This thesis has several aims;
• to explore the available evidence surrounding interceptive orthodontics (IO),
• to explore current general dental practice with regard to the provision of interceptive orthodontic care, and
• to consider the way forward in the UK for providing simple interceptive orthodontic care for children in primary care.
Systematic reviews were conducted in areas where there had previously been no high quality reviews; interventions for the cessation of non-nutritive sucking habits (NNSH) in children, and correction of anterior crossbites in children. Semi-structured interviews were performed, transcribed, and thematic analysis performed, helping to develop a questionnaire. Following development, the questionnaire was posted to 400 General Dental Practitioners (GDPs) across Scotland. The results were analysed, and potential barriers to providing care were identified. A cost analysis was performed, using some of the data from the questionnaire to calculate the current cost to the NHS of managing children with persistent digit sucking habits. A sensitivity analysis was constructed to predict if a saving could be made to the NHS, if there was a change in clinical practice in primary care. Finally, a protocol for an interventional study was developed using the results from some of this work, to increase the provision of IO in primary care.
The systematic review of interventions for NNSH identified 183 initial papers, which after checking for relevance and quality, were reduced to a final six RCTs which were included in the final review. The results suggested that a fixed habit breaker was the most effective intervention for digit suckers. The systematic review of correction of anterior crossbites in children identified 499 papers, which after checking for relevance and quality, were reduced to a final 46 studies which were included in the final review. The results suggested that anterior crossbites were best managed with a fixed “2 x 4” appliance. The interviews suggested confidence, and previous experience may play a role in determining whether a GDP will provide IO. The questionnaire highlighted that confidence, knowledge, and age could all be barriers to providing care, and these were the focus for the design of the intervention study. The cost analysis demonstrated that a potential saving of approximately £20,000 to NHS Tayside could be made by changing current practice from provision of a URA to a fixed habit breaker. If this change was implemented across Scotland this saving could increase to over £1,000,000. Larger savings could be made if less monitoring of the habit and more provision of fixed habit breakers was implemented (over £60,000 in NHS Tayside).
The systematic reviews highlighted the need for high quality studies in their subject areas. The cost analysis demonstrates the range in savings that could be made to the NHS depending on the changes made to current GDP practice. The interviews and questionnaire demonstrated there is scope to improve the provision of IO in primary care. The biggest barrier to providing IO appears to be confidence, specific to designing treatment plans, and how effectively the plan can be carried out for the patient. It is intended that the proposed investigation, outlined at the end of this thesis, to increase GDPs provision of IO, will be conducted. If the intervention proves successful, it could be rolled out across the UK, changing current clinical practice.
|Date of Award||2013|
|Supervisor||David Bearn (Supervisor) & Janet Clarkson (Supervisor)|