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Service Specification Specialty - Orthodontics Specialty Orthodontics is a consultant led specialty service concerned with the Information development of the teeth, jaws and management of established malocclusion. Orthodontic Treatment involves the use of orthodontic appliances (‘braces’) to produce changes in tooth positioning, alignment and relationships, within a dental arch and between dental arches. Typically in the late mixed or early permanent dentition (ages 10-14 years) active treatment will take about 2 years, followed by a period of passive retention; earlier or later orthodontic intervention might be appropriate. The orthodontic specialty works closely with other dental specialties to deliver integrated treatment which requires multi-disciplinary assessment, treatment planning and treatment delivery. - Orthodontic treatment in conjunction with Restorative Dentistry Children and adults with absent or malpositioned teeth may require orthodontic treatment to change tooth positioning prior to restorative tooth replacement. - Orthodontic treatment in conjunction with Paediatric Dentistry These specialties work closely together in the management of the developing dentition. Severe Hypodontia (congenital absence of many teeth) requires multidisciplinary planning and treatment by the Orthodontic Paediatric and Restorative Dentistry specialties. - Orthodontic treatment in conjunction with Oral Surgery Joint assessment and planning is required in the management, in particular, of un-erupted and ectopic teeth, submerging deciduous teeth, supernumeracy teeth and other dental pathology. - Orthodontic treatment in conjunction with Oral & Maxillofacial Surgery Major variants in jaw, and therefore tooth, relationships can only be treated with elective orthognathic surgery. This requires integrated case assessment and treatment planning for a phased treatment delivery involving both specialties. Can only be considered in the adult patient. Accessible, Responsive Community Healthcare - Orthodontic Treatment and Craniofacial Surgery Birmingham is one of four regional craniofacial referral centres in England. The orthodontic department aims to be involved in the management of patients with severe craniofacial deformity. - Orthodontic treatment of the Cleft Lip and Palate Patient The orthodontic service is closely integrated with the Regional Cleft Lip and Palate Centre based at Birmingham Children’s Hospital. The majority of orthodontic treatment for cleft patients in Birmingham, Solihull and the Black Country is carried out at Birmingham Dental Hospital. As a secondary and tertiary treatment service, all referrals are made by primary care practitioners or consultant colleagues and accepted according to referral criteria. Patients vary in complexity and many may require multi-disciplinary management. Referral Criteria The department provides Consultant Orthodontic advice and treatment planning service for referring practitioners. For most patients the late mixed dentition will be the appropriate time; an early referral at age 9-10 should be considered for marked skeletal discrepancies. Unerupted or ectopic teeth in adolescence should be considered an Orthodontic problem. In addition to the generic information given in the Hospital referral guidelines, for an Orthodontic referral you should also include: 1. 2. 3. 4. 5. 6. 7. Nature of malocclusion Reason for referral History of dental attendance Level of oral hygiene and attitude to appliance treatment. Any radiographic findings and, if x-rays have been taken within the past year, the x-rays or copies. If it is anticipated that orthodontic appliance therapy might be appropriate it must be confirmed that the patient is dentally fit, has good oral hygiene and is receiving regular, routine dental care over a period of time. When possible and appropriate an estimate of the Index of Orthodontic Treatment Need (IOTN) Patients initially, be seen for an assessment and opinion only Referral letters are expected to comply with a minimum data set that has been previously identified to general dental practitioners. Failure to comply will result in the referral letter being returned with a request for the missing information. Accessible, Responsive Community Healthcare Treatment Acceptance Criteria IOTN5 IOTN4 (but NOT routinely 4d) Craniofacial Anomalies Cleft Lip and Palate (managed via the Cleft Service) Multidisciplinary cases including o Orthognathic o Hypodontia o Requiring minor oral surgery o Complex restorative Complicating medical histories Special needs The Index of Orthodontic Treatment Need (IOTN) is an index of treatment need and not an indication of treatment complexity. Therefore, where a patient has a high objective treatment need but the orthodontic management is relatively straightforward, the patient will be returned to primary care for treatment with appropriate advice. Treatment will only be offered to patients in the above categories if he or she: o Is at an appropriate stage of dental development o Has a good standard of oral hygiene and dental health o Has a regular primary care dentist o Is deemed sufficiently motivated to support orthodontic treatment Adult patients (over 18) who require multidisciplinary management may be accepted, but not adult patients where there is a straightforward malocclusion that could be corrected in primary care. The department cannot routinely accept patients for the continuation of treatment that has been commenced outside the UK Hospital Service. This includes patients who commence treatment in primary care or abroad. Post-op Discharge Patient Information (leaflets) At the end of active orthodontic treatment virtually all patients are provided with removable orthodontic retainers whilst the occlusion is allowed to settle. Typically retention is managed in the hospital for one year, after which patients are referred back to their General Dental Practitioner for continued retainer management. Accessible, Responsive Community Healthcare