Orthodontic treatment protocol versus Peer Assessment Rating: Assessing the quality of orthodontic treatment.

OBJECTIVE: To apply the Peer Assessment Rating (PAR) to cases that have been assessed by the NHS Business Service Authority (NHSBSA) using the orthodontic treatment protocol (OTO), then compare the NHSBSA outcome assessment with weighted (W) and unweighted (U) PAR scores. DESIGN: Cross-sectional study. SETTING: UK. CASES: Anonymised orthodontic cases submitted to the NHSBSA. METHODS: A sample of 30 reports from 2021/2022 were randomly selected to include different standard of treatment grades. The records were de-identified and the pre- and post-treatment study models were PAR scored by a calibrated assessor. RESULTS: The mean percentage change in PAR was higher in cases from green reports (W: 78%; U: 79%) than amber (W: 68%; U: 67%) and red reports (W: 65%; U: 65%). Alignment and poor buccal segment interdigitation were the most reported concerns for cases included in the red and amber graded reports. A residual increased overjet was the most common occlusal feature leading to PAR scores not being more than 70% improved. Only slight agreement was shown between OTP and PAR using the kappa statistic, and the chi-square statistical test found that outcome measures are statistically significantly different. CONCLUSION: There are fundamental differences between OTP and PAR, and general agreement between them has not been demonstrated. The NHSBSA Report provides a more critical outcome assessment than PAR, identifying elements that are not assessed or measured by the PAR index.

The effectiveness of interventions to increase patient involvement in decision-making in orthodontics: A systematic review.

OBJECTIVES: To examine the effectiveness of interventions that aim to increase patient involvement in treatment decisions in orthodontic, orthognathic and cleft treatment, based on patient-reported outcomes and patient knowledge. DESIGN: Systematic review. DATA SOURCES: OVID databases (MEDLINE, EMBASE and EBM reviews), CENTRAL, WHO's International Clinical Trials Registry Platform and reference lists of included studies. DATA SELECTION: Studies were selected by two reviewers independently and in duplicate based on pre-defined eligibility criteria: Population: People considering or undergoing orthodontic, orthognathic or cleft treatment. Intervention: Any intervention that aims to increase patient involvement in decision-making. Outcomes: Patient-reported outcomes and patient knowledge. Studies: All experimental studies published in English from January 2000 to October 2019 were eligible. DATA EXTRACTION: Standardised data extraction of study information and assessment of risk of bias using the Cochrane Risk of Bias Tool for RCTs and ROBINS-I for non-randomised studies of interventions. DATA SYNTHESIS: 13 randomised controlled trials were included. Due to heterogeneity in the studies, a narrative synthesis was undertaken. The majority (n=11) of studies involved orthodontic patients, with one study of cleft patients and one study of orthognathic and orthodontic patients. Six included studies reported significant differences between intervention and control groups with improved patient knowledge or better patient-reported outcomes. CONCLUSIONS: A variety of different interventions and outcome measures were used making data synthesis challenging. There is some evidence that interventions to increase patient involvement in decision-making can improve patient-reported outcomes and patient knowledge.

Dental core training in oral and maxillofacial surgery: a United Kingdom survey of on-call provision.

Introduction Dental core training posts within oral and maxillofacial surgery (OMFS) units often include on-call provision. There is a lack of current data demonstrating the variation of dental core trainee (DCT) involvement in on-call. This variation may influence trainees' experience of training.Aim To examine the provision of on-call cover in OMFS units across the United Kingdom, including trainee involvement, supervision and training.Method Online surveys were distributed in August 2019 to all DCTs, educational supervisors (ESs) and training programme directors (TPDs) in OMFS units to understand trainee involvement in on-call provision, including levels of supervision and perceived educational benefit.Results In total, 167 trainees responded from 69 OMFS units. Responses were received from 102 ESs/TPDs. All trainees experienced on call, with over 75% covering night shifts. Trainees reported minimal difference between support within hours and out of hours (OOH). Qualitative data from trainees and supervisors highlighted the educational value of on-call within normal hours. However, limited supervised training opportunities were reported OOH.Conclusion This survey highlights the educational value of on-call within hours. The perceived level of support does not vary significantly between normal hours and OOH. Some concerns were expressed regarding OOH supervision and prolonged on-call periods.

Does periodontal treatment have an impact on metabolic control and systemic inflammation in patients with type 2 diabetes?

Design Systematic review and meta-analysis.Data sources A search of two databases, Medline and CENTRAL, was undertaken, limited to articles published in English from the oldest records until 10 July 2018.Study selection Participants included patients diagnosed with type 2 diabetes and periodontitis, with HbA1c and C-reactive protein (CRP) measurements at baseline. The intervention was surgical or non-surgical periodontal therapy. The control was no periodontal treatment, supra-gingival scaling or oral hygiene instruction. The outcome was HbA1c and CRP measurements three months later.Data extraction and synthesis Two independent reviewers assessed articles initially by title and abstract, before reviewing full texts of relevant studies. Disagreements were resolved through discussion or a third reviewer. Data extraction included definition of periodontal disease, periodontal intervention and average changes in HbA1c and CRP. Risk of bias was assessed using the Cochrane Collaboration tool. Two meta-analyses were performed to determine the effects of periodontal intervention on HbA1c and CRP.Results Out of 402 potential studies, nine randomised controlled trials were included. Six studies had no periodontal treatment reported in the control arm, whereas oral hygiene instruction or supra-gingival scaling was described in three studies. The intervention in all studies was non-surgical periodontal treatment, but one also involved surgical debridement. No heterogeneity was detected using the Cochrane Q test or I2 statistic. The majority of studies were deemed to be at high risk of performance bias due to a lack of blinding of participants. The results of the meta-analyses indicated a significant reduction in percentage of HbA1c (difference in means = 0.56, 95% CI [0.36-0.75], p <0.00001) and in CRP levels (difference in means = 1.89, 95% CI [1.70-2.98], p <0.00001).Conclusions Periodontal treatment improves metabolic control as well as reduces systemic inflammation in patients with type 2 diabetes.

A study of the reporting of patient and public involvement and engagement (PPIE) in orthodontic research.

INTRODUCTION: Patient and public involvement and engagement (PPIE) in research is an essential component of high-quality research. Patients and the public can identify which research topics are most relevant to them, contribute to study design, and interpretation and dissemination of findings. While inclusion of PPIE is widely adopted in medical research, awareness within the dental research community is more limited. AIM: To examine patient and public involvement and engagement in orthodontic research activity. DESIGN: Identification and appraisal of use of PPIE in orthodontic research reporting and funding applications using a systematic approach. METHODS: Three sources of information were examined: (1) research articles published between September 2018 and September 2019 in four major orthodontic journals. Articles were examined for reported PPIE; (2) common funding bodies for orthodontic research were assessed to establish whether PPIE was mandated (National Institute for Health Research, Medical Research Council, Wellcome Trust, Chief Scientist Office (Scotland), Health and Care Research Wales, British Orthodontic Society Foundation, Royal College of Surgeons and CLEFT); and (3) publication guidance for authors in these journals was examined to identify whether reporting of PPIE was included. RESULTS: Of the 363 research articles, 2 (0.6%) mention patient/public involvement. None of the 363 research articles mention patient/public engagement. Of nine funding bodies, 2 (22%) request evidence of patient/public involvement as a condition of receiving funding with one (11%) expecting evidence of public engagement to be provided as a condition of receiving funding. None of the four major orthodontic journals include patient/public involvement and/or engagement in their guidance for authors. CONCLUSION: There is currently: (1) a notable lack of reporting of PPIE in orthodontic research; (2) variability in the requirements of funding bodies for researchers to include PPIE in funding applications and throughout the research process; and (3) no stipulation in journals' instructions for authors.

Oral ulceration and blistering in patients with COVID-19.

Design Case series.Introduction The most common signs and symptoms of SARS-CoV-2 infection include headache, sore throat, hyposmia, hypogeusia, diarrhoea, dyspnoea and pneumonia. Dermatological manifestations have also been reported but few authors have documented oral signs and symptoms. Methods Three cases are reported where oral ulceration or blistering is found in patients with confirmed or suspected COVID-19.Results One patient had serologically confirmed COVID-19, whilst the remaining two cases were only suspected. Two patients reported pain from the palate, whilst the third reported in the tongue. The first two patients had lesions affecting keratinised tissue consistent with herpes simplex lesions but with no history of herpetic infection. The third patient had lesions compatible with erythema multiforme.Conclusions The authors suggest a link between COVID-19 and oral ulceration and blistering, but acknowledge these signs may often go undetected due to a lack of intraoral examination during hospital admission.

The clinical benefit of adjunctive antibiotics alongside non-surgical periodontal therapy with respect to periodontopathogenic bacteria?

Data sources The following electronic databases were searched with no language restrictions: MEDLINE, EMBASE and Cochrane library. Reference lists of included studies were searched, alongside the Open Grey database and hand searches in Journal of Dental Research, Journal of Periodontology, Journal of Clinical Periodontology and Journal of Periodontal Research. The editor of each journal was contacted to enquire about relevant accepted and forthcoming articles.Study selection Two independent reviewers screened for randomised controlled trials (RCTs) with a follow-up of at least six months. The main outcome was the change in periodontal pocket depths (PPD) and clinical attachment level (CAL) six months after treatment, where patients were divided according to adjunctive treatment (antimicrobial vs placebo) as well as the pre-treatment detection of periodontopathogenic bacteria.Data extraction and synthesis Data was extracted from all selected papers using a standardised form, including treatment methods, antimicrobial regime and bacterial detection methods. The Cochrane Collaborations tool was used to assess risk of bias. The weighted mean difference (WMD) of treatment effects between bacterial detection groups was obtained and pooled. A two-stage, fixed-effects meta-analysis was performed, and statistical heterogeneity was described using the Q-statistic and I2 index.Results Following the screening of 643 papers and author contact, five placebo-controlled studies were included in the systematic review. All had a low risk of bias. They varied in patient sample sizes, periodontal diagnoses, subgingival debridement protocols, antimicrobial regimes, as well as baseline microbial analysis methods. The meta-analysis of four studies, using amoxicillin and metronidazole as adjuncts, revealed a significant increase in the reduction of PPDs compared to placebo. It also showed no significant difference in the clinical effect on PPDs ≥5 mm when prescribing adjunctive amoxicillin and metronidazole based on the pre-treatment detection of A. actinomycetemcomitans (WMD = 1.16, 95% CI [-5.37, 7.68], I2 = 37.8%).Conclusions Although data on baseline periodontopathogenic bacteria was limited to A. actinomycetemcomitans, this systematic review suggests that there is not enough evidence to support the use of pre-treatment analysis of subgingival bacteria as a criterion for prescribing adjunctive antibiotics.