Adult orthodontics in the Republic of Ireland: specialist orthodontists' opinions

Objectives: To report the opinions of specialist orthodontists regarding the profile, characteristics and treatment of adults currently undergoing orthodontic treatment in the Republic of Ireland (ROI) Design/setting: A national cross-sectional questionnaire study in the ROI. Method: A pilot-tested questionnaire was distributed to 122 specialist orthodontists in the ROI. Questions addressed general and treatment information for current adult orthodontic patients. Those whose treatment involved orthognathic surgery were not excluded. Results: A response of 83% was obtained. Ninety-five per cent of specialists reported treating adults, most of whom were self-referred and were typically professional, female and aged 25-35 years. The overall ratio quoted of professionals to non-professionals was almost 3: 2. For 50% of specialists, males were estimated to account for 20-40% of their adult cases and for 23%, this increased to an estimated 40-60%. Class II division 1 malocclusion and skeletal II were considered the most common dentofacial characteristics. Occlusal features encountered in decreasing frequency were generalised crowding, increased overjet, deep overbite, late lower incisor crowding, spacing and impacted teeth. Fifteen per cent reported that at least 10% of their adult cases required orthodontics with maxillofacial surgery but 8% reported that this was at least 50%. Treatment challenges commonly acknowledged were overbite reduction, anchorage management, 'black triangles' and overjet reduction. Tooth whitening was reckoned to be used by 19% of specialists. Aesthetic upper and stainless steel lower brackets were indicated to be used most often whereas only 19% used clear aligners and 10% used lingual appliances often. Conclusions: The profile and characteristics of adults currently undergoing orthodontic treatment in the ROI were diverse. Higher estimates were quoted for self-than for general dental practitioner-referral. A high percentage of treatment was reported to be undertaken for non-professionals and males. A wide range of treatment and varying use of appliance types were cited.