Journal of the American College of Dentists

Students’ Views on Ethics
August 2011 and included articles published
and available in print or online at
that time. A cursory search was performed
initially to identify potential
articles pertaining to the topic of interest
based on title and abstract. The initial
inclusion criteria were (a) publication in
English, (b) abstract available on
PubMed, (c) content relevant to patients’
understanding or retention of information
given prior to orthodontic treatment
or orthognathic surgery, and (d) full
article available online using University
of California, San Francisco remote
access. Studies were further selected to
be included in the final list of publications
to be reviewed in this article based
on the level of evidence. Articles were
excluded from the review
if they did not meet the initial inclusion
criteria or if they were editorials, expert
opinion, or case reports.
Results
An electronic search on PubMed using
the aforementioned set of keywords
identified 564 articles. Of those, 511
were written in English, and 483 articles
had abstracts available. Through review
of title and abstracts, 21 articles were
identified to be on relevant topics, and
11 were subsequently excluded from
the review due to the nature of the
Table 1. Result of Electronic Search in PubMed Database
Satisfied initial
inclusion criteria
publication and the level of evidence
they provided. Within the final list of
ten articles, four were on patients’ comprehension
or retention of orthodontic
information, one on patients’ comprehension
and retention of orthognathic
surgery information, and five were
related specifically to efficacy of various
communication modes in presenting
orthodontic information to patients
(Table 1).
The level of comprehension and
retention of orthodontic information
through the informed consent process as
well as other supplemental items was
evaluated in four studies, and the major
findings are summarized in Table 2.
Baird and Kiyak (2003), in a study with
a sample of 21 children receiving Phase I
orthodontic treatment and their parents,
assessed understanding of informed
consent through open-ended interview
questions regarding reasons and risks
for treatment. The child and the parent
were interviewed separately. A chart
review was performed to reveal information
reviewed in the consent, and a
vocabulary test was completed. The
study revealed that, overall, parents and
children knew very little about the
child’s diagnosis, and while the chart
listed just over four reasons for treatment
on average, parents could only recall
Full text
available
Selected
Comprehension/Retention of 13 6 4
orthodontic treatment information
Comprehension/Retention of 3 1 1
orthognathic surgery information
Communication method in presenting 7 5 5
orthodontic information
about two on average and children only
one. Furthermore, regarding risks of
treatment, 12 children and seven parents
stated that there were no risks associated
with orthodontic treatment, and another
five children and five parents could not
recall any risks. The study showed a
correlation between education and
vocabulary level, and the number of
reasons and risks reported by parents
and children.
In a similar study of 33 low-income
children beginning their early orthodontic
treatment, Mortensen and colleagues
(2003) examined patient and parent
comprehension of the child’s Phase I
orthodontic treatment with regard to the
purpose of treatment, possible risks, and
responsibilities of children and parents.
The study showed that, on average, of the
2.34 reasons for treatment presented,
patients recalled 1.10 and parents 1.66.
For 2.45 items on procedural information
presented, the recall rate was 1.55
and 1.59 for patient and parents, respectively.
That of risks was 0.66 and 1.48,
respectively, even though 4.66 items
were mentioned by the orthodontist on
average. As for patient’s responsibility,
number of average recalled items was
greater: 2.21 for patients and 2.07 for
parents, out of 3.38 presented. The only
exception to the low recall rate was
parents’ reports of their responsibilities
associated with their children’s treatment
as they listed more than what the
orthodontist had mentioned. Most of
these items were responsibilities for children,
not parents. In all but one part of
informed consent, parents recalled more
than children; the exception was on
what the child should do for a successful
outcome. Children’s recall rate was low
regardless of vocabulary level, but vocabulary
levels of parents were significantly
correlated to their recall rate.
A study conducted by Ernst and others
(2007) in the United Kingdom aimed to
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2011 Volume 78, Number 4