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1.
Br Dent J ; 230(11): 753-757, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34117434

RESUMO

Introduction Long-term orthodontic retention using removable or fixed retainers is needed to maintain the outcome of orthodontic treatment. The aim of this article is to describe how long-term retention is managed and to report on a survey of general dental practitioners (GDPs) as to how this management currently operates in the UK.Materials and methods GDPs were invited to complete a short online survey on orthodontic retention using an open notice posted in the British Dental Journal and a direct email to the members of a local dental clinical society.Results Fifty-six GDPs completed the online survey. Overall, the findings highlighted poor levels of communication between orthodontists and GDPs with respect to the latter assuming responsibility for the management of long-term retention.Conclusion The management of long-term retention could be improved by more effective communication between the orthodontist and GDP. One solution might be a retention management pro forma. GDPs are in some instances willing to undertake more of the management of retention following further training and possible remuneration.

2.
Br Dent J ; 230(5): 308-313, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33712787

RESUMO

Introduction Dental clinical academics are essential members of the dental workforce with roles in teaching, research and scholarship. There is currently a national shortage of UK dental clinical academics, with difficulties recruiting to all grades. In addition, there is evidence of gender inequality within academia, with segregation at a horizontal and vertical level.Aim To investigate the factors that influence a career in orthodontic clinical academia and highlight ways to improve recruitment and retention.Method A qualitative research study utilising focus groups. Purposive sampling was carried out to recruit participants at different stages of an orthodontic career. A total of eight face-to-face focus groups were conducted with 26 participants. Focus groups were split by gender and career stage. An inductive thematic analysis was used to generate themes.Results Three major themes were generated: academic career options, motivations and barriers to pursuing a clinical academic career.Conclusion This paper sheds light on the current factors affecting a career in orthodontic clinical academia. Worryingly, most dentists do not strive for an academic career and the barriers to pursuing this career option are discussed. Ways of addressing the issues facing recruitment and retention of individuals to orthodontic clinical academia are suggested.


Assuntos
Ortodontia , Escolha da Profissão , Assistência Odontológica , Odontólogos , Humanos , Pesquisa Qualitativa
3.
Equine Vet J ; 2020 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-33131087

RESUMO

BACKGROUND: Routine equine odontoplasty is performed by both Veterinary Surgeons and Equine Dental Technicians. The production of aerosolised particulates from motorised equipment has been well documented in human orthodontics but has yet to be investigated in the veterinary industry. OBJECTIVES: To assess the size, quantity and composition of particulates produced during routine motorised odontoplasty and to model their deposition in the human respiratory tree. STUDY DESIGN: Analytic observational study. METHODS: Fifteen-minute routine motorised odontoplasties were performed on cadaver heads with monitoring equipment placed 30 cm away from the oral cavity to simulate the position of the operator's face. For quantitative analysis, an active air sampling photometric monitor was used to detect the concentration of fully respirable (<4.25 µm) particles produced. The use of water and non-water-cooled equipment and 2 different types of face mask (standard surgical and FFP3) were compared. An 8-stage Marple Personal Cascade Impactor modelled the deposition of the particulates in relation to the human respiratory tree. Qualitative analysis of these particulates was performed using scanning electron microscopy and energy dispersive x-ray spectroscopy. RESULTS: Motorised odontoplasty created aerosolised particulates that could reach all levels of the human respiratory tree. These particulates were composed mostly of calcium and phosphate, although traces of metals were found. The concentration of fully respirable particulates exceeded the recommended exposure limits set by the Health and Safety Executive. The use of an FFP-3 face mask significantly reduced the level of inhaled particulates. MAIN LIMITATIONS: This was a simulated experiment. It does not take into account the variety of environments in which routine treatment takes place. CONCLUSIONS: There are possible health risks in performing a large amount of routine motorised dentistry due to inhalation of aerosolised particulates. The use of an adequate face mask lowers exposure levels to within acceptable limits and, therefore, should be worn.

4.
Am J Orthod Dentofacial Orthop ; 158(5): e73-e82, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33008710

RESUMO

INTRODUCTION: White spot lesions are a common side effect of orthodontic treatment. This laboratory study aimed to explore the suitability of chlorhexidine hexametaphosphate (CHX-HMP) as a coating for orthodontic elastomeric ligatures to provide sustained chlorhexidine (CHX) release. METHODS: Dissolution kinetics of CHX-HMP were firstly explored using spectroscopy and a colorimetric phosphate assay. Elastomeric ligatures were categorized into 3 groups-acetone-conditioned, ethanol-conditioned, and as received-and were then immersed in 5 mM CHX-HMP suspension or 5 mM chlorhexidine digluconate solution and rinsed. CHX release was measured over 8 weeks, and the effects of conditioning and immersion on elastomeric force and extension at rupture and surface topography were investigated. RESULTS: CHX-HMP exhibited a gradual equilibration that had not reached equilibrium within 8 weeks, releasing soluble CHX and a mixture of polyphosphate and orthophosphate. CHX digluconate-treated ligatures showed no CHX release, whereas CHX-HMP-treated ligatures showed varying degrees of release. As received, CHX-HMP-treated ligatures showed a modest release of CHX up to 7 days. Acetone conditioning did not enhance CHX-HMP uptake or subsequent CHX release and caused a deterioration in mechanical properties. Ethanol conditioning enhanced CHX-HMP uptake (6×) and led to a sustained CHX release over 8 weeks without affecting mechanical properties. CONCLUSIONS: Within the inherent limitations of this in-vitro study, CHX-HMP led to a sustained release of CHX from orthodontic elastomeric ligatures after ethanol conditioning. Conditioned and coated elastomeric ligatures may ultimately find application in the prevention of white spot lesions in orthodontic patients.


Assuntos
Anti-Infecciosos , Clorexidina , Antibacterianos , Humanos , Fosfatos
5.
Cleft Palate Craniofac J ; : 1055665620959989, 2020 Sep 29.
Artigo em Inglês | MEDLINE | ID: mdl-32990032

RESUMO

OBJECTIVE: This study evaluated association between functional outcomes in children born with unilateral cleft lip and palate (UCLP) and educational attainment. DESIGN: Cleft Care UK (CCUK) was a United Kingdom (UK) wide cross-sectional study. SETTING: UK Cleft Teams (data collected from all UK sites providing centralized cleft services). PATIENTS, PARTICIPANTS: Five-year olds born with nonsyndromic UCLP (n = 268). MAIN OUTCOME MEASURE(S): National tests for educational attainment Key Stage 1 (KS1) undertaken by children at age 7 were linked to CCUK data to describe differences in educational attainment. Associations between functional outcomes and KS1 results were evaluated using regression analysis. We adjusted for birth month, gender, and an area-based measure of socioeconomic status. RESULTS: Data were available for 205 children with UCLP. These children scored lower than national average (NA) scores across all subject areas, with a 0.62 lower score observed in the Average Point Score (APS; P = .01). There was association between being in a lower category for a cleft related outcomes and poorer KS1 results, with a trend for poorer attainment with higher numbers of poor functional outcomes. Those with 3 or more poor outcomes had a -2.26 (-3.55 to -0.97) lower APS compared to those with 0 to 1 poor outcomes. CONCLUSIONS: Children born with UCLP have poorer educational attainment at age 7 across all subject areas though differences were modest. Children with poor functional outcomes at age 5 had worse educational outcomes age 7. Improvements in functional outcomes could enhance educational outcomes.

6.
Am J Orthod Dentofacial Orthop ; 158(2): 166-174, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32624347

RESUMO

Orthodontic treatment with sequential aligners has seen a considerable surge in the last decades, and is currently used to treat malocclusions of varying severity. To enhance tooth movement and broaden the spectrum of malocclusions that can be treated with aligners, composite resin attachments are routinely bonded with the acid-etch technique on multiple teeth, a process known to impose irreversible alterations of the enamel structure, color, gloss, and roughness. Additionally, this clinical setting introduces a unique scenario of different materials applied in a manner that involves the development of friction and attrition between the attachment and the softer aligner material, all performing in the harsh conditions of the oral environment, which impact the aging of these materials. The latter may give rise to alterations of the aligners and the composite attachments and potential intraoral release of Bisphenol A, a known endocrine disrupting agent. Furthermore, at the final stages of contemporary aligner treatment, the removal of multiple, sometimes bulky, composite attachments with a volume and surface far greater than the remnant adhesive after debonding of brackets, through grinding that might be associated with pulmonary effects for the patient or staff. Because of the extensive enamel involvement in bonding, the release of factors from the attachment-aligner complex during service, the aging of these entities in the oral environment, and the laborious debonding/composite grinding process coupled with the hazardous nature of aerosol produced during the removal of these bulky specimens, appropriate risk management considerations should be applied and an effort to confine the application of multiple composite specimens bonded to enamel to the absolutely necessary should be pursued.


Assuntos
Esmalte Dentário , Resinas Compostas , Colagem Dentária , Humanos , Teste de Materiais , Braquetes Ortodônticos , Cimentos de Resina , Propriedades de Superfície , Técnicas de Movimentação Dentária
7.
J Orthod ; 47(2): 129-139, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32338124

RESUMO

OBJECTIVE: To explore the experiences of mentoring higher-grade trainees amongst senior orthodontic trainers at Bristol Dental School. DESIGN: Qualitative study using interpretive methodology. SETTING: University of Bristol Dental School. PARTICIPANTS: Six consultant orthodontists, five of whom also have district general hospital experience. METHODS: One-to-one semi-structured interviews were undertaken on a purposeful sample of orthodontic trainers. The interviews were audio recorded, transcribed verbatim and Thematic Analysis was used to analyse the data. RESULTS: Four main themes emerged from the data were. They were: How to Mentor; Mentor-Mentee Pairings; Resources and Success; and Pitfalls of Mentoring. CONCLUSION: The present study revealed that senior trainers have a good understanding of the qualities of a mentor and appreciate the roles which mentors need to perform. They are altruistic in their motives, but would benefit from more time, organisational support and training to help them perform their duties better.


Assuntos
Tutoria , Humanos , Mentores , Pesquisa Qualitativa , Faculdades de Odontologia
8.
Cleft Palate Craniofac J ; 57(1): 21-28, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31331191

RESUMO

OBJECTIVE: To determine whether a relationship exists between the aesthetic scores given to photographic records of the nasolabial region of patients with repaired unilateral cleft lip and palate (UCLP) and the 5-Year Olds' Index scores of study models for the same participants. DESIGN: Retrospective study. SETTING: University of Bristol Dental Hospital, United Kingdom. PARTICIPANTS: Patients with nonsyndromic UCLP previously enrolled in the Cleft Care UK (CCUK) Study. METHODS: The CCUK participants, who had both study models and photographs (frontal and worm's eye view), were identified and their records retrieved. These were rated by 2 consultants and 2 senior registrars in orthodontics. The 5-Year Olds' Index was used to score the study models, and at a separate sitting, a 5-point Likert scale was used to score the cropped frontal and worm's eye view photographs of the same children. The results were analyzed using intraclass correlation coefficients and Cohen κ. MAIN OUTCOME MEASURES: Correlation between the aesthetic scores of the photographic views and the concordant 5-Year Olds' Index scores of the study models. RESULTS: The intraclass correlation coefficient scores showed very poor agreement between the photographic views and their concordant study models. The level of inter- and intra-rater reliability was strongest when scoring the study models. CONCLUSIONS: There was no agreement between the scores given to various photographic views and their corresponding study models. Scoring the study models using the 5-Year Olds' Index was the most reliable outcome measure for this age-group.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Estética Dentária , Humanos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Reino Unido
9.
Br Dent J ; 227(8): 741-746, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31654014

RESUMO

Orthodontics, like all areas of dentistry, offers the option to pursue a career in academia. In addition to providing clinical care for patients, academic orthodontists have a role in educating dental students and the wider dental community. There is also the option to engage with and undertake research, which may advance treatment and improve patient care. There is currently a shortage of academic orthodontists in the UK, with institutions reporting difficulties in the recruitment to academic posts. This problem is not only confined to orthodontics but widespread among dentistry. As a result, there is concern regarding the long-term future of dental academia. This paper considers why this might be the case and aims to raise awareness of the shortage in dental academic staff. It will discuss some of the main reasons put forward to explain this shortage and offer information and guidance to those interested in pursuing a career as an orthodontic academic.


Assuntos
Odontólogos , Ortodontia , Escolha da Profissão , Assistência Odontológica , Humanos , Ortodontistas , Estudantes de Odontologia
10.
J Orthod ; 46(4): 287-296, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31595815

RESUMO

OBJECTIVE: To carry out a UK national clinical audit of orthognathic acceptance criteria and information provided to orthognathic patients before treatment. DESIGN: National clinical audit. SETTING: Data collected using Bristol Online Surveys. PARTICIPANTS: Sixty-nine UK hospital orthodontic departments submitted data. METHODS: Data were collected at two time points using Bristol Online Surveys over a period of 12 months. These were before treatment at the first multidisciplinary clinic (MDT) and immediately after surgery. The data collected included: Index of Orthognathic Functional Treatment Need (IOFTN); Index of Orthodontic Treatment Need (IOTN); age; previous orthodontic treatment; attendance at an MDT; treatment times; and information provision. RESULTS: Eighty-five units agreed to take part in the audit with 69 submitting data, giving a response rate of 81%. The data from 3404 patients were uploaded, 2263 before treatment and 1141 immediately after surgery. Of patients, 91.07% had an IOFTN score of 4 or 5 and 88.73% had an IOTN score of 4 or 5. The mean age at the first MDT was 22 years in the first cohort and 21 years and 4 months in the second immediate post-surgery cohort. Of patients, 37.93% had undergone some form of previous orthodontic treatment, but only 0.28% had undergone previous orthognathic treatment; 96.93% had an MDT confirm that orthodontic treatment by itself was insufficient to adequately correct their functional symptoms. The average treatment time from bond up to surgery was 2 years and 6 months. With respect to information provision, patients received information from a number of sources, principally the British Orthodontic Society (BOS) patient information leaflets and the BOS website Your Jaw Surgery. CONCLUSIONS: In the UK, the majority of orthognathic cases fulfil the criteria for acceptance for NHS-funded orthognathic treatment, as outlined by the Chief Dental Officer's interim guidance on orthognathic treatment. This suggests any prior approval process would not be a good use of NHS resources in the commissioning of orthognathic treatment.


Assuntos
Procedimentos Cirúrgicos Ortognáticos , Sociedades Odontológicas , Adulto , Grupos Étnicos , Humanos , Índice de Necessidade de Tratamento Ortodôntico , Inquéritos e Questionários , Adulto Jovem
11.
Am J Orthod Dentofacial Orthop ; 155(6): 767-778, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31153497

RESUMO

INTRODUCTION: The aim of this laboratory and randomized clinical trial was to investigate particulate production at debonding and enamel clean-up following the use of flash-free ceramic brackets and to compare them with non-flash-free metal and ceramic brackets. METHODS: In the laboratory study, brackets were bonded to bovine teeth. After 24 hours of immersion in water, the brackets were debonded, the adhesive remnant scores noted, and the enamel cleaned with the use of rotary instruments. Four bracket-adhesive combinations and 2 different enamel pretreatment regimens were tested, including metal and ceramic brackets (conventional, adhesive precoat [APC], and APC flash-free) and conventional acid etch and self-etching primer. Quantitative (mg/m3) and qualitative analysis of particulate production was made in each case. In the clinical trial, 18 patients treated with the use of fixed appliances were recruited into this 3-arm parallel-design randomized controlled trial. They were randomly allocated to 1 of 3 groups: experimental flash-free ceramic bracket or non-flash-free ceramic or metal bracket group. Eligibility criteria included patients undergoing nonextraction maxillary and mandibular fixed appliance therapy. At completion of treatment, the brackets were debonded, and the primary outcome measure was particulate concentration (mg/m3). Randomization was by means of sealed envelopes. Data were analyzed with the use of quantile plots and linear mixed models. The effect of etch, bracket, and stage of debonding of clean-up on particle composition was analyzed with the use of mixed-effects regression. RESULTS: In the laboratory study, the APC brackets produced the highest particulate concentration. Although statistically significantly higher than the metal and conventional ceramic brackets, it was not significantly higher than the ceramic flash-free brackets. In the clinical study, there was no statistically significant effect of bracket type on particulate concentration (P = 0.29). This was despite 3 patients with APC flash-free and 1 patient with conventional Clarity (with 1 bracket) having 1 or more ceramic bracket fracture at debonding requiring removal. No adverse events reported. CONCLUSIONS: Particulates in the inhalable, thoracic, and respirable fractions were produced at enamel clean-up with all bracket types. Although APC and APC flash-free brackets produced the highest concentrations in the laboratory study, there was no difference between any of the brackets in the clinical trial. REGISTRATION: The trial was not registered. FUNDING: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Assuntos
Cerâmica/química , Cimentos Dentários/química , Descolagem Dentária/métodos , Aparelhos Ortodônticos Fixos , Braquetes Ortodônticos , Material Particulado/química , Animais , Bovinos , Humanos , Teste de Materiais , Microscopia Eletrônica de Varredura , Espectrometria por Raios X , Propriedades de Superfície
12.
Cleft Palate Craniofac J ; 56(2): 248-256, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29750571

RESUMO

OBJECTIVE: Can we reliably discriminate severity within the existing categories of the 5-Year-Olds' Index? DESIGN: Retrospective method comparison and development study. SETTING: School of Oral and Dental Science, University of Bristol. METHODS: Dental study models of 5-year-olds with unilateral cleft lip and palate (UCLP) were collected from the archives of 2 national cleft surveys (n = 351). One hundred randomly selected models were ranked to construct the modified 5-Year-Olds' Index and also scored using a visual analogue scale (VAS). Reliability testing was performed on 51 study models. Visual analogue scale scores were used to aid statistical analysis and investigate the reliability of a VAS for outcome measurement. The modified 5-Year-Olds' Index was then applied to 198 study models of 5-year-olds with UCLP. RESULTS: The modified 5-Year-Olds' Index showed excellent intra and interexaminer agreement (intraclass correlation > 0.94) and good discrimination of severity. When applied to the Cleft Care UK participants (n = 198), the modified 5-Year-Olds' Index showed good discrimination of severity within the better categories (groups 1-3) of the 5-Year-Olds' Index. Visual analogue Scale scores resulted in unacceptable variation between measurements. CONCLUSIONS: The new modified 5-Year-Olds' Index is a reliable method of assessing outcomes at 5 years of age and showed improved discriminatory power between the "better" outcome categories than the original 5-Year-Olds' Index. A VAS was found to be unsuitable for assessing outcome at 5 years of age for children with UCLP.


Assuntos
Fenda Labial , Fissura Palatina , Pré-Escolar , Arco Dental , Modelos Dentários , Humanos , Avaliação de Resultados em Cuidados de Saúde , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
13.
J Orthod ; 44(1): 3-7, 2017 03.
Artigo em Inglês | MEDLINE | ID: mdl-28248619

RESUMO

OBJECTIVES: Pain is a common side effect of orthodontic treatment. An objective of this study, part of a large previously reported RCT on pain and analgesic use, was to determine the effect of anxiety on perceived pain and use of analgesia. METHODS: 1000 patients aged 11-17 years, undergoing upper and lower fixed appliance treatment in nine hospital departments were recruited into this two-arm parallel design randomised controlled trial. One arm was given sugar-free chewing gum and the other arm ibuprofen for pain relief. Neither the clinicians nor patients were blinded to assignment. In addition to recording pain experience and analgesic use for 3 days following appliance placement and first archwire change, each patient recorded their level of anxiety immediately following the fitting of the appliance and the first archwire change. RESULTS: 419 chewing gum group (84%) and 407 ibuprofen group (83%) questionnaires were returned following appliance placement, and 343 chewing gum group (70%) and 341 ibuprofen group (71%) questionnaires were returned following the first archwire change. The mean anxiety scores following fitting of the appliance and first archwire change were 2.7 (SD 2.1) and 1.6 (SD 1.8), respectively. There were weak but significant positive associations between anxiety scores and pain scores. Multi-level modelling produced a coefficient for anxiety of 0.23 (95% CI 0.17-0.28) for appliance placement, suggesting a small rise (0.23) on the 11-point pain scale for a one-point increase on the corresponding anxiety scale. Following archwire change, the corresponding coefficient was 0.32 (0.24-0.39). For ibuprofen use, again simple analyses suggested a relationship with anxiety. Multi-level logistic modelling produced an odds ratio for ibuprofen use of 1.11 (95% CI 1.07-1.15) at appliance placement and 1.21 (1.10-1.33) at the first archwire change. There was a 10-20% increase in the odds of using ibuprofen for each one-point increase on the anxiety scale. No such relationship was found between anxiety and chewing gum use. There were no adverse effects or harms reported during the trial. Approvals were granted by the Research Ethics Committee (08/H0106/139), R&D and MHRA (Eudract 2008-005522-36) and the trial was registered on the ISRCTN (79884739) and NIHR (6631) portfolios. Support was provided by the British Orthodontic Society Foundation. CONCLUSIONS: There was a weak positive correlation between anxiety reported and pain experienced following both the initial fitting of the fixed appliances and at the subsequent archwire change. Patients that were more anxious tended to take more ibuprofen for their pain relief.


Assuntos
Goma de Mascar , Ibuprofeno , Adolescente , Ansiedade , Criança , Humanos , Dor , Sociedades Odontológicas
14.
Aust Orthod J ; Spec No: 65-72, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-29709123

RESUMO

A number of arguments surround orthodontics and orthodontic treatment and this article aims to discuss the current thinking and evidence base associated with these controversies.


Assuntos
Ortodontia Corretiva/métodos , Estética Dentária , Humanos , Aparelhos Ortodônticos , Sorriso
15.
Am J Orthod Dentofacial Orthop ; 150(5): 831-838, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27871710

RESUMO

INTRODUCTION: The aims of this study were to describe bacterial load and diversity of the aerosol created during enamel cleanup after the removal of fixed orthodontic appliances and to assess the effect of a preprocedural mouth rinse. METHODS: The study involved the sampling of ambient air adjacent to the patient's mouth during adhesive removal using a slow-speed handpiece and a spiral fluted tungsten carbide bur without water irrigation. Sampling was carried out during enamel cleanup with or without a preprocedural mouth rinse of either sterile water or chlorhexidine. Airborne particles were collected using a viable inertial impactor simulating the human respiratory tree. The bacteria collected were analyzed using both culture and molecular techniques. RESULTS: Bacteria produced during debond and enamel cleanup can reach all levels of the respiratory tree. The use of a preprocedural mouth rinse, either sterile water or chlorhexidine, increased the numbers and diversity of the bacteria in the air. CONCLUSIONS: When using a slow-speed handpiece and a spiral fluted tungsten carbide bur for enamel cleanup after orthodontic treatment, the bacterial load and diversity of the aerosol produced are lower when a preprocedural mouth rinse is not used.


Assuntos
Descolagem Dentária/efeitos adversos , Aparelhos Ortodônticos/microbiologia , Aerossóis , Bactérias/isolamento & purificação , Clorexidina/uso terapêutico , Descolagem Dentária/instrumentação , Descolagem Dentária/métodos , Esmalte Dentário/microbiologia , Eletroforese/métodos , Humanos , Antissépticos Bucais/uso terapêutico
16.
Am J Orthod Dentofacial Orthop ; 150(2): 220-7, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27476354

RESUMO

INTRODUCTION: The aim of this randomized trial was to investigate the effect of the use of a sugar-free chewing gum vs ibuprofen on reported pain in orthodontic patients. METHODS: This was a 2-arm parallel design randomized controlled trial in 9 sites in the southwest of England. Patients about to undergo orthodontic treatment with maxillary and mandibular fixed appliances were recruited and randomly allocated to an experimental chewing gum group or a control ibuprofen group. Eligibility criteria included patients undergoing fixed maxillary and mandibular appliance therapy, aged 11 to 17 years, and able to use ibuprofen and chewing gum. The primary outcome measure was pain experienced after appliance placement using a mean of 3 recordings on a scale of 0 to 10. Secondary outcome measures were pain experienced in the subsequent 3 days, pain after the first archwire change, ibuprofen use, and appliance breakages. Pain scores were recorded with a questionnaire and posted to a collection center by each patient. Randomization was by means of a central telephone service and comprised computer-generated random numbers used to generate a sequential allocation list, with permuted blocks of variable size (2 and 4) and stratified by center. Neither the clinicians nor the patients were blinded to the intervention. Patients in the control group were permitted to use ibuprofen only, and patients in the experimental group were allowed to use ibuprofen if they did not get sufficient analgesia from the chewing gum. Data were analyzed using the principle of intention to treat with multilevel modeling to reflect the structured nature of the data (scores within patient within site). RESULTS: One thousand patients were recruited and randomized in a ratio of 1:1 to the chewing gum and ibuprofen (control) groups. The male-to-female ratios were similar in the groups. The pain questionnaire response rates were good at approximately 84% and 83% after appliance placement (chewing gum group, 419; ibuprofen group, 407) and 70% and 71% after the first archwire change (chewing gum group, 343; ibuprofen group, 341). The primary outcomes were similar for the 2 groups: mean pain scores, 4.31 in the chewing gum group and 4.17 in the ibuprofen group; difference, 0.14 (95% CI, -0.13 to 0.41). There was a suggestion that the relative pain scores for the 2 groups changed over time, with the chewing gum group experiencing slightly more pain on the day of bond-up and less on the subsequent 3 days; however, the differences had no clinical importance. There were no significant differences for the period after archwire change. The reported use of ibuprofen was less in the chewing gum group than in the ibuprofen group; after appliance placement, the mean numbers of occasions that ibuprofen was used were 2.1 in the chewing gum group and 3.0 in the ibuprofen group (adjusted difference, -0.96 [95% CI, -0.75 to -1.17; P <0.001]); after archwire change, the figures were 0.8 and 1.5 occasions (difference, -0.65 [-0.44 to -0.86; P <0.001]). After appliance placement and the first archwire change, there was no clinically or statistically significant difference in appliance breakages between the chewing gum and ibuprofen groups after either bond-up (7% and 8.8%, respectively) or the first archwire change (4.2% and 5.5%, respectively). No adverse events were reported. CONCLUSIONS: The use of a sugar-free chewing gum may reduce the level of ibuprofen usage but has no clinically or statistically significant effect on bond failures. REGISTRATION: International Standard Randomised Controlled Trial Number (79884739) and National Institute of Health Research (6631) portfolios. FUNDING: This research was supported by an award by the British Orthodontic Society Foundation.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Goma de Mascar , Ibuprofeno/uso terapêutico , Braquetes Ortodônticos/efeitos adversos , Fios Ortodônticos/efeitos adversos , Manejo da Dor/métodos , Técnicas de Movimentação Dentária/instrumentação , Adolescente , Criança , Inglaterra , Falha de Equipamento , Feminino , Humanos , Masculino , Mastigação/fisiologia , Medição da Dor , Resultado do Tratamento
17.
Eur J Orthod ; 38(1): 66-70, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25788331

RESUMO

OBJECTIVES: To assess whether a true knowledge of crowding alters treatment decisions compared with estimates of crowding. MATERIALS AND METHODS: Thirty-six orthodontists were asked to estimate crowding using visualization on eight mandibular arch study models and to indicate possible extraction choices. For each model, the intermolar widths, intercanine widths, and clinical scenarios were identical, but the true crowding varied from 0.2 to 8.4mm as to a lesser extent did the curve of Spee. Eleven orthodontists repeated the visualization exercise after 2 weeks to assess reliability. All 36 of the orthodontists were asked to repeat the treatment planning exercise on the same models, but this time was provided with the true amount of crowding in each case. RESULTS: When the 36 orthodontists used direct visualization of the models to assess crowding, the range of their estimates of crowding increased as the crowding increased. As might be expected, they also tended to move towards extraction treatments as the crowding increased (P = 0.013, odds ratio = 3). Although the reliability of the repeat estimates of crowding were moderate, the mean estimates were greater than the true crowding for each model. When orthodontists were presented with the true amount of crowding, rather than their estimate of crowding, it had a significant effect on the decision to extract, with fewer orthodontists recommending extractions. LIMITATIONS: The principal limitation of this study is that it was a laboratory-based study and utilized just the mandibular arch model for estimation and treatment planning. CONCLUSIONS: Direct visualization may overestimate the amount of crowding present. When the true amount of crowding is known, it can lead to more consistent treatment planning, with the decision to extract fewer teeth in the borderline cases. A formal space analysis is likely to assist with treatment planning.


Assuntos
Competência Clínica , Tomada de Decisão Clínica/métodos , Má Oclusão/diagnóstico , Ortodontia Corretiva/normas , Arco Dental/patologia , Assistência Odontológica , Modelos Dentários , Inglaterra , Humanos , Má Oclusão/patologia , Má Oclusão/terapia , Ortodontia Corretiva/métodos , Planejamento de Assistência ao Paciente , Reprodutibilidade dos Testes , Extração Dentária
19.
Appl Environ Microbiol ; 80(20): 6480-9, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25107981

RESUMO

The diversity of bacterial species in the human oral cavity is well recognized, but a high proportion of them are presently uncultivable. Candidate division TM7 bacteria are almost always detected in metagenomic studies but have not yet been cultivated. In this paper, we identified candidate division TM7 bacterial phylotypes in mature plaque samples from around orthodontic bonds in subjects undergoing orthodontic treatment. Successive rounds of enrichment in laboratory media led to the isolation of a pure culture of one of these candidate division TM7 phylotypes. The bacteria formed filaments of 20 to 200 µm in length within agar plate colonies and in monospecies biofilms on salivary pellicle and exhibited some unusual morphological characteristics by transmission electron microscopy, including a trilaminated cell surface layer and dense cytoplasmic deposits. Proteomic analyses of cell wall protein extracts identified abundant polypeptides predicted from the TM7 partial genomic sequence. Pleiomorphic phenotypes were observed when the candidate division TM7 bacterium was grown in dual-species biofilms with representatives of six different oral bacterial genera. The TM7 bacterium formed long filaments in dual-species biofilm communities with Actinomyces oris or Fusobacterium nucleatum. However, the TM7 isolate grew as short rods or cocci in dual-species biofilms with Porphyromonas gingivalis, Prevotella intermedia, Parvimonas micra, or Streptococcus gordonii, forming notably robust biofilms with the latter two species. The ability to cultivate TM7 axenically should majorly advance understanding of the physiology, genetics, and virulence properties of this novel candidate division oral bacterium.


Assuntos
Cultura Axênica , Bactérias/citologia , Bactérias/genética , Boca/microbiologia , Actinomyces/crescimento & desenvolvimento , Actinomyces/fisiologia , Adolescente , Bactérias/classificação , Bactérias/isolamento & purificação , Biofilmes/crescimento & desenvolvimento , Criança , Eletroforese em Gel de Gradiente Desnaturante , Fusobacterium nucleatum/crescimento & desenvolvimento , Fusobacterium nucleatum/fisiologia , Humanos , Dados de Sequência Molecular , Aparelhos Ortodônticos/microbiologia , Filogenia , Porphyromonas gingivalis/crescimento & desenvolvimento , Porphyromonas gingivalis/fisiologia , Proteômica/métodos , RNA Ribossômico 16S , Streptococcus gordonii/crescimento & desenvolvimento , Streptococcus gordonii/fisiologia
20.
J Orthod ; 41(2): 77-83, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24951095

RESUMO

OBJECTIVE: To design a new index categorizing the functional need for orthognathic treatment. DESIGN: Laboratory-based study. SETTING: Records were obtained from two UK hospital-based orthodontic departments. PARTICIPANTS: A panel of four consultant orthodontists, experienced in providing orthognathic care, devised a new index of Orthognathic Functional Treatment Need (IOFTN) with the aid of the membership of the British Orthodontic Society Consultant Orthodontists Group (COG). Twenty-three consultants and post-CCST level specialists took part in the study as raters to test the validity and reliability of the new index. METHODS: A total of 163 start study models of patients who had previously undergone orthognathic treatment were assessed by the panel of four consultant orthodontists using the new index (IOFTN) and the agreed category was set as the 'gold standard'. Twenty-one consultants and post-CCST level specialists then scored the models on one occasion and two scored 50 sets of models twice to determine the test-re-test reliability. RESULTS: Kappa scores for inter-rater agreement with the expert panel for the major categories (1-5) demonstrated good to very good agreement (kappa: 0·64-0·89) for all raters. The percentage agreement ranged from 68·1 to 92% in all cases. Intra-rater agreement for the major categories was moderate to good (kappa: 0·53-0·80). CONCLUSIONS: A new index, the IOFTN, has been developed to help in the prioritization of severe malocclusions not amenable to orthodontic treatment alone. It demonstrates good content validity and good inter-rater and moderate to good intra-rater reliability. As a result of being an evolution of the IOTN, the familiar format should make it easy to determine functional treatment need within daily orthognathic practice.


Assuntos
Índice de Necessidade de Tratamento Ortodôntico , Determinação de Necessidades de Cuidados de Saúde , Procedimentos Cirúrgicos Ortognáticos , Fenda Labial/classificação , Fissura Palatina/classificação , Modelos Dentários , Assimetria Facial/classificação , Humanos , Má Oclusão/classificação , Variações Dependentes do Observador , Mordida Aberta/classificação , Ortodontia , Sobremordida/classificação , Planejamento de Assistência ao Paciente , Reprodutibilidade dos Testes , Reino Unido
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