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.     

A survey of undergraduate orthodontic training and orthodontic practices by general dental practitioners

PURPOSE of the STUDY: To assess satisfaction with undergraduate orthodontic training, the variety of treatments undertaken in general practice, practitioners' perceived competence in orthodontics and the level of interest in continuing education in orthodontics. DESIGN: Cross-sectional questionnaire-based study. MATERIALS and METHODS: A questionnaire was mailed to 520 general practitioners in Dublin, Kildare and Wicklow as listed in Irish Dental Council Register of Dentists 2003. RESULTS: Forty-six percent of dentists responded. More than half (54 per cent) of the respondents were satisfied with both academic and clinical aspects of undergraduate training. Twenty-nine percent regularly perform orthodontic treatment. Only 60 percent feel comfortable treating orthodontic emergencies. Over 70 percent have either already attended or aspire to attend further training in orthodontic diagnosis and interceptive orthodontics. CONCLUSIONS: Our study indicates that in the greater Dublin area, graduates (those qualified less than 10 years) are increasingly satisfied with undergraduate teaching. Orthodontic treatment is performed regularly in general dental practice with interceptive procedures most often carried out. While ability to deal with orthodontic emergencies is not universal, practitioners do appear confident to perform a variety of orthodontic procedures. Interest in continuing education in orthodontics is very high. Our study indicates that participation in continuing education in orthodontics appears to translate into greater provision of orthodontic care in general practice.     

Orthodontic treatment in general dental practice in South Africa

There is an increased demand for orthodontic treatment in South Africa and the general practitioner is showing increasing interest in implementing orthodontic treatment in private practice. The present study investigated the scope of orthodontics undertaken by the private practitioner in South Africa, in order to study the desirability of more comprehensive undergraduate training in orthodontics and continuing education for general practitioners. A questionnaire was completed by 1,012 dental practitioners. The data were analysed statistically by means of the SAS software. The results indicated that general practitioners are engaged in a wider range of orthodontic treatment modalities. The competence of the general practitioner to treat the spectrum of dental malocclusions and the ability of continuing education courses to produce "instant general-practitioner orthodontists", remains a cause for concern. Curricular restructuring requires realistic surveying of sociodemographics, including changes in birthrate and the need and demand for orthodontics in the unique South African situation, if it is to be the goal of the profession to strive for the highest standards. The educational institutions in South Africa should give attention to realistic orthodontic curricular restructuring in view of the changing dental treatment patterns currently being experienced in this country.     

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.     

Profile of orthodontic services provided in private practice by general practitioners and specialist orthodontists for an insured population

In Australia, the proportion, volume and type of orthodontic care provided by general practitioners and orthodontists are largely unknown. The overall objective of this study was to create a profile of orthodontic services provided by general practitioners and orthodontists for a cohort of insured patients using private practices in New South Wales, Australia, from 1st January 1992 to 31st December 1995. Data were derived from claims records submitted by members of a health insurance fund for rebates for fees paid to private practitioners for orthodontic services they received during the study period. Distribution of the volume and type of service provided by general practitioners and orthodontists was compared using the Chi-squared test. Statistical significance was taken at the 5 per cent level. Orthodontic services were provided predominantly by orthodontists (80%). Fixed orthodontic treatment was provided almost exclusively (91%) by orthodontists. The majority of removable appliance services was provided by general practitioners. Orthodontists provided more orthodontic services in the capital city and other metropolitan areas, whereas general practitioners provided more orthodontic services in rural areas. Orthodontists provided more services to members in the highest socio-economic group, whereas general practitioners provided more services to members in the lowest socio-economic group.     

An update in adult orthodontics

The number of adults undertaking fixed orthodontic treatment has grown significantly in recent years. Improved appliance aesthetics, treatment mechanics and social acceptability are some of the contributing factors involved in this increase. This article intends to discuss adult orthodontic treatment and the difficulties involved. It will then present the innovations in treatment modality that have made orthodontics more acceptable to adults and discuss appliance advances that have adjusted the treatment possibilities for adults. CLINICAL RELEVANCE: The general dental practitioner should be aware of the differences in adult and adolescent orthodontic treatment with the help of knowledge of innovations in aesthetics orthodontic appliances and treatment mechanics that have recently become available in orthodontics.     

Rural versus urban analysis of dental procedures provided to Virginia Medicaid recipients

PURPOSE: The purpose of this study was to report the distribution of procedures provided to Virginia Medicaid children by 3 types of dental providers in rural and urban areas. METHODS: Medicaid claims filed for dental patients less than 21 years old were obtained and analyzed for fiscal years 1994-1995. Dental providers were categorized according to their practice type: (1) general practice (GP); (2) pediatric (PD); and (3) public health (PH) dentists. Each type of practice was categorized as practicing in a metropolitan, urban, rural, or completely rural location and evaluated for percentages of preventive, diagnostic, and corrective services provided. RESULTS: Rural areas had a higher percentage of significant providers than did metropolitan or urban areas. General dentists performed more diagnostic and preventive but fewer corrective procedures than pediatric dentists. Pediatric dentists and general dentists in completely rural areas performed more corrective procedures than their counterparts in metropolitan or urban areas. CONCLUSIONS: General, pediatric, and public health dentists in metropolitan and urban areas perform slightly more diagnostic services and fewer corrective services than practitioners in more rural areas.     

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.     

A survey of undergraduate orthodontic education in 23 European countries

This paper reports on a survey of teaching contents and time allocation within the undergraduate orthodontic curriculum in European countries in 1997, and on whether or not these countries set a formal undergraduate examination in orthodontics. A questionnaire and an explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax when necessary. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 23 countries. They indicated that orthodontics was taught in all undergraduate curriculums of the countries surveyed. The number of hours in the undergraduate curriculum devoted to orthodontics was reported as varying from 135 to 500 hours with a mean of 245 hours. The time reported as allocated to theory, clinical practice, laboratory work, diagnosis, and treatment planning varied widely. In general, clinical practice and theory were reported as being allocated most curriculum hours, whilst diagnosis, laboratory work, and treatment planing were reported as receiving relatively less time. Removable appliances were reported to be taught in 22 of the 23 countries, functional appliances in 21 countries and fixed appliances in 17 countries. An undergraduate examination in orthodontics was reported by 20 countries. It was concluded that orthodontics occupies a small proportion of the undergraduate curriculum in dentistry in most countries, the emphasis is on theory and clinical work, and that removable appliances, functional appliances, and certain aspects of fixed appliances are taught in the majority of countries that responded to the questionnaire     

Biomechanics in lingual orthodontics: What the future holds

The field of orthodontics faced a few fundamental pivots since 1800. Edward Angle introduced a systematic approach to treating patients in 1899. Between 1920 and 2000, development of new orthodontic appliances as well as improvements in orthodontics education reshaped orthodontics. Digital technology has changed how orthodontists treat malocclusions in the last two decades. Specifically, advances in digital orthodontics introduced a paradigm shift in lingual orthodontics attracting more orthodontists especially recently graduated practitioners to offer lingual appliances. This review aimed to point out some of important biomechanical factors in lingual orthodontics and to delineate commonalities and contrasts of these factors in clear aligners and labial systems. Highlights of two work in-progress lingual systems were also discussed. One can reason that better understanding of the advantages and challenges associated with lingual systems especially in comparison to clear aligners and labial systems is essential to creating a fully customized orthodontic experience for patients.     

A Survey of Undergraduate Orthodontic Education in 23 European Countries

Abstract

This paper reports on a survey of teaching contents and time allocation within the undergraduate orthodontic curriculum in European countries in 1997, and on whether or not these countries set a formal undergraduate examination in orthodontics. A questionnaire and an explanatory letter were mailed to all members of the EURO-QUAL BIOMED II project. Answers were validated during a meeting of project participants and by fax when necessary. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 23 countries. They indicated that orthodontics was taught in all undergraduate curriculums of the countries surveyed. The number of hours in the undergraduate curriculum devoted to orthodontics was reported as varying from 135 to 500 hours with a mean of 245 hours. The time reported as allocated to theory, clinical practice, laboratory work, diagnosis, and treatment planning varied widely. In general, clinical practice and theory were reported as being allocated most curriculum hours, whilst diagnosis, laboratory work, and treatment planing were reported as receiving relatively less time. Removable appliances were reported to be taught in 22 of the 23 countries, functional appliances in 21 countries and fixed appliances in 17 countries. An undergraduate examination in orthodontics was reported by 20 countries. It was concluded that orthodontics occupies a small proportion of the undergraduate curriculum in dentistry in most countries, the emphasis is on theory and clinical work, and that removable appliances, functional appliances, and certain aspects of fixed appliances are taught in the majority of countries that responded to the questionnaire     

Orthodontic care in suburban Cuyahoga County, Ohio: who provides treatment and whom do they treat?

It has been reported that orthodontic services are being provided to a larger segment of the population by an increasing number of providers. The present study surveyed the dental and orthodontic experiences of 10th grade students attending 16 public and two parochial high schools in suburban Cuyahoga County, Ohio, as well as two schools from the city of Cleveland. Questionnaires were distributed in the classroom and data obtained for 2808 students. Approximately 50% of the sample were girls with an average age of 15.5 +/- 0.8 years. Results of the survey revealed that 84% (2371/2808) had seen a dentist within the past year, and 37% (1047/2808) of the students had received orthodontic treatment from 171 different providers. Of those treated, 87.2% (913/1047) were treated by a specialist in orthodontics, 10.8% (114/1047) by a general dentist, and 0.7% (7/1047) by a pediatric dentist, with 1.3% missing or unknown (13/1047). Patients who had seen a dentist within the past year were more likely to have had orthodontic treatment. Only 7% of the untreated students were told by a dental professional that they needed braces compared with 71% of the treated group. Therefore, we conclude that orthodontic specialists provide most of the orthodontic services in the suburbs of Cuyahoga County, and visiting a general dentist positively influences the utilization of orthodontic services.     

Orthodontic treatment provided by pediatric dentists.

The purposes of this study were to document orthodontic treatment currently provided by pediatric dentists for comparison with past and future studies and to ascertain variables that influence practitioners' orthodontic treatment patterns. A 25-item survey was mailed to 492 diplomates of the American Board of Pediatric Dentistry. Surveys returned within 16 weeks were included for statistical analysis. The response rate was 73%. Most practitioners spent less than 10% of their practice time providing orthodontic treatment and reported that this would not change in the future. Practitioners who were dual trained in pediatric dentistry and orthodontics spent more time providing orthodontic treatment, although nearly half spent at least 50% of their time providing traditional pediatric dental treatment. Most pediatric dentists provided orthodontic treatment in the primary or early mixed dentition stages. The most common conditions treated were anterior crossbite, ectopic eruption, habits, posterior crossbite, and space maintenance. The most common orthodontic appliances used were fixed rapid palatal expanders and removable Hawley appliances with finger springs. Orthodontic treatment provided by pediatric dentists has decreased since it was last surveyed in 1983 and is not expected to change in the next 5 years.     

Survey of dental practice/dental education in Victoria. Part IV. Specialist dental practice

A survey of dentists registered with the Dental Board and resident in the State of Victoria included two sections, one for specialist/restricted practitioners and the other for practitioners, who had gained a postgraduate degree from the University of Melbourne between December 1982 and 1987. The responses of the former suggested that demand for most specialist services appears to be reasonably healthy at the moment and the majority of the latter indicated that they had been adequately trained for specialist practice. It was suggested that there are several market forces which could influence the number of applicants seeking specialist training in future. Strongest demand was likely to be sustained for oral surgery and orthodontics. This is despite evidence of a decline in demand for specialist orthodontic services in private practice. Attention was drawn to the 1986 Ministerial Review of Dental Services in Victoria, in which concern was expressed for the lack of access to orthodontic services for low income families. It was proposed that more cost-effective methods of deploying orthodontic personnel could be used, as in other countries, to provide this access. Demand for specialist services in endodontics, paediatric dentistry, periodontics and prosthodontics could decline in future as general practitioners steadily broaden their range of services through continuing education courses.     

The Four Thames project: development of training in orthodontics for dental practice

The Four Thames Project to develop training in orthodontics for dental practice, offered 26 clinical attachments with Consultants, over a 2-year period (October 1984-1986). A course of tuition was provided centrally in four modules. The programme was evaluated using a postal questionnaire and personal interview of the course participants, and with a postal questionnaire of the participating Consultants. The results of the evaluation are discussed and effects on the orthodontics in the participants' practices and consultants' units are outlined. Those on the first 2-year programme changed the range of their orthodontic practice to include more use of fixed appliances and a reduction in the use of removable appliances and of treatment by extraction and observation alone.     

Orthodontists' perceptions of and adaptations to nonspecialist and direct-to-consumer orthodontic service providers

ObjectivesTo evaluate orthodontists'' perceived impacts on their practices as a result of general practitioners (GPs) and direct-to-consumer (DTC) orthodontic care providers and the adaptational changes implemented in the past 10 years.Materials and MethodsAn electronic survey was administered to 270 orthodontists in Canada and the United States to determine demographic background, perception of perceived impact, and specific changes implemented to improve practice competitiveness.ResultsMore experienced orthodontists (P = .0001) and males (P = .027) were more likely to indicate a perceived impact from GP orthodontics. American orthodontists were significantly more likely than Canadian orthodontists to perceive an impact from DTC providers (P = .017). There was a positive association with orthodontists'' years of experience and having implemented adaptational changes to their practice for a period greater than 10 years across multiple categories. Female orthodontists were more likely to have implemented adaptational changes for a period of less than 10 years across multiple categories.ConclusionsThe perceived impact of GPs providing orthodontic care was greater than that of DTC providers. American orthodontists were significantly more likely to perceive an impact from DTC providers. Orthodontists have experienced a reduction in referrals from GPs and an increase in referred case difficulty. Less experienced and female orthodontists have made the most adaptive changes to their practices in the past 10 years.     

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.     

Undergraduate and continuing education in orthodontics: a view into the 1990s

It has been projected that up to 40 per cent of clinical practice undertaken by general dentists in major cities in Canada may involve some type of orthodontic therapy by the mid-1990s. This major shift has already started and the University of British Columbia has begun to update its curriculum accordingly. Concomitant with a decrease in demand for two year postgraduate education courses and a reduced need for the control of decay, academic programmes across Canada are experiencing an increased demand for more extensive orthodontic education by both undergraduate dental students and general practitioners. Current practice trends indicate that more orthodontics is undertaken by general practitioners and that fewer orthodontists are being trained. The Department of Orthodontics at the University of British Columbia utilizes the Dental Performance Simulation System (J. Morita Corp., Japan) for preclinical training in straight-wire edgewise techniques. In their second year, students fit and cement bands, bond brackets, ligate archwires and fit and adjust headgears on the Simulation System. Two years of clinical sessions (3 hours/week) follow this preclinical training. By carefully selecting only Class I non-extraction cases that can be completed ideally in eight months or less of active edgewise therapy, a realistic generalist/specialist division of labour has been developed. To fully meet the anticipated general practice orthodontic demands in the 1990s, undergraduate academic programmes must be prepared to significantly alter current overall curriculum objectives.     

Implantable devices as orthodontic anchorage: a review of current treatment modalities

Recently, there has been a dramatic increase in the use of implantable devices as direct adjuncts to orthodontic treatment. Whereas the use of conventional dental implants has been researched extensively, the body of literature associated with the more recent uses of implantable devices in orthodontics is relatively small. Currently, a limited number of such devices are used to aid in orthodontic treatment. The options include conventional titanium endosseous dental implants, palatal implants, titanium miniscrews (also known as micro- or mini-implants), and mini-bone plates. Integration of dental implants or implantable devices into contemporary orthodontic practice has the following possible advantages: serving as a means of increasing orthodontic anchorage, virtually eliminating patient compliance issues with regard to wearing of appliances, decreasing overall treatment time, and occasionally permitting orthodontic treatments previously thought to be impossible without surgery. CLINICAL SIGNIFICANCE: This article is a review of the currently available options for use of implantable devices as sources of temporary skeletal anchorage in orthodontics.     

A profile of orthodontic treatment in the general dental service in Scotland 1979-1987

The study casts and records of two samples of patients who had received orthodontic treatment involving the use of appliances within the General Dental Service (GDS) in Scotland during 1979/81 and 1986/87 were examined to study the pattern of treatment, and to determine whether there had been any change over this period. Both samples contained a wide range of malocclusions which were treated mostly with removable appliances. Although few fixed appliances were used and few lower arch treatments were carried out there was a trend towards a greater use of these appliances and an increase in these treatments in 1986/87 compared with 1979/81. There was no change in the infrequent use of headgear while functional appliances were used in only six of the treatments in the 1986/87 sample as compared to none in the 1979/81 sample. In the more recent sample many more treatments were undertaken by 'specialist' General Dental Practitioners (i.e. those who work in the GDS, but limit their practice to orthodontics) and fewer treatments were undertaken under the direction of a Consultant Orthodontist.