Bimaxillary protrusion: Prevalence and associated factors in the Trinidad and Tobago population

Introduction: Bimaxillary protrusion is a malocclusion characterized by proclined upper and lower incisors and prognathic jaws which has been identified in different ethnic groups and populations. Trinidad and Tobago have a mixed ethnicity population suitable to assess the prevalence of bimaxillary protrusion and associated factors in different ethnicities. Method: An epidemiological survey of 972 children, 566 females (58.2%) and 406 males (41.8%) was conducted. The sample population was 11 - 12 year old (mean age 11.84 years) in high schools across the country. None of the subjects were undergoing or had previous orthodontic treatment. Occlusal and anterior posterior relationships were assessed based on BSI 1983 definitions. The two conditions that made up bimaxillary protrusion, bimaxillary prognathism and bimaxillary proclamation, were assessed using extraoral and intraoral parameters respectively. Results: Bimaxillary prognathism and proclination were found with 64.4% and 68.8% prevalence respectively. Both conditions were found across all ethnic groups but with significantly different prevalence rates. There was an association between oral habits and ethnicity. Class 1 incisor relationship, class 1 canines and average overbite were the most common occlusal relationships found. Conclusion: Bimaxillary protrusion is prevalent in the population of Trinidad and Tobago. Prevalence of bimaxillary protrusion is related to ethnicity. There is an association between ethnicity and oral habits.

What influences the implementation of interceptive orthodontics in primary care?

OBJECTIVE: To understand what influences the implementation of mixed dentition interceptive orthodontic treatment in primary care. METHODS: Postal survey of a random sample of 400 general dental practitioners in Scotland. The questionnaire assessed knowledge, beliefs and attitudes towards providing interceptive treatment in seven different clinical scenarios in order to identify variables that may explain the decision to undertake this treatment. RESULTS: One hundred and one (25%) completed questionnaires were received. Confidence to carry out the treatment plan (16%), knowledge (11%), and age (7%) all significantly predicted intention to provide interceptive treatment. CONCLUSIONS: The greatest barrier to providing interceptive orthodontic care in general dental practice is practitioners' lack of self-confidence relating to the effectiveness of their chosen treatment plan.

Reducing white spot lesion incidence during fixed appliance therapy.

UNLABELLED: Fixed orthodontic appliances are commonly used in contemporary orthodontic treatment and can be associated with the development of white spot lesions on the teeth. These lesions can be detrimental to both the aesthetics and health of the teeth so prevention is better than cure and patient selection is critical. This paper discusses predictors of development in addition to methods to help prevent white spot lesions during fixed appliance therapy. Recommendations for oral hygiene regimes during fixed orthodontic appliance treatment are given, the development of white spot lesions (WSLs) described and ways to predict their occurrence identified. CLINICAL RELEVANCE: Most general dental practitioners will have patients who are considering orthodontic treatment or are wearing fixed orthodontic appliances and so are at increased risk of developing WSLs. It is therefore important they are aware of predictors and ways to prevent WSLs.

Problem-based learning in postgraduate dental education: a qualitative evaluation of students' experience of an orthodontic problem-based postgraduate programme.

INTRODUCTION: Problem based learning (PBL) has gained wide acceptance in undergraduate education, but less so in postgraduate education. Qualitative research methodologies can help us gain insight and understanding of the students' experience in undertaking such programmes. AIM: To evaluate the experiences of postgraduate students undertaking a PBL based postgraduate programme. METHODS: Focus groups and semi-structured interviews were used to investigate students' experiences. The qualitative data were coded, the codes were grouped into categories and a coding framework developed. From this a construct is proposed to give insight into students' experiences. The validity of this construct was examined by reviewing the literature. RESULTS: Students entered the programme with high expectations, but soon found they had challenges to overcome. They came to realise that they were on a journey, rather than undertaking a sequence of separate individual learning events. PBL led to significant tensions both within the individuals and the group, caused by the conflict between appreciating PBL as a 'good thing' and yet finding that ;it just doesn't seem to work'. The fear of failure in a high stakes setting only exacerbated these tensions. The literature review revealed an inconsistent approach to the use of PBL and its evaluation in a postgraduate/continuing medical education setting. However it did provide evidence of similar findings in qualitative studies, supporting the construct developed. CONCLUSION: We have proposed a construct to help in understanding the PBL experience for students undergoing a 'high stakes' orthodontic postgraduate programme with a core of PBL.

Proposed requirements for a European Doctorate in Dentistry: a discussion document prepared by a special interest group under the auspices of the Association for Dental Education in Europe.

In the Bologna process a third cycle is distinguished at the doctoral level. In documents on the Bologna process it is advocated to harmonise the structure and requirements of the doctorate, which in Europe are characterised by a wide variety. Differences exist in all possible requirements between countries, and even between schools within one country differences can be seen. In this paper an inventory is made of these differences in the dental doctorate between European countries. Moreover, the need for necessary harmonisation of requirements for a European dental doctorate is strongly advocated and a proposal is presented.

Curriculum structure: principles and strategy.

This report provides general guidelines for the structure of a curriculum, followed by specific advice on the principles of learning and teaching, the process of restructuring and change leadership and management. It provides examples of several educational philosophies, including vertical and horizontal integration. It discusses the use of competence, learning outcomes, level of degree and assessment and provides a number of recommendations. It does not seek to be prescriptive of time allocation to disciplines within a curriculum. Although this report has been written primarily for those who will develop an undergraduate curriculum, the information may be sufficiently generic to apply to the recent development in graduate entry ('shortened dental' or 'accelerated') courses and to postgraduate degree planning and higher education certificate or diploma courses for other dental care professionals (auxiliaries). The report may have a European bias as progress is made to converge and enhance educational standards in 29 countries with different educational approaches - a microcosm of global collaboration.

Retention procedures for stabilising tooth position after treatment with orthodontic braces.

BACKGROUND: Retention is the phase of orthodontic treatment that attempts to keep teeth in the corrected positions after treatment with orthodontic (dental) braces. Without a phase of retention there is a tendency for the teeth to return to their initial position (relapse). To prevent relapse almost every patient who has orthodontic treatment will require some type of retention. OBJECTIVES: To evaluate the effectiveness of different retention strategies used to stabilise tooth position after orthodontic braces. SEARCH STRATEGY: The Cochrane Oral Health Group's (OHG) Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Handsearching of orthodontic journals was undertaken in keeping with the Cochrane OHG search programme. No language restrictions were applied. Authors of randomised controlled trials (RCTs) were identified and contacted to identify unpublished trials. Most recent search: May 2005. SELECTION CRITERIA: RCTs on children and adults, who have had retainers fitted or adjunctive procedures undertaken, following orthodontic treatment with braces to prevent relapse. The outcomes were: how well the teeth were stabilised, survival of retainers, adverse effects on oral health and quality of life. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two review authors. As no two studies compared the same retention strategies (interventions) it was not possible to combine the results of any studies. MAIN RESULTS: Five trials satisfied the inclusion criteria. These trials all compared different interventions: circumferential supracrestal fiberotomy (CSF) combined with full-time removable retainer versus a full-time removable retainer alone; CSF combined with a nights-only removable retainer versus a nights-only removable retainer alone; removable Hawley retainer versus a clear overlay retainer; multistrand wire retainer versus a ribbon-reinforced resin bonded retainer; and three types of fixed retainers versus a removable retainer. There was weak unreliable evidence, based on data from one trial, that there was a statistically significant increase in stability in both the mandibular (lower) (P < 0.001) and maxillary (upper) anterior segments (P < 0.001) when the CSF was used, compared with when it was not used. There was also weak, unreliable evidence that teeth settle quicker with a Hawley retainer than with a clear overlay retainer after 3 months. The quality of the trial reports was generally poor. AUTHORS' CONCLUSIONS: There are insufficient research data on which to base our clinical practice on retention at present. There is an urgent need for high quality randomised controlled trials in this crucial area of orthodontic practice.

The effectiveness of undergraduate teaching of the identification of radiographic film faults.

OBJECTIVES: To see if there were any differences in the ability of final year dental students at two UK dental schools, who were within 4 months of graduation, to identify radiographic film faults. METHODS: The two groups of undergraduates were shown 11 dental radiographs using a slide format. The 11 radiographs included 8 films with film faults, 2 films without technical or processing errors and a film with minimal faults. Each student was asked to assess each film for the presence/absence of film fault(s), to detail how to correct the fault (if appropriate) and to give a subjective quality rating of each film. RESULTS: The range of marks obtained by both groups of students was low. All students found the identification of panoramic film faults more challenging than faults associated with intraoral films. 15% of students from University B scored more than half the possible marks compared with 2% from University A. CONCLUSIONS: Both groups of students had the necessary knowledge of how to correct faults once identified. However, the marked difference in competency in identifying faults between the two groups of students has implications for the future teaching and development of the radiology curriculum.

Retention procedures for stabilising tooth position after treatment with orthodontic braces.

BACKGROUND: Retention is the phase of orthodontic treatment that attempts to keep teeth in the corrected positions after orthodontic (dental) braces. Without a phase of retention there is a tendency for the teeth to return to their initial position (relapse). To prevent relapse almost every patient who has orthodontic treatment will require some type of retention. OBJECTIVES: To evaluate the effectiveness of different retention strategies used to stabilise tooth position after orthodontic braces. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, CENTRAL, MEDLINE and EMBASE were searched. Several journals were handsearched. No language restrictions were applied. Authors of randomised controlled trials (RCTs) were identified and contacted to identify unpublished trials. Most recent search: December 2002. SELECTION CRITERIA: RCTs on children and adults, who have had retainers fitted or adjunctive procedures undertaken, following orthodontic treatment with braces to prevent relapse. The outcomes are: how well the teeth are stabilised, survival of retainers, adverse effects on oral health and quality of life. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were conducted in duplicate and independently by two reviewers. As no two studies compared the same retention strategies (interventions) it was not possible to combine the results of any studies. MAIN RESULTS: Four trials satisfied the inclusion criteria. These trials all compared different interventions: circumferential supracrestal fiberotomy (CSF) combined with full-time removable retainer versus a full-time removable retainer alone; circumferential supracrestal fiberotomy (CSF) combined with a nights-only removable retainer versus a nights-only removable retainer alone; removable Hawley retainer versus a clear overlay retainer; and three types of fixed retainers versus a removable retainer. There was weak unreliable evidence, based on data from one trial, that there was a statistically significant increase in stability in both the mandibular (p < 0.001) and maxillary anterior segments (p < 0.001) when the CSF was used, compared with when it was not used. There was also weak, unreliable evidence that teeth settle quicker with a Hawley retainer than with a clear overlay retainer after 3 months. The quality of the trial reports was generally poor. REVIEWER'S CONCLUSIONS: There are insufficient research data on which to base our clinical practice on retention at present. There is an urgent need for high quality randomised controlled trials in this crucial area of orthodontic practice.

Teaching and learning: an update for the orthodontist.

Developments in teaching and learning have implications for every orthodontist. This paper describes some of the theories of teaching and learning that have led to a quiet revolution in higher education. Developments have included the incorporation of self-directed and problem-based learning concepts, together with a more active and interactive role for the learner. The importance of these changes for orthodontic education is discussed.

Digital records in orthodontics.

In this electronic age there is a general move towards keeping digital records, and many trades and professions now use digital images exclusively. In this article, the advantages (and occasional disadvantages) of the use of digital photography, digital radiography and the latest development--digital study models--in orthodontics are discussed.

Computer-aided Learning (CAL): an effective way to teach the Index of Orthodontic Treatment Need (IOTN)?

OBJECTIVE: To identify if a lecture or access to a computer aided learning (CAL) programme is more effective in teaching undergraduate dental students IOTN. DESIGN: Prospective controlled trial. SETTING: University Dental Hospital of Manchester, 1999 SUBJECTS: Eighty-five 3rd year undergraduate dental students allocated by pseudo-randomisation to two groups. The first group received a lecture and seminar on IOTN, and the second group were given a seminar and access to a purpose written CAL programme. MAIN OUTCOME MEASURE: A standard test was given to the two groups in the form of ten sets of patient records that they had to score with IOTN Dental Health Component (DHC) and Aesthetic Component (AC). RESULTS: There was no difference in mean score for the two groups with AC score (5.02 and 5.03). The CAL group of students performed best for DHC grade (mean score 5.41 compared with 4.24 for lecture group) and this was statistically significant (p < 0.01). CONCLUSION: Undergraduate dental students can learn to use IOTN as well or better when using a CAL programme compared with a lecture.

Functional regulator treatment of Class II division 1 malocclusions.

This controlled retrospective study aimed to identify the contribution of skeletal and dental changes in the correction of Class II division 1 malocclusions using Fränkel's functional regulator II (FRII), with reference to a concurrently recruited control group. One hundred and thirty-eight patients with Class II division 1 malocclusions were identified, those accepting treatment forming the study group and those declining treatment the control group. The study group (n = 70) were treated with a Fränkel appliance. Pre- and post-treatment observation cephalometric radiographs were analysed and compared. Mean values for both skeletal and dental variables in the control group were remarkably consistent throughout the study period; however, this masked individual variations in this group. The skeletal variables in the study group that showed statistically significant differences from the control group were SNB, ANB, BaNA and ANS-Me, but none of these was sufficiently large to be regarded as clinically significant. Dental variables showed clinically and statistically significant differences, including a 10 degree reduction in UI-Max and 3.1 degree increase in LI-Mand. The Fränkel appliance was thus found to be effective in producing desirable occlusal and dental changes in the majority of patients treated.

The delivery of surgical cleft care in the United Kingdom.

BACKGROUND AND PURPOSE: A national survey of cleft teams was undertaken as part of the Clinical Standards Advisory Group investigation of the current status of cleft care in the United Kingdom (UK). METHODS: Fifty-seven cleft teams were identified, of which 90% responded to the survey. MAIN FINDINGS: Nine cleft teams had been established since 1992. Only one region, Northern Ireland, had a centralised cleft service and, despite 82% of teams having databases, only four were able to produce corroborated evidence of receiving at least 30 annual new referrals during 1995. There was a wide variation in the facilities provided by individual cleft teams--only six teams were able to provide all of the key facilities recommended by the Royal College of Surgeons Steering Group on cleft lip and palate. Facilities such as antenatal and neonatal counselling, protocols for record keeping and long-term treatment were similar for high and low volume teams. High volume teams were more likely to have established links with a full range of specialities including psychology, clinical genetics and paediatrics than low volume teams. CONCLUSION: A national survey of cleft services has demonstrated a need for reorganisation. This is now in process and once established will require continual monitoring and assessment.

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 1: background and methodology.

OBJECTIVE: To review the history of cleft care in the United Kingdom and the rationale and methodology of a national study. DESIGN: Descriptive overview to introduce this series of papers. SETTING: Fifty National Health Service cleft teams. PATIENTS/PARTICIPANTS: Two age cohorts, 5-year-olds and 12-year-olds, with nonsyndromic complete unilateral cleft lip and palate and their parents. MAIN OUTCOME MEASURES: Facial development and appearance, quality of bone grafts, speech, oral health and patient/parent satisfaction. CONCLUSIONS: The case for a national assessment of cleft care is made. The methodology of the cross-sectional outcome study is described, together with a survey of training for recently appointed clinicians.

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 3: speech outcomes.

OBJECTIVE: To summarize speech outcomes in children born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN: Prospective descriptive study on a cross-sectional sample of children. PATIENTS/PARTICIPANTS: Data were collected for 238 5-year-olds (born between April 1, 1989, and March 31, 1991) and 218 12-year-olds (born between April 1, 1982, and March 31, 1984) with complete UCLP. MAIN OUTCOMES: Ratings of intelligibility, nasality, "speech cleft type characteristics" and speech therapy intervention. CONCLUSIONS: Nineteen percent of 5-year-olds and 4% of 12-year-olds were judged to be impossible to understand or just intelligible to strangers. Thirty-four percent of 5-year-olds and 17% of 12-year-olds had at least one serious error of consonant production. Eighteen percent of 5-year-olds and 12-year-olds had consistent hypernasality of mild, moderate, or severe degree. Approximately two-thirds of both age groups had undergone speech therapy.

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 2: dentofacial outcomes and patient satisfaction.

OBJECTIVE: To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN: Cross-sectional outcome study. SETTING: Fifty National Health Service cleft centers. PARTICIPANTS: Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. RESULTS: Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. CONCLUSION: A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.

Cleft lip and palate care in the United Kingdom--the Clinical Standards Advisory Group (CSAG) Study. Part 4: outcome comparisons, training, and conclusions.

OBJECTIVE: A critical appraisal of cleft care in the United Kingdom. DESIGN: Retrospective comparative study. SETTING: All National Health Service cleft centers in the United Kingdom. PATIENTS/PARTICIPANTS: Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. MAIN OUTCOME MEASURES: Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. CONCLUSIONS: This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.