Patients' expectations of orthodontic treatment: part 1 - development of a questionnaire

Comparative assessment of treatment efficiency and patient experience between Dental Monitoring and conventional monitoring of clear aligner therapy: A single-center randomized controlled trial

INTRODUCTION

This 2-arm randomized controlled clinical trial (RCT) aimed to assess the effect of Dental Monitoring (DM) on the efficiency of clear aligner therapy (CAT) and patient experience compared with conventional monitoring (CM) used for regularly scheduled clinical appointments.

METHODS

Fifty-six patients with full permanent dentition treated with CAT participated in this RCT. Patients were recruited from a single private practice and treated by 1 experienced orthodontist. Randomization was performed with permutated blocks of 8 patients assigned to either a CM or DM group with allocations concealed in opaque, sealed envelopes. It was not feasible to blind subjects or investigators. The primary treatment efficiency outcome assessed was the number of appointments. Secondary outcomes included the time to reach the first refinement, the number of refinements, the total number of aligners, and treatment duration. The patient experience was assessed using a visual analog scale questionnaire administered at the end of CAT.

RESULTS

No patients were lost to follow-up. There was no significant difference in the number of refinements (mean = 0.1; 95% confidence interval [CI], -0.2 to 0.5; P = 0.43) and the number of total aligners (median = 5; 95% CI, -1 to 13; P = 0.09). There was a significant difference in the number of appointments, with the DM group requiring 1.5 fewer visits (95% CI, -3.3, -0.7; p = 0.02) as well as overall treatment duration, with the DM group taking 1.9 months longer (95% CI, 0.0-3.6; P = 0.04). There was a difference between study groups regarding the importance of face-to-face appointments, with the DM group not perceiving face-to-face appointments as important (P = 0.03).

CONCLUSIONS

DM with CAT resulted in 1.5 fewer clinical appointments and a longer treatment duration of 1.9 months. There were no significant intergroup differences in the number of refinements or total aligners. CM and DM groups had similarly high levels of satisfaction with CAT.

REGISTRATION

The trial was registered at Australian New Zealand Clinical Trials Registry (ACTRN12620000475943).

PROTOCOL

The protocol was published before trial commencement.

FUNDING

This research did not receive any grant from funding agencies.

Malaysian Patients’ Expectations of Orthodontic Treatment in Indian Dental Care Set up: A Questionnaire Survey

Materials and Methods

A cross-sectional study was conducted on 349 Malaysian patients (182 females and 167 males) aged 18–30 years. A questionnaire consisting of ten items developed by Sawyers and Newton was administered to the patients who visited the department of Orthodontics seeking orthodontic treatment. Outcome measures. Descriptive analysis of the responses and comparison of male and female expectations.

Results

Most of the patients expected only a check-up/diagnosis/discussion at their initial appointment, anticipated a fixed type of orthodontic treatment, did not prefer extraction/removal of their teeth, thought the treatment to be painful, and can restrict what they could eat or drink. Positive expectations from the patient included better tooth alignment, enhanced smile, improved confidence, and advancement in professional career. At the same time, nearly half of the patients' assumed speech/mastication does not get affected during the treatment. Moreover, very few patients believed it would be easier to eat/speak/keep their teeth clean after the treatment. Compared to males, more females had significantly anticipated fixed types of orthodontic treatment, thinking the treatment to be painful and restrictive in terms of what they could eat or drink. Most of the females were unsure about the length of the orthodontic treatment and had significantly higher expectations concerning career improvement.

Conclusions

To meet the varied expectations of each of the patients, effective communication between the orthodontist and the patient is essential.

Cross-cultural adaptation of a questionnaire assessing the child and parents' expectations of orthodontic treatment in Brazil

INTRODUCTION

The Sayers and Newton questionnaire was developed in England to assess the child's and parent's expectations about orthodontic treatment.

OBJECTIVE

The aim of this study was to carry out the cross-cultural adaptation of the questionnaire for the Brazilian Portuguese language, to test its reliability, and to compare patients' and their parents' expectations of orthodontic treatment.

METHODS

After translation and cross-cultural adaptation, the questionnaire was applied to 98 patients (12-14 years), who had been referred for treatment, and their caregivers. The internal consistency of the instrument was assessed by Cronbach's Alpha Coefficient and the test-retest reliability, by Intraclass Correlation Coefficient (ICC).

RESULTS

Internal reliability was confirmed by a Cronbach's alpha coefficient of 0.75. Test-retest reliability revealed satisfactory reproducibility (ICC = 0.85). The results showed some significant differences between the expectations of the patients and their caregivers (p < 0.05). There were no significant gender differences (p > 0.05).

CONCLUSIONS

The process of cross-cultural adaptation of the Sayers and Newton questionnaire for the Brazilian Portuguese was concluded. This study demonstrated that this instrument is reliable and applicable to assess the child's and parent's expectations about orthodontic treatment in Brazil, and it has acceptable psychometric properties.

Influence of functional and esthetic expectations on orthodontic pain

OBJECTIVES

To investigate the effect of orthodontic treatment outcome (OTO) expectations on the level of pain intensity experienced after orthodontic elastomeric separation (OES).

MATERIALS AND METHODS

A total of 100 orthodontic patients (74 female and 26 male, age 14 years and above) from the Faculty of Dentistry, Mahidol University were enrolled. Before OES, questionnaires were administered to obtain patients' expectations regarding various aspects of OTO as well as OES pain expectations. Real-time self-reported pain intensity from OES at the maxillary and mandibular first permanent molars was obtained before and immediately after separator placement and at 6 h, 24 h, and then every day until day 7 after OES. Data were analyzed for the relationship between OTO expectations and OES pain intensity. The level of significance was set at 0.05.

RESULTS

The maximum OES pain intensity occurred on day 2 after OES and gradually decreased to the pretreatment level on day 7. The degree of facial, tooth alignment, masticatory function improvement expectations, and a high level of OES pain expectations were significantly associated with the severity of OES pain after separator placement.

CONCLUSION

Esthetic and functional expectations of OTO were significantly associated with OES pain intensity. Thus, knowledge about esthetic and functional expectations may help to predict patient's pain response to orthodontic treatment.

Self-Esteem and Oral Health-Related Quality of Life within a Cleft Lip and/or Palate Population: A Prospective Cohort Study

(1) Objective: To investigate the oral health-related quality of life (OHRQoL) and self-esteem (SE) of a population with cleft lip and/or palate (CLP) and to compare it with a non-affected control cohort. (2) Materials and methods: This study comprised 91 CLP patients and a control group of 790 individuals, seeking orthodontic treatment. OHRQoL and SE were assessed by the Child’s Perception Questionnaire (CPQ) and the Dutch adaptation of the Harter’s Self-Perception Profile for Adolescents. Treatment need and self-perception of oral aesthetic were assessed using the Index of Orthodontic Treatment Need (IOTN) and the Oral Aesthetic Subjective Impact Scale (OASIS). Patients’ expectations and motivation for treatment were also scored. Linear models were used for statistical comparisons between groups. (3) Results: The cleft group scored higher in all domains of the CPQ, OASIS, IOTN and regarding SE for the domains of scholastic competence, athletic competence, physical appearance and behavioral conduct. The cleft group was not only more motivated and expected less discomfort during treatment but also had higher expectations for the treatment outcome. (4) Conclusions: The OHRQoL of CLP patients is strongly correlated with the presence of an oral cleft, while SE remains a personal resource not influenced by the malocclusion or medical condition.

Development of patient information leaflets for fixed, removable, and functional appliances for Arabic-speaking orthodontic patients

OBJECTIVE

To develop Orthodontic Patient Information Leaflets (PILs) in Arabic.

MATERIAL & METHOD

This study included five phases starting with Arabic translation of existing British Orthodontic Society leaflets; initial face validation with three orthodontists; content validation with ten orthodontists; final face validation with ten orthodontists, five postgraduate students, and ten patients; and re-translation to English prior to comparing the new documents with the original PILs to verify that all the necessary information were included. The content validity index (CVI) assessed item level (I-CVI) and scale level (S-CVI).

RESULTS

The three Arabic PILs were face validated with inclusion of mini-screws, rapid maxillary expansion, and interproximal reduction. Content validity was perfect with no item I-CVI < 0.80. The S-CVI/Ave for PIL Fixed Appliances = 0.98, PIL Removable Appliances = 0.98 and PIL Functional Appliances = 0.97. In the final face validation, the three leaflets received 100% agreement from all observers for consistency of leaflet format and style, clarity, readability and use of adequate phrases. Finally, the leaflets were re-translated and the information was checked by native English speakers to ensure the completeness of information. There were no discrepancies and face validity was excellent.

CONCLUSION

Valid PILs for Arabic-speaking patients undergoing orthodontic treatment with fixed, removable, and functional appliances have been developed.

Patients' and parents' expectations of orthodontic treatment in university settings

INTRODUCTION

The primary aim was to compare patients' and parents' orthodontic treatment expectations at the Eastman Institute for Oral Health, University of Rochester, Rochester, NY (UR) in the United States. Secondary aims were to assess the association between sociodemographic factors and UR participants' expectations; and compare participants' expectations between UR, Academic Centre for Dentistry Amsterdam (ACTA) and King's College Dental Hospital, London, United Kingdom (KC) (previously published data).

METHODS

One hundred and forty participants [70 patients and one of their parents (n = 70)] completed a validated questionnaire (10 questions) to measure orthodontic treatment expectations before screening at the Orthodontic Department at UR. Various sociodemographic factors were assessed. The paired t test (for continuous responses) and the Fisher exact test (for categorical responses) were used to compare UR patients' and parents' responses. Two-sample t test and the Fisher exact test were used to compare participants' responses among sociodemographic groups. One-way analysis of variance followed by the Tukey test, and the Fisher exact test were used to compare participants' responses between UR, and ACTA and KC (data collected from previous publications). A multiplicity correction was performed to control the false discovery rate.

RESULTS

Patients at UR expected less check-up and diagnosis, and less discussion about treatment at the initial visit, more dietary restrictions, and less improvement in smile esthetics and social confidence with orthodontic treatment than parents. Participants' responses differed by sociodemographic factors at UR and between UR, ACTA, and KC.

CONCLUSIONS

Expectations of orthodontic treatment differ between patients and their parents, are associated with sociodemographic factors, and vary among United States and European University centers.

Psychometric validation of a pre-existing questionnaire used to measure patient satisfaction following orthodontic treatment in a UK population

Objective:

To determine the psychometric properties of a pre-existing orthodontic satisfaction questionnaire and to assess patient satisfaction of their orthodontic treatment.

Design:

Psychometric assessment of a pre-existing orthodontic satisfaction questionnaire.

Setting:

Two sites at King’s College Hospital NHS Foundation Trust.

Participants:

Individuals aged 12–15 years who had completed fixed orthodontic treatment.

Methods:

An expert panel assessed a pre-existing orthodontic treatment satisfaction questionnaire for validity and readability. As a result, revisions were made to the questionnaire and it was distributed to 103 participants aged 12–15 years, on completion of their fixed orthodontic treatment (T1). Test–retest reliability of the questionnaire was assessed through completion of a second questionnaire by 17 participants, at a two-week interval (T2). The questionnaire was assessed for reliability using item-total correlations (I-TC) and Cronbach’s alpha. Factor analysis allowed exploration of the underlying factor structure of the questionnaire. Test–retest reliability was assessed using Cohen’s kappa coefficient. Multiple regression analysis was used to find out the significant demographic variables that predicts the satisfaction level of treatment.

Results:

Following validity and readability assessment by the expert panel, the questionnaire was revised. Eleven items were removed following item analysis (with I-TC ⩽ 0.3). Factor analysis was deemed uninterpretable. The overall scale demonstrated greater reliability than the underlying sub-scales. Therefore, the sub-scales were removed, resulting in one scale which assessed overall orthodontic satisfaction, comprising 37 items, with a Cronbach alpha of 0.92. The test–retest reliability of the revised 37-item scale was deemed to be poor (kappa coefficient = 0.39). Multiple regression analysis identified ethnicity as a significant predictor of orthodontic treatment satisfaction (P = 0.01).

Conclusion:

This study provides a valid measure to assess orthodontic treatment satisfaction for use in a UK population aged 12–15 years on completion of fixed orthodontic treatment.

Soft tissue facial changes among adult females during alignment stage of orthodontic treatment: a 3D geometric morphometric study

BACKGROUND

To investigate changes in facial morphology during the first six months of orthodontic treatment among adult females receiving orthodontic treatment.

METHODS

43 adult females receiving orthodontic treatment were randomly recruited. 3D facial images were taken at baseline (T0), three months (T1), and six months (T2) after treatment initiation. Spatially dense facial landmarks were digitized to allow for sufficient details in characterization of facial features. 3D geometric morphometrics and multivariate statistics were used to investigate changes in mean and variance of facial shape and facial form associated with treatment.

RESULTS

We observed statistically significant changes in facial shape across the three treatment stages (p = 0.0022). Pairwise comparisons suggested significant changes from T0 to T1 (p = 0.0045) and from T0 to T2 (p = 0.0072). Heatmap visualization indicated that the buccal and temporal region were invaginated while the labial region became protruded with treatment. The magnitude of shape change was 0.009, 0.004, and 0.010 from T0 to T1, T1 to T2, and T0 to T2, respectively, in unit of Procrustes distance. The average magnitude of change per-landmark was 1.32 mm, 0.21 mm, and 1.34 mm, respectively. Changes in mean facial form were not statistically significant (p = 0.1143). No changes in variance of facial shape were observed across treatment stages (p > 0.05).

CONCLUSION

Rate of facial changes was twice as fast during the first three months as that during fourth to sixth month. Buccal and temporal region became invaginated while labial region became protruded with treatment.

How do you identify the patient with 'high expectations' of orthodontic treatment: An empirical approach

OBJECTIVES

To identify an empirical method for identifying patients with 'high expectations' of orthodontic treatment with fixed appliances using a questionnaire-based approach.

DESIGN

Secondary analysis of data from four studies which collected data on patients' expectations of orthodontic treatment using the same questionnaire.

SETTING

Secondary care orthodontic services.

PARTICIPANTS

All four datasets comprised new patients aged 12-15 years, with no history of orthodontic treatment, who fulfilled the criteria for NHS treatment using the Index of Orthodontic Treatment Need (IOTN). Unpublished dataset 1 comprised 100 participants, while dataset 2 had 70 participants, dataset 3 had 67 participants and dataset 4 comprised 40 participants.

METHODS

The questionnaire utilised in all studies had a question which asked respondents to rate seven different expectations of outcome relating to straight teeth, better smile, ease of eating, speaking, cleaning teeth, improved career prospects and social confidence. Dataset 1 was analysed to determine the proportion of patients who had rated all seven outcome expectation items at a maximum score. Similar analyses were performed for the other three datasets to explore the trend in the proportion of patients with high expectations over time.

RESULTS

For dataset 1, 2.0% of participants had high expectations, as defined by their scores on the questionnaire. The proportions for the datasets 2, 3 and 4 were 4.0%, 4.5% and 2.5%, respectively.

CONCLUSION

The method outlined provides an empirical basis for identifying patients with statistically infrequent high expectations. This can potentially help clinicians in the management of such patients.

Patients' expectations: is there a typical patient?

OBJECTIVES

To qualitatively explore, and analyse, patients' expectations before the start of fixed appliance orthodontic treatment and determine whether typologies exist.

DESIGN

A prospective cross-sectional qualitative study, which involved 13 patients (aged 12-15 years).

SETTING

NHS Hospital Orthodontic Department (UK).

MATERIALS AND METHODS

In-depth interviews were conducted with patients who consented to participate before the start of fixed appliance orthodontic treatment. The in-depth interview data were transcribed and then managed using a framework approach, followed by associative analysis.

RESULTS

The in-depth interviews revealed two major themes and associated subthemes which were: first, patients' expectations about the treatment process and outcome; and second, patients' expectations of themselves during and after treatment. Three typologies related to patients' expectations of the orthodontic treatment process were also identified. The first group of participants had minimal expectations of the treatment process, did not anticipate discomfort or pain and did not anticipate that treatment would cause disruption to their daily life. The second group of participants had expectations that treatment would involve arch wire changes, dental extractions and result in some discomfort/pain, which would cause some limited disruption to their daily life (moderate expectations). The third type of participant had expectations of the treatment process involving arch wire changes and dental extractions, and anticipated that the discomfort and pain experienced would significantly affect their daily life (marked expectations).

CONCLUSIONS

These results provide the clinician with information about patient typologies and provide the clinician with some direction when communicating with their patients and managing their expectations before the start of treatment.

Motivation, expectations and understanding of patients and their parents seeking orthodontic treatment in specialist practice

Objectives:

To determine patient and parent/guardian motivation, expectation and understanding of orthodontic treatment.

Design:

A self-completion questionnaire survey of new patients referred for orthodontic assessment.

Setting:

Specialist practices in Surrey and Berkshire (United Kingdom).

Participants:

A total of 500 questionnaires were issued (250 were issued to patients and 250 to parents).

Methods:

The survey was based on a self-completed questionnaire which was issued at the assessment appointment. Both questionnaires were adapted and extended from originally validated questionnaires previously used in a hospital setting. Patients and parents were asked to complete separate anonymous questionnaires. The patient questionnaire consisted of 24 closed-ended questions divided into three domains: motivation; understanding; and expectation of orthodontic treatment. The parent questionnaire consisted of 13 questions covering the same three domains

Results:

The response rate for the patient and parent questionnaires was 95% and 91%, respectively. Forty-seven percent of the patients were aged 11–13 years. In 77% of cases, the referral was initiated by their dentist. Only 3% of patients thought there was nothing wrong with their teeth. There was a poor understanding of what a retainer is and for how long patients are expected to use it.

Conclusions:

Referral for orthodontic treatment was initiated by the patients’ general dental practitioner in the majority of the cases. The anticipation of improved dental appearance was a prime motivating factor. Participants had realistic expectations and there was a good acceptance of appliances and dental extractions for orthodontic treatment. Nevertheless, both patients and parents/guardians were less well informed on the nature and duration of orthodontic retention.

Adolescent perceptions of orthodontic treatment risks and risk information: A qualitative study

INTRODUCTION

For effective risk communication, clinicians must understand patients' values and beliefs in relation to the risks of treatment. This qualitative study aimed to explore adolescent perceptions of orthodontic treatment risks and risk information.

METHODS

Five focus groups were carried out with 32 school/college pupils aged 12-18 in Wales, UK. Participants were purposively selected and had all experienced orthodontic treatment. A thematic approach was used for analysis and data collection was completed at the point of data saturation.

RESULTS

Four themes emerged from the data; (a) day-to-day risks of orthodontic treatment, (b) important orthodontic risk information, (c) engaging with orthodontic risk information and (d) managing the risks of orthodontic treatment. Day-to-day risks of orthodontic treatment that were affecting participants "here and now" were of most concern. Information about preventing the risks of treatment was deemed to be important. Participants did not actively seek risk information but engaged passively with information from convenient sources. Perceptions of risk susceptibility influenced participants' management of the risks of orthodontic treatment.

CONCLUSIONS

This study demonstrates that adolescent patients can understand information about the nature and severity of orthodontic treatment risks. However, adolescent patients can have false perceptions if the risks are unfamiliar, perceived only to have a future impact or if seen as easy to control. Adolescent patients must be provided with timely and easily accessible risk information and with practical solutions to prevent the risks of treatment.

CLINICAL SIGNIFICANCE

The views and experiences gathered in this study can assist clinicians to better understand their young patients' beliefs about treatment risks, facilitate effective risk communication and contribute to improved patient-centred care.

Three questionnaires to assess the perception of fixed orthodontic therapy before, during and after treatment: validity and reliability

Background/objective

To assess the validity and reliability of a series of three questionnaires for the quantification of patient perception of fixed appliance orthodontic treatment.

Subjects and methods

The study was carried out at the University of Dundee with content and face validity being assessed using proformas. Initially ten experts (Orthodontic Specialists) assessed content validity with 11 professionals (seven Orthodontic Specialists and four Postgraduates) and 20 patients assessing face validity. Content validity was determined according to the values of item-level content validity index (I-CVI) and scale-level CVI (S-CVI/Ave), while specially designed feedback forms were used for face validation. Internal consistency determined the reliability of the questionnaires according to the value of Cronbach alpha correlation coefficient test. The three questionnaires were then modified according to the recommendations of professionals and patients with seven experts reassessing content validity and ten newly selected patients assessing face validity.

Results

The first round of content validity revealed that around half of the items in the questionnaires were not valid. Therefore, the questionnaires were not valid as a whole (S-CVI/Ave = 0.60). After modifying the questionnaires and removing the non-valid items, the new versions of the Pre-treatment, Orthodontic Experience, and Post-treatment Questionnaires showed high levels of face validity, content validity (S-CVI/Ave: 0.99, 0.97, and 0.99, respectively) and good levels of internal consistency (α = 0.86, 0.78, and 0.88, respectively).

Limitation

The patient sample was collected from a single university clinic and from one city within the UK and this could affect the generalizability of the results.

Conclusion

Three content valid and reliable questionnaires have been developed and validated for the evaluation of patient perception of fixed appliance orthodontic treatment.

Implications

Unlike other tools that assess oral health-related quality of life, this series of three questionnaires assess the perception of fixed appliance orthodontic treatment before, during and after treatment.

Patient/parent expectations of orthodontic treatment

BACKGROUND

Expectations of orthodontic treatment may differ between the patient and their parents, as the parents' expectations may not reflect those of the child.

OBJECTIVES

The aim of this study, therefore, was to determine the expectations of patients and their parents.

MATERIALS AND METHODS

This was a clinic-based, comparative, cross-sectional study involving 110 patients aged between 10 and 19 years, as well as their accompanying parents or guardians. The expectations of both patients and parents were determined using a questionnaire developed by Sayers and Newton.

RESULTS

Results showed that the expectations of the patients and parents differed significantly in a number of areas with the parents' expectations often exceeding those of the patients. Both patients and parents were found to be ignorant about some aspects of orthodontic treatment, with 47.3% of patients and 39.1% of parents unaware of the duration of orthodontic treatment and, as such, requiring information from their clinicians.

CONCLUSION

The results highlight the importance of patient education and counseling as well as the need to focus on the individual patient and not assume that their expectations mirror those of the accompanying parent.

Patient's expectations of lingual orthodontic treatment: a qualitative study

OBJECTIVE

To investigate patients' expectations of lingual orthodontic treatment.

DESIGN

In-depth interviews were conducted. A framework analysis was carried out to identify themes, concepts and a typology.

SETTING

Two secondary care hospital departments and four primary care orthodontic practices, UK.

MATERIALS AND METHODS

Fifteen new orthodontic patients aged 16-60 years participated in the interviews. All interviews were transcribed verbatim and analysed using framework analysis, including identification of themes within the responses, and typologies of respondents.

RESULTS

Patients seeking lingual orthodontics reported expectations that were similar in quality but different in extent to those seeking labial orthodontics. These patients were well informed about lingual orthodontic treatment before they decide to start treatment. Two typologies were identified. Firstly, males less than 30 years of age, undergoing changes in their lives, who were confident that they wanted a hidden brace, but were not entirely sure of the specifics of the system. Secondly, females aged 30-45, who request a hidden brace and had actively researched what particular systems were available.

CONCLUSIONS

This study shows that patients requesting lingual orthodontics have expectations that are similar in quality but greater in extent when compared to those seeking labial orthodontics.

Patient Feedback on Orthodontic Therapist Student Outreach Training

The introduction of orthodontic therapists as a new group of dental care professionals (DCPs) requires that their training in specialist orthodontic practices has provision for monitoring the level of supervision and clinical care provided by the students. The University of Warwick Diploma in Orthodontic Therapy programme has developed a patient questionnaire with the aim of assessing the patient's perception of the student. The observational questionnaire was designed to cover the four General Dental Council (GDC) domains and learning outcomes for orthodontic therapists, such that patient response could potentially provide valuable feedback to support the training programme. Each of the 10 students had 30 questionnaires to complete. The questionnaire was anonymous and it was designed to be suitable for both young patients and their carers to complete in less than five minutes. The response rate was very high, with 291 of the 300 questionnaires being completed. The level of co-operation may have been partly due to the ease of completion of the questionnaire, but might suggest the willingness to provide supportive feedback for the students. This study provided formative feedback to students' educational and clinical development without impacting on a student's clinical activity and will be used to develop further assessment tools.

What are patients' expectations of orthodontic treatment: a systematic review

Background

What patients expect to happen during treatment or benefit from the treatment might influence the subsequent factors such as treatment outcome, patient satisfaction, patient’s cooperation as well as compliance. The aim of this systematic review is to assess the role of patients’ expectations from orthodontic treatment.

Methods

A systematic literature search of four databases Pubmed, Cochrane, Web of Science and PsychINFO was conducted following PRISMA guidelines. Studies reporting expectations regarding orthodontic treatment were selected and a narrative review was conducted. The quality of study was rated according to STROBE statements and the methodology as well as key findings were summarized.

Results

Thirteen studies (14 papers) were finally included for analysis. Among them, only one was a randomized control trial, while the rest included one cohort study, two questionnaire-developments and ten cross-sectional studies. The STROBE quality of reporting scores of the studies ranged from 12 to 18. Seven papers described expectations of the treatment experiences, along with seven talking about benefit expectations from the treatment. Dental appearance and function improvement were most expected in studies relate to the treatment benefits.

Conclusions

Orthodontics appears to have adopted various standardized questionnaires. However, most of them are poor in the quality of methodology and results analyses, which prohibit synthesizing sufficient evidence to help identify which factors influence patient expectations. The evidence of “expectations” affecting treatment outcomes is not found in current research. Future studies are needed to better understand the impact of “expectation” on the treatment both theoretically and experimentally.

Electronic supplementary material

The online version of this article (doi:10.1186/s12903-016-0182-3) contains supplementary material, which is available to authorized users.

Patients' and parents' concerns and decisions about orthodontic treatment

Objective

Patients' and parents' expectations are important in orthodontic treatment decision making. The literature generally demonstrates the perceived benefits of orthodontic treatment, but patients' and their parents' concerns about orthodontic treatment have not been investigated comprehensively. The aim of this study was to identify patients' and parents' concerns about orthodontic treatment and compare them according to sex, age, and treatment demand level.

Methods

One hundred and eighty-nine children and their parents were interviewed about concerns related to orthodontic treatment. Patients and parents were asked about orthodontic treatment decisions. Answers were recorded as "yes," "no," or "don't know." Chi-squared and Fisher's exact tests were used to compare concerns between age groups, sexes, and treatment demand levels. Kappa statistics were used to assess agreement between patients and their parents.

Results

Concerns about orthodontic treatment were gathered under 10 items as follows: "feeling pain," "the appearance of braces," "being teased," "avoiding smiling," "speech problems," "dietary changes," "problems with transportation," "economic problems," "long treatment duration," and "missing school." There was no statistically significant difference in concerns between the sexes or age groups. Some concern items and treatment demand were inversely related in patients.

Conclusions

The results of this study demonstrate patients' and parents' concerns about orthodontic treatment. Differences between the concerns of patients with different treatment demands imply that children might reject orthodontic treatment because of their concerns. Appropriate consultation of patients addressing their concerns may help reduce anxiety and improve the acceptance of treatment.

Seen and heard: towards child participation in dental research

BACKGROUND

There has been an increasing emphasis in many countries worldwide to capture the views of children on health services and research. A previous systematic review found that most oral health research from 2000 to 2005 was conducted on children and highlighted the need for greater research with children.

AIM

To describe the extent to which oral health research between 2006 and 2014 has been conducted with or on children.

DESIGN

Systematic review. Electronic databases were searched for the literature on child dental health. Each identified paper was examined by two researchers and categorised based on the extent to which children were involved in the research, the type of study (evaluative or otherwise), the country of origin, and the clinical discipline.

RESULTS

The search included 2950 papers after application of the exclusion criteria. Of these, 17.4% were with children, 18.3% involved the use of proxies (parents or clinician), and 64.2% were on children.

CONCLUSIONS

The proportion of studies from 2006 to 2014 involving research with children has increased from 7.3% in 2000-2005. This systematic review provides evidence for movement towards children's involvement in dental research over the last 10 years. Future dental research must focus on incorporating children's perspectives into the evaluation of dental treatments to improve outcomes for children.

Impact of fixed orthodontic appliances on quality of life among adolescents' in India

Context: Malocclusion can seriously impair quality of life and they may affect various aspects of life, including function, appearance, interpersonal relationships and even career opportunities. Objectives: To assess and determine various factors that may influence the impact of orthodontic treatment on the quality of life of adolescents. Study Design: Cross sectional study in adolescents of Moradabad was conducted on 109 males and 113 females (n=222) adolescents having a fixed orthodontic appliance, aged 13 to 22 years (mean 17.5±1.5). A pre-structured questionnaire designed by Mandall et al, with nine conceptual impact sub-scales to highlight the problem faced by the patient in daily life after wearing the appliance was used to collect the data. Unpaired t-test was used to determine the statistical significance and the influence of variables were analysed using multiple linear regression analysis. Results: Factors which demonstrated high impact were oral hygiene (Mean=3.42; SD=0.78) followed by time constraints (Mean=3.23; SD=0.72) and physical impact (Mean=3.00; SD=0.61). Gender difference showed statistical significance in social impact (p=0.009), time constraints (p=0.001) and travel or cost implications (p=0.009). Internal reliability of the questionnaire ranged from low to good (Cronbach’s alpha 0.29-0.81). Test-retest reliability ranged from an intra-class correlation coefficient 0.09-0.42. Conclusions: Patients who had been comprehensively informed about their treatment had greatest levels of satisfaction and compliance with treatment. Younger patients showed an earlier adaptation to treatment with fixed appliances which influenced the treatment to be started at the earliest possible age.

Key words:Impact, malocclusion, quality of life.

Patients' expectations to dental implant: a systematic review of the literature

Objective

To examine the current literature on the impact of patients’ expectations on treatment outcomes or final patient satisfaction and to identify the theoretical frameworks, study designs and measurement instruments which have been employed to assess patients’ expectations within implant dentistry.

Methods

A structured literature search of four databases Pubmed, Cochrane, Web of Science and PsychINFO was conducted following PRISMA guidelines. Any type of literature published in English discussing the topic of ‘patients expectations’ in oral health were identified and further screened. Studies reporting on expectations regarding dental implants were selected and a narrative review was conducted.

Results

The initial search yielded 16707 studies, out of which 1051 ‘potentially effective studies’ were further assessed and final 41 ‘effective studies’ were included [Kappa = 0.76]. Ten observational studies, published from 1999 to 2013, dealt specifically with expectations of dental implants. There was a large degree of heterogeneity among studies in terms of assessment instruments. Expectations relating to aesthetics and function were primarily considered. Among the 10 studies, 8 were classified as quantitative research and 2 as qualitative research. The STROBE quality of reporting scores of the studies ranged from 13.5 to 18.0. Three of the 8 quantitative studies employed a before/after study design (prospective studies) and used visual analogue scales (VAS) to measure patient expectations.

Conclusions

There is a growing interest in patients’ expectations of dental implants. Most studies are cross sectional in nature and the quality of reporting varies considerably. Expectations with respect to aesthetics and function are key attributes considered. The use of visual analogue scales (VAS) provides quantitative assessments of patients’ expectations but the lack of standardization of measures prohibits meta- analyses.