A survey of the delegation of orthodontic tasks and the training of chairside support staff in 22 European countries

This paper reports on a survey which was undertaken to investigate the delegation of orthodontic tasks and the training of chairside support staff in Europe. Two questionnaires were posted to all members of the EURO-QUAL BIOMED II project together with an explanatory letter. The first dealt with the delegation of nine clinical tasks during orthodontic treatment. The second with the types of chairside assistant employed in each country and the training that they are given. Completed questionnaires, which were subsequently validated, were returned by orthodontists from 22 countries. They indicated that there was no delegation of clinical tasks in six of the 22 countries and delegation of all nine tasks in five countries. The most commonly delegated tasks were taking radiographs (in 14 of the 22 countries) and taking impressions (in 13 of the 22 countries). The least commonly delegated tasks were cementing bands (in five of the 22 countries) and trying on bands (in six of the 22 countries). Seven of the 22 countries provided chairside assistants with training in some clinical orthodontic tasks. Eighteen of the 22 countries provided general training for chairside assistants and offered a qualification for chairside assistants. Four of these 18 countries reported that they only employed qualified chairside assistants. Of the four countries which reported that they did not provide a qualification for chairside assistants, two indicated that they employed chairside assistants with no formal training and two that they did not employ chairside assistants. It was concluded that there were wide variations within Europe as far as the training and employment of chairside assistants, with or without formal qualifications, and in the delegation of clinical orthodontic tasks to auxiliaries was concerned.     

Cost and productivity analysis of orthodontic care in Finland

Abstract– The aim of the study was to investigate the costs of orthodontic care provided for children and adolescents up to the age of 18 by municipal health centers in Finland, and to study the productivity of these services. The data were gathered by a questionnaire sent to all health centers; 96% responded. The majority of respondents estimated the share of orthodontic care as 10% of the total gross costs of dental care, given that 14% of all dental visits were for orthodontic reasons. To study the productivity in individual health centers, the output was measured by the estimated number of completely treated patients. The cost of orthodontic treatment per completely treated patient was, on average, FIM 7358, ranging from FIM 1299 to FIM 24 751. The strongest explanatory factor for the average total costs of orthodontic clinics was the number of general dentists with little experience in providing orthodontic treatment. Other explanatory factors were the number of orthodontists or experienced dentists, the percentage of orthodontic tasks performed by auxiliary personnel, and the timing of treatment. Savings might be obtained by devolving treatment to orthodontists or experienced dentists in-stead of to dentists with little orthodontic experience, and by starting treatment early. The estimated optimal size for an orthodontic clinic was found to be a unit with 830 completely treated patients per year, but most of the orthodontic clinics were in fact much smaller with, on average, 133 completely treated patients per year.     

Profile of lingual orthodontic users in Australia

BACKGROUND: The use of lingual orthodontic appliances and the training background of orthodontists in Australia using the lingual orthodontic technique are largely unknown. The aim of this study was to investigate the profile of lingual orthodontic users in Australia. METHODS: Four hundred and fifty questionnaires consisting of 15 questions were sent out to orthodontists in Australia. We obtained a 62 per cent return rate (278) with a 58 per cent rate of completed questionnaires. Statistical analysis using SPSS was performed and various outputs were obtained. RESULTS: Of the completed returns, 23 per cent were current lingual users; 69 per cent were not and 8 per cent were previous users but have stopped using the appliance. The majority (90 per cent) of the current lingual users were males. The highest percentage of users (35 per cent) was in New South Wales while the smallest percentage was in Tasmania (2 per cent). Around 40 per cent of respondents attended lingual courses as part of their specialist training programme, while 73 per cent had attended lingual courses since graduation and 82 per cent would consider attending a lingual course in the future. Of the 60 per cent current users who did not have a lingual component in their specialist training programme, almost nine-tenths had attended lingual courses since graduation. Of the non-lingual users, 14 per cent attended lingual courses as part of their specialist training programme, 28 per cent attended lingual courses since graduation and 38 per cent would consider attending a lingual course in the future. The main reason cited for being a non-lingual user was that lingual orthodontics could not be an integral part of the practice. CONCLUSIONS: Most of the orthodontists who graduated more than 16 years ago from their postgraduate training were non-users of the lingual appliance. It seems that around one in four orthodontists currently use the lingual technique, of which NSW orthodontists make up the largest group. Only one-fifth of users had some lingual component in their formal orthodontic training and about half of them have attended lingual courses after graduation. Almost half of orthodontists in Australia would consider attending a lingual course in the future. This survey provides a sound basis for course co-ordinators to plan for continuing lingual orthodontics in the future.     

Efficacy of training dental students in the index of orthodontic treatment need.

Orthodontic studies over several decades have found generally inconsistent opinions among dentists when evaluating orthodontic treatment need. There has also been recent concern that dental school education does not sufficiently prepare dentists to diagnose malocclusion and make appropriate referrals of potential orthodontic patients. The purpose of this study was to investigate the efficacy of using the index of orthodontic treatment need (IOTN) as a tool to improve dental students' ability to assess orthodontic treatment need. Fourth-year dental students were randomly divided into control, sham-control, and experimental groups stratified for mean grade point average. On 2 occasions, the subjects evaluated 30 orthodontic study models with a gold standard previously established by an expert panel of 15 orthodontists for orthodontic treatment need. The experimental group reevaluated the models after IOTN instruction. Kappa statistics, sensitivity, and specificity were calculated for each subject. Analysis of covariance (ANCOVA) showed that the experimental group had significantly higher agreement with the expert panel after IOTN training than did either control group. IOTN is a promising teaching aid for improving educational outcomes for orthodontic referral.     

Report of a survey conducted by the Consultant Orthodontists Group. The nature and distribution of clinical assistant posts in orthodontics in the United Kingdom in 1987

This paper describes and discusses the results of a survey, conducted by the Consultant Orthodontists Group in the United Kingdom in 1987, which examined the nature and distribution of clinical assistant posts, and consultants' attitudes to the concept of appointing orthodontic auxiliaries. This survey demonstrated a large regional variation in the number of clinical assistant posts and in the number of 'specialist practitioners' and community orthodontists. More than 90% of consultants teach their clinical assistants how to use removable appliances, headgear and simple fixed appliances. More than 70% of consultants also teach their clinical assistants how to use multi-bracketed techniques and functional appliances. Ninety-one per cent of consultants would give their support to developing regional training schemes for clinical assistants in orthodontics. Eighty-eight per cent of consultant orthodontists favoured the appointment of orthodontic auxiliaries to carry out intra-oral work, and 75% believed that they already had a member of staff capable of doing these duties with some further training.     

Occlusal indices revisited

With the increased interest in measuring the need for orthodontic treatment and the quality of the outcome of orthodontic care, the difficulties in using Grainger's Treatment Priority Index (TPI) to screen children in their tenth year is considered. The first part of the study investigated the level of validity of the TPI using 137 study models and three orthodontists. In the light of the results obtained, the TPI was modified. The clinical judgement of a further two orthodontists was compared with the scores obtained form the modified TPI, using another 121 study models. Three Community Dental Officers were employed initially to assess the training needs for personnel who were not trained in orthodontics. A further five Community Dental Officers were involved in the final training programmes. It was concluded that it will be very difficult to produce an index which considers all aspects of malocclusion and which can be used consistently by personnel untrained in orthodontics.     

Dental Hygienists in Australia and their Employment in Orthodontic Practice

Dental hygienists are the designated dental auxiliary of the future in Australia. This article explains how their duties came into existence and why their duties in orthodontic practice seem limited in some instances.

Dental hygienists, a class of operating dental auxiliaries, work in Australian orthodontic practices, but their employment is not widespread. The ratio of hygienists to dentists is reported to be 1:40 in Australia and 1:10 in South Australia (Pash, personal communication).     

Effectiveness of training dental students in two occlusal indices

The purpose of this study was to evaluate the ability of students in a U.S. dental school to learn and apply two indices of orthodontic need: the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome, and Need (ICON). Dental students were randomly selected and separated into three groups: control, IOTN, and ICON. Each evaluated thirty casts that had previously been evaluated by a panel of thirteen orthodontists to develop a gold standard of orthodontic treatment need for these casts. Students re-evaluated the same thirty casts after IOTN and ICON training for their own group, while the control group did not receive any training. Logistic regression of pre- and post-training agreement with the gold standard was calculated for each group to create a clear quadratic relationship. Significant differences were not found between pre- and post-training evaluation for either the IOTN or the ICON groups as compared to the control. However, the IOTN group did show more improvement when compared with the ICON group. This study demonstrates that the use of the IOTN index improved assessment in predoctoral dental students to determine orthodontic treatment need.     

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.     

The delivery of orthodontic care in New Zealand. Part I: Analysis of a census of orthodontists.

A two-part study was undertaken to determine the supply of orthodontic services in New Zealand. Part I focuses on services supplied by specialist orthodontists. A companion paper will describe the amount and characteristics of orthodontic services supplied by dentists. All orthodontists in New Zealand in 1999 were surveyed to provide information on practice location and days practiced in 1996 (the year of the last population Census), and the amount and type of orthodontic treatment carried out in the year 1 July 1998 to 30 June 1999. The response rate was 78.9 percent. Data from 1996 were used to establish and quantify the location and distribution of orthodontists in New Zealand, and their spatial relationship to 12-year-olds and 10- to 14-year-olds using Geographic Information Systems. The information from 1998-1999 was used to determine the amount and variety of services provided by orthodontists and the makeup of their patient base. Nearly two-thirds of orthodontists had a branch practice. Over 50 percent of the 10- to 14-year-old population resided within 5 km of an orthodontist, and nearly three-quarters within 10 km. Disparities between regions existed in the supply of specialist orthodontic services. The catchment areas of main urban areas had more than three times the supply of orthodontists to 12-year-olds than did the secondary and minor urban areas combined. The mean average active patient load was 371, and the mean number of full upper and lower fixed appliances placed was 130.3 during the year of the study. Nearly half of all patients had been referred from dentists, approximately one-quarter were self-referred, and a quarter had been referred by dental therapists. Adults comprised 12.1 percent of the patient load of orthodontists; 60 percent were female.     

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.     

Factors influencing the wearing of protective gloves in orthodontic practice

The purpose of this study was to explore how wearing, or not wearing, protective gloves affects the efficiency of orthodontists in performing certain orthodontic procedures. Thirty-six volunteers were randomly selected from members of the Taiwan Association of Orthodontists. A visual analogue scale (VAS) was used to determine the degree of convenience subjects felt in performing 11 specified orthodontic procedures, with and without gloves. In addition, the time required to bend round and rectangular archwires and to tie and untie ligature wires was recorded.The results showed that for 10 of the 11 orthodontic tasks there was perceived to be no difference when wearing, or not wearing, gloves. Only when bending a round archwire was there perceived to be a difference. When the four orthodontic procedures were undertaken on a typodont and timed, no significant difference was found between the use of gloves/no gloves.     

A Survey of Postgraduate (Specialist) Orthodontic Education in 23 European Countries

Abstract

This paper reports on a survey of the duration, funding, and assessment of postgraduate specialist orthodontic training, the requirement for postgraduate training prior to entering specialist orthodontic training and registration of specialist orthodontists in Europe. A questionnaire and 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. The results indicated that a period of postgraduate training, prior to entering specialist orthodontic training was required in 12 of the responding countries. Specialist orthodontic training was reported as lasting 2 years in three countries, 3 years in 17, and for 4 years in three. Part-time training was reported as a possibility in four countries. In 21 of the 23 countries specialist training was reported to take place in full or part within universities, with some training taking place in government clinics in four countries. In five countries some or all training was reported to take place in specialist practices. Training was said to be funded solely or partially by governments in 15 of the 23 countries, to be solely self-funded in five countries, and partly or solely funded by universities in six countries. A final examination at the end of specialist training was reported to be held in 21 of the 23 countries. The nature of this examination varied widely and there was no such examination in two countries. Twelve of the 23 countries reported that they had a specialist register for orthodontics; 11 that they had no register. In none of the countries surveyed was there a requirement for those on a register to undergo periodic reassessment of competence once they are on the register. It was concluded that there was wide diversity in all aspects of specialist orthodontic training and registration within the countries surveyed.     

A survey of postgraduate (specialist) orthodontic education in 23 European countries

This paper reports on a survey of the duration, funding, and assessment of postgraduate specialist orthodontic training, the requirement for postgraduate training prior to entering specialist orthodontic training and registration of specialist orthodontists in Europe. A questionnaire and 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. The results indicated that a period of postgraduate training, prior to entering specialist orthodontic training was required in 12 of the responding countries. Specialist orthodontic training was reported as lasting 2 years in three countries, 3 years in 17, and for 4 years in three. Part-time training was reported as a possibility in four countries. In 21 of the 23 countries specialist training was reported to take place in full or part within universities, with some training taking place in government clinics in four countries. In five countries some or all training was reported to take place in specialist practices. Training was said to be funded solely or partially by governments in 15 of the 23 countries, to be solely self-funded in five countries, and partly or solely funded by universities in six countries. A final examination at the end of specialist training was reported to be held in 21 of the 23 countries. The nature of this examination varied widely and there was no such examination in two countries. Twelve of the 23 countries reported that they had a specialist register for orthodontics; 11 that they had no register. In none of the countries surveyed was there a requirement for those on a register to undergo periodic reassessment of competence once they are on the register. It was concluded that there was wide diversity in all aspects of specialist orthodontic training and registration within the countries surveyed.     

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.     

Hygienists and operating auxiliaries: the opinions of New Zealand dental practitioners

A postal survey was sent to the 1,122 members of the New Zealand Dental Association holding practising certificates in 1989. Replies were received from 53 percent, of whom 80 percent were general dental practitioners, and 45 percent had previously experienced working overseas with hygienists. Only 1 percent of respondents were opposed to any type of auxiliary working in New Zealand. At the time of the survey, 16 percent were already employing auxiliaries under Section 11 of the 1988 Dental Act. Six percent were employing hygienists and 10 percent were employing NZDA operating auxiliaries. A further 16 percent wanted to employ hygienists in the near future and 10 percent would consider employing NZDA operating auxiliaries. Altogether, 42 percent were employing or wished to employ auxiliaries (22 percent hygienist and 19 percent NZDA operating auxiliary). Dentists responding in this survey spent little time pursuing important hygienist-type duties themselves, but indicated that these were the tasks most likely to be delegated to auxiliaries. Most respondents thought that hygienists should be trained in New Zealand, and 60 percent felt the training should be at the School of Dentistry. The majority were of the opinion that the course should last 18-24 months. Eighty-one percent of respondents thought that former school dental nurses required additional training before being allowed to become auxiliaries, and 42 percent thought such additional training should be up to 3 months long and comprise a block course. Eighty-five percent thought there should be an examination at its completion. Approximately one-third of respondents were not prepared to be involved in training a person to perform auxiliary clinical duties.(ABSTRACT TRUNCATED AT 250 WORDS)     

Video versus lecture: effective alternatives for orthodontic auxiliary training.

Abstract

Many studies have compared the relative effectiveness of visually-aided lectures and videotapes, but methodological flaws have prevented definitive comparison of the techniques. This study assessed the relative effectiveness of the two approaches for orthodontic auxiliary training. This study was a prospective, randomised trial, conducted at the Eastman Dental Hospital and Institute. Two groups of 16 dental auxiliaries, selected at random, studied identification and positioning of orthodontic brackets: one group attended a lecture accompanied by slides and the other viewed a video. Subjects bonded brackets onto acrylic teeth and the results were assessed by computerised image analysis. The subjects completed a questionnaire on their attitudes to the respective teaching methods. Results were assessed for accuracy of bracket placement and variations in type of auxiliary. There was no significant difference between the teaching methods except for bracket positioning where video was slightly better (P < 0.05). There was no significant difference between the types of auxiliary. Generally, video teaching and lecturing were equally effective, with video achieving slightly better results. Both methods were effective at teaching bracket placement, and dental nurses and student hygienists proved equally adept at bracket positioning.     

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.     

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.