Factors influencing satisfaction with the process of orthodontic treatment in adult patients

Patients' perceptions matter: Risk communication and psychosocial factors in orthodontics

INTRODUCTION

Effective risk communication is essential for achieving patient-centered oral health care, but the limited understanding of patients' subjective perceptions of orthodontic-related risks hinders this process. This study aimed to investigate adults' awareness, concerns, and risk-avoidance behaviors about long-term orthodontic risks, exploring their relationship with psychosocial factors.

METHODS

We included 498 adult patients (mean age, 27.3 ± 6.8 years; women, 75.5%) during their initial visits to the orthodontic department at a hospital in Chengdu, China. Participants' understanding of orthodontic risks was gauged before and after exposure to the Oral Health Education Comics (OHEC), a specifically designed digital tool. Concurrently, we used logistic regression models to investigate the associations between patients' depression, anxiety, self-esteem, perfectionism, and dentofacial esthetics with risk perceptions.

RESULTS

Approximately 79.5% of participants initially reported low awareness of orthodontic risks, with most knowledge from online sources. Notably, the percentage of participants with high awareness increased to 64.8% after OHEC. The negative facial soft-tissue change was most concerning for participants: 53.4% showed high concerns, and 28.1% showed high avoidance. Furthermore, linear regression indicated positive associations between depression (β = 0.42 [95% confidence interval {CI}, 0.07-0.77]) and anxiety (β = 0.76 [95% CI, 0.35-1.18]) with orthodontic risk concerns, whereas risk avoidance was positively associated with depression (β = 0.62 [95% CI, 0.27-0.97]), anxiety (β = 1.09 [95% CI, 0.68-1.50]), and perfectionism (β = 0.24 [95% CI, 0.02-0.46]).

CONCLUSIONS

Findings emphasize the imperative of streamlined risk communication in orthodontics. By incorporating comprehensible tools such as OHEC and integrating psychosocial evaluations, more refined patient-practitioner communication and psychosomatic-based dental care can be achieved.

Treatment acceptance in adult patients with anterior open bite: A National Dental Practice-Based Research Network study

INTRODUCTION

Orthodontists have many techniques to treat anterior open bites and must involve patients in making treatment decisions. This study aimed to investigate orthodontic treatment plan acceptance by United States adults with anterior open bites and to identify associations between treatment acceptance and patient demographics and dentofacial characteristics.

METHODS

A prospective, observational cohort study enrolled the patients of 91 orthodontic providers. A total of 345 adults were included in the sample. Provider personal and practice demographics were captured. Patient demographics, treatment goals, dentofacial characteristics, and reasons for not accepting the recommended plans were recorded. Adjusted regression models were used to identify associations between patient characteristics and the likelihood of accepting the most highly recommended plan.

RESULTS

Approximately 78% of patients accepted the most highly recommended treatment plan. 60% of the patients who were recommended surgical plans accepted them. Patients with a history of orthodontics and a concave profile were more likely to accept the most highly recommended plan. Insurance coverage for orthognathic surgery was associated with a higher acceptance rate for surgery. Severe crowding was associated with a lower acceptance of surgery. The most common reasons for declining the recommended plan were not wanting jaw surgery and considering the treatment to be too invasive, risky, and/or costly.

CONCLUSIONS

Patient acceptance is less common at higher levels of invasiveness of treatment. Prior orthodontic treatment, concave profile, and insurance coverage for surgery were associated with accepting treatment. Most patients accepted a surgical plan when it was the most recommended option.

Adult orthodontics, motivations for treatment, choice, and impact of appliances: A qualitative study

INTRODUCTION

Understanding the rationale for adult patients undertaking orthodontic treatment and the impact of appliances on their quality of life has become increasingly important to research efforts and clinical care. This study aimed to understand why adult patients undergo orthodontic treatment and their overall experience with the choice of appliance.

METHODS

A cross-sectional qualitative study using semistructured interviews with adult patients from 4 private specialist orthodontic practices in the London region involving a purposive homogeneous sampling technique to obtain variation regarding gender, treatment modalities (fixed ceramic [FC], removable aligner [RA], and fixed lingual [FL] appliances), and stages of treatment (early, late, and posttreatment stage) was undertaken. A piloted topic guide was used to standardize data collection. Interviews were audio recorded, and field notes were taken. Data were transcribed verbatim and analyzed using framework methodology until data saturation was reached.

RESULTS

A total of 22 participants (FC, 8; RA, 8; and FL, 6), with a mean age of 38.9 ± 11.7 years, with the majority being female (n = 13; 59.1%), were interviewed. Psychosocial and dental health-related factors were reported as the main reasons to seek orthodontic treatment. Social factors and appliance features influence an adult's decision-making in selecting a specific orthodontic appliance. Wearing FC, RA, and FL was seen to have both positive and negative impacts on an adult's quality of life. Functional and psychological factors were the strong influencers on patients' treatment experience.

CONCLUSIONS

The study highlighted the influence of psychosocial factors and dental health concerns in the decision-making processes of adults seeking orthodontic treatment. FC, RA, and FL appear to affect an adult's quality of life, with functional and psychosocial factors being commonly reported.

Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making

OBJECTIVES

To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA).

METHODS

This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence.

CONCLUSIONS

This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.

Evaluation of relational factor in patient satisfaction with the treatment received by dental students

INTRODUCTION

The study focused on the importance of the relational factor and empathy in the general satisfaction of patients for the treatment received by university dental students. To achieve this objective, a tool capable of evaluating the most humanistic dimensions (empathy, kindness, trust) in the development of dental treatment has been designed.

MATERIALS AND METHODS

A review of the literature was carried out and, based on its findings, a questionnaire was designed to assess patient satisfaction with the dental student's empathy. It consisted of 20 questions and was completed by 80 patients. The questionnaire was subjected to a validation process using the Delphi method (content validity) and psychometric analysis (construct validity), through a principal components analysis (PCA).

RESULTS

The results of the PCA showed the existence of four components that suggest grouping the 20 questions into three blocks with a sequential structure, in which the questions would describe the patient's satisfaction throughout their treatment: reception and explanation of the treatment; development and progress of treatment; and expectations and completion of treatment. In each of these blocks, satisfaction was determined by a specific humanistic dimension: communication, trust and benevolence.

CONCLUSION

The validated questionnaire is an effective tool to analyse the relational factors that determine patient satisfaction in a treatment. Furthermore, the analysis of the questionnaire suggests that communication, trust and benevolence are elements that acquire singular importance throughout the care process. This analysis is essential for the acquisition of humanistic skills by future professionals and to optimize the dentist-patient relationship.

Changes in biomarkers levels from gingival crevicular fluid in pre- and postmenopausal women undergoing orthodontic treatment : A systematic review

PURPOSE

This study aimed to verify whether there is a difference in biomarker levels in the gingival crevicular fluid between premenopausal and postmenopausal women undergoing orthodontic treatment.

METHODS

As eligibility criteria, prospective or retrospective observational studies evaluating women undergoing orthodontic treatment (P), comparing postmenopausal (E) and premenopausal (C) women, and analyzing differences in gingival crevicular fluid biomarkers (O) were included. An electronic search was conducted in seven databases (PubMed, Scopus, Web of Science, LILACS, The Cochrane Library, Embase, and EBSCO: Dentistry & Oral Science) and one grey literature source (Google Scholar). All databases were searched from September 2022 to March 2023. After duplicate exclusion and data extraction, the Newcastle-Ottawa scale was applied to assess the quality and risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) tool was used to verify the certainty of evidence.

RESULTS

Three case-control studies that analyzed receptor activator of nuclear factor kappa‑B ligand (RANKL), osteopontin (OPN), and interleukin (IL)-17A levels were included. One study reported a significant difference for RANKL and another for OPN levels. A third study reported that there was a higher expression of IL17‑A in the postmenopausal group. However, the small number of articles limits our systematic review. The heterogeneity and imprecision in the study results cast doubt on the findings' internal validity.

CONCLUSION

The studies reported alterations in biomarker levels but differed in their conclusions. Therefore, further studies must include other types of bone and inflammatory biomarkers in female patients who are pre- or postmenopausal and undergoing orthodontic treatment.

REGISTRATION

The review was registered at the Open Science Framework ( https://doi.org/10.17605/OSF.IO/Q9YZ8 ).

GDF15 Modulates the Zoledronic-Acid-Induced Hyperinflammatory Mechanoresponse of Periodontal Ligament Fibroblasts

Orthodontic tooth movement (OTM) is thought to be impeded by bisphosphonate (BP) therapy, mainly due to increased osteoclast apoptosis and changes in the periodontal ligament (PdL), a connecting tissue between the alveolar bone and teeth. PdL cells, mainly fibroblasts (PdLFs), are crucial regulators in OTM by modulating force-induced local inflammatory processes. Recently, we identified the TGF-β/BMP superfamily member GDF15 as an important modulator in OTM, promoting the pro-inflammatory mechanoresponses of PdLFs. The precise impact of the highly potent BP zoledronate (ZOL) on the mechanofunctionality of PdLFs is still under-investigated. Therefore, the aim of this study was to further characterize the ZOL-induced changes in the initial inflammatory mechanoresponse of human PdLFs (hPdLFs) and to further clarify a potential interrelationship with GDF15 signaling. Thus, two-day in vitro treatment with 0.5 µM, 5 µM and 50 µM of ZOL altered the cellular properties of hPdLFs partially in a concentration-dependent manner. In particular, exposure to ZOL decreased their metabolic activity, the proliferation rate, detected using Ki-67 immunofluorescent staining, and survival, analyzed using trypan blue. An increasing occurrence of DNA strand breaks was observed using TUNEL and an activated DNA damage response was demonstrated using H2A.X (phosphoS139) staining. While the osteogenic differentiation of hPdLFs was unaffected by ZOL, increased cellular senescence was observed using enhanced p21Waf1/Cip1/Sdi1 and β-galactosidase staining. In addition, cytokine-encoding genes such as IL6, IL8, COX2 and GDF15, which are associated with a senescence-associated secretory phenotype, were up-regulated by ZOL. Subsequently, this change in the hPdLF phenotype promoted a hyperinflammatory response to applied compressive forces with an increased expression of the pro-inflammatory markers IL1β, IL6 and GDF15, as well as the activation of monocytic THP1 cells. GDF15 appeared to be particularly relevant to these changes, as siRNA-mediated down-regulation balanced these hyperinflammatory responses by reducing IL-1β and IL-6 expression (IL1B p-value < 0.0001; IL6 p-value < 0.001) and secretion (IL-1β p-value < 0.05; IL-6 p-value < 0.001), as well as immune cell activation (p-value < 0.0001). In addition, ZOL-related reduced RANKL/OPG values and inhibited osteoclast activation were enhanced in GDF15-deficient hPdLFs (both p-values < 0.0001; all statistical tests: one-way ANOVA, Tukey's post hoc test). Thus, GDF15 may become a promising new target in the personalized orthodontic treatment of bisphosphonatepatients.

Semantic equivalence of the Brazilian version of the Patient Satisfaction Questionnaire (B-PSQ)

The Patient Satisfaction Questionnaire (PSQ) is a self-administered instrument to assess adolescent patients' satisfaction with orthodontic treatment. A pre-existing North American instrument was further explored in the Netherlands. Semantic equivalence is part of cross-cultural adaptation and is necessary to achieve a valid and reliable instrument for a specific culture. The present study aimed to evaluate the semantic equivalence of the items, subscales, and overall PSQ between the original English version and the Brazilian Portuguese language version (B-PSQ). The PSQ has 58 items, distributed across 6 subscales: doctor-patient relationship, situational aspects of the clinic, dentofacial improvement, psychosocial improvement, dental function, and a residual category. Semantic equivalence was evaluated according to the following methods: (1) independent translations to Portuguese by two translators, both native in Brazilian Portuguese and fluent in English; (2) an expert committee drafted the first summarized version in Portuguese; (3) two independent back-translations into English by two native English-speaking translators fluent in Portuguese; (4) committee review; (5) committee drafted a summarized version of the back-translations; (6) expert committee drafted the second summarized version in Portuguese; (7) pre-test of the instrument using individual semi-structured interviews with 10 adolescents; (8) review and final version of the B-PSQ. Semantic equivalence between the original and the Brazilian versions of the questionnaire was achieved through diligent and rigorous methods, with effective translation and expert evaluations, incorporating the opinions of the target population.

Clinical communication in orthodontics: Any questions?

OBJECTIVE

To measure patient-perceived standards of clinician communication and identify elements of deficient performance. Good communication can improve the quality of care, patient satisfaction and compliance with treatment.

DESIGN

Cross-sectional questionnaire service evaluation.

SETTING

Two university dental hospital orthodontic departments.

PARTICIPANTS

Any patients aged 10 years and over attending the orthodontic department for treatment or consultation were eligible for inclusion. Patients who required third-party translation services were excluded.

METHODS

Clinicians provided the modified 15-item Communication Assessment Tool (CAT) to up to five patients in a clinical session. A front sheet for clinician characteristics was used and anonymised with a unique identifier. Univariable logistic GEE models examined associations among responses and clinician characteristics.

RESULTS

There were 55 clinicians with 204 patient responses. The overall percentage of '5=excellent' ratings was 88% (SD 0.16). The lowest scoring item was 'encouraged me to ask questions' (55.8%). Based on clinician characteristics, there were lower odds of an excellent response for certain CAT items. There were higher odds of an excellent response if English was not the clinician's first language (1.05; 95% confidence interval = 1.00-1.09; P=0.03).

CONCLUSION

There is a high standard of patient-clinician communication in the hospital orthodontic setting. Key areas of communication that require attention include encouraging patients to ask questions, talking in terms they can understand, recognising their main concerns and involving them in the decision-making process. The results of this study can be used to inform communication skills training and be replicated in similar dental settings (primary and secondary care) as part of quality improvement.

Perceived quality factors that discriminate parents of orthodontic patients according to their satisfaction

Purpose

Monitoring the perception of quality by parents and the satisfaction with their children’s treatment is crucial in developing high-level health-care services. The purpose of this paper is to identify the perceived quality factors by parents of paediatric orthodontic patients according to the levels of satisfaction.

Design/methodology/approach

A survey with 316 parents of paediatric orthodontic patients of 45 offices in a big Brazilian city was conducted. The questionnaires included statements on the parents’ satisfaction and perception of quality concerning their children’s treatment. The data were analysed using multivariate statistics (exploratory factor analysis, cluster analysis and discriminant analysis).

Findings

Parents were classified into three clusters according to their level of satisfaction. This survey identified 11 quality factors perceived by parents of patients regarding their children’s orthodontic treatment. Among them, five factors discriminated the clusters: orthodontist’s technical skills, administrative organisation, location (accessibility and convenience), treatment duration and dental supplies.

Practical implications

This research identified the perceived quality factors that most impacted parents of orthodontic patients’ satisfaction, contributing to dentists in developing strategies and actions to improve the quality of services in dental offices.

Originality/value

This paper included 11 perceived quality factors in the hypothetical model, identified through literature review and a qualitative phase. Moreover, multivariate statistical analyses confirmed the validity and reliability of the questionnaires, classified respondents in clusters and identified the perceived quality factors that most discriminated them. Therefore, the current investigation presented a more comprehensive and robust analysis than the previous studies on this topic.

Adolescents' perception of malocclusion, their motivations, and expectations concerning the orthodontic treatment. Is it all about attractiveness? A qualitative study

INTRODUCTION

In addition to essential clinical parameters, orthodontic treatment outcomes should also consider patients' opinions and perceptions, which could be comprehensively clarified with a qualitative scientific approach. Considering that the information on younger patients' views is scarce, the objective of this study was to investigate how adolescent orthodontic patients perceive malocclusion, and their motivations and expectations concerning orthodontic corrective treatment.

METHODS

In this descriptive qualitative study, 12 adolescents aged 12 to 14 years and of both genders, covering a heterogeneous collection of malocclusions, were recruited from the waiting list of an Orthodontics Graduate Course. They were individually interviewed before the appliance insertion by an experienced researcher using an interview guide and photographic records to stimulate patients' self-perception of their oral condition. The interviews proceeded simultaneously with transcription analyses until saturation. After the transcription evaluation, the framework analysis technique was performed.

RESULTS

Data derived from the transcription analyses were grouped into 3 major themes: perceptions concerning the concepts of normality and abnormality regarding oral health; self-perceptions regarding malocclusion and other discrepancies; and motivations for seeking orthodontic treatment and expectations related to the results.

CONCLUSIONS

Attractiveness was exceptionally relevant among adolescent patients. Most interviewees seemed to focus their attention on esthetically upsetting dentofacial traits, which they expected to be corrected by orthodontic treatment. In addition to self-oriented appearance-driven motivations, parents, other health professionals, friends, and peers also influenced adolescents' perception of their need for treatment. The achievement of a normal dentofacial status seems to be closely attached to social and individual aspirations.

Communication tools and patient satisfaction: A scoping review

Objective

This scoping review aimed to present an overview of the literature on communication tools in esthetic dentistry. A variety of communication tools have been proposed to include patients in the shared decision‐making (SDM) workflow. Only little is known about implementing communication tools in dentistry and their impact on patient communication and patient satisfaction. A systematic literature search was performed in Medline, Embase, Cochrane, and World of Science to identify if communication tools have an impact on patient satisfaction.

Material and Methods

The search included studies from January 1, 2000 to March 3, 2020 published in English, focusing on patient communication tools and patient satisfaction in esthetic dentistry.

Results

Out of 6678 records, 53 full‐texts were examined. Ten studies were included. Data of the included studies were extracted systematically and subsequently analyzed. All studies found that patient communication utilizing specific communication tools positively impacted either patient satisfaction, patient‐dentist relationship, information retention, treatment acceptance, quality of care or treatment outcome.

Conclusions

Additional communication tools besides conventional verbal communication are able to enhance patient satisfaction, improve quality of care and establish a better patient‐dentist relationship. It seems essential to further develop standardized communication tools for SDM in dental medicine, which will allow the comparison of research on this topic.

Clinical significance

This scoping review shows the importance of patient involvement in the decision‐making process for improved patient satisfaction with esthetic dental treatments. With an increased implementation of communication tools, patient satisfaction and SDM may further improve in the future.

Effect of universal adhesive and silane pretreatment on bond durability of metal brackets to dental glass ceramics

This study aimed to investigate the effect of universal adhesive and silane pretreatment on the bond durability of metal brackets to dental glass ceramics. Eighty lithium disilicate glass ceramic specimens were randomly assigned to one of four groups (n = 20) defined by the pretreatment and adhesive used: (i) Adper Single Bond 2; (ii) silane + Adper Single Bond 2; (iii) Single Bond Universal; and (iv) silane +Single Bond Universal. Maxillary central incisor metal brackets were bonded on the ceramic surfaces with resin composite. A shear bond strength test was conducted after 24 h of water storage and after 10,000 thermocycles. Adhesive remnant index scoring and field-emission scanning electron microscopy were performed to determine adhesives remaining on the ceramic surfaces and the ceramic ultrastructure following bracket debonding, respectively. After 10,000 thermocycles, specimens treated with Single Bond Universal preserved an appropriate bond strength between brackets and glass ceramics and showed minimum ceramic surface damage following bracket debonding, which was not the case in the other three groups. The application of a silane-containing universal adhesive without silane pretreatment achieves adequate durability of the bond of metal brackets to dental glass ceramics and allows safe debonding, which may aid in optimizing the effectiveness for orthodontic treatment.

Conservative treatment in adult patient with reimplanted anterior teeth after traumatic avulsion with extensive bone loss: an 8-year follow-up

INTRODUCTION

Orthodontic treatment in patients with traumatized teeth is a condition that needs good planning in order to achieve satisfactory results.

OBJECTIVE

To discuss approaches to orthodontic treatment of malocclusions associated with trauma followed by avulsion of anterior teeth, reimplanted after a short period of time.

CASE REPORT

The treatment started with the distalization of upper posterior teeth, with the aid of mini-implants and sliding jigs, followed by the inclusion of anterior teeth in the arch, followed by intrusion of these teeth.

RESULTS

With the treatment, improved mobility of the anterior teeth was achieved, with better insertion into bone tissue. The most important factor for satisfactory treatment and a good prognosis for avulsion is the time the tooth remains outside the socket. Orthodontic treatment in patients with traumatized teeth is not contraindicated; however, clinical and radiographic aspects must be considered.

CONCLUSION

Among the feasible orthodontic treatment options, the conservative approach can be a very favorable treatment alternative.

Compressive force strengthened the pro-inflammatory effect of zoledronic acid on il-1ß stimulated human periodontal fibroblasts

OBJECTIVES

The number of patients in dentistry taking bisphosphonates (BP) increases every year. There are only little data about the influence of biomechanical stress due to orthodontic treatment and periodontal inflammation in BP patients. This study focused on the effects of the induced inflammation by IL-1ß in compressed human periodontal ligament fibroblasts (HPdLF) exposed to the nitrogen-containing BP zoledronate in vitro.

MATERIALS AND METHODS

HPdLF were incubated with 5 μmol/l zoledronate and 10 ng/ml IL-1ß for 48 h. In the last 3 h, cells were exposed to a compressive, centrifugal force of 34.9 g/cm². Cell viability was analyzed directly after the compressive force by MTT assay. Gene expression of COX-2 and IL-6 was investigated using quantitative qRT-PCR. PGE-2 and IL-6 protein secretion were measured via ELISA.

RESULTS

The cell viability of HPdLF was not affected. Without inflammatory pre-stimulation, COX-2 expression was increased by compression and zoledronate. IL-6 expression was increased under compression. On secretion level, the combination of compression and zoledronate induced a slightly increase of IL-6 secretion. In contrast, inflammatory pre-stimulation strengthened the compressive upregulation of COX-2, as well as induced a higher PGE-2 secretion. Further addition of zoledronate to pre-stimulated cells additionally strengthened the compression-induced upregulation of COX-2 and IL-6 expression as well as protein secretion compared to all other groups.

CONCLUSIONS

Biomechanical stress might trigger a pro-inflammatory potential of BP further enhanced in the presence of an inflammatory pre-stimulation.

CLINICAL RELEVANCE

To prevent excessive host inflammatory responses, occlusal overloading and mechanical stress due to orthodontic treatment should be avoided in BP patients with untreated periodontitis.

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

Patient-centered assessments: how can they be used in dental clinical trials?

Recently, there has been greater interest in adopting a more holistic approach to healthcare. However, this trend should not limit itself merely to the notion that a human being lies behind the mouth being treated. Rather, it should embrace the understanding that this human can actively participate in and contribute to the treatment process. Patient Report Outcome Measures (PROMs) and Patient Report Experience Measures (PREMs) provide means for measuring data from the patient's perspective, and enable health-related feelings and functions to be evaluated. Accordingly, this critical review aims to provide definitions, rationales and applications of patient-centered approaches in dental clinical research. Some patient-centered constructs are especially relevant to dental clinical trials, such as oral health-related quality of life, pain/discomfort, aesthetics and satisfaction concerning treatment and services. The selection and application of patient-reported measures can vary according to condition (generic, disease-specific or treatment-specific) and to the specific population evaluated (age and cognitive impairment). These measures can help weigh risks and benefits, as well as assess the cost effectiveness of treatments, thus influencing treatment recommendations and health policies. The incorporation of these measures into a professional's daily life not only represents an improvement in professional performance, but also addresses a humanitarian concern.

Patient Interviewing Strategies to Recognize Substance Use, Misuse, and Abuse in the Dental Setting

Brief and effective clinical interviewing is critical for identifying patient risk factors, including those associated with substance use. Dental practitioners may perceive identifying patient substance misuse and abuse as a complex undertaking or may consider this clinical assessment beyond the scope of their training and practice. This article describes interviewing strategies that will help dental providers communicate effectively and empathically with their patients to collect relevant clinical information related to substance use, misuse, and abuse and provide better care for their patients.

Patient-reported experience and outcomes from orthodontic treatment

OBJECTIVE

To measure patient-reported impact of orthodontic treatment in terms of pre-treatment concerns, treatment experience and treatment outcome.

SETTING

Four sites in Yorkshire, including two secondary care settings (Leeds Dental Institute and St Luke's Hospital, Bradford) and two specialist orthodontic practices.

DESIGN

Cross-sectional survey.

PARTICIPANTS

NHS orthodontic patients (aged 12+ years) who have completed comprehensive orthodontic treatment, excluding orthognathic surgery and craniofacial anomalies.

METHODS

Participants were opportunistically identified by the direct clinical care team during scheduled appointments and those eligible were invited to participate. Data were collected using the Orthodontic Patient Treatment Impact Questionnaire (OPTIQ), a validated 12-item measure with questions relating to pre-treatment experience, impact of treatment and outcome from treatment.

RESULTS

Completed questionnaires for analysis included 120 from primary care and 83 from secondary care. The most common pre-treatment concerns were alignment (89%) and being embarrassed to smile (63%). The most common expectations from orthodontic treatment were improved confidence to eat (87%) and smile (72%) in front of others, improved appearance of teeth (85%) and reduced teasing/bullying (63%). Only 67% respondents recalled receiving written information and the lowest recall related to retainer type and length of retention. The most commonly reported complications were sore mouth (68%), fixed appliance breakage (61%) and gingivitis (39%). Treatment caused greatest impact in relation to pain, limitations in eating and effect on speech. Overall satisfaction with orthodontic treatment was reported by 96% of respondents, 87% would have orthodontic treatment again (if needed) and 91% would recommend treatment to a friend.

CONCLUSIONS

The OPTIQ is a useful patient-reported tool to identify pre-treatment concerns and expectations, treatment experience and outcome. Orthodontic treatment leads to high levels of satisfaction.

Valid consent and orthodontic treatment

Valid patient consent is a legal and ethical principle that is fundamental to healthcare provision. Oral health practitioners (OHPs) must understand the principles that need to be addressed to ensure that the consent given by a patient is valid. Failure to obtain consent may result in a negligence claim or a complaint of professional misconduct against the OHP. Orthodontic treatment is mostly elective but is not without risk to the patient. Obtaining and maintaining valid consent for orthodontic treatment presents additional challenges in comparison with other dental procedures as the treatment lasts over a longer time and is most commonly performed in adolescents. In addition, prospective patients need to be informed regarding ‘lifelong’ management in the retention phase to minimise the risk of relapse. The present paper outlines the principles of valid consent with particular regard to orthodontic treatment in the adolescent patient. OHPs must ensure that they are satisfied that the competent patient has the capacity to voluntarily consent. Clinicians must also recognise that valid consent is not a one-off ‘tick the box’ procedural exercise but an ongoing process of effective information sharing in light of changing laws and an ever-changing scientific evidence base within a patient-centred model of healthcare.