Development of agreed learning outcomes and the associated use and perceived value of a reflective e-portfolio in a specialist orthodontic training programme

AIMS To achieve consensus on learning outcomes and assessment among staff members within the postgraduate orthodontic programme in Cardiff. To highlight students' and mentors' attitudes to the introduction of a reflective e- portfolio used as a formative and summative assessment tool for reflective abilities, professionalism and learning outcomes in the postgraduate orthodontic programme in Cardiff METHODS A 2-round modified Delphi process was employed to achieve staff members' consensus with regards to the learning outcomes and assessment methods, which initially were defined according to the literature. A 2-stage evaluation research approach was chosen to study the implementation of the e-portfolio in the orthodontic training programme in Cardiff. The e-portfolio was piloted for two months and supervisors' and students' opinions on its content, format and impact on learning were collected from questionnaires. The possibility of using the e-portfolio as an assessment tool was identified by means of mentor interviews and student focus groups after piloting it for one academic year. RESULTS The staff members' consensus achieved in the Delphi process was 98.4% for the learning outcomes and assessment. From the analysis of the first pilot data, supervisors and students showed equal technical difficulties with the e-portfolio, but supervisors expressed more positive support of the e-portfolio as a learning experience compared with students who had more reservations. The second pilot underlined the students' and mentors' support for the use of the e-portfolio as a formative and summative assessment tool for students' reflective skills, professionalism and learning outcomes. CONCLUSION A modified Delphi technique facilitated the process of curriculum revision of the orthodontic specialist training programme in Cardiff. The use of the orthodontic e-portfolio as a learning and assessment tool might depend on changes in the structure of the portfolio, in the traditional system of assessment and in the thinking of the persons involved and responsible for its delivery

Dental Teacher Feedback and Student Learning: A Qualitative Study

Feedback is essential to improve student learning and motivation and to encourage curriculum development by teachers. This study looked at feedback to and from dental students from a qualitative perspective. Methods: Dental teachers were recruited exclusively to this study from the membership of the Association for Dental Education in Europe (ADEE). Delegates from each of the four annual ADEE conferences were invited to attend focus groups to discuss aspects of feedback. Focus groups established an individual theme for the respective conferences: (i) the role of the teacher in delivering feedback; (ii) feedback from the students’ perspective; (iii) changes to feedback due to the COVID-19 pandemic; and (iv) integrating feedback with assessments. Results: Qualitative data collected from the conference delegates were diverse and thought provoking. Delegates reported different styles of feedback varying from individual, personal feedback to no feedback at all. An enforced and mostly positive adaptation to online delivery during the COVID-19 pandemic was reported. A partial return to pre-pandemic practices was described. Conclusions: Feedback is well recognized by students and teachers as contributing to learning. A universal approach to delivering feedback as part of the student learning process can be challenging due to a multitude of variables. Many aspects of changes in dental education, teaching, and feedback practices adopted as a result of the COVID-19 pandemic have been retained post-pandemic, thereby accelerating the anticipated progression to online teaching

Dental age estimation in children affected by juvenile rheumatoid arthritis

Dental root calcification has proven to be a reliable biological evidence to estimate chronological age of children. The development of structures usually examined in the age estimation forensic practice (e.g. skeleton, teeth) is supposed to be influenced by diseases and nutritional, environmental, ethnic, and ultimately even socioeconomic factors. This research aims to study the age estimation in children affected by juvenile rheumatoid arthritis (JRA) with and without steroids treatment and compared with healthy subjects. Material and methods Dental age estimations based on 752 OPGs, 420 girls and 332 boys, aged from 3.3 to 15.99 years, were provided by applying Demirjian and Willems' original methods. Of the whole sample, 103 individuals were affected by JRA and 40 received a continuous corticosteroid therapy, over 1 year long. Conclusions Willems' and Demirjian's original methods, as methods commonly applied to estimate age for sub-adults with unremarkable medical history, can be used for medico-legal purposes to children affected by JRA. Willems' method tended to underestimate age while Demirjian's method resulted to be prone to overestimation for both healthy and JRA-affected children. JRA showed to have no influence on root calcification process even in children that received steroid treatment for 1 year or longer

The Effect of Different Archwires on Initial Orthodontic Pain Perception: A Prospective Controlled Cohort Study

The early stages of orthodontic treatment are frequently associated with pain that can vary in intensity and duration, representing one of the main reasons for treatment discontinuation. Whilst the use of drugs is recognised as being effective to control orthodontic pain, there are no reliable data indicating the best first archwire for efficacy and minimum discomfort. A prospective controlled cohort study was conducted to compare the intensity and the characteristics of orthodontic pain during the first 15 days of treatment with 2 archwires. Fifty subjects were enrolled and divided into two groups: one received 0.012 inch stainless steel (SS) as the first archwire; the other, a 0.014 inch super-elastic nickel–titanium (Ni-Ti) archwire. Patients compiled a visual analogue scale to measure pain intensity over 15 days, a questionnaire for pain characteristics, the Somatosensory Amplification Scale and the State-Trait Anxiety Inventory to control the psychosocial component of pain. Dental casts were digitally analysed to evaluate the initial arch length discrepancy. In the first 3 days of treatment, the mean VAS values of the SS group were significantly lower than those of the Ni-Ti group (p < 0.05). No significant differences emerged between the groups concerning pain characteristics. The 0.012 inch SS archwire could be used at the beginning of orthodontic treatment to minimise pain perception and improve compliance

Condylar asymmetry in patients with juvenile idiopathic arthritis: Could it be a sign of a possible temporomandibular joints involvement?

OBJECTIVES: The aim of the study was to evaluate the condylar and ramal asymmetry of the mandible in patients with juvenile idiopathic arthritis (JIA) using orthopantomographies (OPTs). METHODS: A total of 30 JIA patients with confirmed diagnosis of JIA and a routine OPT, seeking for orthodontic therapy, free of specific symptoms of temporomandibular joint involvement, and 30 normal matched subjects with OPT were comprised in the study. The method of Habets et al. was used to compare the condyles and rami in OPT. The significance of between-group differences were assessed using Mann-Whitney test. RESULTS: The results showed a high significant difference in the range of asymmetry of the condyle, being the patient group highly asymmetrical (P < 0.0001). No differences were found in the range of asymmetry of the ramus between groups (P = 0.47). The intra-group comparison between males and females showed a difference in the patient group (P = 0.04), being the females more asymmetric. CONCLUSIONS: Knowing that the temporomandibular joint (TMJ) is highly susceptible to inflammatory alterations during growth, even in absence of symptomatology, and being the OPT a cost-benefit favorable imaging tool widespread in the dental field, the latter could be used as a first screening examination in JIA patients to calculate the condylar asymmetry index. The use of this screening tool will help the physicians in addressing the patients that should undergo a more detailed TMJ imaging to early detect TMJ abnormalities and to early set up a targeted therapy of the related cranial growth alteration

Cranial structure and condylar asymmetry of patients with juvenile idiopathic arthritis: a risky growth pattern

The aim of the study was to evaluate the cephalometric differences and condylar asymmetry between patients with juvenile idiopathic arthritis (JIA) and normal control group. Sixty-two JIA patients with a latero-lateral cephalogram and orthopantomography, seeking for orthodontic therapy, and 62 normal matched subjects were comprised in the study. Cephalometric analysis was used for the evaluation of facial morphology while the method of Habets et al. (J Oral Rehabil 15(5): 465-471, 1988) was used to compare the condyles in orthopantomography. The significance of between-group differences was assessed using the Mann-Whitney test, as appropriate. The results showed a prevalence of the upper maxilla with hypomandibulia (class II), hyperdivergency with short vertical ramus posterior and posterior rotation of the mandible in JIA children (SNB, ANB, NSL/ML, Fh/ML, NL/ML, ArGo, ML P < 0.0001, ML/Oc P < 0.004, ArGo/GoGn P = 0.02, no difference for SNA). The condyles of the JIA group resulted highly asymmetric (P < 0.0001). The growth pattern of JIA patients resulted clearly different from normal subjects. This serious impairment of the cranial growth may be considered as an indicator of the need for early and continuous orthognatodonthic therapy during the entire period of development for all JIA patients, independently from temporomandibular joint signs or symptoms. To this end, it is important that rheumatologists and orthognathodontists set up a multidisciplinary treatment planned to control the side effects of a deranged growing pattern, to strictly avoid any orthodontic therapies that may worsen function and growth, and to promote treatments improving the physiology and biology of the cranial development

Advantages of cone beam computed tomography (CBCT) in the orthodontic treatment planning of cleidocranial dysplasia patients: a case report

Our aim was to discuss, by presenting a case, the possibilities connected to the use of a CBCT exam in the dental evaluation of patients with Cleidocranial Dysplasia (CCD), an autosomal dominant skeletal dysplasia with delayed exfoliation of deciduous and eruption of permanent teeth and multiple supernumeraries, often impacted. We think that CBCT in this patient was adequate to accurately evaluate impacted teeth position and anatomy, resulting thus useful both in the diagnostic process and in the treatment planning, with an important reduction in the radiation dose absorbed by the patient

A Delphi approach to define learning outcomes and assessment

AIM: The aim of this study was to use a Delphi process for curriculum revision facilitating staff collaboration and curriculum 'alignment' in the orthodontic specialist training programme in Cardiff. METHOD: A 2-round modified Delphi process was employed to achieve consensus amongst a heterogeneous panel with regard to the learning outcomes and assessment methods, which initially were defined according to formal directives and local initiatives. The panel comprised of nine staff members (five consultants, a professor, a reader, a lecturer and a student) who were working in the orthodontic department in Cardiff and involved in the process of curriculum revision. RESULTS: The response rate to the questionnaires was 77.8%. The staff members' consensus achieved in the Delphi process was 98.4% for the learning outcomes and assessment. The results of the Delphi process provided a list of outcomes and their appropriate assessment methods for the specialist orthodontist in Cardiff. DISCUSSION AND CONCLUSION: The results show that the Delphi process was an efficient and cost-effective technique to achieve consensus of opinion on the learning outcomes and the assessment methods for the specialist orthodontist as part of the process of curriculum revision in Cardiff

Acceptability of a reflective e-portfolio instituted in an orthodontic specialist programme: a pilot study

AIM: The purpose of the study was to highlight students' and mentors' acceptability of a reflective e-portfolio instituted in a postgraduate orthodontic programme in the UK. METHODS: A reflective e-portfolio was developed on the basis of principles provided by a literature search and was piloted for 2 months with six students and seven mentors. At the end of the experience, mentors' and students' acceptability of the e-portfolio with a reflective component was studied using questionnaires. The data were analysed using basic quantitative and qualitative methods. RESULTS: Students' response highlighted acceptability issues related to each aspect of the e-portfolio derived from the literature: relevance of the e-portfolio reflective part; time required for the process; support and mentoring; the implementation method; and the electronic medium. Mentors showed a more positive attitude towards the e-portfolio, expressing only some concerns about the time involved in using it. Furthermore, the analysis of the data highlighted some other acceptability matters: the specificity of the e-portfolio, the communication amongst students and the relationship between students and mentors. CONCLUSIONS: The future successful implementation of the reflective e-portfolio will depend on the productive management of the acceptability issues identified by students and mentors, in particular:(i)the specificity of the e-portfolio that would avoid its overlapping with other part of the programme;(ii)the increasing communication amongst students to improve their knowledge of the reflective writing process; and (iii)the development of a relationship between students and mentors helping to create the appropriate environment for reflection