Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BackgroundThe authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.MethodsThe authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.ResultsSixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.ConclusionsWSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist.Clinical implicationsGeneral dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.     

The B.S.S.O. M.Orth. Prize of the Royal College of Surgeons of England 1998

Abstract

Aim: To determine the relationship between treatment need assessment scores of orthodontists, general practitioners, and pediatric dentists.

Study design: Observational.

Sample: Ten general dental practitioners, 18 orthodontists and 15 pediatric dentists reviewed 137 dental casts and recorded their opinion on whether orthodontic treatment was needed.

Results: We found a high level of agreement between pediatric dentists, orthodontists and general practitioners (Kappa range 0.86–0.95). Between the groups, the amount of agreement was lower.

Conclusions: Orthodontists, general dental practitioners, and pediatric dentists in this sample exhibit high levels of agreement on orthodontic treatment need.     

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.     

Interproximal reduction of teeth: Differences in perspective between orthodontists and dentists

Objective:To determine if interproximal reduction of teeth (IPR) is perceived differently by orthodontists and general dentists.Materials and Methods:A Web-based survey containing statements about IPR was developed and randomly distributed to orthodontists and general dentists.Results:The majority of orthodontists and general dentists strongly agreed that IPR is a minimally invasive procedure that poses little risk for the development of interproximal decay. However, general dentists were more likely to perform post-IPR polishing and to apply topical fluoride than are orthodontists (P < .0001). A greater percentage of orthodontists strongly believed that the esthetic and occlusal benefits of IPR outweigh the potential risk of tooth decay when IPR was performed (P < .0001). A greater percentage of general dentists were hesitant to perform IPR, despite research supporting that IPR has little negative effect on the health of teeth.Conclusions:The results of this study disproved the null hypothesis that orthodontists and general dentists share similar views regarding the use of IPR during orthodontic treatment. General dentists were more conservative in their views of IPR and were less comfortable with performing IPR as a routine procedure. General dentists felt more strongly about the importance of post-IPR polishing and application of topical fluoride. Orthodontists were more likely to have researched the long-term effects of IPR on the health of teeth and therefore felt more comfortable performing IPR during orthodontic treatment.     

Geographic distribution of specialist orthodontists and orthodontic providers in Japan

ObjectiveThis study aimed to clarify the geographic distribution of specialist orthodontists and dentists who provide orthodontic services in Japan.MethodsWe obtained data on the populations of 1750 municipalities in Japan in 2010 by referring to the census. We obtained data on the number of dentists who mainly provide orthodontic services (specialist orthodontists) and the number of dentists, including general dentists, who provide orthodontic services (orthodontic providers), by referring to the Survey of Physicians, Dentists, and Pharmacists. Furthermore, we referred to the directory on the website of the Japanese Orthodontic Society (JOS) to obtain data on JOS-qualified orthodontists. To assess the distribution of specialist orthodontists and orthodontic providers, we used Lorenz curves and Gini coefficients.ResultsThe median value for the number of specialist orthodontists and number of JOS-certified orthodontists per 100,000 persons aged between 5 and 40 years old was 0, while that of orthodontic providers was 27.5. Gini coefficients for specialist orthodontists and JOS-certified orthodontists were 0.523 and 0.615, respectively. On the other hand, the Gini coefficient for orthodontic providers was 0.258.ConclusionsRegional inequalities in the availability of specialist orthodontists are high, and medical access to specialist orthodontic services may be limited in areas other than urban districts. In municipalities with a population of fewer than 50,000 inhabitants, the number of specialist orthodontists was very low, but orthodontic providers were relatively evenly distributed. Our research results suggested that studying the distribution of specialist orthodontists and orthodontic providers can provide valuable information for developing dental care policies.     

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.     

Treatment management between orthodontists and general practitioners performing clear aligner therapy

Objective:To investigate differences in case selection, treatment management, and aligner treatment expertise between orthodontists and general practitioners.Materials and Methods:A parallel pair of original surveys with three sections (case selection, treatment management, and demographics) was sent to orthodontists (N = 1000) and general dentists (N = 1000) who were providers of aligner treatment.Results:Orthodontists had treated significantly more patients with aligners, had treated more patients with aligners in the previous 12 months, and had received more aligner training than general dentists (P < .0001). In general, case confidence increased with increasing experience for both orthodontists and general dentists. After adjusting for experience, there was a significant difference in aligner case confidence between orthodontists and general dentists for several malocclusions. General dentists were more confident than orthodontists in treating deep bite, severe crowding, and Class II malocclusions with aligners (P ≤ .0001). Significant differences were also found for all treatment management techniques except interproximal reduction.Conclusion:There was a significant difference in case selection, treatment management, and aligner expertise between orthodontists and general dentists, although the differences in case selection were small. Overall, it was shown that orthodontists and general dentists elected to treat a variety of moderate to severe malocclusions with aligners but with different utilization of recommended auxiliaries, perhaps demonstrating a difference in treatment goals.     

Perceptions of soft tissue laser use in orthodontics: A survey of orthodontists,periodontists, and general dentists

Objectives:To compare attitudes of orthodontists, periodontists, and general dentists regarding the use of soft tissue lasers by orthodontists during the course of orthodontic treatment.Materials and Methods:An analogous survey was developed to evaluate and compare the current opinions of a representative sample (n  =  538) of orthodontists (61.3%), periodontists (24.3%), and general dentists (14.3%) regarding orthodontists'' use of soft tissue lasers.Results:The majority (84%) of orthodontists, periodontists, and general dentists regarded the use of a soft tissue laser by orthodontists as appropriate. When compared to orthodontists and general dentists, a lower percentage of periodontists indicated that soft tissue laser use by orthodontists was appropriate (P < .01). For each of the eight specific soft tissue laser procedures investigated, periodontists reported a significantly lower level of appropriateness than did orthodontists and general dentists (P < .01). Around 75% of the total sample believed that referral would not be affected by the use of soft tissue lasers by orthodontists.Conclusions:Orthodontists, periodontists, and general dentists differed in their opinions of the perceived appropriateness of soft tissue laser use by orthodontists, with periodontists reporting a lower level of appropriateness. Clinicians need to communicate effectively to ensure that orthodontic patients in need of adjunctive soft tissue surgery are treated to the accepted standard of care.     

Comparison of perception of necessity of orthodontic treatment between orthodontists and dentists at dental check-ups with DAI

PurposeThe aims of this study were to examine the gaps in the perception of the necessity of orthodontic treatment between orthodontists and dentists, and identify the items influencing perception using the Dental Aesthetic Index (DAI).Materials and methodsBoth dentists and orthodontists assessed the necessity of orthodontic treatment in the 693 junior and senior high school students, and orthodontists examined the occlusion of the students with DAI. The data were analyzed with Student's t-test, Bonferroni multiple comparison test and decision analysis.ResultsIn the orthodontist’ perception, clearly significant differences were observed in all DAI items between necessary and unnecessary groups. However, maxillary missing teeth, mandibular missing teeth, spacing and diastema did not show a clear difference in the dentists’ perception. In the comparison of perception between orthodontists and dentists, crowding, largest anterior maxillary irregularity and largest mandibular irregularity showed significant differences. Decision analysis demonstrated that crowding was the most important item for both orthodontists and dentists.ConclusionThere were two types of gaps in the perception of the necessity of orthodontic treatment. The first one is an individual difference among the dentists, which is related to the evaluation of missing teeth and space in the dental arches. The other is recognized as gaps in the perception between orthodontists and dentists, which are related to the amounts of crowding. It is important to realize the difference of perception and improve the mutual understanding to prevent overlooking malocclusion.     

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.     

Communication practices and preferences between orthodontists and general dentists

Objective:To evaluate similarities and differences in orthodontists'' and general dentists'' perceptions regarding their interdisciplinary communication.Materials and Methods:Orthodontists (N  =  137) and general dentists (N  =  144) throughout the United States responded to an invitation to participate in a Web-based and mailed survey, respectively.Results:The results indicated that orthodontists communicated with general dentists using the type of media general dentists preferred to use. As treatment complexity increased, orthodontists shifted from one-way forms of communication (letters) to two-way forms of communication (phone calls; P < .05). Both orthodontists and general dentists reported that orthodontists'' communication regarding white spot lesions was inadequate. When treating patients with missing or malformed teeth, orthodontists reported that they sought input from the general dentists at a higher rate than the general dentists reported (P < .005).Conclusions:Orthodontists'' and general dentists'' perceptions of how often specific types of media were used for interdisciplinary communication were generally similar. They differed, however, with regard to how adequately orthodontists communicated with general dentists and how often orthodontists sought input from general dentists. The methods and extent of communication between orthodontists and general dentists need to be determined on a patient-by-patient basis.     

A prospective survey of percutaneous injuries in orthodontists

This national survey provides documentation regarding typical orthodontic practice patterns in the United States, including the prevalence of percutaneous injuries. The sample reflects a similar geographic distribution of the population as a whole, with more practitioners located in areas with higher populations. Most practitioners in this sample were in solo full-time practice, averaging 35 hours per week, and treating patients for 47 weeks per year. A 20-day prospective period was used to collect data regarding exposure to percutaneous injuries. The study identified a mean percutaneous injury rate of 0.085 during a 20-day period for practicing orthodontists, a value that can be extrapolated to slightly less than one (0.99) percutaneous injury per orthodontist per year. The majority of these injuries (84%) occurred outside the mouth. This rate is approximately one third the rate reported for dentists in general practice. (Am J Orthod Dentofacial Orthop 1998;114:654-8)     

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.     

Quality of orthodontic treatment performed by orthodontists and general dentists: A blind comparative evaluation

Objective:To perform a blind comparative evaluation of the quality of orthodontic treatment provided by orthodontists and general dentists.Materials and Methods:Sixty cases of orthodontic treatment were evaluated—30 treated by specialists in orthodontics and 30 treated by general dentists with no specialization course. Orthodontists were selected randomly by lots, in a population of 1596 professionals, and recordings were performed based on the guideline established by the Objective Grading System proposed by the American Board of Orthodontics. Each participant was asked to present a case considered representative of the best outcome among the cases treated, regardless of the type or initial severity of the malocclusion. Statistical analysis involved the chi-square, Wilcoxon, and Mann-Whitney tests. The level of significance was set at P  =  .05 for the statistical tests.Results:The results showed that 29 orthodontists (96.7%) presented cases considered satisfactory and would be approved on the qualification exam, whereas only 15 dentists (50%) had cases considered satisfactory. Moreover, treatment time was significantly shorter among the orthodontists (P  =  .022), and the posttreatment comparison revealed that orthodontists achieved better outcomes considering all the variables studied.Conclusions:Orthodontists spend less time on treatment and achieve better quality outcomes than cases treated by general dentists who have not undergone a specialization course in orthodontics.     

Influence of lateral cephalometric radiography in orthodontic diagnosis and treatment planning

Objective:To evaluate the impact of additional lateral cephalometric radiography in orthodontic diagnosis and treatment planning.Materials and Methods:Forty-three patients seeking orthodontic treatment, and for whom pretreatment diagnostic records were available, were randomly selected. Ten qualified orthodontists were involved in this study. The patients'' records included three photographs of the angle trimmed dental casts, digital lateral cephalometric and panoramic radiographs, and standard clinical photographs comprising seven intra- and four extraoral pictures. Records were evaluated in two sessions. At the first session, orthodontists evaluated records without lateral cephalometric radiography (LCR). In the second session, the same information was presented, but with LCR. Between the two sessions the order in which the cases were presented was altered to avoid bias.Results:The percentage of agreement between sessions was lower for diagnosis than for treatment planning. Concerning skeletal classification, the least experienced orthodontist was the least consistent (28%), while the more experienced orthodontist was the more reliable (67%). In terms of treatment modalities, in general there was an agreement of 64%. The most frequent modifications in treatment modalities were seen in Class II malocclusion patients.Conclusions:The results of our study suggest that the majority of Portuguese orthodontists judge that LCR is important to producing a treatment plan. Despite that, it does not seem to have an influence on orthodontic treatment planning.     

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.     

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.     

Distribution of orthodontic services and fees in an insured population in Washington.

Previous attempts to quantify the amount and type of orthodontic therapy provided by nonorthodontists in the United States have relied on survey data. Although there are advantages to surveys, such as control over survey recipients and inclusion of specific questions, they also have limitations, such as low response rates, response bias, and recall bias. This study used insurance claims data from a large dental benefits provider in Washington to assess the distribution of orthodontic services and fees among various dental providers. All orthodontic claims allowed by Washington Dental Service in 2001 were retrieved, along with treatment codes, fees, and demographic information for both patients and providers. A total of 102,984 orthodontic claims were included in the study. General dentists submitted 7.0% of these claims, orthodontists submitted 90.9%, and pedodontists submitted 1.9%. Orthodontists submitted higher average fees for space maintainers, first payments, and records. The percentage of orthodontic treatment preformed by general dentists and pedodontists in this claims-based study was substantially less than what has been previously reported in survey-based studies. Additionally, a smaller percentage of general dentists and pedodontists in this study performed comprehensive treatment, compared with previous studies. This study illustrates the value of insurance claims data to assess the provision of orthodontic care.     

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.