J. Orthod.
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Journal of Orthodontics, Vol. 32, No. 3, 185-186, September 2005 doi:10.1179/146531205225021078
© 2005 British Orthodontic Society
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Scientific Section

Commentaries on scientific papers published in this edition


   Patients’ motivations for treatment and their experiences of orthodontic preparation for orthognathic surgery
A. C. Williams, H. Shah, H. C. Travess and J. R. Sandy
Top
 Patients’ motivations for...
Report of an adverse...
 
The importance of taking account of what patients expect to get out of treatment and finding out whether what we think meets their expectations is becoming increasingly important. From time-to-time, we may be surprised to learn that we have not done quite as well as we had thought. In this article, the researchers contacted Consultant Orthodontists working at 13 hospitals in the Southwest of England and invited them to identify patients who had undergone combined orthodontic-orthognathic surgical treatment at their units during a 6-year period (1995–2001). The research team examined the notes of each subject identified for the trial, and then contacted those meeting the inclusion criteria and invited them to participate in the study. They were asked to complete a questionnaire dealing with their motivations for treatment, perception of information about treatment and their experiences of orthodontic treatment. The questionnaire was based on issues of importance to patients identified in a previous study using qualitative research methods.

Ultimately, 326 patients (response rate of 58%) who underwent orthognathic surgery during the relevant period completed a questionnaire, and it was found that dental appearance and preventing future dental problems were major motivators for patients to undergo orthognathic treatment. Whilst most of the patients surveyed felt that their pre-treatment expectations were met, orthognathic patients tended to feel better informed about the orthodontic part of their treatment than the surgery. Despite this, a significant proportion were surprised about the duration of treatment and the need to wear retainers at the end; many also found their appliances to be painful or very painful. Furthermore, the patients surveyed would also have liked the opportunity to meet other patients.

The authors conclude that orthognathic patients might benefit from more information about these aspects of their care before they start treatment. However, it is a concern that many patients were apparently motivated to have treatment because they thought it would prevent future dental problems—further investigation seems warranted as there is little evidence to support this notion, so it is unclear how this perception comes about. Finally, the study demonstrates very nicely how patient-centred research can influence (and hopefully improve) our clinical practice, but the authors rightly point out some weaknesses in their study, and suggest how this and other such studies could be improved. For example, and in particular, this was a retrospective study and there is evidence to suggest that what people state as being their motivation after an event may not be consistent with what they would have reported before the event; there may also be selective memory bias and, of course, what took place in 1995 may not be the same as in more recent times.

Overall, this article represents a useful step forward for orthodontic research, and the approach adopted, suggested improvements and data presented will hopefully help to enhance the quality of future studies.

Friedy Luther

Leeds, UK


   Report of an adverse incident in a randomized clinical trial
R. L. McAlinden, P. E. Ellis and J. R. Sandy
Top
 Patients’ motivations for...
 Report of an adverse...
 
This is not really a commentary—simply a recommendation that anyone involved in setting up and/or running an RCT should read this. The moral of the story is really to expect the unexpected, and have systems in place to deal with them. This trial involved a simple comparison of paracetamol with ibuprofen for the control of orthodontic pain. Unfortunately in this report, a patient developed symptoms possibly indicative of an adverse reaction to paracetamol. The authors rightly highlight the need for other researchers to be aware of such possibilities and make suggestions for how such problems can be dealt with. Whilst this report deals with reactions to pharmaceutical products, the products involved could have been dismissed as too mundane to worry about, but no matter what we are dealing with, we must never be complacent—the unexpected does happen.

Friedy Luther

Leeds, UK





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