Nutrient estimates from computerized questionnaires vs. 24-hr. recall interviews.

A computerized nutritional assessment service used by dentists was investigated. Daily nutrient intake of forty-six adult subjects was estimated from replies to a computerized food frequency questionnaire and the results compared with the average nutrient intakes of the same individuals obtained during five 24-hr. dietary recall interviews. Although the two methods produced essentially the same mean for carbohydrate intake and a minimal difference in the mean caloric values, mean estimates of the other nutrients were 6 to 88 per cent greater with the computerized data than via the dietary recalls. The dietary assessment service included unwarranted recommendations for vitamin and mineral supplementation.

Consistency of patient classification in orthodontic diagnosis and treatment planning.

The purpose of this study was to examine diagnosis and treatment planning categorizations used by experienced orthodontists. Thirty-nine clinicians were asked to evaluate six test cases and formulate a diagnosis and treatment plan for each. The information provided was categorized using a problem-oriented classification. The results indicate little agreement exists in diagnostic subcategories, such as molar relationship, degree of crowding, or the nature of skeletal discrepancies. There was also little agreement regarding some treatment strategies, such as extraction of teeth, the use of orthopedic appliances, or the use of surgery. A need exists for better definitions of diagnostic criteria and appropriate treatment options.

Orthodontic residents' indications for use of the lateral TMJ tomogram and the posteroanterior cephalogram.

The purpose of this study was to determine the selection criteria used by orthodontic residents for ordering a corrected lateral tomogram (LT) of the temporomandibular joint (TMJ) and a posteroanterior cephalogram (PAC) for the diagnosis of patients needing orthodontic care. The impact of the radiographs on their treatment plans was also assessed. We conducted a study of the 144 new patients assigned to eight orthodontic residents during a two-year period. The residents responded through questionnaires describing their rationale for ordering the radiographs. A LT was ordered for twenty-eight (19 percent) of the patients. The most common reasons cited for requesting the LTs were TMJ clicking (67 percent) and pain (33 percent). The residents also perceived a need to order the LT for medico-legal protection in 85 percent of these cases. The LT tended not to have an impact on treatment planning. A PAC was ordered thirty-eight times (26 percent). The most common reasons cited by residents for ordering a PAC included clinical findings of facial asymmetry (41 percent) and maxillary airway anatomy (24 percent). Medico-legal protection was a perceived need in only 12 percent of the cases. While the PAC had no impact on treatment planning for 56 percent of the cases, they did define the transverse problems as dental or skeletal for 38 percent of the cases. Six patient traits were statistically associated with PAC requests: difficulty chewing, abnormal TMJ, TMJ clicking, facial asymmetry. crossbite, and midline discrepancy. The teaching of appropriate selection criteria for ordering these radiographs needs to be emphasized early in a resident's training.

Orthodontic radiographic usage by pediatric dentists.

Pediatric educators and practitioners were surveyed to determine the composition of the radiographic examination used to diagnose patient malocclusion; pediatric dentists provide the initial diagnosis for much of the orthodontic service provided to children and adolescents. The initial diagnosis of malocclusion is based on information obtained from a clinical and radiographic examination. Results of the study are based on the 111 pediatric dentists who report providing comprehensive orthodontic treatment. For those who reported providing comprehensive orthodontic therapy, the frequency of ordering each of ten radiographs and the importance of the radiographs to the dentists' diagnosis and treatment plans were measured. The bitewing, lateral cephalometric and panoramic radiographs were the most frequently ordered radiographs for both young and older patients. Radiographic and clinical examinations were judged to be of equal importance to more than fifty percent of the dentists.

The effect of tooth preparation on the retention of stainless steel crowns.

Preparations maintaining the greatest amount of buccal and lingual tooth structure were the most retentive. Cement significantly increased the retention capacity of all preparations. Mechanical retention did not contribute significantly to the separation-resistance of the stainless steel crown. Factors other than retention may be of greater importance to the clinical success of stainless steel crowns.

Contribution of pretreatment radiographs to orthodontists' decision making.

A study was conducted to determine the amount of diagnostic and treatment planning information gained by orthodontists when pretreatment radiographs are added to a set of orthodontic records. Thirty-nine orthodontists evaluated six test cases and formulated a diagnosis and treatment plan. Information was collected about the participants' certainty with their diagnoses and treatment plans, the impact of the radiographs, the number and type of radiographs that were selected, and the difficulty of each case. Results showed that orthodontists were approximately 75% confident of their diagnosis before reviewing any radiograph. There were 741 radiographs ordered, of which 192 produced changes to the diagnostic process. The lateral cephalometric radiograph was the most productive. Panoramic and full-mouth series were productive but provided largely duplicative information.

An algorithm for ordering pretreatment orthodontic radiographs.

A study was conducted to identify selection criteria for ordering pretreatment orthodontic radiographs. Thirty-nine orthodontists evaluated six test cases. They provided information on the rationale for ordering each specific radiograph and the impact of the radiograph on the diagnosis and treatment plan. Skeletal relationship of the jaws was the most common indication for a radiograph request, followed by root formation/length and molar position or development. Of the radiographs, 16% produced a change in diagnosis, and 20% produced a change in treatment plans. The criteria specified for the radiographs, their impact, and relevant information in the literature were used to develop an algorithm or set of decision rules that, when tested on the six test cases, resulted in a 36% reduction in the total number of radiographs.