Patient-reported outcome measures and orthodontics

Comparison of rapid versus slow maxillary expansion on patient-reported outcome measures in growing patients: a systematic review and meta-analysis

BACKGROUND

No systematic review and meta-analysis are present in the literature comparing patient-reported outcome measures (PROMs) in rapid maxillary expansion (RME) versus slow maxillary expansion (SME) in growing patients.

OBJECTIVE

The objective of this systematic review was to compare PROMs in RME versus SME in growing patients.

MATERIALS AND METHODS

Electronic search in PubMed (MEDLINE), Cochrane Library, Scopus, Embase, Web of Science, and OpenGrey was conducted. Only RCTs were included. Inclusion criteria were: growing patients in the mixed dentition or early permanent dentition, mild-to-moderate maxillary transverse deficiency, dental crowding, treatment with fixed expanders for rapid and slow maxillary expansion. Risk of bias was assessed using RoB 2. GRADE statement was performed. The mean of the differences (MD) and the risk ratio (RR) were used for the aggregation of data. A random effect model was applied.

RESULTS

Two articles with a total of 157 patients were finally included in the systematic review and meta-analysis. One article was at low risk of bias, while one was at risk of bias with some concerns. Pain presence was less, though not statistically significant, in SME patients (RR = 2.02, 95%CI from 0.55 to 7.49, P = 0.29, I² = 95%, 2 studies, GRADE very low). Pain intensity was significantly lower in SME appliance in the first week of treatment (pooled MD = 0.86 favoring SME, 95%CI from 0.47 to 1.26, P < 0.0001, I² = 6%, 2 studies, GRADE moderate). There were no significant differences between the two groups in difficulty in speaking, difficulty in swallowing, hypersalivation, difficulty in hygiene, and patient and parent satisfaction.

CONCLUSIONS

Pain intensity was significantly lower in SME compared to RME during the first week of treatment. For the following weeks, there were no differences in pain between the two protocols.

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.

Occlusal Outcome of Orthodontic Treatment for Patients With Complete Cleft Lip and Palate

AIM

To assess occlusal outcomes of orthodontic treatment for patients with complete cleft lip and palate.

DESIGN

Retrospective assessment using the Peer Assessment Rating (PAR) index.

SETTING

Consecutive patients treated by one consultant orthodontist at a tertiary care cleft center.

PARTICIPANTS

One hundred twenty-seven patients with either complete unilateral cleft lip and palate (UCLP) or bilateral cleft lip and palate (BCLP) consecutively treated with fixed appliances.

INTERVENTION

Fixed orthodontic appliance treatment and orthognathic surgery when required.

OUTCOMES

The PAR index assessment was carried out by a calibrated-independent assessor. Treatment duration, the number of patient visits, and data on dental anomalies were drawn from patient records and radiographs.

RESULTS

One hundred two patients' study models were assessed after exclusions. Mean start PAR score for UCLP (n = 71) was 43.9 (95% CI, 41.2-46.6, SD 11.5), with a mean score reduction of 84.3% (95% CI, 81.9-86.7, SD 10.1). The UCLP mean treatment time was 23.7 months with 20.1 appointments. Mean start PAR score for BCLP (n = 31) was 43.4 (95% CI, 39.2-47.6, SD 11.4), with a mean score reduction of 80.9% (95% CI, 76.3-85.5, SD 12.5). The BCLP mean treatment time was 27.8 months with 20.5 appointments.

CONCLUSION

These results compare well with other outcome reports, including those for patients without a cleft, and reflect the standard of care provided by an experienced cleft orthodontist. As with high-volume surgeons, orthodontic treatment for this high need group is favorable when provided by a high-volume orthodontist. These findings may be used for comparative audit with similar units providing cleft care.

Oral health-related quality of life of adolescents assessed with the Malocclusion Impact and Child Perceptions questionnaires

INTRODUCTION

Our study objectives were to evaluate the impact of malocclusion on oral health-related quality of life (OHRQOL) of adolescents aged 11-14 years in Ile-Ife, Nigeria.

METHODS

Two hundred adolescents completed the Child Perceptions Questionnaire: Impact Short Form (CPQ_11-14-ISF:16) and the Malocclusion Impact Questionnaire (MIQ). The Aesthetic Component of the Index of Orthodontic Treatment Need scale was used to determine malocclusion severity. The effect of sex, age, and socioeconomic class on OHRQOL were determined with the Mann-Whitney U test, Kruskal-Wallis H test, correlation tests, and multiple regression analysis using SPSS (version 22.0; IBM, Armonk, NY). Statistical significance was set at P <0.05.

RESULTS

The CPQ_11-14-ISF:16 and MIQ identified the impact of malocclusion on OHRQOL with mean (standard deviation) scores of 12.85 (10.17) and 8.33 (7.50), respectively. Sex, socioeconomic class, and malocclusion severity had no significant effect on OHRQOL (P >0.05); however, OHRQOL differed significantly between the age groups (CPQ_11-14-ISF:16, P = 0.002; MIQ, P = 0.041). Multiple regression analysis showed that age was a significant predictor of OHRQOL determined with CPQ_11-14-ISF:16 (standardized coefficients B score = -0.242, P = 0.001). MIQ demonstrated good criterion validity with CPQ_11-14-ISF:16 (r = 0.59, P <0.001).

CONCLUSIONS

Both measures CPQ_11-14-ISF:16 and MIQ identified the impact of malocclusion on the OHRQOL of adolescents. Sex, socioeconomic class, and malocclusion severity did not affect OHRQOL; however, age was a significant predictor of OHRQOL. Further studies among orthodontic patient populations are desirable.

Occlusal traits of 4-5-year-old Estonians. Parents' perception of orthodontic treatment need and satisfaction with dental appearance

This study aims to evaluate the prevalence of occlusal traits and to assess parents'/caregivers' satisfaction with child's dental appearance and perception of orthodontic treatment need in 4-5-year-old Estonians. Clinical records and plaster casts of 390 children (190 girls and 200 boys, mean age 4.7 years, range 4 - 5 years) were analyzed. Assessed occlusal traits included deciduous canine and second molar sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Parents'/caregivers' opinions regarding their child's teeth were determined with a questionnaire. The most prevalent occlusal traits were symmetrical sagittal relationship in deciduous canines (78.2%) and molars (75.1%), Class I sagittal relationship in deciduous canines (69.7%) and midline diastema (67.7%). Asymmetrical sagittal canine relationship was registered in 21.8% deciduous canines and in 24.9% second deciduous molars. Parents'/caregivers' perceived orthodontic treatment need was related to Class III sagittal relationship in canines, increased overjet and overbite, negative overbite, and crossbite. Prevalence of most occlusal traits in Estonian children were in line with those reported in neighboring countries. Parents/caregivers were well able to observe occlusal traits that deviated from acceptable occlusion.

Prioritising patients in research and practice – why and how?

There is an increasing emphasis on the incorporation of patient reported outcome measures (PROMs) and patient reported experience measures (PREMs) in healthcare. Development, implementation and adoption of these is fundamental in prioritising orthodontic research and practice.