Is team-based learning an alternative approach for UK undergraduate dental education? A scoping review of the literature.

Introduction Team-based learning (TBL) is a dialectic, student-focused method of teaching which has become increasingly popular in international institutions for delivering undergraduate dental education. Despite several dental schools in the UK using dialectic teaching methods, such as problem-based learning, none appear to use TBL.Aims This scoping review aims to identify the literature investigating the use of TBL compared with other teaching pedagogies in delivering undergraduate dental education.Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines were adopted. A search strategy was developed using appropriate MeSH (medical subject headings) terms and key words. Medline, Scopus and the Cochrane Databases were searched.Results Overall, five studies were identified for inclusion. Of these, three studies compared TBL to traditional, didactic teaching methods (such as lectures) and found both student satisfaction and student performance to be greater with TBL. The remaining two studies compared TBL to other dialectic methods of teaching. The results on student performance in these studies were conflicting.Conclusions There is some limited but promising evidence that TBL is effective at delivering undergraduate dental education; however, the scarcity of research evidence highlights the need for more robust exploration.

Extraction of maxillary canines: Esthetic perceptions of patient smiles among dental professionals and laypeople.

INTRODUCTION: Maxillary canines are generally considered important both cosmetically and functionally. Most claims on the importance of maxillary canines, however, have been based on expert opinions and clinician-based studies. There are no scientific studies in the literature reporting on their cosmetic importance or how laypeople perceive a smile treated by maxillary canine extractions. Our objective was to investigate whether there is any difference in the perceptions of patients' smiles treated by extracting either maxillary canines or first premolars, as judged by orthodontists, dentists, and laypeople. METHODS: This retrospective study included 24 participants who had unilateral or bilateral extraction of maxillary permanent canines and fixed appliances in the maxillary and mandibular arches to comprehensively correct the malocclusion, selected from orthodontic patients treated at Chesterfield Royal Hospital NHS trust in the United Kingdom over the last 20 years. The control group of patients had extraction of maxillary first premolars followed by fixed appliances and finished to an extremely high standard judged by the requirement that they had been submitted for the Membership in Orthodontics examination. The finished Peer Assessment Rating scores for this group were less than 5. The end-of-treatment frontal extraoral smiling and frontal intraoral views were presented for both groups. The photographs were blinded for extraction choice and standardized for size and brightness using computer software (Adobe Photoshop CC version 14.0; Adobe Systems, San Jose, Calif). The work file was converted to an editable pdf file and e-mailed to the assessors. The assessor panel consisted of 30 members (10 orthodontists, 10 dentists, and 10 laypeople), who were purposely selected. The measures were rated on a 10-point Likert scale. RESULTS: The attractiveness ratings were not statistically significantly different between the canine extraction and premolar extraction groups, with a mean difference of 0.33 (SD, 0.29) points. A 1-way repeated-measures analysis of variance to test the difference in scores among the laypeople, orthodontists, and dentists (n = 30) showed no statistically significant difference (Wilks lambda = 0.835; P = 0.138), and the Bonferroni test indicated that no pair-wise difference was statistically significant. CONCLUSIONS: No statistically significant difference was found in the smile attractiveness between canine extraction and premolar extraction patients as assessed by general dentists, laypeople, and orthodontists. Further high-quality studies are required to evaluate the effect of canine extraction and premolar substitution on functional occlusion.

Does orthodontic treatment before the age of 18 years improve oral health-related quality of life? A systematic review and meta-analysis.

INTRODUCTION: Orthodontics aims to improve oral health-related quality of life (OHRQoL). In this systematic review, we examined the evidence for changes in OHRQoL after orthodontic treatment for patients treated before they were 18 years old. METHODS: The participants were patients aged less than 18 years. The interventions were nonorthognathic and cleft orthodontic treatment. The comparisons were before and after orthodontic treatment, or nonorthodontic control. The outcomes were validated measures of OHRQoL. The study designs were randomized controlled trials, controlled clinical trials, prospective cohort studies, and cross-sectional or case-control studies. Multiple electronic databases were searched, with no language restrictions; authors were contacted, and reference lists screened. The Newcastle-Ottawa scale was used for quality assessments. Screening, data extraction, and quality assessments were performed by 2 investigators independently. RESULTS: We found 1590 articles and included 13 studies (9 cohort, 3 cross sectional, and 1 case control), with 6 in the meta-analyses. All were judged of low or moderate quality. A moderate improvement in OHRQoL was observed before and after orthodontic treatment (n = 243 participants; standardized mean difference, -0.75; 95% CI, -1.15 to -0.36) particularly in the dimensions of emotional well-being (n = 213 participants; standardized mean difference, -0.61; 95% CI, -0.80 to -0.41) and social well-being (n = 213 participants; standardized mean difference, -0.62; 95% CI, -0.82 to -0.43). CONCLUSIONS: Orthodontic treatment during childhood or adolescence leads to moderate improvements in the emotional and social well-being dimensions of OHRQoL, although the evidence is of low and moderate quality. More high quality, longitudinal, prospective studies are needed.

Clear aligners for orthodontic treatment?

DATA SOURCES: PubMed/Medline, Embase, Cochrane Central Register of Controlled Clinical trials (CENTRAL), Web of Knowledge, SCOPUS, Google Scholar and LILACS databases. STUDY SELECTION: Clinical prospective and retrospective studies of orthodontic treatment with clear aligners on patients over the age of 15 that included clear descriptions of the materials and applied technique were included. Selection was undertaken independently by two reviewers. DATA EXTRACTION AND SYNTHESIS: Two reviewers extracted data independently with study quality being assessed using the grading system described by the Swedish Council on Technology Assessment in Health Care (SBU). A narrative summary of the findings was presented. RESULTS: Eleven studies involving a total of 480 patients were included consisting of two randomised controlled trials, five prospective studies and four retrospective studies. Six studies were considered to be of moderate quality, the remainder of limited quality. CONCLUSIONS: Most of the studies presented with methodological problems: small sample size, bias and confounding variables, lack of method error analysis, blinding in measurements, and deficient or missing statistical methods. The quality level of the studies was not sufficient to draw any evidence-based conclusions.

The impact of malocclusion and its treatment on the oral health related quality of life of adults, assessed using the Oral Health Impact Profile (OHIP-14).

DATA SOURCES: PubMed, Medline and Embase via OVID were searched up to November 2013. This was supplemented by a hand search of the reference lists of all relevant publications and recently published review articles. The search was restricted to the English language. STUDY SELECTION: Two review authors independently searched and selected the studies. Interventional or observational studies of individuals aged 15 years and above with either a malocclusion, or those who had undergone treatment for a malocclusion, were included. Studies must have included a control group without a malocclusion (for assessment of malocclusion impact), or a control group requiring treatment for correction of malocclusion (to assess the impact of treating malocclusion). Oral health related quality of life (OHRQoL) had to be measured using OHIP-14. DATA EXTRACTION AND SYNTHESIS: Two review authors independently carried out data abstraction and methodological quality assessment. Studies were divided into three groups based on the type of comparison groups; with and without malocclusion (independent design), the same group of individuals before and after treatment (pre-post design), and an orthodontically treated group with a group requiring treatment (treated-untreated groups design). For each group, data were pooled if the same type and details of OHIP-14 scores were reported. A Q test, I(2) test and random-effects model were used. Begg and Egger tests and funnel plots were used to measure bias, including publication bias. RESULTS: Twenty-five studies were included; eleven studies had an independent design, ten studies were classed as pre-post studies, and four studies were categorised as demonstrating a treated-untreated groups design. Data from four of the independently designed studies, which included a total of 892 patients, were pooled and a meta-analysis conducted. The data from three of the pre-post designed studies, with a total of 110 patients, were also pooled in a separate meta-analysis. The standardised mean difference (SMD) in OHIP-14 total score in the independently designed studies was 0.84 (95% CI: 0.25 to 1.43) and in the pre-post design group was 1.29 (95% CI: 0.67 to 1.92). The studies in both meta-analyses demonstrated statistically significant levels of heterogeneity. There was also evidence of publication bias in the meta-analysis conducted using the independently designed studies. CONCLUSIONS: There are currently no high quality studies in the form of longitudinal or randomised controlled trials to assess the impact of malocclusion and its associated treatment on OHIP-14 scores respectively. Results from existing studies, which are predominantly cross-sectional, suggest that OHIP-14 scores are significantly lower in individuals without a malocclusion, indicating higher levels of OHRQoL. Similarly, longitudinal studies have shown that OHIP-14 scores are significantly lower after patients have received treatment for their malocclusion. The small number of trials, and their associated methodological concerns, limits the validity and reliability of the meta-analyses conducted, and the results obtained must be subjected to further scrutiny and confirmation.

Managing chronic orofacial pain: A qualitative study of patients', doctors', and dentists' experiences.

OBJECTIVE: Persistent pain in the face, mouth, and jaws is a common presentation to dental and medical services. The aetiology remains unclear, but a growing evidence base recognizes the effectiveness of psychological rather than biomedical interventions. To understand how this approach might be implemented into clinical practice, knowledge is needed of patients' and clinicians' experience of chronic orofacial pain (COFP). The aim of this study was to explore the experience and understanding of COFP by patients and primary and secondary care medical and dental practitioners. DESIGN: Qualitative interview study. METHODS: Audio-recorded semi-structured interviews with a purposive sample of 12 dentists, 11 general practitioners, and seven patients were thematically analysed. RESULTS: Clinicians and patients recognized the role that psychological factors could play in the development and maintenance of COFP, yet management and self-management strategies were largely limited to biomedical interventions. Achieving a diagnosis proved problematic but largely functional for both parties. GPs and dentists viewed COFP as a non-dental problem and felt inadequately equipped to manage the condition. GPs, unlike dentists, felt obligated to support patients using techniques for managing patients with other long-term conditions. Frustration at the current inadequacy of COFP management often led to conflict with (or disengagement from) the clinician-patient relationship. CONCLUSIONS: Current management of COFP is ineffective and unsatisfactory for patients and practitioners, which impacts on their relationship. Fundamental barriers to accessing and implementing psychological interventions for COFP arise from ineffective communication between physicians and patients, and between medical and dental practitioners. Statement of contribution What is already known on this subject? COFP is characterized by persistent pain in the face, mouth, or jaws that are not the result of organic disease or physical trauma. Patients with COFP present to both medical and dental services and receive sub-optimal care. No studies have examined the experiences of managing this problem from the perspectives of dentists, general practitioners and patients. What does this study add? Patients, dentists, and GPs recognize the role that psychological factors have in maintaining and addressing facial pain symptoms, yet principally manage it through biomedical interventions. Challenges exist over arriving at a diagnosis and managing the problem, and challenges are exacerbated by poor communication between doctors and medical services. Improvements are needed in liaison between medical and dental services and further training to support primary care clinicians to facilitate a stepped care approach to managing COFP.

Psychosocial interventions for the management of chronic orofacial pain.

BACKGROUND: Psychosocial factors have a role in the onset of chronic orofacial pain. However, current management involves invasive therapies like occlusal adjustments and splints which lack an evidence base. OBJECTIVES: To determine the efficacy of non-pharmacologic psychosocial interventions for chronic orofacial pain. SEARCH METHODS: The following electronic databases were searched: the Cochrane Oral Health Group Trials Register (to 25 October 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE via OVID (1950 to 25 October 2010), EMBASE via OVID (1980 to 25 October 2010) and PsycINFO via OVID (1950 to 25 October 2010). There were no restrictions regarding language or date of publication. SELECTION CRITERIA: Randomised controlled trials which included non-pharmacological psychosocial interventions for adults with chronic orofacial pain compared with any other form of treatment (e.g. usual care like intraoral splints, pharmacological treatment and/or physiotherapy). DATA COLLECTION AND ANALYSIS: Data were independently extracted in duplicate. Trial authors were contacted for details of randomisation and loss to follow-up, and also to provide means and standard deviations for outcome measures where these were not available. Risk of bias was assessed and disagreements between review authors were discussed and another review author involved where necessary. MAIN RESULTS: Seventeen trials were eligible for inclusion into the review. Psychosocial interventions improved long-term pain intensity (standardised mean difference (SMD) -0.34, 95% confidence interval (CI) -0.50 to -0.18) and depression (SMD -0.35, 95% CI -0.54 to -0.16). However, the risk of bias was high for almost all studies. A subgroup analysis revealed that cognitive behavioural therapy (CBT) either alone or in combination with biofeedback improved long-term pain intensity, activity interference and depression. However the studies pooled had high risk of bias and were few in number. The pooled trials were all related to temporomandibular disorder (TMD). AUTHORS' CONCLUSIONS: There is weak evidence to support the use of psychosocial interventions for chronic orofacial pain. Although significant effects were observed for outcome measures where pooling was possible, the studies were few in number and had high risk of bias. However, given the non-invasive nature of such interventions they should be used in preference to other invasive and irreversible treatments which also have limited or no efficacy. Further high quality trials are needed to explore the effects of psychosocial interventions on chronic orofacial pain.

Patients' knowledge of risk factors for dental disease. A pilot service evaluation in a general dental practice.

UNLABELLED: The major dental diseases, including erosion, caries and periodontal disease, are preventable, and the Department of Health has produced guidelines in a 'Prevention Toolkit' to aid prevention of these diseases in primary care. AIM: To investigate patients' knowledge of the key themes in the Prevention Toolkit and to compare their knowledge of the different dental diseases. METHODS: Patients attending a general dental practice in North West England were asked to complete a questionnaire while they waited to see their dentist. The questionnaire had been piloted for readability, relevance of questions, and ease of use. It included nine true/false questions on key prevention messages. Data from the respondents were used to assess whether there were differences in knowledge by age or gender and between the types of dental diseases. Results were analysed using chi-square tests. RESULTS: 105 patients completed the questionnaire. Of the 420 questions relating to periodontal diseases, 322 (77%) were answered correctly and 196 (47%) of the 420 questions on caries were answered correctly; however, only 32 (31%) of the 105 questions relating to erosion were answered correctly. There were significantly lower levels of knowledge of caries (P<0.01) compared with periodontal diseases. Worryingly, 47 (45%) of 105 respondents stated incorrectly that brushing teeth immediately after consuming a 'fizzy' drink would protect the teeth. CONCLUSION: The results of this pilot service evaluation indicate that in the practice concerned, more needs to be done to promote disease prevention at the primary care level. The current questionnaire could form a valuable tool to audit and reinforce patients' knowledge, although it needs further development and validation. Longitudinal evaluation of the questionnaire, linking it with disease outcome measures, has the potential to indicate whether change in knowledge translates into behavioural change.

Reviewing the evidence: can cognitive behavioral therapy improve outcomes for patients with chronic orofacial pain?

AIMS: To review evidence for chronic orofacial pain management using cognitive behavioral therapy (CBT). METHODS: Electronic databases were searched for randomized controlled trials in which CBT was compared either alone or in combination with other forms of therapy for management of chronic orofacial pain. The quality of trials was assessed blind by three authors using a validated scale that had been specifically designed to score the quality of randomized controlled trials for psychological interventions. Author agreement was assessed using interclass correlation co_efficients. RESULTS: Fourteen potentially relevant randomized controlled trials were identified. Seven trials were excluded, leaving seven for analysis; two studies were merged as they included the same trial and therefore six trials were used in the final analysis. All but one of the randomized controlled trials identified were based on temporomandibular disorders (TMD). Scoring of the trials showed that the three raters were in close agreement, with four trials performing well (scores of 22-35) whilst the remaining two trials were poor (scores < 18). Of the four trials, one did not show any improvement with CBT prior to conservative treatment whilst the other three showed that CBT alone or in conjunction with conservative treatment improved both short-term and long-term outcomes in functional, dysfunctional, and chronic TMD patients. CONCLUSIONS: CBT, either alone or in combination with biofeedback, conservative treatment and/or self-care, can improve outcomes for patients with TMD in secondary care. However, further research is needed to assess its effectiveness in primary care and in management of other chronic orofacial pain conditions. Further, the number of sessions needed, mode of delivery, and cost-effectiveness also remain unclear.