Workflows and Laboratory Cost for Removable Digital Complete Denture: Two Case Reports with and without Existing Denture.

The integration of digital dentistry in the fabrication of complete dentures (CDs) has been facilitated through the use of intraoral scanners and computer-aided design and manufacturing (CAD/CAM). However, the financial implications associated with the fabrication of digital CDs have been rarely explored. This study is aimed at presenting two different approaches to CD fabrication, combining conventional with digital techniques, and comparing the total cost of fabrication. The first case involved a 70-year-old woman without existing denture, while the second case involved a 97-year-old woman with inadequate retention and stability of CDs in both jaws. In the first patient, who lacked information about her old denture, the first approach was employed, utilizing milling technology for denture processing. The second patient, who already had an existing denture, underwent the second approach, which employed printing technology for denture processing. CAD/CAM replicas of the existing dentures were used for the final impression, bite registration, and as a guide for tooth arrangement. Two digital protocols and laboratory cost in CD fabrication have been proposed. The relatively high cost of CAD/CAM CDs restricts the widespread of digital technology in CD fabrication.

Cross-cultural translation and modification of the revised oral assessment guide for oral health assessment by non-dentists.

OBJECTIVES: This study aimed to conduct a cross-cultural translation of the revised oral assessment guide (ROAG) into Thai language and to modify the tool to increase its validity and reliability. MATERIALS AND METHODS: The present study was a cross-sectional design conducted in dental and hospitalized patients, and community-dwelling people. The original English-version of the ROAG was translated into Thai, which was evaluated for validity and reliability. The tool was then revised to develop the modified ROAG for non-dentist (ndROAG) comprising 9 oral assessment categories with a three-level response; healthy, mild, and severe alteration. The criterion validity of the ndROAG was tested in 82 adult and older participants, and 46 non-dentists comprising dental assistants, dental hygienists, community health volunteers, and nurses, using a calibrated dentist as the reference standard. The ndROAG was translated back into an English version. The criterion validity was evaluated using weighted Kappa (Kw) and intraclass correlation coefficient (ICC). Internal consistency was determined using Cronbach alpha. The three-level response was dichotomized into healthy and changed to determine the sensitivity and specificity. RESULTS: The Kw values, ICC, and Cronbach alpha values of the ndROAG were higher than those of the pre-test ROAG. The sensitivity of the ndROAG in identifying the healthy and changed state ranged from 57.1 to 100.0% with the lowest value in the saliva category, whereas the specificity ranged from 90.9-100.0%. CONCLUSION: The original ROAG was translated and revised into the ndROAG with improved validity and reliability. The ndROAG can be used by non-dentists to assess the oral health of adult and older individuals to detect oral changes, which includes self-care instructions and patient referral guidance.

Three decades of a lesson learned from Thailand: compulsory service for dentist workforce distribution.

BACKGROUND: Thailand has encountered an imbalanced dentist distribution and an internal brain drain of dentists from public to private health care facilities. To tackle these challenges, the compulsory service (CS) program, which has been initially implemented for physicians, was extended for dentists. METHOD: This policy and workforce document review describes the background, development, and policy implementation of the CS program in Thailand during the past three decades. Outcomes after policy implementation and future directions are also discussed. The information was gathered from the relevant policy and workforce documents available from 1961 to 2021. RESULTS: In Thailand, junior dentists, specifically newly graduates, have to enroll in the CS program by working as oral health practitioners in public hospitals for at least 3 years. Dentists must pay a maximum fine of 400 000 baht (~ 12 571 USD) if they wish to skip the program. This fine is lowered according to the number of attending years in the program. CS program conditions are related to each university's admission track. The CS enrolled dentists receive several financial and non-financial benefits, including educational, employment-related, and living provisions. Altogether, successive Thai governments have launched directive policies to increase dentist distribution in rural areas and their retention in public hospitals. These policies have been implemented in 3 stages: (1) increase production of new dentists, (2) allocation of newly dental graduates to public hospitals, and (3) provide benefits for working in public hospitals. CONCLUSION: During the past three decades, several public policies have been implemented to improve dentist retention and distribution to public hospitals across Thailand, particularly in rural areas. The present CS program may not completely resolve the oral health inequalities because the dentist retention rate in public hospitals depends on multi-dimensional considerations. Further modifications on the CS program and future well-planned policies are needed.

Modified retention and stability criteria for complete denture wearers: A risk assessment tool for impaired masticatory ability and oral health-related quality of life.

STATEMENT OF PROBLEM: Some complete denture wearers report difficulty with daily activities, especially activities related to denture retention and stability. However, no standard criteria are available for professionally based assessment of complete denture quality. PURPOSE: The purpose of this clinical study was to determine the association between professionally based assessment of complete denture quality, evaluated by conventional and Chulalongkorn University (CU)-modified Kapur criteria and multiple patient-based outcomes: oral health-related quality of life (OHRQoL), eating satisfaction, and masticatory performance. The sensitivity and specificity of these criteria in estimating the outcomes were investigated. MATERIAL AND METHODS: The participants were 126 individuals with removable acrylic resin complete dentures. Denture retention and stability were scored based on the Kapur method, with excellent intraobserver reliability indicated by a Kappa score of 0.91 to 0.99. The clinical quality of the complete denture was classified according to conventional and CU-modified Kapur criteria. The participants were interviewed for OHRQoL by using the Thai version of the Oral Impacts on Daily Performances (OIDP) index and responses were reported as the absence or presence of oral impacts. Participants' satisfaction eating with their dentures was determined by using a 5-point Likert scale and dichotomized into satisfied and dissatisfied categories. Masticatory performance was evaluated by the multiple sieve method of peanut mastication. After adjusting for covariates, the associations between denture quality and overall and condition-specific (CS) impacts on eating and on eating satisfaction were analyzed by using binary logistic regression, while its association with masticatory performance was determined using linear regression. Goodness-of-fit post estimation was conducted to determine the sensitivity and specificity of each denture quality criterion in estimating patient-based outcomes. RESULTS: Complete denture retention and stability, evaluated by conventional and CU-modified Kapur criteria, were associated with multiple patient-based outcomes. However, denture stability showed a stronger association than retention. The CU-modified criteria assessed the quality of maxillary and mandibular dentures individually and revealed a higher sensitivity in estimating all patient-based outcomes. CONCLUSIONS: Retention and stability were important indicators in estimating the masticatory ability and OHRQoL of complete denture wearers. The CU-modified Kapur criteria can identify impaired masticatory ability and OHRQoL in complete denture wearers better than conventional criteria.