An update on orthodontic manpower in ireland

There has been considerable debate in Europe over the past few years on manpower requirements in orthodontics. In some countries today the need for orthodontic care cannot be accommodated due to lack of professional manpower whereas in others a surplus of orthodontic treatment facilities exists. The aim of the present study was to establish a baseline for orthodontic demographics in the Republic of Ireland. The number of orthodontists currently practising in Ireland was identified together with the number of Irish graduates currently on training programmes. Population figures were obtained from the Central Statistics Office. The orthodontic manpower situation has altered dramatically in the Republic of Ireland over the past 20 years. The number of 12-year-olds per orthodontist has reduced over the past 18 years from 2773 in 1980 to 890 in 1998. The age profile of the orthodontists presently practising in Ireland is low with an expected retirement over the next 20 years of only 28 of the 69 orthodontists identified. This study provides baseline information on orthodontic manpower in Ireland, and will facilitate Ireland's participation in similar or comparative studies in the future.     

An Update on Orthodontic Manpower in Ireland

Abstract

There has been considerable debate in Europe over the past few years on manpower requirements in orthodontics. In some countries today the need for orthodontic care cannot be accommodated due to lack of professional manpower whereas in others a surplus of orthodontic treatment facilities exists. The aim of the present study was to establish a baseline for orthodontic demographics in the Republic of Ireland.

The number of orthodontists currently practising in Ireland was identified together with the number of Irish graduates currently on training programmes. Population figures were obtained from the Central Statistics Office.

The orthodontic manpower situation has altered dramatically in the Republic of Ireland over the past 20 years. The number of 12-year-olds per orthodontist has reduced over the past 18 years from 2773 in 1980 to 890 in 1998. The age profile of the orthodontists presently practising in Ireland is low with an expected retirement over the next 20 years of only 28 of the 69 orthodontists identified.

This study provides baseline information on orthodontic manpower in Ireland, and will facilitate Ireland's participation in similar or comparative studies in the future.     

Early screening for orthodontic treatment Differences in assessments made by a consultant orthodontist and three public health dentists

The aim of the present study was to compare the differences in the assessments of occlusal and functional features, the need for and timing of orthodontic treatment and the complexity of treatment made by a consultant orthodontist and three public health dentists. The data comprised the examinations of 260 children aged 7–8 yr (87% of total age group of the community) attending the first grade of primary school in a medium-sized town in eastern Finland. The examinations were carried out according to agreed criteria. The main indications for treatment were Class II malocclusion, lateral crossbitc and crowding. When assessing treatment need, agreement between the orthodontist and the three dentists was fairly good (agreement in 69%, Kappa statistic 0.51), sensitivity for each dentist ranged from 0.86 to 0.97 and specificity from 0.72 to 0.92. The agreement on the timing of treatment was poor (agreement in 49%, Kappa statistic 0.18). In most cases of disagreement, the dentists would begin the treatment earlier than the orthodontist. The agreement on the complexity of treatment was rather poor (agreement in 61%, Kappa statistic 0.22). In most cases of disagreement, the treatment was regarded as more complex by the orthodontist than by the dentists. When dentists work with a consultant orthodontist, it seems justified to have the dentist screen the children at the age of 7–8 yr for early orthodontic treatment, but the orthodontist should assess the timing and complexity of treatment.     

Orthodontic preparation for orthognathic surgery: how long does it take and why? A retrospective study

We investigated the duration of pre-operative orthodontic treatment of patients who had combined orthodontic and orthognathic treatment and examined the variables that influenced this. Records of patients who had undergone such treatment in the past 5 years were collected (n=65) from three consultant orthodontists and one Senior Specialist Registrar/Fixed Term Training Appointment (FTTA). The number of days from placement of the first active orthodontic component to the day that final planning impressions were taken was used to calculate the duration of treatment before the patient was ready for operation. The variables investigated were: sex, age, malocclusion, extractions (excluding third molars), and the clinician. The median duration of pre-operative treatment was 17 months (range 7-47). Only the orthodontist appeared to affect this duration, but this requires further investigation as it may merely reflect variation in other factors such as compliance. We conclude that patients should be informed that the pre-operative phase may last 12-24 months.     

Patients’ and parents’ expectations of orthodontic treatment

Abstract

Objective: To investigate the expectations of children and their primary care-givers towards orthodontic treatment and to compare the results with those of a UK sample.

Design: A questionnaire survey of children and their primary care-givers attending for their first consultation.

Setting: The Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands.

Subjects and methods: A total of 168 subjects (84 patients and 84 parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and parents and differences between boys and girls were examined using parametric statistical methods. The data from the Dutch sample were compared with a similar UK sample.

Results: Patients and parents shared similar expectations of orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with orthodontic treatment.

Conclusions: Since the expectations of patients and their parents differ on several aspects, effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis that Dutch patients’ and parents’ expectations of orthodontic treatment differ from the expectations of English patients and parents was supported.     

Psychological support for orthognathic patients -- what do orthodontists want?

AIMS: (1) To evaluate consultant orthodontist opinion on referral of orthognathic patients to a liaison psychiatrist or psychologist and (2) To investigate the value of training orthodontic specialists in recognition of patients with psychological profiles that might affect orthognathic outcome. DESIGN: Questionnaire-based study. SUBJECTS AND METHODS: A structured questionnaire was distributed to all consultant orthodontists in the UK. RESULTS: Approximately 40% of consultants thought that up to 10% of their orthognathic patients would benefit from psychological assessment by appropriately trained personnel. Twenty per cent of consultants were not certain what proportion of their patients would benefit from referral and over half the respondents said they do not refer any orthognathic patients for assessment. The most common reasons for referral were past/current psychiatric history (36%), unrealistic expectations (32%), 'gut instinct' (14%), no significant clinical problem (13%). Reasons not to refer were: nobody to refer to (30.5%), fear of patient reacting badly (15.8%), not sure who to refer to (14.7%), response from mental health team not useful (12.4%), waiting list too long (9.6%). The majority of clinicians felt they would benefit from training in this field (84.7%), as over 80% reported no teaching or training in psychological assessment/management. CONCLUSIONS: Although we have no evidence to prove that interdisciplinary care is better for patients, clinical experience and reports from clinicians working in large centres, tells us there are probable advantages. The development of a training programme for both orthodontists and mental health teams would seem to be beneficial for both clinicians and patients.     

口腔正畸医生诊疗行为与患者治疗满意度的相关性研究

目的:探讨口腔正畸医生诊疗行为与患者治疗满意度两者之间的相互关系。方法:选取门诊410名口腔正畸患者,采用“口腔医生行为评价量表”,口腔治疗满意度量表进行问卷调查,并分别按照性别、年龄和疗程进行分组比较。对获得的数据使用SPSS18.0软件进行相关分析、逐步回归和秩和检验等统计分析。结果:口腔正畸医生诊疗行为与患者治疗满意度之间的相关系数R=0.750,有明显的统计学差异(P<0.05)。在24种口腔正畸医生诊疗行为中,有6种与患者治疗满意度产生明显的正相关(P<0.05)。女性较男性对治疗的满意程度更高(P<0.05)。青少年与成人之间以及在不同疗程间的满意度无显著性差异。结论:口腔正畸医生要规范自己的诊疗行为,加强与患者的沟通交流,提高患者治疗满意度。     

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骨性畸形在牙颌面畸形中占有相当高的比例,许多患者要通过正颌手术治疗.通常患者首诊到正畸科、颌面外科(整形外科、正颌外科).是否要行正颌手术治疗往往要取决于正畸科是否能通过代偿正畸治疗解决问题.若代偿矫治的结果能使患者和医生都满意,则患者可以避免更复杂、风险更大的正颌手术治疗;若患者的要求很高(可能是美观方面)或畸形非常严重,单纯正畸治疗已不能很好地解决患者对颌面部美观和功能恢复的要求,正颌手术就是惟一正确的选择、目前,在正畸和手术联合治疗开展比较好的医疗单位,是否手术以及手术如何设计几乎是由正畸医生主导.所以,这就要求正畸医生除了要全面掌握骨性牙颌面畸形术前、术后正畸治疗的理论和临床技能外,还要比较透彻地了解各种正颌手术术式、手术的最大限度、术前术后正畸、(牙合)板制作等方面知识.本文将结合临床实际,就几个正畸和手术联合治疗的重要问题进行讨论,重点在各种畸形正颌手术的术式选择策略,正畸和手术联合治疗的术前、术后正畸治疗原则等.     

Attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients

Abstract

Objective: To determine UK orthodontic consultants' attitudes to the provision of orthodontic advice to general dental practitioners by electronic means.

Design: Questionnaire.

Setting: Conducted by email and surface mail as appropriate in August 2000.

Subjects: All those UK NHS orthodontic consultants contained in the membership lists of the Consultant Orthodontists Group of the British Orthodontic Society.

Outcome: An 86 per cent response was obtained from the 231 consultants.

Results: More than half (58 per cent) of the consultants were interested in providing an electronic diagnostic service for the general dental practitioners in their locality and 70 per cent were in favour of further research into this possibility. Provided this was mediated through their GDP, only 26% would oppose consultant advice being given electronically from a centralized source.

Conclusions: A majority of UK orthodontic consultants support the concept of using teledentistry to make their advice more accessible to dentists and patients.     

Management of unerupted maxillary canines where no orthodontic treatment is planned; a survey of UK consultant opinion

Abstract

Objective: To assess current consultant opinion on the management of impacted maxillary canines in patients for whom no orthodontic treatment is planned.

Design: Questionnaire survey.

Method: Questionnaires were sent to all UK consultant orthodontists identified from the Consultant Orthodontists Group database. Follow-up questionnaires were sent to those who had not replied within 6 weeks. An overall response rate of 76% was achieved.

Results: Most consultants were in favor of intervention, with removal of the unerupted canine, although a significant minority suggested a conservative approach. Of the latter group, nearly all recommended radiographic monitoring, but there was little agreement regarding the frequency and duration of this. The risk of root resorption was stated to be the most important factor justifying monitoring.

Conclusions: Significant variation was found amongst UK consultant orthodontists with regard to the management of impacted canines, where orthodontic treatment was not planned. The clinical and radiographic features, which the respondents stated would influence their decision to remove or leave the canine, were not those that existing research suggests as being the primary risk factors. It is suggested that, once the patient has passed the peak age for initiation of resorption, a more conservative approach may be appropriate.     

Media advertising effects on consumer perception of orthodontic treatment quality

OBJECTIVE: To determine the effect of media advertising on consumer perception of orthodontic treatment quality. MATERIALS AND METHODS: A survey instrument was designed to evaluate factors influencing consumer selection of an orthodontist and consumer perception of different forms of media advertising (radio, television, newspaper, magazine, direct mail, and billboard) by orthodontic practices. The surveys were distributed by eight orthodontic offices in and around the Richmond, Virginia area. The survey return rate was 97%. RESULTS: Respondents most often cited dentist and patient referrals as how they learned of the orthodontic practices they visited (50% to 57%). A caring attitude and good practitioner reputation were the top reasons influencing actual selection of an orthodontist (53% and 49%, respectively). Of respondents, 14% to 24% felt that advertising orthodontists would offer a lower quality of care than nonadvertising orthodontists. Newspaper, magazine, and direct mail advertisements were viewed more favorably than radio, television, and billboard advertisements. Chi-square analyses revealed few statistically significant differences in perception between different income and education groups. CONCLUSIONS: The majority of patients do not perceive advertising to reflect poorly on the quality of orthodontic care. However, patients with different income and education levels perceive media advertising differently.     

Community orthodontic services: a local review

A review is presented of orthodontic treatment and working conditions in one area of the Community Dental Service over a typical period of one year (1984). Treatment totals, case load, working facilities and schedules are discussed, drawing comparisons with the hospital service and specialist practice and with previously published surveys of orthodontics in the community service. An estimate of the size of school population likely to support a full-time community orthodontist is made together with the number of referring practitioners. Comments are also made on the range of treatment provided, patients' attitudes, cooperation and such problems as missed appointments. A short section is devoted to actual timings of specific procedures in orthodontics, followed by discussion of the hospital attachment for community orthodontists, with some recommendations on working conditions and comments on career structure.     

Orthodontic therapy in the patient treated with cyclosporine

Cyclosporine is an immunosuppressive drug that is gaining widespread use in the treatment of a variety of disorders. Gingival hyperplasia, a common side effect of cyclosporine therapy, has significant implications for orthodontic treatment, especially as the drug becomes more widely used to treat diseases prevalent in adolescents. A 5-year study of a group of patients with type 1 diabetes who were receiving cyclosporine treatment revealed a series of findings that are of importance to the orthodontist, including the potential for orthodontic appliances to increase the severity of the induced gingival enlargement and the potential of the gingival hyperplasia to complicate orthodontic therapy. Guidelines to minimize the degree of cyclosporine-induced gingival enlargement in the orthodontic patient are suggested.     

The effect of orthodontic referral guidelines: a randomised controlled trial

OBJECTIVE: To develop and evaluate the effectiveness of referral guidelines for the referral of orthodontic patients to consultant and specialist practitioner orthodontists. DESIGN: Single centre randomised controlled trial with random allocation of referral guidelines for orthodontic treatment to general dental practitioners. SETTING: Hospital orthodontic departments and specialist orthodontic practices in Manchester and Stockport. SUBJECTS: General dental practitioners and the patients they referred for orthodontic treatment. MAIN OUTCOME MEASURE: Appropriateness of referral, defined as whether the patient was accepted for orthodontic treatment. RESULTS: The referral guidelines did not reduce the number of inappropriate referrals. CONCLUSIONS: Referral guidelines for orthodontic referrals did not influence the behaviour of the general dental practitioners. More research into the optimum methods of dissemination and implementation of referral guidelines for use in the general dental service is needed.     

The Senior Registar Orthodontic Group

The Consultant orthodontist is a key member of the orthodontic profession in the UK, and it is essential that trainee consultants receive the best education possible if orthodontics is to continue to advance as it has in recent years. The Senior Registar Orthodontic Group has an important role to play in that education.     

Orthodontic Treatment Following Orthognathic Surgery: How Long Does It Take and Why? A Retrospective Study

PURPOSE: This study was conducted to examine the duration of postoperative orthodontic treatment of patients who underwent combined orthodontic and orthognathic treatment and investigate factors that might influence this, to assess the strength of association between preoperative and postoperative orthodontic treatment duration, and to perform a retrospective power calculation to assess the likelihood of this study detecting a clinically significant (weeks) difference. PATIENTS AND METHODS: Records of patients who had undergone combined orthodontic and orthognathic treatment between 1998 and 2003 (n = 69) were obtained from 3 consultant orthodontists at 3 major hospitals in Leeds, UK. The duration of postoperative orthodontic treatment was calculated as the date of the operation to the date of fixed appliance removal. Variables investigated included patient age and gender, malocclusion, type of operation, presence of open bite, extractions (excluding third molars), hospital, operator, missed appointments/breakages and debonding, and retainer arrangements. RESULTS: The median duration of postoperative treatment was 7.5 months (range, 5 to 11 months). None of the variables clearly affected this duration; no correlation was found between preoperative and postoperative treatment times (r(s) = -.07; P > .05). A retrospective power calculation demonstrated a 57.5% likelihood of this study detecting a difference of 8 weeks between 2 groups. CONCLUSIONS: Patients should be informed that the postoperative orthodontic phase of combined orthognathic-orthodontic treatment may last approximately 5 to 11 months. No association was found between preoperative and postoperative treatment duration. Many more patients will have to be recruited to assess whether specific variables result in a clinically significant difference in treatment duration.     

医护人员行为对正畸患者满意度影响的调查分析

目的了解医护人员行为对正畸患者治疗满意度的影响,为临床工作提供参考。方法随机选取完成正畸治疗的200例患者,采用自行设计的调查表,在治疗后由同一名护士现场对正畸患者进行调查,记录相应的分值后进行统计学分析。结果医护人员行为与正畸患者治疗满意度相关（R=0．47）,其中“治疗前医生是否认真解释治疗的可能结果”与患者满意度存在线性相关关系（P〈0．05）,回归方程为Y=1．48＋0．34X4。结论临床医生治疗前应该与患者充分沟通,认真解释治疗可能出现的结果,与患者共同制定合适的治疗方案。