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Biomedical subjects

S J Cunningham

Publications and source records attributed to S J Cunningham.

At least 19 recordsLinked to original sources
PubMed2006

Orthodontic treatment for deep bite and retroclined upper front teeth in children.

BACKGROUND: Correction of the type of dental problem where the bite is deep and the upper front teeth are retroclined (Class II division 2 malocclusion) may be carried out using different types of orthodontic treatment. However, in severe cases, surgery to the jaws in combination with orthodontics may be required. In growing children, treatment may sometimes be carried out using special upper and lower dental braces (functional appliances) that can be removed from the mouth. In many cases this treatment does not involve taking out any permanent teeth. Often, however, further treatment is needed with fixed braces to get the best result. In other cases, treatment aims to move the upper first permanent molars backwards to provide space for the correction of the front teeth. This may be carried out by applying a force to the teeth and jaws from the back of the head using a head brace (headgear) and transmitting this force to a part of a fixed or removable dental brace. This treatment may or may not involve the removal of permanent teeth. In some cases, neither functional appliances nor headgear are required and treatment may be carried out without extraction of any permanent teeth. Instead of using a headgear, in certain cases, the back teeth are held back in other ways such as with an arch across or in contact with the front of the roof of the mouth which links two bands glued to the back teeth. Often in these cases, two permanent teeth are taken out from the middle of the upper arch (one on each side) to provide room to correct the upper front teeth. It is important for orthodontists to find out whether orthodontic treatment only, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion produces a result which is any different from no orthodontic treatment or orthodontic treatment only involving extraction of permanent teeth. OBJECTIVES: To establish whether orthodontic treatment, carried out without the removal of permanent teeth, in children with a Class II division 2 malocclusion, produces a result which is any different from no orthodontic treatment or orthodontic treatment involving removal of permanent teeth. SEARCH STRATEGY: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE were searched. The handsearching of the main international orthodontic journals was updated to April 2006. There were no restrictions with regard to publication status or language of publication. International researchers, likely to be involved in Class II division 2 clinical trials, were contacted to identify any unpublished or ongoing trials. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of orthodontic treatments to correct deep bite and retroclined upper front teeth in children. DATA COLLECTION AND ANALYSIS: Screening of eligible studies, assessment of the methodological quality of the trials and data extraction were to be conducted in duplicate and independently by two review authors. Results were to be expressed as random-effects models using mean differences for continuous outcomes and risk ratios for dichotomous outcomes with 95% confidence intervals. Heterogeneity was to be investigated including both clinical and methodological factors. MAIN RESULTS: No RCTs or CCTs were identified that assessed the treatment of Class II division 2 malocclusion in children. AUTHORS' CONCLUSIONS: It is not possible to provide any evidence-based guidance to recommend or discourage any type of orthodontic treatment to correct Class II division 2 malocclusion in children.

Child↗
PubMed2006

Psychological support for orthognathic patients -- what do orthodontists want?

AIMS: (1) To evaluate consultant orthodontist opinion on referral of orthognathic patients to a liaison psychiatrist or psychologist and (2) To investigate the value of training orthodontic specialists in recognition of patients with psychological profiles that might affect orthognathic outcome. DESIGN: Questionnaire-based study. SUBJECTS AND METHODS: A structured questionnaire was distributed to all consultant orthodontists in the UK. RESULTS: Approximately 40% of consultants thought that up to 10% of their orthognathic patients would benefit from psychological assessment by appropriately trained personnel. Twenty per cent of consultants were not certain what proportion of their patients would benefit from referral and over half the respondents said they do not refer any orthognathic patients for assessment. The most common reasons for referral were past/current psychiatric history (36%), unrealistic expectations (32%), 'gut instinct' (14%), no significant clinical problem (13%). Reasons not to refer were: nobody to refer to (30.5%), fear of patient reacting badly (15.8%), not sure who to refer to (14.7%), response from mental health team not useful (12.4%), waiting list too long (9.6%). The majority of clinicians felt they would benefit from training in this field (84.7%), as over 80% reported no teaching or training in psychological assessment/management. CONCLUSIONS: Although we have no evidence to prove that interdisciplinary care is better for patients, clinical experience and reports from clinicians working in large centres, tells us there are probable advantages. The development of a training programme for both orthodontists and mental health teams would seem to be beneficial for both clinicians and patients.

Humans↗
PubMed2004

Which factors influence willingness-to-pay for orthognathic treatment?

The aims of this interview-based questionnaire study were to establish which factors influence willingness-to-pay (WTP) for orthognathic treatment and to compare WTP values, from both members of the general public and orthognathic patients, with the actual cost of treatment, the hypothesis being that the more highly valued the intervention, the higher the WTP value. Data were collected from 88 orthognathic patients and a convenience sample of 100 adults using the so-called 'payment card' method. Demographic data were recorded, as well as ability to pay, incisor relationship, occupation, and level of education. In addition, the resources used in orthognathic treatment were estimated for five patients who participated in the study. The results showed that there was a significant difference between the mean WTP values for the public and patient groups. Patients were prepared to pay [see symbol in tex]2750 more than members of the general public. In addition, a significant relationship was found between WTP and incisor relationship in the patient group, with Class II division 1 patients prepared to pay [see symbol in text]3130 more than those with Class III malocclusions. Ability to pay did not significantly affect WTP. The mean total costs estimated for orthognathic treatment were lower than the mean patient WTP value and similar to the mean WTP value for the public group. In terms of cost-benefit, it appears that orthognathic treatment provides 'good value for money'. This study also showed that both patients and the general public were prepared to place a monetary value on the correction of dentofacial deformity and that this form of economic evaluation is a useful tool in monitoring health care in the UK.

Adolescent↗
PubMed2004

How to...write a paper.

Writing a paper may seem like a daunting process for the inexperienced researcher (and sometimes for those who are experienced!). However, this does not need to be the case if the approach is logical and systematic. This article covers some of the most important aspects of writing a scientific paper.

Authorship↗
PubMed2004

How to write a thesis.

The prospect of writing a thesis can be intimidating. However, there are certain formats that the writer should follow in order to make life much easier. This article covers a logical approach to presenting research findings. Also included are suggestions for a last minute checklist.

Academic Dissertations as Topic↗
PubMed2003

A cost-utility analysis of patients undergoing orthognathic treatment for the management of dentofacial disharmony.

INTRODUCTION: Management of dentofacial discrepancies using orthognathic treatment is now a common procedure in the United Kingdom. Although the benefits of orthognathic intervention are often considered, the cost implications have not been investigated to our knowledge. This study is a cost-utility analysis of orthognathic treatment. PATIENTS AND METHODS: Twenty-one patients were interviewed five times during treatment using the time trade-off (TTO) method to establish utility values. Quality adjusted life years (QALYs) gained as a result of treatment were calculated and discounted. The resource use was calculated for each of the 21 patients individually and the costs subjected to both a sensitivity analysis and discounting. The incremental mean cost per additional QALY was calculated (as compared with a 'no treatment' approach). RESULTS: The incremental cost for each additional QALY was 561 pounds sterling for the groups combined, based on mean additional costs and QALYs (546 pounds sterling for the bimaxillary group and 617 pounds sterling for the single jaw group). DISCUSSION: Orthognathic treatment seems to provide good outcomes at relatively low cost. Even allowing for the uncertainty in mean costs and QALYs, there is a high probability of treatment being cost-effective. Cost-utility analysis is still a relatively new technique in dentistry and further studies should be encouraged.

Adult↗
PubMed2001

A comparison of information retention at an initial orthodontic consultation.

The exchange of information is an everyday part of orthodontic treatment. However, the amount of information that is understood and retained, by patients and their parents, is not known. There has been very little research in the area of information retention in dentistry. This has implications with the demands for improved provision of information for patients. This questionnaire-based study, compared the effectiveness of written, verbal, and visual methods of providing orthodontic information. It assessed the retention of this information, by patients and parents, in both the short- and long-term. Twenty-eight patients and their parents, were allocated alternately into one of three groups, receiving written, verbal, or visual information. Short-term retention of knowledge was assessed 10-15 minutes after receiving the information and long-term retention rated by a second questionnaire mailed 8 weeks later. Overall, little difference was found between the three methods. The findings suggested that verbal information should not be given to patients unless supplemented by written and/or visual information, and that parents were more attentive to verbal instructions than their children.

Adolescent↗
PubMed2001

Are pre-treatment psychological characteristics influenced by pre-surgical orthodontics?

A number of investigations have looked at psychological changes occurring in association with orthognathic treatment. However, most of these studies have used a pre-surgery questionnaire as the baseline measurement. There is little data relating to the true baseline, i.e. that prior to any active treatment. Until this aspect is investigated, it is not possible to assume that pre-surgery is an acceptable baseline. This questionnaire based study aimed to assess changes in six psychological outcome measures between T1 (prior to any active treatment) and T2 (following pre-surgical orthodontics/prior to surgery). The outcome variables were: state anxiety, trait anxiety, depression, self-esteem, body image, and facial body image. Sixty-two patients (39 females and 23 males) completed both questionnaires. The results showed that intervention, in the form of orthodontic treatment, had a minimal effect on the chosen psychometric outcome variables. There was a significant reduction in satisfaction with body image amongst patients who initially reported mild to moderate dental/facial problems, whilst a moderate increase in satisfaction occurred in those patients reporting severe conditions initially. Also of note were significant increases in state anxiety amongst older patients whilst trait anxiety showed greater increases in females than males.

Adult↗
PubMed2001

Quality of life and its importance in orthodontics.

Over the last 10-15 years, the terms quality of life (QOL) and health-related quality of life (HRQL) have been seen increasingly in medical literature. Much of the orthodontic treatment that is undertaken is justified on the basis of improving health-related quality of life. With this in mind, studying HRQL in orthodontic patients has the potential to provide information about treatment needs and outcomes, and may also facilitate improved care. Clinicians should therefore be aware of some of the ways in which health-related quality of life may be assessed. The first part of this review article looks at the general concepts of health-related quality of life, whilst the second section focuses on dentistry and orthodontics.

Attitude to Health↗
PubMed2001

An introduction to economic evaluation of health care.

Economic evaluation is an accepted method for the appraisal of health care programmes. Although it is used widely in medicine, its use in the field of dentistry has achieved popularity more recently. Economic evaluation in dentistry is likely to become increasingly important in the future and this paper introduces readers to some of the basic concepts.

Costs and Cost Analysis↗
PubMed2001

A comparison of parents' and patients' views of orthognathic treatment.

The aim of this study was to assess parents' views of orthognathic treatment and compare them with the views of their son or daughter who underwent the treatment. Fifty patients who had undergone orthognathic treatment and one of their parents were recruited over an 8-month period between July 1999 and March 2000. The study was a retrospective, questionnaire-based study. Comparison of parents' and patients' views was undertaken using Cohen's kappa coefficient. This was also used to compare individual parent and patient views pre- and posttreatment. Response rates were 90% (n = 45) for patients and 80% (n = 40) for parents. Parents rated their son or daughter as having a more attractive facial and dental appearance and higher levels of self-confidence both pre- and posttreatment than the patients graded themselves. Parents and patients both felt there was significant improvement in facial and dental appearance and self-confidence following treatment.

Adolescent↗
PubMed2000

Economic evaluation of healthcare--is it important to us?

Economic evaluation is now an accepted method for the appraisal of healthcare programmes. Although it is used widely in medicine, its use in the field of dentistry is only just beginning to achieve popularity. Economic evaluation in dentistry is likely to become increasingly important in the future and this paper aims to introduce the basics of the technique as well as describing some of the dental settings in which it is currently being used.

Cost Control↗
PubMed2000

Development of a condition-specific quality of life measure for patients with dentofacial deformity: I. Reliability of the instrument.

UNLABELLED: The assessment of quality of life is becoming increasingly important in clinical research. Its importance in dentistry has been realised only relatively recently. Health-related quality of life is concerned with the aspects of quality of life that relate specifically to an individual's health. This may be measured using two groups of instruments: (i) generic measures, which provide a summary of health-related quality of life and sometimes generate a single index measure of health or (ii) condition-specific measures, which focus on a particular condition, disease, population or problem and are potentially more responsive to small, but clinically important, changes in health. OBJECTIVES: The aim of this study was to develop a condition-specific quality of life measure for those patients with severe dentofacial deformity who were requesting orthognathic treatment and to assess the reliability of this instrument. METHOD: Instrument content was derived through a literature review and interviews with clinicians and patients. The resulting instrument was tested for internal consistency and test-retest reliability. RESULTS AND CONCLUSION: The instrument was found to divide into four clinically meaningful domains. Internal consistency and test-retest reliability were good. Patient acceptance of the questionnaire was also encouraging.

Health Services Needs and Demand↗
PubMed2000

Are orthognathic patients different?

This questionnaire-based study investigated the psychological profile of orthognathic patients prior to starting treatment and compared the findings with a control group of non-patients. Comparison of the data used multivariate multiple regression analysis where outcome variables and independent variables were studied simultaneously. Some differences were found in the psychological profile of the orthognathic patient. They displayed higher levels of state anxiety (P < 0.001), higher numbers of individuals in their social support network (P < 0.05), and lower body image and facial body image (P < 0.001). Self-esteem was also found to be lower, but only at borderline levels of significance (P = 0.052).

Age Factors↗
PubMed2000

A comparison of health state utilities for dentofacial deformity as derived from patients and members of the general public.

The cost-utility approach is a method of economic evaluation, which assigns a ratio of cost to benefit, based on utility values of the health state in question. It allows efficient use of health care resources and is a useful method in that it permits comparison of a wide range of medical interventions, including those which are life saving and those that improve quality of life. This study obtained utility values for dentofacial deformity from orthognathic patients and members of the general public using three recognized methods--rating scale (RS), standard gamble (SG), and time trade-off (TTO). There were no significant differences between the utility values for the two groups of respondents. Method agreement between the TTO and the SG (the 'gold standard') was better than that between the RS and SG. In addition, the SG and TTO were found to have greater repeatability than the RS.

Adult↗
PubMed2000

The application of multilevel, multivariate modelling to orthodontic research data.

OBJECTIVE: To demonstrate the use of multilevel multivariate modelling in the evaluation of multiple outcome dental data. BASIC RESEARCH DESIGN: Multiple outcome dental research data are used to illustrate the problems of analysing such complex information structures i.e. several outcomes clustered within subjects. Appropriate and statistically efficient methods of data analysis are proposed and illustrated step-by-step. The data structure is analysed using multilevel multivariate regression techniques and this process is discussed in comparison to conventional single-level multiple regression. PARTICIPANTS: Questionnaire data were obtained from an orthognathic study of 84 subjects seeking treatment and 106 'non-treatment' controls (full details of which are reported elsewhere). RESULTS: Multivariate multiple regression analysis demonstrated a number of advantages over separate single-level multiple regression approaches, including a gain in statistical efficiency and greater insight into: a) the role of (significant) explanatory variables and b) outcome variable interactions. Multilevel multivariate analysis reduced the risk of both Tipe I and Type II statistical errors. CONCLUSIONS: The study demonstrates the benefit of multilevel multivariate modelling over conventional single-level techniques for statistical analysis of multiple outcome data. As a result of ongoing technical developments in the power, speed and memory of modern PCs, multilevel multivariate regression can now be undertaken with relative ease. Consequently, researchers are better equipped to analyse such complex data structures, particularly within dentistry where multivariate data are common.

Data Interpretation, Statistical↗
PubMed2000

Relationship between utility values and willingness to pay in patients undergoing orthognathic treatment.

OBJECTIVE: To determine utility and willingness to pay (WTP) values for patients undergoing orthognathic treatment in a National Health Service hospital in the United Kingdom and to establish whether WTP values can be used as a measure of strength of preference. PARTICIPANTS: Forty patients who were about to start orthognathic treatment were recruited over a 10-month period between January and October 1998. OUTCOME MEASURES: Utility values were obtained using the standard gamble method and WTP values were determined using a payment card method. The relationship between the two was assessed. RESULTS: The mean utility value was 0.73 and the mean WTP was 6,833 pounds. The correlation between these two measures was -0.46 (P<0.01). CONCLUSIONS: The correlation between the utility and WTP values was in the expected direction thus suggesting that WTP may be used as a measure of strength of preference. Therefore, willingness to pay may be a useful technique to combine with cost utility analysis.

Adult↗