Socioeconomic disparities in orthodontic treatment outcomes and expenditure on orthodontics in England's state-funded National Health Service: a retrospective observational study

Keeping track: An intra-UK comparison of orthodontic commissioning and treatment outcome assessments

INTRODUCTION

Across the United Kingdom (UK), National Health Service (NHS) orthodontic treatment is commissioned differently across the devolved nations. There is a relative paucity in the literature describing the way in which the orthodontic services in each country are commissioned and treatment outcomes measured.

OBJECTIVE

To highlight the differences in the following: commissioning of primary care orthodontic services across the UK; assessment of treatment outcomes; and the potential impacts these differences have on contractors, performers and patient care.

MATERIALS AND METHODS

Data were collected using an online mixed-methods approach. Systematic content analysis was used to extract the required information from the websites and guidance documents of orthodontic service providers, which was then catalogued and verified electronically by senior dental advisors in the four devolved UK nations.

RESULTS

The Index of Orthodontic Treatment Need (IOTN) is a mandatory needs assessment tool used across all four nations, with an agreed minimum threshold of a dental health component (DHC) score of 3 and an aesthetic component (AC) score of 6 for NHS treatment. While the peer assessment rating (PAR) is the most utilised method of assessing post-treatment outcomes, it is applied differently by each country.

CONCLUSION

While NHS orthodontic services across the UK share mutual elements of service delivery, there are significant differences in the prior approval process and assessment of treatment outcomes. More research is required to assess the economic feasibility of orthodontic treatment from the associated treatment outcomes.

Unlocking the potential of NHS primary care dental datasets

Introduction Maximising the use of routinely collected health data for research is a key part of the UK Government's Industrial Strategy. Rich data are generated by NHS primary care dental services, but the extent of their use in research is unknown.Aims To profile the utility of the post-2006 NHS dental datasets for research, map how they have been used to date and develop recommendations to maximise their utility.Methods The content of and access to the four UK NHS dental datasets was collated using publicly available information and a free-text questionnaire, completed by the relevant data controllers. A scoping review was carried out to identify and map literature that has utilised NHS dental activity data.Results The contents of the UK NHS dental activity datasets are described, alongside how they may be accessed for research. Strengths and weaknesses of these datasets for research are highlighted. The scoping review identified 33 studies which had utilised NHS dental activity data since 2006. We classified 15 as public health practice, 11 as service evaluation and 7 as research.Conclusion In comparision to other NHS activity datasets, it appears that the UK dental datasets have been underutilised for research. We make 11 recommendations on how their utility for research may be increased.

Treatment efficiency of activator and skeletal anchored Forsus Fatigue Resistant Device appliances

OBJECTIVES

The aim of the study was to investigate the treatment efficiency of miniplate anchored Forsus Fatigue Resistant Device (MAF) as compared with the activator appliance.

MATERIALS AND METHODS

Mandibular retrognathia was treated with two methods, the MAF group (8 girls, 11 boys, mean age 13.03 ± 0.69 years) and the activator group (7 girls, 12 boys, mean age 12.68 ± 0.73 years). An untreated control group (9 girls, 10 boys, mean age 12.95 ± 0.73 years) was constructed to eliminate growth-related changes through the American Association of Orthodontists Foundation Legacy Collection. Data of 114 lateral cephalograms were analyzed.

RESULTS

The inhibition of the maxillary growth was greater in the MAF group, whereas forward displacement of the mandible was higher in the activator group (P < 0.05). Sagittal maxillomandibular relation was improved similarly in both treatment groups (P < 0.05). Mandibular length was increased in both treatment groups with the highest increase in the activator group (P < 0.05). Retroclination of the incisors was observed in the MAF group (P < 0.05). The upper lip was retruded in the MAF group and lower lip was protruded in the activator group (P < 0.05).

CONCLUSION

The activator created greater mandibular changes, whereas the MAF provides somewhat smaller mandibular changes due to the restriction caused by retroclined maxillary incisors.

CLINICAL RELEVANCE

Although both MAF and activator treatments caused favorable maxillomandibular changes, new treatment alternatives that reduce dentoalveolar side effects and eliminate patient cooperation are still required to achieve skeletal correction in class II malocclusion treatment in growing patients.

Influence of increased body mass index on orthodontic tooth movement and related parameters in children and adolescents: A systematic review of longitudinal controlled clinical studies

Objectives:

To assess the impact of increased body mass index (BMI) on orthodontic tooth movement (OTM) and related parameters in children and adolescents.

Search sources:

A search of six electronic databases and manual searching were performed up to June 2019 without language and time restrictions.

Data selection:

Eligibility criteria were as follows: (1) longitudinal controlled clinical studies; (2) children and adolescents undergoing orthodontic therapy (OT); (3) no systemic diseases; (4) experimental group: patients with increased BMI; and (5) control group: patients with normal BMI.

Data extraction:

Screening, study selection and data extraction were performed; bias within studies was assessed using the Risk of Bias In Non-randomised Studies (ROBINS-I) tool.

Results:

Seven studies were included. One study showed that an increased BMI is associated with less wear-time of removable orthodontic appliances and one study found no significant association. One study showed that an increased BMI is associated with less cooperation during OT; however, not with the treatment results. One study reported higher pain experience during OT in adolescents with than without increased BMI. Two studies showed that increased BMI in adolescents is related to OTM, one with increased and one with decreased rates of OTM, respectively. One study reported an association between increased BMI and incidence of white spot lesions and gingivitis during OT. The ROBINS-I tool showed low to moderate risk of bias within studies.

Conclusions:

The influence of BMI on OTM and related parameters in children and adolescents remains debatable.