A two-centre study assessing the impact of the COVID-19 pandemic on orthodontic patients in secondary care.

OBJECTIVE: To evaluate the impact of the coronavirus pandemic on patients in active orthodontic treatment. DESIGN: Digital online survey. SETTING: Two secondary care orthodontic departments in the United Kingdom. PARTICIPANTS: A prospective convenience sample of 103 patients in active orthodontic treatment. METHODS: A 12-item questionnaire developed using the platform SurveyMonkey was used to assess the following: (1) patient's feelings towards attending their orthodontic appointments; (2) their desire to continue with their treatment; (3) how many patients encountered problems with their appliance during the lockdown; (4) how patients sought help during the first national lockdown period; and (5) any other concerns regarding impact on their orthodontic treatment. RESULTS: A total of 103 participants responses were collected over a four-week period across two departments. Of them, 45% required a face-to-face appointment to solve a problem with their appliance; 45% of patients who had problems with their orthodontic appliance were able to resolve the issue through digital means either via telephone/email advice from their provider or from accessing help via the Internet; and 99% of patients wanted to continue with their orthodontic treatment. CONCLUSION: Our study has shown that a significantly higher percentage of patients are more concerned regarding attending face-to-face appointments after the first national lockdown due to the coronavirus pandemic. Providers of orthodontic care should ensure they support their patients by providing digital support and adopt virtual means of managing emergency cases patients in the event of any further imposed national or local lockdowns. Furthermore, access and availability of emergency face-to-face orthodontic care is necessary for many patients in active orthodontic treatment.

Inferior alveolar nerve anaesthesia: A rare complication of orthodontic tooth movement.

Inferior alveolar nerve (IAN) damage is a rare but recognised complication of dental procedures including third molar surgery, implant surgery, endodontic treatment and local anaesthetic injections. However, it is rarely caused by orthodontic tooth movement. This report highlights a case of temporary IAN anaesthesia to the right mental region, which was likely to have occurred secondary to the orthodontic uprighting of a lingually tilted molar using a high strength arch wire. Immediate deactivation of the appliance and an acute reducing dose of systemic steroids resulted in complete resolution of symptoms. To the best of the author's knowledge, there have been seven previously described cases of IAN paraesthesia but no cases reporting IAN anaesthesia secondary to orthodontic fixed-appliance treatment. This case highlights the importance of dentists practising orthodontics to have an awareness of the clinical and radiographic signs that may indicate a high-risk case requiring appropriate referral for cone beam imaging and careful orthodontic planning. Furthermore, this case emphasises the need to warn high-risk patients of the symptoms of this rare complication and how it may be managed. This will ultimately help to minimise the risk of litigation and optimise patient experience and care.

The scaffold protein PDZK1 modulates expression and function of the organic anion transporting polypeptide 2B1.

The protein family of Organic Anion Transporting Polypeptides (OATPs) summarizes various transporters known to facilitate cellular uptake of xenobiotics. One member of this family is OATP2B1. This transporter is ubiquitously expressed and possesses a PDZ-binding motif at the C-terminus. PDZK1 (PDZ domain-containing 1) is a scaffold protein that influences function of different membrane proteins by sorting/stabilization of their membrane localization. It was aim of the herein reported study to investigate whether there is an interaction between OATP2B1 and PDZK1, and to further characterize its impact on transport function. At first expression of both OATP2B1 and PDZK1 was evaluated in liver, kidney and intestine. Based on the existence of a C-terminal PDZ-class I binding motif in OATP2B1 and the co-expression in all tested tissues an interaction was likely. Testing the influence of PDZK1 on OATP2B1 transport function revealed enhanced transport capacity for estrone 3-sulfate, thereby suggesting a change in OATP2B1 amount in the membrane. This assumption was validated by Western blot analysis. Finally, deletion of the C-terminal PDZ-binding motif in OATP2B1 lowered the impact of PDZK1 on transport function. Taken together, we report an interaction of PDZK1 with OATP2B1, which influences localization and function of the transporter. Changes in PDZK1 expression may therefore be one factor contributing to interindividual differences in OATP2B1 mediated pharmacokinetic processes.

Coping strategies and social support in the family impact of cleft lip and palate and parents' adjustment and psychological distress.

OBJECTIVE: To examine the role of parents' coping strategies and social support in the family impact of cleft lip and palate (CLP) and levels of adjustment and psychological distress and to investigate whether a child's age, type of cleft, or other reported medical problems influenced such outcomes. DESIGN: A cross-sectional study. PARTICIPANTS: One hundred three parents of children or young adults with CLP recruited from families attending a multidisciplinary cleft lip and palate clinic. OUTCOME MEASURES: Family impact, psychological distress, and positive adjustment were assessed using validated psychological questionnaires. RESULTS: Findings indicated that while there were many impacts of a child's CLP, negative outcomes (family impact, psychological distress) were not high. In contrast, parents reported high levels of positive adjustment or stress-related growth as a result of their child's condition. Participants also reported high levels of social support and relied more on the use of approach rather than avoidance-oriented coping strategies. Having more support from friends and family was associated with less negative family impact, lower psychological distress, and better adjustment. Greater use of approach coping was associated with more positive adjustment; whereas, avoidant coping was associated with a greater family impact and more psychological distress. Having a younger child and/or a child with medical problems in addition to CLP was associated with a greater impact on the family. CONCLUSIONS: How parents cope with their child's condition and the levels of support received may have implications for caregivers, the family unit, and the delivery of more family-oriented CLP services.

Maxillary anterior tooth size and arch dimensions in unilateral cleft lip and palate.

OBJECTIVE: To investigate differences in size of the maxillary permanent anterior teeth and arch dimensions between individuals with repaired unilateral cleft lip and palate (UCLP) and a matched control group representing the general population. DESIGN: Retrospective study cast review. PARTICIPANTS: Study casts of 30 subjects due to commence orthodontic treatment following an alveolar bone graft (ABG) were collected from the Cleft Lip and Palate Units in South Yorkshire. Thirty control subjects were collected from a previously validated control group of white individuals in South Yorkshire. MAIN OUTCOME MEASURES: Casts were analyzed with an image analysis system to measure the dimensions of the maxillary permanent anterior teeth, incisor chord lengths, and the intercanine and intermolar widths. The results were analyzed statistically using paired t-tests and two-way univariate analysis of variance (ANOVA). RESULTS: The mesiodistal widths of maxillary anterior teeth in the study group were smaller than the noncleft control group (p

Failed attendances at hospital dental clinics among young patients with cleft lip and palate.

OBJECTIVE: To determine the frequency of missed dental appointments among children with a cleft lip and/or palate (CL/P). DESIGN: A prospective study of failed appointments over a 12-month period. SETTING: Three different CL/P clinics within a British dental hospital. PATIENTS: Forty-five CL/P children (mean age of 8.8 years) and 45 age-matched, gender-matched, and postal code-matched noncleft patients. MAIN OUTCOME MEASURES: The overall percentage of missed appointments at three different clinics by CL/P patients and the difference in attendance rates at the pediatric dentistry clinic between CL/P and non-CL/P children. RESULTS: Pediatric dentistry had the highest rate of missed appointments (22.4%), followed by the multidisciplinary cleft clinic (9.2%) and the orthodontic clinic (8.8%). CL/P patients missed a significantly greater proportion of their pediatric dentistry appointments than noncleft children (22.4% versus 11.9%). Patients with a bilateral CL/P were significantly more likely to miss an appointment than patients with a unilateral CL/P. Age, gender, medical history, and distance traveled had no significant effect on attendance rates. CONCLUSIONS: Further work is needed to identify risk factors for poor attendance and to develop strategies to reduce the frequency of missed appointments in this vulnerable group.