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.     

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.     

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 orthodontic workforce in Ireland: a report by the Orthodontic Society of Ireland

There are currently 110 specialist orthodontists in the Republic of Ireland. The response rate to this survey was 95 (85%); one-third of the orthodontic workforce are women; there are 49 (45%) orthodontists employed in the hospital service (including consultants) and 60 (55%) working in private practice; half (50%) of the orthodontists in hospital settings are female; only nine (18%) of those in private practice are female; two-thirds (66%) of the orthodontists in Ireland are under the age of 45; a little over one-quarter (28%) are under the age of 35; of those in the 25-35 age bracket, almost 80% are employed in the HSE. With increasing age, more orthodontists work in private practice; adult patients comprise 28% of the reported caseload in private practice compared to 12% in hospital settings; non-extraction patients account for 37% of the caseload in hospital settings compared with 57% in private practice; and almost one-quarter (24%) of those in hospital practice stated that they intended to change their working practice in the future.     

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.     

Adult orthodontics in the Republic of Ireland: specialist orthodontists’ opinions

Objectives: To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI)

Design/setting: A national cross-sectional questionnaire study in the ROI.

Method: A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded.

Results: A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25–35 years. The overall ratio quoted of professionals to non-professionals was almost 3:2. For 50% of specialists, males were estimated to account for 20–40% of their adult cases and for 23%, this increased to an estimated 40–60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, ‘black triangles’ and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often.

Conclusions: The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self- than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non-professionals and males. A wide range of treatment and varying use of appliance types were cited.     

A manpower study of orthodontic specialists for the State of Indiana: a preliminary report.

To develop current manpower data and project the future need for orthodontic specialists, a survey questionnaire was mailed to Indiana orthodontists (90 percent response). In addition, a telephone survey of orthodontic receptionists was conducted during the same time period (95 percent response). In general, orthodontists perceived a lower state of business than did their staffs. About 77 orthodontists are expected to retire by the year 2010. Based on maintaining the adjusted potential patient-to-orthodontist ratio (increasing adult and declining children in the population), it was projected that only about 66 (86 percent) of the retirees require replacement. To maintain manpower at eight percent fewer orthodontists than are currently in practice, three to four new orthodontists per year will be needed in Indiana over the next two decades.     

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.     

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.     

Retention protocols and use of vacuum-formed retainers among specialist orthodontists

Abstract

Objective: To evaluate retention protocols and use of vacuum-formed retainers (VFRs) among specialist orthodontists.

Design: Postal/electronic (e-) questionnaire.

Setting: Republic of Ireland.

Participants: Members of the Dental Council of Ireland Specialist Register of Orthodontists and/or Orthodontic Society of Ireland.

Methods: A pilot-tested questionnaire was distributed to 123 eligible specialist orthodontists. Questions addressed respondent demographics, preferred retainer choice in the maxillary and mandibular arches, prescribed wear protocols, VFR characteristics and factors influencing retainer choice. Statistical analyses were performed using PASW® version 18.

Results: The response rate was 82%. VFRs were the most commonly chosen retainer, prescribed by 53% of respondents in the maxilla and 33% in the mandible. Full-time followed by part-time wear of removable retainers (RRs) was the wear protocol favoured by the majority (70–76%). Full occlusal coverage was the VFR design favoured by 93%. VFR sheet thicknesses of 1.0 mm (68%) and 0.75 mm (16%) were most commonly prescribed. Seventeen per cent were aware that their patients used their VFRs as a receptacle for dental bleaching gel. Life-time wear of retainers was advised by 67–78%. The operator factor that most influenced retainer choice was the pre-treatment situation (88%).

Conclusions: VFRs were the most common retainer choice in the maxilla and mandible with full-time wear followed by part-time wear of RRs favoured by most. Full occlusal coverage with a thickness of 1.0 mm was the VFR design prescribed by the majority. More than one in six specialist orthodontists were aware that their patients used their VFRs as a receptacle for dental bleaching gel.     

Future Manpower Requirements for Orthodontics Undertaken in the General Dental Service

Abstract

The fall in the number of births in England and Wales which took place between 1964 and 1977 is beginning to have an effect on the present-day demand for orthodontic treatment. Using the best available data a mathematical model has been used to predict the likely demand for orthodontic treatment in the General Dental Services of England and Wales from now until 2008. This suggests that there is likely to be a sharp decline in the number of new orthodontic patients presenting for treatment at practices limited to orthodontics during the next 5 years. The recent expansion in the number of places available for postgraduate study of orthodontics makes it extremely unlikely that the position will improve significantly thereafter. There can be little doubt that we are now producing too many orthodontic specialists even allowing for the increase in manpower which might be required to satisfy a future demand for higher standards of treatment.     

The consultant orthodontic service--1996 survey.

OBJECTIVE: To evaluate the working patterns and facilities of the consultant orthodontist service. DESIGN: A cross-sectional survey. SETTING: Consultant orthodontist departments in the UK. SUBJECTS AND METHODS: All consultant orthodontists in the UK were sent a questionnaire that gathered information on the individual consultant, the facilities available, the new patients referred and patients under current treatment. RESULTS: The consultant orthodontist service provided treatment to a high number of patients who were in definite need of orthodontic treatment. A marked reduction in the use of removable appliances suggests improving standards of care and provision of more complex treatment. The caseload was high and a fair proportion of patients were returned to their referring dentists with treatment plans. The consultant service has not completely evolved into a service that provides treatment at a super-specialist level alone. CONCLUSIONS: There has been little change in the consultant orthodontist service over the past ten years. Arguably, this is because of the wishes of the purchasers and the shortage of trained orthodontic manpower as a direct result of poor manpower planning and lack of funds for post-graduate training.     

A Review of Direct Orthodontic Bonding

Abstract

Considerable interest has been shown in the method of bonding orthodontic attachments directly to the tooth surface eliminating the use of bands. Many orthodontists are using this technique routinely in clinical practice, and most orthodontic supply houses now produce some form of “bonding kit”. This article aims to present a background, against which the present usage of the technique can be assessed.     

Software Reviews

Abstract

A postal questionnaire survey of consultant orthodontists in England and Wales was undertaken as part of a national audit of the care of children horn with cleft lip/and or cleft palate. A 100% response rate was achieved. The majority of respondents stated that they provide orthodontic treatment for cleft patients hut only 78% of these attend multi-disciplinary cleft clinics. Consultant orthodontists provide treatment not only in the form of appliances for patients born with clefts hut are also involved in the counseling of parents and coordination of regional data bases. Only 24% of hospital orthodontists are involved in the provision of presurgical appliances for cleft babies on a regular basis. The lack of rationalisation of orthodontic services and a low uptake of standardised record keeping protocols for cleft patients by consultant orthodontists gives cause for concern.     

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.     

Methods used for prevention of white spot lesion development during orthodontic treatment with fixed appliances

Abstract

Objectives: The aim of this study was to survey methods that Dutch orthodontists use to prevent development or progression of enamel decalcifications during orthodontic treatment. Materials and methods: A pre-tested questionnaire was sent by post to all orthodontists in the Netherlands with a private practice (n = 189). Results: The response rate was 81%. At the start of orthodontic treatment a basic practice protocol for prevention of enamel demineralization was used by 93% of the orthodontists. This included oral hygiene instructions (92%) and the advice for additional use of a fluoride mouth rinse (64%). Other preventive measures were rarely prescribed. About 85% of those who prescribed a fluoride mouth rinse advised to rinse once a day, directly after evening tooth brushing. Conclusions: The results suggest that the commonly used practice of fluoride mouth rinsing directly after evening tooth brushing by orthodontic patients during fixed appliance treatment ignores actual evidence of preventive advices. This study recommends mouth rinsing at another moment than after evening tooth brushing, thus increasing the frequency of fluoride intakes, which might enhance the effectiveness in preventing WSL development or progression during orthodontic treatment.     

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.     

Influence of gender on office staff management in orthodontics

Objective:To examine the gender differences in managing practice and staff members in orthodontic practices.Materials and Methods:All orthodontists in Virginia and Maryland (n  =  427) were surveyed and demographic information was collected. For the crude analyses of the data, a Fisher''s exact test or χ² test was performed. For the adjusted analyses, genders were compared using a logistic regression or analysis of covariance. The covariates were adjusted for age, program length, years in practice, number of years since graduation, and practice state.Results:The length of the residency program attended did not differ with gender. No gender differences in practice ownership or creating the practice were observed. There was a significant gender difference in implementation of performance reviews: female orthodontists were more likely to provide performance reviews and tended to accept more poor reviews before staff termination than male orthodontists. However, when provided, no gender difference was observed in the number of performance reviews.Conclusion:Gender has a significant impact on the implementation of performance reviews in practices. Practice ownership status was not influenced by providers'' gender.