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Aim: To elucidate factors that influence choice of appliance type in General Dental Service (GDS) orthodontics in England and Wales., Method: Records were obtained for 1527 cases, representing a systematic 2 per cent sample of GDS cases completed during 1990-91. Evaluation involved Discriminant Analysis to find the most influential factors in appliance choice. Factors considered included patient and practitioner characteristics, and features of the malocclusion as assessed by Occlusal Indices., Results: Full data were available for 1217 cases. 24 per cent of treatments included use of dual- and 26 per cent single-arch fixed appliances. Appliance choice was predictable in 55 per cent of cases. Older patients, orthodontically qualified practitioners, high Peer Assessment Rating score at start, permanent dentition, lower grades of the Dental Health Component of the Index of Orthodontic Treatment Need at start, and practitioners with high gross earnings from orthodontics, all tended to be associated with more frequent use of fixed appliances., Conclusions: Possession of a diploma or membership in orthodontics was associated with more frequent use of both dual- and single-arch fixed appliances. Better appliance selection, and thus more effective treatments in the GDS, may result from a greater availability of practitioners with formal postgraduate training in orthodontics.

A sample of 172 orthodontic patients treated by 10 general dental practitioners in their practices was assessed in terms of treatment need and standard of treatment provided. The practitioners had been clinical assistants, for a minimum of 2 years, at a District General Hospital before starting any of the cases. Prior to treatment 70% of the cases had a 'clear need' for treatment on dental health grounds and 73% of the cases had a 'moderate' or 'great need' for treatment on aesthetic grounds. Using the Peer Assessment Rating nomogram to assess the treatment standard, 83% of patients could be classed as 'improved' or 'greatly improved' with treatment but 17% were 'worse or no different'. The standard of treatment produced by fixed appliances was found to be superior to that produced by removable appliances alone. When removable appliances were used the best results were obtained when consultant advice was given. The results for the clinical assistant sample are compared with the results for the GDS sample published in 1993. Ways of further improving the treatment standards produced by the general dental practitioners are considered.

Out of a sample of 1210 orthodontic patients treated within the General Dental Services in England and Wales, a high proportion showed no improvement. Upper and lower fixed appliances had the greatest influence on the outcome of treatment in terms of aesthetics, dental health need and standards. When treatment was analysed according to the appliance used, there were no statistically significant differences in the standard of treatment undertaken by specialist orthodontists and general dental practitioners. Methods for improving British orthodontic standards are considered.

A survey has been undertaken on a representative sample of 1210 patients collected from a 5% sampling procedure employed by the Dental Practice Board. Discontinued cases were excluded from the study. It was revealed that the majority of orthodontic treatment was undertaken by practitioners who had in general been qualified for at least 10 years and, in the main, did not possess an orthodontic qualification. The greater proportion of treatment was undertaken using removable appliances, although fixed appliances were used in 43% of prior approval cases and treatments attracted an average fee of 171 pounds (1988 prices). There was a marked variation in the proportion and type of treatment carried out in the various regions within the General Dental Services.