Fazal Ghani, Irfan Salim, Mohammad Ali, Hasbia Gul.
Referral Trends and Adjunctive Treatments Among Prosthodontic Patients.
J Pak Dent Assoc Jan ;19(4):191-7.

OBJECTIVE: Subjects reporting for prosthodontic treatment require referral to specialists’ dental and medical departments for various adjunctive treatments prior to the provision of prostheses. It is aimed to investigate referral trends and types of adjunctive treatments needed in subjects reporting to the Prosthodontics Department, Khyber College of Dentistry Peshawar. METHODOLOGY: Using the methods of comprehensive history recording, clinical examination and a pre-structured data collection form, data from each of 155 subjects, randomly selected was recorded. These included subjects’ age, gender, consultation reasons, socio-economic status (SES), dental status, carious and restorative status, oral hygiene status, over-jet and overbite, bony defects and exostoses, size of tongue, salivary gland hypo-function (SGH), medication use, range of mouth-opening, presence of pain, TMJ click and presence of risk factors for temporo-mandibular disorders (TMD). Subsequently, diagnosis, treatment plan and a decision for referral and of the needed adjunctive treatment was made. RESULT: Females were 61 (39%) and males 94 (61%). The age range of 72% subjects was 17 – 50 years. Some 88% had poor-to-satisfactory socio-economic status. In 97 % subjects, restoration of aesthetics and mastication were the main reasons for prosthodontic therapy. The percentages of subjects who were fully dentate, partially dentate, edentulous and those having one jaw edentulous and other fully or partly dentate respectively were 16, 60, 19 and 5. Overjet and overbite were unacceptable in 13.5% and 12.3% subjects. Oral hygiene was poor in 13%. Restorations of unacceptable quality were seen in 13% subjects. Ridge defects and exostoses were seen in 20 subjects. More than two-third were taking medications with 2.3% suffering from SGH. Mouth-opening was adequate in 98 % with 6% having pain in the oro-facial region. No opening or closing click was seen in 79% subjects. Despite the presence of TMD risk factors, none had TMD. The need for referrals was seen in 70% subjects. The proportions of subjects requiring referral to various inter-disciplinary dental and medical specialists, respectively, were; prosthodontics (4%), periodontics (39%), orthodontics (7%), conservative dentistry (32%), oral surgery-oral medicine (35%) and medical specialists (6%) CONCLUSION: In many subjects, need for referral and provision of adjunctive therapy prior to prosthodontic therapy was seen.

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