Orthodontics in the general dental service of England and Wales: a critical assessment of standards

Abstract

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

A closer look at General Dental Service orthodontics in England and Wales II: What determines appliance selection?

“…The 1987-88 study 3 and the earlier of these two papers, 8 showed that orthodontic qualification was not a factor in measures of outcome on a national scale, once appliance type was included in the analysis. It is interesting, however, that these results identify orthodontic qualification as quite a strong predictor of fixed appliance use, and in particular, of dual arch fixed appliance use.…”

“…This may explain the apparent disparities between this and earlier studies on outcome. 3,8,10 While it is likely that some practitioners can gain a degree of proficiency with fixed appliance techniques after short courses, or a few perhaps by private study alone, most would be more competent and confident in their use after a period of practise under a mentor. The need for more practitioners who have been trained on formal postgraduate courses is therefore underlined as an important factor in any future improvement of GDS orthodontics.…”

A closer look at General Dental Service orthodontics in England and Wales II: What determines appliance selection?

“…Appliance selection is the main criterion in outcome, [1][2][3][4][5][6]8 but those who have had a formal training in orthodontics are more likely to use fixed appliances. Where other practitioners had learned to use these appliances, whether on short courses, clinical assistant attachments, or indeed, perhaps when they were self-taught, their results appeared to have been similar to those attained by orthodontic diplomates or members.…”

“…Appropriate choice of appliances has been suggested to be of particular importance. 7,8 Generally, regardless of the sphere of practice considered and of other factors involved, dual arch fixed appliances have been shown to be the most reliable, [3][4][5][6]8 whilst single arch fixed appliance treatments tend to be more effective than those involving only removable appliances. 5,6 Appliance type was shown to over ride differences due to hospital grade of operator and individual hospital departments.…”

“…Dental Service (GDS) orthodontics, 3,4,6,8 although it has recently been shown that orthodontic standards of general dental practitioners were improved by clinical assistant attachments (in the south-west of England), 9 whilst a similar localised study in the north-west of England suggested that the standards of orthodontically qualified practitioners were in fact rather better still. 10 Although the relevance of selection of the appropriate appliance for each case has been emphasised, 7,8 it is generally accepted that removable appliances can only perform a limited range of tooth movements, and the overall picture is that more judicious appliance selection, and in particular, wider use of fixed appliances, would result in better standards in the GDS.…”