Objective: To measure patient-reported impact of orthodontic treatment in terms of pre-treatment concerns, treatment experience and treatment outcome. Setting: Four sites in Yorkshire, including two secondary care settings (Leeds Dental Institute and St Luke’s Hospital, Bradford) and two specialist orthodontic practices. Design: Cross-sectional survey. Participants: NHS orthodontic patients (aged 12+ years) who have completed comprehensive orthodontic treatment, excluding orthognathic surgery and craniofacial anomalies. Methods: Participants were opportunistically identified by the direct clinical care team during scheduled appointments and those eligible were invited to participate. Data were collected using the Orthodontic Patient Treatment Impact Questionnaire (OPTIQ), a validated 12-item measure with questions relating to pre-treatment experience, impact of treatment and outcome from treatment. Results: Completed questionnaires for analysis included 120 from primary care and 83 from secondary care. The most common pre-treatment concerns were alignment (89%) and being embarrassed to smile (63%). The most common expectations from orthodontic treatment were improved confidence to eat (87%) and smile (72%) in front of others, improved appearance of teeth (85%) and reduced teasing/bullying (63%). Only 67% respondents recalled receiving written information and the lowest recall related to retainer type and length of retention. The most commonly reported complications were sore mouth (68%), fixed appliance breakage (61%) and gingivitis (39%). Treatment caused greatest impact in relation to pain, limitations in eating and effect on speech. Overall satisfaction with orthodontic treatment was reported by 96% of respondents, 87% would have orthodontic treatment again (if needed) and 91% would recommend treatment to a friend. Conclusions: The OPTIQ is a useful patient-reported tool to identify pre-treatment concerns and expectations, treatment experience and outcome. Orthodontic treatment leads to high levels of satisfaction.
Fixed retainers are a popular method of maintaining incisor position following orthodontic treatment. This paper reviews the complications reported with fixed retainers and reports a case in which suspected activation in a multistrand bonded retainer had caused severe unwanted movement of two teeth in the upper labial segment. Clinical Relevance: This paper stresses the importance of passive fixed retainers and the need for long-term review of patients wearing bonded retainers.
A new condition-specific orthognathic questionnaire has been developed which has been shown to be reliable, valid and responsive for the well-being scale. The HADS, as tested by Rasch analysis, was found not to be valid for this orthognathic population.
There is currently no specific occlusal index related to hypodontia and there is a paucity of published literature on this subject. The aim of this study was to determine the relationship, if any, between the Peer Assessment Rating (PAR) Index, the Index of Complexity, Outcome and Need (ICON), and the Dental Aesthetic Index (DAI) score and the severity of hypodontia. All new patients attending the Newcastle Dental Hospital hypodontia clinic between February 2002 and March 2003 were included in the study. Of the 60 patients, two were excluded as the models were unavailable and one because they were predominantly in the primary dentition, making scoring impractical. The patient casts were scored with respect to PAR, ICON, and DAI. The mean patient age at presentation was 12 years, with a standard deviation of 1.89 and a range of 9-16 years, and a female to male ratio of 1.1:1. A significant positive correlation, using Kendall tau b, was found between the number of missing teeth, excluding third molars, and the DAI score (tau = 0.215, P = 0.027). There was no significant positive correlation between PAR (tau = -0.186, P = 0.056) and ICON (tau = 0.017, P = 0.861) score and the number of missing teeth. The results of this investigation indicate that further research is required in order to assess if the DAI could be used to determine whether or not to refer hypodontia patients for specialist advice.
The last decade has seen the orthodontic workforce transformed by the introduction of orthodontic therapists. This article aims to highlight how they have changed the provision of orthodontic treatment and how the orthodontic profession has caught up with general dentistry where task delegation to dental therapists and hygienists has been commonplace for many years. CPD/Clinical Relevance: This article will enable readers to see just what roles OTs undertake, increase their awareness of who may be undertaking the treatment on the patients they refer on and highlight the guidelines on appropriate supervision that their referring orthodontists should be following.
Social media has become increasingly relevant to Orthodontics in several ways. This article highlights how both current and prospective patients may utilize social media to access information about, and voice their experiences of, orthodontic treatment. The applications of this to orthodontic research will also be discussed. Orthodontists should be aware of the role of social media in both education and marketing, as well as the current guidance and best practice in these areas. This knowledge should enable clinicians to maximize the advantages and avoid the pitfalls of social media in day-to-day life. CPD/Clinical Relevance: Clinicians should be aware of the potential impact of social media on education, research, marketing and patients' experiences of treatment.
Questionnaires are versatile tools that allow data to be collected from different respondent groups for a range of purposes. This article outlines the use of questionnaires in orthodontics for research, quality improvement and clinical purposes. We highlight the importance of questionnaire design, particularly choosing the type of response to generate useful data and approaches to psychometric testing to measure validity and reliability. Orthodontic-specific questionnaires that have been developed and tested aresummarized. CPD/Clinical Relevance: Questionnaires are a useful tool for collecting information about patient concerns, experience and outcomes; this information is essential to improve the quality of care. It is crucial that valid and reliable tools are used to optimize the usefulness of information.
Anterior open bite cases are very challenging to manage due to the high relapse potential associated with this feature of malocclusion. It is helpful if the aetiology is established before embarking on treatment to ensure that the appropriate treatment modalities are carried out. Determining whether the aetiology of an anterior open bite is caused by an ‘endogenous tongue thrust’ is extremely difficult. In particular, differentiating between an adaptive and endogenous tongue thrust can be extremely challenging. The case study presented explores the clinical considerations when diagnosing and treating anterior open bites. CPD/Clinical Relevance: This report raises the question: is it possible to diagnose an endogenous tongue thrust?
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