"Over-reviewing" of research? An analysis of orthodontic reviews.

INTRODUCTION: Research overviews may be undertaken to identify gaps in the literature, evaluate existing systematic reviews (SRs), and summarize evidence. This paper aims to profile overviews that have been conducted in orthodontics and related interventions since 2012 and to evaluate the degree of overlap among these overviews. METHODS: Overviews published between January 1, 2012 and June 20, 2023 were identified using an electronic search involving Google Scholar and PubMed. A descriptive summary was produced, and citation matrices were used to evaluate the percentage of overlap between overviews using corrected covered area and covered area. This was classified as slight, moderate, high, or very high. RESULTS: A total of 35 overviews were identified across a wide range of topics. Eight overviews included <10 SRs; 21 had 10-20 SRs; and 6 included >20 SRs (median no. of SRs per overview, 15; range, 3-62). Meta-analysis was conducted in only 5 overviews. Overlap between overviews on the same topic ranged from slight (2.7%) to very high (53.8%). CONCLUSIONS: Almost all overview topics address treatments and their effects, with a wide variation in the number and quality of SRs included. There is considerable overlap in some orthodontic overviews, suggesting unnecessary duplication and research waste. Researchers should be encouraged to focus on primary data collection to add more high-quality data to SRs, which will ultimately enhance the yield from secondary and tertiary orthodontic research.

Adult orthodontic patients: What is important to them?

OBJECTIVE: To understand patients' motivations for pursuing treatment, to appreciate what information patients seek and to explore potential factors affecting decision making in adults considering, undergoing or who have had orthodontic treatment in the private sector. DESIGN: Cross-sectional questionnaire study. SETTING: Online questionnaire. PARTICIPANTS: A total of 209 (83% women, 16% men, 1% preferred not to say) completed responses were received. METHODS: Once piloted, the final survey was made available online to adults in the United Kingdom (UK) and Republic of Ireland (RoI) who were either considering having orthodontic treatment, currently undergoing treatment or had recently completed treatment in the private sector. RESULTS: The most commonly selected motivating factor was to 'improve the appearance of my teeth' (82%). The information sought related predominantly to treatment duration (64%), potential end results (56%), types of appliances that were available (55%) and cost (52%). The two most commonly reported social factors that had influenced participants to consider treatment were 'seeing myself on social media' (31%) and 'it is more socially acceptable to have braces' (31%). CONCLUSION: While this area remains relatively underexplored in the literature, it is crucial to develop a comprehensive understanding due to the increasing number of adults seeking orthodontic treatment. This study not only reinforces the existing knowledge regarding adults seeking orthodontic treatment, such as the predominant role of aesthetics as a motivating factor, but also introduces some novel insights. Specifically, we highlight the influence of social factors on decision-making processes and the importance of effectively communicating the duration of treatment to patients.

Interactive effects of rising temperatures and urbanisation on birds across different climate zones: A mechanistic perspective.

Climate change and urbanisation are among the most pervasive and rapidly growing threats to biodiversity worldwide. However, their impacts are usually considered in isolation, and interactions are rarely examined. Predicting species' responses to the combined effects of climate change and urbanisation, therefore, represents a pressing challenge in global change biology. Birds are important model taxa for exploring the impacts of both climate change and urbanisation, and their behaviour and physiology have been well studied in urban and non-urban systems. This understanding should allow interactive effects of rising temperatures and urbanisation to be inferred, yet considerations of these interactions are almost entirely lacking from empirical research. Here, we synthesise our current understanding of the potential mechanisms that could affect how species respond to the combined effects of rising temperatures and urbanisation, with a focus on avian taxa. We discuss potential interactive effects to motivate future in-depth research on this critically important, yet overlooked, aspect of global change biology. Increased temperatures are a pronounced consequence of both urbanisation (through the urban heat island effect) and climate change. The biological impact of this warming in urban and non-urban systems will likely differ in magnitude and direction when interacting with other factors that typically vary between these habitats, such as resource availability (e.g. water, food and microsites) and pollution levels. Furthermore, the nature of such interactions may differ for cities situated in different climate types, for example, tropical, arid, temperate, continental and polar. Within this article, we highlight the potential for interactive effects of climate and urban drivers on the mechanistic responses of birds, identify knowledge gaps and propose promising future research avenues. A deeper understanding of the behavioural and physiological mechanisms mediating species' responses to urbanisation and rising temperatures will provide novel insights into ecology and evolution under global change and may help better predict future population responses.

An evaluation of a biophysical model for predicting avian thermoregulation in the heat.

Survival and reproduction of endotherms depend on their ability to balance energy and water exchange with their environment, avoiding lethal deficits and maximising gains for growth and reproduction. At high environmental temperatures, diurnal endotherms maintain body temperature (Tb) below lethal limits via physiological and behavioural adjustments. Accurate models of these processes are crucial for predicting effects of climate variability on avifauna. We evaluated the performance of a biophysical model (NicheMapR) for predicting evaporative water loss (EWL), resting metabolic rate (RMR) and Tb at environmental temperatures approaching or exceeding normothermic Tb for three arid-zone birds: southern yellow-billed hornbill (Tockus leucomelas), southern pied babbler (Turdoides bicolor) and southern fiscal (Lanius collaris). We simulated metabolic chamber conditions and compared model outputs with thermal physiology data collected at air temperatures (Tair) between 10 and 50°C. Additionally, we determined the minimum data needed to accurately model diurnal birds' thermoregulatory responses to Tair using sensitivity analyses. Predicted EWL, metabolic rate and Tb corresponded tightly with observed values across Tair, with only minor discrepancies for EWL in two species at Tair≈35°C. Importantly, the model captured responses at Tair=30-40°C, a range spanning threshold values for sublethal fitness costs associated with sustained hot weather in arid-zone birds. Our findings confirm how taxon-specific parameters together with biologically relevant morphological data can accurately model avian thermoregulatory responses to heat. Biophysical models can be used as a non-invasive way to predict species' sensitivity to climate, accounting for organismal (e.g. physiology) and environmental factors (e.g. microclimates).

A qualitative evaluation of attitudes toward extractions among primary care orthodontists in Great Britain.

INTRODUCTION: The need to extract permanent teeth as part of orthodontic treatment has been keenly debated over many decades. Changes in the frequency of extraction have been well documented; however, we continue to lack an understanding of what influences clinicians' decisions regarding extracting permanent teeth. METHODS: Purposive sampling was undertaken to obtain representative views from primary care practitioners across Great Britain with a range of experience representing genders and wide geographic distribution. Twenty participants (9 female, 11 male) took part in in-depth, qualitative, 1-to-1 interviews based on a piloted topic guide. Interviews were conducted via video conferencing software with audio recording and verbatim transcription. Thematic analysis was performed with discussion and agreement to identify the main themes. RESULTS: Five main themes were identified: (1) patient-related factors, such as age and features of the malocclusion, (2) operator factors, including the level of experience, (3) setting, with regard to geographic location and method of remuneration, (4) mechanical approaches, including variations in appliance systems; and (5) self-directed ongoing education, including both formal continuing professional development and informal learning from peers. These factors acted as barriers, enablers, or both in relation to nonextraction treatment. CONCLUSIONS: Five key influences on extraction decisions among orthodontists in Great Britain were identified. Extraction choices appear to be influenced by various interrelated factors, evolving over time and with increased experience.

A qualitative exploration of the experiences of young people and their parents regarding the impact of missing school to attend hospital-based orthodontic appointments.

OBJECTIVE: To explore the experiences of young people and their parents regarding the impact on school performance due to time away from school for orthodontic appointments and to explore their views about a possible extension to the current service. DESIGN: A qualitative study using semi-structured interviews. SETTING: UK district hospitals. PARTICIPANTS: A total of 11 pairs of interviewees: young people undergoing fixed appliances and their parents. METHODS: Semi-structured interviews were conducted with young people and their parents. The interviews were audio recorded and transcribed verbatim. A framework approach was used to analyse the data. RESULTS: A thematic analysis of the data identified five main themes which were as follows: (1) expectations of the treatment process and appointments; (2) impact of school absences and treatment; (3) appointments; (4) implications for young people, parents and others; and (5) satisfaction with treatment. These themes were then further subdivided and analysed. CONCLUSION: Young people and their parents felt that attending appointments for orthodontic treatment had minimal impact on a young person's school performance. However, some young people did engage in coping mechanisms in order to ensure this was the case. Young people and their parents advised they were satisfied with the process of the treatment despite the time missed at school/work. Some young people and their parents saw a real benefit to appointments that could be fitted into a 'NHS seven-day' service model, but this did not apply to all interviewees.

Comparative morphology and soft tissue histology of the remote-touch bill-tip organ in three ibis species of differing foraging ecology.

Ibises (order: Pelecaniformes, family: Threskiornithidae) are probe-foraging birds that use 'remote-touch' to locate prey items hidden in opaque substrates. This sensory capability allows them to locate their prey using high-frequency vibrations in the substrate in the absence of other sensory cues. Remote-touch is facilitated by a specialised bill-tip organ, comprising high densities of mechanoreceptors (Herbst corpuscles) embedded in numerous foramina in the beak bones. Each foramen and its associated Herbst corpuscles make up a sensory unit, called a 'sensory pit'. These sensory pits are densely clustered in the distal portion of the beak. Previous research has indicated that interspecific differences in the extent of sensory pitting in the beak bones correlate with aquatic habitat use of ibises, and have been suggested to reflect different levels of remote-touch sensitivity. Our study investigates the interspecific differences in the bone and soft tissue histology of the bill-tip organs of three species of southern African ibises from different habitats (mainly terrestrial to mainly aquatic). We analysed the external pitting pattern on the bones, as well as internal structure of the beak using micro-CT scans and soft tissue histological sections of each species' bill-tip organs. The beaks of all three species contain remote-touch bill-tip organs and are described here in detail. Clear interspecific differences are evident between the species' bill-tip organs, both in terms of bone morphology and soft tissue histology. Glossy Ibises, which forage exclusively in wetter substrates, have a greater extent of pitting but lower numbers of Herbst corpuscles in each pit, while species foraging in drier substrates (Hadeda and Sacred Ibises) have more robust beaks, fewer pits and higher densities of Herbst corpuscles. Our data, together with previously published histological descriptions of the bill-tip organs of other remote-touch foraging bird species, indicate that species foraging in drier habitats have more sensitive bill-tip organs (based on their anatomy). The vibrations produced by prey (e.g., burrowing invertebrates) travel poorly in dry substrates compared with wetter ones (i.e., dry soil vs. mud or water), and thus we hypothesise that a more sensitive bill-tip organ may be required to successfully locate prey in dry substrates. Furthermore, our results indicate that the differences in bill-tip organ anatomy between the species reflect complex trade-offs between morphological constraints of beak shape and remote-touch sensitivity requirements, both of which are likely related to each species' foraging behaviour and substrate usage. Our study suggests that structures in the bone of the bill-tip organ could provide valuable osteological correlates for the associated soft tissues, and consequently may provide information on the sensory ecology and habitat usage of the birds in the absence of soft tissues.

Chronic, sublethal effects of high temperatures will cause severe declines in southern African arid-zone birds during the 21st century.

Birds inhabiting hot, arid regions are among the terrestrial organisms most vulnerable to climate change. The potential for increasingly frequent and intense heat waves to cause lethal dehydration and hyperthermia is well documented, but the consequences of sublethal fitness costs associated with chronic exposure to sustained hot weather remain unclear. Using data for species occurring in southern Africa's Kalahari Desert, we mapped exposure to acute lethal risks and chronic sublethal fitness costs under past, present, and future climates. For inactive birds in shaded microsites, the risks of lethal dehydration and hyperthermia will remain low during the 21st century. In contrast, exposure to conditions associated with chronic, sublethal costs related to progressive body mass loss, reduced nestling growth rates, or increased breeding failure will expand dramatically. For example, by the 2080s the region will experience 10-20 consecutive days per year on which Southern Pied Babblers (Turdoides bicolor) will lose ∼4% of body mass per day, conditions under which this species' persistence will be extremely unlikely. Similarly, exposure to air temperature maxima associated with delayed fledging, reduced fledgling size, and breeding failure will increase several-fold in Southern Yellow-billed Hornbills (Tockus leucomelas) and Southern Fiscals (Lanius collaris). Our analysis reveals that sublethal costs of chronic heat exposure are likely to drive large declines in avian diversity in the southern African arid zone by the end of the century.

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.

Hot days are associated with short-term adrenocortical responses in a southern African arid-zone passerine bird.

Relatively little effort has been directed towards elucidating the role of physiological stress pathways in mediating avian responses to global heating. For free-ranging southern pied babblers, Turdoides bicolor, daily maximum air temperatures (Tmax) between ∼35 and ∼40°C result in reduced foraging efficiency, loss of body mass and compromised breeding success. We tested the hypothesis that very hot days are experienced as stressors by quantifying relationships between Tmax and faecal glucocorticoid metabolite (fGCM) levels in naturally excreted droppings. On days when Tmax<38°C, fGCM levels were independent of Tmax (mean±s.d. 140.25±56.92 ng g-1 dry mass). At Tmax>38°C, however, fGCM levels increased linearly with Tmax and averaged 190.79±70.13 ng g-1 dry mass. The effects of Tmax on fGCM levels did not carry over to the following morning, suggesting that very hot days are experienced as acute stressors.

How hornbills handle heat: sex-specific thermoregulation in the southern yellow-billed hornbill.

At a global scale, thermal physiology is correlated with climatic variables such as temperature and aridity. There is also evidence that thermoregulatory traits vary with fine-scale microclimate, but this has received less attention in endotherms. Here, we test the hypothesis that avian thermoregulation varies with microclimate and behavioural constraints in a non-passerine bird. Male and female southern yellow-billed hornbills (Tockus leucomelas) experience markedly different microclimates while breeding, with the female sealing herself into a tree cavity and moulting all her flight feathers during the breeding attempt, becoming entirely reliant on the male for provisioning. We examined interactions between resting metabolic rate (RMR), evaporative water loss (EWL) and core body temperature (Tb) at air temperatures (Ta) between 30°C and 52°C in male and female hornbills, and quantified evaporative cooling efficiencies and heat tolerance limits. At thermoneutral Ta, neither RMR, EWL nor Tb differed between sexes. At Ta >40°C, however, RMR and EWL of females were significantly lower than those of males, by ∼13% and ∼17%, respectively, despite similar relationships between Tb and Ta, maximum ratio of evaporative heat loss to metabolic heat production and heat tolerance limits (∼50°C). These sex-specific differences in hornbill thermoregulation support the hypothesis that avian thermal physiology can vary within species in response to fine-scale microclimatic factors. In addition, Q10 for RMR varied substantially, with Q10 ≤2 in some individuals, supporting recent arguments that active metabolic suppression may be an underappreciated aspect of endotherm thermoregulation in the heat.

Pulses of anthropogenic food availability appear to benefit parents, but compromise nestling growth in urban red-winged starlings.

The provision of anthropogenic food undoubtedly influences urban bird fitness. However, the nature of the impact is unclear, with both benefits and costs of urban diets documented. Moreover, the influence of short-term fluctuations in food availability, linked to urban weekday/weekend cycles of human presence, is largely unknown. We explored whether breeding red-winged starlings Onychognathus morio in Cape Town, South Africa, altered foraging and provisioning behaviour between days with high human presence (HHP) and days with low human presence (LHP)-i.e. weekdays versus weekends and vacation days. We investigated the relationship between starling diet, adult body mass and nestling development. Breeding adults consumed and provisioned the same quantity of food, but a significantly greater proportion of anthropogenic food on HHP compared to LHP days. Adults apparently benefited from the anthropogenic diet, experiencing significantly greater mass gain on HHP days. However, nestlings experienced a cost, with the number of HHP days during the nestling period associated negatively with nestling size. Adults may, therefore, benefit from the high calorie content of anthropogenic food, while nestlings may be negatively affected by nutrient limitation. The quantity of food available in urban environments may, therefore, benefit adult survival, while its quality imposes a cost to nestling growth.

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics.

OBJECTIVES: To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers. DESIGN: A cross-sectional, observational study. SETTING: NHS teaching hospital. PARTICIPANTS: A total of 31 adult patients and their treating clinicians were included in the study. METHODS: The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION12 scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION12 scale. RESULTS: There was excellent inter-rater reliability between the two independent raters using the OPTION12 scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323). CONCLUSIONS: The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.

Hot droughts compromise interannual survival across all group sizes in a cooperatively breeding bird.

Climate change is affecting animal populations around the world and one relatively unexplored aspect of species vulnerability is whether and to what extent responses to environmental stressors might be mitigated by variation in group size in social species. We used a 15-year data set for a cooperatively breeding bird, the southern pied babbler Turdoides bicolor, to determine the impact of temperature, rainfall and group size on body mass change and interannual survival in both juveniles and adults. Hot and dry conditions were associated with reduced juvenile growth, mass loss in adults and compromised survival between years in both juveniles (86% reduction in interannual survival) and adults (60% reduction in interannual survival). Individuals across all group sizes experienced similar effects of climatic conditions. Larger group sizes may not buffer individual group members against the impacts of hot and dry conditions, which are expected to increase in frequency and severity in future.

High temperatures drive offspring mortality in a cooperatively breeding bird.

An improved understanding of life-history responses to current environmental variability is required to predict species-specific responses to anthopogenic climate change. Previous research has suggested that cooperation in social groups may buffer individuals against some of the negative effects of unpredictable climates. We use a 15-year dataset on a cooperative breeding arid zone bird, the southern pied babbler Turdoides bicolor, to test (i) whether environmental conditions and group size correlate with survival of young during three development stages (egg, nestling, fledgling) and (ii) whether group size mitigates the impacts of adverse environmental conditions on survival of young. Exposure to high mean daily maximum temperatures (mean Tmax) during early development was associated with reduced survival probabilities of young in all three development stages. No young survived when mean Tmax > 38°C, across all group sizes. Low survival of young at high temperatures has broad implications for recruitment and population persistence in avian communities given the rapid pace of advancing climate change. Impacts of high temperatures on survival of young were not moderated by group size, suggesting that the availability of more helpers in a group is unlikely to buffer against compromised offspring survival as average and maximum temperatures increase with rapid anthropogenic climate change.

Information seeking behaviour of dental trauma patients and their parents.

BACKGROUND AND AIM: Dental trauma is a common public health issue that can be associated with high costs and lifelong treatment. Children and parents should have the correct information regarding its management to reduce the potential long-term sequelae. Understanding their information seeking behaviour is therefore important to ensure that they are able to access, understand and retain the relevant information. The aim of this study was to investigate (a) the different ways that patients undertaking treatment for dental trauma, and their parents, look for relevant information, (b) their information needs, and (c) their preferred format of information. MATERIAL AND METHODS: This was a two-phase study: Phase I involved in-depth interviews with 10 patients who were currently undergoing treatment for dental trauma, and 11 parents. In phase II, the themes and sub-themes identified from the interviews were used to develop patient and parent questionnaires, which were distributed to all trauma patients and parents who fulfilled the inclusion criteria and who were attending the dental clinics from March to May 2014. RESULTS: Patients and parents had different concerns immediately following the trauma, during treatment and in the long term, and they wanted different forms of information to answer their concerns. Reliability was the main issue about trusting the information available in the Internet, social media and other online sources. Therefore, patients preferred to obtain information verbally from their dentist, while parents preferred written information. CONCLUSION: Patients and parents have different information needs, and these also vary at different stages of treatment. It is therefore important to customize the way information is provided for each group accordingly.

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics.

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

Knowledge of, and attitudes to, shared decision-making in orthodontics in the UK.

OBJECTIVE: To establish UK orthodontic treatment providers' knowledge of, and attitudes to, shared decision-making (SDM). SDM involves patients as equal partners in decisions about treatment. DESIGN: Cross-sectional survey. SETTING: Online survey across the UK. POPULATION: Dentists and orthodontists providing orthodontic treatment in the UK. METHODS: Potential participants were contacted through the British Orthodontic Society mailing lists. An online survey was developed to examine knowledge of, and attitudes to, SDM using a combination of evidence-based statements and free text boxes. Questions regarding previous training in SDM and preferences for further training were also included. RESULTS: The survey was completed by 210 respondents, yielding an approximate response rate of 15%. Respondents were mainly consultants (34%) and specialist orthodontists (42%). SDM was well described in terms of the people involved in this process, how it is approached, the components and topics of discussion, and the overall purpose of SDM. Generally, there was consistency in attitudinal responses, with the largest variance in responses to questions about the professional-patient partnership, the interface between SDM and clinical guidelines, and accepting a decision that is discordant with the professional's opinion. Fifty-one respondents reported having some previous teaching/training in SDM, with the majority (87%) indicating that they would like more training. CONCLUSION: Clinicians providing orthodontic treatment in the UK have a good understanding of the meaning of shared decision-making. Concerns raised about using SDM and knowledge gaps suggest there is value in providing SDM training for the orthodontic team and that orthodontic providers would welcome it.

How do you identify the patient with 'high expectations' of orthodontic treatment: An empirical approach.

OBJECTIVES: To identify an empirical method for identifying patients with 'high expectations' of orthodontic treatment with fixed appliances using a questionnaire-based approach. DESIGN: Secondary analysis of data from four studies which collected data on patients' expectations of orthodontic treatment using the same questionnaire. SETTING: Secondary care orthodontic services. PARTICIPANTS: All four datasets comprised new patients aged 12-15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants. METHODS: The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time. RESULTS: For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively. CONCLUSION: The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients.

Investigating perceptions of patient-centred care in orthodontics.

OBJECTIVES: To assess and compare patient and clinician perceptions of patient-centredness for adults about to commence active orthodontic treatment, and to assess whether the following variables affected perceptions of patient-centredness: patient gender and age; clinician gender and grade; and stage of treatment. DESIGN: A prospective, cross-sectional questionnaire study. SETTING: Eastman Dental Hospital, UCLH NHS Foundation Trust. PARTICIPANTS: A total of 112 adult patients and 30 clinicians completed 224 questionnaires (112 patient and 112 clinician questionnaires). METHODS: A validated, dyadic questionnaire, the '9-Item Patient Perception of Patient-Centredness' (PPPC), was used to collect data from both patients and their corresponding clinicians after initial assessment or records/treatment planning consultations. Total PPPC scores (possible score range = 9-36) were calculated for each patient and clinician to ascertain the extent to which they perceived they were engaging in patient-centredness, where higher scores corresponded with better performance. RESULTS: Patients and clinicians perceived high engagement in patient-centredness with median scores of 32/36 and 29/36, respectively. There was a statistically significant difference between total scores with patients perceiving consultations to be more patient-centred than clinicians (P < 0.001). None of the variables (patient gender and age, clinician gender and grade, stage of treatment) were statistically significant. CONCLUSION: Patients and clinicians both perceived high engagement in patient-centredness. Patients perceived consultations to be significantly more patient-centred than clinicians (P < 0.001).