“They expect you to give teeth like God, which is very hard”: Dental Clinicians’ and Technologists’ Experiences and Perspectives on Removable Complete Denture Fabrication Services in Makerere University Dental Hospital, Uganda.

“They expect you to give teeth like God, which is very hard”: Dental Clinicians’ and Technologists’ Experiences and Perspectives on Removable Complete Denture Fabrication Services in Makerere University Dental Hospital, Uganda. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article “They expect you to give teeth like God, which is very hard”: Dental Clinicians’ and Technologists’ Experiences and Perspectives on Removable Complete Denture Fabrication Services in Makerere University Dental Hospital, Uganda. David Nono, Mathias Akugizibwe, Godfrey Bagenda, Isaac Okullo, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4362028/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 3 You are reading this latest preprint version Abstract Background: Globally, there is growing concern regarding mouth sores, occlusion, cost, ridge resorption, and retention, in the delivery of removable complete dentures (RCDs) fabrication services brought about by the aging of the population and poor oral healthcare. However, there is limited literature about the experiences of dental clinicians and technologists in handling removable complete denture fabrication. The available literature mainly focuses on the process of removable complete denture fabrication in general with less emphasis on the experiences of technologists and clinicians in removable complete denture fabrication. This study aimed to explore dental clinicians’ and technologists’ experiences and perspectives on removable complete denture fabrication. Methods: The study employed a qualitative design, 25 in-depth interviews were conducted with dental clinicians and technologists in Makerere University Dental Hospital. Both practicing dental technologists and clinicians were purposively selected after providing written informed consent. Interviews’ audios were transcribed verbatim, coded in Nvivo 14 and data were analyzed thematically. Results: Findings revealed that dental practitioners mainly referred to or followed international guidelines during removable complete denture fabrication. Clinical and socio-demographic assessments like age, oral hygiene, ridge level, underlying health conditions, and mental stability of the patient were done by dental clinicians before removable complete denture fabrication. Dental technologists and clinicians mentioned patients having a lot of expectations like looking the way they used to be before losing their teeth and hoping to get their natural teeth back, being able to eat well/everything, improving physical appearance, and having permanent teeth. However, the patients also had fears and concerns about discomfort, and some worried that they would be given teeth for the dead whites or swallowing the dentures while asleep, eating, or kissing. Conclusion : The study revealed knowledge gaps about removable complete denture fabrication and a lack of local contextualized guidelines in low and middle-income countries due to reliance on international guidelines. Complete denture therapy Computer-aided design Computer-aided manufacturing Dental technologists Dental clinicians Background Removable Complete Denture (RCD) fabrication services are becoming increasingly important on a global scale as a result of the improved lifespan of the population and inadequate preventive services [ 1 ]. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures (RCDs), implant-supported prostheses, and computer-aided design/computer-aided manufacturing (CAD/CAM) [ 2 – 3 ]. According to Clark et al. [ 1 ], there has been a discernible difference in the number of visits and remake rate between RCDs that were made conventionally and digitally. The usage of CAD/CAM technology has significantly increased as a result of quick delivery services of various dental restorations [ 4 ]. Additionally, advancements in partially or fully digital workflows have made it possible to fabricate RCD in fewer, shorter sessions and with the use of materials that have better qualities [ 5 ]. Moreover, it has been demonstrated that CAD/CAM-based RCDs release less monomer than traditional RCD, which has several benefits with regard to practical applicability [ 6 ]. Studies showed that the use of CAD/CAM technology has demonstrated promise for streamlining the fabrication procedure and enhancing RCD fitness and retention [ 7 ], which have a major impact on patients' speech and masticatory abilities, and eventually improve their quality of life [ 8 ]. In Uganda, the therapy for edentulous patients has predominantly been realized through the use of conventional complete dentures. The fabrication of a complete denture entails several steps which include diagnosis, treatment planning, impression taking and border molding, dental model casts and occlusal rim blocks, bite registration, selection and set up of artificial teeth, wax denture try-in, and denture processing and insertion [ 9 ]. Despite the Uganda National Oral Health Policy [ 10 ], which recommends the fabrication of RCDs for the treatment of edentulous patients using internationally accepted guidelines [ 10 ], there is no published data on the experiences of technologists or clinicians in the fabrication of RCD. The aim of the present study was to explore the experiences and perspectives of dental clinicians and technologists in RCD fabrication services in Makerere University Dental Hospital, Uganda. Materials and Methods Study Design The study employed a qualitative design to explore the experiences of RCD fabrication services among dental clinicians and technologists. It was conducted using in-depth interviews of dental clinicians and technologists guided by data saturation. Study Site The study was conducted in Makerere University Dental Hospital in Kampala. Kampala is the capital city of Uganda. The hospital is a teaching and health service delivery facility of Makerere University. It is the largest and adequately equipped dental facility employing the highest number of dental specialists in Uganda. It has a well-established prosthetic dental laboratory and offers specialized dental services including rehabilitation of edentulous patients with RCD mostly staff and students of the University, and other communities outside the University at a minimal fee. The hospital attends to approximately 660 outpatients per month of which about 20 are rehabilitated using RCD (Registry of Dental Records, 2022). The selected participants were actively practicing dentistry, particularly in the area of RCD fabrication. Selection of Study Participants Purposive sampling was used to select key informants in consideration of areas of their clinical services. The selection also included variation in duration of practice, level of training, roles in denture fabrication procedures, and fitting to ensure a fair representation of the study population. The last key informants (13th dental clinician and 12th technologist) were determined based on data saturation Inclusion criteria Dental clinicians and technologists participating in the provision of RCDs in Makerere University Hospital. Exclusion criteria Dental clinicians and technologists who were sick and unable to participate in the study. Data Collection Before participating in the study, written informed consent was provided by the participants. They were assured of confidentiality such that no identifiers like names were used in data collection and preparation of reports. The research assistants personally approached dental practitioners to invite them to participate in the study. The interviews were conducted in a conducive environment preferred by the participants, ensuring confidentiality and privacy in the comfort of the participants to share their insights. The interview comprised open-ended questions with probes to prompt dialogue and unmediated opinions on aspects of experiences, and perspectives toward RCD fabrication. Data collection and the subsequent analysis were conducted as an interactive process. The last participant for IDI was established by informational redundancy, i.e. when the discussion or interview generated no new information [ 11 – 12 ]. The interview for each respondent took 30 to 45 minutes and was audio-recorded. This was done with the help of a trained research assistant with a background in social sciences and experience in qualitative research. Quality control The data collection tools were pretested by the principal investigator and amendments were made to improve their validity and reliability. The research assistant was trained in data collection. The key informant interviews were audio-recorded to capture any discussion that may have been missed in taking notes. Additional notes capturing body language and gestures during the interviews were also recorded. Data Management and Analysis Data management involved the transcription of interview verbatim recordings. After transcription, the 25 transcripts: 12 for the dental technologists and 13 for the dental clinicians were coded leading to the development of a code book. The code book was tested using five transcripts and imported into Nvivo 14 for systematic organization and analysis. Data were analyzed using themes [ 13 ]. After reading and re-reading the transcripts, emerging and recurrent themes were identified and subsequently interpreted. Personal experiences were captured as individual quotes. Ethical Considerations Ethical approval of the protocol was obtained from the Makerere University School of Health Sciences Research and Ethics Committee (Reference Number: MAKSHSREC-2023-486) as well as the Uganda National Council for Science and Technology (Reference Number: HS3092ES). Permission to carry out the study was obtained from the administration of Makerere University Dental Hospital. Written informed consent was obtained from all the respondents before taking part in the study in accordance with the Helsinki Declaration [ 14 ]. All the data collected were kept securely in a cabinet under lock and key and only accessible to the investigator. Results The study involved 25 respondents with varying demographic characteristics (Table 1 ). All the respondents had either a Bachelor in Dental Surgery or a Bachelor of Dental Technology: Thirteen were registered dental clinicians (surgeons) and 12 dental technologists. Fourteen participants were aged 26–35 years (Table 1 ). Table 1 The frequency distribution of the respondents according to their social demographic characteristics (n = 25) Characteristics N (%) Sex Male 18 (72) Female 7 (28) Role Dental clinicians(surgeons) 13 (52) Dental technologists 12 (48) Age 18–25 6 (24) 26–35 14 (56) 36–45 5 (20) Education Bachelors 25 (100) Experiences in managing patients with removable complete denture (RCD) We explored the experiences of dental clinicians and technologists in managing patients with RCDs and different themes and sub-themes emerged: 1. Prior assessments and /or key considerations for RCD fabrication When asked to describe the procedure of assessing the patients to determine who fits what services of RCD and what the dental practitioners consider as key factors in making decisions for RCD fabrication procedures, both male and female participants mentioned two key categories of considerations for any RCD fabrication procedures, namely, clinical and socio-demographic assessments or considerations. In terms of clinical assessments or considerations, dental practitioners reported that they have been considering the underlying conditions that could be associated with loss of teeth or how to manage post-insertion activities. Conditions like the morphology of the ridges, the oral hygiene, and if the patient is living with diseases for example diabetes, hypertension, and ulceration might propel the dental practitioners to make very critical considerations before recommending RCD fabrication. Sometimes they recommended not to fabricate RCD at all if the patient’s conditions were not good, but also, if they discovered that RCD may lead to severe management outcomes, they did not advise the patient to opt for RCD. The details are given below: “For some patients with a condition which is not well managed like Diabetes Mellitus, it affects the soft tissues of the periodontium and such conditions must be put into consideration” (P001_40-year-old_ Male _dental surgeon). The oral hygiene of the patient was also a key factor to consider: “The key factor that must be observed whenever we provide removable complete denture is the oral hygiene because if your oral hygiene is not ideal you will misuse or will not take care of the complete denture” (P001_40-year-old_ Male _dental surgeon). “Of course, we generally consider the overall hygiene of the patient and the alveolar ridge. Some people might have lost teeth some time back and the ridge could have resorbed. So, we consider those [factors]” (P020_34 year_Male_Dental Surgeon). Equally, assessing whether the mouth has been prepared to receive the RCD or not was a key consideration. It was revealed that in cases of loss of teeth due to accidents, one would require the wounds to first heal and also to ensure that all the retained roots have been extracted: “You examine the patient’s mouth to determine whether he or she qualifies for a complete denture, and then you do mouth preparation. In mouth preparation, you remove any retained roots and give the patient 3 months for the wounds to adequately heal before starting complete denture fabrication processes” (P001_40-year-old_ Male _dental surgeon). “One of the purposes of a complete denture is to restore function. If the patient has a problem with the temporomandibular joint, you may need to address it first, before complete denture fabrication” (P018_30 year_Male_ Dental Surgeon). Relatedly, the morphology of the patient’s ridge also determines whether to have RCD fabrication or not or whether to use denture adhesives or implant support: “First of all, I look at the ridge and decide if it favors a complete denture in terms of height and width for support, retention, and stability. Producing a complete denture is one thing, but if it will adequately function is another.” (P023_26 year_Male_Dental Surgeon). “The ridge, say in the maxilla, which is flat might disturb as retention might be poor. A person who gags a lot may not qualify for complete dentures” (P015_31_year-old_Male Dental). “The quality of the ridges in some cases does not need a removable complete denture, it may need a fixed implant-supported complete denture. So, those matters must be put in place [into consideration]” (P001_40-year-old_ Male _dental surgeon). The mental stability of the patient was also a key clinical consideration before recommending a complete denture fabrication. “For any patient getting a complete denture, they should be mentally ready to have it [denture] because you may give a complete denture to a patient who is not ready to undergo a complete denture rehabilitation and then this denture becomes a problem, and can cause issues to some of them and even suffocate them” (P002_42 year-old_Female_dental surgeon). The other key demographic consideration is the age of the patient. Participants revealed that because some patients who needed complete dentures were the elderly, there were concerns regarding their ability to adjust to living with and maintaining the appliances, which may not be possible. “There is a certain age where you may not dispense a complete denture; I had a patient whose relatives were from abroad so they wanted to offer her an RCD and they did all that it took; they paid the money and the appliance was delivered, but in the long run when they went back abroad, the old woman threw the appliance away because she said that at her age she does not need” (P001_40-year-old_ Male _dental surgeon). Similarly, another participant narrated: “There are medical conditions that one considers for some of these patients…, most of them are elderly patients, some having other conditions like high blood pressure and diabetes mellitus, and even some of them having psychotic problems, which may be a challenge for them to follow the instructions of using complete dentures” (P003_43 year-old_Male_dental surgeon). Other considerations included: patients with periodontitis or sometimes the grade of the teeth mobility (grade two or three) was reported to influence the decision to either make a complete denture or not. “Patients who have teeth that are periodontally compromised to grade three mobility, but not for removal because the patient is not mentally ready… those are hopeless. But if the teeth have grade-two mobility, one can leave them and make for them transitional dentures, One can make a denture following all the steps, but leave space for the natural teeth, and later make that transition to a complete denture…”(P013_25_year-old_Female_ Dental Intern). Similarly, one other factor that dental practitioners consider when deciding whether to have a complete denture or not is the willingness of the patient to have a complete denture or not. One of the participants emphasized: “I think that the main thing I'll consider is whether the patient will be willing from day one to show up for appointment for every step of denture fabrication because it takes a while as you might already know” (P014_23 year-old_Female_Dental Intern). 2. Patient preparation and consenting for denture fabrication To broaden our understanding of the knowledge and experiences of dental practitioners who offer denture fabrication services, we took an interest in exploring whether and how the patients are prepared and consented before the procedures are done. Our study revealed that before the decision to have the patient undergo denture fabrication, dental practitioners indicated many key steps that are taken into account. Among the many, the willingness of the patient and consenting to the procedures was key. Also, patients are given enough information especially for them to know that the appliance is removable and will need to be cleaned. For some categories of patients like the old and with mental health problems, the dental practitioners ensure that the caretakers are involved in all the procedures. Given that the complete dentures are foreign to the human body, dental practitioners ensure that patients are also told about the likely inconvenience that involves the dentures in order to get prepared to adjust and live with them. “Yes, we always tell them about the discomfort of the denture during chewing, the possibility of roughness that could injure the gum, the bulkiness that may restrict tongue movement, and keeping it clean. However, with time they get used to the dentures” (P003_43yr_Male dental surgeon). So, the discomfort that comes with putting on the dentures and advice on how the patients can get used to wearing them, requires emphasis on consistent use of the dentures whether at home or office was key for them to get used. Another factor was the importance of cleaning them to avoid likely infections and the participants said: “For the discomfort with some of the procedures, for example, if the material the practitioner uses to take an impression is hot, one can give them some cold water to rinse their mouth before and then temper the material in the water that has a lower temperature” (P014_23 year-old_Female_Dental Intern). “Well, the very first thing that we tell them, is [that the] denture is not part of your body, as time goes on the denture tends to become loose because there is shrinkage… so they must come back for relining and maintain utmost oral hygiene. Then also because dentures tend to exert some bit of dislodging forces, the tissues tend to form flabby ridges. For some patients, if the dentures are ill-fitting, they may cause sores or stomatitis” (P018_30 year-old_Male_Dental Surgeon). Some dental practitioners talked about the duration and the fees it will take for the patient to have their dentures fixed as another factor to consider, thus the participant elaborated: “You make patients aware [that,] for example, this is going to take a long time to accomplish. You have to be ready to show up for appointments because that is the most important thing to be able to receive the denture in time. Then for the payment of money, you can tell, them, to keep saving, to pay for the costs involved” (P014_23 year-old_Female_Dental Intern). Consenting the patients was also a very important part of the preparation for denture fabrication procedures. While consenting patients, the focus is largely on giving the patients as much information as possible to ensure that they clearly understand all it takes. The common information provided relates to the benefits, side effects, and the cost of treatment. “We explain every procedure to the patients, then we ask them if they have consented, the other issue is monetary expenses because you explain to them how much it costs, and so on” ( P001_40 year-old_Male dental surgeon). “We do this for all patients who need dentures because we have to explain to them the benefits, but also the side effects of complete dentures” (P002_42 year-old_Female dental surgeon). However, as opposed to other forms of consent that are normally sought, some dental practitioners revealed that they do not give written informed consent, but rather, implied consent. “Not entirely written informed consent, but most times when they come, that is implied consent. They tell you what they want for, example, tooth replacement and so you let them know what you're going to do for them and your expectations, and if they're ready for that treatment, you go on and provide it. So, that is some form of implied consent” (P013_25_year-old_Female Dental). As part of the consenting process, dental practitioners’ focus is always on providing details like the advantages, disadvantages, risks, and visual demonstrations of how the denture looks and how to care for the denture. The implication of this is that the patients make informed decisions. “I first tell them about the treatment for example, I bring an actual denture so they can see how it looks like or show them photographs or videos. Then, I educate them about the advantages, disadvantages, risks, and complications of dentures. I also educate them on denture care” (P014_23 year-old_Female_Dental Intern). “There are limitations explained to the patient….. that there are other things that will occur in the initial course of treatment. We tell them, someone can develop sores in the mouth and how to handle them when they occur” (P020_34 year-old_Male_Dental Surgeon). Another participant also revealed that the consent they obtained was not comprehensive enough to qualify as informed consent. The participants are given little information and not in detail. As it is supposed to be. “I try, but from the informed consent I know, it is not complete. We just tell the patient what a complete denture is, the advantages and disadvantages, and not so much information. That is why I'm saying it's not complete. I also tell them some alternative treatments, but not everything” (P015_31_year-old_Male Dental). In some cases, dental practitioners conceal some information so that the patient is only given the information that will propel them to accept the denture procedures if the dental practitioner thinks that it will help the patient. “Well, I ask for informed consent from every patient. I walk them through what they ought to receive, but there are some instances where I tend to withhold some information from the patient because I want them to benefit or to get at least the best option. Let me say, I drive them to something that will benefit them. Most times, I used to do written informed consent, but nowadays, because of the big number of patients I see, I do verbal consent” (P018_30 year-old_Male Dental Surgeon). Some participants admitted that although written consent would be the best, they do not document the processes, but rather they mostly do verbal consenting. “Truth be told, we don’t usually document informed consent, though documentation would be the best. We usually tell patients what the procedure we are going to do, what advantages and disadvantages the procedure will bring to them, how much time the procedure will take and how much money they are supposed to spend on the procedure” (P023_26 year-old_Male_ Dental Intern). 3. Benefits of undergoing removable complete denture fabrication We asked our participants to elaborate on the benefits of removable complete denture fabrication. Our analysis revealed some major benefits that a patient derives from undergoing complete denture fabrication including mastication, restoration of facial features, correction of speech defects, and boosted self-esteem and confidence. 3.1. Mastication functionality Dental surgeons and technologists revealed that complete dentures restore masticatory function, allowing individuals to eat a variety of foods they were not eating before and improving their ability to chew food like meat, which they cannot afford without teeth. Most dental practitioners revealed that this was one of the key expectations that patients come up with while seeking denture fabrication services. “Many of them will say, I cannot eat some meat. That means they miss the chewing part of the teeth” (P021_45 year-old_Male_Dental Surgeon). “Complete denture helps a person in eating because when one has lost teeth, eating will be a challenge when smashing or biting any food” (P010_33 year_Male_Dental Technologist). 3.2. Restoration of facial features Complete denture fabrication was thought to improve beauty. It was reported that a complete denture offers a more aesthetically pleasing appearance as it restores facial height and structure, which improves beauty for those who have fallen cheeks and maintains the natural contour of the face. This improves the beauty of patients. “You know edentulous patients usually have collapsed faces. So, I tell them about restoring their facial appearance and masticatory efficiency, so they will be able to eat certain foods” (P016_31year_Male Dental Technologist). “And also, in most cases the face of patients who don’t have teeth, the face drops which will quite disorganize the beauty. So, when you put complete denture, it will improve on somebody’s beauty or facial look and above all somebody’s smile because everyone survives on the smile” (P001 40-year-old male dental surgeon). “When people lose teeth, there is a tendency of cheeks falling in, but with complete dentures, the cheeks can be able to gain their structure (P019 24-year-old female dental intern). 3.3. Correction of speech defects Complete denture fabrication improves speech by restoring the missing teeth: “Complete denture replaces missing teeth which helps edentulous patients to speak, if they do not have teeth, then speaking will be a big problem. They will have a problem with pronouncing certain letters like ‘S, T, and C that need to bring the teeth together. The teeth also control the movement of the tongue during the speech” (P022_38 year_Male_Dental Technologist). 3.4. Boosts self-esteem and confidence Complete denture fabrication improves self-esteem by restoring the missing teeth. This improves their facial appearance which enhances their confidence in public and it also improves how they talk. The regained self-esteem and confidence help the patients restore their smile without hiding or covering their mouth. “I want my smile back, I need to eat my meat, I need to speak in the community [public] on a freeway, but the key things they say are: I need to eat properly smile, and speak in the community [public] because those are some attributes that lower someone’s self-esteem if s/he cannot speak or express oneself” (P001_40 year-old_Male dental surgeon). “About the quality of life, tooth loss is like any other disease, it comes with stigma. So, when someone gets complete denture therapy, you expect it to boost his/her confidence in public, and in addition, it restores functions like chewing, and eating. So, mainly the denture is about the appearance, aesthetics, and also the function” (P012_29 year_Male_Dental Technologist). 4. Steps followed in removable complete denture fabrication Participants mentioned several steps they go through for complete denture fabrication, including examination and diagnosis involving assessing the patient's oral condition, facial expressions, and overall health. Then, they do mouth preparation, take impressions, fabricate occlusal rim blocks (ORBs), do bite registration, do articulation, set up teeth, and then try-in wax RCD. This is followed by RCD fabrication, review and adjustment, patient education, and then final delivery of the RCD to the patient. In addition, dental clinicians and technologists emphasized that they follow international guidelines in doing RCD fabrication. They mainly refer to textbooks for international standards for guidance in RCD fabrication. These guidelines include specific measurements for the height and thickness of ORBs. “According to what I do in fabrication RCD, I follow the textbooks, measuring the height and width of the occlusal rim blocks which are documented in the books” (P008_25-year-old male dental technologist). However, despite the existing guidelines in textbooks, there is a consensus among the professionals that each patient is unique and they always make individual adjustments. Factors such as jaw size, facial morphology, and patients’ comfort play a crucial role in determining the optimal height of occlusal rim blocks. Some clinicians emphasize the importance of being adaptable and making adjustments based on the patient's specific needs. “For instance, in books, they usually write about the heights and width of ORBs for different races, but we always ask patients for the previous photographs they had when they had teeth. The photographs would help you to estimate how they looked like before they lost teeth. Additionally, during the process of fabrication of RCD, the patients’ comfort will guide the estimation of the height” (P003_43-year-old male dental surgeon). 5. Height determination of occlusal rim blocks (ORBs) during RCD fabrication We asked the participants about height determination for ORBs during complete dentures fabrication and they responded that height determination is done in collaboration between the clinician and dental technologist. However, they both ascertained that height determination varies from patient to patient. They reported reliance on international standards from research done in developed countries and cited the absence of local guidelines for ORB fabrication. They, thus mentioned variations in height determination with some mentioning taking values of 18 to 22 mm and 16 to 18 mm for upper anterior and posterior height, respectively. The lower jaw is 18 millimeters for both anterior and posterior sections. “There are [international] standard guidelines that we follow, take an example of the height of the maxillary occlusal rim blocks: anteriorly, it is 20 to 22 mm and posteriorly, 16 to 18 mm. Then, anterior and posterior widths are 3 to 5mm and 8–10 mm, respectively. However, there are variations in each case so, it is upon the practitioner to know that each variation suits a particular client. The variation may divert from the normal because one has to look at a number of completely edentulous cases that have taken long leading to advanced bone resorption presenting shorter heights. Most of them are from 15 to 17 mm posteriorly and anteriorly rarely do reach 20 mm, but might be around 18 mm. So, those standards are available and we respect them, but each client is handled independently and we must find out from the practical aspect, which height is suitable for a specific client” (P004_33yr_Male_dental surgeon). “They are documented dimensions used the world over, and there are different journals that I have seen that recommend dimensions that have lower values than what was documented initially for upper anterior and posterior portions of occlusal rim block (20 to 22 mm and 16 to 18 mm). From my personal experience, for the upper and lower rims, I can’t use 22 mm and 18 because most of the patients complain of the teeth meeting constantly saying that they speak like children, because of the dimensions being too high. So, l use lower limits of occlusal rim blocks where the lower rims are 16 mm and the upper, 20 mm. The fact that international standard guidelines are globally accepted, makes me feel that those standard dimensions do not work in every population, there are variations” (P022_38 year_Male_Dental Technologist). Impression-taking was considered the foundation of the whole RCD fabrication process because it determines how the RCD fabrication process is completed. It was argued that a mistake made during an impression affects the whole process. This is done by taking accurate impressions where you capture the anatomical landmarks, the palatal seal, and the frenal attachments. However, some mentioned taking inaccurate impressions at times due to the use of materials like alginate. Other factors influencing accurate impressions include patient’s gagging and clinicians’ lack of time and skills. “There are several factors affecting the quality of impression, one, there are some materials like alginate that don't give you a good impression. Two, some clinicians are in a hurry, and they don't give the necessary time. And three, you find that sometimes there are patients who have other habits like gagging during impression taking, which can cause you to make errors in the impression taking” (P021_45-year-old_Male_ dental surgeon). 6. Patient concerns and fears about removable complete denture fabrication We also explored the experiences of dental practitioners on the concerns and fears that patients present with about complete denture fabrication procedures. Our findings revealed several perceptions that patients have about the RCD. Some fears were linked to misconceptions and rumors. One of the participants indicated that some patients came thinking they would be given teeth that are plucked out of the corpses of white people as stated: “Yes, there are many concerns, some patients said they think we go and pick these teeth from dead bodies. The other day a lady told me that her teeth were very bad and yet, my mother died with very nice teeth. I wish she had consented with me to inherit her teeth, you would have plucked out all the teeth from her body and given them to me. So, some of them fear and there are people when they hear the word ‘artificial’, they think they are the teeth of the ‘Bazungu’ plucked from dead bodies.” (P001_40 -year-old_Male dental surgeon). Other patients feared that maybe at some point while asleep or eating, they could easily swallow the dentures and end up suffocating. Also, some patients were worried that there could be an incident where the dentures could fall out in public especially when the person is speaking. “Yeah, some patients actually think they will swallow the dentures and suffocate although we try as much as possible to explain that it is impossible to swallow complete dentures because there is no way they could go past the throat. Then the other fear could be when they are speaking in public, these dentures could fall out of their mouths, which could affect their social lives” (P002_42-year-old_Female_dental surgeon). “The worries; won’t it fall when I'm talking in public, will I eat the way I'm supposed to eat my food? Some, for example, women come when they have not told their husbands that they don't have teeth, and is like eh, what if I'm kissing my husband and that denture comes out” (P011_28-year-old_Female_Dental Technologist). Participants further revealed that patients also worried about how comfortable they would be after getting the complete denture. Some patients fear that wearing complete dentures could have health implications, fearing that it may cause cancer on top of fearing that they could easily swallow the dentures by accident. “We have had cases where clients have said that they fear complete dentures can cause certain illnesses like cancer. We have had cases where patients who think they can swallow the dentures will not be comfortable with the denture in their mouth because of being a foreign body. Some patients feel they will not be comfortable chewing food taste of food may be different” ( P004_33-year-old_Male_dental surgeon). Regarding the discomfort, some complained that the complete dentures were sometimes too much extended especially the upper side which caused the mouth to start feeling heavy. “Some patients were complaining that they feel the mouth is heavy while others also felt the dentures especially, the upper one was overly extended, but that usually happens to people who have a gagging effect” (P001_40- year-old_Male_Dental Surgeon). Equally, technologists expressed that most patients feared the associated costs of having a complete denture but also feared that the material from which the dentures are made could cause cancer. “Their biggest fear is the costs, there are a lot of fears that these complete dentures are way too expensive so that one makes them a little bit skeptical about them. Then sometimes they think that the material from which the complete dentures are made as if they are not bio-compatible as if they cause cancers so like that” (P020_34-year-old_Male_Dental Surgeon). Some patients feared the size of the dentures, especially when the dental practitioners were demonstrating to them, they worried about how the dental practitioners would manage to fix it in their mouth. They feared that they may not eat well seeing that the size of the denture was big. “Sometimes when you’re explaining to them you have to have also a kind of sample to show them how it looks like so that somebody does not just picture it in the mouth but also see it so that when they have it, they know how to fit it in the mouth so a person will see and say; doctor this thing looks big, will I be able to use it? But will I [be able to speak], will I eat well? So they have a lot of worries” (P002_42 year-old_Female_Dental Surgeon). 7. Patient expectations for seeking removable complete denture fabrication We also aimed to understand from the dental practitioners what the patients’ expectations are when they come for removable complete denture services. Our findings revealed several expectations that patients had. Largely, patients were expectant that they would be able to have their beauty, especially when they smile, restored so that they were able to speak freely in public, and since most of them had stopped eating certain foods, they expected to start eating foods like meat after having their dentures. “I want my smile again, eat meat, and speak freely in public. These are some of the things that lower someone’s self-esteem” (P001_40 year_old_Male- dental surgeon). “Some patients wonder if they will be able to eat sugar cane or bite meat on hard bones.” (P003_43 year-old_Male-dental surgeon). Some dental practitioners revealed to have encountered female patients who wanted to have dentures so that they could restore their physical appearances to attract men and give birth to children, and also get job opportunities, which they thought to have missed because of having no teeth. In this case, self-esteem was always key for the patients. “Many of the patients are looking out to restore cosmetic appearance. A thirty-year-old woman with no teeth blamed her entire life on the fact that she didn’t have a husband and children because she didn’t have teeth, which were removed when she was a child. This psychologically affected her.” (P002_42 year-old-Female-dental surgeon). Another patient also revealed similar insights indicating: “They said it has been a while without having teeth and they just want to look younger and more beautiful in order to prepare a date. I have taken long without going for a date” (P007_27 year-old_Male-dental surgeon). “Ninety percent of patients want esthetics and beauty, while a small percentage will consider other factors like eating well” (P004_33 year-old_Male-dental surgeon). A few participants narrated that some patients have the desire to even look better than they used to look before they lost their teeth. They have a belief that dental practitioners can fabricate the dentures and make them look much better than they used to look. Other patients seek services to restore their teeth that look exactly like their lost ones. “They come with a lot of expectations in that someone would want you to place teeth that exactly look like what they had lost. They will expect to function normally like the way they used to speak. They would expect the complete dentures to be a permanent replacement of teeth… they expect them to be normal natural teeth. Additionally, they don’t expect them to be too costly so in the end when you tell them how much each will cost, they will be shocked and start asking you whether they will be like their natural teeth” (P003_43 year-old_Male_dental surgeon). In preference, some of the patients do not expect to receive removable dentures, but rather, they expect to receive fixed dentures that are permanent. Besides, some patients expect to spend very little time at the clinic. Some health workers attributed the patients’ high expectations to limited knowledge about the denture fabrication procedures. 8. Handling or meeting patient expectations Given the dental practitioners’ observation that most patients come with high expectations due to the limited knowledge about RCD fabrication, we asked about what the dental practitioners do in return to manage such expectations. We found that dental practitioners do explain to the patients in simple language for easy and quick comprehension. “In most cases, we give them adequate information in simple language to alleviate the fears and also assure them that in the long run, they will get used to the denture” (P001_40 year-old_Male dental surgeon). Also, while explaining to the patients, the focus is put on detailed information that eliminates fears, for example, information about the dentures falling out, eating limitations, and replacing the exact natural dentition. “We explain and assure the m that they can’t swallow the dentures and as long as the denture has been well made, it should not even fall out in public when they are speaking. We explain to them that their eating will be improved though with some limitations because there are things that they cannot eat like meat unless it is well cooked. Some ill-fitting dentures can cause ulcerations on the mucosa, especially in patients who have a flat alveolar ridge, the denture may fall out because it doesn’t have enough support to hold them. In the event that the denture causes wounds, we advise them to remove the denture from the mouth and apply medication for a few days to allow the wound to heal before putting back the denture” (P002_42 year-old_Female_dental surgeon). To dental practitioners, comprehensive counseling is very key in handling patients’ high expectations. “When the patients come, I will have to counsel them that what they are going to get is not going to be like their natural teeth. It is usually good if the practitioner has some samples of dentures, which they can show them how they look like and what they are expecting to happen including any discomfort” (P003_43-year_Male_dental surgeon). Also, handling patients’ expectations is dependent on the fears that a patient presents. It is done while emphasizing counseling and revealing denture fabrication procedures. The patients are told about the consequences of having the dentures, especially the types of food they are not likely to eat, how to clean them, and subsequent adjustments. They are also guided on proper ways of care for the dentures, especially by avoiding risky behaviors like opening bottle tops. “Of course how we counteract the fears of the patients depends on individual client; take an example if somebody came fearing the adverse effect of cancer, you counsel him/her with assurance that dentures do not cause the same. So it’s basically about counseling a client and giving him/her confidence that what s/he is going to get will be good for him or her” (P004_33 year-old_Male_dental surgeon). “Yeah, first of all, me personally, I normally tell them that don’t expect me to be so perfect like God. I can only do my best to improve the quality of your situation, but I don’t believe that I can completely eliminate it” (P021_45-year-old_Male_Dental Surgeon). Giving detailed explanations to the patients helps to reassure them of what it means to have a denture, but also to get patients to know how to manage and care for their dentures. This is very critical to prepare the patients to overcome their fears and high expectations. 9. Challenges faced by health workers while offering denture fabrication services Participants revealed that they experienced a lot of practical and knowledge-related challenges. These varied from limited resources, managing too many patients’ expectations and complaints, limited knowledge about denture fabrication among practitioners, and anxiety among patients to mention but a few. Regarding, patients presenting with so many complaints about any form of pain or discomfort they felt even when it has nothing to do with the denture fabrication procedures as revealed by one of the participants. Other challenges were related to resource limitations. It was revealed that the process requires a lot of trays and sometimes different designs, yet they are in most cases very limited. Equally, some dental practitioners reported having experienced the challenge of working with inexperienced staff who are not well-trained in delivering complete denture fabrication. To them, this hinders the delivery of quality services in the process of denture fabrication. One of the health workers noted this to be a very big gap in the professional service: “There is a big gap in the lower cadres who are not formally taught about complete dentures, but yet, they are treating patients with complete dentures, which has messed up the quality, the professionalism of the whole process” (P001_40 year-old_Male_dental surgeon). Another participant also revealed the incompetent nature of some health workers showing a gap between what is being practiced and what they were taught in school about the bite registration process. “A recent scenario was where I had a technician coming in to do all the different steps of denture fabrication and my major problem was when he was doing bite registration, especially in a patient whose teeth had malalignment. The patient had two teeth in the upper and one supra erupted tooth in the lower jaw`AQRRRRRR6, which indicated the bite registration was very poor based on what I learned in school” (P002_42 year-old_Female-dental surgeon). Some dental practitioners are reported to have experienced challenges related to patients who fear the procedures and are tense, which sometimes leads to poor positioning and eventually poor impressions. One of the participants revealed that when the patient is not relaxed, it becomes hard to make a proper impression. “You want to take the impression, but the patient is not relaxed or is tensed. If you tell them to bite in centric occlusion on occlusal bite block, they can give you different bites to the extent that you always fail in getting accurate parameters or exact measurements” ( P003_43 year-old_Male_dental surgeon). Discussion The present study was cross-sectional employing a qualitative approach using purposive sampling to explore the experiences and perspectives of dental clinicians and technologists in order to provide insights into their challenges regarding RCD fabrication services in Makerere University Dental Hospital in Uganda. In-depth interviews were chosen as the method of data collection to gather rich and context-specific perspectives from participants so as to generate findings that could be used to formulate strategic planning in the treatment of edentulous patients and the training of dental students. To our knowledge, there was no published information regarding the experiences and perspectives of dental clinicians and technologists in RCD fabrication services for Ugandan edentulous patients. The present study established the baseline data of the experiences and perspectives of RCD fabrication services among dental clinicians and technologists that could be used for related future studies. Additionally, the present findings will inform policymakers in strategic planning and reviewing existing guidelines [ 10 ] in fabricating RCDs that are suitable for Ugandan edentulous patients. Several aspects of the RCD fabrication process such as prior assessments, preparation, benefits, worries/fears and expectations of the patients, and obstacles experienced by dental practitioners are highlighted by the themes in the present study. While demonstrating that knowing the patient's unique demands like ORB height, denture retention, esthetics and state of oral health is essential before beginning the complete denture construction process, our findings are consistent with those of other studies [ 15 ]. It is worth noting that since good treatment planning has an impact on the process outcomes, dental clinicians and technologists must perform comprehensive assessments of patient’s oral hygiene, dental impressions, and radiographic evaluations. In support of previous studies [ 16 ], the present study discovered that effective communication and patient education are essential for preparing individual patients for the denture fabrication process. Therefore, beyond verbal and implied consent, which were sometimes accepted by patients, clinicians and technologists need to engage patients in a thorough consenting process to aid informed decision-making [ 17 ]. This can be through explaining the steps involved, potential benefits and risks, and expected outcomes of denture treatment [ 18 ]. After all, obtaining informed consent ensures that patients understand the nature of the procedure, their role in the treatment process, and the expected outcomes, thus promoting patient satisfaction and adherence to treatment and denture management plans [ 15 ]. The present study showed that RCD provides several advantages to edentulous patients, including enhanced masticatory function, self-esteem, and general quality of life. This finding was in line with other authors [ 19 – 20 ] who have found comparable results like complete dentures being able to improve speech, making chewing and digestion easier, increasing self-confidence, and improving social relations by restoring oral function and beauty. Acknowledging these advantages is essential to encouraging patients to seek denture care and follow maintenance and post-treatment guidelines [ 21 ]. For complete dentures to be fabricated and fitted successfully, ideal vertical and occlusal dimensions must be achieved. Evaluating aspects including patient comfort, phonetics, occlusal stability, and face aesthetics are necessary for accurate height measurement [ 21 ]. To guarantee appropriate denture aesthetics, function, and stability, dental professionals and technologists must take into account patient preferences, unique anatomical variations, and functional requirements. The present study showed that patients were sometimes afraid of the RCD fabrication process for a variety of reasons, such as pain, discomfort, expense, and perceived functional or cosmetic constraints. Therefore, effective communication, empathy, and patient-centered treatment are necessary to address these issues [ 22 ]. In a similar vein, other studies [ 17 ] ascertained that to allay concerns and improve patient satisfaction and compliance, clinicians and technologists must pay attention to patients' fears and anxieties, and offer comfort, knowledge, and support throughout treatment. Additionally, providing individualized and patient-centered treatment requires an awareness of patients' expectations and reasons for seeking denture fabrication [ 23 ]. Dentures may be desired by patients to improve their quality of life, relieve discomfort, improve appearance, or restore oral function [ 24 ]. The present study revealed mutual understanding and satisfaction of dental clinicians and technologists connected to treatment goals of patients' expectations, preferences and values in support Of previous findings [ 25 ]. Mericske-Stern [ 22 ] revealed that health professionals need to foster a collaborative and multidisciplinary approach that involves clear communication, shared decision-making ongoing feedback and evaluation because patients come to them with a variety of expectations. Furthermore, Sudheer and Vivekananda [ 26 ] reported that to achieve the best results, dental technicians and clinicians must therefore customize treatment plans to each patient's needs and preferences, answering any concerns and changing the course of action as needed. It is important to manage patient expectations by informing patients about the benefits and limitations of denture therapy, encouraging reasonable expectations and offering continuing support and direction to improve patient outcomes. However, when offering denture fabrication services, dental professionals may run into several obstacles, such as a lack of resources, technological difficulties, scheduling conflicts and patient-related issues including non-compliance or irrational expectations [ 27 ]. To overcome these obstacles, creative service delivery methods, professional development, and organizational support are needed [ 24 ]. Patel et al. [ 28 ] advised that partnerships with pertinent stakeholders and community resources together with cooperative efforts by dental practitioners, technicians, and support personnel can assist remove obstacles and improve the caliber and accessibility of denture fabrication services. Conclusion The findings of the present study provided valuable insights into the experiences and perspectives of dental clinicians and technologists in managing patients with complete dentures. However, the study revealed a knowledge gap about complete denture fabrication and a lack of local contextualized guidelines in a low-income country, Uganda due to reliance on international guidelines [ 10 ]. Therefore, future studies need to be conducted in different health facilities in the country to improve patient experience of RCDs, consenting processes, and reviews of dental practitioners’ practices to inform the formulation of local policy guidelines about RCD fabrication as well as the inclusion of practical learning of RCD fabrication amongst dental students. Recommendations. Policymakers should formulate local guidelines based on contextual factors and align them with international guidelines. Continuous professional development should be done among dental professionals through offering further training and inclusion of practical removable complete denture fabrication in the curricula of dental students. Patient education programs should be introduced to inform the general public about removable complete denture fabrication to solve fears and anxiety. Dental professionals should offer detailed explanations to patients without reservation for them to get detailed information that would enable them to decide about having a complete denture. Social workers should be employed in dental clinics to manage patient fears and anxiety before and after completing denture therapy. Regular reviews and assessments of dental practitioners' practices should be conducted to ensure adherence to evolving best practices. These reviews can inform ongoing education initiatives and contribute to the continuous improvement of dental care quality. Implications for Clinical Practice : Aligning local practices with international guidelines: Dental practitioners mentioned that they follow international guidelines, but sometimes work based on the patient’s characteristics. This highlights the need for aligning the practice of working based on patient characteristics to international guidelines such that they do what is recommended and stay updated on global best practices. Dental professionals should prioritize ongoing training to align their clinical practices with the latest evidence-based guidelines. Also, emphasis should be put on the development of the local guidelines and including complete denture fabrication in the curricula for dental students. Informed consent practices: While obtaining patient consent is a standard practice, the revelation that some practitioners may conceal information for motivational purposes raises ethical concerns. Dental practitioners should uphold transparent and comprehensive informed consent practices, providing patients with all necessary information to make informed decisions about their dental care. Effective communication with patients: Recognizing the impact of patient expectations and fears on the denture fabrication process, dental practitioners should prioritize effective communication. This involves not only managing patient expectations but also addressing concerns and fears through detailed and understandable explanations, particularly in layman's language. Implications for Future Research : Ethical considerations in informed consent: Future research should explore the ethical dimensions of informed consent in RCD fabrication. Investigating the extent to which information is sometimes concealed and its impact on patient decision-making will contribute to the development of clearer ethical guidelines for practitioners. Research with patients: Further studies should consider looking at the patient experience of RCD fabrication to compare it with dental professional’s experiences. Patient education interventions: Research initiatives should focus on developing and evaluating interventions to enhance patient education about the RCD fabrication process. This includes assessing the effectiveness of educational materials, workshops, or informational sessions in bridging the knowledge gap and managing patient expectations. Professional development for dental workers: Given the challenges faced by dental surgeons and technologists, research should investigate strategies to address knowledge gaps within the dental workforce. Identifying effective professional development programs can contribute to improved competency and confidence among dental professionals. Psycho-social aspects of denture fabrication: Future research could delve deeper into the psycho-social aspects of denture fabrication, exploring the psychological impact of patient expectations and fears. This includes understanding how addressing these aspects contributes to overall patient satisfaction and well-being. Limitations of the Study : This was a qualitative study with a small sample size and from one health facility. Generalizing the results to a broader population may require caution, and future research should aim for more diverse participant representation and use mixed-method studies. The study may not have fully captured contextual factors influencing clinical practices like organizational or cultural factors on denture fabrication approaches in order to provide a more comprehensive understanding. Abbreviations ORB Occlusal rim block RCD Removable complete denture Declarations Ethics approval and consent to participate Ethical approval of the protocol was obtained from the Makerere University School of Health Sciences Research Ethics Committee (Reference Number: MAKSHSREC-2023-486) as well as the Uganda National Council for Science and Technology (Reference Number: HS3092ES). Permission to carry out the study was obtained from the administration of Makerere University Dental Hospital. Written informed consent was obtained from all the participants who took part in the study. The purpose of the study was explained to the participants and their participation was voluntary. Their agreement to participate in the study did not waive their rights in any way and this was in accordance with the Helsinki Declaration (World Medical Association, 2013). All the data collected were kept securely in a cabinet under lock and key and only accessible to the investigator. Consent for publication Not applicable Availability of data and materials Data sources are available on request. The request can be sent to the corresponding author at [email protected] Conflict of interest The authors declare that there is no conflict of interest. Funding Sources This research was supported by the Government of Uganda through the Makerere University Research and Innovations Fund (grant number MAK-RIF ROUND 5, 2023-2024). The views expressed herein are those of the authors and do not necessarily represent the views of the Government of Uganda, Makerere University, or the MAK-RIF secretariat. Author’s contributions DN, IO, MA, GB, and CMR participated in the conception of the study, study design, data analysis, and manuscript preparation. DN and GB participated in data collection. All authors read and approved the final manuscript. Acknowledgments The authors are grateful to the Government of Uganda through the Makerere University Research and Innovations Fund, the MAK-RIF secretariat for supporting this study, and participants for their willingness to participate in the study. Author’s Details DN Male PhD student (UCN), Principal Dental Technologist BSc.DT (Mak), MSc. (Cardiffmet-UK), Pg.Med. Edu, MAcadMEd (USW-UK), Msc. Med. Edu, (USW-UK). CMR Male Associate Professor BDS (Mak), PhD (UOB-Norway). IO Male Senior Lecturer BDS (Mak), MPH (UON-Kenya), PhD (UOB-Norway). EM Male Principal Dental Technologist Bsc.DT (Mak), Msc.Health Services Research (Mak) GB Male Researcher BA (Mak), MHsc.Biothetic (Mak), PhD student (Mak). MA Male Researcher BA, MA (Mak). References Clark WA, Brazile B, Matthews D, Solares J, De Kok IJ. A comparison of conventionally versus digitally fabricated denture outcomes in a university dental clinic. J Prosthodont. 2021;30(1):47–50. Miranda BB, Dos Santos MB, Marchini L. 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Br Dent J. 2000;189(5):248–52. Sudheer A, Reddy GV, Reddy G. Behavior shaping of complete denture patient: a theoretical approach. J Contemp Dent Pract. 2012;13(2):246–50. Anadioti E, Musharbash L, Blatz MB, Papavasiliou G, Kamposiora P. 3D printed complete removable dental prostheses: A narrative review. BMC Oral Health. 2020;20:1–9. Patel J, Jablonski RY, Morrow LA. Complete dentures: an update on clinical assessment and management: part 1. Br Dent J. 2018;225(8):707–14. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editor assigned by journal 07 May, 2024 Submission checks completed at journal 07 May, 2024 First submitted to journal 03 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4362028","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":301562678,"identity":"8d72b31d-a5ee-4977-8e36-b0f65483fd43","order_by":0,"name":"David Nono","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAvElEQVRIiWNgGAWjYHACAwYenn9yINaBB8RrkTlgDNaSQLwWmwOJDSAmUVrMpZu3SbzJuZM+P+zwQ6AtdnK6DQS0WM45ViY558yz3I230wyAWpKNzQ4QctWNHGNj3h7m3I2zE0BaDiRuI07LP+Z0w9npH4jWYviYh+dwgrx0DtG2pBU+nMOTZrhBOqfgQIIBUX5J3nDgDY+NvPzs9M0fPlTYyRHUgtALVmlArHIQkG8gRfUoGAWjYBSMKAAA8/xIeDlOAqMAAAAASUVORK5CYII=","orcid":"","institution":"Makerere University","correspondingAuthor":true,"prefix":"","firstName":"David","middleName":"","lastName":"Nono","suffix":""},{"id":301562679,"identity":"c8f04b23-9747-4198-818f-3773163c45bb","order_by":1,"name":"Mathias Akugizibwe","email":"","orcid":"","institution":"Virus Research Institute \u0026 London School of Hygiene","correspondingAuthor":false,"prefix":"","firstName":"Mathias","middleName":"","lastName":"Akugizibwe","suffix":""},{"id":301562680,"identity":"2971d91f-3007-4659-b3dc-420567bebfa4","order_by":2,"name":"Godfrey Bagenda","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Godfrey","middleName":"","lastName":"Bagenda","suffix":""},{"id":301562681,"identity":"6415565d-69b4-467d-9cff-1df1c5d43efc","order_by":3,"name":"Isaac Okullo","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Isaac","middleName":"","lastName":"Okullo","suffix":""},{"id":301562682,"identity":"a1704cf0-115e-45f8-80b8-e263c83b42c3","order_by":4,"name":"Charles Mugisha Rwenyonyi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Charles","middleName":"Mugisha","lastName":"Rwenyonyi","suffix":""}],"badges":[],"createdAt":"2024-05-03 05:21:40","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4362028/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4362028/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":56456862,"identity":"014d47ec-9747-40e4-b71c-a4ff1e624a22","added_by":"auto","created_at":"2024-05-14 12:22:52","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":752182,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4362028/v1/bd202691-a989-44fc-9115-9c84f4c71ace.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"“They expect you to give teeth like God, which is very hard”: Dental Clinicians’ and Technologists’ Experiences and Perspectives on Removable Complete Denture Fabrication Services in Makerere University Dental Hospital, Uganda.","fulltext":[{"header":"Background","content":"\u003cp\u003eRemovable Complete Denture (RCD) fabrication services are becoming increasingly important on a global scale as a result of the improved lifespan of the population and inadequate preventive services [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The therapy for edentulous patients can be realized through the use of conventional removable complete dentures (RCDs), implant-supported prostheses, and computer-aided design/computer-aided manufacturing (CAD/CAM) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. According to Clark et al. [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], there has been a discernible difference in the number of visits and remake rate between RCDs that were made conventionally and digitally.\u003c/p\u003e \u003cp\u003eThe usage of CAD/CAM technology has significantly increased as a result of quick delivery services of various dental restorations [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Additionally, advancements in partially or fully digital workflows have made it possible to fabricate RCD in fewer, shorter sessions and with the use of materials that have better qualities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Moreover, it has been demonstrated that CAD/CAM-based RCDs release less monomer than traditional RCD, which has several benefits with regard to practical applicability [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Studies showed that the use of CAD/CAM technology has demonstrated promise for streamlining the fabrication procedure and enhancing RCD fitness and retention [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], which have a major impact on patients' speech and masticatory abilities, and eventually improve their quality of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Uganda, the therapy for edentulous patients has predominantly been realized through the use of conventional complete dentures. The fabrication of a complete denture entails several steps which include diagnosis, treatment planning, impression taking and border molding, dental model casts and occlusal rim blocks, bite registration, selection and set up of artificial teeth, wax denture try-in, and denture processing and insertion [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite the Uganda National Oral Health Policy [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], which recommends the fabrication of RCDs for the treatment of edentulous patients using internationally accepted guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], there is no published data on the experiences of technologists or clinicians in the fabrication of RCD. The aim of the present study was to explore the experiences and perspectives of dental clinicians and technologists in RCD fabrication services in Makerere University Dental Hospital, Uganda.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThe study employed a qualitative design to explore the experiences of RCD fabrication services among dental clinicians and technologists. It was conducted using in-depth interviews of dental clinicians and technologists guided by data saturation.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eStudy Site\u003c/h2\u003e \u003cp\u003eThe study was conducted in Makerere University Dental Hospital in Kampala. Kampala is the capital city of Uganda. The hospital is a teaching and health service delivery facility of Makerere University. It is the largest and adequately equipped dental facility employing the highest number of dental specialists in Uganda. It has a well-established prosthetic dental laboratory and offers specialized dental services including rehabilitation of edentulous patients with RCD mostly staff and students of the University, and other communities outside the University at a minimal fee. The hospital attends to approximately 660 outpatients per month of which about 20 are rehabilitated using RCD (Registry of Dental Records, 2022). The selected participants were actively practicing dentistry, particularly in the area of RCD fabrication.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eSelection of Study Participants\u003c/h2\u003e \u003cp\u003ePurposive sampling was used to select key informants in consideration of areas of their clinical services. The selection also included variation in duration of practice, level of training, roles in denture fabrication procedures, and fitting to ensure a fair representation of the study population. The last key informants (13th dental clinician and 12th technologist) were determined based on data saturation\u003c/p\u003e \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003eDental clinicians and technologists participating in the provision of RCDs in Makerere University Hospital.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003eDental clinicians and technologists who were sick and unable to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData Collection\u003c/h2\u003e \u003cp\u003e Before participating in the study, written informed consent was provided by the participants. They were assured of confidentiality such that no identifiers like names were used in data collection and preparation of reports. The research assistants personally approached dental practitioners to invite them to participate in the study. The interviews were conducted in a conducive environment preferred by the participants, ensuring confidentiality and privacy in the comfort of the participants to share their insights. The interview comprised open-ended questions with probes to prompt dialogue and unmediated opinions on aspects of experiences, and perspectives toward RCD fabrication. Data collection and the subsequent analysis were conducted as an interactive process. The last participant for IDI was established by informational redundancy, i.e. when the discussion or interview generated no new information [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The interview for each respondent took 30 to 45 minutes and was audio-recorded. This was done with the help of a trained research assistant with a background in social sciences and experience in qualitative research.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eQuality control\u003c/h2\u003e \u003cp\u003eThe data collection tools were pretested by the principal investigator and amendments were made to improve their validity and reliability. The research assistant was trained in data collection. The key informant interviews were audio-recorded to capture any discussion that may have been missed in taking notes. Additional notes capturing body language and gestures during the interviews were also recorded.\u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eData Management and Analysis\u003c/h2\u003e \u003cp\u003eData management involved the transcription of interview verbatim recordings. After transcription, the 25 transcripts: 12 for the dental technologists and 13 for the dental clinicians were coded leading to the development of a code book. The code book was tested using five transcripts and imported into Nvivo 14 for systematic organization and analysis. Data were analyzed using themes [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. After reading and re-reading the transcripts, emerging and recurrent themes were identified and subsequently interpreted. Personal experiences were captured as individual quotes.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e of the protocol was obtained from the Makerere University School of Health Sciences Research and Ethics Committee (Reference Number: MAKSHSREC-2023-486) as well as the Uganda National Council for Science and Technology (Reference Number: HS3092ES). Permission to carry out the study was obtained from the administration of Makerere University Dental Hospital. Written informed consent was obtained from all the respondents before taking part in the study in accordance with the Helsinki Declaration [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. All the data collected were kept securely in a cabinet under lock and key and only accessible to the investigator.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eThe study involved 25 respondents with varying demographic characteristics (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). All the respondents had either a Bachelor in Dental Surgery or a Bachelor of Dental Technology: Thirteen were registered dental clinicians (surgeons) and 12 dental technologists. Fourteen participants were aged 26\u0026ndash;35 years (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe frequency distribution of the respondents according to their social demographic characteristics (n\u0026thinsp;=\u0026thinsp;25)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCharacteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eN (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (72)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (28)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRole\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental clinicians(surgeons)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13 (52)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDental technologists\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12 (48)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e18\u0026ndash;25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (24)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e26\u0026ndash;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (56)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e36\u0026ndash;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (20)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBachelors\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (100)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eExperiences in managing patients with\u003c/b\u003e \u003cb\u003eremovable complete denture (RCD)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eWe explored the experiences of dental clinicians and technologists in managing patients with RCDs and different themes and sub-themes emerged:\u003c/p\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e1. Prior assessments and /or key considerations for RCD fabrication\u003c/h2\u003e \u003cp\u003eWhen asked to describe the procedure of assessing the patients to determine who fits what services of RCD and what the dental practitioners consider as key factors in making decisions for RCD fabrication procedures, both male and female participants mentioned two key categories of considerations for any RCD fabrication procedures, namely, clinical and socio-demographic assessments or considerations.\u003c/p\u003e \u003cp\u003eIn terms of clinical assessments or considerations, dental practitioners reported that they have been considering the underlying conditions that could be associated with loss of teeth or how to manage post-insertion activities. Conditions like the morphology of the ridges, the oral hygiene, and if the patient is living with diseases for example diabetes, hypertension, and ulceration might propel the dental practitioners to make very critical considerations before recommending RCD fabrication. Sometimes they recommended not to fabricate RCD at all if the patient\u0026rsquo;s conditions were not good, but also, if they discovered that RCD may lead to severe management outcomes, they did not advise the patient to opt for RCD. The details are given below:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For some patients with a condition which is not well managed like Diabetes Mellitus, it affects the soft tissues of the periodontium and such conditions must be put into consideration\u0026rdquo;\u003c/em\u003e (P001_40-year-old_ Male _dental surgeon).\u003c/p\u003e \u003cp\u003e The oral hygiene of the patient was also a key factor to consider:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The key factor that must be observed whenever we provide removable complete denture is the oral hygiene because if your oral hygiene is not ideal you will misuse or will not take care of the complete denture\u0026rdquo; (P001_40-year-old_ Male _dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Of course, we generally consider the overall hygiene of the patient and the alveolar ridge. Some people might have lost teeth some time back and the ridge could have resorbed. So, we consider those [factors]\u0026rdquo; (P020_34 year_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eEqually, assessing whether the mouth has been prepared to receive the RCD or not was a key consideration. It was revealed that in cases of loss of teeth due to accidents, one would require the wounds to first heal and also to ensure that all the retained roots have been extracted:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You examine the patient\u0026rsquo;s mouth to determine whether he or she qualifies for a complete denture, and then you do mouth preparation. In mouth preparation, you remove any retained roots and give the patient 3 months for the wounds to adequately heal before starting complete denture fabrication processes\u0026rdquo; (P001_40-year-old_ Male _dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;One of the purposes of a complete denture is to restore function. If the patient has a problem with the temporomandibular joint, you may need to address it first, before complete denture fabrication\u0026rdquo; (P018_30 year_Male_ Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eRelatedly, the morphology of the patient\u0026rsquo;s ridge also determines whether to have RCD fabrication or not or whether to use denture adhesives or implant support:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;First of all, I look at the ridge and decide if it favors a complete denture in terms of height and width for support, retention, and stability. Producing a complete denture is one thing, but if it will adequately function is another.\u0026rdquo; (P023_26 year_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The ridge, say in the maxilla, which is flat might disturb as retention might be poor. A person who gags a lot may not qualify for complete dentures\u0026rdquo; (P015_31_year-old_Male Dental).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The quality of the ridges in some cases does not need a removable complete denture, it may need a fixed implant-supported complete denture. So, those matters must be put in place [into consideration]\u0026rdquo; (P001_40-year-old_ Male _dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe mental stability of the patient was also a key clinical consideration before recommending a complete denture fabrication.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For any patient getting a complete denture, they should be mentally ready to have it [denture] because you may give a complete denture to a patient who is not ready to undergo a complete denture rehabilitation and then this denture becomes a problem, and can cause issues to some of them and even suffocate them\u0026rdquo; (P002_42 year-old_Female_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eThe other key demographic consideration is the age of the patient. Participants revealed that because some patients who needed complete dentures were the elderly, there were concerns regarding their ability to adjust to living with and maintaining the appliances, which may not be possible.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is a certain age where you may not dispense a complete denture; I had a patient whose relatives were from abroad so they wanted to offer her an RCD and they did all that it took; they paid the money and the appliance was delivered, but in the long run when they went back abroad, the old woman threw the appliance away because she said that at her age she does not need\u0026rdquo;\u003c/em\u003e (P001_40-year-old_ Male _dental surgeon).\u003c/p\u003e \u003cp\u003eSimilarly, another participant narrated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There are medical conditions that one considers for some of these patients\u0026hellip;, most of them are elderly patients, some having other conditions like high blood pressure and diabetes mellitus, and even some of them having psychotic problems, which may be a challenge for them to follow the instructions of using complete dentures\u0026rdquo; (P003_43 year-old_Male_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOther considerations included: patients with periodontitis or sometimes the grade of the teeth mobility (grade two or three) was reported to influence the decision to either make a complete denture or not.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Patients who have teeth that are periodontally compromised to grade three mobility, but not for removal because the patient is not mentally ready\u0026hellip; those are hopeless. But if the teeth have grade-two mobility, one can leave them and make for them transitional dentures, One can make a denture following all the steps, but leave space for the natural teeth, and later make that transition to a complete denture\u0026hellip;\u0026rdquo;(P013_25_year-old_Female_ Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSimilarly, one other factor that dental practitioners consider when deciding whether to have a complete denture or not is the willingness of the patient to have a complete denture or not. One of the participants emphasized:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I think that the main thing I'll consider is whether the patient will be willing from day one to show up for appointment for every step of denture fabrication because it takes a while as you might already know\u0026rdquo; (P014_23 year-old_Female_Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e2. Patient preparation and consenting for denture fabrication\u003c/h2\u003e \u003cp\u003eTo broaden our understanding of the knowledge and experiences of dental practitioners who offer denture fabrication services, we took an interest in exploring whether and how the patients are prepared and consented before the procedures are done. Our study revealed that before the decision to have the patient undergo denture fabrication, dental practitioners indicated many key steps that are taken into account. Among the many, the willingness of the patient and consenting to the procedures was key. Also, patients are given enough information especially for them to know that the appliance is removable and will need to be cleaned. For some categories of patients like the old and with mental health problems, the dental practitioners ensure that the caretakers are involved in all the procedures. Given that the complete dentures are foreign to the human body, dental practitioners ensure that patients are also told about the likely inconvenience that involves the dentures in order to get prepared to adjust and live with them.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, we always tell them about the discomfort of the denture during chewing, the possibility of roughness that could injure the gum, the bulkiness that may restrict tongue movement, and keeping it clean. However, with time they get used to the dentures\u0026rdquo; (P003_43yr_Male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSo, the discomfort that comes with putting on the dentures and advice on how the patients can get used to wearing them, requires emphasis on consistent use of the dentures whether at home or office was key for them to get used. Another factor was the importance of cleaning them to avoid likely infections and the participants said:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For the discomfort with some of the procedures, for example, if the material the practitioner uses to take an impression is hot, one can give them some cold water to rinse their mouth before and then temper the material in the water that has a lower temperature\u0026rdquo; (P014_23 year-old_Female_Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, the very first thing that we tell them, is [that the] denture is not part of your body, as time goes on the denture tends to become loose because there is shrinkage\u0026hellip; so they must come back for relining and maintain utmost oral hygiene. Then also because dentures tend to exert some bit of dislodging forces, the tissues tend to form flabby ridges. For some patients, if the dentures are ill-fitting, they may cause sores or stomatitis\u0026rdquo; (P018_30 year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome dental practitioners talked about the duration and the fees it will take for the patient to have their dentures fixed as another factor to consider, thus the participant elaborated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You make patients aware [that,] for example, this is going to take a long time to accomplish. You have to be ready to show up for appointments because that is the most important thing to be able to receive the denture in time. Then for the payment of money, you can tell, them, to keep saving, to pay for the costs involved\u0026rdquo; (P014_23 year-old_Female_Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eConsenting the patients was also a very important part of the preparation for denture fabrication procedures. While consenting patients, the focus is largely on giving the patients as much information as possible to ensure that they clearly understand all it takes. The common information provided relates to the benefits, side effects, and the cost of treatment.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We explain every procedure to the patients, then we ask them if they have consented, the other issue is monetary expenses because you explain to them how much it costs, and so on\u0026rdquo;\u003c/em\u003e (\u003cem\u003eP001_40 year-old_Male dental surgeon).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We do this for all patients who need dentures because we have to explain to them the benefits, but also the side effects of complete dentures\u0026rdquo; (P002_42 year-old_Female dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e However, as opposed to other forms of consent that are normally sought, some dental practitioners revealed that they do not give written informed consent, but rather, implied consent.\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;Not entirely written informed consent, but most times when they come, that is implied consent. They tell you what they want for, example, tooth replacement and so you let them know what you're going to do for them and your expectations, and if they're ready for that treatment, you go on and provide it. So, that is some form of implied consent\u0026rdquo; (P013_25_year-old_Female Dental).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eAs part of the consenting process, dental practitioners\u0026rsquo; focus is always on providing details like the advantages, disadvantages, risks, and visual demonstrations of how the denture looks and how to care for the denture. The implication of this is that the patients make informed decisions.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I first tell them about the treatment for example, I bring an actual denture so they can see how it looks like or show them photographs or videos. Then, I educate them about the advantages, disadvantages, risks, and complications of dentures. I also educate them on denture care\u0026rdquo; (P014_23 year-old_Female_Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There are limitations explained to the patient\u0026hellip;.. that there are other things that will occur in the initial course of treatment. We tell them, someone can develop sores in the mouth and how to handle them when they occur\u0026rdquo; (P020_34 year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother participant also revealed that the consent they obtained was not comprehensive enough to qualify as informed consent. The participants are given little information and not in detail. As it is supposed to be.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I try, but from the informed consent I know, it is not complete. We just tell the patient what a complete denture is, the advantages and disadvantages, and not so much information. That is why I'm saying it's not complete. I also tell them some alternative treatments, but not everything\u0026rdquo; (P015_31_year-old_Male Dental).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn some cases, dental practitioners conceal some information so that the patient is only given the information that will propel them to accept the denture procedures if the dental practitioner thinks that it will help the patient.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Well, I ask for informed consent from every patient. I walk them through what they ought to receive, but there are some instances where I tend to withhold some information from the patient because I want them to benefit or to get at least the best option. Let me say, I drive them to something that will benefit them. Most times, I used to do written informed consent, but nowadays, because of the big number of patients I see, I do verbal consent\u0026rdquo; (P018_30 year-old_Male Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Some participants admitted that although written consent would be the best, they do not document the processes, but rather they mostly do verbal consenting.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Truth be told, we don\u0026rsquo;t usually document informed consent, though documentation would be the best. We usually tell patients what the procedure we are going to do, what advantages and disadvantages the procedure will bring to them, how much time the procedure will take and how much money they are supposed to spend on the procedure\u0026rdquo; (P023_26 year-old_Male_ Dental Intern).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003e3. Benefits of undergoing removable complete denture fabrication\u003c/h2\u003e \u003cp\u003eWe asked our participants to elaborate on the benefits of removable complete denture fabrication. Our analysis revealed some major benefits that a patient derives from undergoing complete denture fabrication including mastication, restoration of facial features, correction of speech defects, and boosted self-esteem and confidence.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Mastication functionality\u003c/h2\u003e \u003cp\u003eDental surgeons and technologists revealed that complete dentures restore masticatory function, allowing individuals to eat a variety of foods they were not eating before and improving their ability to chew food like meat, which they cannot afford without teeth. Most dental practitioners revealed that this was one of the key expectations that patients come up with while seeking denture fabrication services.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Many of them will say, I cannot eat some meat. That means they miss the chewing part of the teeth\u0026rdquo; (P021_45 year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Complete denture helps a person in eating because when one has lost teeth, eating will be a challenge when smashing or biting any food\u0026rdquo; (P010_33 year_Male_Dental Technologist).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Restoration of facial features\u003c/h2\u003e \u003cp\u003eComplete denture fabrication was thought to improve beauty. It was reported that a complete denture offers a more aesthetically pleasing appearance as it restores facial height and structure, which improves beauty for those who have fallen cheeks and maintains the natural contour of the face. This improves the beauty of patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You know edentulous patients usually have collapsed faces. So, I tell them about restoring their facial appearance and masticatory efficiency, so they will be able to eat certain foods\u0026rdquo; (P016_31year_Male Dental Technologist).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;And also, in most cases the face of patients who don\u0026rsquo;t have teeth, the face drops which will quite disorganize the beauty. So, when you put complete denture, it will improve on somebody\u0026rsquo;s beauty or facial look and above all somebody\u0026rsquo;s smile because everyone survives on the smile\u0026rdquo; (P001 40-year-old male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When people lose teeth, there is a tendency of cheeks falling in, but with complete dentures, the cheeks can be able to gain their structure (P019 24-year-old female dental intern).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Correction of speech defects\u003c/h2\u003e \u003cp\u003eComplete denture fabrication improves speech by restoring the missing teeth:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Complete denture replaces missing teeth which helps edentulous patients to speak, if they do not have teeth, then speaking will be a big problem. They will have a problem with pronouncing certain letters like \u0026lsquo;S, T, and C that need to bring the teeth together. The teeth also control the movement of the tongue during the speech\u0026rdquo; (P022_38 year_Male_Dental Technologist).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Boosts self-esteem and confidence\u003c/h2\u003e \u003cp\u003eComplete denture fabrication improves self-esteem by restoring the missing teeth. This improves their facial appearance which enhances their confidence in public and it also improves how they talk. The regained self-esteem and confidence help the patients restore their smile without hiding or covering their mouth.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I want my smile back, I need to eat my meat, I need to speak in the community [public] on a freeway, but the key things they say are: I need to eat properly smile, and speak in the community [public] because those are some attributes that lower someone\u0026rsquo;s self-esteem if s/he cannot speak or express oneself\u0026rdquo; (P001_40 year-old_Male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;About the quality of life, tooth loss is like any other disease, it comes with stigma. So, when someone gets complete denture therapy, you expect it to boost his/her confidence in public, and in addition, it restores functions like chewing, and eating. So, mainly the denture is about the appearance, aesthetics, and also the function\u0026rdquo; (P012_29 year_Male_Dental Technologist).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003e4. Steps followed in removable complete denture fabrication\u003c/h2\u003e \u003cp\u003e Participants mentioned several steps they go through for complete denture fabrication, including examination and diagnosis involving assessing the patient's oral condition, facial expressions, and overall health. Then, they do mouth preparation, take impressions, fabricate occlusal rim blocks (ORBs), do bite registration, do articulation, set up teeth, and then try-in wax RCD. This is followed by RCD fabrication, review and adjustment, patient education, and then final delivery of the RCD to the patient. In addition, dental clinicians and technologists emphasized that they follow international guidelines in doing RCD fabrication. They mainly refer to textbooks for international standards for guidance in RCD fabrication. These guidelines include specific measurements for the height and thickness of ORBs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;According to what I do in fabrication RCD, I follow the textbooks, measuring the height and width of the occlusal rim blocks which are documented in the books\u0026rdquo; (P008_25-year-old male dental technologist).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e However, despite the existing guidelines in textbooks, there is a consensus among the professionals that each patient is unique and they always make individual adjustments. Factors such as jaw size, facial morphology, and patients\u0026rsquo; comfort play a crucial role in determining the optimal height of occlusal rim blocks. Some clinicians emphasize the importance of being adaptable and making adjustments based on the patient's specific needs.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;For instance, in books, they usually write about the heights and width of ORBs for different races, but we always ask patients for the previous photographs they had when they had teeth. The photographs would help you to estimate how they looked like before they lost teeth. Additionally, during the process of fabrication of RCD, the patients\u0026rsquo; comfort will guide the estimation of the height\u0026rdquo; (P003_43-year-old male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec21\" class=\"Section2\"\u003e \u003ch2\u003e5. Height determination of occlusal rim blocks (ORBs) during RCD fabrication\u003c/h2\u003e \u003cp\u003eWe asked the participants about height determination for ORBs during complete dentures fabrication and they responded that height determination is done in collaboration between the clinician and dental technologist. However, they both ascertained that height determination varies from patient to patient. They reported reliance on international standards from research done in developed countries and cited the absence of local guidelines for ORB fabrication. They, thus mentioned variations in height determination with some mentioning taking values of 18 to 22 mm and 16 to 18 mm for upper anterior and posterior height, respectively. The lower jaw is 18 millimeters for both anterior and posterior sections.\u003c/p\u003e \u003cp\u003e\u003cem\u003e \u0026ldquo;There are [international] standard guidelines that we follow, take an example of the height of the maxillary occlusal rim blocks: anteriorly, it is 20 to 22 mm and posteriorly, 16 to 18 mm. Then, anterior and posterior widths are 3 to 5mm and 8\u0026ndash;10 mm, respectively. However, there are variations in each case so, it is upon the practitioner to know that each variation suits a particular client. The variation may divert from the normal because one has to look at a number of completely edentulous cases that have taken long leading to advanced bone resorption presenting shorter heights. Most of them are from 15 to 17 mm posteriorly and anteriorly rarely do reach 20 mm, but might be around 18 mm. So, those standards are available and we respect them, but each client is handled independently and we must find out from the practical aspect, which height is suitable for a specific client\u0026rdquo; (P004_33yr_Male_dental surgeon).\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003e\u0026ldquo;They are documented dimensions used the world over, and there are different journals that I have seen that recommend dimensions that have lower values than what was documented initially for upper anterior and posterior portions of occlusal rim block (20 to 22 mm and 16 to 18 mm). From my personal experience, for the upper and lower rims, I can\u0026rsquo;t use 22 mm and 18 because most of the patients complain of the teeth meeting constantly saying that they speak like children, because of the dimensions being too high. So, l use lower limits of occlusal rim blocks where the lower rims are 16 mm and the upper, 20 mm. The fact that international standard guidelines are globally accepted, makes me feel that those standard dimensions do not work in every population, there are variations\u0026rdquo; (P022_38 year_Male_Dental Technologist).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eImpression-taking was considered the foundation of the whole RCD fabrication process because it determines how the RCD fabrication process is completed. It was argued that a mistake made during an impression affects the whole process. This is done by taking accurate impressions where you capture the anatomical landmarks, the palatal seal, and the frenal attachments. However, some mentioned taking inaccurate impressions at times due to the use of materials like alginate. Other factors influencing accurate impressions include patient\u0026rsquo;s gagging and clinicians\u0026rsquo; lack of time and skills.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There are several factors affecting the quality of impression, one, there are some materials like alginate that don't give you a good impression. Two, some clinicians are in a hurry, and they don't give the necessary time. And three, you find that sometimes there are patients who have other habits like gagging during impression taking, which can cause you to make errors in the impression taking\u0026rdquo; (P021_45-year-old_Male_ dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003e6. Patient concerns and fears about removable complete denture fabrication\u003c/h2\u003e \u003cp\u003eWe also explored the experiences of dental practitioners on the concerns and fears that patients present with about complete denture fabrication procedures. Our findings revealed several perceptions that patients have about the RCD. Some fears were linked to misconceptions and rumors. One of the participants indicated that some patients came thinking they would be given teeth that are plucked out of the corpses of white people as stated:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yes, there are many concerns, some patients said they think we go and pick these teeth from dead bodies. The other day a lady told me that her teeth were very bad and yet, my mother died with very nice teeth. I wish she had consented with me to inherit her teeth, you would have plucked out all the teeth from her body and given them to me. So, some of them fear and there are people when they hear the word \u0026lsquo;artificial\u0026rsquo;, they think they are the teeth of the \u0026lsquo;Bazungu\u0026rsquo; plucked from dead bodies.\u0026rdquo; (P001_40 -year-old_Male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eOther patients feared that maybe at some point while asleep or eating, they could easily swallow the dentures and end up suffocating. Also, some patients were worried that there could be an incident where the dentures could fall out in public especially when the person is speaking.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yeah, some patients actually think they will swallow the dentures and suffocate although we try as much as possible to explain that it is impossible to swallow complete dentures because there is no way they could go past the throat. Then the other fear could be when they are speaking in public, these dentures could fall out of their mouths, which could affect their social lives\u0026rdquo; (P002_42-year-old_Female_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;The worries; won\u0026rsquo;t it fall when I'm talking in public, will I eat the way I'm supposed to eat my food? Some, for example, women come when they have not told their husbands that they don't have teeth, and is like eh, what if I'm kissing my husband and that denture comes out\u0026rdquo; (P011_28-year-old_Female_Dental Technologist).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eParticipants further revealed that patients also worried about how comfortable they would be after getting the complete denture. Some patients fear that wearing complete dentures could have health implications, fearing that it may cause cancer on top of fearing that they could easily swallow the dentures by accident.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We have had cases where clients have said that they fear complete dentures can cause certain illnesses like cancer. We have had cases where patients who think they can swallow the dentures will not be comfortable with the denture in their mouth because of being a foreign body. Some patients feel they will not be comfortable chewing food taste of food may be different\u0026rdquo;\u003c/em\u003e (\u003cem\u003eP004_33-year-old_Male_dental surgeon).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eRegarding the discomfort, some complained that the complete dentures were sometimes too much extended especially the upper side which caused the mouth to start feeling heavy.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some patients were complaining that they feel the mouth is heavy while others also felt the dentures especially, the upper one was overly extended, but that usually happens to people who have a gagging effect\u0026rdquo; (P001_40- year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eEqually, technologists expressed that most patients feared the associated costs of having a complete denture but also feared that the material from which the dentures are made could cause cancer.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Their biggest fear is the costs, there are a lot of fears that these complete dentures are way too expensive so that one makes them a little bit skeptical about them. Then sometimes they think that the material from which the complete dentures are made as if they are not bio-compatible as if they cause cancers so like that\u0026rdquo; (P020_34-year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome patients feared the size of the dentures, especially when the dental practitioners were demonstrating to them, they worried about how the dental practitioners would manage to fix it in their mouth. They feared that they may not eat well seeing that the size of the denture was big.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Sometimes when you\u0026rsquo;re explaining to them you have to have also a kind of sample to show them how it looks like so that somebody does not just picture it in the mouth but also see it so that when they have it, they know how to fit it in the mouth so a person will see and say; doctor this thing looks big, will I be able to use it? But will I [be able to speak], will I eat well? So they have a lot of worries\u0026rdquo; (P002_42 year-old_Female_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003e7. Patient expectations for seeking removable complete denture fabrication\u003c/h2\u003e \u003cp\u003eWe also aimed to understand from the dental practitioners what the patients\u0026rsquo; expectations are when they come for removable complete denture services. Our findings revealed several expectations that patients had. Largely, patients were expectant that they would be able to have their beauty, especially when they smile, restored so that they were able to speak freely in public, and since most of them had stopped eating certain foods, they expected to start eating foods like meat after having their dentures.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;I want my smile again, eat meat, and speak freely in public. These are some of the things that lower someone\u0026rsquo;s self-esteem\u0026rdquo; (P001_40 year_old_Male- dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Some patients wonder if they will be able to eat sugar cane or bite meat on hard bones.\u0026rdquo; (P003_43 year-old_Male-dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome dental practitioners revealed to have encountered female patients who wanted to have dentures so that they could restore their physical appearances to attract men and give birth to children, and also get job opportunities, which they thought to have missed because of having no teeth. In this case, self-esteem was always key for the patients.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Many of the patients are looking out to restore cosmetic appearance. A thirty-year-old woman with no teeth blamed her entire life on the fact that she didn\u0026rsquo;t have a husband and children because she didn\u0026rsquo;t have teeth, which were removed when she was a child. This psychologically affected her.\u0026rdquo; (P002_42 year-old-Female-dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAnother patient also revealed similar insights indicating:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They said it has been a while without having teeth and they just want to look younger and more beautiful in order to prepare a date. I have taken long without going for a date\u0026rdquo; (P007_27 year-old_Male-dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Ninety percent of patients want esthetics and beauty, while a small percentage will consider other factors like eating well\u0026rdquo; (P004_33 year-old_Male-dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eA few participants narrated that some patients have the desire to even look better than they used to look before they lost their teeth. They have a belief that dental practitioners can fabricate the dentures and make them look much better than they used to look. Other patients seek services to restore their teeth that look exactly like their lost ones.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;They come with a lot of expectations in that someone would want you to place teeth that exactly look like what they had lost. They will expect to function normally like the way they used to speak. They would expect the complete dentures to be a permanent replacement of teeth\u0026hellip; they expect them to be normal natural teeth. Additionally, they don\u0026rsquo;t expect them to be too costly so in the end when you tell them how much each will cost, they will be shocked and start asking you whether they will be like their natural teeth\u0026rdquo; (P003_43 year-old_Male_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eIn preference, some of the patients do not expect to receive removable dentures, but rather, they expect to receive fixed dentures that are permanent. Besides, some patients expect to spend very little time at the clinic. Some health workers attributed the patients\u0026rsquo; high expectations to limited knowledge about the denture fabrication procedures.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e8. Handling or meeting patient expectations\u003c/h2\u003e \u003cp\u003eGiven the dental practitioners\u0026rsquo; observation that most patients come with high expectations due to the limited knowledge about RCD fabrication, we asked about what the dental practitioners do in return to manage such expectations. We found that dental practitioners do explain to the patients in simple language for easy and quick comprehension.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;In most cases, we give them adequate information in simple language to alleviate the fears and also assure them that in the long run, they will get used to the denture\u0026rdquo; (P001_40 year-old_Male dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAlso, while explaining to the patients, the focus is put on detailed information that eliminates fears, for example, information about the dentures falling out, eating limitations, and replacing the exact natural dentition.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;We explain and assure the m that they can\u0026rsquo;t swallow the dentures and as long as the denture has been well made, it should not even fall out in public when they are speaking.\u003c/em\u003e We \u003cem\u003eexplain to them that their eating will be improved though with some limitations because there are things that they cannot eat like meat unless it is well cooked. Some ill-fitting dentures can cause ulcerations on the mucosa, especially in patients who have a flat alveolar ridge, the denture may fall out because it doesn\u0026rsquo;t have enough support to hold them. In the event that the denture causes wounds, we advise them to remove the denture from the mouth and apply medication for a few days to allow the wound to heal before putting back the denture\u0026rdquo; (P002_42 year-old_Female_dental surgeon).\u003c/em\u003e\u003c/p\u003e \u003cp\u003eTo dental practitioners, comprehensive counseling is very key in handling patients\u0026rsquo; high expectations.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;When the patients come, I will have to counsel them that what they are going to get is not going to be like their natural teeth. It is usually good if the practitioner has some samples of dentures, which they can show them how they look like and what they are expecting to happen including any discomfort\u0026rdquo; (P003_43-year_Male_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eAlso, handling patients\u0026rsquo; expectations is dependent on the fears that a patient presents. It is done while emphasizing counseling and revealing denture fabrication procedures. The patients are told about the consequences of having the dentures, especially the types of food they are not likely to eat, how to clean them, and subsequent adjustments. They are also guided on proper ways of care for the dentures, especially by avoiding risky behaviors like opening bottle tops.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Of course how we counteract the fears of the patients depends on individual client; take an example if somebody came fearing the adverse effect of cancer, you counsel him/her with assurance that dentures do not cause the same. So it\u0026rsquo;s basically about counseling a client and giving him/her confidence that what s/he is going to get will be good for him or her\u0026rdquo; (P004_33 year-old_Male_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;Yeah, first of all, me personally, I normally tell them that don\u0026rsquo;t expect me to be so perfect like God. I can only do my best to improve the quality of your situation, but I don\u0026rsquo;t believe that I can completely eliminate it\u0026rdquo; (P021_45-year-old_Male_Dental Surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Giving detailed explanations to the patients helps to reassure them of what it means to have a denture, but also to get patients to know how to manage and care for their dentures. This is very critical to prepare the patients to overcome their fears and high expectations.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003e9. Challenges faced by health workers while offering denture fabrication services\u003c/h2\u003e \u003cp\u003eParticipants revealed that they experienced a lot of practical and knowledge-related challenges. These varied from limited resources, managing too many patients\u0026rsquo; expectations and complaints, limited knowledge about denture fabrication among practitioners, and anxiety among patients to mention but a few. Regarding, patients presenting with so many complaints about any form of pain or discomfort they felt even when it has nothing to do with the denture fabrication procedures as revealed by one of the participants. Other challenges were related to resource limitations. It was revealed that the process requires a lot of trays and sometimes different designs, yet they are in most cases very limited. Equally, some dental practitioners reported having experienced the challenge of working with inexperienced staff who are not well-trained in delivering complete denture fabrication. To them, this hinders the delivery of quality services in the process of denture fabrication. One of the health workers noted this to be a very big gap in the professional service:\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;There is a big gap in the lower cadres who are not formally taught about complete dentures, but yet, they are treating patients with complete dentures, which has messed up the quality, the professionalism of the whole process\u0026rdquo; (P001_40 year-old_Male_dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003e Another participant also revealed the incompetent nature of some health workers showing a gap between what is being practiced and what they were taught in school about the bite registration process.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;A recent scenario was where I had a technician coming in to do all the different steps of denture fabrication and my major problem was when he was doing bite registration, especially in a patient whose teeth had malalignment. The patient had two teeth in the upper and one supra erupted tooth in the lower jaw`AQRRRRRR6, which indicated the bite registration was very poor based on what I learned in school\u0026rdquo; (P002_42 year-old_Female-dental surgeon).\u003c/em\u003e \u003c/p\u003e \u003cp\u003eSome dental practitioners are reported to have experienced challenges related to patients who fear the procedures and are tense, which sometimes leads to poor positioning and eventually poor impressions. One of the participants revealed that when the patient is not relaxed, it becomes hard to make a proper impression.\u003c/p\u003e \u003cp\u003e \u003cem\u003e\u0026ldquo;You want to take the impression, but the patient is not relaxed or is tensed. If you tell them to bite in centric occlusion on occlusal bite block, they can give you different bites to the extent that you always fail in getting accurate parameters or exact measurements\u0026rdquo;\u003c/em\u003e \u003cb\u003e(\u003c/b\u003e\u003cem\u003eP003_43 year-old_Male_dental surgeon).\u003c/em\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study was cross-sectional employing a qualitative approach using purposive sampling to explore the experiences and perspectives of dental clinicians and technologists in order to provide insights into their challenges regarding RCD fabrication services in Makerere University Dental Hospital in Uganda. In-depth interviews were chosen as the method of data collection to gather rich and context-specific perspectives from participants so as to generate findings that could be used to formulate strategic planning in the treatment of edentulous patients and the training of dental students. To our knowledge, there was no published information regarding the experiences and perspectives of dental clinicians and technologists in RCD fabrication services for Ugandan edentulous patients. The present study established the baseline data of the experiences and perspectives of RCD fabrication services among dental clinicians and technologists that could be used for related future studies. Additionally, the present findings will inform policymakers in strategic planning and reviewing existing guidelines [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] in fabricating RCDs that are suitable for Ugandan edentulous patients. Several aspects of the RCD fabrication process such as prior assessments, preparation, benefits, worries/fears and expectations of the patients, and obstacles experienced by dental practitioners are highlighted by the themes in the present study.\u003c/p\u003e \u003cp\u003eWhile demonstrating that knowing the patient's unique demands like ORB height, denture retention, esthetics and state of oral health is essential before beginning the complete denture construction process, our findings are consistent with those of other studies [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. It is worth noting that since good treatment planning has an impact on the process outcomes, dental clinicians and technologists must perform comprehensive assessments of patient\u0026rsquo;s oral hygiene, dental impressions, and radiographic evaluations.\u003c/p\u003e \u003cp\u003eIn support of previous studies [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e], the present study discovered that effective communication and patient education are essential for preparing individual patients for the denture fabrication process. Therefore, beyond verbal and implied consent, which were sometimes accepted by patients, clinicians and technologists need to engage patients in a thorough consenting process to aid informed decision-making [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This can be through explaining the steps involved, potential benefits and risks, and expected outcomes of denture treatment [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. After all, obtaining informed consent ensures that patients understand the nature of the procedure, their role in the treatment process, and the expected outcomes, thus promoting patient satisfaction and adherence to treatment and denture management plans [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study showed that RCD provides several advantages to edentulous patients, including enhanced masticatory function, self-esteem, and general quality of life. This finding was in line with other authors [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] who have found comparable results like complete dentures being able to improve speech, making chewing and digestion easier, increasing self-confidence, and improving social relations by restoring oral function and beauty. Acknowledging these advantages is essential to encouraging patients to seek denture care and follow maintenance and post-treatment guidelines [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. For complete dentures to be fabricated and fitted successfully, ideal vertical and occlusal dimensions must be achieved. Evaluating aspects including patient comfort, phonetics, occlusal stability, and face aesthetics are necessary for accurate height measurement [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. To guarantee appropriate denture aesthetics, function, and stability, dental professionals and technologists must take into account patient preferences, unique anatomical variations, and functional requirements.\u003c/p\u003e \u003cp\u003eThe present study showed that patients were sometimes afraid of the RCD fabrication process for a variety of reasons, such as pain, discomfort, expense, and perceived functional or cosmetic constraints. Therefore, effective communication, empathy, and patient-centered treatment are necessary to address these issues [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. In a similar vein, other studies [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] ascertained that to allay concerns and improve patient satisfaction and compliance, clinicians and technologists must pay attention to patients' fears and anxieties, and offer comfort, knowledge, and support throughout treatment. Additionally, providing individualized and patient-centered treatment requires an awareness of patients' expectations and reasons for seeking denture fabrication [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Dentures may be desired by patients to improve their quality of life, relieve discomfort, improve appearance, or restore oral function [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe present study revealed mutual understanding and satisfaction of dental clinicians and technologists connected to treatment goals of patients' expectations, preferences and values in support Of previous findings [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Mericske-Stern [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] revealed that health professionals need to foster a collaborative and multidisciplinary approach that involves clear communication, shared decision-making ongoing feedback and evaluation because patients come to them with a variety of expectations. Furthermore, Sudheer and Vivekananda [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] reported that to achieve the best results, dental technicians and clinicians must therefore customize treatment plans to each patient's needs and preferences, answering any concerns and changing the course of action as needed. It is important to manage patient expectations by informing patients about the benefits and limitations of denture therapy, encouraging reasonable expectations and offering continuing support and direction to improve patient outcomes. However, when offering denture fabrication services, dental professionals may run into several obstacles, such as a lack of resources, technological difficulties, scheduling conflicts and patient-related issues including non-compliance or irrational expectations [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. To overcome these obstacles, creative service delivery methods, professional development, and organizational support are needed [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Patel et al. [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] advised that partnerships with pertinent stakeholders and community resources together with cooperative efforts by dental practitioners, technicians, and support personnel can assist remove obstacles and improve the caliber and accessibility of denture fabrication services.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe findings of the present study provided valuable insights into the experiences and perspectives of dental clinicians and technologists in managing patients with complete dentures. However, the study revealed a knowledge gap about complete denture fabrication and a lack of local contextualized guidelines in a low-income country, Uganda due to reliance on international guidelines [\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e]. Therefore, future studies need to be conducted in different health facilities in the country to improve patient experience of RCDs, consenting processes, and reviews of dental practitioners\u0026rsquo; practices to inform the formulation of local policy guidelines about RCD fabrication as well as the inclusion of practical learning of RCD fabrication amongst dental students.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRecommendations.\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003ePolicymakers should formulate local guidelines based on contextual factors and align them with international guidelines.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eContinuous professional development should be done among dental professionals through offering further training and inclusion of practical removable complete denture fabrication in the curricula of dental students.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePatient education programs should be introduced to inform the general public about removable complete denture fabrication to solve fears and anxiety.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eDental professionals should offer detailed explanations to patients without reservation for them to get detailed information that would enable them to decide about having a complete denture.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eSocial workers should be employed in dental clinics to manage patient fears and anxiety before and after completing denture therapy.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eRegular reviews and assessments of dental practitioners' practices should be conducted to ensure adherence to evolving best practices. These reviews can inform ongoing education initiatives and contribute to the continuous improvement of dental care quality.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Clinical Practice\u003c/strong\u003e:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eAligning local practices with international guidelines: Dental practitioners mentioned that they follow international guidelines, but sometimes work based on the patient\u0026rsquo;s characteristics. This highlights the need for aligning the practice of working based on patient characteristics to international guidelines such that they do what is recommended and stay updated on global best practices. Dental professionals should prioritize ongoing training to align their clinical practices with the latest evidence-based guidelines. Also, emphasis should be put on the development of the local guidelines and including complete denture fabrication in the curricula for dental students.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eInformed consent\u0026nbsp;practices: While obtaining patient consent is a standard practice, the revelation that some practitioners may conceal information for motivational purposes raises ethical concerns. Dental practitioners should uphold transparent and comprehensive informed consent practices, providing patients with all necessary information to make informed decisions about their dental care.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eEffective communication with patients: Recognizing the impact of patient expectations and fears on the denture fabrication process, dental practitioners should prioritize effective communication. This involves not only managing patient expectations but also addressing concerns and fears through detailed and understandable explanations, particularly in layman's language.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eImplications for Future Research\u003c/strong\u003e:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eEthical considerations in informed consent: Future research should explore the ethical dimensions of informed consent in RCD fabrication. Investigating the extent to which information is sometimes concealed and its impact on patient decision-making will contribute to the development of clearer ethical guidelines for practitioners.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eResearch with patients: Further studies should consider looking at the patient experience of RCD fabrication to compare it with dental professional\u0026rsquo;s experiences.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePatient education interventions: Research initiatives should focus on developing and evaluating interventions to enhance patient education about the RCD fabrication process. This includes assessing the effectiveness of educational materials, workshops, or informational sessions in bridging the knowledge gap and managing patient expectations.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eProfessional development for dental workers: Given the challenges faced by dental surgeons and technologists, research should investigate strategies to address knowledge gaps within the dental workforce. Identifying effective professional development programs can contribute to improved competency and confidence among dental professionals.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003ePsycho-social aspects of denture fabrication: Future research could delve deeper into the psycho-social aspects of denture fabrication, exploring the psychological impact of patient expectations and fears. This includes understanding how addressing these aspects contributes to overall patient satisfaction and well-being.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eLimitations of the Study\u003c/strong\u003e:\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cp\u003eThis was a qualitative study with a small sample size and from one health facility. Generalizing the results to a broader population may require caution, and future research should aim for more diverse participant representation and use mixed-method studies.\u003c/p\u003e\n\u003c/li\u003e\n\u003cli\u003e\n\u003cp\u003eThe study may not have fully captured contextual factors influencing clinical practices like organizational or cultural factors on denture fabrication approaches in order to provide a more comprehensive understanding.\u003c/p\u003e\n\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eORB\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eOcclusal rim block\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eRCD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRemovable complete denture\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval of the protocol was obtained from the Makerere University School of Health Sciences Research Ethics Committee (Reference Number: MAKSHSREC-2023-486) as well as the Uganda National Council for Science and Technology (Reference Number: HS3092ES). Permission to carry out the study was obtained from the administration of Makerere University Dental Hospital. Written informed consent was obtained from all the participants who took part in the study. The purpose of the study was explained to the participants and their participation was\u0026nbsp;voluntary. Their agreement to participate in the study did not waive their rights in any way and this was in accordance with the Helsinki Declaration\u0026nbsp;(World Medical Association, 2013).\u0026nbsp;All the data collected were kept securely in a cabinet under lock and key and only accessible to the investigator.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eData sources are available on request. The request can be sent to the corresponding author at [email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis\u0026nbsp;research\u0026nbsp;was\u0026nbsp;supported\u0026nbsp;by the Government of Uganda through the Makerere University Research and Innovations Fund (grant number MAK-RIF\u0026nbsp;ROUND 5, 2023-2024).\u0026nbsp;The views expressed herein are those of the authors and do not necessarily represent the views of the Government of Uganda, Makerere University, or the MAK-RIF secretariat.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDN, IO, MA, GB, and CMR participated in the conception of the study, study design, data analysis, and manuscript preparation. DN and GB participated in data collection. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors are grateful to the\u0026nbsp;Government of Uganda through the Makerere University Research and Innovations Fund, the MAK-RIF secretariat for supporting this study, and\u0026nbsp;participants for their willingness to participate in the study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDN Male PhD student (UCN), Principal Dental Technologist BSc.DT (Mak), MSc. (Cardiffmet-UK), Pg.Med. Edu, MAcadMEd (USW-UK), Msc. Med. Edu, (USW-UK).\u003c/p\u003e\n\u003cp\u003eCMR Male Associate Professor BDS (Mak), PhD (UOB-Norway).\u003c/p\u003e\n\u003cp\u003eIO Male Senior Lecturer BDS (Mak),\u0026nbsp;MPH (UON-Kenya), PhD (UOB-Norway).\u003c/p\u003e\n\u003cp\u003eEM Male Principal Dental Technologist Bsc.DT (Mak), Msc.Health Services Research (Mak)\u003c/p\u003e\n\u003cp\u003eGB Male Researcher BA (Mak), MHsc.Biothetic (Mak), PhD student (Mak).\u003c/p\u003e\n\u003cp\u003eMA Male Researcher BA, MA (Mak).\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eClark WA, Brazile B, Matthews D, Solares J, De Kok IJ. A comparison of conventionally versus digitally fabricated denture outcomes in a university dental clinic. J Prosthodont. 2021;30(1):47\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiranda BB, Dos Santos MB, Marchini L. Patients\u0026rsquo; perceptions of benefits and risks of complete denture therapy. J Prosthodont. 2014;23(7):515\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCarlsson GE, Omar R. The future of complete dentures in oral rehabilitation. A critical review. J Rehabil. 2010;37(2):143\u0026ndash;56.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSoltanzadeh P, Suprono MS, Kattadiyil MT, Goodacre C, Gregorius W. An in vitro investigation of accuracy and fit of conventional and CAD/CAM removable partial denture frameworks. J Prosthodont. 2019;28(5):547\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaragliano-Muniz P, Kukucka ED. Incorporating digital dentures into clinical practice: flexible workflows and improved clinical outcomes. J Prosthodont. 2021;30(S2):125\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinmassl PA, Wiedemair V, Huck C, Klaunzer F, Steinmassl O, Grunert I, Dumfahrt H. Do CAD/CAM dentures really release less monomer than conventional dentures? Clin Oral Invest. 2017;21:1697\u0026ndash;705.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanazawa M, Inokoshi M, Minakuchi S, Ohbayashi N. Trial of a CAD/CAM system for fabricating complete dentures. Dent Mater J. 2011;30(1):93\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSteinmassl O, Dumfahrt H, Grunert I, Steinmassl PA. CAD/CAM produces dentures with improved fit. Clin Oral Invest. 2018;22:2829\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePrakash P, Singh K, Bahri R, Bhandari SK. Utility versus futility of facebow in the fabrication of complete dentures: A systematic review. J Indian Prosthodontic Soc. 2020;20(3):237\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health. Patient's Rights and Responsibilities Charter. 2019 June. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://library.health.go.ug/sites/default/files/resources/Final%20copy%20of%20the%20PATIENT%20RIGHTS%20%26%20RESPONSIBILITY%20CHARTER.pdf\u003c/span\u003e\u003cspan address=\"http://library.health.go.ug/sites/default/files/resources/Final%20copy%20of%20the%20PATIENT%20RIGHTS%20%26%20RESPONSIBILITY%20CHARTER.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Accessed 20th Feb 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE. 2020;15(5):e0232076.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHennink M, Kaiser BN. Sample sizes for saturation in qualitative research: A systematic review of empirical tests. Soc Sci Med. 2022;292:114523.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBraun V, Clarke V. Using thematic analysis in psychology. Qualitative Res Psychol. 2006;3(2):77\u0026ndash;101.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Medical Association. Declaration of Helsinki: Ethical principles for medical research involving human subjects. JAMA. 2013;310(20):2191\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMubaraki MQ, Moaleem MM, Alzahrani AH, Shariff M, Alqahtani SM, Porwal A, Al-Sanabani FA, Bhandi S, Tribst JP, Heboyan A, Patil S. Assessment of conventionally and digitally fabricated complete dentures: A comprehensive review. Materials. 2022;15(11):3868.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChiramana S, Ashok K, Examination. Diagnosis and Treatment Planning for Complete Denture Therapy\u0026ndash;A Review. 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J Pak Med Assoc. 2023;73(10):2029\u0026ndash;35.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarvell BW, Clark RK. The physical mechanisms of complete denture retention. Br Dent J. 2000;189(5):248\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSudheer A, Reddy GV, Reddy G. Behavior shaping of complete denture patient: a theoretical approach. J Contemp Dent Pract. 2012;13(2):246\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAnadioti E, Musharbash L, Blatz MB, Papavasiliou G, Kamposiora P. 3D printed complete removable dental prostheses: A narrative review. BMC Oral Health. 2020;20:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePatel J, Jablonski RY, Morrow LA. Complete dentures: an update on clinical assessment and management: part 1. Br Dent J. 2018;225(8):707\u0026ndash;14.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Complete denture therapy, Computer-aided design, Computer-aided manufacturing, Dental technologists, Dental clinicians","lastPublishedDoi":"10.21203/rs.3.rs-4362028/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4362028/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eGlobally, there is growing concern regarding mouth sores, occlusion, cost, ridge resorption, and retention, in the delivery of removable complete dentures (RCDs) fabrication services brought about by the aging of the population and poor oral healthcare. However, there is limited literature about the experiences of dental clinicians and technologists in handling removable complete denture fabrication. The available literature mainly focuses on the process of removable complete denture fabrication in general with less emphasis on the experiences of technologists and clinicians in removable complete denture fabrication. This study aimed to explore dental clinicians’ and technologists’ experiences and perspectives on removable complete denture fabrication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003eThe study employed a qualitative design, 25 in-depth interviews were conducted with dental clinicians and technologists in Makerere University Dental Hospital. Both practicing dental technologists and clinicians were purposively selected after providing written informed consent. Interviews’ audios were transcribed verbatim, coded in Nvivo 14 and data were analyzed thematically.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Findings revealed that dental practitioners mainly referred to or followed international guidelines during removable complete denture fabrication. Clinical and socio-demographic assessments like age, oral hygiene, ridge level, underlying health conditions, and mental stability of the patient were done by dental clinicians before removable complete denture fabrication. Dental technologists and clinicians mentioned patients having a lot of expectations like looking the way they used to be before losing their teeth and hoping to get their natural teeth back, being able to eat well/everything, improving physical appearance, and having permanent teeth. However, the patients also had fears and concerns about discomfort, and some worried that they would be given teeth for the dead whites or swallowing the dentures while asleep, eating, or kissing.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e: The study revealed knowledge gaps about removable complete denture fabrication and a lack of local contextualized guidelines in low and middle-income countries due to reliance on international guidelines.\u003c/p\u003e","manuscriptTitle":"“They expect you to give teeth like God, which is very hard”: Dental Clinicians’ and Technologists’ Experiences and Perspectives on Removable Complete Denture Fabrication Services in Makerere University Dental Hospital, Uganda.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-05-14 12:22:45","doi":"10.21203/rs.3.rs-4362028/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorAssigned","content":"","date":"2024-05-07T15:34:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-07T15:34:54+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2024-05-03T05:18:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f9e9efa2-a783-4bba-b522-8d0d66d3c289","owner":[],"postedDate":"May 14th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2024-06-08T06:22:04+00:00","versionOfRecord":[],"versionCreatedAt":"2024-05-14 12:22:45","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4362028","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4362028","identity":"rs-4362028","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}