Do pediatric dentists practice the orthodontics they are taught?

PURPOSE: The purpose of this study was to determine whether the orthodontic treatment provided by pediatric dentists reflects the orthodontic training received in pediatric dental residency programs. METHODS: Five questions from a survey of the American Academy of Pediatric Dentistry (AAPD) diplomates in August 2002 and a survey of pediatric dental residency program directors in June 2002 were statistically analyzed to compare the orthodontic treatment provided by diplomates to that provided within pediatric dental residency programs. RESULTS: Patient populations differed financially between pediatric dental residencies and diplomates of the AAPD. Residents treated significantly more public assistance patients. The residents were more likely than diplomates to use most orthodontic appliances and treat most stages of dental development and most conditions/malocclusions with orthodontics. Diplomates anticipated a decrease in the amount of orthodontic treatment provided in the next 5 years, while program directors anticipated an increase. CONCLUSIONS: The majority of the orthodontic treatment provided by pediatric dental residents and diplomates was similar, although the residents were exposed to more diverse orthodontic treatment modalities than those used by diplomates. The residencies were also more likely than the diplomates to increase the amount of orthodontic treatment provided in the next 5 years.     

The provision of orthodontic services by general dental practitioners. 1. Methods and descriptive results

Information regarding orthodontic service provision by general dental practitioners in Australia is limited. The aim of this survey was to determine the amount and variety of orthodontic services provided by general dental practitioners in the Melbourne Statistical Division, Victoria, Australia. A random sample of 307 dentists drawn from the Victorian Dentists Register was surveyed by mailed questionnaire: 218 (71%) replied. Data were collected using a fortnight log. During this time 59 per cent of the dentists saw at least one orthodontic patient; one dentist saw 66 orthodontic patients. Removable orthodontic appliances were used by 35 per cent of the dentists and fixed orthodontic appliances by 18 per cent. Twenty-six per cent provided comprehensive orthodontic treatment, 22 per cent aligned incisors, and 21 per cent corrected anterior cross-bites. The general dental practitioners surveyed provided a wide range of preventive and interceptive orthodontic services to generally a small percentage of their patients.     

Orthodontists' views on indications for and timing of orthodontic treatment in Finnish public oral health care

The aim of this study was to analyse the variation in the views of Finnish orthodontists on the indications for orthodontic treatment, timing of orthodontic assessment, and treatment methods used. The views were elicited by a questionnaire that was sent to all 146 specialist orthodontists under 65 years of age living in Finland in 2001. The response rate was 57 per cent. The association between an orthodontist's experience and timing of treatment was tested by Fisher's exact test. Stepwise logistic regression analysis was used to estimate the association between the demographic characteristics of orthodontists and the tendency to start Class II division I treatment early. Most orthodontists recommended that the first assessment of occlusion should be carried out before 7 years of age. A crossbite was mentioned as the most frequent indication for treatment in the primary and early mixed dentition, and a severe Class II division I malocclusion with an increased overjet as the most frequent indication in the late mixed dentition. Most respondents preferred early treatment, but there was a wide variation in the choice of appliances and in the timing of treatment of malocclusions other than crossbite and Class II malocclusions. A quadhelix, headgear, and the eruption guidance appliance were the most frequently used appliances in early treatment, with fixed appliances being most frequently used during the late mixed and permanent dentition phase. Orthodontists working full time in municipal health centres tended to prefer early treatment more often than those working part-time or outside health centres. There was no statistically significant association between an orthodontist's experience and timing of Class II division I and Class III treatment (P = 0.142 and P = 0.296, respectively). The preference for an early start in Class II division I treatment might be related to differing professional decisions, but no explaining factors could be found in the regression analysis.     

The provision of orthodontic services by general dental practitioners. 2. Factors influencing variation in service provision

Previous work has shown that variations exist amongst general dental practitioners in the volume and type of orthodontic services provided, the type of orthodontic appliances used, and the objectives of the orthodontic treatment. The aims of this survey were to identify practitioner characteristics that account for variations in the level of orthodontic services provided and which distinguish providers and non-providers of orthodontic services. Multiple regression analysis revealed that four practitioner characteristics explained 41 per cent of the variance in the number of orthodontic patients treated. Dentists who treated more orthodontic patients: 1) treated more general practice patients; 2) frequently used multiple sources to keep up to date in orthodontics; 3) perceived their patient base to contain more children; and 4) were likely to have attended a Truitt course. Eleven variables best distinguished providers from non-providers of orthodontic treatment; 1, 2 and 3 above had the highest correlation with the discriminant function. The Null Hypothesis that selected characteristics of dentists providing orthodontic services were no different from those of dentists not providing orthodontic services was rejected. The provision of orthodontic services was associated with a higher level of continuing orthodontic education as well as treating more general practice patients, especially children.     

Provision of orthodontic care to adolescents in South Australia: The type, the provider, and the place of treatment

There are many pathways involving different providers and locations that individuals may take in obtaining orthodontic services. The aim of this study was to document the provision of orthodontic services and establish the pathways taken toward fixed orthodontic treatment by adolescents in South Australia. Data were collected on the use of orthodontic services by a cohort of adolescents enrolled in the School Dental Service at age 13 years and again at age 15 years. By age 15 years, 83.2 per cent of the adolescents had received orthodontic consultations, 27.3 per cent had received fixed orthodontic treatment and 41.4 per cent had received other forms of orthodontic treatment (extractions, space retainers or removable appliances). The majority of fixed orthodontic treatment was supplied by orthodontists in the private sector, while extractions and removable appliances were provided mainly by public sector general dentists. Most individuals used services in both the public and private sectors and the most frequent pathway taken by the adolescents receiving fixed orthodontic treatment involved consultation in both the public and private sectors, non-fixed orthodontic treatment in the public sector and fixed orthodontic treatment in the private sector. The findings indicate wide access to orthodontic consultation and a high uptake of fixed orthodontic treatment once the adolescent sought private sector orthodontic consultation. Orthodontic care was seen to be an interactive process between public sector general dentists and private sector orthodontists.     

Simple removable appliances to correct anterior and posterior crossbite in mixed dentition: Case report

Different techniques have been used to correct anterior and posterior crossbites in mixed dentition. This case report illustrates the treatment of anterior and unilateral posterior crossbites during the mixed dentition. The patient was a 9-year-old boy with a crossbite of the maxillary right permanent central incisor and a unilateral right posterior crossbite, both expressed by a functional shift in the sagittal and transverse dimensions. Two upper acrylic removable appliances, each with an expansion jackscrew, were used to correct the crossbites. The total active treatment time was 4 months; the treatment outcomes were successfully maintained for the subsequent 4 months. General and pediatric dentists, as well as orthodontists, may find this technique useful in managing crossbite cases of the mixed dentition and utilizing the discussion and illustrations for further clinical guidance.     

The delivery of orthodontic care in New Zealand. Part II: Analysis of a census of dentists

Part I of this study reported the level and distribution of the supply of specialist orthodontic services in New Zealand. This paper focuses on the amount and variety of orthodontic services supplied by dentists. A questionnaire sent to all dentists in New Zealand sought information on the amount and type of orthodontic treatment carried out between 1 July 1998 and 30 June 1999. The reply rate was 80.9 percent. The majority of dentists carried out some form of orthodontic treatment, predominantly of a minor nature. A small number provided significant amounts of treatment, both simple and complex. The majority of orthodontic treatment and the majority of comprehensive fixed-appliance treatment were undertaken by orthodontists. One-quarter of all orthodontic patients in New Zealand were treated by dentists, irrespective of the complexity of treatment. Nearly a fifth of all full fixed upper and lower appliances, and nearly a third of all single-arch fixed appliances were placed by dentists during the study period. In general, male dentists, dentists over the age of 40, those who had attended an orthodontic continuing education course in the previous 5 years, and those who referred fewer patients to an orthodontist carried out more procedures, including those of a complex nature; they also had a higher average active orthodontic patient load. Wanting to be more or less busy had little influence on the amount or complexity of treatment performed. Dentists in regions with a low supply of specialist orthodontic services provided more comprehensive fixed appliance treatment and had a higher orthodontic patient load. However, the presence or absence of an orthodontist in an urban area seemed to have little impact on the complexity of treatment or the orthodontic patient load of dentists. Despite fewer orthodontists in secondary and minor urban areas, dentists in these areas did not have a higher orthodontic patient load, but carried out a wider range of procedures and more complex procedures than those in main urban areas.     

Dental care for special needs patients: a survey of Texas pediatric dentists

The purpose of this study was to determine the amount of time Texas pediatric dentists spent, as both residents and in their professional position, in the treatment of special needs patients. In addition, an attempt was made to determine the dental services offered to these patients along with the barriers to obtaining care. A survey was mailed to the 334 members of the Texas Academy of Pediatric Dentistry. From the returned surveys (61.9% or 207/334) the following conclusions were drawn: 1) Most respondents had a significant portion of their training program devoted to special patient care, 2) Virtually all reported treating some special needs patients in their professional position, 3) Most provided conscious sedation and general anesthesia and adjuncts to behavior management for these patients, 4) Insufficient financial reimbursement was a major reason cited for not providing dental services to more of these patients.     

Patients with special health care needs in general and pediatric dental practices in Ontario

The objective of this study was to determine the involvement of Ontario's general and pediatric dentists in providing care to patients with special health care needs (PSHCNs). A questionnaire was developed and sent to a randomly selected sample of general dentists and to all pediatric dentists in Ontario; response rates were 52% and 90%, respectively. Most general dentists and all pediatric dentists reported that they provided a full range of dental services to PSHCNs. Most (80%) general dentists treat PSHCNs of all ages, whereas 60% of pediatric dentists report only treating PSHCNs up to the age of 18 years. A majority of both groups report treating PSHCNs whose dental care is paid through various government-funded programs. Most general dentists received training in the treatment of PSHCNs in undergraduate dental school, and 40% reported taking continuing education courses in this area. Most pediatric dentists received this training during their advanced dental specialty training, and 29% reported taking continuing education courses in this area. The results of this survey appear to demonstrate that general and pediatric dentists in Ontario provide a full range of dental services to PSHCNs, treat patients with a variety of disabilities and of all ages and are interested in pursuing continuing education that focuses on the delivery of dental care to PSHCNs. However, the results may be inaccurate because of question design flaws and responder bias among the 52% of surveyed general dentists who returned their questionnaires.     

Cost and productivity analysis of orthodontic care in Finland

Abstract– The aim of the study was to investigate the costs of orthodontic care provided for children and adolescents up to the age of 18 by municipal health centers in Finland, and to study the productivity of these services. The data were gathered by a questionnaire sent to all health centers; 96% responded. The majority of respondents estimated the share of orthodontic care as 10% of the total gross costs of dental care, given that 14% of all dental visits were for orthodontic reasons. To study the productivity in individual health centers, the output was measured by the estimated number of completely treated patients. The cost of orthodontic treatment per completely treated patient was, on average, FIM 7358, ranging from FIM 1299 to FIM 24 751. The strongest explanatory factor for the average total costs of orthodontic clinics was the number of general dentists with little experience in providing orthodontic treatment. Other explanatory factors were the number of orthodontists or experienced dentists, the percentage of orthodontic tasks performed by auxiliary personnel, and the timing of treatment. Savings might be obtained by devolving treatment to orthodontists or experienced dentists in-stead of to dentists with little orthodontic experience, and by starting treatment early. The estimated optimal size for an orthodontic clinic was found to be a unit with 830 completely treated patients per year, but most of the orthodontic clinics were in fact much smaller with, on average, 133 completely treated patients per year.     

Indication for and Frequency of Early Orthodontic Therapy or Interceptive Measures

The early treatment of nonskeletal and skeletal orthodontic anomalies in the deciduous and early mixed dentition is intended to prevent the development of pronounced anomalies in the late mixed and permanent dentition with the ultimate aim of reducing or even eliminating the need for later orthodontic treatment. There is a general consensus in the international literature that early therapy is indicated in cases of anterior and lateral crossbite and Class III malocclusion, and possibly for extreme forms of mandibular retrognathism (overjet > or =10 mm) and of open bite. However, evidence of the efficiency of early orthodontic measures is just as rare as studies providing serviceable information on the incidence of tooth malalignments and malocclusions in the deciduous and early mixed dentition, some of whose findings are in any case highly divergent. This makes it substantially more difficult to draw conclusions on the extent to which early orthodontic therapy may be indicated. In order to obtain information on the incidence of nonskeletal and skeletal orthodontic problems constituting a treatment need, 2326 first-year schoolchildren aged between 6 and 7 years were examined in Frankfurt am Main and in the Rural District of Offenbach. In only 14.7% of the children were no relevant orthodontic findings recorded. 77.2% displayed mild to severe dysgnathic symptoms, though without early orthodontic therapy being considered indicated. Treatment with orthodontic appliances was considered urgent for 187 of the children (8.04%). With 8.3% and 7.9% respectively, lateral and anterior crossbite were top of the list of anomalies with an urgent treatment need. Among the patients with lateral crossbite, the prognostically less favorable unilateral form was recorded approximately four times more often than the bilateral form. Markedly increased sagittal overjet > or =10 mm) was registered in only 1.4% of the children, and negative overjet (Class III) (with the exception of edge-to-edge bite) in 1.9%. Extreme anterior open bite > or =6 mm) was recorded in only two children (0.09%). In 19.6% of the children, a supporting zone was reduced in at least one quadrant, necessitating interceptive measures such as the insertion of a space maintainer or later orthodontic treatment (space opening or extraction therapy).     

Orthodontic treatment and referral patterns: A survey of pediatric dentists,general practitioners,and orthodontists

Objective

This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists.

Materials and methods

Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions.

Results

In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups.

Conclusions

The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.     

Parents' satisfaction with their child's orthodontic care: a comparison of orthodontists and pediatric dentists

PURPOSE: The purpose of this study was to compare the quality of orthodontic care between orthodontists and pediatric dentists when measured by parental satisfaction. METHODS: Six pediatric dentists and 5 orthodontists participated in the study. Quality of care was measured using the peer assessment rating (PAR) occlusal index, treatment duration, and parental satisfaction. Parental satisfaction was evaluated using a 25-item questionnaire measuring 3 dimensions: (1) treatment process; (2) psychosocial effects of treatment; and (3) treatment outcomes. The questionnaire items were scored on a scale of "strongly disagree" to "strongly agree." RESULTS: At baseline, no differences were seen in the gender, starting dentition, and permanent teeth extractions of patients treated by the orthodontist and pediatric dentists. Statistically significant differences were seen in patients': (1) pretreatment age; (2) race; (3) primary teeth extractions; (4) treatment stages; and (5) pre-PAR scores. No statistically significant differences between orthodontists and pediatric dentists were observed regarding overall parental satisfaction or the dimensions of satisfaction. These results did not change after controlling for potential confounding factors such as patient's age, gender, starting dentition, treatment stage, extraction recommendations, pre-PAR score, treatment duration, and percentage PAR reduction. CONCLUSIONS: The quality of orthodontic care, when measured by parental satisfaction, was similar between orthodontists and pediatric dentists. This indicates that, as far as parents are concerned, pediatric dentists performed orthodontic treatment to the same high standard as orthodontists.     

Prevalence of malocclusion traits and orthodontic treatment in a Finnish adult population

Objective The aim of the study was to examine the prevalence of malocclusion traits and the extent of orthodontic treatment in a Finnish adult population. Materials and methods The study population comprised subjects (n?=?1964) from the Northern Finland Birth Cohort 1966 living in the city of Oulu and within 100?km of it. A clinical oral and dental examination with registration of occlusion was carried out in 2012 in connection with a 46-year follow-up survey. Data on previous orthodontic treatment were collected based on a questionnaire. Results In the clinical examination, 39.5% of the subjects had at least one malocclusion trait. The most common malocclusion traits were lateral crossbite (17.9%), overbite?≥?6?mm (11.7%) and overjet?≥?6?mm (9.7%). Crossbite on the left premolars, negative overjet and increased overbite were found more frequently in men. The prevalence of malocclusion traits was at the same level in treated and untreated groups. Overall, 18.6% of the subjects had undergone orthodontic treatment. Women showed a significantly higher prevalence of orthodontic treatment. Conclusions The most common malocclusion trait in the present study was lateral crossbite. Significant male dominance in the prevalence of malocclusion was observed, which has not been reported earlier in Finland. Orthodontic treatment of malocclusion traits was more common among females in Northern Finland. This study indicates that orthodontic treatment provided in childhood was, on average, adequate in reducing malocclusion traits to the level observed in the general population.     

Anterior crossbite correction with fixed appliances in the adult dentition

Anterior crossbite in the adult dentition, if not corrected, can cause other functional problems for the patient. These adult patients can be treated quickly and with confidence by most general dentists with the use of pre-adjusted appliances and straight wire. This article presents a clinical picture of three cases involving anterior crossbite correction in the adult patient with the use of fixed appliances and an acrylic splint.     

Factors affecting the duration of orthodontic treatment in children. A retrospective study

Factors that affect the duration of orthodontic treatment in children were studied from treatment records, dental and cephalic radiographs, and dental plaster casts of a random sample of 93 orthodontic patients who were treated during the period 1983-1994 and were aged 7 to 13 years at the start of treatment. The duration of treatment and 15 variables describing the patients' age at the start of treatment, the gender distribution of the patients, the progress of treatment, the occlusal status, skeletal deviations, malocclusion classes (Angle), and patients' age at the start of treatment, were recorded. The data were analysed by means of analysis of variance, chi-square test, and multiple regression analysis. The mean treatment time was 2.9 years. The regression analysis revealed that the variations in sex variables, malocclusion class, patients' age at the start of treatment, type of appliances used, number of appliances used, number of missed appointments, and main additional diagnosis explained about 41% of variation in treatment time. Treatment of Class I and Class II/1 patients with combinations of fixed and removable appliances, early start, high number of appliances used, and high number of missed appointments prolonged the duration of treatment. Treatment of Class I patients with frontal crossbite was relatively short.     

Orthodontic training in pediatric dental residencies

The purpose of this study was to determine the amount and types of orthodontic training in pediatric dental residencies. A twenty-one-item survey was mailed to sixty directors of pediatric dental residencies. Follow-up surveys were sent to those who had not responded. Fifty-two surveys were returned for a response rate of 87 percent. Most programs provided forty-eight formal orthodontic course hours, one-half to one day of clinical orthodontic experience per week, and six to ten case starts for each resident. Most program directors anticipated this amount of experience would increase or stay the same in the future.Though most programs had an affiliated graduate orthodontic program, fewer than half of the programs had an orthodontist on faculty from the affiliated program (43 percent). As expected, orthodontic training varies with different program characteristics. The faculty members teaching orthodontics in pediatric dental residencies are often not from affiliated graduate orthodontic programs. Most program directors do not anticipate a decrease in the didactic or clinical components in the next five years.     

Orthodontics in 12-year old children. Demand,treatment motivating factors and treatment decisions

Ninety-three per cent of all 12-year old patients at a clinic in western Sweden accepted an invitation to take part in a dental examination in order to evaluate early orthodontic treatment. Treatment in the primary or mixed dentition periods should aim at creating normal craniofacial, occlusal and dental development and, if possible, at reducing the need for later, more complicated treatment. The treatment success was low regarding overjet correction but fairly good with regard to diagnosis and treatment of crossbite/forced occlusion, ectopic eruption and congenitally missing teeth. Whether correction of crossbite had reduced crowding was impossible to evaluate in this study. However, relatively few subjects with a history of crossbite correction desired alignment of teeth. The study confirmed earlier observations that TMD prevention is not a major motivating factor for orthodontic treatment. The majority of the children, including those desiring treatment, judged their dental appearance to be fairly average. The dentists more often than the children regarded the subjects' appearance to be better than average. Prediction of later orthodontic treatment, recorded at the age of 14 years, turned out to have a weak association to evaluation of aesthetics both by the children and the dentists. Nor did recording of TMD improve prediction. The study confirms earlier observations that discussions about orthodontic treatment on mainly aesthetic grounds ought to be postponed well into the permanent dentition period, and by attempting to avoid "making the normal abnormal".