6

Introductory Remarks to the Clinical Chapters

A preview of the clinical chapters

It is much more common for a dentist to have to provide complete dentures as replacements for existing dentures than to provide them for a patient who has not worn dentures before.

What is the reason for this pattern of treatment? Clearly, one of the main factors is that the average life expectancy of patients receiving complete dentures for the first time is considerably greater than the average life expectancy of the dentures themselves. This is, of course, particularly the case if the patient’s first complete dentures were immediate restorations whose useful life is relatively short. Thus, dentures are likely to be replaced several times during the life of the patient.

The remaining chapters of this book are largely concerned with clinical procedures and, because of the pattern of demand mentioned above, the major emphasis is placed on the treatment of patients requiring replacement dentures.

Chapter 7 deals with the first stage of treatment, i.e. history, examination and treatment planning. Then in Chapter 8, the use of old dentures is discussed as their existence affects treatment from the outset. The next logical step is to consider the measures that may be required to prepare the oral tissues (Chapter 9) before continuing with the stages of denture construction (Chapters 10–15). The book concludes with a discussion of some clinical problems and their possible solutions (Chapter 16).

Of course, there are patients who require complete dentures, who have not had dentures before. In these cases the initial assessment is usually a less complicated procedure. After mouth preparation, the conventional clinical stages of treatment are followed, as described in the appropriate chapters.

Quality of treatment – its control and enhancement

In recent years much emphasis has been placed on measures designed to evaluate and improve the quality of care. This has led to the active promotion of two concepts:

Clinical audit

Clinical audit has been defined as:

the systematic, critical analysis of the quality of dental care, including the procedures and processes used for diagnosis, intervention and treatment, the use of resources and the resulting outcome and quality of life as assessed by both professionals and patients.

(Clinical Audit and Peer Review in the General Dental Services, April 2001)

The aim of the concept is self-examination by the clinician. For example, criteria are established to judge the quality of outcome of a procedure, the actual outcome is measured against the criteria and, where the criteria have not been fully met, changes are made to improve the procedure and the audit cycle is repeated after a convenient time.

Peer review

Peer review

provides an opportunity for groups of dentists to get together to review aspects of practice. The aim is to share experiences and identify areas in which changes can be made with the objective of improving the quality of service offered to patients.

(Clinical Audit and Peer Review in The General Dental Services, April 2001)

We hope that this textbook will be seen as providing a useful foundation on which quality initiatives can be built. As a contribution to the thinking behind clinical audit and peer review we have included short sections in the clinical chapters entitled ‘Quality control and enhancement’ where we offer ideas on clinical topics which might be examined more closely within an audit cycle.

The clinician/dental technician interface

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