There is currently insufficient evidence on which to base the clinical practice of early routine grommet placement in children with cleft palate.

No abstract

This cover sheet may not be removed from the document.Please scroll down to view the document. Methods: Patients about to undergo orthodontic treatment using upper and lower fixed appliances were recruited into this 2-arm parallel design RCT in 9 trial sites in the South West of England. They were randomly allocated to one of two groups, namely the experimental chewing gum group or control ibuprofen group. Eligibility criteria included patients undergoing upper and lower fixed appliance therapy, aged 11-17 years, who were able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced using a mean of three recordings on a scale of 0-10. Secondary outcome measures were pain experienced in the subsequent three days, again after the first archwire change, the use of ibuprofen and appliance breakages. Pain scores were recorded using a questionnaire and posted to a collection centre by the patient. Randomisation was by means of a central telephone service and comprised computer-generated pseudo-random numbers used to generate a sequential allocation list, with permuted blocks of variable size (two and four) and stratified by centre. Neither clinicians nor the patients were blinded to the intervention. Patients in the control group were only permitted to use ibuprofen whilst patients in the experimental group were allowed to use ibuprofen only if they didn't get sufficient analgesia from using chewing gum.Data were analysed using the principle of Intention to Treat with multilevel modelling to reflect the structured nature of the data (scores within patient within site).Results: 1000 patients were recruited and randomised in a ratio of 1:1 to either the chewing gum or ibuprofen (control) groups. The male to female ratio was similar in both groups 3 (chewing gum 35.6%: 64.4%, ibuprofen 38.4%: 61.6%). The pain questionnaire response rates were good at approximately 84% and 83% following appliance placement (chewing gum group 419: ibuprofen group 407) and 70% and 71% following the first archwire change (chewing gum group 343: ibuprofen group 341). The primary outcome was similar for the two groups: mean pain 4.31 in the experimental (chewing gum) group and 4.17 in the control (ibuprofen) group, difference 0.14 (95% confidence interval -0.13 to 0.41). There was a suggestion that the relative pain scores for the two groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent three days; however, the differences were not of clinical importance. There were no significant differences for the period following archwire change. The reported use of ibuprofen was less in the chewing gum group than in the control ibuprofen group:following appliance placement the mean number of occasions ibuprofen was used was 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference -0.96 (95%CI -0.75 to -1.17, p<0.001)); following archwire change the analogous figures were 0.8 and 1.5 occasions (difference -0.65 (-0.44 to -0.86,...

The importance of detection of these mutations is mainly in postnatal diagnosis and genetic counselling. Knowledge of the family specific mutation may also be used in prenatal diagnosis to confirm whether the foetus is affected or not, and give the parents the choice of whether to continue with the pregnancy.

Orthodontic treatment carries with it the risks of tissue damage, treatment failure and an increased predisposition to dental disorders. The dentist must be aware of these risks in order to help the patient make a fully informed choice whether to proceed with orthodontic treatment. This paper outlines the potential hazards and suggests how they may be avoided or minimized.