An occasionally irregular blog about orthodontics

Anxious about fixed braces? October research update: Part 2

By on October 17, 2013 in Clinical Research, Uncategorized with 3 Comments
Anxious about fixed braces? October research update: Part 2

Anxious about fixed braces?  What can we do to make it better?

Assessment of the effect of combined multimedia and verbal information vs verbal information alone on anxiety levels before bond up in adolescent orthodontic patients: A single center randomized controlled trial.



Jemnique Pal Kaur Sal et al American Journal of Orthodontics 2013: 144: 505-11

The quality of information that we give to our patients is, of course, extremely important.  While we think that we are doing a good job, it is surprising and concerning that many patients do not recall what we “explain” to them. 

This is also influenced by the clinical surroundings within which we practice.  This has been brought home to me by my recent “minor” surgery that I have just had done. It still hurts by the way!  I found the major medical centre that I attended was very disorientating, particularly in finding my way around. This may have been due to my age but it was clearly influenced by the green line on the floor that I was following stopping in several places. Rather like a cycle lane in South Manchester!  When my post op instructions were explained to me, I thought that I understood but when I was asked later I could not remember several important pieces of advice.   It is certainly, clear that when information is not received then anxiety could result and this paper investigates the effect of providing information on anxiety levels in patients before being bonded up.

This was a very well carried out and written up study.

The  literature review to the paper outlined anxiety very well and they pointed out that orthodontic patients are unclear about the process of fitting appliances and would like more information.  The authors aims were to evaluate two different methods of providing information to patients. The methods were verbal information (treatment as usual) or a DVD designed to provide additional information plus verbal information.

They randomised 90 patients  into two group of 45 who received the standard information or the DVD plus standard information.

The primary outcome measure was anxiety measured by the State-Trait-Anxiety Index

The study was written up according to CONSORT guidelines, the randomization and allocation concealment were clear, the sample size was calculated and the statistical analysis was relevant to the data.

What did they find?

Their primary finding was the group allocation (DVD better) and initial anxiety levels had an effect.  However, the amount of variation explained by the regression analysis was low, meaning that other factors, not measured in the study must have had an influence.  Importantly, the use of the DVD did not reduce anxiety below normal levels and it was also clear the reduction may not be clinically relevant. Interestingly the level of anxiety was similar to that reported to have similar level to attending a school examination.

What did I think?

I think that this was an interesting study that started to ask a question that we, as orthodontists, may not have considered to be important.  In my clinical practice, I have not really considered whether placing an appliance is a procedure that patients about which patients would be anxious.  This is probably because  I think that  placing a fixed appliance is “not a problem” when compared to procedures that a dentist can carry out!  This is a great example of the value of considering patient perceptions in research and actually asking patients and public on the areas that they would like us to research into. As opposed to us carrying out research projects on types of appliances and reporting cephalometric festivals.  I will return to this later.

Will this study change my practice?  Yes, I am going to try to explain things more carefully the next time I carry out a bond up. Will I use a DVD?  I am not sure, I will contact the authors to see if they can let us have a copy and take it from there.  Is the DVD the correct medium in the present time? I am not sure, as other social media are clearly more accessible to may people and perhaps this study needs extending to the development of web based media or even a pre-bond up app?

In summary, this was a paper that when I read the title I thought “so what”? but having read it carefully, it is a really interesting piece of work and is helpful to our clinical practice.

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There Are 3 Comments

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  1. I direct my patients to my YouTube channel and this video of me fitting fixed braces. Maybe I also need to do one for the care instructions.

    • Kevin O'Brien says:

      Megan, thanks for posting this. I think that the video is great and a very useful tool for patients. I am going to be cheeky and ask my patients to look at this before their bond up appointments. Have you any others videos that you would like to share? What is the address of your you tube channel?

  2. Neil Hillyard says:

    An interesting article and one I can directly relate to as an adult patient who elected to undertake the traditional ’24 months braces’ approach. I had taken a great deal of interest in my treatment planning, obsessively researching all the options available to me and felt I entered the bonding appointment with a reasonable level of knowledge of the procedure, however, it was during the installation of the archwires and attachment of the modules when my orthodontist decided to provide the required explanations of what to expect and do/not do post appointment. From a patients point of view, providing detailed instruction at a time when your sight is being obliterated with fast moving hands attaching modules and you are experiencing the unique sensations of feeling the brackets and the tightness of the archwire for the first time, is not the ideal time to ensure you have the full attention of the patient. To this day I still cannot recall anything that was said over these minutes but the longer, more relaxed chat with the therapist some five minutes later is still clear as they had my full attention away from the earlier distractions.

    I would certainly advocate providing patients with the required time to process and understand instructions for the long term benefit of the patient and practice.

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