Psychological support for orthognathic patients -- what do orthodontists want?

AIMS: (1) To evaluate consultant orthodontist opinion on referral of orthognathic patients to a liaison psychiatrist or psychologist and (2) To investigate the value of training orthodontic specialists in recognition of patients with psychological profiles that might affect orthognathic outcome. DESIGN: Questionnaire-based study. SUBJECTS AND METHODS: A structured questionnaire was distributed to all consultant orthodontists in the UK. RESULTS: Approximately 40% of consultants thought that up to 10% of their orthognathic patients would benefit from psychological assessment by appropriately trained personnel. Twenty per cent of consultants were not certain what proportion of their patients would benefit from referral and over half the respondents said they do not refer any orthognathic patients for assessment. The most common reasons for referral were past/current psychiatric history (36%), unrealistic expectations (32%), 'gut instinct' (14%), no significant clinical problem (13%). Reasons not to refer were: nobody to refer to (30.5%), fear of patient reacting badly (15.8%), not sure who to refer to (14.7%), response from mental health team not useful (12.4%), waiting list too long (9.6%). The majority of clinicians felt they would benefit from training in this field (84.7%), as over 80% reported no teaching or training in psychological assessment/management. CONCLUSIONS: Although we have no evidence to prove that interdisciplinary care is better for patients, clinical experience and reports from clinicians working in large centres, tells us there are probable advantages. The development of a training programme for both orthodontists and mental health teams would seem to be beneficial for both clinicians and patients.

The bigger the better: can magnification aid orthodontic clinical practice?

The use of magnification in dentistry appears to be of increasing interest. This is also reflected in our own specialty, with a number of optical companies exhibiting their products at orthodontic conferences and meetings. This article reviews the principles of magnification, briefly discusses the magnification loupes that are available on the market at the present time, and highlights the advantages and disadvantages of using magnification for orthodontic treatment.

Osteomyelitis complicating osteopetrosis--a case report.

Osteomyelitis of the jaws is uncommon but can be a complication of extraction or exposure of teeth in patients who are immunosuppressed or have undergone radiotherapy to the head and neck region. We report a case of osteomyelitis in a patient who has osteopetrosis. The initial clinical presentation was that of an infected retained root, secondary to denture trauma to the supporting tissues. Radiological interpretation was difficult owing to the increased bone density and surgical exploration revealed only a dense region of necrotic bone.