Pivots and pirouettes: adapting a robust departmental CPD and training program to the COVID-19 crisis.

The onset of the COVID-19 pandemic caused swift change in society, affecting both personal and professional lives. In radiation therapy (RT), professional and social interactions are highly important to maintaining team culture and effective patient care. Continuing Professional Development (CPD) is also an integral part of maintaining professional and personal competence and growth for healthcare professionals. This article examines the rationale for and methods of swiftly adapting a robust CPD program and training calendar to an online offering for radiation therapists (RTs) at the Princess Alexandra Hospital Radiation Oncology Department, Brisbane, Australia. Reasons for the change, how it was achieved quickly, and the opportunity to build resilience in the staff group are discussed. Successes and challenges of achieving meaningful change in a short timeframe are described, ensuring RTs maintained access to both CPD and social support during the crisis. Initial feedback suggested a positive response from RTs, but the situation remains dynamic and will need to be monitored and adapted as the pandemic continues.

Associations of mental health with cardiovascular risk phenotypes and adiposity in adolescence: A cross-sectional community-based study.

AIM: Cardiovascular disease and mental illness commonly co-occur in later life, but it is unknown how early these associations arise. We aimed to determine the extent to which: (i) childhood mental health is associated with functional and structural cardiovascular risk phenotypes and adiposity in late childhood/adolescence, and (ii) associations between mental health and cardiovascular phenotypes may be explained by differential body mass index. METHODS: This cross-sectional study drew on three longitudinal community-based cohort studies (two enriched for overweight/obesity) in metropolitan Melbourne, Australia, with harmonized follow-up in 2014. Mental health exposures included emotional and behavioural problems (Strength and Difficulties Questionnaire) and psychosocial health and general well-being (Pediatric Quality of Life Inventory (PedsQL)), which were assessed by self- and parent-proxy report. Cardiovascular risk phenotypes and adiposity measures included mean arterial pressure, pulse wave velocity, carotid artery intima-media thickness, retinal arterioleto-venule ratio, waist circumference, % body fat, and BMI z-score. We used multivariable linear regression models, adjusting for age, sex and neighbourhood disadvantage, to examine associations. RESULTS: Of the 364 participants (mean age 14.7, standard deviation 2.0, years), 30% were overweight and 16% obese. All adiposity indicators were positively associated with higher behavioural/emotional problems and poorer psychosocial health and negatively associated with better ratings of positive general well-being, as reported by parents and children (all P ≤ 0.03). However, there was little evidence that cardiovascular functional or structural phenotypes varied by mental health. CONCLUSIONS: By late childhood/adolescence, mental health is strongly associated with adiposity but not with cardiovascular structure or function. This suggests that the known relationship between these constructs may not develop until early or mid-adulthood.

How good are we at estimating crowding and how does it affect our treatment decisions?

OBJECTIVES: To assess the estimation of crowding by orthodontists and their subsequent extraction choices. MATERIALS AND METHODS: Sixty-two orthodontists were asked to quantify crowding on eight lower arch study models using their preferred method and also to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.1 to 7.5mm across the eight models as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the exercise after 9 months to assess reliability. RESULTS: The preferred method of space estimation by all of the orthodontists was direct visualization. However, the estimates of crowding were very variable. For the most crowded lower model with 7.5mm of crowding, the estimates ranged from 5 to 20mm. Extraction choices were less variable than estimates of crowding and shifted from second to first premolars as crowding increased. Estimates of crowding and treatment decisions changed with time in 28 of 33 repeat measures. Estimates of crowding were unrelated to clinical experience. LIMITATIONS: The principal limitation of this study is that it was a laboratory-based study and utilized just the lower arch model for estimation and treatment planning. CONCLUSIONS: Extraction decisions and estimates of crowding tended to vary both initially and over time but were less varied in the case of the extraction decisions. Although this may have been a reflection of the limited treatment options, perhaps reassuringly, as the degree of crowding increased, so did the likelihood of prescribing extractions and the decisions generally shifted from second to first premolars. How orthodontists estimate crowding and make subsequent extraction choices is important and has potential medico-legal implications.

The current status of 3D imaging in dental practice.

This article aims to describe the current status of 3-dimensional (3D) imaging in dental practice. Advances in this field have made 3D imaging far more accessible in all dental fields. This paper describes methods of imaging dental hard and soft tissues and their clinical uses. In addition, the potential advantages and disadvantages of various systems are discussed, as well as expected future developments.

Axenfeld-Rieger syndrome (ARS): A review and case report.

Axenfeld-Rieger syndrome (ARS) is a rare, autosomal dominant condition characterized by ocular, craniofacial, dental, and periumbilical abnormalities. Relatively little information exists on this syndrome within the dental literature despite the fact that midface hypoplasia and maxillary hypodontia are classical presenting features of this syndrome. This is a case report of a 7-year-old Caucasian female with ARS who presented with significant ocular and dental anomalies. She was also found to have osteopenia. Her dental condition is described, her immediate treatment is shown, and her long-term treatment needs are discussed.

Effect of arch form on the fabrication of working archwires.

INTRODUCTION: Previous studies have shown that most practitioners plan to maintain intercanine and intermolar widths during orthodontic treatment with fixed appliances. The aim of this study was to determine whether this was put into practice by clinicians during the latter stages of orthodontic treatment with fixed appliances. METHODS: This 2-part investigation was a laboratory-based measurement study at Bristol Dental Hospital, United Kingdom, from 2005 to 2007. Using standardized maxillary and mandibular study models with identical intermolar and intercanine widths but with differing degrees of tooth misalignment, 30 clinicians were asked to fabricate final working archwires according to their normal clinical practice. Then the intercanine and intermolar widths of the archwires were measured. In the second part of the study, the same intra-arch dimensions were measured directly from 50 pretreatment and posttreatment patient study models obtained from a subsample of 10 of the clinicians. RESULTS: The intercanine and intermolar widths measured on the adapted archwires from the standardized study models showed wide variations in the results, even though the intercanine and intermolar widths of the models were identical. Data from 50 treated patients also showed that, in most, there were wide variations in intercanine and intermolar widths between the patients' pretreatment and posttreatment study models. CONCLUSIONS: Although most clinicians aim to maintain the pretreatment arch form, this study shows that this is often not transferred to clinical practice.

Alveolar bone grafting: results of a national outcome study.

INTRODUCTION: In 1998, the Clinical Standards Advisory Group (CSAG) report demonstrated a successful radiographic outcome of 58%, for alveolar bone grafting, from 157 cases of unilateral cleft lip and palate (UCLP) in children aged 12 years. No further national studies have assessed the current level of radiographic outcome following the re-organisation of cleft services since the recommendations from the CSAG report. PATIENTS AND METHODS: In 2008, radiographic images were requested for alveolar bone grafts performed in calendar year 2006 from each of the now established UK cleft centres. A sample of 206 patients with 235 grafted sites was scored by a panel of trained assessors, following a calibration exercise, using a modified Kindelan index. Inter- and intra-observer variation was assessed. RESULTS: The overall radiographic success rate for the 2006 images assessed was 85%. There was no statistical difference for radiographic success between centres or surgeons or cleft type when defined as either a bilateral or unilateral alveolar defect for a patient. CONCLUSIONS: Alveolar bone grafting appears to have improved radiographic outcomes when compared with the CSAG report following the re-organisation of surgical services for children with cleft lip and/or palate.

An evaluation of clinicians' choices when selecting archwires.

The aim of this research was to determine the choices made by clinicians with respect to archwires and arch form during the initial and latter stages of orthodontic treatment with fixed appliances. A questionnaire-based study was carried out at Bristol Dental Hospital between November 2005 and March 2006. Questionnaires were distributed within the dental hospital and at local meetings in order to obtain a mixed sample of hospital and practice-based orthodontists. The clinicians asked to complete the questionnaire were consultant orthodontists (n = 37), specialist practitioners (n = 36), senior specialist registrars in orthodontics (n = 10), and dentists with a special interest in orthodontics (n = 17). The questionnaire consisted of two parts: the first was concerned with the initial alignment phase of treatment and the second with the space-closing phase of treatment in premolar extraction cases. The choice of archwires, significance of arch form, and intra-arch dimensions considered important at both stages were assessed. The clinicians were also asked about their usual practice with regard to adaptation of working archwires and the use of study models and symmetry charts. One hundred questionnaires were returned, giving a response rate of 92.6 per cent. The majority of clinicians felt that preservation of the pre-treatment arch form was essential in the latter but not in the early stages of treatment. In particular, conservation of the original intercanine width was considered important. However, there was no uniformity in how arch form should be preserved. Some respondents used study models and symmetry charts as an aid, but even then they were used in different ways. There was no uniformity in the landmarks used when adapting stainless steel archwires to arch form. Therefore, even when clinicians do adapt their archwires carefully with the intention of preserving arch form, are they choosing the correct arch form?

Marcus Gunn (jaw-winking) phenomenon: a case report.

While Marcus Gunn phenomenon (MGP) is well documented in the medical literature, little data exist within the dental literature. This is a case report of an adolescent with MGP who presented for orthodontic treatment and required bite-opening in order to treat her malocclusion. No operative complications were experienced and orthodontic treatment has been uneventful. Although MGP may be uncommon in a dental context, dentists and other oral health professionals can play a significant part in its detection and diagnosis.

Sucking habits in childhood and the effects on the primary dentition: findings of the Avon Longitudinal Study of Pregnancy and Childhood.

INTRODUCTION: Most previous research on non-nutritive sucking habits has been cross-sectional in nature. This study determined the prevalence of non-nutritive sucking habits and the effects on the developing dentition within a longitudinal observational cohort. METHODS: The Children in Focus group of the Avon Longitudinal Study of Pregnancy and Childhood study was studied. Questionnaire data on non-nutritive sucking habits were collected on the children at 15 months, 24 months, and 36 months of age. Dental examinations were performed on the same children at 31 months, 43 months, and 61 months of age. RESULTS: At 15 months, 63.2% of children had a sucking habit, 37.6% used just a dummy, and 22.8% used a digit. By 36 months, sucking had reduced to 40%, with similar prevalence of dummy and digit sucking. Both habits had effects on the developing dentition, most notably in upper labial segment alignment and the development of anterior open bites and posterior crossbites. CONCLUSIONS: The majority of children had non-nutritive sucking habits up until 24 months of age. Both digit and dummy sucking were associated with observed anomalies in the developing dentition, but dummy-sucking habits had the most profound influence on the anterior and posterior occlusions of the children.

Multidisplinary management of hypodontia in adolescents: case report.

The purpose of this article is to describe a team approach to treatment of hypodontia in adolescent dentition. A case report of hypodontia with a microdontic lateral incisor in a Class I malocclusion illustrates the principles of case management. Multidisciplinary consultation during treatment planning and coordination and appropriate timing of subsequent interdisciplinary dental care enables the clinician to provide the optimum care. The scope of orthodontic and restorative management depends on the severity of the hypodontia.

Mandibular premolar impaction: 2 case reports.

The purpose of this article is to review the principles of case management of impacted mandibular premolars and to illustrate their potential to respond well to treatment. Although the scope of treatment may be influenced by the patient"s age, past dental history, severity of impaction, dentoalveolar development and root form, the 2 case reports demonstrate the inherent potential for good treatment outcome even in the most unfavourable circumstances.