How families prepare their children for tooth extraction under general anaesthesia: Family and clinical predictors of non-compliance with a 'serious game'.

OBJECTIVE: To explore family and clinical factors for usage of an online serious game designed to prepare children with ECC for dental treatment under general anaesthesia. DESIGN: Observational study. Secondary data of 60 children, aged 5-to-7, randomised to the intervention group in a phase-III randomised controlled trial [NIHR Portfolio 10006, ISRCTN: 18265148] testing the efficacy of the serious game http://www.scottga.org (available online). Usage was captured automatically, with each click, in real time. The total number of replays and total number of missing slides per game-run performed by the child, were recorded and used to monitor usage. Compliance outcomes were: total time running the game and number of completely missed slides. RESULTS: 57/60 played the game. Median age of parent/carer was 32. For 74% of the families, fathers resided at home and for 65% the parent/carer had A-levels-to-university education. At recruitment, 70% of the children were reported as anxious/highly-fearful and 37% as "significantly psychologically disturbed". CONCLUSIONS: Factors for non-compliance were absence of a father at home (P = 0.01) and higher child-anxiety (P = 0.01) and, to a lesser extent, a low parent/carer education level (P = 0.09). Interactive cartoons featuring dental assessment, oral health messages and modelling featured in the more popular slides.

Assessing the influence of mandibular prominence on perceived attractiveness in the orthognathic patient, clinician, and layperson.

The purpose of this investigation was to undertake an objective and quantitative evaluation of how mandibular prominence influences perceived attractiveness. The mandibular prominence of an idealized profile image was altered in 2 mm increments from -16 to 12 mm, in order to represent retrusion and protrusion of the mandible, respectively. These images were rated on a 7-point Likert scale by a preselected group of pre-treatment orthognathic patients, clinicians, and laypeople. A duplicate image was used to assess intra-examiner reliability. From the results of this study, it is recommended that in treatment planning to alter the sagittal prominence of the mandible in an individual with an otherwise normal soft tissue facial profile, an 'ideal' sagittal position with soft tissue pogonion on or just behind a true vertical line through subnasale may be used. However, mandibular retrusion up to -4 mm or protrusion up to 2 mm was essentially unnoticeable. Surgery was desired from mandibular protrusions of greater than 3 mm (orthognathic patients and laypeople) and 5 mm (clinicians) and retrusions greater than -8 mm. The overall direction of aesthetic opinion appeared to be the same for all the observer groups; the greater the retrusion or prominence of the lower jaw, the less attractive the perceived attractiveness and the greater the desire for surgical correction. Orthognathic patients were found to be more critical than laypeople, suggesting that in future studies, greater emphasis might be put on evaluating the perceptions of patients as opposed to only a lay population.