Jayne E. Harrison

How readable are orthodontic patient information leaflets

Objective To assess the readability of published orthodontic patient information leaflets (PILs) and their eligibility for the Plain English Campaigns Crystal Mark. Design A retrospective, observational study. Setting PILs available from professional organizations and commercial companies. Materials and methods Twenty-six orthodontic PILs were assessed. The entire text of each leaflet was reproduced in Microsoft Word, 2000. Readability statistics were obtained via the ‘Tools’ menu. The design elements of each leaflet were assessed. The leaflets were sent to the Plain English Campaign for assessment of their eligibility for the Crystal Mark. Outcome measures Leaflet and sentence length, passive percentage, Flesch Reading Ease score, Flesch Kincaid Grade Level, design percentage and eligibility for the Plain English Campaigns Crystal Mark. Results Overall, nearly half of the leaflets (42.3%) were rated as ‘fairly difficult’ or ‘difficult’ to read. However, the BOS PILs were significantly better than the AAO leaflets in all but one outcome with the BOS leaflets being rated as ‘standard’ or ‘fairly easy’ to read, meaning that 70–80% of the UK population would be able to understand them. None of the PILs were eligible for the Plain English Campaigns Crystal Mark. Conclusions The orthodontic PILs assessed were difficult to read and none were eligible for the Plain English Campaigns Crystal Mark. However, the BOS leaflets were much easier to read and better designed than those produced by the AAO making them a useful tool to improve patients’ understanding of different treatment options and allowing them to be used in the informed consent process.

Prospective, multi-center study of the effectiveness of orthodontic/orthognathic surgery care in the United Kingdom

INTRODUCTION The aim of this study was to evaluate the effectiveness of orthodontic/orthognathic surgical care provided in the North West region of England. It was an observational, prospective cohort study at 13 maxillofacial clinics in the United Kingdom. METHODS The 131 patients comprised 47 males (35.9%) and 84 females (64.1%), with an average age of 22.6 years. They received orthodontic/orthognathic treatment according to the normal protocols of the operators. They were then followed until all orthodontic treatment was completed. Final skeletal pattern, final peer assessment rating score, number of attendances, and duration of treatment were recorded. RESULTS At the end of the 5-year study, 94 patients had completed treatment, and 71 had complete data. Data analysis showed that, overall, the treatments provided were effective in terms of skeletal and dental occlusal outcomes; the final mean peer assessment rating score was 10.58. However, treatment duration was longer than commonly expected, with a mean length of 32.8 months (SD,11.3). The outcome of treatment was influenced by only pretreatment skeletal discrepancy. CONCLUSIONS This prospective investigation showed that orthodontic/orthognathic surgical care was effective. The outcome of treatment was influenced only by the severity of the pretreatment skeletal discrepancy.

Publication bias: raising awareness of a potential problem in dental research

With the development of evidence-based dentistry it is important to consider how accurate and representative our published pool of evidence is. In this article we will describe publication bias and discuss the causes and potential effects it may have upon the pool of scientific evidence available in dentistry.

Orthodontic Clinical Trials III: Reporting of ethical issues associated with clinical trials published in three orthodontic journals between 1989 and 1998

Aims The aims of this study were to assess whether reports of orthodontic clinical trials complied with the requirements of the Declaration of Helsinki. Design A retrospective observational study. Setting The American Journal of Orthodontics and Dentofacial Orthopedics (AJODO), Journal of Orthodontics (formerly and up until 1999 known as the British Journal of Orthodontics, BJO) and European Journal of Orthodontics (EJO). Data source Clinical trials published between 1989 and 1998. Method A hand search was performed to identify all clinical trials. Each trial report was assessed for inclusion of a statement that ethical approval and/or informed consent had been obtained. Results One-hundred-and-fifty-five papers were identified, of which 85 (54.8%) were reports of randomized controlled trials (RCTs) and 70 (45.2%) of controlled clinical trials (CCTs). 16.1% (25/155), of the trial reports stated that ethical approval had been obtained and a quarter (39/155, 25.1%) indicated that informed consent had been obtained. Conclusions Most orthodontic clinical trial reports failed to state whether ethical approval and/or informed consent had been obtained. The reporting of the ethical issues associated with orthodontic clinical trials could be improved further not only by the instructions to authors in orthodontic journals stating the need for studies to comply with the Declaration of Helsinki, but also by Journal editors refusing to publish trials that do not comply.

An analysis of papers published in the British and European Journals of Orthodontics.

Objectives To identify all randomized controlled trials (RCTs) and compare papers published in two orthodontic journals. Design A retrospective, observational study. Setting The British Journal of Orthodontics (BJO) and European Journal of Orthodontics (EJO). Data source Papers published between 1989 and 1993. Method A hand search of all papers was performed. The type, subject, setting and methods of each paper were classified and recorded. Results 200 papers were identified in BJO and 275 in EJO. Six RCTs were identified which represents 2·8 per cent of clinical research papers. Significant differences were found between the type (P < 0·001), subject (P < 0·001), setting (P < 0·01), and methods (P < 0·05) of papers published in the two Journals. More papers in BJO were case reports clinical opinions, and update articles, and reported on orthodontic materials or assessed methods of measuring the outcome of treatment. Ninety per cent of papers in EJO reported the results of research projects. More papers were related to animal studies; were laboratory based or epidemiological. Conclusion Despite the RCT being regarded as the ‘Gold Standard’ for the evaluation of therapeutic interventions and materials only six (5.1 per cent) of such studies used this method. Significant differences in the type, setting and subject of papers published in BJO and EJO between 1989 and 1993 were found.

Delay and failure to publish dental research

ObjectiveTo investigate the incidence and time taken to full publication of abstracts presented at dental scientific meetings.DesignA retrospective observational study.SettingAll abstracts from the 1993 proceedings of the European Orthodontic Society (EOS) and European Organisation for Caries Research (ORCA) and a 10% random sample of abstracts from the International Association for Dental Research (IADR) conferences.MethodsA cross-referenced Medline search of abstract title and authors was undertaken to determine whether abstracts had been published as full papers. Searches were censored 1 year prior to and 5 years post publication as an abstract. Publication rate was compared between abstracts presented orally and as posters.Main outcome measuresPublication as a full paper and time taken to publication.Results546 abstracts were investigated. 252 abstracts (46.1%) were found as full reports. Median time to publication of all abstracts was 18 months (IQR 9, 30 months). 99 of the oral abstracts (57%) and 153 (41%) of the poster abstracts were published. Relative Risk Oral vs Poster=1.37 CI (1.19, 1.55).ConclusionMore than half of the research presented at EOS, IADR and ORCA in 1993 remained unpublished 5 years after presentation at the conference. Oral presentations were published more frequently than poster presentations.

How well do reports of clinical trials in the orthodontic literature comply with the CONSORT statement

Objectives To assess whether clinical trials published in the orthodontic literature comply with the Consolidated Standards of Reporting Trials (CONSORT) statement, and whether compliance has changed over time. Design Retrospective study. Sample Clinical trials published in four orthodontic journals (American Journal of Orthodontics and Dentofacial Orthopedics, Angle Orthodontist, European Journal of Orthodontics, and Journal of Orthodontics) at three time points [1995/6 (pre‐CONSORT), 2000/1 (post‐CONSORT) and 2005/6 (post revised‐CONSORT)]. Methods Trials were scored using a 36‐point checklist developed from the CONSORT statement. Each item on the checklist was scored as either included, not included, or not applicable if the trial design did not allow its inclusion. The proportion of trials describing randomization, allocation concealment, and blinding was also calculated. The mean scores were compared between time points and between journals. Results A total of 151 reports were included. The mean score was 41·5% (SD 10·3). The mean post‐CONSORT score was higher than the pre‐CONSORT score (P = 0·01; WMD, 5·73; 95% CI, 1·64–9·82), and the mean post revised‐CONSORT was also higher than the pre‐CONSORT score (P = 0·01; WMD, 4·44; 95% CI, 1·02–7·87). At the post revised‐CONSORT time point, the mean score in the journals which had adopted the CONSORT statement was higher than for those which had not (P<0·001; chi square, 17·78; df = 3). Reporting of randomization, allocation concealment and blinding was inadequate at all three time points. Conclusions The reporting of clinical trials in the orthodontic literature has improved since the publication of the CONSORT statement, particularly in journals which have adopted the statement. However, the reporting of randomization, allocation concealment and blinding remains inadequate.

Natural rubber latex allergy: implications for the orthodontist

Natural rubber latex (NRL) allergy can have potentially serious consequences, and reports of orthodontic patients reacting to NRL have increased significantly over recent years. It is therefore important for the orthodontist to know how to manage patients with an NRL allergy and how to deal with possible reactions to NRL. Safe and effective practice depends on recognizing patients who are at risk of NRL allergy, and an awareness of materials and equipment that contain NRL and the availability of suitable NRL-free alternatives.

Early orthodontic treatment for Class II malocclusion reduces the chance of incisal trauma: Results of a Cochrane systematic review.

UNLABELLED In this article, we summarize the most clinically relevant findings of our recently updated Cochrane systematic review into the treatment of Class II Division 1 malocclusion. METHODS A systematic review of the databases was performed to identify all randomized controlled trials evaluating early treatment with functional appliances to correct Class II Division 1 malocclusion. RESULTS Three early treatment studies with data from 353 participants were included in this review. The results showed no significant difference for any outcomes, except new incidence of incisor trauma, which was significantly less for the early treatment group. The risk ratio analysis for new incisor trauma showed that providing early treatment reduced the risk of trauma by 33% and 41% in the functional and headgear groups, respectively. However, when the numbers needed to treat were calculated, early treatment with functional appliances prevents 1 incidence of incisal trauma for every 10 patients (95% CI, 5-174), and headgear treatment prevents 1 incidence of incisal trauma for every 6 patients (95% CI, 3-23). CONCLUSIONS Orthodontic treatment for young children, followed by a later phase of treatment when the child is in early adolescence, appears to reduce the incidence of new incisal trauma significantly compared with treatment that is provided in 1 phase when the child is in early adolescence. However, these data should be interpreted with caution because of the high degree of uncertainty. There are no other advantages in providing 2-phase treatment compared with 1 phase in early adolescence.

Skeletal anchorage systems in orthodontics: absolute anchorage. A dream or reality?

This article examines the concept of orthodontic anchorage and focuses on ways skeletally derived anchorage is gained. A brief history of the different skeletal anchorage systems to date is given. The article gives an emphasis on the use of one particular skeletal anchorage technique—the micro-implant—to assist with orthodontic anchorage and active tooth movement. Advantages and disadvantages of this new technique are discussed. An illustration of the use of micro-implants is given with reference to a case where they have been used in a novel manner to provide distal movement of maxillary molars.