A survey of removable partial denture prosthodontics: attitudes of dentists to treatment planning D. A. S. Parker, MDSc, PhD, FRACDS* N. H. Cheung, DMD, BScDent(Hons)i L. C. Richards, BScDent(Hons), PhDS

Abstract Information concerning the attitudes and practices of dentists in South Australia to the treatment planning phase of removable partial denture prosthodontics was determined following a postal survey. Generally, the concepts of practitioners were similar to those presently taught to undergraduate students in the University of Adelaide, but some disparities were noted.

Analysis of the results according to the decade in which respondents graduated revealed that those who graduated in the 1970s were more likely to place greater importance on the various concepts encompassed by the questionnaire than those who graduated in earlier decades. It is suggested that some attitudes of dentists who have practices in rural areas or who work in partnershiplassociate- ship-type practices might be determined by inter-professional relationships.

(Received for publication May 1984. Revised March 1987. Accepted April 1987.)

Introduction Previous studies have indicated that there were

disparities between what was taught in dental schools in countries such as the United Kingdom and what was practised by dentists in their offices.'-4 As similar information was unavailable for Australia, a survey was undertaken in 1981 to

*Senior Lecturer, Department of Dentistry, The University of Adelaide. ?Currently: Lecturer, Department of Dental Prosthetics, The University of Hong Kong. $Lecturer, Department of Dentistry, The University of Adelaide.

gather information relating to the concepts and attitudes of dentists in general practice towards various aspects of removable partial denture prosthodontics. This paper reports on the findings of this study in relation to the treatment planning phase.

General practitioners who were graduates of the University of Adelaide and who worked most of their time in a private practice in South Australia were asked to participate in a postal survey. Their responses were considered alongside the current teaching concepts in the Dental School of the University of Adelaide, and were analysed in various ways to see whether factors could be identified which influenced these responses.

Methods Data were collected from dentists in general

practice in South Australia by means of a question- naire which was mailed to participants. The questionnaire, which was arranged in nine parts, contained over 200 questions seeking information about the attitudes of practitioners towards various phases of removable partial denture prosthodontics. Only those questions pertaining to the treatment planning phase will be considered in detail in this paper.

A series of questions was asked to elicit personal information about the respondents, such as their qualifications, year of graduation and the type and location of their practices. Persons who did not include removable partial denture prosthodontics in their practices were asked to return the form without completing further questions. In succeeding sections questions were asked which it was hoped would clarify the attitudes of dentists to various aspects of history-taking, examination of the oral tissues and existing dentures, recording of

Australian Dental Journal 1987;32(5):343-53. 343

radiographs and study models, and treatment planning. For all questions, except those relating to the types of radiographs usually required, respondents were asked to indicate the level of importance they attached to the particular aspect; five levels were provided, from ‘extremely important’ to ‘of no importance’.

The Dentist Register (1981) published by the South Australian Government was used to select those practitioners who were to receive question- naires. Dentists known to be in specialist or restricted practice, employed by the Government or the University of Adelaide, and those with inter- state or overseas qualifications, as well as those whose names were recorded on the Register prior to 1950 or after 1980, were eliminated. Two hundred dentists from the 410 whose names remained on the Register after the above culling were selected at random for inclusion in the survey. Questionnaires were mailed to those people with covering letters explaining the nature and purpose of the survey, and pre-paid, self-addressed envelopes for return of their answers were provided.

Responses were coded for analysis using the Statistical Package for the Social Sciences.’ The frequency distributions of responses were deter- mined and analysed according to the decades in which the dentists graduated, whether their practices were within a 30 km radius of the General Post Office (GPO) or not, whether they were in solo or a partnership or associateship type of practice, and whether they had a particular interest in removable prosthodontics.

The Chi-squared test was employed to determine statistical significance, a probability level of P < 0.05 indicated a significant difference between the groups of data tested.

Results One hundred and thirty of the 200 questionnaires

(65 per cent) were returned within the specified time and without follow-up. Of these, 98 satisfied the criteria for acceptance in the survey, so that all persons whose responses were included in the data file were:

(a) graduates of the University of Adelaide possessing the degree of Bachelor of Dental Surgery,

(b) in private, general practice, (c) known to practise removable partial denture

(d) known to have graduated between 1950 and prosthodontics,

1979, inclusive.

1. Personal characteristics i. Decade of graduation

Twenty-one persons graduated in the 1950s (1950 to 1959, inclusive), 27 in the 1960s, and 50 in the 1970s.

ii. Location of practices Twenty-five respondents practised in the City of

Adelaide, 60 in the suburbs or near rural areas and 12 in country areas (outside the 08 telephone zone, which has a radius of approximately 30 km from the GPO). One practitioner failed to respond to this question. The distribution of dentists according to the location of their practices and the year of gradu- ation is indicated in Fig. 1. It was of interest that only one dentist in twenty-six who graduated in the 1960s compared with one in six who graduated in the 1950s and 1970s practised in rural areas.

iii. Type of practice The types of practices in which respondents had

spent most time in the two-year period leading up to the survey were categorized into four divisions, namely, solo, partnership or associateship, principal, and assistant (Fig. 1). Two respondents indicated that they worked in some other form of practice but did not specify its nature. Clearly, the majority of dentists worked in a partnership/ associateship arrangement with one or more colleagues - 62 per cent of graduates from the 1950s, 56 per cent from the 1960s, and 48 per cent from the 1970s. It was also of interest that only the more recent graduates were employed as assistants.

iv. Disciplines of special interesl Respondents were asked to indicate up to two of

the major disciplines of dentistry listed in the question in which they felt they had a special interest. Fifty-seven indicated that one of their major interests was conservative dentistry, while 24 included complete denture prosthodontics and the same number crown and bridge prosthodontics. Only 12 practitioners listed removable partial denture prosthodontics as a major interest (Table 1).

When the responses for each field of interest were calculated as a percentage of the total responses for each decade it was clear that graduates from the 1950s were interested more in removable prosthodontics (complete and partial) than those who graduated in the next two decades, who had a greater interest in crown and bridge prosthodontics.

344 Australian Dental Journal 1987;32:5.

v)

C a, c

1950s

1 City

Solo

I Yes

30t

Key to graphs All respondents

Table 1. Respondents’ interests in the major disciplines of dental practice.

Decade

1960s 1970s

Location

Suburban Non-rural Rural

Type of practice

... .

Partner Principal Assistant

Prosthodontic interest

No

A

15

0

c

5 z 30t B

R . ..’ .....

15

0 1950s 1960s 1970s

Decade of graduation Fig. 1. -A, Location of dentists’ practices according to the decade in which they graduated. B, Types of practices according to the

decade in which respondents graduated.

Decade of graduation All Interest respondents 1950s 1960s 1970s

Conservative dentistry Complete denture prosthondontics Partial denture prosthodontics Crown and bridge prosthodontics Endodontics Preventive dentistry Periodontia Other?

30

13

6

13 11 12 6 9

29 35 29

28 8 10

13 3 5

3 12 17 11 7 13 11 13 12 3 10 4 5 12 9

*As respondents were asked to indicate up to two interests, results are expressed as a percentage of the total number of responses from all respondents and respondents in each decade of graduation. tlncluded oral surgery, orthodontics and paedodontics.

v. Tutor in removable prosthodontics Twelve of the respondents had tutored in

removable prosthodontics at the University of Adelaide; 5 graduated in the 1950s, 4 in the 1960s, and 3 in the 1970s.

2. Concepts of history and examination phases i. Medical, social and dietary history

Responses of practitioners to the four questions asked which related to various aspects of the medical, social and dietary histories of patients are presented in Table 2. Few dentists considered that summarizing medical, social and family histories was important; only 54 per cent regarded an assessment of patients’ dietary habits as at least ‘very important’; and less than 50 per cent thought that consultation with a patient’s physician was more than ‘moderately important’ when that patient had a medical problem. The percentages of persons who responded ‘extremely or very important’ to each question were analysed according to the decade in which they graduated, the location and type of their practices and whether or not they indicated that they had a particular interest in complete denture or removable partial denture prosthodontics or had tutored prosthodontics at the University of Adelaide (Fig. 2). The latter group of respondents comprised 31 persons and was designated ‘interest in prosthodontics’. For simplicity of description, answers of ‘extremely or very important’ were described as positive and should be regarded as conforming with present teaching philosophies and

Australian Dental Journal 1987:32:5. 345

Table 2. Importance of aspects of history and examination phases in treatment planning*

Extremely or Moderately Little or no very important important importance

Written summary of medical history 19 52 29 Summary of social and family history 16 35 48 Consultation with physician if patient has medical problem 45 34 21 Assessment of patients’ oral hygiene habits 97 3 0 Assessment of patients’ dietary habits 54 37 10 Assessment of patients’ attitudes to retention of remaining natural teeth 98 2 0 Assessment of patients’ attitudes to dentures 92 8 0 Assessment of periodontal status 98 2 0 Assessment of pulpal status of remaining teeth 71 27 3 Analysis of occlusion 80 16 3 Assessment of bone resorption in edentulous areas 45 43 I I Assessment of old prosthesis if present 49 40 10 Radiographic records 52 39 9 Study casts 61 30 9 Articulation of study casts 50 28 22 Surveying of study casts 62 21 17

*Figures represent the percentage of responses from dentists for each of the questions asked.

l o 0 l 50

A

i C 0 E : o ?2 c 0

g) roo 0 c al al

- e n

50

c

C

a b C d e

B

D

a b C d e

Fig. 2. -Percentage of practitioners who responded positively to the questions concerning the importance of written summaries of patients’ medical histories (A); social and family histories (B); consultations with medical practitioners (C); and dietary histories (D). Each question was analysed according to the responses from all respondents (a); respondents in each decade (b); location of practices

(c); type of practice (d); and respondents interest in, or no specific interest in, prosthodontics (e).

practices of the University of Adelaide Dental graduates from the 1970s were most likely to School. respond positively. Persons who worked in rural

Graduates from the 1960s were less likely to areas were more likely to stress the importance of respond positively to the four questions than those a social and family history and of consulting medical from either of the other two decades, whereas practitioners when necessary than were their

346 Australian Dental Journal 1987;32:5.

A 100

50

ul 24 5 0 B ?! C -

100 UJ Q C a a

w

e n 50

0 a b C d e

D

a b C d e

Fig. 3. -Percentage of practitioners who responded positively to questions concerning the importance of assessing patients’ attitudes to the retention of remaining natural teeth (A); and to their dentures (B); oral hygiene habits (C); and existing prostheses (D). Each

question was analysed according to the responses from all respondents (a), and for the four variables as in Fig. 2.

colleagues in metropolitan practices. Whereas dentists in partnership-type practices were more likely to respond positively than those in solo practices to the question concerning a written medical history, more persons in solo practices responded this way to the questions regarding the social and family history. There were few differences between the percentages of positive responses from those persons who were thought to have a particular interest in removable prostho- dontics relative to those who did not.

Chi-squared tests were performed on all variables for each question, but none showed that there were statistically significant differences between the responses of the various groups.

ii. Assessment of patients’ attitudes Two questions were asked about dentists’

concepts of the importance of assessing patients’ attitudes to dentures and the retention of their remaining natural teeth. Results showed that almost all respondents placed considerable importance on these aspects (Table 2).

Both questions were analysed according to the four variables described above, but there were no differences between the percentages of responses for any of the variables tested (Fig. 3).

iii. Oral and denture examination Six questions concerning various aspects of the

examination phase were asked. Most respondents stressed the importance of assessing the periodontal status and oral hygiene habits of patients, but placed less importance on assessment of pulpal status and analysis of the occlusion. Less than half thought that assessment of existing prostheses and bone resorption in edentulous areas was at least ‘very important’ (Table 2).

As shown in Fig. 3 and 4, relatively fewer graduates from the 1960s responded positively to the six questions asked compared with graduates from the other decades, whereas more graduates from the 1970s tended to stress the importance of the attributes concerned. Similarly, relatively more dentists in Adelaide practices compared with those in country areas responded positively to most questions; the most marked difference between the concepts of the two groups related to the assessment of bone resorption. A greater number of people in partnership-type practices responded positively to all six questions, whereas there was little difference between the concepts of those in the group classified as having an interest in prosthodontics and those without such interest. For only two questions, namely those related to occlusal analysis and

Australian Dental Journal 1987;32:5 347

A B 100

50

In

$ 0

?! i In

100 0 0) cn m c Q

4-

F Q 50 n

0

C

a b C d e

D

a b C d e

Fig. 4. -Percentage of practitioners who responded positively to questions concerning the importance of assessing the periodontal (A) and the pulpal status of patients’ natural teeth (B); the resorption of bone in the edentulous areas (C); and the nature of patients’ occlusions (D). Each question was analysed according to the responses from all respondents (a), and for the four variables as in Fig. 2.

A B 100

50

$ E 0 In

?! c

loo cn m c 0)

Q

- F

5a

C

C

a b C d e

D

a b C d e

Fig. 5. -Percentage of practitioners who responded positively to questions concerning the use of regional perapical (A), and bite-wing (B), radiographs; and the importance of study casts (C); and articulated and surveyed study casts (D). Each question was analysed

according to the responses from all respondents (a), and for the four variables as in Fig. 2.

348 Australian Dental Journal 1987;32:5

Table 3. Importance of aspects of treatment planning phase* Extremely or Moderately Little or no

very important important importance

Written treatment plan 30 34 36

Detailed diagram of RPD design 62 24 14 Provision of temporary RPD if treatment prolonged 18 41 41

Discussion of treatment with patient 92 2 4

Stabilization of healthy periodontal condition? 92 5 2 Endodontic treatment of abutment teeth? 93 5 2 Completion of all restorationst 88 7 5

Instruction in oral hygiene 96 4 0 Denture to be left out of mouth at night 58 30 12

Completion of only those restorations related to RPDt 54 15 31

Regular recall visits 75 19 6

*Figures represent the percentage of responses from dentists for each of the questions asked. tBefore construction of RPD (removable partial denture).

assessment of bone resorption, were the number of positive responses significantly different for the variables tested; more graduates from the 1970s responded ‘extremely’ or ‘very important’ compared with those who graduated in the 1960s (P < 0.05).

iv. Radiographs and study casts Results of the questions asked relating to radio-

graphic records and study casts are shown in Table 2. In addition to the question asked concerning the importance of radiographic records, practitioners were requested to indicate which radiographs they ‘usually required’ for patients for whom they were to construct removable partial dentures; orthopan- tornographs were nominated by 8 per cent, full mouth surveys by 5 per cent, regional periapicals by 67 per cent, and bite-wings by 55 per cent.

Figure 5 indicates the percentages of respondents who ‘usually’ or ‘always’ required periapical and bite-wing radiographs. Relatively more dentists from the 1960s and the non-rural areas responded positively to both questions. Fewer dentists from the 1950s required either form of radiograph and fewer persons in solo practices ‘usually’ required periapical radiographs.

Also indicated in Fig. 5 are the percentages of dentists who responded ‘extremely’ or ‘very important’ to the single question concerning the need for study casts and to all questions relating to obtaining, surveying and articulating study casts. Thus, while slightly more than 60 per cent stressed the importance of obtaining study casts, less than 40 per cent responded in the same way when all three questions were combined. Also included are the results of the analyses by the four variables outlined previously. Graduates from the 1970s and those in partnership-type practices were more likely to respond positively to the questions relating to articulated and surveyed study casts.

3. Concepts of treatment planning phase Questions asked relating to the treatment

planning phase and the distribution of responses from practitioners are indicated in Table 3. Dentists stressed the importance of discussing treatment plans with patients, of providing oral hygiene instruction, of completing necessary mouth prepar- ation before undertaking the construction of removable partial dentures and to a lesser extent the provision of a regular recall service. Very few thought it important to provide a temporary removable partial denture if treatment was to be prolonged, less than one-third stressed the import- ance of written treatment plans although nearly two-thirds thought it important to prepare a detailed diagram of the removable partial denture design. Forty-two per cent of respondents did not believe it was ‘very important’ for patients to take their partial dentures out of their mouths at night.

Responses relating to those questions regarding ‘mouth preparation’ were grouped by ascertaining the percentage of positive responses to both the questions concerning periodontal and endodontic therapy and for either or both questions relating to restorations. This group and the other seven questions comprising the examination phase were analysed according to the decade of graduation, the type and location of practices of respondents, and whether they had an interest in prosthodontics or not (Fig. 6, 7).

Results indicated that graduates from the 1970s were most likely to respond positively to the questions asked. Chi-squared tests revealed that significantly more graduates from the 1970s relative to the other two decades combined responded positively to those questions relating to the removal of dentures at night and written treatment plans (P<0.05). The main differences between the responses of rural and Adelaide-based practitioners

Australian Dental Journal 1987;32:5. 349

A

loo r B

v)

a v)

g o a L

c 0 C g) 100 m C a a

- e n

50

0 a b C d e

D

r

a b C d e

Fig. 6. -Percentage of practitioners who responded positively to questions concerning the importance of compiling written treatment plans (A); detailed diagrams of partial denture designs selected (B); discussing treatment plans with patients (C); and providing a regular recall service (D). Each question was analysed according to the responses from all respondents (a), and for the four variables as in Fig. 2.

100

50

u) a v)

C 0 0 4 ?!

0, 100 - 0

0 m C - E n

50

C

A

C

a b C d e

B

D

a b C d e

Fig. 7. -Percentage of practitioners who responded positively to questions concerning the importance of the provision of temporary partial dentures (A); instruction in oral hygiene (B); the completion of mouth preparation procedures (namely, stabilization of healthy periodontal conditions, endondontic therapies and related restorations) prior to the construction of partial dentures (C); and removing dentures from the mouth at night (D). Each question was analysed according to the responses from all respondents (a), and for the

four variables as in Fig. 2.

350 Australian Dental Journal 1987;32:5.

concerned the importance of a detailed diagram of the design of the removable partial denture, oral hygiene instruction, and leaving the denture out of the mouth at night. Dentists in rural areas were more likely to respond positively to the first question, whereas more practitioners in non-rural areas responded positively to the latter two questions. Relatively more persons in partnership- type practices responded positively to the questions relating to a written treatment plan (Chi-squared: P<O.O5) and its discussion with the patient, and to the question regarding the provision of a temporary removable partial denture. The per- centages of positive responses from persons with an interest in prosthodontics were higher for those questions concerning the provision of a temporary prosthesis and the non-use of dentures at night.

Discussion In this study, the attitudes of dentists in general

practice in South Australia towards various aspects of the treatment planning phase in removable partial denture prosthodontics were evaluated and compared with concepts presently taught under- graduate students in the University of Adelaide. Four factors were identified which it was felt might influence the responses of graduates to the questions asked, namely, the decade in which they graduated, whether or not they lived in country areas, the type of practice in which they worked, and whether they had a particular interest in removable prostho- dontics.

When compared with graduates from the 1950s, those practitioners who graduated in the 1970s were as likely to practise in rural areas, less likely to be in a partnershiplassociateship-type of practice and more likely to be employed as assistants. Graduates from the 1960s were less likely to practice in rural areas and more likely to be in solo practices compared with those from the 1950s and 1970s. These differences between graduates from the three decades might be explained by the rapid increase in the population in the metropolitan areas of Adelaide during the 1960s with a corresponding increase in the demands for dental services, whereas, during the 1970s this ‘population explosion’ subsided, there were more graduates, the water supplies had been fluoridated and there was an expanded government dental service for primary school children. Thus, it is likely that the demand for dental services was reduced and the prospect of establishing a new practice less attractive. However, it is also possible that graduates from the 1960s, who would have been between the ages of about 35 and 45 years when the survey was under-

taken, were more independent and preferred solo practice.

The study also revealed an interesting change in the interests of graduates in the latter two decades in that they were more likely to list crown and bridge prosthodontics with conservative dentistry as the two main fields of special interest for them in dentistry, whereas graduates from the 1950s were more likely to include removable prosthodontics than fixed. Possibly, these changes reflect changes in dental technology, practice and teaching in the last three decades.

It was of interest, therefore, to determine whether any of the characteristics referred to above, such as the decade in which they graduated or the type of practice in which they worked, influenced the concepts of the dentists surveyed in regard to the treatment phase of removable partial denture prosthodontics. Although caution needs to be exercised in drawing conclusions, especially when related to those who practised in rural areas because of the small number of people involved, some gener- alizations can be made.

Clearly, more dentists who graduated in the 1970s responded positively to a greater number of questions than those who graduated in the 1950s and particularly the 1960s and, hence, it could be said that their concepts were closer to those presently taught to undergraduate students in the University of Adelaide.

While there were some differences between the concepts of those who practised in rural and non- rural areas, and those who indicated a major interest in, or had tutored in removable prosthodontics, generally none of the groups had attitudes which were uniformly closer to those presently taught in the dental school. However, more dentists in partnership-type practices compared with those who practised alone responded positively to most of the questions asked. In this study no attempt was made to determine whether these differences reflected the influences of more than one person in a practice or whether they were related to the year of graduation, but it must be remembered that a higher percentage of graduates from the 1960s relative to the other two decades practised alone.

Analysis of individual questions highlighted particular areas in which the concepts of practit- ioners and those of the educators differed. Thus it appeared from the responses obtained to the six questions which represented the history taking stage of treatment planning, namely, recording a medical history, summarizing a family and social history, consulting a medical practitioner, assessing dietary habits and patients’ attitudes towards their natural

Australian Dental Journal 1987325 351

teeth and dentures, that only the latter two aspects were perceived as being at least ‘very important’ by dentists in their management of patients who required removable partial dentures. Whilst it was surprising to find that so few stressed the import- ance of a written summary of a patient’s medical history, it was even more surprising that less than 50 per cent stressed the importance of consulting physicians when patients presented with medical problems. This might reflect a reluctance on the part of dentists to consult with their medical colleagues, especially if such persons are unknown to them. Support for this contention was provided by the finding that nearly twice as many dentists in rural areas compared with those in non-rural regions stressed the importance of such consultation for it is widely believed that professional persons in country areas have closer social relationships than those in the city. Perhaps it is because of closer personal relationships in the country that rural- based dentists also were more likely to respond positively to the question concerning the impor- tance of a social and family history. It was of interest that those persons in partnership-type practices were twice as likely to stress the importance of a written summary of the medical history and three times as likely to stress the importance of a written treatment plan relative to their colleagues in solo practice.

Whether or not this reflected characteristics such as peer pressure or the need for more than one dentist to have access to information was not determined.

Periapical radiographs were ‘usually’ required by nearly 70 per cent of dentists who were planning to construct removable partial dentures for their patients. Fewer persons required bite-wing radio- graphs. Graduates from the 1960s and those with an interest in prosthodontics were most likely to require both periapical and bite-wing radiographs, while those who graduated in the 1950s or were in rural or solo practices were least likely to require periapical radiographs and those who graduated in the earliest decade were least likely to require bite- wings as well. To what extent these results reflected a reluctance on the part of respondents to use radiography, the non-availability of equipment or the perceived value of radiographs could not be determined in this study. It is conceivable that the results reflect changes in teaching philosophies between the three decades.

In regard to the question of study models, many more dentists stressed the importance of obtaining study models for patients who required removable partial dentures than stressed the importance of articulating and surveying these study models. The

decade in which respondents graduated appeared to influence their responses to all questions, and to the combination of questions. However, there was little difference in the responses between the other variables except that dentists in partnerships were nearly twice as likely to stress the importance of articulating and surveying study models as their colleagues in solo practice.

The histograms portraying the attitudes of dentists to the questions comprising the treatment planning stage indicate the high level of importance placed on sequencing of mouth preparation, oral hygiene instruction, discussion of treatment plans with patients and to a slightly lesser extent the provision of a recall service for patients. Approxim- ately 60 per cent stressed the importance of patients leaving removable partial dentures out of their mouths at night and of providing a detailed diagram of the removable partial denture design as part of treatment planning. Few saw the need to prepare written treatment plans or to provide temporary removable partial dentures if treatment was to be prolonged. The findings in regard to the non-use of dentures at night are in accord with other reports6.’ that approximately 40 per cent of people with partial dentures wear these protheses continu- ously, and thus highlight the need for dentists to be more aware of ongoing research in prostho- dontics and related disciplines. In view of the findings of workers such as Ghamrawys and Addy and Bates9,l0 there seems to be little excuse for dentists being ambivalent about the need for partial dentures to be removed at night. Although the need to discuss putative treatment plans with patients was advocated strongly by most respondents, the lack of importance placed on recording treatment plans and partial denture designs might raise doubts about the effectiveness of such discussions.

It was of interest to determine whether a higher percentage of those people who indicated that one of their major interests in dentistry included complete and/or removable partial denture prosthodontics or that they had tutored in prosthodontics responded positively to those questions which might be regarded as being specific to prosthodontics rather than general to restorative dentistry. Six questions were considered, namely, assessment of patients’ attitudes to prostheses, assessment of existing dentures and bone resorption in the edentulous saddles, designing dentures, the provision of temporary prostheses, and the non-use of dentures at night. Although a slightly higher percentage of dentists in this group responded positively to most questions, only for the latter was the difference substantial. These findings support the comment made earlier that persons who were

352 Australian Dental Journal 1987;32:5.

thought to have additional experience or interest in prosthodontics did not appear to hold attitudes which were different from other persons in general dental practice.

In summary, this survey has revealed that dentists in general practice in South Australia appreciate the importance of many aspects of the treatment planning phase for patients who require removable partial dentures and as such have attitudes which are in accord with those presently taught to under- graduate students. Nevertheless, there are aspects in which such attitudes are at variance, especially among those practitioners who are not recent graduates or who work alone. The findings of the study also suggest that professional relationships might be important factors influencing the attitudes of dental practitioners.

Authors’ note: A similar survey was carried out for Victorian

dentists in 1984. Results of this survey will be presented in a future publication along with comparisons between South Australian and Victorian responses.

References 1. Barsby MJ, Schwarz WD. A survey of the teaching of partial

denture construction in dental schools in the United Kingdom. J Dent 1979;7: 1-8.

2. Schwarz WD, Barsby MJ. Design of partial dentures in dental practice. J Dent 1978;6:166-70.

3. Schwarz WD, Barsby MJ. A survey of the practice of partial denture prosthetics in the United Kingdom. J Dent

4. Silversen JB, Shafer SM, Smales FC, Sheiham A. Time and methods used for complete denture construction by dental students and general dental practitioners in Great Britain in 1972. J Dent 1978;6:196-200.

5. Nie NH, Hull CH, Jenkins JC, Steinbrenner K, Bent DH. Statistical package for the social sciences. New York: McGraw-Hill, 1975.

6. Parker DAS, Morris TJ, Dooland MB, Richards LC. A survey of partially endentulous adults in South Australia. J Dent Res 1983;62:Abstr:682.

7. Rantanen T, SiirlP HS, Lehvila P. Effect of instruction and motivation on dental knowledge and behavior among wearers of partial dentures. Acta Odontol Scand 1980;38:9-15.

8. Ghamrawy E. Quantitative changes in dental plaque formation related to removable partial dentures. J Oral Rehabil 1976;3:115-20.

9. Addy M, Bates JF. The effect of partial dentures and chlorhexidine gluconate gel on plaque accumulation in the absence of oral hygiene. J Clin Periodontol 1977;4:41-7.

10. Addy M, Bates JF. Plaque accumulation following the wearing of different types of removable partial dentures. J Oral Rehabil 1977;6:111-7.

1980;8:95- 10 1.

Address for reprints: Department of Dentistry,

The University of Adelaide, GPO Box 498,

Adelaide, SA 5001.

Australian Dental Journal 1987;32:5 353