Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists.

INTRODUCTION: Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. METHODS: This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. RESULTS: All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). CONCLUSIONS: The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Appointment keeping behavior of Medicaid vs non-Medicaid orthodontic patients.

INTRODUCTION: State Medicaid programs were established to care for the poor by eliminating financial barriers that otherwise prevent them from being treated in the mainstream health care system. The number of children eligible for Medicaid services is increasing, yet the number of Medicaid providers remains low. Health care providers cited failed appointments as a major problem with Medicaid patients and a great deterrent to participating. The purpose of this study was to determine whether a difference in appointment-keeping behavior exists between Medicaid and non-Medicaid orthodontic patients. METHODS: During a 12-month period, a tally of appointments was kept for all active patients (n = 707) at Virginia Commonwealth University's Department of Orthodontics. Patients were categorized as either Medicaid or non-Medicaid, and their appointment-keeping behavior was evaluated. RESULTS: A significant difference was found in the number of failed appointments between the groups. The Medicaid patients failed 247 (15.4%) of 1609 appointments, and the non-Medicaid patients failed 367 (8.3%) of 4438 appointments. Medicaid patients accounted for 26.6% of all appointments but were responsible for about 40% of all appointment failures. In addition, 104 (56.2%) of 185 Medicaid patients missed 1 appointment or more during the year, compared with 211 (40.4%) of 522 non-Medicaid patients. CONCLUSIONS: The findings from this study support the concern among dental practitioners and orthodontic specialists that Medicaid patients have a higher rate of appointment failures than non-Medicaid patients, although the frequency of missed appointments was substantially lower for orthodontic appointments than that reported for general dental appointments.

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists.

BACKGROUND: The authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists. METHODS: The authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina. RESULTS: Sixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist. CONCLUSIONS: WSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist. Clinical implications. General dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.