Communication methods and production techniques in fixed prosthesis fabrication: a UK based survey. Part 1: Communication methods

OPEN Communication methods and production techniques in fixed prosthesis fabrication: a UK based survey. Part 1: Communication methods IN BRIEF • Highlights the importance of dentist- RESEARCH technician communication. • Concludes that dentists must ensure that written prescriptions contain all the necessary information so that the dental technician can fabricate fixed prostheses correctly and without delay. • Recommendations for improved communication are made with the ultimate goal of better patient service. J. Berry,1 M. Nesbit,2 S. Saberi2 and H. Petridis*3 Statement of the problem The General Dental Council (GDC) states that members of the dental team have to ‘communicate clearly and effectively with other team members and colleagues in the interest of patients’. A number of studies from different parts of the world have highlighted problems and confirmed the need for improved communication methods and production techniques between dentists and dental technicians. Aim The aim of this study was to identify the communication methods and production techniques used by dentists and dental technicians for the fabrication of fixed prostheses within the UK from the dental technicians’ perspective. The current publication reports on the communication methods. Materials and methods Seven hundred and eighty-two online questionnaires were distributed to the Dental Laboratories Association membership and included a broad range of topics. Statistical analysis was undertaken to test the influence of various demographic variables. Results The number of completed responses totalled 248 (32% response rate). The laboratory prescription and the telephone were the main communication tools used. Statistical analysis of the results showed that a greater number of communication methods were used by large laboratories. Frequently missing items from the laboratory prescription were the shade and the date required. The majority of respondents (73%) stated that a single shade was selected in over half of cases. Sixty-eight percent replied that the dentist allowed sufficient laboratory time. Twentysix percent of laboratories felt either rarely involved or not involved at all as part of the dental team. Conclusion This study suggests that there are continuing communication and teamwork issues between dentists and dental laboratories. INTRODUCTION Prosthodontics is a discipline that requires a synergy between the dentist and dental technician in order to fabricate intraoral prostheses with acceptable fit, function and aesthetics.1–3 Proper communication between the two parties is very important because, in the majority of cases, the dental technicians are remotely located and usually never actually see the patient. The General Dental Council’s (GDC) policy document Principles of dental team working4 states that: ‘Members of the dental team will work effectively together’, 1 Clinical Lecturer, Department of Adult Oral Health, Institute of Dentistry, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London; 2Senior Technical Instructor, Prosthodontic Unit, UCL Eastman Dental Institute, London; 3Senior Lecturer, Department of Restorative Dentistry, Prosthodontics Unit, UCL Eastman Dental Institute, London *Correspondence to: Dr Haralampos (Lambis) Petridis Email: Online article number E12 Refereed Paper - accepted 19 June 2014 DOI: 10.1038/sj.bdj.2014.643 © British Dental Journal 2014; 217: E12 and also that members have to ‘communicate clearly and effectively with other team members and colleagues in the interest of patients’, and that ‘if you ask a colleague to provide treatment, a dental appliance or clinical advice for a patient, make sure that your request is clear and that you give your colleague all the information they need’.4 The prerequisite for a proper prescription written by a qualified dentist has also been set in the Medical Devices Directive (MDD).5 A number of studies6–12 from different parts of the world have highlighted problems and confirmed the need for improved communication methods and production techniques between dentists and dental technicians, during the fabrication of fixed prosthodontic appliances. Problems seem to occur even within the same hospital setting.13,14 Communication issues have included lack of information regarding the prosthesis design and materials, the lack of understanding of the necessary technical steps and time required, and lack of proper shade communication.6–12 Most of the times, the final decision was left with the technician, without proper feedback. All of the above issues, compounded by the time pressure for completion of the restorations as noted in some studies,8,11 may explain the finding that many dental technicians feel insufficiently valued in the dental team.11,12,15 A number of studies1,12,14,16 have highlighted the lack of suitable instruction to dental undergraduates regarding effective communication between dentists and technicians, and the lack of knowledge regarding dental prosthesis fabrication at the time of qualification as the main factors for the re-occurring problems. This has led to the introduction of inter-professional education schemes in Australia.17 The last survey of UK‑based dental laboratories was published in 2009,12 and suggested that the GDC had failed in its aims published in The first five years; a framework for undergraduate dental education,18 as serious communications issues were identified.12 The purpose of this cross-sectional study was to identify the communication BRITISH DENTAL JOURNAL 1 © 2014 Macmillan Publishers Limited. All rights reserved. RESEARCH methods and production techniques used by dentists and dental technicians for the fabrication of fixed prostheses within the UK from the dental technicians’ perspective. The current publication reports on the communication methods. MATERIALS AND METHODS A questionnaire was constructed to investigate communication methods and production techniques used between dentists and dental laboratories from the laboratories perspective. An effort was made to include a broad range of topics. At the same time elements of previously published research were incorporated in order to obtain meaningful results that would be comparable to past surveys. The final questionnaire consisted of 30 questions within the following subcategories: general information, communication methods, impression disinfection and suitability, production techniques, shade matching, and time and team management issues. The questionnaire was piloted among dental technicians both at UCL Eastman Dental Institute and in selected commercial laboratories. The Dental Laboratories Association (DLA, Nottingham, UK) was approached and approved the use of their database of e‑mail contacts (782 addresses). A web-based survey tool, Opinio (ObjectPlanet Inc. Oslo, Norway), was utilised for the administration of the survey and assimilation of data. Sett (...truncated)