Abstract
As I write this editorial, the winter solstice is approaching, the days are dull and short, and the business of Christmas surrounds us. By the time you read this, the days will be lighter and noticeably longer; the daffodils will be blooming and spring will have sprung. For me, March now brings back memories of the COVID-19 pandemic, the sudden shut down of services and our first lockdown.
Remote working - too remote and too many?
The lockdowns during the COVID-19 pandemic were strange and frightening times and our worlds have changed in many ways since then. The pandemic accelerated the use of new forms of communication which has impacted many spheres of our work. Meetings, teaching and even orthodontic appointments no longer need to be held in person. This has had advantages in terms of time, travel and accessibility. From this, we have seen remote working, virtual learning and more flexible work patterns develop.
In this issue of the Journal, there is a systematic review on the effectiveness of dental monitoring systems in orthodontics (Sangalli et al., 2024). Remote dental monitoring has allowed patients and their clinicians to ‘check in’ with each other to monitor the progress of treatment and the need for an in-person appointment to, for example, change an archwire, undertake a repair or move to the next aligner. In the review, the authors found that the use of dental monitoring, alongside standard orthodontic care, resulted in participants needing significantly fewer in-person visits but no overall reduction in treatment time. This suggests that if fewer appointments are required, clinicians may have increased patient capacity. This system has changed the pattern of the usual 6-8 weekly appointments and allowed in-person visits to be more focussed and personalised to the individual’s treatment needs. However, at what point does monitoring become too remote, visits too infrequent and clinicians’ caseloads too high? As the demise of the Smile Direct Club has shown us (https://smiledirectclub.co.uk/), the supervision of allegedly 65,000 UK patients by 5 dentists via their telehealth platform, was an unsustainable care delivery model that left patients vulnerable (Crouch, 2023). Perhaps this was a case of monitoring too many by too few and being too remote. Whilst we need to be open to the use of new technologies to enhance the care we provide, we must also ensure that its use is appropriately regulated to ensure ethical practice, maintain standards and protect patients.
Evidence into practise
One of the key roles of orthodontic journals is to report research that has the potential to change clinical practise for the benefit of our patients. However, the translation of research findings into clinical practise is a balance between the clinical relevance of scientific findings and the practicality of adapting clinical practise in any given situation. In this issue we have two surveys; one on current Twin Block appliance wear protocols in the UK (Ong et al., 2024) and the other about trainees’ satisfaction with training (Tsang and Mittal, 2024) which demonstrate how clinical practise may have changed in light of current research and how research findings may be used to improve training.
In the Twin Block survey (Ong et al., 2024), it is interesting to read that for participants who had changed their clinical practise by reducing the hours of wear, the most quoted reason was ‘research evidence / conferences / courses’. For those prescribing more wear time, the main reason was ‘clinical experience / treatment outcome’. So, here we have a balance between evidence and experience leading to clinical changes, which is the essence of evidence-based practice.
In the survey of trainees (Tsang and Mittal, 2024) and the Meet the Author feature written by Stacey Tsang, pointers are given on how to improve the satisfaction with post-CCST training in the UK. These include more flexible training options, fewer administrative tasks and more experience in some areas, for example: contemporary orthodontics, treatment supervision and management experience. Some of these areas will be addressed by the new GDC curriculum for UK training whilst others will need to be addressed at a local level. Another aspect apparent is that most trainees envisage themselves working part-time once they are a Consultant which will have significant implications for workforce planning. Like Stacey, I hope that those responsible for training appreciate these aspects and use this evidence to strengthen training at this level. By doing so, it will ensure that we can continue to attract and recruit good candidates to these posts and in turn, the Consultant workforce.
The study by van Ommeren et al. (2024) also has the potential to change clinicians’ clinical practise. In it they find that molar tubes on terminal molars, Kobayashi hooks and power-pins showed the highest rate of failure during orthognathic surgery. If this evidence is put into clinical practise, molar bands should be used on the terminal molars to prevent the potential risk of molar tubes being lost in the wound or airway. The use of crimpable or soldered hooks in preference to Kobayashi hooks and power-pins would prevent problems with stabilisation during plate fixation.