Quality assessment of clinical practice guidelines used in oral and maxillofacial surgery.

An assessment of the quality of oral and maxillofacial surgery clinical practice guidelines is lacking. The aim of this investigation was to assess the quality of guidelines using the RIGHT (Reporting Items for practice Guidelines in HealThcare) checklist. The primary outcome was to assess the score (quality) of guidelines based on the RIGHT checklist and to identify predictors (region, type, single or multi-centre, and speciality/non-speciality) influencing the quality score. In this review, following a search of electronic databases and national society websites, a total of 25 guidelines were independently assessed by two assessors against the 22-item RIGHT checklist. Inter-assessor reliability was assessed. Deficiencies in the reporting of items relating to limitations, funding, declaration and management of interests, healthcare questions, and quality assurance were evident. The median overall score for the guidelines was 28 (range 14-66). Guidelines produced by multiple centres (ß=57.15, 95% confidence interval -26.62 to 87.68, P= 0.001, multivariate analysis) and non-speciality societies (ß=20, 95% confidence interval -0.03 to 40.03, P=0.05, univariate analysis) tended to have higher quality scores. Overall, the quality of clinical practice guidelines used in oral and maxillofacial surgery was deemed suboptimal. If clinical practice guidelines are to be used in making treatment decisions for patients, clinicians should be aware of their possible limitations.

Information for oral and maxillofacial patients: can it be improved?

The aim and objective of this study was to evaluate the quality and readability of leaflet and online Oral and Maxillofacial Surgery patient information leaflets (PILs). The quality, readability and grade level of each PIL was assessed using the DISCERN, Flesch Reading Ease and Flesh-Kincaid Grade Level instruments respectively. In total, 140 patient information leaflets were assessed. For both leaflet and online PILs, many items of the DISCERN instrument were deemed of low quality and poorly reported. The median overall quality score was 30.2. Variation in the quality and readability scores between leaflet and online PILs and those produced by various societies was evident. Overall, PILs were deemed to be of moderate quality. Online PILs were of lower quality, more difficult to read and aimed at a higher reading age level.

National clinical guidelines for the management of unerupted maxillary incisors in children.

This article summarises recently updated guidelines produced by the Clinical Governance Directorate of the British Orthodontic Society through the Clinical Standards Committee of the Faculty of Dental Surgery, Royal College of Surgeons of England (FDSRCS) on the management of unerupted maxillary incisor teeth in children. The maxillary incisor teeth usually erupt in the early mixed dentition but eruption disturbances can occur and are often attributable to local factors. A failure of eruption will affect the developing occlusion and potentially influence psychological development of the child. The general principles of management for delayed eruption or impaction of these teeth is to ensure that adequate space exists in the dental arch and to remove any obstruction to eruption. Consideration should also be given to further promoting eruption through surgical exposure of the incisor, with or without subsequent orthodontic traction. A number of factors influence the decision-making process, including patient age, medical history, potential compliance, aetiology and position of the unerupted incisor. Treatment planning should be complemented by careful clinical assessment and the use of appropriate special investigations. To optimise the treatment outcome a multidisciplinary specialist approach is recommended.

Arteriovenous malformation of the mandible--a case report.

Both arteriovenous malformations (AVMs) and solitary bone cysts of the mandible are uncommon lesions. The latter can be considered fairly innocuous but AVMs require careful management. The following is a description of a case where an arteriovenous malformation of the mandible presented with mental nerve paraesthesia. However, radiographically the features appeared to be consistent with a solitary bone cyst. It is important for clinicians in both a primary and secondary care setting to be aware that this type of lesion can have life threatening complications.

A survey of undergraduate orthodontic teaching and factors affecting pursuit of postgraduate training.

Background Undergraduate orthodontic teaching has been focused on developing an understanding of occlusal development in an effort to equip practitioners to make appropriate referrals for specialist-delivered care. However, there is a growing interest among general dentists in delivering more specialised treatments, including short-term orthodontic alignment. This study aimed to assess the levels of knowledge of occlusal problems among final year undergraduate dental students, as well as their interest in various orthodontics techniques and training.Methods A 36-item electronic questionnaire was sent to all final year undergraduate students in four dental institutes in the UK (Barts and the London, Kings College London, Cardiff and Dundee). The questionnaire explored satisfaction with undergraduate orthodontic teaching; students' perception of knowledge, based on General Dental Council learning outcomes; perceptions of the need for specialist involvement in the management of dental problems; interest in further training in orthodontics; and potential barriers to undertaking specialist training.Results The overall response rate was 66% (239/362). The majority of students (84.1%) were aware of GDC guidance in terms of undergraduate teaching. Students reported a preference for case-based and practical teaching sessions in orthodontics, with less interest in lectures or problem-based learning approaches. A high percentage were interested in further teaching in interceptive orthodontics (60.3%) and fixed appliance therapy (55.7%). Further training including specialist orthodontic training (36.4%), Invisalign (59%) and Six Month Smiles (41%) courses appealed to undergraduates. Levels of student debt, course fees and geographical issues were seen as potential barriers to formal, specialist training pathways.Conclusions Satisfaction with undergraduate orthodontic teaching is high and interest in further training, including specialist training pathways, continues to be high. While short-term orthodontics is not taught at undergraduate level, there appears to be an appetite to undertake alternatives to conventional orthodontics among dental students.

A comparison of two different techniques for early correction of Class III malocclusion.

OBJECTIVE: To compare the effectiveness of Reverse Twin-Block therapy (RTB) and protraction face mask treatment (PFM) with respect to an untreated control in the correction of developing Class III malocclusion. MATERIALS AND METHODS: A retrospective comparative study of subjects treated cases with either PFM (n  =  9) or RTB (n  =  13) and untreated matched controls (n  =  10) was performed. Both the PFM and control group samples were derived from a previously conducted clinical trial, and the RTB group was formed of consecutively treated cases. The main outcome variables assessed were skeletal and dental changes. Lateral cephalograms were taken at the start and end of treatment or during the observation period. Analysis of variance was used to compare changes in cephalometric variables arising during the study period in the lateral group. Linear regression analysis and an unpaired t-test were used to determine the impacts of treatment duration and gender, respectively. RESULTS: Significantly greater skeletal changes arose with PFM therapy than with RTB therapy or in the control group (SNA, SNB, and ANB; P < .001). The dentoalveolar effects of RTB therapy exceeded those of PFM treatment, with significantly more maxillary incisor proclination (P < .001) and mandibular incisor retroclination (P < .006) arising with treatment. CONCLUSIONS: Both appliances are capable of correction of Class III dental relationships; however, the relative skeletal and dental contributions differ. Skeletal effects, chiefly anterior maxillary translation, predominated with PFM therapy. The RTB appliance induced Class III correction, primarily as a result of dentoalveolar effects.

Bullying in schoolchildren - its relationship to dental appearance and psychosocial implications: an update for GDPs.

Bullying in school-aged children is a global phenomenon. The effects of bullying can be both short- and long-term, resulting in both physiological and psychological symptoms. It is likely that dental care professionals will encounter children who are subjected to bullying. The aim of this narrative review is to discuss the incidence of bullying, the types of bullying, the effects of bullying and the interventions aimed at combating bullying in schoolchildren. The role of dentofacial aesthetics and the relationship of bullying and the presence of a malocclusion are also discussed.