Patient reported experiences and treatment outcomes of orthodontic patients treated within secondary care settings in the South West of England during the COVID-19 pandemic.

OBJECTIVE: To assess the impact of the temporary cessation of orthodontic services on patients undergoing treatment during the COVID-19 pandemic. DESIGN: Two-phase multicentre service evaluation. SETTING: Secondary care orthodontic departments in the South West of England. MATERIALS AND METHODS: Phase 1 - Patient-Reported Experience Measure questionnaire (PREM). The questionnaire was distributed to patients who had undergone orthodontic treatment during the COVID-19 pandemic once services had resumed. Phase 2 - assessment of treatment outcomes, specifically with the Peer Assessment Rating (PAR) Index. A total of 280 PAR scores were obtained from a cohort of patients treated before and during the pandemic. RESULTS: A total of 711 PREM questionnaires were completed. Participants generally felt relaxed when visiting secondary care settings, orthodontic departments and whilst wearing orthodontic appliances during the pandemic. Nearly 40% of participants were concerned that the pandemic would impact on their treatment, particularly treatment length. Treatment outcomes revealed that patients treated before and during the pandemic experienced percentage PAR score reductions of 83.9% and 80.6%, respectively. Patients receiving treatment during the pandemic experienced longer treatment durations of 126 days. CONCLUSION: During the pandemic, low levels of anxiety were reported with respect to receiving orthodontic treatment in secondary care settings. Irrespective of the pandemic, a high standard of orthodontic treatment was provided. However, patient concerns regarding treatment length were justified.

Quantitative and qualitative analysis of particulate production during simulated clinical orthodontic debonds.

OBJECTIVES: The objectives of this investigation were firstly to quantitatively and qualitatively determine particulate production during orthodontic debond and enamel cleanup procedures, and secondly to examine what methods can be employed to minimize operator exposure to such dust particles. METHODS: A qualitative study was performed to determine the aerodynamic diameters and compositions of particulates produced during simulated clinical debonds and enamel cleanup procedures on extracted teeth. In each case the enamel was cleaned using tungsten carbide burs in either a high or slow speed handpiece, with or without water coolant spray, with or without high volume evacuation (HVE) or a face mask. RESULTS: The use of a high speed handpiece with a tungsten carbide bur and water irrigation at enamel cleanup produced the greatest concentration of respirable particulates. Within this dust, calcium, phosphorus, aluminum and silicon were the most commonly found elements. The dust levels observed did not exceed limits advised for respirable dusts in general. However, the concentration of silica within the dusts created is unknown. The face mask and HVE were effective at reducing exposure to respirable particles, but the mask was most effective, reducing exposure by up to 96%. SIGNIFICANCE: A face mask is an effective means of reducing dust inhalation and is advised for all clinical procedures that produce dusts.

Inhalation of aerosols produced during the removal of fixed orthodontic appliances: a comparison of 4 enamel cleanup methods.

INTRODUCTION: During enamel cleanup after the removal of fixed appliances, aerosols, splatter, and dust are produced that can be inhaled. Although most inhaled particles are harmless, some might be associated with chronic diseases. Modern laboratory methods can now accurately simulate the human lung and predict the site of deposition of these inhaled particles. METHODS: Orthodontic brackets and bands were attached to extracted teeth to simulate complete dental arches. Four variations of enamel cleanup were used: the variables were hand-piece speed and presence or absence of water. Air sampling was conducted by using a cascade impactor, and the filter media collected from each experiment were viewed under a scanning electron microscope to locate the particulate matter. X-ray microanalysis was used to identify particle composition. RESULTS: The amount of debris deposited on the filter media was highly variable. The combination of fast hand piece with water irrigation demonstrated the highest concentration of debris deposited at the greatest depth in the (artificial) lung. Although the particles are most likely to be deposited in the conducting airways and terminal bronchi, some might be deposited in the terminal alveoli of the lungs and cleared only after weeks or months. The most common elements identified were calcium, phosphorus, silica, and aluminum. Other elements included iron and lanthanum. CONCLUSIONS: Aerosol particulates produced during enamel cleanup might be inhaled irrespective of hand-piece speed or the presence or absence of water coolant.

Three-dimensional assessment of the facial soft tissue changes that occur postoperatively in orthognathic patients.

With the development of 3-dimensional technology it has become increasingly possible to record the facial soft tissue changes that occur with growth and following orthodontic treatment. This article describes the use of the optical surface laser scanner to record and quantify the facial soft tissue changes following orthognathic surgery. Ten skeletal Class III patients were laser scanned, at previously determined time intervals, over a 6-month period following orthognathic surgery. Computer superimposition of the scanned images provided a graphic demonstration of the soft tissue changes as they occurred between the time intervals. Analysis of the results demonstrates a nonuniform, asymmetric resolution of facial swelling and adaptation of the soft tissues to the altered skeletal structure. This occurred principally over the initial 4 months following surgery. However, smaller changes continued to occur throughout the study period. This suggests that the facial soft tissues continue to change over a period of greater than 6 months. This knowledge is important as it is integral for obtaining informed consent from patients.

Aerosols and splatter in dentistry--a neglected menace?

Two main types of particulate matter may be produced during routine dental procedures, namely aerosols and splatter. The principal difference between them is the size of the particles from which they are made. The behaviour of such particles in air and their possible health risks are complex. However, the use of high volume evacuation, pre-procedural mouthrinses and rubber dam are the most effective methods of reducing the unwanted risk of exposure.