C. D. Stephens

Quality control in orthodontics: indices of treatment need and treatment standards

Two reliable and valid occlusal indices have been developed to assess treatment need (Index of Treatment Need, IOTN) and the standard of treatment (The PAR Index, Peer Assessment Rating). The IOTN assesses both dental aesthetics and dental health need. The PAR index provides a single summary score for the overall alignment and occlusion. The difference between the pre- and post-treatment scores reflects the degree of improvement and the success of orthodontic intervention and active treatment. Several practical uses of the indices are described: the estimation of treatment need in an unselected and a referred population and the assessment of the standard of treatment in the Hospital and General Dental Services. It has been suggested that the use of the occlusal indices would offer several advantages: (1) uniformity in prescribing patterns, (2) safeguards for the patient, (3) patient counselling and (4) monitoring and promoting standards

Orthodontics in the general dental service of England and Wales: a critical assessment of standards

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered

The relationship between the index of orthodontic treatment need and consensus opinion of a panel of 74 dentists.

This study looked at the aesthetic and dental health components of the index of orthodontic treatment need in relation to peer assessment of dental health and aesthetic need (panel of 74 dentists). The dental health component had a Spearmans correlation coefficient of +0.64 and the aesthetic component +0.86 when compared with the mean subjective opinion of 74 dentists. It has been proposed to have three categories for both the dental health and aesthetic components in accordance with consensus opinion. The panel of 74 examiners were more likely to regard aesthetics as a greater need for treatment than dental health

Computer-assisted learning in dentistry a view from the UK

OBJECTIVES The objectives of this paper are to review the development and impact of computer assisted learning (CAL) in dentistry with emphasis on the UK. DATA SOURCES This is a wide ranging review of dental, medical and technical literature. STUDY SELECTION An attempt has been made to evaluate present knowledge in an objective manner and to make some prediction as to the future development and use of computer-based teaching methods in dentistry. CONCLUSIONS The introduction of computers as an educational tool in dentistry and the provision of CAL is having an impact not only on how dentists are trained but also on the skills they will need to acquire in the future to keep pace with this new technology. It is suggested that there is a great potential for computer-based continuing professional education for dental practitioners, and that the Internet will provide access to such material.

Storage of Orthodontic Study Models in Hospital Units in the U.K.

Orthodontic study models form an essential part of the dental records of patients undergoing diagnosis and treatment. In order to ascertain the problems encountered by hospital orthodontic units in the utilization and storage of study models, a questionnaire was circulated in February 1991 to members of the Consultant Orthodontists Group. All respondents took pretreatment study models, while 9 per cent took their final study models at some time other than the end of active treatment; 85·5 per cent of respondents stored their study models in their units, but most were beginning to experience difficulties in this regard. There was a wide range for storage times, and only 10 per cent of employing authorities had a stated policy on the storage of study models. There was a highly significant difference (P&z.Ltc;0·001) between the time that models are stored at present, and the desired storage times. Most respondents appeared to be rather uncertain about the precise medico-legal requirements concerning model storage. The implications for audit and medico-legal matters are discussed in the light of these findings.

DENTISTS' OPINIONS OF AN ONLINE ORTHODONTIC ADVICE SERVICE

An online teledentistry service was tested for eight months to determine whether it could help to reduce the high level of inappropriate orthodontic referrals to consultants and provide general dental practitioners (GDPs) with quick access to advice that would enable them to tackle a wider range of cases themselves. Six GDPs took part in the trial and were interviewed after it had been running for four months. The most important conclusions from the interviews were that the process of sending cases was quite straightforward, that teledentistry was a good way of getting advice and that it was popular with both patients and their parents. The GDPs enjoyed the experience and felt that there had been significant benefits, especially in educational terms.

Online orthodontic advice : a protocol for a pilot teledentistry system

A prototype teledentistry service was established that incorporated a PC-based expert system designed to assist in orthodontic cases. It guided the general dental practitioner (GDP) through the assessment of a patients malocclusion and helped ensure that all relevant clinical observations were made and details recorded. The resulting data file, containing radiographic images and clinical data, was then transferred via the Internet to a dental specialist. The specialists recommendations were returned by the same route or, where appropriate, a realtime videoconference was conducted. During an eight-month trial, six GDPs referred 158 cases through the teledentistry system; another 24 cases were referred directly to a local consultant. The protocol used during the trial worked satisfactorily. The GDPs found that it was straightforward and covered all aspects of the cases they submitted.

A Modification to the Incisor Classification of Malocclusion

During the study of two-hundred orthodontic cases under treatment in the General Dental Service, four clinicians showed only moderate agreement using the British Standard Classification of Incisor Malocclusion. Cohens Kappa statistic was used to measure the inter-examiner agreement. The 35 cases in which there was high disagreement between the examiners were scrutinized to determine the source of this disagreement. Following discussion, revised definitions were produced which included the introduction of a Class II-intermediate group. After an interval of 2 months these 35 cases were reclassified using the new definitions. Increased inter-examiner agreement was found. Four examiners (three of whom were common to the original study) then used the modified classification to describe the incisal relationship of 100 cases referred for treatment at Bristol Dental Hospital. The inter-examiner and the intra-examiner agreement were both found to be good. It is recommended that the Incisor Classification of Malocclusion be extended to include a Class II-intermediate group.

Holograms and Study Models Assessed by the PAR (Peer Assessment Rating) Index of Malocclusion—A Pilot Study

A selection of 30 sets of study models, representing a wide range of malocclusions, was drawn from the records of a clinical orthodontic department. Four holograms were made of each set of models; the study models and their corresponding holograms were then scored using the Peer Assessment Rating (PAR) Index of malocclusion. Significantly lower scores (P < 0·01) were obtained from the holograms, which were ascribed to three out of the seven components which make up the index.

Orthodontics in the General Dental Services of England and Wales: the provision of treatment.

A survey has been undertaken on a representative sample of 1210 patients collected from a 5% sampling procedure employed by the Dental Practice Board. Discontinued cases were excluded from the study. It was revealed that the majority of orthodontic treatment was undertaken by practitioners who had in general been qualified for at least 10 years and, in the main, did not possess an orthodontic qualification. The greater proportion of treatment was undertaken using removable appliances, although fixed appliances were used in 43% of prior approval cases and treatments attracted an average fee of 171 pounds (1988 prices). There was a marked variation in the proportion and type of treatment carried out in the various regions within the General Dental Services