The awareness and usage of orthodontic apps and social media by orthodontists in the UK: A questionnaire-based study.

OBJECTIVE: To assess the awareness and usage of mobile apps and social media among orthodontic clinicians to support patients with orthodontic treatment, support the professional development of orthodontists, and identify any relevant apps and social media platforms currently recommended to patients. DESIGN: Cross-sectional questionnaire-based study. SETTING: United Kingdom. METHODS: A questionnaire was developed and distributed to members of the British Orthodontic Society (BOS). To increase the response rate, the questionnaire was circulated at three time points between January and March 2020. RESULTS: A total of 149 orthodontists responded to the questionnaire (15% response rate) with 113 orthodontists completing all questions (11.4%). Of those who answered, 81% (n = 111) had been qualified for >10 years, 35% worked in practice (n = 48), 34% worked in a hospital (n = 47) and 26% worked in both hospital and practice (n = 36). The results indicated that 20% of clinicians (n = 22) used apps to support patients and 33% (n = 37) reported using apps for professional purposes. Brush DJ appeared to be the most popular patient focused app (39%, n = 18) whereas the IOTN (17%, n = 8), Invisalign (17%, n = 8) and Dental Monitoring apps (9%, n = 4) were the most popular clinician-focused apps. With regard to social media, 53% (n = 60) of respondents reported that they used social media to communicate generic orthodontic information and promote their practice to patients. The most commonly used social media platforms were Facebook and Instagram. Of respondents, 96% expressed a willingness to recommend an evidence-based mobile app to patients if available, and 88% were willing to recommend an evidence-based social media platform. CONCLUSIONS: Orthodontic clinicians are utilising mobile apps and social media to support both patients and their own professional development. There is a willingness to increase the use of evidence-based platforms and apps to support patients.

Occlusal outcomes in combined orthodontic and orthognathic treatment.

OBJECTIVE: To investigate the treatment outcome in terms of the malocclusion features and the changes in the occlusion of patients undergoing orthodontic/orthognathic treatment using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome and Need (ICON) and to test the application of the Index of Orthognathic Functional Treatment Need (IOFTN) on this sample as a measure of orthognathic pre-treatment need. DESIGN: Retrospective longitudinal cohort study. SETTING: The orthodontic department at the Eastman Dental Hospital. MATERIAL AND METHODS: The study models of a sample of 100 orthodontic/orthognathic patients who were treated at the Eastman Dental Hospital were measured using the PAR index and ICON at three stages: pre-treatment, pre-surgery and at debond. Treatment need was assessed by measuring IOTN and IOFTN using start study models. RESULTS: 99% of the sample showed an improvement in PAR score, with 82% of the sample being greatly improved. ICON showed that 95% of the sample had an improvement of different degrees with 5% being not improved or worse. The IOFTN qualified 97% of the patients for orthognathic treatment when used retrospectively on the sample while the DHC of IOTN qualified the whole sample for orthodontic treatment. CONCLUSIONS: Orthodontic/orthognathic treatment showed improved and acceptable overall results. The PAR index and ICON were valid measures to investigate the outcome of orthognathic treatment. IOFTN proved to be a useful tool in determining and prioritizing orthognathic treatment based purely on functional need.

Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: part 2 - cross-sectional validation.

OBJECTIVE: To test the items, identified through qualitative inquiry that might form the basis of a new Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life (OHQoL) of young people with malocclusion. METHODS: Piloting with 13 young people reduced the number of items from 37 to 28. Cross-sectional testing involved a convenience sample aged 10-16 years, attending the Orthodontic Department of the Charles Clifford Dental Hospital, Sheffield. The fit and function of the initial MIQ questions were examined using item response theory. RESULTS: 184 participants (113 females; 71 males) completed a questionnaire (response 85%), seven participants were excluded due to missing responses. The mean age of participants was 12·9 years (SD 1·4) and they had a wide range of malocclusions. The majority were White British (67·4%). Data from 47 participants were used to analyse test-retest reliability. Rasch analysis was undertaken, which further reduced the number of items in the questionnaire from 28 to 17. Unidimensionality of the scale was confirmed. The analysis also identified that the original 5-point response scale could be reduced to three points. The new measure demonstrated good criterion validity (r = 0·751; P < 0·001) and construct validity with the two global questions ('Overall bother' ρ = 0·733 and 'Life overall' ρ = 0·701). Internal consistency (Cronbach's alpha = 0·906) and test-retest reliability Intraclass correlation coefficient (ICC = 0·78; 95% CI 0·61-0·88) were also good. CONCLUSION: Cross-sectional testing has shown the new MIQ to be both valid and reliable. Further evaluation is required to confirm the generalisability as well as the ability of the new measure to detect change over time (responsiveness).

Development of the Malocclusion Impact Questionnaire (MIQ) to measure the oral health-related quality of life of young people with malocclusion: part 1 - qualitative inquiry.

OBJECTIVES: To seek the views of adolescents with malocclusion about how the appearance and arrangement of their teeth affects their everyday life and to incorporate these views into a new Malocclusion Impact Questionnaire (MIQ). METHODS: Semi-structured interviews were undertaken with a purposive sample of 30 young people (10-16 years) referred for orthodontic treatment to two dental teaching hospitals. The interviews were recorded, transcribed and analysed using framework analysis. Several themes and sub themes were identified and these were used to identify items to include in the new measure. RESULTS: Three themes emerged which were: concerns about the appearance of their teeth, effect on social interactions and oral health/function. Participants expressed the view that their teeth did not look normal, causing them embarrassment and a lack of confidence, particularly when they were with their peers or having their photograph taken. Concerns regarding the potential effect of a malocclusion on oral health, in terms of food becoming stuck between crooked teeth, interferences when chewing and increased risk of damaging the teeth were also identified. The themes were used to generate individual items for inclusion in the questionnaire. CONCLUSIONS: Common themes relating to the impact of malocclusion on the lives of young people were identified and generated items for the new MIQ to measure the oral health-related quality of life of young people with malocclusion. Part 2 outlines the further development and testing of the MIQ.

A Case Series: The Orthodontic Management of Central Incisors with Horizontal Root Fractures.

This case series illustrates the successful orthodontic management of previously root-fractured central incisors. Orthodontic treatment was carried out to correct the underlying malocclusion, remove traumatic occlusal forces and to provide a suitable occlusion for future restorative treatment should the root-fractured teeth be lost in the future. Clinical relevance: Dental trauma occurs commonly; having affected 10% of orthodontic patients. All practitioners should be able to discuss the possibility of orthodontic treatment with patients who have had previous trauma to their front teeth.

Adult orthodontics--who's doing what?

OBJECTIVES: To estimate the number of adults currently being treated by specialist orthodontists in the UK, both within the National Health Service (NHS) and privately, together with the factors relating to adults undergoing orthodontic treatment, their malocclusions and details of treatment undertaken. DESIGN: Self-administered postal questionnaire. PARTICIPANTS AND SETTING: All individuals entered on the General Dental Council's Specialist List in Orthodontics, registered within the UK. METHODS: A questionnaire was sent to all those on the General Dental Council's Specialist List in Orthodontics to ascertain the numbers of adult patients being treated by specialist orthodontists and factors relating to their treatment. This included age and gender of adults being treated, sources of referral, type of orthodontic treatment carried out, disciplines involved in multidisciplinary treatment, appliance types used and issues which practitioners felt affected adult treatment. Adults undergoing orthognathic treatment were excluded from this study. RESULTS: The questionnaire yielded a response rate of 70%. Those respondents working in combined hospital/university posts treated the largest proportion of adults within the NHS and those working in specialist orthodontic practice treated the largest number privately. Within 1 year, the estimated mean number of adult cases started by specialist orthodontists within the NHS was 20.9 and privately was 28.2. The majority of adults treated were reported to be within the 26-35 year age group. Most adult patients were referred for orthodontic treatment by their general dental practitioners and over 70% of treatment provided was orthodontic-only. Adults' concerns regarding the appearance of orthodontic appliances was quoted by orthodontists as being the most commonly occurring potentially complicating factor with regards to both NHS and private treatment. CONCLUSIONS: Although there are reports in the literature that the number of adult orthodontic patients is increasing, there are no comprehensive figures regarding the number of adults previously treated within the NHS and privately in the UK to compare our data with. This paper presents initial data relating to practitioners' estimates of the numbers of adults being treated in the UK.

Advances in orthodontics.

There has been tremendous progress in orthodontics since Edward Angle first popularised the fixed orthodontic appliance at the turn of the century. Recent years have seen an increased demand for orthodontic treatment from both adolescents and adults and, in addition, patient and clinician expectations of treatment outcomes continue to rise. A desire for more aesthetic materials has resulted in both smaller and 'tooth-coloured' appliances. Improvements in technology, often outside orthodontics, have also led to the development of new materials. The best example of this was the development of nickel titanium alloy by the NASA space programme, which was subsequently adapted for use in nickel titanium archwires. Other technological advances adopted for use in orthodontics include magnets, computerised imaging systems and distraction osteogenesis. This review paper looks at some of the innovations in the fields of materials as well as in techniques and appliance systems.