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.     

Meeting Reports

Abstract

At present there is debate concerning the practice of recycling orthodontic components. A survey of 300 members of the British Orthodontic Society showed that 47.5 per cent of respondents recycled metal brackets and that more specialist practitioners than consultants did so (p < 0.001). Only 7.2 per cent of the orthodontists who recycled brackets informed their patients that recycled brackets were used.     

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.     

Audit in Orthodontic Practice: How Well do we Communicate with our Referring Practitioners?

Abstract

A questionnaire survey of 102 dental practitioners who refer patients to our specialist practice was undertaken to determine how satisfied they were with our current communication methods. Eighty-five replies were received (83 per cent). Seventy-two per cent felt that they were kept sufficiently informed about treatment decisions and progress. Almost all the practitioners were satisfied with our current extraction letter arrangements and with our practice of referring patients requiring oral surgery procedures directly to a local oral surgeon. Forty-six per cent of respondents noted a lapse in attendance by some patients undergoing active orthodontic treatment and 40 per cent requested more information regarding our waiting list. In general, 34 per cent of our referring practitioners felt that our communication methods could be improved to some degree, and a number of suggested improvements were made. Additional information was also obtained on referral patterns and the practitioners' own involvement with providing orthodontic treatment.     

How UK orthodontists advise patients on oral hygiene.

Abstract

In 1993, 1038 UK orthodontists (all the members of the British Association of Orthodontists and the British Society for the Study of Orthodontics) were asked by questionnaire about the oral hygiene advice they gave to patients undergoing routine orthodontic treatment. All the orthodontists gave advice on tooth brushing. Most (89.5 per cent) gave dietary advice and (84 per cent) used disclosing tablets. A fluoride rinse was recommended by 73 per cent and a chlorhexidine mouthwash by 41.9 per cent. Many orthodontists advocate appropriate oral hygiene measures, but the efficacy of such methods is determined by the patient's motivation. The orthodontist therefore requires skills in behavioural management. Oral hygiene measures may be more cost-effective when undertaken by trained auxiliaries.     

Current Products and Practice

Abstract

Objective: To collect information on the current consent practices of consultant orthodontists for orthodontic and joint orthognathic treatment.

Design: Postal questionnaire.

Subjects and Methods: The questionnaire was sent to all 222 consultant orthodontists held on the database of the British Orthodontic Society. The questionnaire consisted of five multi-part questions requiring tick-box responses.

Outcome: A total of 199 questionnaires were returned.

Results: Written information on orthodontic treatment was provided by 56 per cent of respondents whilst 41 per cent obtained written consent. Written information on joint orthognathic treatment was provided by 47.5 per cent of respondents, whilst 20 per cent obtained joint written consent. Most who obtained written consent for orthodontics and joint orthognathic treatment used 16 years as an appropriate age for patients to provide their own consent.

Conclusions: Consent practice amongst consultant orthodontists varies, with 35 per cent providing neither written information nor seeking written consent prior to orthodontic or joint orthognathic treatment.     

A Survey of Malocclusion and the Need for Orthodontic Treatment in a Shropshire School Population

Abstract

Occlusal features and the need for orthodontic treatment are difficult to assess objectively. Methods of assessment which have been devised for public health purposes are different from those which are needed for clinical purposes.

A study was carried out on 1000 children, aged 11 to 12 years, to assess certain occlusal features and the need for orthodontic treatment in clinical terms, and to determine which occlusal features brought about the need for treatment. The criteria for assessment are defined.

The population was found to have a high prevalence of dental arch crowding and of Class 2 dental arch relationship. The features were each present in more than half the population. Other findings regarding occlusal features are outlined.

There was little difference between the sexes for the occlusal and aetiological features studied.

No orthodontic treatment was found to be necessary in 40·1 per cent of the population. Treatment by planned extraction of teeth only was necessary in 22·0 per cent, and active tooth movement with appliances, either with or without extraction of teeth, in 37·9 per cent.

Crowding of the dentition and Class 2 dental arch relationship were found to be the main cause of the need for orthodontic treatment. In this population, more than 50 per cent of the necessary appliance treatment would be involved in treating Class 2 Division 1 occlusion.

There were no significant differences between the sexes in the need for orthodontic treatment.     

A Thousand Consecutive Treated Orthodontic Cases—A Survey

Abstract

An analysis of 1000 consecutive treated cases from a private orthodontic practice was made. Inter alia the results show: the male to female ratio was 4: 6; the mean age of first attendance was 10·7 years and the mean age at the start of active treatment was 11·6 years. 49 per cent of the cases were Angle Class I; 39 per cent Class II/1; 8 per cent Class II/2 and 4 per cent Class III. Over half the patients had an increased overbite. 21 per cent had an anterior crossbite and 11 per cent showed a posterior crossbite. Approximately 75 per cent of the cases showed crowding of the labial segments. There was crowding in 26 per cent of the upper buccal segments and in 49 per cent of the lower ones.

93 per cent of the patients received active treatment for the upper arch but only 4 per cent had appliances in the lower arch. A quarter of the cases were treated without upper extractions; in the lower arch the figure was 58 per cent. 94.1 per cent of the patients were treated with removable appliances requiring, on average, 1·5 appliances per case to complete treatment. 30 per cent of the cases received no retention. 54 per cent wore a retainer for less than 6 months.

88 per cent of the patients completed treatment and co-operation was satisfactory in 87 per cent. The mean treatment period for each patient was 13·1 months involving an average of 11·7 visits. The average active treatment time for each patients was 95 minutes. 74 per cent of the completed cases had a satisfactory result.

The discussion supports the case for relating the type of orthodontic treatment to the total dental need of the patient. This requires more knowledge of what is meant by “dental health”. A plea is made that orthodontists should not become rigid in their approach to treatment.     

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.     

Gifts from orthodontists to general dentists

Objectives:To determine how often general dentists receive gifts from orthodontists, the value and number of the gifts they receive, and how they perceive the motivation behind the gift.Materials and Methods:This was a questionnaire-based study. A questionnaire was constructed and tested for validity and reliability. An electronic version of survey was sent via email to 1300 general dentists.Results:The validity and reliability of the survey was confirmed. Two hundred fifty-four valid responses were received (20%). Eighty-five percent of responding general practitioners reported that they received gifts from an orthodontist. Almost 100% reported that they referred patients to orthodontists. About one-third of the responding general practitioners reported that their office provided orthodontic care. There were statistically significant correlations between the number of annual patient referrals the general practitioners reported making and the number and value of the gifts they received from the orthodontists. Female general practitioners reported receiving a higher number of gifts of greater total value than male practitioners. General practitioners who reported providing orthodontic treatment did not differ from those who did not in the number of referrals they made annually and the number and value of the gifts they received. Quality of care was the most common reason general practitioners reported for their referral to an orthodontist. Forty-four percent of the responders reported that they received discounted orthodontic treatment.Conclusions:General practitioners refer patients to orthodontists and receive gifts from them. The number and value of the gifts reflects the number of referrals they make.     

Contribution of women dentists to general practice

The number of women general dental practitioners has increased in the last few years as the number of women graduating from UK dental schools has also increased. The increase in women practitioners from 1975 to 1985 is of the order of 10 per cent, although only 23 per cent of the total owned their own practices either alone or in partnership. The paper describes the author's own experiences in setting up a thriving practice and the problems she encountered as a woman. Also described are the author's observations in striving for greater goals for general dental practitioners in terms of continuing education and vocational training.     

Attitudes of Irish and European dentists to water quality of dental unit water systems

BACKGROUND: Dental unit water systems (DUWS) are used in dental practices to provide water to irrigate the oral cavity. Dental surgeries across the European Union (EU) use DUWS that may be prone to microbial contamination. OBJECTIVES: To determine Irish dental practitioners' attitudes to perceived risk from working with DUWS and their protocols for the management of biofilm in their DUWS and compare these with other European dentists. DESIGN: A questionnaire was used to determine DUWS types in use, practitioners' attitudes to risks associated with using DUWS and their DUWS management protocols. RESULTS: There were six different types of DUWS, 40 per cent of which were > 5 years old, 42 per cent of DUWS were fed by purified or distilled water. Only four per cent of practitioners carried out microbiological analysis on their water, but 38 per cent indicated that they cleaned or disinfected their DUWS. One-hundred per cent of practitioners were not aware of national/international guidelines for microbial contamination of DUWS but 77 per cent were concerned about DUWS water quality. CONCLUSIONS: The majority of practitioners were working with equipment that is < 5 years old. The majority of DUWS were not treated but practitioners were concerned about dental unit water quality and would welcome regular microbiological water tests and clear advice on cleaning/disinfection of the water supply in their dental units. Practitioner attitudes and behaviours were broadly similar in the other European countries studied.     

Endodontic follow-up practices,sources of knowledge,and self-assessed treatment outcome among general dental practitioners in Sweden and Norway

Abstract

Objective: To reduce the gap between what can be achieved in endodontic treatments and the observed treatment outcome among general dental practitioners, the present study set out to assess the status of the endodontic practices as regards to knowledge and self-assessed skills among general dental practitioners in Sweden and Norway.

Material and method: The questionnaire was sent to 1384 general dental practitioners. It contained questions regarding access to continuing education in endodontics, sources of knowledge for clinical management of patients, post-operative follow-ups, self-assessed success-rate, and the initial diagnosis impact on the outcome of endodontic treatments.

Results: The response rate was 61.4%. Almost half estimated their endodontic success-rate to be 90%. About two-thirds of the respondents did not know, or did not believe, that the initial diagnosis could affect the outcome of their endodontic treatments. Respondents who did not believe the diagnosis could impact the outcome were more likely to estimate their success rate as the highest (p<.001). Less than half performed post-operative follow-ups a year after treatment. A third of the respondents had not attended any continuing endodontic education.

Conclusion: Dentists who do not receive regular feedback on their treatments may lack insight into their own shortcomings. If this is combined with insufficient knowledge and understanding it may result in sub-par endodontic treatments being performed. It is important to have reliable ways to communicate current endodontic knowledge and to establish robust methods that may help dentists accurately assess their own performance in endodontics.     

Letters to the Editor

Abstract

Orthodontic study models form an essential part of the dental records of patients undergoing diagnosis and treatment. In order to ascertain the problems encountered by hospital orthodontic units in the utilization and storage of study models, a questionnaire was circulated in February 1991 to members of the Consultant Orthodontists Group.

All respondents took pretreatment study models, while 9 per cent took their final study models at some time other than the end of active treatment; 85·5 per cent of respondents stored their study models in their units, but most were beginning to experience difficulties in this regard. There was a wide range for storage times, and only 10 per cent of employing authorities had a stated policy on the storage of study models. There was a highly significant difference (P&;z.Ltc;0·001) between the time that models are stored at present, and the desired storage times. Most respondents appeared to be rather uncertain about the precise medico-legal requirements concerning model storage. The implications for audit and medico-legal matters are discussed in the light of these findings.     

General anaesthesia, parenteral sedation, and emergency drugs and equipment in general dental practice

General dental practitioners were surveyed with respect to their use of general anaesthesia, parenteral sedation, and possession of emergency drugs and equipment.

Over 50 per cent of respondents used some form of general anaesthetic or parenteral sedation technique. Most of these respondents used inhalational general anaesthesia, and about 50 per cent used relative analgesia (RA) and/or intravenous sedation techniques: however, the number of administrations of relative analgesia far exceeded that of any other technique.

Over 80 per cent of respondents possessed a source of oxygen, and some 30 per cent had corticosteroids and adrenaline available for use in an emergency. The level of emergency drugs and equipment was higher for those using general anaesthesia or parenteral sedation.

General dental practitioners expressed a keen desire for the provision of advice on both the management of emergencies in the dental surgery and appropriate equipment and drugs.     

Professional perceptions of the benefits of orthodontic treatment

The aim of this study was to assess general dental practitioners' and orthodontists' perceptions of the benefits of orthodontic treatment. A specially designed questionnaire was sent to a random sample of 150 general dental practitioners (GDPs) and all orthodontists in Northern Ireland (excluding hospital practitioners) with a postgraduate qualification (n = 29). There was a 93 per cent response rate by the general dental practitioners and all but one specialist practitioner returned the questionnaire. The questionnaire comprised 14 visual analogue scales (VAS) whereby participants were asked to rate the importance of various possible dental health and psychosocial benefits of orthodontic treatment. In addition to the VAS, the influence of dentist variables such as number of years since qualification, orthodontic cases completed, referral rates and attendance at postgraduate lectures were examined. When ratings on the 14 dental health and psychosocial scales were examined overall, GDPs rated an improvement in self-esteem while orthodontists considered an improvement in physical attractiveness as the most important benefit of orthodontic treatment. Even though psychosocial variables received the highest ratings, examination of the mean ratings (and 95 per cent confidence intervals) revealed that some dental health factors were also rated highly by both groups. While the results do indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment, they also suggest that both GDPs and orthodontists have an unrealistic expectation of the dental health gain likely to result from orthodontic treatment.     

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.     

A report on the feasibility of establishing a paediatric emergency dental service at Glasgow Dental Hospital.

A six-month pilot emergency service for children was established at Glasgow Dental Hospital to provide care for patients in pain, offer preventive advice and ensure ongoing dental care. The service was staffed by experienced community dental officers. In the main study period 2965 patients were seen. The majority (54 per cent) were referred from general dental practitioners; however, 27 per cent came directly to the hospital without seeking dental advice in their locality. The most common problems were toothache (55 per cent), occasional pain (28 per cent) and swelling (14 per cent). Eighty per cent of the patients were directed to oral surgery for extractions under general anaesthesia and six per cent for extractions under local anaesthesia. Dental caries still causes pain and distress to a large number of Glasgow school children. Clearly water fluoridation would greatly improve dental health and in so doing reduce the proportion of children requiring extractions under a general anaesthetic. The emergency service is currently being reorganised so as to place more emphasis on following up those patients who do not have a dentist, or who presented for care without a referral letter.     

Perception of orthodontic treatment need among Swedish children,adolescents and young adults

Objective: Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

Materials and methods: A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

Results: The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2?±?1.5), than among subjects, age 15 (3.6?±?1.2) (p?=?.0009), and subjects, age 19 (3.5?±?1.2) (p?=?.00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p?=?.002 and .001, respectively) and (ii) previous orthodontic treatment (p?=?.005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p?=?.002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p?=?.047) than Swedes, age 19.

Conclusions: The lower limit for orthodontic treatment need among subjects, age 10, was higher – compared to subjects, ages 15 and 19 – and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.     

Dental care access among individuals with Down syndrome: a Malaysian scenario

Objective. The purpose of this cross-sectional study was to assess the legal representatives’ perceptions on dental care access of individuals with Down syndrome (DS) compared to their non-DS siblings in Peninsular Malaysia. Methods: This cross-sectional study was conducted throughout community-based rehabilitation centers (CBRC) and the Down Syndrome Organization. Legal representatives of individuals with DS within the criteria were given a structured and validated questionaire. Result. This study demonstrated that individuals with DS (76.9%) significantly utilized more health services than non-DS siblings (23.1%). The service most regularly used was speech therapy followed by opthalmology and dental services. Twenty-five per cent of respondents reported difficulty in finding dental care services for their DS child and 46.9% admitted that healthcare for their DS child took more time. The majority of DS individuals received less complex dental treatment and none received any orthodontic treatment, despite their severe occlusal problems. Conclusion. A high proportion of parents appear to be able to access dental and medical care for their DS child. However, some parents perceived difficulty in finding oral healthcare.