Dental students' experiences of treating orthodontic emergencies - a qualitative assessment of student reflections

Emergency appointments and psychological distress during COVID-19 lockdown among orthodontic patients in Spain

Background

COVID-19 created an unexpected situation for dental patients. However, the impact of the lockdown on orthodontic patients is still unknown. Hence, this study was conducted to analyse the number and type of emergencies, distress and fear of getting infected among brackets and aligners orthodontic patients during the COVID-19 lockdown.

Material and Methods

A total of 324 questionnaires about emergency appointments during the lockdown and Kessler Psychological Distress Scale-K10 were distributed between March and December 2022 among patients who were on active orthodontic treatment during lockdown at the Master of Orthodontics at the University Alfonso X el Sabio during February and December 2022. Chi-square was used to compare groups.

Results

Emergency appointment was needed by 37.78% of patients during lockdown: 73.5% among those with aligners and 45.9% with brackets (p<.01). Loose bracket was the most prevalent emergency for bracket patients and lack of aligners among invisible orthodontic patients. Of those, 36.95% in need of orthodontic emergency appointments didn´t attend the clinic for fear of being infected; 21% of patients had high or very high anxiety levels.

Conclusions

Orthodontic patients had moderate levels of anxiety and fear of being infected during lockdown. Of these, 31.78% needed an emergency appointment. Key words:Orthodontics, COVID-19, dental healthcare, dentistry, emergency.

Aligning orthodontic education: Investigating the use of a digital app to improve the performance in managing orthodontic problems

INTRODUCTION

General dentists are qualified to manage orthodontic emergencies within their scope of practice. This may involve advice, hands-on intervention or referral to a specialist orthodontist. This study aimed to assess the effect of an orthodontic app on dental undergraduates' ability to manage common orthodontic issues. In addition, this study aimed to determine the confidence of dental students in finding information related to orthodontic emergencies (CFI) as well as their confidence in managing orthodontic emergencies (CMOE).

MATERIALS AND METHODS

Students were randomised into one-of-three groups, an app group, an internet group and a closed-book, exam-style group. All participants self-reported their CFI and CMOE. Following this, all participants were asked to complete a multiple-choice question (MCQ) paper based on clinical orthodontic scenarios. In addition, the app group were instructed to complete an app usability questionnaire (MAUQ).

RESULTS

Approximately, 91.40% of students (n = 84) had not received clinical training in managing orthodontic emergencies, and 97.85% (n = 91) had not managed an orthodontic emergency clinically within the last 6 months of their training. The mean score for CFI was 0.10 out of 1.0 (SD 0.11) and CMOE was 0.28 out of 1.0 (SD 0.23). Statistically significant better MCQ scores were found in the app group, and no statistically significant difference was found between the internet and exam-style group.

CONCLUSIONS

This study is the first to consider the use of an orthodontic app to aid in the management of orthodontic issues. It has practical implications for how mobile apps can aid in learning and can be incorporated into the wider dental field.

Orthodontic urgencies and their management during COVID-19 pandemic-A web-based survey

OBJECTIVES

This investigation aimed to evaluate the most common orthodontic urgencies, their management, and changes in routine biosafety measures and the total income of the dental office in South India during the COVID-19 pandemic.

METHODS

A questionnaire was drafted using Google Forms with questions in four domains pertaining to orthodontic urgencies, biosafety measures, treatment duration, and income. After validation, this questionnairewas sent to 750 orthodontists via WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif) over a period of 14 days.Descriptive statistics and comparisons were performed using independent t- and Chi-square tests.

RESULTS

Majority of the orthodontists (62.3%) had closed their clinics only during the first lockdown. Many (63%) had scheduled urgent appointments along with routine limited patients per day. The most frequent urgencies were related to the breakage of brackets, archwires, molar tubes, bands, and temporary anchorage devices. Aligners were the least problematic. The treatment time was also prolonged. Telephonic advice and virtual assistance via WhatsApp messages/videos were found to be successful in the management of urgencies.Most orthodontists had strengthened their routine biosafety measures.The financial impact of this pandemic was considerable, with nearly 50% reduction in total income.

CONCLUSIONS

Urgencies linked to preadjusted edgewise appliances, such as breakage of brackets and tubes, and archwire-related injuries were the most common. Prolongation of treatment time and negative financial impact were the other problems encountered during this pandemic. Drastic changes had occurred in routine biosafety measures, which prevented the spread of infection among orthodontists and patients.

Orthodontic Curricula in Undergraduate Dental Education-A Scoping Review

OBJECTIVE

To investigate commonalities and variations in the learning outcomes, curriculum content, assessment methods, and competencies in undergraduate orthodontic curricula globally.

METHODS

This scoping review followed the updated methodological guidance proposed by the Joanna Briggs Institute and reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). A search on electronic databases PubMed, Scopus, and Embase was conducted for the last 25 years. Google Scholar was used to identify eligible unpublished and grey literature.

RESULTS

The total number of reports identified was 231. After removal of 62 duplicates, 169 reports were included in the title and abstract screening. Finally, 17 studies were included in the review, which included 13 cross-sectional surveys, three expert panel proceedings, and one discussion paper. Marked variations were reported in undergraduate orthodontic curricula and competency assessments at the level of individual countries, regionally as well as globally. The challenges of imparting competency in orthodontic treatment during undergraduate dental education are also acknowledged.

CONCLUSION

Lack of consistency in undergraduate orthodontic education was evidenced by several Delphi studies aiming to develop a consensus on orthodontic teaching in undergraduate programs. A common message emanating from the available studies on undergraduate orthodontic education seems to emphasize a focus on assessment and diagnosis of the orthodontic treatment needs of patients and a basic understanding of contemporary treatment options to facilitate patient referral.

An exploration of the impact of working in pairs on the dental clinical learning environment: Students' views

INTRODUCTION

The aims of this study were to explore the undergraduate dental clinical students' experiences and perspectives of paired working in the clinical learning environment.

MATERIALS AND METHODS

An interpretivist methodological approach with a socio-cultural lens was used. A stratified purposeful sampling strategy was chosen. Students digitally recorded three audio-diaries using Gibbs' cycle to guide reflection on collaborating clinically with a peer. 1:1 semi-structured interviews were held using a topic guide. Inductive thematic data analysis was undertaken.

RESULTS

Eight participants were recruited. Main themes related to individual characteristics (motivation, professionalism, knowledge and experience) and relational features (feeling safe, attaching value, positive working relationships) that contributed to effective collaborative partnerships. The social setting is important for learning in the dental clinical environment. Benchmarking is used by students to motivate and reassure. Students learnt from their peers, particularly when they felt safe and supported and had developed good relationships. A lesser quality learning experience was highlighted in the assistant role.

CONCLUSION

Paired working for clinical training was viewed mostly positively. Working with a variety of peers was beneficial and enabled development of interpersonal skills and professionalism. More effective collaborative learning partnerships were described when students felt they belonged and had affective support. Disadvantages of paired working were noted as reduced hands-on experience, particularly for senior students and when working in the assistant role. Ground rules and setting learning goals to change the mind-set about the assistant role were recommended. Emotional and practical support of students is needed in the clinical setting.

Clinical audit of orthodontic chart documentation by dental undergraduates

INTRODUCTION

Clinical audit is a quality improvement process that seeks to improve patient care and outcomes through the systematic review of care against explicit criteria and the implementation of change. The objective of this audit was to evaluate the quality of orthodontic chart documentation by dental undergraduates against established guidelines.

MATERIALS AND METHODS

An audit checklist with 13 criteria for good documentation was adapted from guidelines proposed by the American Association of Orthodontists and British Orthodontic Society. Orthodontic chart documentation in 103 removable appliance therapy patients under 4th and 5th year dental undergraduates' care was retrieved from the electronic record of the University dental clinic and audited. The audit exercise explored in detail the thirteen criteria for good documentation and eight assessment attributes of the first criterion, namely, basic orthodontic examination. The level of compliance was measured as the percentage records meeting the criteria. The data were statistically analysed using SPSS 26.0 (SPSS, Inc., Chicago, IL, USA).

RESULTS

There was no complete compliance for any of the criteria. Thirty-five (33.9%) patient charts reported basic orthodontic examination documentation adequately. Compliance was the highest for documentation of treatment modality (77.6%), appliance delivery encounters (77.6%), and appliance adjustment appointments (83.5%). About 51.4% of the 68 patient charts (treatment of 35 patients of the total 103 were in the progress stage) stated adequately the outcome of treatment. Only 22% of the 68 patient charts had the details for retention protocol. There was statistically significant difference in chart documentation between male and female students for basic orthodontic assessment and appliance delivery and patient instructions attributes.

CONCLUSION

The clinical audit demonstrated poor compliance with the criteria for orthodontic chart documentation. The audit should be repeated after the provision of learning opportunities and self-critical analysis.

The Impact of COVID-19 Pandemic on Patients Receiving Orthodontic Treatment

OBJECTIVE

 The coronavirus disease 2019 (COVID-19) pandemic impacted the provision of dental treatment in a timely manner including orthodontic treatment. The objective of this study was to assess challenges encountered by patients undergoing orthodontic treatment during the pandemic and their attitude toward managing these challenges.

MATERIAL AND METHODS

 A cross-sectional sample of orthodontic patients at Prince Rashid Hospital in the north of Jordan was recruited to participate in a self-administered questionnaire that included questions related to orthodontic problems encountered during the lockdown, ways to overcome these problems, and concerns about their treatment.

RESULTS

 A total of 120 patients participated, 40 males and 80 females. Most participants (n = 86) had a fixed orthodontic appliance, who reported various orthodontic problems (82%), but the most common problems reported were exposed wire endings and loosening of brackets. Likewise, the most commonly reported problem among those with removable appliances (n = 34) was a broken or loose appliance (60%). However, patients of both types of appliances ignored the problem and waited until the re-opening of dental offices. Further, most patients missed at least one appointment for different reasons and three-quarters of them (76.6%) did not communicate with their orthodontists during the lockdown. Patients expressed their disagreement with the closure of dental offices during the pandemic because of their concern of a prolonged waiting to receive another appointment.

CONCLUSION

 The COVID-19 pandemic had a significant impact on orthodontic care and the maintenance of appointments during the lockdown periods. Patients varied in ways they managed their orthodontic problems, including their commitment to communicate with the dentists or maintain their appointments. Hence, patients should be trained on how to manage the appliance problems when they need and encourage them to accept distant communication during the emergencies.

Dental students' experience of conscious sedation: A qualitative review of student reflections

INTRODUCTION

The UK General Dental Council (GDC) requires dental graduates to competently identify, manage and refer patients with dental pain and anxiety. This study aimed to explore sedation training experience quantitatively and qualitatively through individual reflective logs.

MATERIALS & METHODS

A single-centred mixed-methods evaluation of teaching, within a UK university conscious sedation department. Fourth-year dental students undertook lectures and supervised clinical sessions following the undergraduate curriculum. Patient attendance patterns, individual experience and group experience were analysed descriptively. Reflective log sheets were analysed by Thematic Framework Analysis.

RESULTS

Seventy-two students participated. Of 153 booked patients, 79 (51.6%) attended of which 74 (48.4%) were treated by undergraduates. The mean performed inhalation sedation and intravenous sedation cases per student were 1 and 0.8, respectively. Three students (4%) assisted only. Group experience varied. Three themes arose from reflections: consolidation of theory and learning; confidence through experience; and responding to challenges.

DISCUSSION

Whilst experience quotas were not met, GDC requirements for increasing students' knowledge and confidence within CS were met. Practical experience enhanced learning. "Hands-on" experience was most valuable for self-reported confidence but learning by proxy also aided development. Students recognised challenges, but not the implications for themselves or their career. Strategies to reduce barriers to experience require research.

CONCLUSION

Whilst variable, all students were provided learning opportunities. Physical experience gave the greatest confidence. Opportunities afforded by the undergraduate curriculum allowed students to learn and develop through consolidation of theory, response to challenges and ultimately the gaining of confidence.

Patients' perceptions of orthodontic treatment experiences during COVID-19: a cross-sectional study

BACKGROUND

COVID-19 has impacted the care of patients undergoing orthodontic treatment. We aimed to provide an overall view of patients' perspectives, concerns, and expectations towards their treatment throughout the clinic lockdown during the pandemic; and to assess patients' levels of mental distress and its association with their confidence in resuming care.

METHODS

An anonymous, validated, in-person paper questionnaire was distributed to adult orthodontic patients' post-lockdown at an academic institution. The survey focused on the clinical aspects and patients' perspectives regarding orthodontic treatment during the pandemic. The Kessler Mental Distress Scale (K10) was used to evaluate their psychological status. Survey responses were descriptively summarized and confidence in resuming care was compared between normal patients and patients with mental distress using Mann-Whitney tests.

RESULTS

One hundred fifty-four patients were surveyed from July to October 2020. Mean age of the participants was 29.30 (SD = 12.01) years and 62% were females. Emergencies during the closure (21%, 32/154) involved primarily irritation with protruding wires. Patients were neutral regarding tele-dentistry and preferred their current fixed appliances over clear aligners. Upon resuming care, 80.51% were extremely pleased with the restrictive protocols and with high level of confidence in resuming treatment. The average level of anxiety was low, and a modest association was found between mental distress and reduced confidence in resuming treatment.

CONCLUSIONS

Few numbers of minor emergencies occurred during the clinic closure. Despite the rising interest in tele-dentistry, patients were neutral on considering this option to monitor treatment and were content with fixed appliances. Patients had high confidence levels to resume their care based on the protocols established upon reopening. The association of mental distress and confidence in resuming care is suggestive and needs further investigation.

The Implications of the COVID-19 Pandemic on the Interest in Orthodontic Treatment and Perspectives for the Future. Real-Time Surveillance Using Google Trends

Background: The COVID-19 pandemic outbreak may have a large impact on orthodontic treatment. Regular orthodontic visits were strongly and widely interrupted by the unprecedented epidemiological threat. Methods: The data regarding orthodontic queries were investigated in a real-time surveillance using Google Trends. Search terms “braces”, “invisalign”, “get braces”, “get braces off”, “braces pain” and the phrase “social distancing” were analyzed regarding the year preceding the pandemic outbreak and the time of the pandemic. Moreover, the five-year trend for queries “braces” vs. “invisalign”, as an example of different types of orthodontic appliances, was compared. Results: There was a significant decrease in orthodontics phrase queries in the spring of 2020, connected with the worldwide restrictions and lockdowns announced all over the world. There was a lower interest in the “braces pain” query during the first lockdown in 2020. The number of searches for “invisalign” increased steadily over time, while the number of searches for “braces” was relatively stable across the investigated time period. Conclusions: The course of the COVID-19 pandemic has had a large impact on the orthodontic-related search queries. Orthodontists must be better-prepared for any sudden changes in the possible future in the epidemiological situation that may change accessibility to dental offices.

Urgencies and emergencies in orthodontics during the coronavirus disease 2019 pandemic: Brazilian orthodontists' experience

Introduction

The present study aimed to evaluate the most common urgencies and emergencies in orthodontics during the coronavirus disease 2019 (COVID-19) pandemic and to assess how orthodontists in Brazil were dealing with patients and challenges.

Methods

Early in 2020, as the COVID-19 pandemic spread around the world, routine dental care was suspended in many countries, and only patients needing urgent or emergency care could be seen. During this period, orthodontists in Brazil were invited to participate in an anonymous online survey. Over 48 hours (May 1-3, 2020), 395 orthodontists (specialists, MScs, and PhDs) responded. They answered questions regarding dental office and appointments during the pandemic, the type of urgency or emergency care provided, the type of appliance and urgencies, etc. The level of concern about the impact of the pandemic on patients' orthodontic treatments and the financial impact on the dental office was also evaluated. Descriptive statistics were performed with percentages, and responses were compared between specialists, MScs, and PhDs, using chi-square tests.

Results

Specialists were the majority of respondents. Most orthodontists were handling only emergencies or urgencies. The most frequent urgencies were bracket breakage, archwire breakage, and breakage of molar tubes and/or bands. Stainless steel fixed appliances were the most common type of appliance related to unscheduled appointments. The majority of patients got in touch with the orthodontist using the professional WhatsApp messenger (WhatsApp Inc, Menlo Park, Calif). Orthodontists were more concerned with the financial impact of the pandemic than with the orthodontic treatment itself.

Conclusions

Breakage of brackets, archwires, or tubes and/or bands were the most common causes of urgency and/or emergency appointments during the pandemic. The level of concern about the financial impact of the stay-at-home orders and the COVID-19 pandemic was significantly greater for specialists and MScs than for PhDs.

•

We surveyed orthodontists in Brazil during the coronavirus disease 2019 pandemic.

•

Most frequent urgencies were breakages of brackets, archwires, molar tubes, or bands.

•

Stainless steel fixed appliances were the type most related to unscheduled appointments.

•

Most patients contacted the orthodontist using the professional WhatsApp messenger.

•

Orthodontic specialists and MScs were more concerned than PhDs about financial impacts.

Teaching orthodontic emergencies using the "flipped classroom" method of teaching-A mixed methods RCT

INTRODUCTION

In the United Kingdom, the General Dental Council requires newly graduated dentists to be competent in managing orthodontic emergencies. Undergraduate students typically receive limited exposure to orthodontics, with teaching primarily delivered via conventional lectures. Flipped teaching involves knowledge being acquired in students' own time, with class time focussing on construction of meaning.

METHODS

A total of 61 undergraduate dental students were randomised into either a flipped or a conventional group. The conventional group (n = 30) attended a lecture describing the management of six common emergencies. The flipped group (n = 31) were given access to six videos via a virtual learning environment and later completed practical tasks related to the material. Both groups completed a single best answer assessment. Perceptions of flipped classroom teaching were explored via focus groups.

RESULTS

For questions on orthodontic emergencies, the conventional group had a mean examination result of 70.5% (SD 8.0%) compared with the flipped group of 72.8% (SD 12.9%). There was no significant difference between the groups (P = .532). For regular orthodontic questions, the conventional group had a mean examination result of 64.8% (SD: 19.9%) compared with 78.3% (SD: 21.7%). There was no significant difference between the groups (P = .083). Thematic analysis identified the following themes: ways in which videos encourages more effective learning, improved engagement, awareness of learning needs and proposed teaching/curriculum changes. The overarching theoretical perspective was facilitating an experiential learning cycle using flipped classroom teaching.

CONCLUSIONS

In the context of this investigation, the flipped classroom method of teaching resulted in comparable examination performance and improved levels of satisfaction.

Evidence in Orthodontics related to qualitative research

Introduction:

Research in Orthodontics has historically followed the positivist model based on the direct relationship of cause and effect between diseases and their specific etiological factors. Despite the objectivity and the great potential of statistical procedures, quantitative methods have progressively been sharing space with other models that can encompass the multiplicity of factors that affect the health-disease process, which until such time was reduced to its biological dimension.

Objectives:

This study aims, through an integrative review, to identify orthodontics articles published over a 10-year period that have used, exclusively or not, some method of qualitative research, and analyze the main aspects of their content.

Methods:

A survey was performed on Pubmed, Medline, Scopus, and Lilacs databases from 2007 to 2016 with a focus on the applicability of the qualitative methodology in orthodontic research.

Results:

The 27 articles selected showed a trend to increase in publications, with the most recent four years concentrating almost 60% of them. Most studies were from Europe, particularly the UK, and the more frequent study objectives were related to the perception of people about the reasons for orthodontic treatment, about the aesthetic and psychosocial impact of malocclusion or orthodontic treatment, and the implications of these factors for their quality of life.

Conclusions:

Because of its potential to explore behaviours and socio-cultural attitudes sustained in subjectivity, qualitative research offers new possibilities for orthodontic studies and can be used in an exclusive or complementary way in relation to quantitative methods.

Management of orthodontic emergencies in primary care - self-reported confidence of general dental practitioners

Objective To determine general dental practitioners' (GDPs) confidence in managing orthodontic emergencies.Design Cross-sectional study.Setting Primary dental care.Subjects and methods An online survey was distributed to dentists practicing in Wales. The survey collected basic demographic information and included descriptions of ten common orthodontic emergency scenarios.Main outcome measure Respondents' self-reported confidence in managing the orthodontic emergency scenarios on a 5-point Likert scale. Differences between the Likert responses and the demographic variables were investigated using chi-squared tests.Results The median number of orthodontic emergencies encountered by respondents over the previous six months was 1. Overall, the self-reported confidence of respondents was high with 7 of the 10 scenarios presented scoring a median of 4 indicating that GDPs were 'confident' in their management. Statistical analysis revealed that GDPs who saw more orthodontic emergencies in the previous six months were more confident when managing the presented scenarios. Other variables such as age, gender, geographic location of practice and number of years practising dentistry were not associated with self-reported confidence.Conclusions Despite GDPs encountering very few orthodontic emergencies in primary care, they appear to be confident in dealing with commonly arising orthodontic emergency situations.