ORAL HEALTH

Health Evidence Bulletins - Wales
Team Leader: Mr Tony Glenn

Date of completion: 8/3/1998

The contents of this bulletin are likely to be valid for approximately one year, by which time significantly new research evidence may become available


Dento-facial anomalies

(Users are advised to consult the supporting evidence for a consideration of all the implications of a recommendation)

The Statements The Evidence
3a. Genetic counselling is likely to assist in the prevention of heritable dentofacial anomalies.

(Health gain notation - 2 "likely to be beneficial")

Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3b. Assessment of orthodontic needs can be made using the index of orthodontic treatment need (IOTN).

(Health gain notation - 2 "likely to beneficial")

Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3c. IOTN 4 or 5 cases can be improved by orthodontic treatment.

(Health gain notation - 1 "beneficial")

Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3d. IOTN 3 cases, following expert opinion, can be improved by orthodontic treatment but further evaluation is recommended.
(Health gain notation 3 "trade-off between beneficial and adverse effects")
Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3e. IOTN 1 or 2 cases can be treated by orthodontic interventions but the health gain is unproven.
(Health gain notation 4 "unknown")
Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3f. In the diagnosis of dento-facial discrepancies, it is accepted custom and practice to consider information collected from sources in the following list:
history, visual examination, palpation, radiographs (x-rays), study models, computerised tomography (CT) scans, study models.
(Health gain notation - 1 "beneficial")
Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)

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3g. Prevention of tooth decay and of gingivitis is mandatory during orthodontic treatment.
(Health gain notation - 1 "beneficial")
Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3h. Where extractions are indicated for orthodontic purposes, decayed or filled teeth with a poor prognosis should be chosen rather than sound teeth where possiblei.
(Health gain notation - 1 "beneficial")
i. Hunter ML, Addy M, Dummer PMH, Hunter B, Kingdon A, Shaw WC. A longitudinal study of the condition of first permanent molars in a group of adolescents with special reference to elective orthodontic tooth extraction. Community Dental Health 1991; 8: 9-15
(Type IV evidence - observational studies)
3i. Multidisciplinary teamwork is required when, for example, orthognathic surgery and/or speech therapy is required in addition to orthodontic treatment i.
(Health gain notation - 1 "beneficial")
i. Oral Health. Protocol for Investment in Health Gain. Welsh Health Planning Forum. Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3j. A systematic review of orthodontic treatment for posterior cross bites is currently in progressi. i. Harrison JE, Ashby D. Orthodontic treatment for posterior cross bites. Cochrane Database of Systematic Reviews. Review expected in April 1998.
3k. The benefits of orthodontic treatment have to be balanced against the risks and the likely success of treatment. Orthodontic treatment should be directed at those individuals in which the greatest benefit can be achievedi,ii.

(Health gain notation - 3 "trade-off between beneficial and adverse effects")

i. Shaw WC, O’Brien KD, Richmond S, Brook P. Quality control in orthodontics: risk/benefit considerations. British Dental Journal 1991; 170: 33-37
(Type V evidence - expert opinion);
ii. Thilander BL. Complications of orthodontic treatment. Orthodontics and Periodontics 1992; 2 (IV): 28-37
(Type V evidence - expert opinion);
3l.  Orthodontic treatment assessment can be made during the peer assessment rating index (PAR)i.
(Health gain notation - 2 "likely to be beneficial")
i. Oral Health.  Protocol for Investment in Health gain.   Welsh Health Planning Forum.  Cardiff: Welsh Office NHS Directorate, November 1992
(Type V evidence - expert opinion)
3m. Guidelines on the management of patients with impacted third molar teeth, pericoronitis and the prevention of dry sockets are available i. i. Faculty of Dental Surgery. National Clinical Guidelines 1997. London: Royal College of Surgeons, 1997
(Recommendations classified according to type of evidence)
3n. Guidelines on the management of palatally ectopic maxillary canine and unerupted maxillary incisors are available i. i. Faculty of Dental Surgery. National Clinical Guidelines 1997. London: Royal College of Surgeons, 1997
(Recommendations classified according to type of evidence)
3o. Scarce, highly specialised resources are required for consistent success in the management of cleft lip and/or palate. Appropriate levels of expertise are likely to be achieved and maintained at specialist centresi.
(Health gain notation - 2 "likely to be benefiial")
i. Clinical Standards Advisory Group (CSAG). Report of cleft lip and/or palate. London: The Stationery Office, 1998.
(Type V evidence - expert opinion)
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Health Evidence Bulletins: Wales, Duthie Library, UWCM, Cardiff CF14 4XN. e-mail: weightmanal@cardiff.ac.uk