The orthodontic condition of children in England, Wales and Northern Ireland 2013.

Background The 2013 Children's Dental Health Survey is the fifth in a series of national surveys.Aims This paper reports the orthodontic condition of 12- and 15-year-olds and how they and their parents feel about the appearance of their teeth.Methodology A representative sample of children (5y, 8y, 12y, 15y) in England, Wales and Northern Ireland were invited to participate in dental examinations. A modified Index of Orthodontic Treatment Need (IOTN) was used as a measure of orthodontic treatment need for 12- and 15-year-olds. Children and parents were invited to complete a questionnaire about oral health behaviour and attitudes.Results Nine percent of 12-year-olds and 18% of 15-year-olds were undergoing orthodontic treatment at the time of the survey. Forty-four percent of 12-year-olds and 29% of 15-year-olds expressed a desire for straighter teeth, however over half of this group would not qualify for NHS treatment. Unmet treatment need was higher in children eligible for free school meals (P <0.05 at 15y).Conclusions Provision of and demand for orthodontic treatment is increasing, with a significant proportion of children who desire orthodontic care not eligible to receive it. Children from deprived backgrounds have greater unmet orthodontic treatment need.

The orthodontic condition of children in the United Kingdom, 2003.

BACKGROUND: The 2003 Children's Dental Health Survey is the fourth in a series of decennial national children's dental health surveys in the United Kingdom. AIMS: This paper reports on the orthodontic condition of children aged 12 and 15 years. METHODOLOGY: A representative sample of children across the UK were invited to participate in a clinical dental examination in school. Two thousand, five hundred and ninety-five 12-year-olds and 2,142 15-year-olds were examined. Current and past orthodontic treatment and type of appliance worn were recorded. Orthodontic treatment need was assessed by the Modified IOTN in those not undergoing treatment. A postal questionnaire sought parents' views on the orthodontic condition of their children and perceived need for treatment. RESULTS: At age 12, 35% were judged to have an orthodontic treatment need, 57% had no need and 8% were wearing an appliance. The corresponding figures at age 15 were, 21% (need), 65% (no need) and 14% (wearing appliance). A higher proportion of girls (p < 0.05) were wearing an appliance than boys. A greater proportion of 15-year-olds were undergoing treatment than in the 1993 and 1983 surveys and the use of fixed appliances had increased. CONCLUSIONS: In this representative sample of UK children, one in five were still judged as having an orthodontic treatment need at age 15 years, as determined by the modified index of orthodontic treatment need. However, considerable variation was observed between professional and lay perceptions of need.

Modified IOTN: an orthodontic treatment need index for use in oral health surveys.

This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.

Equity and orthodontic treatment: a study among adolescents in Northern Ireland.

This epidemiological study investigated the reasons why children in Northern Ireland who need orthodontic treatment do not receive treatment even when it is provided free by the state. A total of 1584 15- and 16-year-olds were examined in 23 high schools with the Index of Orthodontic Treatment Need. The characteristics of the adolescents who had received orthodontic treatment were compared with those who had a definite need for treatment and yet did not receive treatment or advice. One in 10 of the adolescents examined had an unmet need for orthodontic treatment. Logistic regression analysis was used to assess the influence of 11 variables including socioeconomic status, religion, and standard of dental health on the uptake of orthodontic care. This analysis revealed that the only significant predictors of whether an adolescent received orthodontic treatment was the dental attendance pattern of the adolescent, the adolescent's dental health, and the dental attendance pattern of the adolescent's mother. Those adolescents who had good dental health, who regularly attended a dentist, and whose mother regularly attended a dentist were more likely to receive orthodontic treatment.

A field trial of an orthodontic treatment need learning package for general dental practitioners.

OBJECTIVE: To evaluate whether GDPs using an index of Orthodontic Treatment Need (IOTN) learning package in a practice setting referred (or treated) more patients with a definite need for orthodontic treatment. DESIGN: A randomised controlled trial. SUBJECTS AND METHODS: 20 GDPs (test group) used the package when selecting patients for orthodontic care during normal dental practice. A control group of 20 GDPs did not use the package. Over a 12-month period impressions were taken by the participating GDPs of all patients selected for orthodontic treatment, either referred to another practitioner or to be treated by the GDP. MAIN OUTCOME MEASURE: IOTN used by two expert examiners. RESULTS: Among the patients selected for orthodontic treatment by the test group there were more patients with a definite objective need for orthodontic treatment (78.1% versus 62.5% in the control group). After adjustment for potential confounding variables, the odds on a patient selected by a test group dentist being in definite need were 2.24 (95% CI 1.25, 4.01) more than the odds on a patient selected by a control group dentist (P = 0.007). CONCLUSIONS: Use of the IOTN learning package by GDPs would reduce the proportion of patients selected for orthodontic treatment with low or moderate objective need.

Pilot study of an orthodontic treatment need learning package for general dental practitioners.

This pilot study evaluated an Index of Orthodontic Treatment Need Learning Package which was developed for use by general dental practitioners. Fifty-seven dentists participated in a randomised controlled trial which involved assessing the need for orthodontic treatment among two representative samples of 16 study casts. All the dentists assessed the first set of study casts without any aids or assistance. During the assessment of the second set of study casts one group of dentists used an IOTN Learning Package in the form of a poster, another group used an IOTN Learning Package in the form of a booklet, and the remaining group acted as a control and did not use any Learning Package. The results reveal that compared with the control dentists, the dentists using the IOTN poster and the IOTN booklet had, respectively, 1.8 and 2.6 fewer errors when assessing aesthetic need and 2.0 and 2.1 fewer errors when assessing dental health need.

Calibration of dentists in the use of occlusal indices.

Dentists' opinions as to both need for and outcome of orthodontic treatment show wide variation. Within the profession there is an opportunity to reduce subjective bias and standardise criteria by the use of occlusal indices. The results of this study demonstrate that a group of dentists can easily be trained to record the Aesthetic and Dental Health Components of the Index of Orthodontic Treatment Need and the PAR index to a satisfactory level.

The influence of social class, gender, and peers on the uptake of orthodontic treatment.

The accurate prediction of the future demand for orthodontic treatment requires an understanding of the factors which influence the uptake of orthodontic treatment. This paper examines the influence of social class, gender, and peer group on the uptake of orthodontic treatment. A representative random sample comprising five-hundred-and-forty 15- and 16-year-old adolescents were interviewed in school. The results indicate that familiarity with orthodontic appliances among a subject's peer group has a greater influence on the uptake of orthodontic treatment than the subject's social class or gender.

A comparison of orthodontic screening methods used in school dental inspections.

The validity of two currently used orthodontic screening programmes was investigated and compared to an objective measure of need for orthodontic treatment. The results indicate that existing orthodontic screening methods underestimate the numbers of children with severe malocclusions. The use of a more objective measure of orthodontic treatment need is recommended.

The need for orthodontic treatment in the child population of the United Kingdom.

The effective management of a public dental health system requires accurate data on the needs of the population. Previous assessments of the levels of orthodontic treatment need in populations, by both epidemiologists and orthodontists, vary considerably. This paper presents the findings of two independent investigations into orthodontic treatment need in the United Kingdom using the Index of Orthodontic Treatment Need (IOTN, Brook and Shaw, 1989). The results indicate that approximately one-third of 11-12-year-olds were in objective need of orthodontic treatment. The basis for allocation to the treatment need groups was similar in both studies, as were the proportions of the most severe occlusal traits.

Effectiveness of a personalised referral letter following orthodontic screening.

No data exist on the usefulness of orthodontic screening in guiding those children who need orthodontic treatment towards professional advice. This study evaluated the effectiveness of a personalised referral letter following an orthodontic screening programme employing an objective measure of treatment need, the Index of Orthodontic Treatment Need (IOTN). Out of a total sample of 924 children aged 11-12 yr, 201 were in need of orthodontic treatment and no orthodontic treatment was planned. From this subsample test and control groups matched for sex, socio-economic background, dental disease and aesthetic impairment were created. Following screening, the parents of the test group only were sent a specific orthodontic referral letter. The dental practitioners of the children in the test and control groups were contacted during a follow-up investigation carried out 8 months later, this revealed that significantly more children entered orthodontic treatment pathways from the test group. This study demonstrated that a screening programme, using IOTN as a screening test, and a referral procedure which provided parents with specific information were successful in guiding over one third of children with a need for orthodontic treatment towards orthodontic advice.

Residual orthodontic treatment need in a sample of 15- and 16-year-olds.

This study investigated the residual unmet orthodontic need, both normative and perceived, in young adults who had passed the age at which orthodontic treatment would have normally commenced. A total of 506 15- and 16-year-olds attending eight secondary schools were screened by a single trained examiner using the 'Index of Orthodontic Treatment Need' (IOTN). There were 154 (30.4%) subjects classified as being in need of orthodontic treatment using IOTN and 82 of these (16% of the sample) were found to be in need of orthodontic treatment but had no recollection of orthodontic treatment ever being discussed with them. Children with malocclusion, who had received no orthodontic advice, came from across the range of socio-economic groups, were more likely to be male, and were less likely to be happy with their appearance than their unaffected peers.