The identification of agreed criteria for referral following the dental inspection of children in the school setting.
AIM: To clarify the function of the school based dental inspection. OBJECTIVE: For representatives of the Community Dental Service, General Dental Service and Hospital Dental Service to identify an agreed set of criteria for the referral of children following school dental inspection. DESIGN: Qualitative research methodology used to establish a consensus for the inclusion of referral criteria following dental screening. SETTING: Ellesmere Port, Cheshire, England. MATERIALS: A Delphi technique was used to establish a consensus amongst the study participants on the inclusion of nine possible criteria for referral following dental screening. All participants scored each criterion in the range 1-9, with a score of 1 indicating that referral of individuals with the condition should definitely not take place, and a score of 9 indicating referral should definitely take place. Referral criteria were accepted only if they achieved a group median score of 7 or more, with an interquartile range of three scale points, with the lower value being no less than 7. RESULTS: Four of the nine possible criteria met the agreed group standard for inclusion: 'Sepsis', 'Caries in the secondary dentition', 'Overjet > 10 mm', and 'Registered & caries in the permanent dentition'. CONCLUSION: It is possible to agree clear criteria for the referral of children following the school dental inspection. (+info)
The problem of the class iii malocclusion.
The etiology and treatment of Class III malocclusion has been discussed. The value of electromyographic assessment in the assessment and prediction of Class III malocclusion has been shown. (+info)
Morphological changes in periodontal mechanoreceptors of mouse maxillary incisors after the experimental induction of anterior crossbite: a light and electron microscopic observation using immunohistochemistry for PGP 9.5.
Ruffini nerve endings (mechanoreceptors) in the periodontal ligament (PDL) of mouse incisors were examined to elucidate whether experimentally-induced crossbites cause any changes or abnormalities in their morphology and distribution. Anterior guiding planes were attached to the mandibular incisors of 3-week-old C3H/HeSlc mice. At 3 days and 1, 2, 4, 6, and 8 weeks post-attachment of the appliance, the mice were sacrificed by perfusion fixation. Frozen sagittal cryostat sections of the decalcified maxillary incisors were processed for immunohistochemistry of protein gene product 9.5, followed by histochemical determination of tartrate-resistant acid phosphatase activity to reveal sites of alveolar bone resorption. Despite the absence of bone resorption within the lingual PDL of control mice, distinct resorption sites were seen in the respective regions of the experimental animals. Unlike the controls, many Ruffini endings showing vague and swollen contours, with unusually long and pedunculated micro-projections were observed in the affected lingual PDL of the incisors in the experimental animals with short-term anterior crossbite induction. Club-shaped nerve terminations with few, if any, micro-projections were observed in the lingual PDL of experimental animals with long-term induction, as well as in aged control mouse incisors. Differences in the distribution of Ruffini endings were also observed. These results indicate that changing the direction of the force applied to the PDL results in rapid and prolonged changes in the morphology of Ruffini-like mechanoreceptors. (+info)
Motivation for and satisfaction with orthodontic-surgical treatment: a retrospective study of 28 patients.
Motivation for starting treatment and satisfaction with treatment results were evaluated on the basis of replies to a 14-item questionnaire and clinical examination of 28 orthognathic patients from 6 months to 2 years after treatment. The most common reasons for seeking professional help were problems in biting and chewing (68 per cent). Another major reason was dissatisfaction with facial appearance (36 per cent). Many patients also complained of temporomandibular joint symptoms (32 per cent) and headache (32 per cent). Women (8/19) were more often dissatisfied with their facial appearance than men (2/9), but the difference was not statistically significant. In agreement with earlier studies, the results of orthognathic treatment fulfilled the expectations of almost every patient. Nearly 100 per cent of the patients (27/28) were satisfied with treatment results, although 40 per cent experienced some degree of numbness in the lips and/or jaw 1 year post-operatively. The most satisfied patients were those who stated temporomandibular disorders as the main reason for seeking treatment and whose PAR-index had improved greatly. The majority of the patients experienced the orthodontic treatment as painful and as the most unpleasant part of the whole treatment, but all the patients were satisfied with the pre-treatment information they were given on orthodontics. Orthodontic-surgical therapy should be of a high professional standard technically, but the psychological aspects are equally important in the treatment protocol. The professionals should make efforts to understand the patient's motivations for and expectations of treatment. Patients should be well prepared for surgery and supported for a long time after to help them to adjust to post-surgical changes. (+info)
The functional shift of the mandible in unilateral posterior crossbite and the adaptation of the temporomandibular joints: a pilot study.
Changes in the functional shift of the mandibular midline and the condyles were studied during treatment of unilateral posterior crossbite in six children, aged 7-11 years. An expansion plate with covered occlusal surfaces was used as a reflex-releasing stabilizing splint during an initial diagnostic phase (I) in order to determine the structural (i.e. non-guided) position of the mandible. The same plate was used for expansion and retention (phase II), followed by a post-retention phase (III) without the appliance. Before and after each phase, the functional shift was determined kinesiographically and on transcranial radiographs by concurrent recordings with and without the splint. Transverse mandibular position was also recorded on cephalometric radiographs. Prior to phase I, the mandibular midline deviated more than 2 mm and, in occlusion (ICP), the condyles showed normally centred positions in the sagittal plane. With the splint, the condyle on the crossbite side was displaced 2.4 mm (P < 0.05) forwards compared with the ICP, while the position of the condyle on the non-crossbite side was unaltered. After phase III, the deviation of the midline had been eliminated. Sagittal condylar positions in the ICP still did not deviate from the normal, and the splint position was now obtained by symmetrical forward movement of both condyles (1.3 and 1.4 mm). These findings suggest that the TMJs adapted to displacements of the mandible by condylar growth or surface modelling of the fossa. The rest position remained directly caudal to the ICP during treatment. Thus, the splint position, rather than the rest position should be used to determine the therapeutic position of the mandible. (+info)
A comparison of sagittal and vertical effects between bonded rapid and slow maxillary expansion procedures.
The purpose of this study was to determine the vertical and sagittal effects of bonded rapid maxillary expansion (RME), and bonded slow maxillary expansion (SME) procedures, and to compare these effects between the groups. Subjects with maxillary bilateral crossbites were selected and two treatment groups with 12 patients in each were constructed. The Hyrax screw in the RME treatment group and the spring of the Minne-Expander in the SME treatment group were embedded in the posterior bite planes, which had a thickness of 1 mm. At the end of active treatment these appliances were worn for retention for an additional 3 months. Lateral cephalometric radiographs were taken at the beginning and end of treatment, and at the end of the retention period. The maxilla showed anterior displacement in both groups. The mandible significantly rotated downward and backward only in the RME group. The inter-incisal angle and overjet increased in both groups. No significant differences were observed for the net changes between the two groups. (+info)
An appraisal of the Peer Assessment Rating (PAR) Index and a suggested new weighting system.
The PAR Index was developed to measure treatment outcome in orthodontics. Validity was improved by weighting the scores of some components to reflect their relative importance. However, the index still has limitations, principally due to the high weight assigned to overjet. Difficulties also arise from the application of one weighting system to all malocclusions, since occlusal features vary in importance in different classes of malocclusion. The present study examined PAR Index validity using orthodontic consultant assessments as the 'Gold standard' and clinical ranking of occlusal features and statistical modelling to derive a new weighting system, separate for each malocclusion class. Discriminant and regression analyses were used to derive new criteria for measuring treatment outcome. As a result a new and more sensitive method of assessment is suggested which utilizes a combination of point and percentage reductions in PAR scores. This was found to have better correlations with the 'Gold standard' than the PAR nomogram. (+info)
Assessment of clinical case presentations for the Membership in Orthodontics, Royal College of Surgeons of England 1995, 1996.
The cases presented and treated at successive examinations by the candidates for the Membership Examination in Orthodontics in 1995 and 1996 at The Royal College of Surgeons of England, were of a very high standard and demonstrated a wide range of treatment modalities. All cases had fixed appliances, predominantly with pre-adjusted Edgewise appliances. IOTN confirmed that most cases were in great need of treatment, with PAR scores showing them to be treated to a high standard. (+info)