Jonathan R Sandy

Cleft lip and palate care in the United Kingdom - The Clinical Standards Advisory Group (CSAG) study. Part 2: Dentofacial outcomes and patient satisfaction

OBJECTIVE To describe facial development and appearance, quality of bone grafts, oral health, and patient/parent satisfaction, with clinical outcome, for children in two age cohorts born with unilateral cleft lip and palate (UCLP) throughout the United Kingdom. DESIGN Cross-sectional outcome study. SETTING Fifty National Health Service cleft centers. PARTICIPANTS Children born with complete UCLP between April 1, 1982, and March 31, 1984, (12-year-olds) and April 1, 1989, and March 31, 1991 (5-year-olds). Data were collected for 239 5-year-olds and 218 12-year-olds. The parents of these children were also interviewed to determine levels of satisfaction with care received. MAIN OUTCOME MEASURES Skeletal pattern, dental arch relationship, success of alveolar bone grafting, facial appearance, oral health status, and patient/parent satisfaction. RESULTS Nearly 40% of 5- and 12-year-olds had poor dental arch relations, and 70% of 12-year-olds had midface retrusion. Fifteen percent of 12-year-olds had not received an alveolar bone graft, and only 58% of bone grafts that had been undertaken were successful. Twenty percent of 12-year-olds and 40% of 5-year-olds had untreated dental caries. Less than one-third of subjects had a good facial appearance as judged by a panel of experts. Levels of patient and parent satisfaction were generally high. CONCLUSION A rigorous evaluation of cleft care in the United Kingdom reveals disappointing outcomes.

Corrosion of orthodontic appliances—should we care?

Contemporary orthodontics relies on various bonded attachments, archwires, and other devices to achieve tooth movement. These components are composed of varying materials with their own distinctive physical and mechanical properties. The demands made on them are complex because they are placed under many stresses in the oral environment. These include immersion in saliva and ingested fluids, temperature fluctuations, and masticatory and appliance loading. The combination of these materials in close proximity and in hostile conditions can result in corrosion. Our purpose in this article was to consider the literature to date with regard to potential mechanical, clinical, and health implications of orthodontic corrosion.

Recent advances in understanding mechanically induced bone remodeling and their relevance to orthodontic theory and practice

This review highlights recent developments in bone cell biology, evaluates previous research, and offers future direction toward improving our understanding of events that mediate orthodontic tooth movement. The in vivo and in vitro models that have been developed to examine the responses of connective tissues and how they have contributed to our understanding of the mechanisms involved in mechanically induced bone remodeling are discussed in detail. Osteoblasts are now recognized as the cells that control both the resorptive and the formative phases of the remodeling cycle, and receptor studies have shown them to be the target cells for resorptive agents in bone. The osteoblast is perceived as a pivotal cell, controlling many of the responses of bone to stimulation with hormones and mechanical forces. It is apparent that not all the cellular responses induced by mechanically deformed tissues can be explained by the current paradigm emphasizing the importance of prostaglandin production and cAMP elevation; the mobilization of membrane phospholipids giving rise to inositol phosphates offers an alternative second messenger pathway. It is also argued from circumstantial evidence that changes in cell shape produce a range of effects mediated by membrane integral proteins (integrins) and the cytoskeleton, which may be important in transducing mechanical deformation into a meaningful biologic response.

Cleft lip and palate care in the United Kingdom: The clinical standards advisory group (CSAG) study. Part 4 : Outcome comparisons, training, and conclusions

OBJECTIVE A critical appraisal of cleft care in the United Kingdom. DESIGN Retrospective comparative study. SETTING All National Health Service cleft centers in the United Kingdom. PATIENTS/PARTICIPANTS Children born with unilateral complete clefts of the lip and palate between April 1, 1982, and March 31, 1984 (12-year-olds), and April 1, 1989, and March 31, 1991 (5-year-olds). Newly appointed and senior cleft clinicians. MAIN OUTCOME MEASURES Skeletal pattern, dental arch relationship, success of alveolar bone grafting, dental health, facial appearance, oral health status, patient/parent satisfaction. CONCLUSIONS This paper highlights the poor outcomes for the fragmented cleft care in the United Kingdom, compared with European centers. There is an urgent need for a review of structure, organization, and training.

Satisfaction with facial appearance among subjects affected by a cleft.

OBJECTIVE This study examined the satisfaction of patients with clefting and their parents with facial appearance and how this alters with age. The relationship between satisfaction with appearance and psychosocial functioning was also examined. DESIGN Prospective SETTING Subjects were recruited for the study from nine hospital-based clinics. PARENTS, PARTICIPANTS: All subjects has some type of cleft and were 10, 15 or 20 years of age. In all, 111 subjects with clefting and 62 parents were included. MAIN OUTCOME MEASURES Facial appearance was rated on a subjective ordinal scale of 1 to 7; psychosocial adjustment was measured with the Childhood Experience Questionnaire. RESULTS Self-satisfaction with appearance among the 10- and 15-year-old subjects correlated with their psychosocial adjustment (p = .027). The 20-year-old subjects were, on average, significantly more satisfied with their appearance than the 10- and 15-year-olds (p = .009 and p = .012, respectively). However, some 20-year-old subjects remained greatly dissatisfied with aspects of their facial appearance. Subjects with visible anomalies were significantly more dissatisfied with their appearance than subjects with invisible anomalies (p = .035). The 15-year-old subjects were identified as being significantly more dissatisfied with appearance than their parents (p = .005). CONCLUSIONS Subjects affected by a cleft with visible impairments are more dissatisfied with their facial appearance than are subjects with invisible impairments. Satisfaction with facial appearance among 10- and 15-year-old subjects with a cleft may be associated with their self-reported levels of psychosocial functioning. Measuring self-satisfaction with appearance may help to identify subjects at risk from adjustment problems.

Patients’ motivations for treatment and their experiences of orthodontic preparation for orthognathic surgery

Objective To determine patients’ motivations for undergoing orthognathic surgery and their experiences of the orthodontic aspects of this treatment. Design Retrospective questionnaire survey using a patient-centred measure. Setting Thirteen National Health Service (NHS) hospital orthodontic departments. Subjects Three-hundred-and-twenty-six patients (58% response rate) who underwent orthognathic surgery during the period 1 January 1995 to 30 September 2001 completed a questionnaire. Main outcome measures Motivations for treatment and perception of information about treatment and experiences of orthodontic treatment. Results Major motivations for treatment were to have straight teeth (80%), to prevent future dental problems (69%) and to improve self-confidence (68%). Females sought treatment to improve self-confidence and their smile. Males wanted treatment to improve their social life. Most of these issues had improved following surgery. Most (94%) respondents felt well-informed about their orthodontics. However, 36% wore braces for longer than they expected. Males and younger patients knew less about the duration of treatment than other groups. Fifty-eight per cent of subjects found their braces difficult to clean and 9% reported that they were very painful. Older patients experienced fewer problems wearing braces than younger patients. Conclusions Improving dental appearance and preventing future dental problems are major motivators for orthognathic patients. Although patients felt well informed about what to expect from their orthodontic treatment, a significant proportion, particularly younger patients and males, were surprised at the length of treatment and the need to wear retainers. This suggests that orthognathic patients might benefit from better information regarding the orthodontic aspects of their care.

Orthodontics. Part 6: Risks in orthodontic treatment

Orthodontics has the potential to cause significant damage to hard and soft tissues. The most important aspect of orthodontic care is to have an extremely high standard of oral hygiene before and during orthodontic treatment. It is also essential that any carious lesions are dealt with before any active treatment starts. Root resorption is a common complication during orthodontic treatment but there is some evidence that once appliances are removed this resorption stops. Some of the risk pointers for root resorption are summarised. Soft tissue damage includes that caused by archwires but also the more harrowing potential for headgears to cause damage to eyes. It is essential that adequate safety measures are included with this type of treatment.

Adult Orthodontics—A Review

The increased demand for orthodontic treatment by adults suggests a review of the literature might be timely. In this review we explore whether the increase in demand is real and matched by need. We also examine the reasons for treatment being sought and special considerations which are Important during orthodontic treatment. Finally, we compare the orthodontic experience of adults and adolescents. We conclude that adults seeking treatment can be excellent patients with high motivation and co-operation. The limitations of orthodontic treatment must be explained at the beginning of treatment since adult expectations of orthodontics can be very high.

Sucking habits in childhood and the effects on the primary dentition: findings of the Avon Longitudinal Study of Pregnancy and Childhood

INTRODUCTION Most previous research on non-nutritive sucking habits has been cross-sectional in nature. This study determined the prevalence of non-nutritive sucking habits and the effects on the developing dentition within a longitudinal observational cohort. METHODS The Children in Focus group of the Avon Longitudinal Study of Pregnancy and Childhood study was studied. Questionnaire data on non-nutritive sucking habits were collected on the children at 15 months, 24 months, and 36 months of age. Dental examinations were performed on the same children at 31 months, 43 months, and 61 months of age. RESULTS At 15 months, 63.2% of children had a sucking habit, 37.6% used just a dummy, and 22.8% used a digit. By 36 months, sucking had reduced to 40%, with similar prevalence of dummy and digit sucking. Both habits had effects on the developing dentition, most notably in upper labial segment alignment and the development of anterior open bites and posterior crossbites. CONCLUSIONS The majority of children had non-nutritive sucking habits up until 24 months of age. Both digit and dummy sucking were associated with observed anomalies in the developing dentition, but dummy-sucking habits had the most profound influence on the anterior and posterior occlusions of the children.

DUAL ELEVATION OF CYCLIC-AMP AND INOSITOL PHOSPHATES IN RESPONSE TO MECHANICAL DEFORMATION OF MURINE OSTEOBLASTS

Mechanical deformation of bone cells was thought to be mediated via prostaglandin production and the cyclic AMP pathway. We present evidence that the phosphoinositide pathway is also activated by mechanical stress. We find that inositol phosphate production, but not glycerophosphoinositol production, is elevated, and the activation of adenylate cyclase is relatively small. These results are not compatible with the proposal that mechanical deformation of bone cells acts solely via prostaglandin synthesis.