Motivation for orthodontic treatment investigated with Q-methodology: patients' and parents' perspectives

INTRODUCTION

Motivation and cooperation are vital components of orthodontic treatment if a good outcome is to be achieved. In this study, we used Q-methodology to investigate motivating factors among adolescents seeking orthodontic treatment and parents wanting their children to undergo orthodontic treatment. This technique asks participants to rank a series of statements, and the analysis of this ranking then provides insight into the participants' opinions.

METHODS

Each of these complementary studies was divided into 2 phases: interviews to generate a list of reasons for seeking orthodontic treatment and the use of Q-methodology to assess and categorize the relative importance of these reasons for the groups of participants. In the patient study, 32 items were generated from the interviews and placed in order of importance on a Q-methodology grid by 60 patients who were about to commence orthodontic treatment. The rankings were subjected to factor analysis, which categorized the patients' views into groups of shared opinions. The same methodology was used with the parent group, and a Q-methodology grid was designed to accommodate 35 items that were then ranked by the 60 parents. The rankings were subjected to factor analysis as for the patient group.

RESULTS

For the patients, factor analysis identified 3 factors, all of which included esthetics, as important. The remaining respondents had more individual viewpoints and did not map to any of the 3 factors. For the parents, factor analysis identified 4 factors, all of which included treatment in adolescence to prevent future problems, as important.

CONCLUSIONS

This study showed that Q-methodology is a novel and efficient tool that can be used in dental research with few difficulties. It might prove useful for the aspects of care for which subjective views or opinions play an important role.

The costs of keeping cool in a warming world: implications of high temperatures for foraging, thermoregulation and body condition of an arid-zone bird

Recent mass mortalities of bats, birds and even humans highlight the substantial threats that rising global temperatures pose for endotherms. Although less dramatic, sublethal fitness costs of high temperatures may be considerable and result in changing population demographics. Endothermic animals exposed to high environmental temperatures can adjust their behaviour (e.g. reducing activity) or physiology (e.g. elevating rates of evaporative water loss) to maintain body temperatures within tolerable limits. The fitness consequences of these adjustments, in terms of the ability to balance water and energy budgets and therefore maintain body condition, are poorly known. We investigated the effects of daily maximum temperature on foraging and thermoregulatory behaviour as well as maintenance of body condition in a wild, habituated population of Southern Pied Babblers Turdoides bicolor. These birds inhabit a hot, arid area of southern Africa where they commonly experience environmental temperatures exceeding optimal body temperatures. Repeated measurements of individual behaviour and body mass were taken across days varying in maximum air temperature. Contrary to expectations, foraging effort was unaffected by daily maximum temperature. Foraging efficiency, however, was lower on hotter days and this was reflected in a drop in body mass on hotter days. When maximum air temperatures exceeded 35.5 °C, individuals no longer gained sufficient weight to counter typical overnight weight loss. This reduction in foraging efficiency is likely driven, in part, by a trade-off with the need to engage in heat-dissipation behaviours. When we controlled for temperature, individuals that actively dissipated heat while continuing to forage experienced a dramatic decrease in their foraging efficiency. This study demonstrates the value of investigations of temperature-dependent behaviour in the context of impacts on body condition, and suggests that increasingly high temperatures will have negative implications for the fitness of these arid-zone birds.

Impact of dentofacial deformity and motivation for treatment: a qualitative study

INTRODUCTION

Satisfaction with the outcome of orthognathic treatment is generally high; however, an important minority remains dissatisfied with the results. The reasons for this could be inadequate patient understanding and preparation, external motivation, and unrealistic expectations. In-depth appreciation of these issues can be obtained using qualitative research methods, but there is a paucity of qualitative research in this field.

METHODS

This was a cross-sectional qualitative study of orthognathic patients conducted at a teaching hospital. In-depth interviews were conducted with 18 prospective orthognathic patients. The data were managed by using the framework approach and analyzed by using the critical qualitative theory.

RESULTS

Two main themes were explored in the interviews: the impact of the dentofacial deformity and the motivation for treatment. Both the everyday problems of living with a dentofacial deformity and the motivation for seeking treatment could be classified either as exclusively practical (including functional and structural), exclusively psychological (including psychosocial and esthetic), or a combination. Different coping strategies were also described. The sources of motivation ranged between purely external to purely internal, with most subjects between these 2 extremes.

CONCLUSIONS

In this article, we present a classification of the impact of dentofacial deformity that is a refinement of the traditional one that includes esthetic, functional, and psychosocial factors. The motivating factors, together with the triggers for accessing treatment and the source of motivation, are generally linked directly or indirectly to the problem and the impact of the condition. However, in a few patients, the motivation might not relate to the impact of the problem but to a complex array of other factors such as personality, upbringing, and relationships. Therefore, clinicians should not make assumptions but explore these factors on an individual basis without preconceived ideas.

Assessment of motivation and psychological characteristics of adult orthodontic patients

INTRODUCTION

In recent years, the demand for adult orthodontic treatment has grown rapidly; yet there is a paucity of information on this subgroup of patients. It is well known that understanding the psychological characteristics and motives of any patient is fundamental and that these factors might affect patient satisfaction and adherence with treatment. There is therefore a need for clinicians to improve their understanding of this subgroup to enhance the patient's experience of treatment delivery and to increase the potential for a successful treatment outcome. The aim of this study was to develop a measure for the assessment of motivating factors and psychological characteristics of adults seeking orthodontic treatment.

METHODS

This study involved the qualitative development of a valid patient-centered questionnaire to assess motivating factors for adults seeking orthodontic treatment. This was achieved through semi-structured in-depth interviews; key themes were identified and used to construct a questionnaire assessing motivation for treatment. This was then combined with 3 previously validated questionnaires to measure self-esteem, anxiety or depression, and body image and facial body image. The questionnaire was distributed to 172 adult orthodontic patients at different stages of treatment in a large teaching hospital in the United Kingdom. In addition, the self-esteem, body image, and facial body image scores were compared with data on orthognathic patients from the same hospital and with data from members of the general public.

RESULTS

Desire to straighten the teeth and improve the smile were the key motivating factors for the adult group studied. Other motives included to improve the bite, improve facial appearance, and close (dental) spacing. With respect to the psychological characteristics of self-esteem, body image, and facial body image, the adult orthodontic group was comparable with the general public. However, differences were noted when comparing data from the adult orthodontic group with previously collected data on orthognathic patients.

CONCLUSIONS

The motives for adults to seek orthodontic treatment are numerous and varied, whereas psychological traits appear to be closer to those of the general public than to orthognathic patients.

The relationship between base dimensions, force to failure, and shear bond strengths of bondable molar tubes

OBJECTIVES

To compare forces versus failure and shear bond strengths, and to explore their association with the base dimensions of four currently available bondable molar tubes.

MATERIALS AND METHODS

Tubes were bonded to hydroxyapatite discs using a conventional light-cured adhesive and were tested to shear failure with the Instron Universal testing machine. Results were analyzed using the Kruskal-Wallis test and regression and survival analyses.

RESULTS

No statistical difference was observed between the four groups globally in terms of force to failure (P  =  .059) and bond strength (P  =  .179). However, regression analysis showed that each 1 mm(2) increase in base surface area required an additional force of 3.11 N to debond the tube. Survival analysis showed that the tube with the greatest base dimensions had the best survival with increasing force to failure.

CONCLUSIONS

Although a relationship was demonstrated between force to failure and base surface area, it was not a simple one. No statistically significant relationship was found between bond strength and base surface area.

A new style of orthognathic clinic

The Orthognathic Team at the Eastman Dental Hospital has developed a new style of multidisciplinary clinic to supplement the traditional orthognathic consultation. The aim of the new clinic is to increase patient satisfaction and involvement in the consent and decision making process, as well as optimizing the information given to prospective patients regarding all aspects of this complex elective treatment. Results of a survey of patients attending the clinic found that 80% thought that the information given was 'just the right amount' and 96% were satisfied with the new structure. They particularly found it useful to meet a patient who had completed treatment. All of those who attended said that they understood the information given to them and would recommend the clinic to those considering orthognathic treatment. They also liked having other patients there with them on the clinic.

How important are lateral cephalometric radiographs in orthodontic treatment planning?

INTRODUCTION

The purpose of this study was to investigate whether lateral cephalometric radiographs influence orthodontic treatment planning. It aimed to compare the odds of a change in treatment plan in three groups of orthodontists who treatment planned six cases on two occasions, T1 and T2, with the provision of a lateral cephalometric radiograph being varied.

METHODS

The records of 6 orthodontic patients were copied onto compact discs and sent to the 199 participating orthodontists. The orthodontists were allocated to 3 groups, A, B, and C. Clinicians in group A were given all records except the lateral cephalometric radiographs at the T1 and T2 planning sessions. Clinicians in group B were given all records except the lateral cephalometric radiograph at T1 and all records including the lateral cephalometric radiograph and tracing at T2. Clinicians in group C were given all records including the lateral cephalometric radiographs and tracings at T1 and T2. All participants were sent records at T1; those who returned the treatment-planning questionnaire were sent the second set of records and questionnaire at T2, 8 weeks later. Invitations to participate were distributed to all specialist orthodontists who were members of the British Orthodontic Society (n = 950). Of these, 199 orthodontists agreed to take part, a response rate of 21%. Of the 199 who agreed to participate, 149 completed the first treatment-planning questionnaire (T1), for a response rate of 75%. Of the 149 who completed that questionaire, 114 completed the second treatment-planning questionnaire (T2), for a 77% response rate.

RESULTS

The availability of a lateral cephalometric radiograph and its tracing did not make a significant difference to any treatment-planning decisions, with the exception of the decision to extract or not between groups B and C for all 6 patients combined, and between groups B and C and groups B and A for patient 4 (Class I incisor relationship on a Class II skeletal base).

CONCLUSIONS

For most treatment-planning decisions in these 6 patients, the availability of a lateral cephalometric radiograph and its tracing did not make a significant difference to the treatment decisions. For 1 patient, there was a significant change in the extraction decision when a lateral cephalometric radiograph was provided. This highlights the uncertainty surrounding the necessity for lateral cephalometric radiographs in treatment planning. Further research in this area is encouraged to resolve this dichotomy.

Picture archiving and communications systems: a study of reliability of orthodontic cephalometric analysis

The objectives of this study were to investigate the possibility of using a picture archiving and communications system (PACS) for basic chairside cephalometric analysis and to compare PACS with hand-tracing and on-screen digitization using a commercial program (Dolphin Imaging Plus Version 10.0). One hundred digital lateral cephalometric radiographs were selected and analysed using the Eastman analysis. Angular and linear measurements were recorded and a single operator traced each radiograph twice, using each of the following methods: PACS, hand-tracing, and Dolphin Imaging. The British Standards Institution Coefficient of Repeatability was used to investigate repeatability within each method and the Bland and Altman method to investigate systematic and random errors between methods. The PACS was more repeatable than Dolphin for measuring the angle between the upper incisors and the maxillary plane but was less repeatable than hand-tracing for measuring percentage lower anterior face height (LAFH). There were statistically significant systematic differences between PACS, hand-tracing, and Dolphin for measurement of lower incisor inclination. However, all three methods agreed, on average, and differences between methods were all within clinically acceptable limits. PACS was found to be clinically acceptable to be used chairside, without the need for hand-tracing or involvement of any orthodontic software. This offers the freedom to analyse digital cephalograms within a clinical area at the same appointment as when the digital radiograph is taken.

Orthognathic treatment and temporomandibular disorders: a systematic review. Part 1. A new quality-assessment technique and analysis of study characteristics and classifications

INTRODUCTION

Orthognathic treatment is undertaken to correct jaw discrepancies and involves a combination of orthodontics and surgery. The effects of orthodontic treatment on temporomandibular disorders (TMD) have been widely debated in the literature, but fewer studies focus on the effects of orthognathic treatment on TMD.

METHODS

A systematic review was conducted to (1) determine the percentage of orthognathic patients with signs or symptoms of TMD, (2) establish the range of signs or symptoms, and (3) examine studies that followed patients longitudinally through treatment to determine the effect of orthognathic intervention on TMD symptoms.

RESULTS

Of 480 identified articles, 53 were eligible for inclusion in this review. Part 1 of this 2-part article describes the methodology of conducting this review, the difficulties encountered (including the quality-assessment issues), and a narrative analysis of study characteristics and classification methods. Part 2 reports the remaining results, evidence tables, and meta-analyses.

CONCLUSIONS

The diversity of diagnostic criteria and classification methods used in the included studies makes interstudy comparisons difficult. There is a definitive need for well-designed studies with standardized diagnostic criteria and classification methods for TMD.

Orthognathic treatment and temporomandibular disorders: a systematic review. Part 2. Signs and symptoms and meta-analyses

INTRODUCTION

There have been conflicting viewpoints in the literature regarding the effects of orthognathic treatment on temporomandibular disorders (TMD). A systematic review was conducted to determine the percentage of orthognathic patients with TMD, establish the range of signs and symptoms, and follow patients longitudinally through treatment for any changes in signs and symptoms.

METHODS

Part 1 of this 2-part article described the methodology of this review, with a narrative analysis of the study characteristics and the TMD classification methods. Part 2 describes the percentage of patients suffering from TMD and the signs and symptoms reported. Meta-analyses were conducted on data from clinically similar studies.

RESULTS

Pain decreased after surgery for both self-reported symptoms and clinically diagnosed pain on palpation. However, postsurgical results were more varied for joint sounds. The percentage of patients with clicking had a tendency to decrease postsurgery, but improvements in crepitus were questionable. The results from all meta-analyses in this review were subject to considerable statistical heterogeneity, and it was not possible to draw strong inferences relating to the percentage of orthognathic surgery patients with TMD with any degree of certainty.

CONCLUSIONS

Although orthognathic surgery should not be advocated solely for treating TMD, patients having orthognathic treatment for correction of their dentofacial deformities and who are also suffering from TMD appear more likely to see improvement in their signs and symptoms than deterioration.

Implementation of the virtual learning environment into a UK orthodontic training programme: the postgraduate and lecturer perspective

The virtual learning environment (VLE) was formally introduced into the orthodontic postgraduate teaching programme at the UCL Eastman Dental Institute in October 2006 with the main role to support the existing didactic teaching. The aim of this study was to establish the programme co-ordinator, lecturer and postgraduate perspective on the introduction of the VLE as an adjunct to other teaching methods. All participants were interviewed utilising open-ended questions to ascertain their response. The interviews were semi-structured and were continued until no new information was elicited. The interviews suggested that the programme co-ordinator, lecturers and the majority of the postgraduates were confident that the VLE could produce a better learning experience. The VLE has a number of advantages and disadvantages, however, there is great potential for the VLE to encourage a constructivist approach to teaching and learning. Moves have been made to align aspects, such as assessment, with the VLE and the rest of the curriculum.

A national review of mandibular orthognathic surgery activity in the National Health Service in England over a nine year period: part 1--service factors

We aimed to investigate the changing provision of mandibular orthognathic surgery in England for the period 1 April 1997-30 March 2006. Data on hospital inpatient activity were extracted from the NHS Hospital Episode Statistics (HES) database for all mandibular orthognathic surgical procedures between these dates. We investigated provider factors (in which units providing services were classified as undertaking either high or low volumes of activity) and temporal changes. There was a steady increase in the number of procedures over time, and a decrease in the mean time spent in hospital (p<0.001). Provider units with high volumes of activity had shorter inpatient stays than those that provided low volume (p<0.001) and exhibited a greater reduction in the duration of inpatient stays (p=0.02). Patterns of care are changing, and increasing numbers of treatments are being done as day-cases (p<0.001). Units with high volumes seem to be more efficient in terms of duration of hospital stay than low volume units. However, our data do not allow an insight into the quality of care provided, and further research is needed to address this issue.

Orthodontic treatment for deep bite and retroclined upper front teeth in children

BACKGROUND

Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth.

OBJECTIVES

To establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth.

SEARCH STRATEGY

The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. The handsearching of the main international orthodontic journals was updated to April 2006. There were no restrictions with regard to publication status or language of publication. International researchers, likely to be involved in Class II division 2 clinical trials, were contacted to identify any unpublished or ongoing trials.

SELECTION CRITERIA

Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children.

DATA COLLECTION AND ANALYSIS

Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors.

MAIN RESULTS

No RCTs or CCTs were identified that assessed the treatment of Class II division 2 malocclusion in children.

AUTHORS' CONCLUSIONS

It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

Reproducibility of soft tissue landmarks on three-dimensional facial scans

This study evaluated the reproducibility of 24 soft tissue landmarks on six three-dimensional (3D) facial scans. The scans were taken on a DSP400 facial scanner and were viewed using a customized software program. Intraoperator data were obtained by one researcher placing the 24 landmarks on all six scans a total of 30 times. Thirty different orthodontists of varying experience were then asked to place all 24 landmarks on each of the six facial scans in order to establish interoperator reproducibility. The standard deviations (SDs) from the mean were calculated from the data for each individual landmark in the x-, y-, and z-axes. For the intraoperator data, 12 of the 24 landmarks were found to be reproducible to within a 1 mm SD for each plane of space. The interoperator data showed lower reproducibility with just two landmarks showing less than a 1 mm SD in all three planes of space. Familiarity with 3D facial scans and associated software programs is important in improving reproducibility. In addition, the landmarks investigated in this study included those not often used. It is suggested that landmarks showing poor reproducibility for both inter- and intraoperator data should be avoided, if at all possible, or at least used with caution.

Patient- and clinician-perceived need for orthognathic surgery

INTRODUCTION

To better understand why patients believe they need orthognathic treatment, a study was undertaken to examine perceived need for treatment by patients and clinicians. This questionnaire-based study was undertaken at The John Radcliffe Hospital, Oxford, United Kingdom.

SUBJECTS AND METHODS

Forty patients were recruited from combined orthodontic-surgical clinics. They were asked to rate their perceived need for treatment based on facial appearance, dental appearance, function, and overall need. Twenty orthodontists and 20 maxillofacial surgeons were asked to rate perceived need for treatment based on the same parameters, using study models and clinical photographs. Ratings were marked on visual analog scales.

RESULTS

Significant differences were found between patients and clinicians in perceived need for treatment based on facial appearance (orthodontists compared with patients, P = .023; surgeons compared with patients, P = .001). In addition, maxillofacial surgeons rated a significantly greater overall need for treatment than patients (P = .027), and they rated treatment need based on facial appearance (P = .005) and function (P < .001) significantly higher than orthodontists.

CONCLUSIONS

Clinicians rated greater need for orthognathic treatment based on facial appearance than did patients. Surgeons also rated greater overall need for treatment than patients. In addition, surgeons rated treatment need based on facial appearance and function significantly higher than orthodontists, but large variations existed in both clinician groups.