The effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group: A multicentre two-arm parallel randomised controlled trial.

OBJECTIVE: To evaluate the effectiveness of bone anchored maxillary protraction (BAMP) in the management of class III skeletal malocclusion in children aged 11-14 years compared with an untreated control group in terms of perceived need for orthognathic surgery, skeletal and dental change, and psychological impact. DESIGN: A multicentre two-armed parallel randomised controlled trial. SETTING: Six UK hospital orthodontic units. METHODS: A total of 57 patients were randomly allocated into either the BAMP group (BAMPG) (n = 28) or a no treatment control group (CG) (n = 29). OUTCOMES: Data collection occurred at registration (DC1),18 months (DC2) and 3 years (DC3), where skeletal and dental changes were measured from lateral cephalograms and study models. Oral Aesthetic Subjective Impact Score (OASIS) and Oral Quality of Life (OHQOL) questionnaires were used to assess the psychological impact of treatment. RESULTS: The mean age was 12.9 ± 0.7 years and 12.6 ± 0.9 years in the BAMPG and CG, respectively. At DC2, the BAMPG achieved a class III ANB improvement of +0.6° compared with -0.7° in the CG (P = 0.004). The overjet improvement was +1.4 mm for the BAMPG and -0.2 mm for the CG (P = 0.002). There was no evidence of any other group differences for the other skeletal or dental cephalometric outcomes (P > 0.05) or the questionnaire data (OASIS P = 0.10, OHQOL P = 0.75). At DC2, the 18-month follow-up, 22% of the BAMPG achieved a positive overjet. At the 3-year follow-up (DC3), fewer participants in the BAMPG were perceived to need orthognathic surgery (48%) compared with 75% of participants in the CG (P = 0.04), with an odds ratio of 0.31 (95% confidence interval = 0.10-0.95). CONCLUSION: The BAMP technique did not show any social or psychological benefits; however, the skeletal class III improvement in ANB and the overjet change were sufficient to reduce the perceived need for orthognathic surgery by 27% compared with the CG.

Personality differences in dental professionals: A cross-sectional survey.

INTRODUCTION: Despite its influence on occupational performance and team dynamics, there has been little research into the personality of dental professionals. Existing research does not typically use the prevailing five-factor model of personality. We aimed to measure the personality of dental professionals in the United Kingdom and investigate differences among groups. METHODS: The sample (n = 906) comprised dental nurses (n = 475), general dental practitioners (GDPs) (n = 182), orthodontists (n = 201), and oral and maxillofacial surgeons (OMFSs) (n = 48). Recruitment was via email and social media. The questionnaire collected data on demographic variables and contained the Big Five Inventory, a validated self-report personality test. Participants scored on extraversion, conscientiousness, agreeableness neuroticism, and openness. A one-way analysis of variance and post-hoc tests with Bonferroni correction were used to identify significant differences in personality between occupations. Hierarchical multiple regression determined the influence of occupation over and above demographic variables. RESULTS: On a 5-point scale, orthodontists had a mean conscientiousness score 0.23 points higher than GDPs (95% confidence interval [CI], 0.10-0.36). Dental nurses had a mean conscientiousness score 0.28 points higher than GDPs (95% CI, 0.17-0.39). Dental nurses had a mean agreeableness score 0.16 points higher than orthodontists (95% CI, 0.05-0.27) and 0.30 points higher than OMFSs (95% CI, 0.10-0.50). For neuroticism, orthodontists had a mean score 0.21 points lower than dental nurses (95% CI, 0.06-0.36), and OMFSs had a mean score 0.43 points lower than dental nurses (95% CI, 0.16-0.70). GDPs had a mean neuroticism score 0.43 points higher than OMFSs (95% CI, 0.14-0.71; P = 0.001). Differences were small to moderate in size (d = 0.35-0.45) and occupation was associated with personality after accounting for demographic variables. CONCLUSIONS: The personalities of dental nurses, GDPs, orthodontists, and OMFSs differed. Occupation was associated with differences in personality after accounting for demographic characteristics.

'Love makes me feel good inside and my heart is fixed': What adults with intellectual disabilities have to say about love and relationships.

BACKGROUND: Adults with intellectual disabilities have historically been hindered, rather than supported, in their desire to form loving relationships. This paper sought to explore with them what kinds of support they wanted in the 21st Century. METHOD: Semi-structured in-depth interviews were conducted with 40 adults with intellectual disabilities in the United Kingdom. RESULTS: Participants placed a high value on having a partner and being supported to maintain and develop a loving relationship. The factors which constrained them in achieving this included a lack of social opportunities, barriers created by social care services and limits on them exercising autonomy. Facilitating factors included access to specialist dating agencies, strong family and staff support and opportunities to learn about relationships. CONCLUSIONS: The importance of a loving relationship as a source of pleasure and meaning in the lives of adults with intellectual disabilities who are often disadvantaged in many other spheres of life is emphasised.

"Put bluntly, they are targeted by the worst creeps society has to offer": Police and professionals' views and actions relating to domestic violence and women with intellectual disabilities.

BACKGROUND: Little is known about the attitudes and practices of key personnel towards the domestic violence experienced by women with intellectual disabilities. METHOD: An online survey was conducted of Police officers and health and social care professionals. A total of 717 Police and other professionals across a wide variety of UK sites responded. Research questions were focussed on direct experience, attitudes and responses. RESULTS: Approximately half of all respondents had direct experience of working with a woman with intellectual disabilities who had been through domestic violence. Professionals were more likely than the Police to see women with intellectual disabilities as being especially vulnerable. The majority of both professionals and Police believed women with intellectual disabilities were deliberately targeted by violent and abusive men. CONCLUSIONS: More training is needed for both the Police and health and social care professionals specifically in domestic violence as it affects women with intellectual disabilities.

'Cautiously optimistic': Older parent-carers of adults with intellectual disabilities - Responses to the Care Act 2014.

This article discusses potential opportunities for best practice in the United Kingdom that may be brought about by the Care Act (2014). Carers in the United Kingdom were given new rights within this legislation with a focus on needs led assessment. The underpinning philosophy of the Care Act is to streamline the previous legislation and offers a framework for carers and people in receipt of care, to enable a more personalized approach to care and support. Offering a discussion of likely opportunities brought about by provisions of the Care Act, this article draws on a small study involving older parent/carers of sons or daughters with intellectual disabilities. Exploring the extent to which such parents of adults with intellectual disabilities were aware of the details of this legislation and the potential impact it may have on their lives highlighted other significant areas, some of which are discussed below. Semi-structured interviews were conducted with five parents over the age of 60 of sons or daughters with intellectual disabilities in North West England. The study adds to the body of knowledge and understanding about parents of adults with intellectual disabilities and explores and provides a deeper understanding of parents' experiences of the implementation of this specific piece of legislation and their perception of the relevance of it to themselves. Findings include some awareness of the legislation and some feelings of optimism about its likely implications, although participants appeared less clear about the specificities and the impact of these upon them and/or their sons or daughters. Findings from the semi-structured interviews also showed parent's articulation of the extent of reciprocal care manifest between them and their son or daughter with an intellectual disability, as well as an awareness of the fragility of their own emotional well-being.

Orthodontic management of a non-vital immature tooth treated with regenerative endodontics: a case report.

Management of non-vital immature permanent teeth in children remains a challenge in paediatric dentistry. The resulting short roots, thin root dentinal walls, and compromised crown root ratios, not only affect the long-term survival of these teeth but also complicate any intended orthodontic treatment. This case report shows a successful orthodontic movement of a traumatised non-vital immature tooth treated using regenerative endodontics.

Partner Selection for People with Intellectual Disabilities.

BACKGROUND: The aim of this research was to understand the characteristics that adults with intellectual disabilities look for in a partner. There have been numerous studies that have explored partner selection for people without intellectual disabilities, but no research that specifically identified the traits valued in a partner by people with intellectual disabilities. METHOD: In-depth interviews were conducted with eleven participants across two UK sites. All participants were adults with an intellectual disability who had been in a relationship with a partner for over a year. The narratives were analysed utilizing hermeneutic phenomenology, guided by the theory of Van Manen (1990). RESULTS: The findings highlighted that, regardless of age, participant's relationships typically developed within a segregated environment for people with intellectual disabilities over the past 10 years. People with intellectual disabilities expressed a wish to be loved, to be treated kindly and to have companionship. However, they did not place high value on attributes such as financial security, social status or intelligence. CONCLUSIONS: The research demonstrated how poorly integrated people with intellectual disabilities are within mainstream society. Desired characteristics and expectations for participant's relationships were rooted in a shared history and culture, which was shaped by their intellectual disability and support needs.

People with intellectual disabilities at the end of their lives: The case for specialist care?

BACKGROUND: People with intellectual disabilities have a shorter life expectancy, but healthcare improvements mean that they are beginning to live longer, with associated health difficulties. This means that there is an urgent need to focus research on ageing as well as end-of-life care. This study aimed to explore a specialist intellectual disability service for older people who are dying and how it related to their quality of life and to costs associated with care provided. METHOD: Data were collected for nine residents and 15 staff members of the specialist service. A single case study design with mixed methods including observations, interviews, standardized questionnaires and costs analysis was utilized. RESULTS: We found positive results regarding overall quality of life, although individuals had limited social networks. Placement fees paid by local health trusts and social services departments were slightly higher than the estimated cost of care reflecting good financial management by a small voluntary sector organization. CONCLUSION: Whilst the philosophical arguments around "specialist" care persist, this service fills a gap in intellectual disability care provision.

The effect of using an audience response system on learning, motivation and information retention in the orthodontic teaching of undergraduate dental students: a cross-over trial.

OBJECTIVE: New methods of teaching and learning are constantly being sought in the adult learning environment. Audience Response Systems (ARS) have been used in many different learning environments, especially in the field of medical education. The objective of this investigation was to ascertain the effect of ARS use in undergraduate teaching in a UK dental school. DESIGN: A cross-over clustered randomized educational trial. SETTING: Leeds Dental Institute. PARTICIPANTS: Year 4 undergraduate dental students in orthodontics. METHODS: Students at Leeds Dental Institute were taught two different topics within the curriculum to test the use of ARS in a cross-over trial. A questionnaire was delivered to the test (ARS) and control (non-ARS) groups. RESULTS: The response rate to the questionnaires was 89·5% (test group) and 82·9% (control group). The ARS enabled students to perform better as shown by knowledge retention (P = 0·013). Students found the seminar more interesting (P = 0·013), easier to concentrate (P = 0·025) and easier to participate in (P = 0·020) when ARS was used. When ARS was used, students were more able to answer questions (P<0·0001), were more likely to prepare for the seminar (P<0·0001) and significantly preferred using ARS (P<0·0001). CONCLUSIONS: ARS was found to significantly improve student concentration and participation in small group seminar teaching and significantly improved knowledge retention. ARS may be useful in facilitating orthodontic teaching in the future.

Three-Dimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS): A new structured pictographic tool for reporting root resorption caused by impacted maxillary canines detected on CBCT images and its impact on orthodontic treatment planning.

OBJECTIVES: The objective of this study was to determine whether use of a root resorption pictogram, the Three-Dimensional Leeds Orthodontic Root Resorption Target Scale (3D-LORTS), in addition to cone beam computed tomography reports was associated with a change in orthodontic extraction decisions in cases with impacted maxillary canines and associated root resorption of adjacent teeth and to assess orthodontists' experiences using the pictogram. STUDY DESIGN: Orthodontists completed a web-based survey in which they selected their preferred treatment plan for 6 cases. Each case was randomly presented twice, initially without and then subsequently with the pictogram. Statistical analysis was conducted to assess differences in extraction decisions with and without the pictogram and the participants' experiences using the 3D-LORTS. RESULTS: A total of 194 orthodontists completed the survey. Significant differences in treatment decisions were found for 3 individual cases (P < .05) and for the 6 cases overall (P < .05). The majority of participants had positive perceptions of the pictogram, particularly with respect to ease of use, effect on understanding of root resorption location and severity, and usefulness as a communication aid. CONCLUSIONS: Inclusion of the pictogram in cone beam computed tomography reports was associated with an overall change in orthodontists' extraction decisions. The majority of orthodontists reported positive experiences using the 3D-LORTS.

Impact of Food-Based Weight Loss Interventions on Gut Microbiome in Individuals with Obesity: A Systematic Review.

The observation that the gut microbiota is different in healthy weight as compared with the obese state has sparked interest in the possible modulation of the microbiota in response to weight change. This systematic review investigates the effect of food-based weight loss diets on microbiota outcomes (α-diversity, ß-diversity, relative bacterial abundance, and faecal short-chain fatty acids, SCFAs) in individuals without medical comorbidities who have successfully lost weight. Nineteen studies were included using the keywords 'obesity', 'weight loss', 'microbiota', and related terms. Across all 28 diet intervention arms, there were minimal changes in α- and ß-diversity and faecal SCFA concentrations following weight loss. Changes in relative bacterial abundance at the phylum and genus level were inconsistent across studies. Further research with larger sample sizes, detailed dietary reporting, and consistent microbiota analysis techniques are needed to further our understanding of the effect of diet-induced weight loss on the gut microbiota.

Obstructive sleep apnoea and the role of the dental team.

Overview Obstructive sleep apnoea (OSA) is a medical condition characterised by multiple episodes of reduced or absent breathing during sleep. OSA can reduce quality of life and raise the risk of significant medical conditions, such as strokes, hypertension, type II diabetes mellitus and sudden cardiac death. This article aims to summarise the key features of OSA and the role the dental team can play in its management.Clinical relevance OSA can have life-threatening consequences if left untreated and the dental team have a role in recognition, referral and treatment.Objectives The reader should have better knowledge of OSA and their potential role in diagnosis and management.

Exploring the impact of mental capacity on breast screening for women with intellectual disabilities.

This study explores the impact of mental capacity in relation to breast screening for women with intellectual disabilities in the UK. Participation in breast screening is considerably lower for women with intellectual disabilities compared to the general population. Barriers to screening include poor mobility and behavioural difficulties. There is currently no research which primarily explores the relationship between mental capacity and breast screening for this group of individuals. This paper presents the results of a cross-sectional survey of 131 women with intellectual disabilities supported by eight Social Care Providers within England and Wales. The data were collected between January 2017 and July 2017. The current research explores the decision-making process surrounding breast screening, considering the impact of associated risk factors during this process. Participants completed a specifically created survey addressing the aforementioned issues. The results indicated that women who lacked capacity, were less likely to engage in breast screening. It was also demonstrated that the process outlined in the Mental Capacity Act (MCA; 2005) was not always followed; women were not routinely assessed if there were doubts regarding their decision-making ability around breast screening and best interest meetings (BIM) were not always held if the person lacked capacity. In order to be able to generalise the current findings, further research is needed to gain a broader understanding of how professionals make decisions around breast screening for women with intellectual disabilities in case the individuals are unable to decide this independently.

A review of cone beam computed tomography for the diagnosis of root resorption associated with impacted canines, introducing an innovative root resorption scale.

OBJECTIVE: The aim of the study was to review all cases referred for cone beam computed tomography (CBCT) to the department of dental radiology at the Leeds Dental Institute to aid diagnosis of root resorption associated with impacted canines. We aimed to establish if referral for and reporting of these CBCT assessments were in compliance with current guidelines. In addition, we introduced a new and innovative tool to aid reporting of CBCT images of root resorption associated with an impacted tooth. All plain film radiographs taken before CBCT were reviewed to determine if root resorption was evident or suspected from the plain film radiographs. STUDY DESIGN: Root resorption was recorded from plain film radiographs taken before CBCT by using a resorption scale designed by the authors for assessing root resorption associated with impacted canines (Two-Dimensional Leeds Resorption Scale). CBCT radiography reports of all cases were reviewed to identify cases with confirmed root resorption. RESULTS: All cases referred for CBCT were compliant with guidelines relating to referrals and reporting. CONCLUSIONS: CBCT provided improved detection rates (63%) of root resorption associated with impacted canines. The resorption scale developed by the authors (Three-Dimensional Leeds Orthodontic Root Resorption Target Scale) is intended to address the subjective nature of reporting of CBCT images taken to assess root resorption associated with impacted teeth.