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Current trends in complete denture teaching in

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Article in British dental journal official journal of the British Dental Association: BDJ online · March 2010
DOI: 10.1038/sj.bdj.2010.210 · Source: PubMed

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Current trends in complete IN BRIEF
• Concern is raised that GDC requirements

denture teaching in

RESEARCH
laid out in 'The First Five Years' for
competency in complete denture
construction are not being met.
•
British dental schools The external examiner system, Teaching
Quality Assurance and GDC visitations do
not ensure standards laid down in 'The
First Five Years' are being met.
R. K. F. Clark,1 D. R. Radford2 and A. S. Juszczyk3 • There is no national plan for provision
of complete dentures other than the
haphazard coverage provided by the NHS.

Aims Against the background of the publication of the General Dental Council’s interim report on undergraduate den-
tal education the aim was to investigate current trends in teaching of complete denture construction to undergraduates
in the twelve long established dental schools and to gather the opinions of lead teachers of complete denture courses
regarding students’ competence on graduation. Materials and method A questionnaire containing twenty-five factual
questions and eight opinion questions was sent by email to the lead teacher in each of the twelve long established dental
schools. Results Replies were received from all twelve schools. All schools teach complete denture construction although
the number of cases students are required to treat varies from 5-6 to 1-2. Laboratory courses also varied in content and in
most schools all technical work for patients was completed by technicians. Opinions varied regarding the level of com-
petence achieved by students and their preparedness for Vocational Training. Three respondents thought students were
adequately prepared, four thought they were, but with reservations and five thought their students were under prepared.
The majority thought that the external examiner system, Teaching Quality Assessments and GDC visitations did not ensure
GDC requirements for competence in complete denture construction were being met.

INTRODUCTION
The second edition of The First Five Years
listed removable prosthodontics amongst
the required competencies1. The recent
interim report of the next version of
The First Five Years also includes com-
plete denture construction in the list of
required competencies.2 However, con-
cern has been expressed that curriculum
time for complete denture teaching has
already been eroded to the point where
students may not be adequately equipped
when they qualify.3,4 Furthermore, a lack of
manpower planning and inadequate data
relating to the predicted number of eden-
tulous patients to be expected in future,
together with life style changes, may result
in serious deficiencies in provision of
complete dentures.3,4
1
*Professor/Honorary Consultant, 2Senior Lecturer/
Honorary Consultant, 3Chief Dental Technical Instruc-
tor, King’s College London Dental Institute, Floor 25,
Guy’s Tower, Guy’s Hospital, St Thomas’ Street,
London, SE1 9RT
*Correspondence to Professor Robert Clark
Email:rkfc@talk21.com
Online article number E10
Refereed Paper - accepted 24 November 2009
DOI: 10.1038/sj.bdj.2010.210
© British Dental Journal 2010; 208: E10
In the 1970s, discussion centred around
whether complete denture teaching should
be pitched at a level commensurate with
National Health Service (NHS) practice or
at a higher level. Ninety percent of den-
tistry was then delivered under the NHS
but financial considerations meant that
the complete denture service, particularly,
was restricted to the basics. Nevertheless,
dental undergraduates on average treated
eleven complete denture cases and two
immediate replacement complete den-
ture cases before qualifying.5 A survey of
Heads of prosthetics departments5 reported
‘Respondents made it clear that they fully
recognised the dilemma of teaching stand-
ards which under present conditions, it
would be impossible to put into practice
under the NHS. The general feeling was
that ideals should be taught and that the
undergraduates should be encouraged to
strive towards these ideals. They should be
taught that there is a wide range of denture
tolerance in the population and that the
majority of patients can be provided with
satisfactory dentures constructed by sim-
ple techniques. However, the more exact-
ing patient would require more complex
forms of treatment and it should be within
the graduates’ capabilities to provide all
levels of patient care’. This policy seems
to have stood the test of time in that these
seventies graduates have practised, appar-
ently successfully, during a period when
less and less treatment has been provided
under the aegis of the NHS.
More recently the debate has centred on
the expectation that there will be a reduc-
tion in the numbers of edentulous patients,
even though these patients will still make
up a sizeable portion of the population
and many of them will be more difficult
as a result of becoming edentulous later
in life, having high expectations and pos-
sibly other concomitant health issues.
There is a serious risk that this reduction
in numbers of edentulous patients may
lead to the illogical step of teaching less.
Already anecdotal evidence suggests that
the amount of teaching and clinical expe-
rience currently being gained by under-
graduates has been reduced and vocational
trainers have pointed to removable pros-
thodontics as one of the weakest areas for
vocational trainees.6
The purpose of this study therefore
was to investigate the current situation
regarding teaching of complete denture

BRITISH DENTAL JOURNAL 1

© 2010 Macmillan Publishers Limited. All rights reserved.
RESEARCH
construction in the 12 long established
British dental schools.
MATERIALS AND METHOD
A questionnaire (Table 1) was sent by
email to the person identified as the sen-
ior teacher responsible for the course in
complete denture construction in each
of the long established dental schools in
England, Scotland and Wales. The recipi-
ent was asked to respond to the 33 ques-
tions or in the event that it was addressed
to the wrong person to forward it on the
most appropriate person. The questions
were divided into two sections, 25 factual
questions (Section 1) and eight opinion
questions (Section 2). The initial emailing
was followed up by a second emailing ten
days later to those who had not responded
and this was followed up about a week
later by telephone calls to those who had
still not replied. Recipients were assured of
anonymity for them and their institution
in any resulting publication.
RESULTS
Replies were received from all twelve
schools. Five responded to the first email,
five to the second and the remaining two
responded following a phone call encour-
aging them to respond.
Results of Section 1:
factual questions
Clinical teaching
All schools still include complete denture
teaching in their curricula but there is a
large variation in the amount of experi-
ence students gain. Schools fell into three
equal groups: those in which students were
required to treat 4-6 complete denture
cases, those that required 2-3 cases and
those who only required 1-2 cases to be
treated prior to qualification. The major-
ity of schools taught complete dentures
during the 3rd, 4th and 5th years with
most taking place in the 4th and 5th years
(Table 2) but students only gain complete
denture experience in the 5th year in five
schools and in three schools students do
no complete denture work in years 4 or 5.
A limited amount of additional treatment
was also reported for outreach and gen-
eral practice clinics. Staff/student ratios
varied, ranging between 1:6, 1:8 and 1:10
or 12. In the schools with ratios of 1:10
2 BRITISH DENTAL JOURNAL
or 12 there was some paired teaching
where two students work together, one as
clinician, the other as dental nurse. The
higher ratios tended to be found in schools
whose students treated fewer cases. The
ratio of full time to part time staff var-
ied from 100% full time in two schools
to between ½ and ¾ full time in four
schools, approximately a third full time in
three schools and as low as 1:10 in three
schools. There was wide variation in the
number of registered specialists involved
in teaching from 80% in one school to
only one out of eight in another school
but most had between a third and a half of
their teachers on a specialist register. Only
three schools reported that they still use
a live clinical demonstration to introduce
students to the clinical stages of complete
denture construction. All schools embraced
e-learning and most of the schools that no
longer give live demonstrations used video
programmes instead.
Laboratory work
All schools continue to provide laboratory
courses related to complete dentures but
there is wide variation of content from a
phantom head course covering all aspects
to those that only cover such rudiments
as pouring models and making custom
impression trays. In only one school do
students complete the technical work for
a patient’s dentures and in another take
the case to the trial denture stage. All
schools provide technical back up for the
cases that students treat. The vast majority
of this work is done in house. Only one
school sends nearly all its work (90%) to
outside laboratories.
Clinical work
Impression compound is still used for
primary impressions in three schools;
alginate is used either by itself or in com-
bination with impression compound or
silicone putty in the remaining schools.
Alginate, zinc oxide/eugenol and silicone
remain popular for working impressions.
The majority of schools use average value
articulators, one uses Denar, one uses
Dentatus, one Gibling and one Bioart. The
articulator is available in the clinic for
the trial denture appointment and the fit
appointment in all schools except the one
that sends most of its technical work to
outside laboratories.
© 2010 Macmillan Publishers Limited. All rights reserved.
Method of denture construction
All schools continue to teach a traditional
method of complete denture construction
and in varying proportions also teach a
copy denture technique. Two schools
treat nearly all their cases convention-
ally. One school makes about half using
a copy denture technique and the others
about one third with a copy denture tech-
nique. Techniques used vary: only three
schools use heat cured bases for the jaw
relationship stage, only one regularly uses
a face bow and most only occasionally
do a check record, remount and occlusal
adjustment using the articulator at the fit
stage. In only about half of schools are
students required to undertake manage-
ment of immediate replacement complete
dentures cases although most have the
opportunity to make immediate additions
to existing dentures.
Assessment
Continuous assessment and internal
examination are the commonest meth-
ods of testing students’ competence. Only
one school has a degree examination in
prosthetic dentistry although four have a
section of the final exam and in a further
three schools students are at risk of being
examined in the final examination.
Technician training
No schools currently train clinical dental
technicians (CDTs). However, two plan to
start in the future and two will contribute
to regional schemes. Four schools currently
train dental technicians, two participate in
day release schemes and one school has
plans to train in the future.
Results of Section 2:
opinion questions
Technical services
Respondents from schools in which techni-
cal services are provided in house gener-
ally thought the standard was good. Those
using outside laboratories were generally
less satisfied. The majority of respondents
felt that their students were equipped to
communicate with dental technicians when
they become vocational trainees (VTs)
although some expressed reservations. For
instance, ‘Yes, but what happens in VT
is another story’; ‘Yes I think we teach it
but it gets forgotten’ and ‘I am afraid that
 RESEARCH

Which textbooks do you recommend your students to read?

Table 1 The Questionnaire (Either title or author will suffice)
CURRENT TRENDS IN COMPLETE DENTURE TEACHING
Part 1. Factual questions
How many complete denture cases do your students treat?

During which years of the course do you teach complete denture construction?
How do you teach communication with the dental technician?

What is the Staff/Student ratio for teaching/supervision

of the students in the clinic? How is the competence of your students examined?
continuing assessment …
What proportion of the clinical teaching/supervision is non-degree/internal examination …
provided by part-time staff? degree examination in prosthetic dentistry …
a section of the final degree exam …
What proportion of the clinical teaching/supervision is at risk of being examined as part of final degree exam …
provided by full-time staff? other – please state

Does your school train clinical dental technicians? …

What proportion of your staff providing clinical teaching/supervision
are registered specialists in prosthodontics? If not, does your school have any plans to train clinical dental technicians
in the future?

Do you still give clinical demonstrations to students (the students watching

a staff member treat a patient) before they start to treat complete denture Does your school train dental technicians?
patients themselves? …
Do you have a preclinical complete denture course? If so what does it cover? If not, does your school have any plans to train dental technicians in future?

What modern innovations such as video, virtual campus, computer based Part 2. Opinion Questions
systems, do you use in teaching complete denture construction?

With reference to question 12 above, which asked

Do your students do any of the technical work for the complete dentures they If students do not do any of the technical work for their patient’s dentures,
make for patients? … is it done by dental technicians
If not, what technical exercises do they do to help them understand the techni- in house …
cal stages of complete denture construction? in outside dental laboratories” …
do you consider the standard of technical support available
If students do not do any of the technical work for their patient’s dentures, for your students to be
is it done by dental technicians? good …
in house … adequate …
in outside dental laboratories … poor …
Which impression materials are routinely used for With reference to question 20 above, which asked
primary impressions …
How do you teach communication with the dental technician
secondary impressions …
are you satisfied that when your students graduate and become vocational
Which type of articulator is used routinely for teaching and patient treatment? trainees they can communicate adequately with dental laboratories? …
Are you satisfied that when your students graduate and become vocational
trainees they are adequately prepared to treat complete denture patients? …
Is the articulator available in the clinic at the try-in and fit stages?
Are you satisfied that examination of complete denture construction
is allocated an adequate portion of your qualifying examinations? …
Which method of complete denture construction do you teach? Do you think the external examiner system offers sufficient safeguard
a traditional method of complete denture construction … that the GDC requirements for competence in the complete denture field
a copy denture/replica denture type of technique … are being met? …
a mixture of both – please state proportions … Do Teaching Quality Assessments (TQAs) ensure that GDC requirements for
competence in the complete denture field are being met? …
Which of the following procedures are routinely taught and practiced
in your school? Do you think periodic GDC inspections ensure that GDC requirements for
The use of permanent bases for the jaw relationship stage competence in the complete denture field are met? …
of complete denture construction …
Compared to 10 years ago, are your students, when they graduate,
Facebow transfer …
better prepared …
Check record, remount and occlusal adjustment of dentures
using an articulator at the fit stage … as well prepared …
less well prepared …
How many immediate replacement complete dentures do your students make?
to treat complete denture patients when they enter general practice
as vocational trainees? …

BRITISH DENTAL JOURNAL 3

© 2010 Macmillan Publishers Limited. All rights reserved.
RESEARCH
because of the limited clinical experience
our students have they will struggle with
communication when any complexity is
involved. They should be capable of out-
lining basic requirements’.
Competence
Opinions on whether students were ade-
quately prepared to treat complete denture
patients when they become vocational
trainees were divided: three schools saying
yes, and four saying yes with reservations
such as ‘I would say they have a reasonable
grounding but they would certainly need
input from their trainers’, ‘...I am satisfied
that we give them adequate opportunity
to diagnose and treat edentulous patients.
What they actually take from that into VT
is another story...’ and ‘...they graduate with
diagnostic and treatment planning skills and
should be able to identify a case they can
treat...’. Five schools thought their students
were not adequately prepared, for example
‘No they won’t be as most will only have
treated one case in all their clinical years.
They probably won’t treat a fully edentulous
patient in the final year so they will be very
wary of edentulous patients they meet in
VT. This is a real concern because many of
our trainers do not consider themselves to
be competent at complete denture provision.
Some recent graduates have reported back
to me that in their VT practice complete
dentures are avoided’.
Checks and balances
Some respondents felt that in their schools
the examinations allocated an adequate
portion to complete dentures although res-
ervations were expressed that the level of
the examination reflected the level of the
teaching. Respondents from three schools
thought that the final examination did
not cover complete denture prosthetics
adequately. The view of a large majority
was that the external examiner system,
teaching quality assessments and periodic
General Dental Council (GDC) visitations
did not ensure that GDC requirements
for competence in the complete den-
ture field were being met. Some typical
comments were:
‘...In this institution, external examiners
have no specific remit to examine compe-
tence in the complete denture field as all
clinical examinations cover the range of
clinical disciplines...’
4 BRITISH DENTAL JOURNAL
‘...safeguards regarding competence in
the complete denture field are essentially
internal. External examiners will see evi-
dence of competence in complete denture
construction only in as far as complete
denture provision is a part of the treatment
for patients presented as part of Finals
examination. Not all of these patients are
seen by the external examiner...’
‘...No, especially as recently the external
examiners here asked for the edentulous
patient to be removed from the Finals
examination as they couldn’t find enough
questions to ask the student about a patient
presenting for complete dentures...’
‘...I am concerned that this area of den-
tistry will be down graded in the new
edition of the First Five Years, it is all a
chicken and egg situation. Dental schools
are happy to reduce the exposure and then
the GDC has to go along with it unless
they stand up and say enough is enough.
Until the GDC says that, exposure will be
further reduced. However, by that stage the
infra-structure for the education for this
important area will have been transferred
to other areas of the curriculum - one can-
not turn the clock back that easily...’
When asked ‘Compared with ten years
ago, are your students, when they gradu-
ate, better prepared, as well prepared or
less well prepared?’, only one third of
respondents gave an unqualified answer
of as well prepared, another third gave
qualified answers relating to the qual-
ity expected for vocational training,
while the other third thought the stu-
dents less well prepared. No respond-
ents identified an improvement. Typical
comments were:
‘...Academically they have the theory, but
practical skills and clinical experience is
nothing like that produced ten years ago
when 6 C-/-C cases were the norm...’
‘...this is not a straightforward answer
as we prepare them to be able to diagnose
and treatment plan for prosthetics within
a GDP environment. We provide skills to
enable them to treat straightforward cases
and the capacity to refer where necessary.
Ten years ago is looking back we wish to
look to the present and enthuse them to
undertake further study in the subject’.
© 2010 Macmillan Publishers Limited. All rights reserved.
Table 2 Distribution of prosthodontic
teaching time at the 12 schools, each row
representing a different school
2nd year 3rd year 4th year 5th year
X X* X*
X
X
X X X* X*
X X X
X
X X
X X
X X X
X X
X
X X*
X* = may make complete dentures in GDP or outreach sessions
DISCUSSION
Some recipients of the questionnaire who
did not reply to the initial email but replied
to the second email stated that they had
tried to put a positive gloss on their reply
so that it reflected as well as possible on
their dental school. Amongst those who
were telephoned a desire was expressed
that they did not want their school to look
bad as a result of their answers. This may
go some way to explaining some of the
contradictions found in the answers.
All schools have reduced the number of
cases treated since the study of Murphy et
al.5 No further surveys of complete denture
teaching in UK dental schools appear to
have been published and so the decline in
numbers is impossible to plot on a year
by year basis. However, it is believed that
the reduction has accelerated over the last
ten years. The schools where students are
required to treat the greater numbers of
patients have probably only reduced the
number of cases required slightly com-
pared to what has been assumed to be the
norm of ten years ago, whereas the other
schools have seen a drastic reduction in
the number of cases treated and hence
in the clinical experience of their gradu-
ates. Whereas the view that students are
adequately equipped in complete denture
construction for vocational training and
are as well prepared as ten years ago may
be tenable in relation to the schools where

students treat six or more patients, it is
very doubtful that it applies to students
who may have only treated one or two
cases as undergraduates. The effect of the
difference in the number of cases treated is
to some extent reflected in the two surveys
which have been carried out. Trainers in
the south were critical of trainees compe-
tence in all aspects of removable prostho-
dontcs6 whereas trainers in the north-west
thought that trainees were weak at imme-
diate replacement dentures but satisfactory
at routine complete and removable partial
denture work.7
There seems to be a discrepancy between
the number of cases treated and the time
spent (Table 2) which can only be explained
if Table 2 describes the time spent in remov-
able prosthodontics clinics, only part of
which will be complete denture work.
Staff/student ratios approaching and reach-
ing double figures are less than ideal and
paired teaching reduces the time available
for individual students to have hands on
experience. Sadly, the larger ratios tended to
be in schools where fewer cases were treated
and where arguably the opposite would
have been desirable if students were to gain
maximum benefit from fewer cases.
The view and the satisfaction expressed
that graduates are equipped to communi-
cate with technicians in commercial dental
laboratories when they enter vocational
training is in direct disagreement with the
findings of Juszczyk et al.,8 who found
that laboratory owners had the opposite
view. The relatively small amount of tech-
nical work done by students compounds
the problem of lack of experience and the
ability to communicate with technicians.
Knowledge and understanding are prereq-
uisites of effective communication.
Comparatively few schools train dental
technicians and so many dental students do
not have the benefit of training alongside
dental technicians as is recommended by
the GDC.9,10 No schools currently train CDTs
although two plan to run programmes and
another two will contribute to regionally
organised programmes. At present there is
only one course running (at time of writ-
ing), a postgraduate dental institute, for
15 students per year. If the concept of a
dental team is to have any real meaning
then clinical dental technicians, dental
technicians and dental students need to
train alongside each other.
BRITISH DENTAL JOURNAL
All schools still teach the traditional
method of denture construction although
a copy denture technique is also taught
in most schools. Only one school teaches
a copy denture technique to the same
extent as the traditional technique. This is
perhaps surprising because many courses
appear to have suffered from reduction
in available time for teaching and a copy
denture technique has the advantage of
needing less clinical time. In fact, it has
been suggested that in curricula where
time for complete denture teaching is
restricted a copy denture technique might
be a good way of teaching undergradu-
ates a sufficient amount to enable them
to treat the more straightforward cases in
practice, rather than teaching a watered
down version of the traditional technique,
with all the inadequacies that watering
down brings. The full traditional technique
could then be taught thoroughly at the
postgraduate level.11 Evidence that courses
have been watered down is that very few
of the techniques originally advocated12
survive in modern day teaching; only three
schools still use heat-cured bases for the
jaw relationship appointment, whereas
Murphy 5 reported that most used acrylic
resin bases; only one regularly uses a face
bow whereas Murphy 5 reported four regu-
larly used it and nine occasionally used it.
The check record and remount procedure
has never been used universally although
it is taught as an optional extra rather
than an important final refinement of the
denture occlusion.
Another result of watering down the
traditional teaching is that much of the
intellectual material of the subject is also
removed leaving only a purely mechanical
process. Furthermore, much of the intellec-
tual content of complete denture prostho-
dontics is transferable to other aspects of
dentistry in much the same way as under-
standing and acquisition of many of the
technical skills.
The elderly, amongst whom the majority
of the edentulous patients are to be found
are an expanding group, yet no national
plan for the delivery of dental care to the
elderly exists other than the haphazard
pattern of care available from dentists pre-
pared to offer treatment under National
Health Service terms and a few community
dental services, which offer a prosthetic
dentistry referral service. However, the
© 2010 Macmillan Publishers Limited. All rights reserved.
RESEARCH
Government has recently set up a work-
force called Medical Education England
(MEE) which has a sub-committee, the
Dental Programme Board, chaired by the
Chief Dental Officer, which has established
six project groups to identify future work-
force requirements. One of the groups is to
assess the impact of skill-mix on dental
workforce supply with particular regard
to the contribution which DCP groups like
dental therapists, CDTs etc can make to
meeting dental need.13 It is to be hoped
that this new workforce will be able to fill
the current policy void.
Planning for complete denture treatment
requirements is usually based misleadingly
on the number of completely edentulous
people and figures are produced which
purport to show that the number is declin-
ing. A recent estimate is that between 1998
and the next review of adult dental health
the number will go down from 11% to
6%.12 These figures do not provide a com-
plete picture: 6% of the adult population
is still nearly four million people and per-
haps more importantly this figure does not
include those who are edentulous in just
one jaw, a group that provide an additional
set of clinical problems which are no less
easy to manage.
The General Dental Council from time to
time publishes details of what it considers
dental undergraduates should be taught.
This forms the basic knowledge and com-
petency considered to be necessary to
register as a dental surgeon in The United
Kingdom and Northern Ireland. The draft
of the version published in 200114 excluded
complete dentures from the list of compe-
tencies, but after strenuous representations
it was retained in the final version. The
recently published interim report,2 prior to
the next edition of The First Five Years,
still retains complete denture construction
in the list of competencies. Unfortunately
there is no mechanism in place to ensure
that the dental schools teach to the level
expected by the GDC. The traditional sys-
tem of external examiners is failing as
fewer and fewer schools include complete
dentures in their final examinations and as
external examiners for final examinations
may be from other specialities and possibly
only have a limited understanding of com-
plete denture prosthodontics (as illustrated
by the comment above about not knowing
what to ask when confronted by complete
5
RESEARCH
denture cases in the clinical exam). Other
mechanisms such as TQA and GDC inspec-
tions do not fill the deficit. There is there-
fore no enforced national standard to
which dental schools need to adhere. In
the past when prosthetic dentistry was an
easily identifiable subject in its own right,
often with its own university examination,
rather than merged with other restorative
disciplines, the external examiner system
was much more effective in maintaining
standards and because most students also
sat Royal College Licentiate examinations,
which were independent of the universi-
ties, there was a much greater degree of
uniformity of course content and standard.
The absence of sufficient safeguards needs
to be addressed by the GDC.
Many young dentists are now qualifying
without the complete denture skills required
for practice and the system of vocational
training does not provide the level of edu-
cation required to provide all the skills
that are missing. Inevitably these young
dentists are faced with a dilemma when
confronted by a patient requiring complete
dentures that they do not feel able to pro-
vide. An adequate system of referrals has
not established itself between practition-
ers and dental schools are accepting fewer
referrals and treating fewer patients. The
notion that there are adequate numbers of
older practitioners to make all the dentures
required is flawed: not only are there geo-
graphical difficulties and difficulties aris-
ing from the absence of an inter-practice
referral culture, but the older dentists are
the most likely to have ‘gone private’ and
thereby put themselves beyond the reach
of many of the older edentulous patients.
There is no evidence to suggest that eden-
tulousness will ever become of historical
interest only; someone has to be able to
6 BRITISH DENTAL JOURNAL
View publication stats
make dentures. The introduction of CDTs
might at first glance appear to provide
a solution. However, there are currently
only approximately 100 on the register and
there is only one training course taking
fifteen students per year, although other
courses are planned.
Furthermore, the main reason that the
establishment of the CDT training courses
has been supported is because of a long-
standing Government commitment to
legitimise denturism and, in this connec-
tion, ensure that as many as possible of
the denturists, who are practising illegally,
have the opportunity to obtain a register-
able qualification. There is no presumption
by Government that large numbers of CDTs
will be required.13 On numerical grounds, it
may be that they will never be available in
sufficient numbers. Their effectiveness as
deliverers of a service to the elderly eden-
tulous patients of the future will be further
weakened because they will almost exclu-
sively be working privately and charging
fees at the same level as private dentists.
The economics of private complete denture
practice make this inevitable. Furthermore,
a one year training course will only pro-
duce a basic level practitioner. Further
training comparable to dental postgradu-
ate training either formally or in-service
will be required if they are to be equipped
to treat the difficult cases.
This present study has highlighted
problems perceived by dental teachers of
undergraduate removable prosthodontics.
There is clearly a need for a comprehensive
study incorporating the views of trainers
and trainees in all areas of the country
to help ensure that trainees are suitably
equipped for their VT year and that they
are then able to achieve a sufficient range
of experience.
© 2010 Macmillan Publishers Limited. All rights reserved.
CONCLUSIONS
Complete denture courses in British den-
tal schools vary considerably from good
through adequate to barely adequate to
inadequate. Some teachers have expressed
the view that their students are not ade-
quately prepared for making complete
dentures as vocational trainees. There
are no checks and balances at a national
level that ensure that GDC standards
are met.
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