What is the value of orthodontic treatment?

Orthodontic treatment is as popular as ever. Orthodontists frequently have long lists of people wanting treatment and the cost to the NHS in England was £258m in 2010-2011 (approximately 10% of the NHS annual spend on dentistry). It is important that clinicians and healthcare commissioners constantly question the contribution of interventions towards improving the health of the population. In this article, the authors outline some of the evidence for and against the claims that people with a malocclusion are at a disadvantage compared with those without a malocclusion and that orthodontic treatment has significant health benefits. The authors would like to point out that this is not a comprehensive and systematic review of the entire scientific literature. Rather the evidence is presented in order to stimulate discussion and debate.

Repair vs replacement of failed restorations in general dental practice: factors influencing treatment choices and outcomes.

OBJECTIVE: To investigate the impact of repair vs replacement of failed restorations on patient related outcome measures, and to explore the clinical factors that influence this decision. DESIGN: Multicentre, prospective practice-based study. SETTING: Dental practices within Salford, Trafford and East Lancashire in the North West of England. SUBJECTS AND METHODS: General dental practitioners were asked to participate and to recruit adult patients attending for routine dental treatment. INTERVENTIONS: Repair or replacement of failed restorations. MAIN OUTCOME MEASURES: Dental anxiety before treatment using the Corah Dental Anxiety Scale and pain intensity immediately and 24 hours post-operatively using the McGill short form pain questionnaire. Operative outcomes included depth of caries, time taken to complete the procedure, use of local anaesthetic and dental material used. RESULTS: Of the 103 patients diagnosed with a failed restoration, a statistically significantly greater number underwent replacement than repair (p = 0.004). Patients undergoing repairs were significantly less anxious (p = 0.008) and had shorter procedure times (p = 0.044). Repairs were associated with minimal caries depth and less use of local anaesthetic. CONCLUSION: Failed restorations should be repaired where clinically possible, as they are quick and associated with less patient anxiety. Future research should focus on providing high quality prospective data evaluating the longevity of repaired vs replaced restorations.

Post-traumatic Stress Disorder.

Unexpected extreme sudden traumatic stressor may cause post-traumatic stress disorder (PTSD). Important traumatic events include war, violent personal assault (e.g., sexual assault, and physical attack), being taken hostage or kidnapped, confinement as a prisoner of war, torture, terrorist attack, severe car accidents, and natural disasters. In childhood age sexual abuse or witnessing serious injuries or unexpected death of a beloved one are among important traumatic events.PTSD can be categorized into two types of acute and chronic PTSD: if symptoms persist for less than three months, it is termed "acute PTSD," otherwise, it is called "chronic PTSD." 60.7% of men and 51.2% of women would experience at least one potentially traumatic event in their lifetime. The lifetime prevalence of PTSD is significantly higher in women than men. Lifetime prevalence of PTSD varies from 0.3% in China to 6.1% in New Zealand. The prevalence of PTSD in crime victims are between 19% and 75%; rates as high as 80% have been reported following rape. The prevalence of PTSD among direct victims of disasters was reported to be 30%-40%; the rate in rescue workers was 10%-20%. The prevalence of PTSD among police, fire, and emergency service workers ranged from 6%-32%. An overall prevalence rate of 4% for the general population, the rate in rescue/recovery occupations ranged from 5% to 32%, with the highest rate reported in search and rescue personnel (25%), firefighters (21%), and workers with no prior training for facing disaster. War is one of the most intense stressors known to man. Armed forces have a higher prevalence of depression, anxiety disorders, alcohol abuse and PTSD. High-risk children who have been abused or experienced natural disasters may have an even higher prevalence of PTSD than adults.Female gender, previous psychiatric problem, intensity and nature of exposure to the traumatic event, and lack of social support are known risk factors for work-related PTSD. Working with severely ill patients, journalists and their families, and audiences who witness serious trauma and war at higher risk of PTSD.The intensity of trauma, pre-trauma demographic variables, neuroticism and temperament traits are the best predictors of the severity of PTSD symptoms. About 84% of those suffering from PTSD may have comorbid conditions including alcohol or drug abuse; feeling shame, despair and hopeless; physical symptoms; employment problems; divorce; and violence which make life harder. PTSD may contribute to the development of many other disorders such as anxiety disorders, major depressive disorder, substance abuse/dependency disorders, alcohol abuse/dependence, conduct disorder, and mania. It causes serious problems, thus its early diagnosis and appropriate treatment are of paramount importance.