Examination forms for edentulous patients—A survey

Examination

forms

Joseph

Nassif,

Bitburg

Air Base, Germany

D.D.S.,

M.Sc.,

for edentulous

patients-A

survey

A.B.*

G

raduates of dental colleges have different levels of skill. Their proficiency and expertise improve through experience and knowledge gathered over years of clinical practice. I observed firsthand the abilities of some recent dental college graduates in the practice of clinical prosthodontics.? One observation of interest was their thoroughness in examining and diagnosing edentulous patients. This insight prompted me to research the types of examination and diagnosis forms being used in dental colleges. I sent the following letter to prosthodontic departments at 54 dental colleges in the United States: “Dear Dr. ---, I am conducting forms

being I would

a survey to determine the questionnaire, examination, used for edentulous patients at the various teaching institutions. if you could send to me the appreciate it, Dr. -,

and

diagnosis

forms that your

students use at school for edentulous patients.” Forty-six dental colleges responded by enclosing examination and diagnosis forms. The purpose of this article is to create an awareness of the spectrum of questions on prosthodontic forms used in dental colleges and to stimulate discussion about what forms contain the necessary information to provide optimal therapy for edentulous patients.

THE SURVEY The following data were compiled from the examination and diagnosis forms submitted by 46 United States dental col1eges.S General. (1) One college uses an interview form;, 45 colleges do not use an Interviews of edentulous patients in the only dental interview form. Comment: Presented as a table clinic before the American This article represents the views of the author the United States Air Force or the Department of *Base

Dental

Surgeon

tProsthodontic $Names

222

of dental

and

rotating colleges

Chief,

program, available

Prosthodontic 1969-1973, from

Prosthodontic Society in Washington, D. C. and does not necessarily reflect the views of Defense. Services. not

the author

accredited, upon

Vandenberg

request.

AFB, Calif.

Examination I. Entries

Table

-

related

to past dental

forms

for edentulous

patients

223

history No. of colleges

Entry

I. 2. 3 4. 5, 6. 7. 8. 9. 10.

11. 12. 13. - 14.

29 20 18 16 13 8 6

How many sets of complete dentures have you worn? How long have you been edentulous? How long have you worn each complete denture? Complaints about existing complete dentures. Did you have problems in adjusting to previous complete dentures? How did you lose your natural teeth? How soon after your teeth were extracted were complete dentures made? Date of last extractions. Are your present complete dentures loose? Patient’s reason for the visit. Does patient wear complete dentures at night? Patient’s last visit to the dentist. Pain or discomfort with present complete dentures? Four least-used entries.

Tcrble

II.

Entries

related

to complete

denture

6 4 4 3 3 3 7

expectations*

No. of Entry

colleges

1. Is the mental attitude of the patient ascertained? Describe what the patient expects from complete dentures. 3. Does the patient like the esthetics of the present complete dentures? 4. What is the patient’s opinion as to why the present dentures should be replaced? 5. Are the expectations of the patient realistic? 61.How do the present complete dentures compare with the patient’s natural teeth? 7. What does the patient not like about his present complete dentures? E,. Who is the source of information with regard to new complete dentures? 9. Does the patient expect complete dentures to eliminate wrinkles? 108. - Do your friends and relatives get along fine with complete dentures? 2.

*The most frequent entry, mental

attitude,

26 9 9

8 4 2 2

-

I I

is related to expectations only indirectly.

college using a form are conducted prior to the oral examinations. Verbal and nonverbal responses and cues are recorded on a standardized interview form. This entry is related to the next statement. (2) One college employs a dentist with a degree in psychology; 45 colleges did not mention use of a dentist with a degree in psychology. Comment: This dentist while the dental student observed and conducted the interview of the patient, eylaluated information prior to recording selected data on an interview form. Plainfield,l Koper,2 Pound,3 DeVan,4 Silverman,s and Bliss6 have discussed the importance of an interview. (3) Thirty-three colleges use a separate form for edentulous patients; 11 colleges do not use a separate form for edentulous patients. Comment: The 33 separate examination forms generally offered greater latitude in the number and detail of entries recorded. At 11 colleges, the prosthodontic examination comprised a section of a dental health record. Generally, these latter forms had fewer prosthodontic

224

J. F’rosthet. February,

Nassif

Table III. Entries

related

to evaluation

of complete

Dent. 1976

dentures*

1. Is there adequate lip support? External form of complete dentures. Vertical dimension of occlusion and interocclusal space. Centric occlusion and centric relation. Position and height of occlusal plane. Size, position, and shade of anterior teeth. Size, type, and condition of posterior teeth. Retention and stability of complete dentures. Do complete dentures cover the retromolar pads? 10. Has the retromylohyoid fossa been used to best advantage? 11. Does the lower complete denture extend below the mylohyoid line? 12. Are the complete denture flanges extended properly? 13. Coverage of available tissue by complete dentures. 14. Evaluation of phonetics. 15. Does the patient use denture adhesives? 16. Cleanliness of complete dentures. 17. How will new complete dentures be an improvement? 18. What would you do to improve upon the existing complete dentures’! *Twenty-six prosthodontic forms listing no entries contrast with six forms listing 10 to 14 entries. 2. 3. 4. 5. 6. I. 8. 9.

entries, and there was less possibility of providing essay answers. Interestingly, two dental colleges used forms which allowed the compiling of data for a computer. (4) Four colleges were revising present prosthodontic forms. Fifteen specific entries. Some of the following entries are worded in question form to facilitate understanding. (1) Is there an entry for the chief comfhint of the patient? 25 colleges-yes; 2 1 colleges-no. Comment : Twenty-one of the 25 forms providing entries for chief complaint had accompanying separate prosthodontic forms. (2) Number of entries per prosthodontic form relating to past dental history (Table I) : seven colleges--no entries; 14 colleges-one to two entries; 16 collegesthree to four entries; six colleges--five to seven entries; two colleges-11 entries; one college-not specified. (3) Number of entries per prosthodontic form relating to complete denture expectations (Table II) : 13 colleges-no entries; 19 colleges-one entry; six colleges-two entries; three colleges-three entries; three colleges-four entries; two colleges-five to six entries. (4) Number of entries per form that comment on the present complete dentures of the patient (Table III) : 26 colleges--no entries; four colleges-one to two entries; seven colleges-four to seven entries; six colleges-10 to 14 entries; three colleges-not specified. (5) Number of entries per form relating to oral anatomy (Table IV) : five colleges-five to nine entries; 21 colleges-10 to 14 entries; 14 colleges-15 to 19 entries; two colleges-20 to 24 entries; two colleges-25 to 29 entries; two colleges -not specified. (6) Number of entries per form concerning oral physiology (such as muscle tone, gag reflex, and type of saliva) : two colleges-no entries; 11 colleges-one to

Volume 35 Number 2

l’able

IV. Entries

Examination related

forms

for edentulous

patients

225

to oral anatomy*

1. Size of mouth opening 23. Displaceability of posterior palatal seal area 24. Arch form 2. Lip form 25. Palate shape 3. Lip thickness 26. Edentulous gingiva 4. Vermilion borders 21. Size of denturebearing area 5. Lip length 6. Labial mucosa 28. Condition of residual ridge mucosa 29. Ridge shape 7. Buccal mucosa 30. Ridge size 8. Height of vestibule 9. Muscle and frena attachments 31. Ridge width 32. Ridge relations IO. Floor of mouth I 1. Tongue size 33. Ridge parallelism 12. Tongue position 34. Size and resiliency of tuberosities 35. Coronoid process-buccal pouch width i 3. Hard palate 36. Intermaxillary space 14. Soft palate 15. Uvula 37. Location of pterygomaxillary (hamular) notches 16. Tonsillar pillars 38. Amount of space available for denture flanges 39. Height and width of buccal pouch 17. Oropharynx 18. Alveolar mucosa 40. Size of retromolar pads 19. Palatal throat form 41. Mental foramen location 42. External oblique ridge location 20. House classification of throat form 2 1. Lateral throat form 43. Maxillary and mandibular tori 22. Neil classification of lateral throat form 44. Soft-tissue condition *Thirty-five prosthodontic forms list 10 to 19 entries. Five forms list nine or less entries. The greatest number of entries used from this list by any one school were found on four forms which listed 20 to 29 entries. to seven entries; two entries; 23 colleges-three to four entries; six colleges-five two colleges-l 1 entries; two colleges-not specified. Comment: These figures are related to the next entry. (7) Number of forms listing specific oral physiology entries: 37 colleges-saliva quantity; 36 colleges-saliva quality; 21 colleges-muscle tone; 17 colleges-temporomandibular movements; 13 colleges-temporomandibular joint sounds; eight colleges-gag reflex; seven colleges-coordination; five colleges-speech; five c01control ; two ’ colleges-stamina. Comleges-gait ; four colleges-neuromuscular ment: Two forms employed all of these entries, while 23 forms employed only three to four entries (see preceding group entry on oral physiology). Thirty-seven forms listed saliva quantity, while five forms listed speech. (8) Number of forms using oral diagrams to show abnormal or unfavorable areas: 16 colleges-yes; 30 colleges-no. Comment: Fourteen of the oral diagrams were employed at colleges having separate prosthodontic forms. (9) Number of colleges classifying the mental attitude of the patient (such as philosophic, indifferent, hysterical, etc.) : 26 colleges-yes; 12 colleges-no; eight colleges-asked questions such as, “What is your impression of the patient?” (10) Number of forms employing descriptive terms for classifying mental attitude: 23 colleges-indifferent; 12 colleges-philosophic; 10 colleges-hysterical; eight colleges-nervous/anxious; six 10 colleges-exacting; nine colleges-critical; colleges-pessimistic; five colleges-hostile or equivalent term; five colleges-norma!.; four colleges-cooperative; four colleges-skeptical; three colleges-appre-

226

Nassif

J. Prosthet. February,

Dent. 1976

hensive ; three colleges-receptive ; 10 colleges-other descriptive terms; eight colleges-not specified. Comment: Eight forms employed the four descriptive terms used in the House classification (indifferent, philosophic, hysterical, exacting) . One form employed 12 terms, seven employed five, and 16 employed three or less descriptive terms. (11) Is a prognosis asked for? 24 colleges-yes; 12 colleges-no; 10 collegesask for other types of comments. (12) HOW many college forms ask for a prognosis in more than one area (such as anatomic and psychologic prognoses) ? seven colleges-yes ; 39 colleges-no. (13) Different prognoses found on seven forms asking for more than one prognosis : four colleges-anatomic, physical, or mechanical prognosis ; two collegesmental attitude or psychological prognosis; four colleges-ask for prognoses or related term in four to nine areas (such as for esthetics, phonetics, and comfort). (14) How many forms had an entry relating to the patient zvearing complete dentures at night? three colleges-yes; 43 colleges-no. (15) How many forms had an entry for the attitude of the patient after receiving new complete dentures ? five colleges-yes ; 41 colleges-no.

SUMMARY Examination and diagnosis forms for edentulous patients from 46 dental colleges in the United States were used in this study. Selected data were taken from each form and compiled under four genera1 and 15 specific entries. Some college forms use entries requiring few and succinct responses, while other forms use entries requiring many and detailed responses. It appears that a correlation does exist between the thoroughness of the examination form and the proficiency of the dental student rendering complete denture therapy. Stated in a positive manner, this survey of college complete denture examination forms suggests that most dental students: use a separate complete denture form for the examination and diagnosis; ask for the chief complaint of the patient; ask one to four questions on past dental history; record 10 to 19 entries relating to oral anatomy; record one to four entries relating to oral physiology; record the mental attitude using two to four descriptive terms; and record one prognosis. Stated in a negative manner, this survey of college complete denture examination do not examine the present complete forms suggests that most dental students: dentures worn by the patient; do not use oral diagrams to show unfavorable or abnormal areas; do not ask for a prognosis in two or more areas; do not ask if the patient wears complete dentures at night; do not ascertain the attitude of the patient after receiving complete dentures; do not ask questions on complete denture expectations; do not use an interview form; and do not work with a staff dentist who has a psychology degree. The intent of this study is to create a spectrum of awareness concerning the presence or absence of specific information on the examination forms. Complete denture examination forms would be more beneficial to the dental student if they provided a high quality of pertinent clinical information. This information would aid the dental student in making an intelligent diagnosis, treatment plan, and prognosis.

ycwul;t

“2”

Examination

forms

for

edcntulous

patients

227

References 1. 2. 3. 4. 5. 6.

Plainfield, S.: Communication Distortion. The Language of Patients and Practitioners of Dentistry, J. PROSTHET. DENT. 22: 11-19, 1969. Koper, A.: The Initial Interview With Complete Denture Patients: Its Structure and Strategy, J. PROSTHET. DENT. 23: 590-597, 1970. Pound, E.: Preparatory Dentures: A Protective Philosophy, J. PROSTHET. DENT. 15: 5-18, 1965. DeVan, M.: Procedures Preceding the Prosthodontic Prescription, J. PROSTHET. DENT. 13: 1006-1010, 1963. Silverman, S. I. : The Psychologic Considerations in Denture Prosthesis, J. PROSTHET. DENT. 8: 582-590, 1958. Bliss, C. H.: Psychologic Factors Involved in Presenting Denture Service, J. PROSTHET. DENT. 1: 49-63, 1951. USAF HOSPITAL APO NEW YORK

09132

ARTICLES Registrations on Kennedy’s Donald

Mohammed

Tooth

Mazaheri,

and

McAdam,

Intraoral

A theoretical semiprecision S. McLeod,

and Guy

of palatal

D.D.S.,

M.Sc.,

cuspal

guidance

elevation

and

and Ensieh

palatopharyngeal

H. Mazaheri,

in canine

D.D.S.

and group-function

of radiotherapy

analysis of the mechanics intracoronal retainer B.D.S.,

L.D.S.R.C.S.,

of techniques D.D.S.,

Comparative

D.M.D.

cast based

occlusion

stability

J, Miranda, D.D.S., and Earl W. Collard,

patients

M.S.

James

Frank Ph.D.,

cast to the maxillary

E. Fiebiger,

color photography Jr., D.D.S.,

An evaluation C. Metzler,

ISSUES

D.D.S.

infrared

A. McCarty,

IN FUTURE

the mandibular system

D.D.S.,

aspects

loading

D. Blake

Neil

for relating classification

0. Lundquist,

Prosthodontic stimulation

Gird

TO APPEAR

and Harry

of two

of the Thompson

dowel

D.D.S.

for finishing H. Chandler,

removable

Walter E. Dilts, D.D.S., MS.

D.M.D.,

margins

of gold

inlays

D.D.S.

die systems Manville

G. Duncanson,

Jr., D.D.S.,