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.

Service evaluation of referrals to secondary care: A question of complexity?

OBJECTIVES: To evaluate referral patterns to secondary care and categorise referrals by complexity level. To assess compliance with commissioning guidelines for cases accepted for treatment in secondary care, comparing complexity to Index of Orthodontic Treatment Need (IOTN) data. DESIGN: Service evaluation of all referrals during study period recorded prospectively. The standard was set that >85% of cases offered treatment in secondary care should be complexity level 3b. SETTING: Seven NHS orthodontic departments within a regional clinical effectiveness group in secondary care in England. PARTICIPANTS: All patients seen as new referrals during the three-month study period. METHODS: Data recorded at clinic appointment on data collection proforma including referral information, complexity, IOTN and outcome of the first appointment. Data were collated on a spreadsheet and simple statistics were applied. RESULTS: A total of 493 patients were included in data analysis. Median waiting time for a new patient appointment was 11.0 weeks. For the whole study group, 53.8% were IOTN 5, 30.8% IOTN 4, 9.7% IOTN 3; complexity levels were 54.2% complexity 3b, 37.1% 3a and 6.7% 2. Of the patients, 30.0% were offered treatment in secondary care at their first attendance; of these, 74.3 % were IOTN 5, 93.2% were complexity level 3b. CONCLUSION: The gold standard has been met in the region as a whole and at each individual unit. There is a large discrepancy between the IOTN score and complexity level in those patients offered orthodontic treatment in secondary care. Routine recording of complexity level is recommended for all patients seen in the secondary care setting.

Motivation and compliance with intraoral elastics.

INTRODUCTION: Intraoral elastics are commonly used in orthodontics and require regular changing to be effective. Unfortunately, poor compliance with elastics is often encountered, especially in adolescents. Intention for an action and its implementation can be improved using "if-then" plans that spell out when, where, and how a set goal, such as elastic wear, can be put into action. Our aim was to determine the effect of if-then plans on compliance with elastics. METHODS: To identify common barriers to compliance with recommendations concerning elastic wear, semistructured interviews were carried out with 14 adolescent orthodontic patients wearing intraoral elastics full time. Emerging themes were used to develop if-then plans to improve compliance with elastic wear. A prospective pilot study assessed the effectiveness of if-then planning aimed at overcoming the identified barriers on compliance with elastic wear. Twelve participants were randomized equally into study and control groups; the study group received information about if-then planning. The participants were asked to collect used elastics, and counts of these were used to assess compliance. RESULTS: A wide range of motivational and volitional factors were described by the interviewed participants, including the perceived benefits of elastics, cues to remember, pain, eating, social situations, sports, loss of elastics, and breakages. Compliance with elastic wear was highly variable among patients. The study group returned more used elastics, suggesting increased compliance, but the difference was not significant. CONCLUSIONS: The use of if-then plans might improve compliance with elastic wear when compared with routine clinical instructions.

Recovery of sensation after orthognathic treatment: patients' perspective.

INTRODUCTION: In this study, we considered patients' self-assessments to establish the recovery of sensory disturbance and the resultant distress over a 6-month postoperative recovery period after orthognathic surgery. METHODS: A prospective longitudinal cohort questionnaire survey recruited 47 consecutive patients who met the study criteria (16 years of age or over; single jaw or bimaxillary surgery). A questionnaire to measure perceived facial and oral sensory loss was sent to the participants at 1 week, 6 weeks, and 6 months postsurgery. RESULTS: Thirty-one participants (66%) completed the first questionnaire, and 26 (55%) completed all 3 assessments. The total sample comprised 14 male and 17 female subjects with a mean age of 21.2 years (SD, 4.93 years). There was a marked reduction in the proportion reporting sensory impairment at the 26-week point for both sites, although more so intraorally. At all 3 times, there were high correlations between the extent of sensory loss and the distress associated with it. CONCLUSIONS: Change in sensation occurs rapidly in the first 6 weeks postoperatively and more slowly thereafter. The distress caused by sensory loss is strongly related to the amount of sensory disturbance for both the face and the mouth.