Musculoskeletal disorders and related factors in the Colombian orthodontists' practice.

Objective. This study aimed to characterize the symptoms of musculoskeletal disorders (MSDs) and their related factors in a group of orthodontists in the city of Medellín (Colombia). Methods. A cross-sectional study was conducted in a sample of 100 orthodontists. A survey provided sociodemographic and work-related information. MSDs were recorded through the Nordic questionnaire. Descriptive and bivariate analyses were carried out by determining the prevalence of MSD symptoms by anatomical zone and selected variables. Results. Prevalence of MSDs was 81% for males and 88% for females. Anatomical regions were the neck (males 44%, females 59%), shoulders (males 44%, females 48%), lower back-lumbar zone (males 63%, females 51%), elbow-forearm (males 15%, females 15%) and wrist-hand (males 32%, females 51%). The frequency of symptoms was higher in males >41 years old, with more than a work contract or females who worked >40 h per week, and in orthodontists (males-females) who reported higher work-related dissatisfaction levels. Conclusions. A high prevalence of MSDs was found among orthodontists, with differences in the frequency of symptoms related to sociodemographic and work-related factors. Preventive strategies related to health and work safety would be advisable considering the particular needs of this dentist group.

The prediction of impacted versus spontaneously erupted mandibular third molars.

BACKGROUND: To evaluate the predictive capacity of orthodontists and oral maxillofacial surgeons (OMFSs) in anticipating the process of impaction or eruption of lower third molars (L3Ms) through the examination of serial panoramic radiographs. METHODS: Sixty-eight lower third molars (L3Ms) were analyzed in 34 orthodontically treated patients without extraction. Twenty-seven OMFSs and 27 orthodontists were randomized in order to analyze the radiographs. Initially, the evaluators issued the prognosis for the L3Ms in XR1, a posterior for the XR1 + XR2. Concordance of the diagnosis was examined using Kappa statistics, and the differences between the groups of evaluators were examined using the chi-square test at p<0.05. RESULTS: When examining XR1 in cases where the teeth erupted spontaneously, the prognostic accuracy rate for OMFSs and orthodontists was similar, 63 and 65.7%, respectively (p=0.19). When evaluating XR1 + XR2, the accuracy among orthodontists (60%) was similar to that reported for XR1 (p=0.19), while OMFSs presented a reduction in the accuracy (55.3%, p<0.0001). When the L3Ms remained impacted, accuracy in XR1 was lower than in spontaneously erupting L3Ms, although similar between OMFSs (50.1%) and orthodontists (49.1%). Furthermore, for impacted L3Ms, when examining XR1 + XR2, the OMFSs presented a significant higher accuracy (71.8%, p <0.0001). CONCLUSIONS: Orthodontists and OMFSs seem unable to predict spontaneous eruption or impaction of the lower third molars from single or longitudinal x-rays. When adding a second longitudinal x-ray, orthodontists and more significantly OMFSs tend to indicate more extractions.

The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs

ABSTRACT Objective: To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis. Methods: 22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2). Results: The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001). Conclusions: Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

RESUMO Objetivo: Avaliar a habilidade de ortodontistas e cirurgiões bucomaxilofaciais (CBMF) em propor um prognóstico para terceiros molares inferiores. Métodos: Foram analisados 22 pacientes tratados ortodonticamente sem extração, cujos terceiros molares inferiores irrompidos espontaneamente (n= 44) foram avaliados por meio de radiografias panorâmicas seriadas. A primeira radiografia foi obtida logo após o tratamento ortodôntico (RX1), entre 13 e 19 anos de idade. A segunda radiografia (RX2) foi avaliada dois anos depois, em média. As radiografias foram analisadas aleatoriamente por 54 especialistas, 27 ortodontistas e 27 CBMFs, para obter sua opinião sobre a abordagem a ser adotada na RX1. Em seguida, outra opinião foi coletada adicionando-se a segunda radiografia seriada (RX1+2). Resultados: A concordância das respostas foi moderada para os CBMFs (Kappa = 0,44; p< 0,0001) e significativa para os ortodontistas (Kappa = 0,39; p< 0,0001). Após analisar apenas a primeira radiografia (RX1) dos molares antes deles irromperem espontaneamente, os CBMFs indicaram extração em 44,5% dos casos; enquanto os ortodontistas, em 42%, sem diferença entre os grupos (p= 0,22). Na análise de RX1+2, os ortodontistas mantiveram o mesmo nível de indicação de extração (45,6%, p= 0,08), enquanto os cirurgiões passaram a indicar mais extrações (63,2%, p< 0,0001). Conclusões: Ortodontistas e CBMFs não foram capazes de predizer a erupção de terceiros molares por meio da análise de uma única radiografia panorâmica, indicando extrações em cerca da metade dos terceiros molares examinados. Uma análise de acompanhamento, incluindo mais uma radiografia, não melhorou a precisão do prognóstico entre os ortodontistas, e piorou entre os CBMFs.

Ortodontia: especialidade de meio ou de resultado? / Orthodontic: especially of the environment or the result?

A evolução da técnica ortodôntica ampliou as possibilidades de tratamento e, sem dúvida, trouxe ao paciente maiores expectativas em relação ao resultado estético e ao tempo de tratamento. Desta forma, torna-se imprescindível o aprofundamento dos debates quanto à caracterização da relação contratual existente entre ortodontista e paciente. Este trabalho tem por objetivo apresentar termos jurídicos e revisar a literatura referente ao tema para que o ortodontista possa compreender suas responsabilidades na relação comercial com o paciente baseado na legislação vigente. Pode-se concluir que o assunto é controverso e sem posicionamento jurídico definitivo, e que maiores debates e publicações são necessários.

The evolution of the orthodontic technique has provided more possibilities of treatment, and certainly brought has raised patients’ expectations about the aesthetic result and duration of the treatment. By this way, the depth of the debates about the characterization of the contract relationship between orthodontist and the patient becomes essential. This work aims at presenting legal terms and a literature review about the theme in order to make clear to orthodontists which are their responsibilities in the commercial relationship with the patient according to current legislation. It could be concluded that the subject is controversial and does not have a stated legal placement, requiring further debates.

Orthodontic manpower requirements of Trinidad and Tobago / Necesidades de personal de ortodoncia en Trinidad y Tobago

OBJECTIVE: A study was done to estimate the orthodontic manpower requirements of Trinidad and Tobago. METHODS: A questionnaire was administered via e-mail to 9 of 11 orthodontists. Information from a population census, a report on the orthodontic treatment needs of children in Trinidad and Tobago and this questionnaire were used to calculate the number of orthodontists and chairside orthodontic assistants needed in Trinidad and Tobago. RESULTS: On average, 50 per cent of the 289 patients treated by each orthodontist in Trinidad and Tobago annually are children. Approximately, 13 360patients can be expected to demand orthodontic treatment every year in this country. The number of orthodontists and chairside assistants required to treat these patients was estimated to be 44 and 154, respectively. CONCLUSIONS: Currently, Trinidad and Tobago only has a quarter of the number of orthodontists and orthodontic chairside assistants required to treat the number of patients in need. As the demand is relatively high in Trinidad and Tobago and the number of orthodontists has increased slowly and inadequately for the past decade, the orthodontists are likely to remain adequately employed and happy with their job unlike dentists who are currently in private practice for less than a year.

OBJETIVO: Se realizó un estudio con el propósito de calcular la necesidad de personal para el trabajo de ortodoncia en Trinidad y Tobago. MÉTODOS: Se administró una encuesta via correo electrónico a 9 de 11 ortodoncistas. La información de un censo de población, un reporte sobre las necesidades de tratamiento ortodóncico de los niños en Trinidad y Tobago, así como esta encuesta, se usaron para calcular el número de ortodoncistas y asistentes dentales de ortodoncia necesitados en Trinidad y Tobago. RESULTADOS: Como promedio, el 50 por ciento de los 289 pacientes tratados anualmente por cada ortodoncista en Trinidad y Tobago son niños. Puede esperarse que aproximadamente 13360pacientes pidan tratamiento de ortodoncia todos los años en este país. Estimados indicaron que el número de ortodoncistas y asistentes ortodoncistas requeridos para tratar a estos pacientes es 44 y 154, respectivamente. CONCLUSIONES: Actualmente, Trinidad y Tobago sólo tiene un cuarto del número de ortodoncistas y asistentes de ortodoncia requeridos para tratar al número de pacientes con necesidades. Como que la demanda es relativamente alta en Trinidad y Tobago y el número de ortodoncistas ha aumentado lenta e inadecuadamente en los últimos diez años, es probable que los ortodoncistas permanezcan adecuadamente empleados y felices con su trabajo, a diferencia de los dentistas que están actualmente en la práctica privada por menos de un año.