A survey of referred patients experiencing problems with complete dentures J. P. Smith, M.D.S., F.D.S.R.C.S.(Eng.),* and D. Hughes, B.D.S.** C:harles Clifford Dental Hospital, Sheffield, England A prosthodontic consultant service exists in dental schools and hospitals in the United Kingdom. It is available either to give advice 1.0 practitioners or to treat patients. Yemm’ reviewed the records of referred den- ture patients over a 5-year period. He noted that there are no reports of the types of patients referred with prosthodontic problems. Various other studies have investigated the links between the success or failure of dentures and the psychologic state of the patients.2-5 Nairn and Brunello’ commented “In the work previous- ly done with denture wearers, no attempt seems to have been made to assess the quality of the dentures.” This article describes an investigation of edentulous patients referred to a prosthodontic department during 1 year. An attempt has been made to assess whether the referrals were justified and whether they were the result of failure on the part of the referring practitioner, the patient, or the technical service. STUDY POPULATION .During the period Feb. 1, 1984 to Jan, 31, 1985, a defined group of patients was admitted to the study, namely edentulous patients who had been referred by a general dental practitioner who had attempted treatment before seeking the advice of the specialist. Patients who were referred by hospital colleagues and general medical practitioners were excluded. Over the study period 461 new patients were seen in the department; 144 with temporomandibular joint dysfunction and the remaining 317 individuals required prosthodontic treatment. A total of 53 of these patients met the criteria for the present study. Eight patients were excluded from the analysis. Three did not attend for treatment, three did not keep their follow-up appointments, and two did not complete all of the questionnaires, nor did they respond to telephone and postal enquiries. Forty-five patients remained for analysis. The group included 28 women (average 70 years of age, range 50 to 64 years) and 17 men (average 63 years of age, range 40 to 83 years). ‘Consultant Dental Surgeon (Prosthodontics). ‘*Associate Specialist (Prosthodontics). ‘IHE JOURNAL OF PROSTHETIC DENTISTRY METHODS Consultation visit At the first visit the main complaints of the patients were recorded. It was noted whether the patient’s previous denture-wearing history was successful and what steps the referring dentist had taken to satisfy the patient before referral A technical assessment of the dentures was made, with special attention to retention, stability, occlusion and articulation, vertical dimension, and the border exten- sion of the denture bases. The anatomy of the denture- bearing areas was noted. The findings were recorded on previously .tested data sheets according to our agreed criteria (Appendix 1). The patients also completed two questionnaires requiring yes/no answers. One recorded the patients’ assessment of their dentures (PAD/A-Appendix 2). The second questionnaire, the Ten Question Index (TQI/A-Appendix 3), was derived from the Cornell Medical Index by Abramson et al.’ This questionnaire assesses the emotional status of the responder. The patient was then put on the waiting list. Second visit After impressions were made, the patients were asked to complete the Ten Question Index for a second time (TQI/B). The dentures were then completed. Follow-up visit After the insertion of new dentures, a follow-up appointment was given for reexamination in 4 to 6 weeks. At this visit the patients were asked to assess the new dentures by using PAD/A again with an additional question, “Are these dentures an improvement on your previous dentures?” (Appendix 2). Referring dentists When a patient was enrolled in the investigation, the date of qualification of the referring dentist was found from the Dental Register. The dentists were contacted and asked for information about the technical services they used. RESULTS Referring dentists There were 32 referring dentists. Eighteen had qual- ified before 1974 (senior) and 14 had qualified after 583SMITH AND HUGHES Table I. Length of time before referral >3 Months 4-6 Months 7-9 Months 10 Months-l year <IS Months Junior dentist 3 3 5 1 6 Senior dentist 5 7 3 1 11 Table II. Faults found in referred patients’ dentures Retention Stability Extension Mandib- Mandib- Vertical Mandib- Maxillary ular Maxillary ular Occlusion ,dimension Maxillary ular Junior dentist Senior dentist Total 4 11 7 13 12 10 18 17 6 18 14 16 13 7 27 27 10 29 21 29 25 17 45 44 Table III. Patients’ assessment of their dentures (PAD/A and B) “No” answers recorded Appearance Fit Foods Speech Comfort PAD/A (NO) 16 38 32 23 40 PAD/B (NO) 4 10 18 13 13 1974 (junior). Six junior and eight senior dentists had by a reline. Three had relined dentures. One dentist had used their own laboratories whereas nine junior and nine provided a soft lining and microvalves and one had tried seniors had used commercial laboratories. a soft lining alone. Referral pattern Chief complaints Ten of the junior group referred one patient each and four referred two. The senior group made 13 referrals; three made two referrals and two referred four patients each. The length of time between the insertion of the dentures and referral is shown in Table I. The junior group referred six patients within 6 months of the provision of their dentures, whereas in the same period the senior group referred 12 patients. For the period of 7 months or more, the junior group referred 13 patients. In the same time period 14 were referred by the senior group. The most frequent complaints were those of pain (35) and looseness (25). Difficulty in