|| |
The information provided in this study indicates weakness in communication between the students and the laboratory dental technicians. Students must have proper understanding to the prosthesis they make. Further training is important and should be added as modules in prosthodontics curriculum to the undergraduate dental students in senior years as they forget some of the basics of writing the forms.
Furthermore, efforts should be made to form accountable policies and guidelines for prosthodontic treatment procedures. Specific ethical and legal guidelines should be introduced to prosthodontic courses in early years. The importance of correctly completing a prescription needs to be highlighted at the beginning and throughout dental students' education. Likewise, the planning of faculty development programs for clinical supervisors, mainly the new comers of faculty who will take part in teaching will help to achieve improvements in this aspect.
Finally, a new improvement in internet connection, uploading and downloading data facilitates transferring data between dental clinic to a dental laboratory, and it could be made with restrictions and allowed to submit it only if all the vital fields completed according to the type of the prosthesis selected.
The authors wish to acknowledge the students who were delayed from submitting immediately their work to the laboratories at the end of each session as the authors check their forms for few minutes.
Financial support and sponsorship
This study was financially supported by King Abdulaziz University.
Conflicts of interest
There are no conflicts of interest.
| References|| |
Berry J, Nesbit M, Saberi S, Petridis H. Communication methods and production techniques in fixed prosthesis fabrication: A UK based survey. Part 1: Communication methods. Br Dent J 2014;217:E12.
Lynch CD, Allen PF. Quality of communication between dental practitioners and dental technicians for fi xed prosthodontics in Ireland. J Oral Rehabil 2005;32:901-5.
Lynch CD, Allen PF. Why do dentists struggle with removable partial denture design? An assessment of fi nancial and educational issues. Br Dent J 2006;200:277-81.
Jenkins SJ, Lynch CD, Sloan AJ, Gilmour AS. Quality of prescription and fabrication of single-unit crowns by general dental practitioners in Wales. J Oral Rehabil 2009;36:150-6.
Lynch CD, Allen PF. Quality of written prescriptions and master impressions for fi xed and removable prosthodontics: A comparative study. Br Dent J 2005;198:17-20.
Al-Ahmar AO, Lynch CD, Locke M, Youngson CC. Quality of master impressions and related materials for fabrication of complete dentures in the UK. J Oral Rehabil 2008;35:111-5.
Chan CT, Sukotjo C, Gehrke KW, Yuan JC, Campbell SD, Clark DM, et al
. Laboratory quality assurance in the department of restorative dentistry at the university of Illinois at Chicago, college of dentistry. J Prosthodont 2013;22:85-91.
Imbery TA, Diaz N, Greenfi eld K, Janus C, Best AM. Quality of impressions and work authorizations submitted by dental students supervised by prosthodontists and general dentists. J Dent Educ 2016;80:1229-36.
Al-Alsheikh HM. Quality of communication between dentists and dental technicians for fi xed and removable prosthodontics. King Saud Univ J Dent Sci 2012;3:55-60.
Dickie J, Shearer AC, Ricketts DN. Audit to assess the quality of communication between operators and technicians in a fixed prosthodontic laboratory: Educational and training implications. Eur J Dent Educ 2014;18:7-14.
Owall B, Budtz-Jörgensen E, Davenport J, Mushimoto E, Palmqvist S, Renner R, et al
. Removable partial denture design: A need to focus on hygienic principles? Int J Prosthodont 2002;15:371-8.
Zlatarić DK, Celebić A, Valentić-Peruzović M. The effect of removable partial dentures on periodontal health of abutment and non-abutment teeth. J Periodontol 2002;73:137-44.
Fonte Porto Carreiro A, de Carvalho Dias K, Correia Lopes AL, Bastos Machado Resende CM, Luz de Aquino Martins AR. Periodontal conditions of abutments and non-abutments in removable partial dentures over 7 years of use. J Prosthodont Feb 2016;10. doi: 10.1111/jopr.12449. [Epub ahead of print].
EC Medical Devices: Directive No. 10. Guidelines to Medical Devices Directives 93/42/EEC for Manufacturers of Custom-Made Dental Devices. Dublin, Department of Health and Children; 1997.
British Society for the Study of Prosthetic Dentistry: Guides to Standards in Prosthetic Dentistry-Complete and Partial Dentures; 2005. Available from: http://www.bsspd.org/File.ashx?id=3723
. [Last accessed on 2012 Jan 06].
Haj-Ali R, Al Quran F, Adel O. Dental laboratory communication regarding removable dental prosthesis design in the UAE. J Prosthodont 2012;21:425-8.
Stewart CA. An audit of dental prescriptions between clinics and dental laboratories. Br Dent J 2011;211:E5.
Al-Kheraif AA, Mobarak FA. Infection control practice in dental laboratories in Riyadh. Saudi Dent J 2008;20:163-9
[Table 1], [Table 2], [Table 3], [Table 4]