Relationship between orthodontic expertise and perception of treatment needs for maxillary protrusion: Comparison of dental students, residents, and orthodontists

The effects of professional expertise on perceptions of treatment need in patients with class II division 1 malocclusion: a comparison between orthodontists, general dentists, and lay people in Germany

PURPOSE

This study aimed to compare the perception of practitioners with varying levels of expertise and laypeople regarding the orthodontic treatment need and facial harmony in patients with increased anterior overjet.

METHODS

Three groups of observers (orthodontists, general dentists, and laypeople, in total n = 48) were asked to rate on images-using a 10-point visual analog scale (VAS)-the facial harmony and treatment need of a sample of 8 patients with class II division 1 malocclusion and overjets of 2, 4, 6, and 8 mm.

RESULTS

Statistically significant differences were observed between the three groups of observers regarding patients with an overjet of 4 mm and above (p < 0.001). Treatment need was perceived at an overjet of 4 mm by orthodontists and 6 mm by general dentists, whereas laypeople did not perceive a need for treatment in any of the groups (p < 0.001). Regarding perception of facial harmony, orthodontists had the lowest threshold (4 mm overjet), while dentists followed at a greater overjet of 6 mm or more (p < 0.001). A statistically significant correlation between the noticed facial harmony and the perceived orthodontic treatment need was found in all observers (p < 0.001).

CONCLUSION

The perceived orthodontic treatment need for class II division 1 malocclusion increased with increasing professional expertise.

A predictive rule for mortality of inpatients with Staphylococcus aureus bacteraemia: A classification and regression tree analysis

OBJECTIVE

To create a predictive rule to identify risk factors for mortality among patients with Staphylococcus aureus bacteraemia (SAB).

DESIGN, SETTING AND PATIENTS

This was a retrospective cohort study of all adult patients with SAB at a large community hospital in Tokyo, Japan, from April 1, 2004 to March 31, 2011. Baseline data and clinically relevant factors were collected from electronic charts. The primary outcome was in-hospital mortality. All candidate predictors were included in a classification and regression tree (CART) analysis. A receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was obtained. A cross-validation analysis was performed.

MEASUREMENTS AND MAIN RESULTS

A total of 340 patients had SAB during the study period. Of these, 118 (34.7%) patients died in hospital. Among 41 potential variables, the CART analysis revealed that underlying malignancy, serum blood glucose level, methicillin resistance, and low serum albumin were predictors of mortality. The AUC was 0.73 (95% CI: 0.67-0.79). For validation, the estimated risk was 0.26 (± SE: 0.02) in the resubstitution analysis and 0.33 (± SE: 0.03) in the cross-validation analysis.

CONCLUSION

We propose a predictive model for the mortality of patients with SAB consisting of four predictors: underlying malignancy, low serum albumin, high glucose, and methicillin resistance. This model may facilitate appropriate preventative management for patients with SAB who are at high risk of mortality.

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BACKGROUND

The authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.

METHODS

The authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.

RESULTS

Sixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.

CONCLUSIONS

WSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist. Clinical implications. General dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.