Decision making regarding management of compromised first permanent molars in patients with molar incisor hypomineralisation: A comparison of orthodontists and paediatric dentists.

OBJECTIVES: To obtain the views and opinions of specialist members of the British Orthodontic Society (BOS) and British Society of Paediatric Dentistry (BSPD) in relation to (1) the multidisciplinary management of patients affected by molar incisor hypomineralisation (MIH) and (2) the diagnosis and management of MIH-affected first permanent molars (FPMs) in four clinical scenarios, and compare the responses to those of an expert panel consensus. DESIGN: A prospective cross-sectional study. SETTING: Part 1: Eastman Dental Institute and part 2: online questionnaire. METHODS: Four clinical scenarios showing patients with differing severities of MIH affected FPMs were considered by a panel of orthodontists and paediatric dentists to agree on the severity of MIH and management. A 21-item online questionnaire sent to both specialist groups, after pilot study. The questionnaire covered demographics, access to multidisciplinary clinics, clinicians' opinions on various management aspects, and questions relating to the management of the same 4 clinical scenarios. RESULTS: The overall response was 21.9% (20% of the orthodontists and 45% of the paediatric dentists). Approximately half of the respondents from both groups felt that these patients should be managed through a multidisciplinary treatment type clinic (49.0% of the orthodontists and 47.2% of the paediatric dentists). Only 40.3% of the orthodontists and 35.0% of the paediatric dentists agreed completely with the panel consensus on all management options. When assessing overall agreement on all four FPMs for all scenarios, agreement was predicted by severity of MIH (P<0.001) and complexity of malocclusion (P<0.001) where more complex malocclusions and more severe MIH resulted in poorer agreement, but specialty was not a significant predictor (P=0.21). CONCLUSION: The majority of the respondents from both groups, felt that managing patients with MIH affected FPMs is challenging. Approximately half of the orthodontists and the paediatric dentists, felt that MIH affected patients should be managed through a multidisciplinary type clinic. Managing more severe cases on multidisciplinary clinics is indicated, to incorporate specialist input into decision making.

Queries to the British Orthodontic Society.

OBJECTIVE: As the representative body for orthodontic specialists, the British Orthodontic Society (BOS) provides advice and guidance to professionals and patients on a variety of topics. The BOS receive frequent queries from professionals and patients and, where appropriate, provide advice and guidance. By reflecting on the types of queries received, it is hoped that general guidance can be developed and 'frequently asked questions' information established to improve knowledge in these particular areas. DESIGN: Retrospective assessment of queries raised to the BOS. SETTING: BOS headquarters, London. METHODS: All queries raised to the BOS by professionals and patients from January 2017 to October 2018 were collated and divided into those raised by dental professionals or by patients. Within each group, all queries were further subcategorised into different topic areas. For each of the main topics, guidance will be developed to improve clinician and patient knowledge in these areas. RESULTS: In the time period assessed, 422 queries were received to the BOS, 51.8% (n = 229) were from patients and 48.2% (n = 213) from professionals. Commissioning was the most common topic queried by professionals (34.3%), which included NHS contracts and tendering. Queries regarding associate matters (9.4%), specific clinical queries (9.4%) and BOS issues (8.9%) were also common topics raised by professionals. The most common topic queried by patients was the eligibility for NHS treatment (29.3%), followed by specific clinical queries (22.3%) and seeking recommendations for clinicians (10.5%). CONCLUSIONS: Overall, a large number of queries were received by the BOS. While some queries required specific information from the BOS, the majority of queries could be addressed through already published information and guidance. This project identifies the more common queries and provides clear guidance on where to find the appropriate advice.

The causes, diagnosis and treatment of anterior open bite.

Anterior open bite has multiple aetiologies, but can be broadly described as being dental or skeletal in origin. Accurate differentiation is essential in determining the appropriate treatment plan: dental open bites may close spontaneously in the growing patient and are generally amenable to orthodontic treatment, whereas skeletal open bites frequently worsen with growth and usually require a combination of orthodontics and orthognathic surgery. The incidence of post-treatment relapse is high, making these malocclusions a challenge to treat successfully.