Why do patients transition between orthodontic appliances? A qualitative analysis of patient decision-making

OBJECTIVES

To gain an in-depth understanding of patients' decision-making processes when choosing to transition to a different orthodontic appliance (OA).

METHODS

This was a retrospective qualitative study using one-on-one in-depth semi-structured interviews. Patients were recruited through purposive convenience sampling. Participants who had elected to transition from and to one of these OAs: metal brackets, tooth-coloured brackets, or clear aligners before the end of treatment were recruited. Recruitment ceased when data saturation was achieved. The interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis.

RESULTS

Twenty-three adult participants (12 males, 11 females) with their ages ranging from 18 to 52 years were interviewed. The analysis of the data revealed that participants perceived two reasons for the transition: (1) insufficient initial information and (2) evolving life circumstances and personal style. Data analysis of participants who expressed a notable discrepancy between their expectations and the reality of the OA they chose revolved around three themes: (a) health benefits and threats, (b) personal control, and (c) financial considerations. Data analysis of participants who described transitioning between OAs due to changes in personal circumstances and style, revealed two themes: (a) change in personal values and motivations and (b) change in social and psychological influence.

CONCLUSIONS

This qualitative study highlighted the complex multifactorial nature of patient decision-making when choosing and transitioning OAs. Orthodontists can benefit from understanding these factors to engage in thorough patient-centered counselling, provide tailored treatment recommendations, and optimize the choice of appliances.

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND

Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment.

METHODS

A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2).

RESULTS

Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.

"It's just inappropriate": Harassment of dental students by patients

INTRODUCTION

Harassment is an issue that occurs in all workplaces and institutions. Due to increased exposure to patients, higher rates of harassment are experienced in health care systems. Health care workers need to form a professional relationship with patients to attend to their health care needs; however, harassment by patients can disrupt this relationship and have detrimental physical, mental, and emotional impacts on the health practitioner.

OBJECTIVE

The purpose of this study was to examine the prevalence and impact of harassment by patients toward clinical students at a prominent Australasian dental school.

METHODS

A 14-item survey was distributed to clinical students. The survey collected basic demographic information and contained Likert-scale closed questions on harassment prevalence and experience and a free text question asking for details of a significant harassment experience. Descriptive statistics and analysis of free text data were performed.

RESULTS

The response rate was 67%. About 20% of respondents reported experiencing at least one incident of harassment. Verbal harassment was most commonly reported, followed by sexual and racial harassment. All incidences of sexual harassment were reported by female students, while racial harassment was most frequently reported by students of Asian ethnicity. Most students indicated they were unsure of how to respond to harassment by patients.

CONCLUSION

Dental students were exposed to harassment by patients.

IMPLICATIONS

Appropriate policies and education on responding to harassment, alongside support for the same, could help ensure the safety and wellbeing of students.

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

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.

Managing orthodontic appliances in everyday life: A qualitative study of young people's experiences with removable functional appliances, fixed appliances and retainers

OBJECTIVE

To compare young people's experiences of wearing a range of orthodontic appliances.

DESIGN

A cross-sectional, qualitative study with purposive sampling.

SETTING

UK dental teaching hospital.

PARTICIPANTS

Twenty-six orthodontic patients aged 11-17 years.

METHODS

Patients participated in in-depth semi-structured interviews. All interviews were transcribed verbatim and analysed thematically.

RESULTS

Young people reported physical, practical and emotional impacts from their appliances. Despite these reported impacts, participants described 'getting used' to and, therefore, not being bothered by their appliance. Framework analysis of the data identified a multi-dimensional social process of managing everyday life with an appliance. This involves addressing the 'dys-appearance' of the body through physically adapting to an appliance. This process also includes psychological approaches, drawing on social networks, developing strategies and situating experiences in a longer-term context. Engaging in this process allowed young people to address the physical, practical and emotional impacts of their appliances.

CONCLUSION

This qualitative research has identified how young people manage everyday life with an appliance. Understanding this process will help orthodontists to support their 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.

The Influence of Treatment Expectations on Clinical Outcomes and Cortisol Levels in Patients With Chronic Neck Pain: An Experimental Study

BACKGROUND

The role of contextual factors like pre-existing treatment expectations has been established. However, the effect of verbally delivered treatment expectations in patient-therapist communication has not been considered, nor has the role of cortisol changes within the placebo/nocebo response in people with chronic neck pain.

OBJECTIVE

To examine the effect of verbally delivered treatment expectations on clinical outcomes in physical therapy practice and to determine if changes in cortisol levels are associated with changes in neck pain and disability.

METHODS

Eighty-three patients with chronic neck pain were randomly allocated to 3 different verbally delivered expectations (positive, negative, neutral) during physical therapy interventions.

MAIN OUTCOME MEASURES

salivary cortisol, pain and disability, and cervical range of motion.

RESULTS

Pain significantly improved in the positive (P < 0.001) and neutral (P < 0.001) expectations groups. For salivary cortisol levels, a significant increase was observed in response to treatment in the neutral (P = 0.045) and negative (P < 0.001) expectations groups. No significant correlations were found between changes in salivary cortisol levels and the change in pain in the neutral and negative expectations groups.

CONCLUSIONS

Physical therapists treating people with chronic neck pain should be attentive when communicating the expected treatment effects to their patients. Whereas verbally delivered positive or neutral expectations may be beneficial for pain-related measures, giving negative expectations may result in a lack of a treatment response on pain. Cortisol levels increased in response to verbally delivered neutral and negative expectations, in the absence of a nocebo effect. This questions the presumed role of cortisol in the nocebo effect.

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.

Adults seeking orthodontic treatment: expectations, periodontal and TMD issues

The growth in adult orthodontics presents new challenges to both the general dental practitioner and the orthodontist. Although many of the main objectives of orthodontic treatment are similar for adults, young adults and children, adult patients frequently bring significant challenges in several areas not often seen in the younger patient group. In areas such as planning realistic treatment outcomes, it is paramount that the patient's expectations are identified, respected and managed where appropriate. The adult patient's dental health often dictates deviation from the ideal treatment plan and periodontal problems are a common example. Based on current evidence, this paper presents an overview of some of the difficulties in the management of these issues, as well as highlighting developments with regard to pain conditions and their relevance to orthodontic treatment and its effects on temporomandibular joint disorders (TMD) management.

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.

How patient and carer expectations of orthodontic treatment vary with ethnicity

OBJECTIVE

To investigate if the orthodontic treatment expectations of Black British children and their primary carers vary compared with White British children and their primary carers.

SETTING

A hospital orthodontic department (Queen Mary's Hospital, Sidcup, London, UK).

PARTICIPANTS

Patients and their accompanying primary carers who had not received fixed orthodontic appliance treatment and were aged between 12 and 14 years old.

METHOD

Informed consent was obtained from 100 patients and their primary carers, who completed a psychometrically validated questionnaire, to measure their expectations before a new patient orthodontic consultation. This cohort consisted of 50 Black British patients and their primary carers and 50 White British patients and their primary carers.

RESULTS

Mean responses from patients and their primary carers for each ethnic group were compared using the independent groups t-test. Significant statistical differences were found between the two ethnic groups. The greatest statistical differences occurred between Black British patients and their primary carer and Black British primary carers and White British primary carers. Patients tended to have similar orthodontic expectations. There were no statistical significant differences in expectations between White British children and their primary carers.

CONCLUSION

Differences in expectations of orthodontic treatment were more common between Black British and White British primary carers, than their children. White British primary carers had higher expectations at their child's initial appointment and expected dental extractions to be part of the orthodontic treatment plan. These differences have some implications for the provision of orthodontic care. A clinicians understanding of patients and their primary carer's expectations at the start of treatment can help in the quality and delivery of orthodontic care provided.

Effect of year one orthodontic treatment on the quality of life of adolescents, assessed by the short form of the Child Perceptions Questionnaire

AIM

To evaluate the effect of the first 12 months of orthodontic treatment on the quality of life of Brazilian adolescents and to examine the evaluative properties of the short form of the Child Perceptions Questionnaire (CPQ11-14).

STUDY DESIGN AND METHODS

This study involved a sample of 101 adolescents undergoing orthodontic treatment with a fixed appliance. Participants were asked to answer the Brazilian version of the short form of the CPQ11-14 before treatment (T1) and 12 months after the placement of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed-rank test and the Bonferroni correction for the overall score and the short form of the CPQ11-14 subscales. Responsiveness of the measure and the minimal clinically important difference (MCID) were also evaluated.

RESULTS AND STATISTICS

Out of the 101 individuals originally admitted to this study, three were excluded due to cessation of treatment and failure to return the questionnaire, providing a response rate of 97.0%. Statistically, significant improvements were found in the overall score (P < 0.001) as well as in both emotional well-being (P < 0.001) and social well-being (P = 0.007) subscales. The reductions in score were associated with an effect of size showing moderate clinically meaningful changes in the overall score and in the functional limitations, emotional well-being and social well-being. The MCID was 3.35.

CONCLUSION

The first 12 months of orthodontic treatment with a fixed appliance had a positive effect on the quality of life of western adolescents.