The impact of orthodontic appliances on eating - young people's views and experiences.

OBJECTIVES: Orthodontic appliances are known to cause patients difficulty with eating. Learning more about the issues patients face, while eating with orthodontic appliances in place, will allow us to create more informative and relevant patient information, thereby improving patient compliance and treatment success. This study aims to understand how orthodontic appliances impact on eating in the broader context and to explore adolescent patients' perceptions of eating with orthodontic appliances. METHODS: Purposive sampling was used and 19 participants currently undergoing orthodontic treatment and aged 11-14 years were selected for either a focus group or semi-structured interview to explore eating-related issues. Data collection and analysis were carried out as an iterative process broadly following principles of thematic analysis. Data collection ceased when no new themes emerged. RESULTS: Two main themes relating to eating problems emerged: restriction of food choice and problems associated with the eating process. Participants reported restricting food choice due to physical aspects of the appliance, advice given by their orthodontist, fear of breakage and also to minimize embarrassment. Participants also reported problems with the time taken to eat, chewing problems, taste change and being messy while eating. Additionally, time in treatment, the location of eating and relationship with those present during eating influenced emotions. Some participants indicated a positive impact of orthodontic appliances on their diet. CONCLUSIONS: These results can be used to further inform dietary advice offered to patients. Factors were identified which may not be considered in clinical practice but which could improve the value of dietary advice given to patients.

Managing resources in NHS dentistry: using health economics to inform commissioning decisions.

BACKGROUND: The aim of this study is to develop, apply and evaluate an economics-based framework to assist commissioners in their management of finite resources for local dental services. In April 2006, Primary Care Trusts in England were charged with managing finite dental budgets for the first time, yet several independent reports have since criticised the variability in commissioning skills within these organisations. The study will explore the views of stakeholders (dentists, patients and commissioners) regarding priority setting and the criteria used for decision-making and resource allocation. Two inter-related case studies will explore the dental commissioning and resource allocation processes through the application of a pragmatic economics-based framework known as Programme Budgeting and Marginal Analysis. METHODS/DESIGN: The study will adopt an action research approach. Qualitative methods including semi-structured interviews, focus groups, field notes and document analysis will record the views of participants and their involvement in the research process. The first case study will be based within a Primary Care Trust where mixed methods will record the views of dentists, patients and dental commissioners on issues, priorities and processes associated with managing local dental services. A Programme Budgeting and Marginal Analysis framework will be applied to determine the potential value of economic principles to the decision-making process. A further case study will be conducted in a secondary care dental teaching hospital using the same approach. Qualitative data will be analysed using thematic analysis and managed using a framework approach. DISCUSSION: The recent announcement by government regarding the proposed abolition of Primary Care Trusts may pose challenges for the research team regarding their engagement with the research study. However, whichever commissioning organisations are responsible for resource allocation for dental services in the future; resource scarcity is highly likely to remain an issue. Wider understanding of the complexities of priority setting and resource allocation at local levels are important considerations in the development of dental commissioning processes, national oral health policy and the future new dental contract which is expected to be implemented in April 2014.

Paying for treatments? Influences on negotiating clinical need and decision-making for dental implant treatment.

BACKGROUND: The aim of this study is to examine how clinicians and patients negotiate clinical need and treatment decisions within a context of finite resources. Dental implant treatment is an effective treatment for missing teeth, but is only available via the NHS in some specific clinical circumstances. The majority of people who receive this treatment therefore pay privately, often at substantial cost to themselves. People are used to paying towards dental treatment costs. However, dental implant treatment is much more expensive than existing treatments--such as removable dentures. We know very little about how dentists make decisions about whether to offer such treatments, or what patients consider when deciding whether or not to pay for them. METHODS/DESIGN: Mixed methods will be employed to provide insight and understanding into how clinical need is determined, and what influences people's decision making processes when deciding whether or not to pursue a dental implant treatment. Phase 1 will use a structured scoping questionnaire with all the General dental practitioners (GDPs) in three Primary Care Trust areas (n = 300) to provide base-line data about existing practice in relation to dental implant treatment, and to provide data to develop a systematic sampling procedure for Phase 2. Phases 2 (GDPs) and 3 (patients) use qualitative focused one to one interviews with a sample of these practitioners (up to 30) and their patients (up to 60) to examine their views and experiences of decision making in relation to dental implant treatment. Purposive sampling for phases 2 and 3 will be carried out to ensure participants represent a range of socio-economic circumstances, and choices made. DISCUSSION: Most dental implant treatment is conducted in primary care. Very little information was available prior to this study about the quantity and type of treatment carried out privately. It became apparent during phase 2 that ISOD treatment was an unusual treatment in primary care. We thus extended our sample criteria for Phase 3 to include people who had had other implant supported restorations, although not single tooth replacements.