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1.
Cleft Palate Craniofac J ; 57(1): 5-13, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31248277

RESUMO

OBJECTIVES: To (1) determine the prevalence of nonperialveolar palatal fistula up to age 5 following repair of unilateral cleft lip and palate (UCLP) in the United Kingdom, (2) examine the association of palatoplasty techniques with fistula occurrence, and (3) describe the frequency of fistula repairs and their success. DESIGN: Cross-sectional study. SETTING: All 11 centralized regional cleft centers in the United Kingdom. PARTICIPANTS: Two hundred sixty-eight children born between 2005 and 2007 recruited by Cleft Care UK, a nationwide cross-sectional study of all 5-year-old children born with nonsyndromic UCLP. MAIN OUTCOME MEASURE: Nonperialveolar palatal fistula prevalence up to age 5. RESULTS: Fistulas were found in 72 children (31.3%, 95% confidence interval: 25.4%-37.7%) and had no significant association with palate repair sequences. Twenty-four fistulas were repaired by age 5, 12 of which had data showing 10 (83.3%) successful repairs. CONCLUSION: The prevalence of nonperialveolar fistulas following primary palatoplasty of UCLP in the United Kingdom was higher than previously reported. This information should be part of the preoperative discussion with families. Prospective collection of the presence of fistulas will be necessary before we can associate the occurrence of fistulas with a surgeon, institution, surgical technique, or protocol of care.

2.
Cleft Palate Craniofac J ; 57(1): 21-28, 2020 Jan.
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.

3.
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
4.
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
5.
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
6.
J Orthod ; 46(1_suppl): 77-80, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31056037

RESUMO

This short review is an opportunity to focus on significant positive changes for those children born with some form of oro-facial clefting and who are treated in a centralised service within the National Health Service (NHS). There has also been an opportunity to provide a focus for research as part of this service model. Orthodontists have played a key role in all aspects of this and will continue to be central to further improvements in caring for cleft children.


Assuntos
Fenda Labial , Fissura Palatina , Criança , Humanos , Medicina Estatal , Reino Unido
7.
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 , Reprodutibilidade dos Testes , Estudos Retrospectivos , Resultado do Tratamento
8.
Cleft Palate Craniofac J ; 55(2): 248-251, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29351033

RESUMO

OBJECTIVE: We highlight a major study that investigated the impact of reconfigured cleft care in the United Kingdom some 15 years after centralization. We argue that centralization as an intervention has a major impact on outcomes. SETTING: Audit clinics held in Cleft Centers in the United Kingdom. PATIENTS, PARTICIPANTS: Five-year-olds born between April 1, 2005, and March 31, 2007, with nonsyndromic unilateral cleft lip and palate. INTERVENTIONS: Centralization of cleft care. MAIN OUTCOME MEASURE(S): We collected routine clinical measures (speech recordings, hearing, photographs, models, oral health, psychosocial factors) in a very similar way to a previous survey. RESULTS: We identified 359 eligible children and recruited 268 (74.7%) to the study. Overall, their outcomes were better post-centralization. There have been marked improvements in dentoalveolar arch relationships and in speech whereas the prevalence of dental caries and hearing loss are unchanged. CONCLUSIONS: Centralized cleft care has changed UK outcomes considerably and there is no argument for returning to a dispersed model of treatment.


Assuntos
Fenda Labial/cirurgia , Fissura Palatina/cirurgia , Assistência à Saúde/normas , Pré-Escolar , Feminino , Humanos , Masculino , Medicina Estatal , Inquéritos e Questionários , Reino Unido
9.
Cleft Palate Craniofac J ; 55(5): 676-681, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29360408

RESUMO

BACKGROUND: Since the implementation of centralized services in the United Kingdom for those affected by cleft lip and/or palate (CL/P), several studies have investigated the impact of service rationalization on the delivery of care. While large-scale quantitative studies have demonstrated improvements in a range of patient outcomes, and smaller studies have reported on the benefits and challenges of centralization from the views of health professionals, little research has attempted to capture the patient perspective. Furthermore, few studies have investigated the views of adult "returners" who have undergone treatment both pre- and postcentralization. METHODS: Qualitative data relevant to the subject of this article were extracted from 2 previous larger studies carried out between January 2013 and March 2014. A total of 16 adults born with CL/P contributed data to the current study. These data were subjected to inductive thematic analysis. RESULTS: The findings suggest that centralization of CL/P services has considerably enhanced the patient experience. Specifically, the overall standard and coordination of care has improved, service delivery has become more patient centered, and access to professional psychological support and peer support has greatly improved patients' capacity to cope with the associated emotional challenges. CONCLUSIONS: The data collected provide additional insight into the impact of centralization from the perspective of a largely unexplored patient population. In combination with other literature, these findings are also relevant to future efforts to centralize other specialist services around the world.


Assuntos
Fenda Labial/psicologia , Fissura Palatina/psicologia , Prestação Integrada de Cuidados de Saúde/normas , Adulto , Tomada de Decisões , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Sistemas de Apoio Psicossocial , Pesquisa Qualitativa , Medicina Estatal , Reino Unido
10.
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
11.
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
12.
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
13.
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
14.
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
15.
Cleft Palate Craniofac J ; 52(1): e1-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25058121

RESUMO

BACKGROUND: Cleft care provision in the United Kingdom has been centralized over the past 15 years to improve outcomes for children born with cleft lip and palate. However, to date, there have been no investigations to examine how well these multidisciplinary teams are performing. METHODS: In this pilot study, a cross-sectional questionnaire surveyed members of all health care specialties working to provide cleft care in 11 services across the United Kingdom. Team members were asked to complete the Team Work Assessment (TWA) to investigate perceptions of team working in cleft services. The TWA comprises 55 items measuring seven constructs: team foundation, function, performance and skills, team climate and atmosphere, team leadership, and team identity; individual constructs were also aggregated to provide an overall TWA score. Items were measured using five-point Likert-type scales and were converted into percentage agreement for analysis. RESULTS: Responses were received from members of every cleft team. Ninety-nine of 138 cleft team questionnaires (71.7%) were returned and analyzed. The median (interquartile range) percentage of maximum possible score across teams was 75.5% (70.8, 88.2) for the sum of all items. Team performance and team identity were viewed most positively, with 82.0% (75.0, 88.2) and 88.4% (82.2, 91.4), respectively. Team foundation and leadership were viewed least positively with 79.0% (72.6, 84.6) and 76.6% (70.6, 85.4), respectively. CONCLUSIONS: Cleft team members perceive that their teams work well, but there are variations in response according to construct.


Assuntos
Atitude do Pessoal de Saúde , Fenda Labial/terapia , Fissura Palatina/terapia , Equipe de Assistência ao Paciente/organização & administração , Criança , Estudos Transversais , Humanos , Liderança , Projetos Piloto , Qualidade da Assistência à Saúde , Inquéritos e Questionários , Reino Unido
17.
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
18.
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
19.
Am J Orthod Dentofacial Orthop ; 145(5): 569-78, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24785921

RESUMO

INTRODUCTION: The aim of this study was to compare the time to initial alignment and extraction space closure using conventional brackets and active and passive self-ligating brackets. METHODS: One hundred adolescent patients 11 to 18 years of age undergoing maxillary and mandibular fixed appliance therapy after the extraction of 4 premolars were randomized with stratification of 2 age ranges (11-14 and 15-18 years) and 3 maxillomandibular plane angles (high, medium, and low) with an allocation ratio of 1:2:2. Restrictions were applied using a block size of 10. Allocation was to 1 of 3 treatment groups: conventional brackets, active self-ligating, or passive self-ligating brackets. All subjects were treated with the same archwire sequence and space-closing mechanics in a district general hospital setting. The trial was a 3-arm parallel design. Labial-segment alignment and space closure were measured on study models taken every 12 weeks throughout treatment. All measurements were made by 1 operator who was blinded to bracket type. The patients and other operators were not blinded to bracket type during treatment. RESULTS: Ninety-eight patients were followed to completion of treatment (conventional, n = 20; active self-ligating brackets, n = 37; passive self-ligating brackets, n = 41). The data were analyzed using linear mixed models and demonstrated a significant effect of bracket type on the time to initial alignment (P = 0.001), which was shorter with the conventional brackets than either of the self-ligating brackets. Sidak's adjustment showed no significant difference in effect size (the difference in average response in millimeters) between the active and passive self-ligating brackets (the results are presented as effect size, 95% confidence intervals, probabilities, and intraclass correlation coefficients) (-0.42 [-1.32, 0.48], 0.600, 0.15), but the conventional bracket was significantly different from both of these (-1.98 [-3.19, -0.76], 0.001, 0.15; and -1.56 [-2.79, -0.32], 0.001, 0.15). There was no statistically significant difference between any of the 3 bracket types with respect to space closure. Space-closure times were shorter in the mandible, except for the Damon 3MX bracket (Ormco, Orange, Calif), where active and total space-closure times were shorter in the maxilla. No adverse events were recorded in the trial. CONCLUSIONS: Time to initial alignment was significantly shorter for the conventional bracket than for either the active or passive self-ligating brackets. There was no statistically significant difference in passive, active, or total space-closure times among the 3 brackets under investigation.


Assuntos
Desenho de Aparelho Ortodôntico , Braquetes Ortodônticos , Fechamento de Espaço Ortodôntico/instrumentação , Técnicas de Movimentação Dentária/instrumentação , Adolescente , Dente Pré-Molar/cirurgia , Cefalometria/métodos , Criança , Cobre/química , Ligas Dentárias/química , Elastômeros , Feminino , Seguimentos , Humanos , Masculino , Mandíbula/patologia , Maxila/patologia , Níquel/química , Fios Ortodônticos , Aço Inoxidável/química , Fatores de Tempo , Titânio/química , Extração Dentária
20.
J Dent Educ ; 78(4): 589-96, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24706689

RESUMO

Multiple Mini Interviews (MMI) are an increasingly popular tool for selecting entrants to undergraduate degree programs in dentistry in the United Kingdom. This article reports on the use of MMI to select dental students at the University of Bristol, United Kingdom, over two successive admissions cycles (2011-12 and 2012-13). MMI provided an efficient means to discriminate between the performance of applicants who were all academically highly qualified, with total scores ranging from 35 percent to 87 percent of the maximum possible score. Female candidates performed significantly better than male candidates when assessed by total score (p=0.011; mean score 94.4 for female applicants and 91.9 for male applicants) and by outcome (offer/decline; p=0.016; 58.6 percent of female and 46.4 percent of male interviewees received an offer of study following interview). There was no statistically significant effect of starting station on candidate performance (p=0.359), indicating that a candidate's overall chance of success in the MMI was not influenced by which station he or she experienced first. Stakeholder acceptance was good, with 75 percent of candidates and 95 percent of assessors preferring MMI over traditional interviews.


Assuntos
Entrevistas como Assunto , Seleção de Pessoal , Critérios de Admissão Escolar , Estudantes de Odontologia , Atitude do Pessoal de Saúde , Escolha da Profissão , Estudos de Coortes , Comunicação , Participação da Comunidade , Compreensão , Comportamento Cooperativo , Pesquisa em Odontologia , Avaliação Educacional , Inglaterra , Ética Odontológica , Docentes de Odontologia , Retroalimentação , Feminino , Humanos , Masculino , Destreza Motora/fisiologia , Competência Profissional , Fatores Sexuais
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