Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Designing the Study Questionnaire
2.2. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A
Appendix B
- me personally
- the dental assistant
- the secretary
- other clinic staff
- Children
- Parents/guardians
- Adult patients
- Elderly patients
- Periodontal patients
- Patients with specific general diseases (e.g., heart diseases)
- Patients with severe aesthetic problems
- Patients with severe functional problems
- Patients who have a multidisciplinary treatment plan
- Patients who will need extractions
- All the above
- None of the above
- 0–15 min
- 15–30 min
- 30–60 min
- 60 min and above
- I don’t inform the patients
- Printed pictures showing similar cases
- digital images/videos
- published studies
- special facial analysis software
- no audio-visual media
- other
- on social media (Facebook, Instagram, etc.)
- with email marketing
- on the clinic’s website
- in the waiting room
- in information brochures
- I am not interested in marketing my office
- Other
References
- Merriam Webster. Dictionary. Informed Consent. Available online: https://www.merriam-webster.com/dictionary/informed%20consent (accessed on 12 December 2023).
- Cocanour, C.S. Informed Consent-It’s more than a signature on a piece of paper. Am. J. Surg. 2017, 214, 993–997. [Google Scholar] [CrossRef] [PubMed]
- Moreira, N.C.; Pacheco-Pereira, C.; Keenan, L.; Cummings, G.; Flores-Mir, C. Informed consent comprehension and recollection in adult dental patients: A systematic review. J. Am. Dent. Assoc. 2016, 147, 605–619.e607. [Google Scholar] [CrossRef] [PubMed]
- Bahadori, M.; Raadabadi, M.; Ravangard, R.; Baldacchino, D. Factors affecting dental service quality. Int. J. Health Care Qual. Assur. 2015, 28, 678–689. [Google Scholar] [CrossRef] [PubMed]
- Sam, G.; Alaskar, Z.A.; Elqomsan, M.A.S.A.; Alateeg, M.A. Ethics In Orthodontics: A Retrospective review. Int. J. Ethics Trauma Vict. 2016, 2, 18–20. [Google Scholar] [CrossRef]
- Johansson, K.; Lindh, C.; Paulsson, L.; Rohlin, M. A tool for assessment of risk of bias in studies of adverse effects of orthodontic treatment applied in a systematic review on external root resorption. Eur. J. Orthodont. 2021, 43, 457–466. [Google Scholar] [CrossRef] [PubMed]
- Kaitsas, R.; Kaitsas, F.; Paolone, G.; Paolone, M.G. Ortho-Perio Risk Assessment and timing flowchart for lingual orthodontics in an interdisciplinary adult ortho-perio patient: A case report of “Perio-Guided” Orthodontic treatment. Int. Orthodont. 2022, 20, 100598. [Google Scholar] [CrossRef] [PubMed]
- American Association of Orthodontics (AAO). Forms and Releases. Available online: https://www2.aaoinfo.org/practice-management/legal-resource-center/forms-and-releases/ (accessed on 12 December 2023).
- Antoniadou, M.; Masoura, E.; Devetziadou, M.; Rahiotis, C. Ethical Dilemmas for Dental Students in Greece. Dent. J. 2023, 11, 118. [Google Scholar] [CrossRef]
- Wishney, M. Potential risks of orthodontic therapy: A critical review and conceptual framework. Aust. Dent. J. 2017, 62 (Suppl. S1), 86–96. [Google Scholar] [CrossRef]
- Verrusio, C.; Iorio-Siciliano, V.; Blasi, A.; Leuci, S.; Adamo, D.; Nicolo, M. The effect of orthodontic treatment on periodontal tissue inflammation: A systematic review. Quintessence Int. 2018, 49, 69–77. [Google Scholar]
- Cerroni, S.; Pasquantonio, G.; Condo, R.; Cerroni, L. Orthodontic Fixed Appliance and Periodontal Status: An Updated Systematic Review. Open Dent. J. 2018, 12, 614–622. [Google Scholar] [CrossRef]
- Benkaddour, A.; Bahije, L.; Bahoum, A.; Zaoui, F. Orthodontics and enamel demineralization: Clinical study of risk factors. Int. Orthod. 2014, 12, 458–466. [Google Scholar] [CrossRef] [PubMed]
- Weltman, B.; Vig, K.W.; Fields, H.W.; Shanker, S.; Kaizar, E.E. Root resorption associated with orthodontic tooth movement: A systematic review. Am. J. Orthod. Dentofacial Orthop. 2010, 137, 462–476; discussion 412A. [Google Scholar] [CrossRef] [PubMed]
- Javed, F.; Al-Kheraif, A.A.; Romanos, E.B.; Romanos, G.E. Influence of orthodontic forces on human dental pulp: A systematic review. Arch. Oral Biol. 2015, 60, 347–356. [Google Scholar] [CrossRef] [PubMed]
- Khan, A.R.; Fida, M.; Gul, M. Decalcification and bond failure rate in resin modified glass ionomer cement versus conventional composite for orthodontic bonding: A systematic review & meta-analysis. Int. Orthod. 2020, 18, 32–40. [Google Scholar] [PubMed]
- Li, Y.; Jacox, L.A.; Little, S.H.; Ko, C.C. Orthodontic tooth movement: The biology and clinical implications. Kaohsiung J. Med. Sci. 2018, 34, 207–214. [Google Scholar] [CrossRef] [PubMed]
- De Felippe, N.L.; Da Silveira, A.C.; Viana, G.; Smith, B. Influence of palatal expanders on oral comfort, speech, and mastication. Am. J. Orthod. Dentofacial Orthop. 2010, 137, 48–53. [Google Scholar] [CrossRef]
- Fraundorf, E.C.; Araujo, E.; Ueno, H.; Schneider, P.P.; Kim, K.B. Speech performance in adult patients undergoing Invisalign treatment. Angle Orthod. 2022, 92, 80–86. [Google Scholar] [CrossRef]
- Singh, S.; Singla, L.; Anand, T. Esthetic Considerations in Orthodontics: An Overview. Dent. J. Adv. Stud. 2021, 9, 55–60. [Google Scholar] [CrossRef]
- Damasceno Melo, P.E.; Bocato, J.R.; de Castro Ferreira Conti, A.C.; Siqueira de Souza, K.R.; Freire Fernandes, T.M.; de Almeida, M.R. Effects of orthodontic treatment with aligners and fixed appliances on speech. Angle Orthod. 2021, 91, 711–717. [Google Scholar] [CrossRef]
- Zigante, M.; Spalj, S. Clinical predictors of metal allergic sensitization in orthodontic patients. Cent. Eur. J. Public Health 2022, 30, 173–178. [Google Scholar] [CrossRef] [PubMed]
- Gölz, L.; Papageorgiou, S.N.; Jäger, A. Nickel hypersensitivity and orthodontic treatment: A systematic review and meta-analysis. Contact Dermat. 2015, 73, 1–14. [Google Scholar] [CrossRef]
- Rashid, Z.J.; Gul, S.S.; Shaikh, M.S.; Abdulkareem, A.A.; Zafar, M.S. Incidence of Gingival Black Triangles following Treatment with Fixed Orthodontic Appliance: A Systematic Review. Healthcare 2022, 10, 1373. [Google Scholar] [CrossRef] [PubMed]
- Konstantonis, D.; Anthopoulou, C.; Makou, M. Extraction decision and identification of treatment predictors in Class I malocclusions. Prog. Orthod. 2013, 14, 47. [Google Scholar] [CrossRef] [PubMed]
- Al-Ani, M.H.; Mageet, A.O. Extraction Planning in Orthodontics. J. Contemp. Dent. Pract. 2018, 19, 619–623. [Google Scholar] [CrossRef]
- Thirunavukkarasu, V.N.; Ramachandra, S.S.; Dicksit, D.D.; Gundavarapu, K.C. Extraction protocols for orthodontic treatment: A retrospective study. Contemp. Clin. Dent. 2016, 7, 41–44. [Google Scholar]
- Dowsing, P.; Murray, A.; Sandler, J. Emergencies in orthodontics. Part 1: Management of general orthodontic problems as well as common problems with fixed appliances. Dent. Update 2015, 42, 131–134, 137–140. [Google Scholar] [CrossRef]
- Toz Ertop, M.; Cicek, O.; Erener, H.; Ozkalayci, N.; Demir Cicek, B.; Comert, F. Evaluation of the Demineralization Development around Different Types of Orthodontic Brackets. Materials 2023, 16, 984. [Google Scholar] [CrossRef]
- Acir, K.C.; Çicek, O.; Özkalaci, N. The Effects of Different Types of Surface Conditioning Methods on Enamel Demineralization: An In-vitro Rebonded Bracket Study. Med. J. West Black Sea 2023, 2, 180–187. [Google Scholar] [CrossRef]
- Banakar, M.; Bagheri Lankarani, K.; Jafarpour, D.; Moayedi, S.; Banakar, M.H.; Mohammad Sadeghi, A. COVID-19 transmission risk and protective protocols in dentistry: A systematic review. BMC Oral Health 2020, 20, 275. [Google Scholar] [CrossRef]
- Perry, J.; Popat, H.; Johnson, I.; Farnell, D.; Morgan, M.Z. Professional consensus on orthodontic risks: What orthodontists should tell their patients. Am. J. Orthod. Dentofac. Orthop. 2021, 159, 41–52. [Google Scholar] [CrossRef] [PubMed]
- Omran, R.; Dowie, A. Increased demand for orthodontic treatments during the COVID-19 pandemic: A commentary. Br. Dent. J. 2023, 234, 84–87. [Google Scholar] [CrossRef] [PubMed]
- Greco, P. Ethics in orthodontics. Am. J. Orthodont Dent. Orthop. 2023, 165. [Google Scholar] [CrossRef]
- Izadi, A.; Jahani, Y.; Rafiei, S.; Masoud, A.; Vali, L. Evaluating health service quality: Using importance performance analysis. Int. J. Health Care Qual. Assur. 2017, 30, 656–663. [Google Scholar] [CrossRef] [PubMed]
- Bernabe, E.; Sheiham, A.; de Oliveira, C.M. Impacts on daily performances related to wearing orthodontic appliances. Angle Orthod. 2008, 78, 482–486. [Google Scholar] [CrossRef] [PubMed]
- Cohen, E.S.; Yen, S.L. Informed Consent for Orthodontic Treatment: An Overview of Contemporary Materials and Techniques. J. Am. Dent. Assoc. 2014, 145, 439–442. [Google Scholar]
- Hancox, R.J.; Shelton, W.; Sutherland, M.; Magee, K.P. Orthodontic informed consent: An overview. J. World Fed Orthodont. 2014, 3, e129–e133. [Google Scholar]
- Kumar, S.; Asokan, S.; John, J.; Geetha Priya, P.R. A Survey on the Practices of Orthodontists in Obtaining Informed Consent from Patients: A Cross-Sectional Study. J. Pharm. Bioallied Sci. 2016, 8 (Suppl. S1), S86–S90. [Google Scholar]
- Clementini, M.; Laino, L.; De Vivo, D.; Ferrara, E.; Lupi, S.M. Professional Responsibility in Orthodontics: Risk Management. Open Dent. J. 2018, 12, 1091–1095. [Google Scholar]
- Alam, M.K.; Abutayyem, H.; Kanwal, B.; Alswairki, H.J. Effect of COVID-19 on orthodontic treatment/practice- A systematic review and meta-analysis. J. Orthod. Sci. 2023, 12, 26. [Google Scholar] [CrossRef]
- Maltezou, H.C.; Tseroni, M.; Vorou, R.; Koutsolioutsou, A.; Antoniadou, M.; Tzoutzas, I.; Panis, V.; Tzermpos, F.; Madianos, P. Preparing dental schools to refunction safely during the COVID-19 pandemic: An infection prevention and control perspective. J. Infect. Dev. Ctries 2021, 15, 22–31. [Google Scholar] [CrossRef]
- Carr, K.M.; Fields, H.W.; Beck, F.M.; Kang, E.Y.; Kiyak, H.A.; Pawlak, C.E.; Firestone, A.R. Impact of verbal explanation and modified consent materials on orthodontic informed consent. Am. J. Orthod. Dent. Orthop. 2012, 141, 174–186. [Google Scholar] [CrossRef]
- Carter, A.; Al-Diwani, H. What is the best method to ensure informed consent is valid for orthodontic treatment? A trial to assess long-term recall and comprehension. Evid. Based Dent. 2022, 23, 52–53. [Google Scholar] [CrossRef]
- Skulski, B.N.; Fields, H.W.; Johnston, W.M.; Robinson, F.G.; Firestone, A.; Heinlein, D.J. Rehearsal’s effect on recall and comprehension of orthodontic informed consent. Am. J. Orthod. Dentofacial Orthop. 2021, 159, e331–e341. [Google Scholar] [CrossRef] [PubMed]
- Lee, S.J.; McGrath, C.P.; Samman, N. Technology as a means to enhance orthodontic practice. Aust. Orthod. J. 2006, 22, 151–156. [Google Scholar]
- Terry, M.; Cain, J. The Emerging Issue of Digital Empathy. Am. J. Pharm. Educ. 2016, 80, 58. [Google Scholar] [CrossRef] [PubMed]
- Hollander, M.H.; de Leeuw, R.J. Towards a wearable oral robotic instrument for orthodontic treatment. Eur. J. Orthod. 2016, 38, 624–629. [Google Scholar]
- Kellar, K.L. Informed Consent: A “Repetition” of the Principal Elements? Transfus. Med. Rev. 2009, 23, 197–205. [Google Scholar]
- Devetziadou, M.; Antoniadou, M. Branding in Dentistry: A Historical and Modern Approach to a New Trend. J. Dent. Oral Disord. 2020, 6, 1130. [Google Scholar] [CrossRef]
- Devetziadou, M.; Antoniadou, M. Dental Patient’s Journey Map: Introduction to Patient’s Touchpoints. On. J. Dent. Oral Health 2021, 4, 1–16. [Google Scholar] [CrossRef]
- Elwyn, G.; Frosch, D.; Thomson, R. Shared decision making: A model for clinical practice. J. Gen. Int. Med. 2012, 27, 1361–1367. [Google Scholar] [CrossRef]
- Entwistle, V.A.; Carter, S.M.; Cribb, A.; McCaffery, K. Supporting patient autonomy: The importance of clinician-patient relationships. J. Gen. Int. Med. 2010, 25, 741–745. [Google Scholar] [CrossRef]
- McColl, E.; Jacoby, A.; Thomas, L. Design and use of questionnaires: A review of best practice applicable to surveys of health service staff and patients. Health Technol. Assess. 2001, 5, 1–256. [Google Scholar] [CrossRef] [PubMed]
- Phillips, A.W.; Reddy, S.; Durning, S.J. Improving response rates and evaluating nonresponse bias in surveys: AMEE Guide No. 102. Med. Teach. 2016, 38, 217–228. [Google Scholar] [CrossRef] [PubMed]
- Meyer, V.; Maurice, M.D.; Benjamens, S.B.; El Moumni, M.; Lange, J.F.; Pol, R.A. Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery: A Systematic Review. Ann. Surg. 2022, 275, e75–e81. [Google Scholar] [CrossRef] [PubMed]
- Sprague, S.; Quigley, L.; Bhandari, M. Survey design in orthopaedic surgery: Getting surgeons to respond. J. Bone Joint Surg. Am. 2009, 91 (Suppl. S3), 27–34. [Google Scholar] [CrossRef]
- Edwards, P.J.; Roberts, I.; Clarke, M.J.; DiGuiseppi, C.; Wentz, R.; Kwan, I.; Cooper, R.; Felix, L.M.; Pratap, S. Methods to increase response to postal and electronic questionnaires. Cochrane Database Syst. Rev. 2009, 3, MR000008. [Google Scholar] [CrossRef]
What is Your Highest Degree in Dentistry? | |||||||
---|---|---|---|---|---|---|---|
Bachelor | Master | PhD | Total | ||||
N | % | N | % | N | % | N | |
Greece | 5 | 20.8% | 50 | 43.5% | 22 | 75.9% | 77 |
Slovakia | 19 | 79.2% | 65 | 56.5% | 7 | 24.1% | 91 |
Total | 24 | 100.0% | 115 | 100.0% | 29 | 100.0% | 168 |
Country | Gender | Highest Degree in Dentistry * | Years in Profession as Orthodontist ** | |||||||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Survey Item | Greece | Slovakia | Males | Females | Bachelor | Master | PhD | 1–10 | 11–20 | 21–30 | >30 | |||||||||||
M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | M | SD | |
Q1 | 2.26 | 1.25 | 1.37 | 0.49 | 2.15 | 1.2 | 1.61 | 0.88 | ||||||||||||||
Q5 | 3.62 | 1.25 | 3.00 | 1.23 | ||||||||||||||||||
Q6 | 3.11 | 1.24 | 3.50 | 1.05 | 3.50 | 1.02 | 3.49 | 1.02 | 2.84 | 1.16 | 3.50 | 1.25 | ||||||||||
Q7 | 2.99 | 1.15 | 1.81 | 0.77 | 2.62 | 1.18 | 2.23 | 1.09 | 2.08 | 0.93 | 2.29 | 1.12 | 2.83 | 1.19 | ||||||||
Q8 | 1.61 | 1.00 | 1.29 | 0.68 | ||||||||||||||||||
Q9 | 3.40 | 1.41 | 2.55 | 1.24 | ||||||||||||||||||
Q10 | 3.27 | 1.73 | 1.81 | 1.08 | 2.91 | 1.71 | 2.29 | 1.5 | ||||||||||||||
Q11 | 3.01 | 1.60 | 2.49 | 1.28 | ||||||||||||||||||
Q12 | 2.68 | 1.23 | 1.90 | 0.98 | 2.51 | 1.3 | 2.14 | 1.08 | 1.88 | 0.95 | 2.17 | 1.12 | 2.26 | 1.16 | ||||||||
Q13 | 3.56 | 1.29 | 2.80 | 1.38 | ||||||||||||||||||
Q15 | 3.16 | 1.59 | 2.70 | 1.33 | ||||||||||||||||||
Q16 | 2.06 | 1.13 | 1.76 | 0.84 | ||||||||||||||||||
Q17 | 3.34 | 1.59 | 2.60 | 1.41 | ||||||||||||||||||
Q18 | 3.08 | 1.19 | 3.84 | 1.09 | ||||||||||||||||||
Q19 | 2.09 | 1.49 | 1.46 | 0.96 | ||||||||||||||||||
Q20 | 3.75 | 1.43 | 2.86 | 1.19 | ||||||||||||||||||
Q21 | 2.10 | 1.51 | 2.66 | 1.34 | ||||||||||||||||||
Q22 | 2.51 | 1.68 | 1.89 | 1.09 | ||||||||||||||||||
Q27 | 2.47 | 1.50 | 1.41 | 0.83 | 2.21 | 1.52 | 1.75 | 1.15 |
Outcome | Predictor | B | 95% CI | Beta | T | p |
---|---|---|---|---|---|---|
Q1 score | Country * | −0.81 | −1.11, −0.51 | −0.40 | −5.34 | 0.001 |
Gender | −0.24 | −0.56, 0.08 | −0.11 | −1.46 | 0.147 | |
Q7 score | Country * | −1.17 | −1.50, −0.84 | −0.52 | −7.10 | 0.001 |
Gender | 0.07 | −0.28, 0.41 | 0.03 | 0.39 | 0.695 | |
Highest Degree in Dentistry | 0.07 | −0.21, 0.35 | 0.04 | 0.51 | 0.615 | |
Q27 score | Country * | −0.99 | −1.39, −0.60 | −0.38 | −5.03 | 0.001 |
Gender | −0.09 | −0.51, 0.32 | −0.04 | −0.46 | 0.644 | |
Number of Children | −0.13 | −0.30, 0.04 | −0.11 | −1.53 | 0.128 |
Practices of Communication and Marketing | Score |
---|---|
Frequency of recurrence of the risk communication process during the progress of orthodontic treatment | 89.3% |
Frequency of orthodontists being the main source of communication | 86.3% |
Mean time spent informing patients in the first appointment | 15–30 min |
Common communication tools | Digital images or videos |
Most frequent marketing communication tool | Clinic’s website |
Frequent Challenges when Communicating Risks | % Percentage |
---|---|
Lack of patient cooperation/communication | 37.5 |
Lack of time | 16.1 |
Low health literacy/misinformation (internet, general dentists, etc.) | 8.3 |
No problem | 27.4 |
Risks | Proposed Actions |
---|---|
Comprehensive risk discussion | Ensure a detailed and comprehensive discussion of potential risks associated with orthodontic treatment. Emphasize risks such as root resorption, temporary changes to occlusion, sleep difficulties, failure to achieve ideal results, and other critical factors identified in the study. |
Visual aid utilization | Incorporate visual aids such as digital images and videos during the informed consent process. This aligns with contemporary trends and enhances patient understanding of potential risks and treatment procedures. |
Written or digital consent | Provide options for written or digital consent. Acknowledge the prevalence of digital trends in healthcare and allow patients to choose their preferred mode of providing consent. |
Repetition of risk discussions | Encourage orthodontists to repeat risk discussions during treatment. This repetition enhances patient comprehension and awareness throughout the orthodontic journey. |
Tailored approaches based on individual characteristics | Recognize and adapt the consent process based on individual characteristics, such as gender and professional background. Acknowledge that male orthodontists may prefer discussing specific risks more frequently, while female orthodontists may lean towards obtaining written or digital consent. |
Cultural sensitivity | Consider cultural differences in risk communication. |
Continued education | Promote continued education for orthodontists on effective communication strategies and informed consent. This ensures that professionals stay updated on best practices and contribute to ongoing improvements in patient care |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Karkazi, F.; Antoniadou, M.; Demeterová, K.; Konstantonis, D.; Margaritis, V.; Lysy, J. Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia. Healthcare 2024, 12, 492. https://doi.org/10.3390/healthcare12040492
Karkazi F, Antoniadou M, Demeterová K, Konstantonis D, Margaritis V, Lysy J. Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia. Healthcare. 2024; 12(4):492. https://doi.org/10.3390/healthcare12040492
Chicago/Turabian StyleKarkazi, Franzeska, Maria Antoniadou, Katarína Demeterová, Dimitrios Konstantonis, Vasileios Margaritis, and Juraj Lysy. 2024. "Orthodontic Risk Perspectives among Orthodontists during Treatment: A Descriptive Pilot Study in Greece and Slovakia" Healthcare 12, no. 4: 492. https://doi.org/10.3390/healthcare12040492