Impact of orthodontic treatment on adolescents' quality of life: a longitudinal evaluation of treated and untreated individuals

Association between oral health-related behaviors and quality of life of adolescents among three provinces in Northwest China

Objective

To assess the oral health-related quality of life (OHRQoL) of adolescents in Northwest China, and to explore the relationship between sociodemographic characteristics, oral health-related behaviors and OHRQoL.

Methods

A cross-sectional survey of adolescents aged 12-15 years in Shaanxi, Gansu province and Ningxia Hui Autonomous Region of Northwest China was conducted by stratified cluster random sampling. Oral examinations were performed with World Health Organization (WHO) standards, and the condition of crowns and periodontal was recorded. Adolescents' oral health-related behaviors and OHRQoL were collected by questionnaire. Chi-square test and binary logistic regression analysis were used to examine the relationship.

Results

A total of 7,648 subjects were included. The prevalence of low OHRQoL which defined as a score higher than 0, was 83.8%. A low OHRQoL was most prevalent in Gansu Province and least prevalent in Shaanxi Province. Younger (OR = 0.73, CI = 0.60-0.87), female (OR = 1.27, CI = 1.11-1.44), rural (OR = 1.44, CI = 1.21-1.72), and mother with less education (OR = 0.69, CI = 0.60-0.81) all showed statistically significant influence on teenagers' OHRQoL. From a behavior perspective, teens' OHRQoL was correlated with their frequency of sugar consumption (OR = 1.72, CI = 1.41-2.10), dental appointment rate (OR = 1.29, CI = 1.064-1.57), self-assessment of oral health (OR = 3.09, CI = 2.29-4.19), DMFT index (OR = 1.19, CI = 1.04-1.37), number of teeth calculus (OR = 1.20, CI = 1.01-1.43), and dental trauma (OR = 0.47, CI = 0.39-0.57) over the previous year; however, brushing their teeth was not statistically significant.

Conclusions

Generally speaking, oral health-related behaviors-such as eating more sugary foods and scheduling dental appointments within the last year-have a significant negative impact on the quality of life of adolescents in Northwest China. Female, and adolescents from families with low educational backgrounds are more likely to be affected by such behaviors in their daily lives.

Impact of treatment with orthodontic aligners on the oral health-related quality of life

BACKGROUND

There is an increasing interest in information on the effects of orthodontic aligners on the oral health-related quality of life (OHRQoL) of people.

AIM

To compare the impact of orthodontic aligners versus conventional fixed appliances on OHRQoL, using a validated tool and controlling for sociodemographic and clinical variables.

METHOD

Sixty-one individuals participated in this study. Group 1 (G1) consisted of 33 individuals under treatment with orthodontic aligners and Group 2 (G2) comprised 28 individuals under treatment with conventional fixed appliances. OHRQoL was evaluated with the Oral Health Impact Profile (OHIP-14) in which 14 items are distributed across seven dimensions: functional limitation, physical pain, psychological discomfort, physical disability, psychological disability, social disability, and handicap. The higher the score, the more negative is the perception of the individual regarding his/her OHRQoL. Descriptive statistics, Mann-Whitney test, and Poisson regression were performed. Effect Size (ES) and Minimal Clinically Important Difference (MCID) were also determined.

RESULTS

Participants' mean age was 30.69 years. Individuals in G1 had a significantly lower score for physical pain and the total score of OHIP-14 compared to individuals in G2 (p < 0.05). The ES was large (ES = 0.74) for physical pain and moderate (ES = 0.46) for the total score. The ES was moderate for physical disability (ES = 0.50). The difference between groups for physical pain (1.30) and for physical disability (0.90) was greater than the MCID (0.87 and 0.88, respectively). Poisson regression showed that G2 individuals showed a score for physical pain 1.39 times higher than those of G1 in the adjusted model (OR = 1.39, [1.03-1.89], p = 0.031).

CONCLUSION

Those under treatment with orthodontic aligners have a more positive perception of OHRQoL compared to those wearing fixed appliances.

Influence of risedronate on orthodontic tooth movement in rodents: a systematic review and case report

INTRODUCTION

Bisphosphonates have an inhibitory impact on osteoclastic activity, reducing bone resorption. However, the influence of risedronate on tooth movement is not well-defined.

OBJECTIVE

This systematic review assessed the effect of risedronate intake on orthodontic tooth movement. A case report was also provided.

METHODS

Two independent reviewers searched six databases (PubMed, Web of Science, Ovid, Lilacs, Scopus, and Open Grey). The searches were carried out in April/2020, and an update was set in place in June/2023. Therefore, the searches considered a timeline from the databases' inception date until June/2023, with no publication date and/or language restrictions. The clinical question focused on evaluating the orthodontic tooth movement and relapse movement (Outcome) in animals (Population) exposed to risedronate (Exposure), compared to control groups (Comparison). The Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were applied, and the protocol was registered in PROSPERO (CRD42020168581). The risk of bias was determined using the Systematic Review Centre for Laboratory Animal Experimentation protocol (SYRCLE).

RESULTS

Two studies in rats and one in guinea pigs were included in the systematic review. The studies reported a decrease in orthodontic tooth movement, a reduction in the relapse movement, and a reduced number of positive tartrate-resistant acid phosphatase (TRAP) cells, with a significantly reduced number of bone gaps after the administration of risedronate in rats. A case report illustrated the effects of risedronate administration in one patient.

CONCLUSION

Based on the systematic review, risedronate seems to impair orthodontic tooth movement and relapse due to a decrease in bone resorption cells.

Pain perception and expectation related to interradicular mini-implants insertion: a systematic review and meta-analysis

OBJECTIVES

The aim of this systematic review was to compare the expectation and perception of pain reported by patients before and after the installation of interradicular mini-implants.

MATERIALS AND METHODS

Electronic search was performed in six databases. Inclusion criteria were randomized controlled trials (RCTs) or non-randomized controlled clinical trials (nRCTs); studies using mini-implants in the interradicular region; assessment of pain intensity by visual analogue or numerical scale. The risk of bias assessment was based on the Rob 2 tool and Robins-I.

RESULTS

A total of 1566 articles were retrieved, and 21 met the eligibility criteria. Six were classified as high risk, one as critical and the other one as uncertain, according to the Robins-I tool. In articles evaluated by the Rob2 tool, ten were classified as serious risk and three as moderate risk. A meta-analysis was also performed. Weighted means were calculated among the studies using the random-effects model and forest plots were generated. Heterogeneity was assessed through the Q test and I2 statistics. It was observed, with moderate evidence, that on a scale of 0 to 10, the pain expectation (effect size 4.75) is higher than that effectively pain generated by the procedure (effect size 1.94).

CONCLUSION

Pain expectation was greater than that actually generated by the procedure, being almost non-existent 7 days postoperatively.

CLINICAL RELEVANCE

This study may help the clinician to reassure the patient regarding the sensations that could be experienced during and after the installation.

WEARING ORTHODONTIC APPLIANCES MAY NOT IMPACT THE ORAL HEALTH-RELATED QUALITY OF LIFE (OHRQOL) OF CHILDREN AND ADOLESCENTS

ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis. Vidigal MTC, Mesquita CM, de Oliveira MN, de Andrade Vieira W, Blumenberg C, Nascimento GG, Pithon MM, Paranhos LR. Eur J Orthod. 2022 Aug 16; 44(4):359-368.

SOURCE OF FUNDING

Government.

TYPE OF STUDY/DESIGN

Systematic review with meta-analysis of data.

Semantic equivalence of the Brazilian version of the Patient Satisfaction Questionnaire (B-PSQ)

The Patient Satisfaction Questionnaire (PSQ) is a self-administered instrument to assess adolescent patients' satisfaction with orthodontic treatment. A pre-existing North American instrument was further explored in the Netherlands. Semantic equivalence is part of cross-cultural adaptation and is necessary to achieve a valid and reliable instrument for a specific culture. The present study aimed to evaluate the semantic equivalence of the items, subscales, and overall PSQ between the original English version and the Brazilian Portuguese language version (B-PSQ). The PSQ has 58 items, distributed across 6 subscales: doctor-patient relationship, situational aspects of the clinic, dentofacial improvement, psychosocial improvement, dental function, and a residual category. Semantic equivalence was evaluated according to the following methods: (1) independent translations to Portuguese by two translators, both native in Brazilian Portuguese and fluent in English; (2) an expert committee drafted the first summarized version in Portuguese; (3) two independent back-translations into English by two native English-speaking translators fluent in Portuguese; (4) committee review; (5) committee drafted a summarized version of the back-translations; (6) expert committee drafted the second summarized version in Portuguese; (7) pre-test of the instrument using individual semi-structured interviews with 10 adolescents; (8) review and final version of the B-PSQ. Semantic equivalence between the original and the Brazilian versions of the questionnaire was achieved through diligent and rigorous methods, with effective translation and expert evaluations, incorporating the opinions of the target population.

Einfluss der Dauer kieferorthopädischer Behandlung auf das subjektive Empfinden der mundgesundheitsbezogenen Lebensqualität

Hintergrund Aufgrund der aktuell noch geringen Datenlage war es Ziel dieser Studie, den Einfluss der Dauer einer kieferorthopädischen Behandlung auf die mundgesundheitsbezogene Lebensqualität (MLQ) zu untersuchen.

Methode Die beobachtende, prospektive Längsschnittstudie erfolgte mit der deutschen Basisversion des Oral Health Impact Profile (OHIP-G14) im Zeitraum von 2008–2018. Die MLQ wurde zu drei Zeitpunkten (T1, T2, T3) bei 598 Patient*innen innerhalb ihrer kieferorthopädischen Behandlung erhoben und die Ergebnisse statistisch analysiert. Ein durchschnittlicher Anstieg (∆OHIP-G14) von>2,00 Punkten wurde als klinisch relevant (Minimal Important Difference, MID) und Zeichen einer herabgesetzten mundgesundheitsbezogenen Lebensqualität definiert.

Ergebnisse Von initial 598 eingeschlossenen Patient*innen füllten 79 ProbandInnen die Fragebögen zu allen drei Zeitpunkten vollständig aus und konnten in die Studie aufgenommen werden. Das Durchschnittsalter lag zu Beginn der Behandlung bei 11,5 Jahren (SD=3,3), am Ende der Behandlung bei 16,3 Jahren (SD=3,1). Die durchschnittliche Behandlungsdauer betrug 4,7 Jahre (SD=2,3). Ein Vergleich der erreichten Summenwerte zu den Zeitpunkten T1, T2, T3 der ernannten Subgruppen (Geschlechter, Altersgruppen, Behandlungsapparatur und -zeitraum) untereinander zeigte in keiner der Gruppen signifikante Unterschiede (Mann-Whitney-U-Test, Kruskal-Wallis-Test, Chi-Quadrat-Test p<0,05). Ein Vergleich der Gesamtwerte der jeweiligen Zeitpunkte zeigte eine klinisch (∆OHIP-G14>2,00) und statistisch signifikante Abnahme der MLQ während der initialen Behandlungsphase (T1 vs. T2, p<0,001). Die Verbesserung der MLQ am Ende der Behandlung (T2 vs. T3) war statistisch nicht signifikant (p=0,128) und hatte keine klinische Auswirkung (MID ∆OHIP-G14<2,00). Weitere Analysen der Behandlungsdauer und der OHIP-Summenwerte ergaben zu keinem Zeitpunkt signifikante Abhängigkeit oder Korrelation zwischen Behandlungsdauer und MLQ (β2=− 0,078, β3=0,191, multiple lineare Regression, p=0,05; r2=0,073, r3=0,103, Spearman Korrelation, p=0,05).

Schlussfolgerung Im Vergleich zu T1 war die MLQ während der Behandlung sowohl zu T2 als auch T3 leicht herabgesetzt. Es kann jedoch festgestellt werden, dass der Durchschnitt der erhobenen Summenwerte zu allen drei Zeitpunkten der Befragung (T1, T2 und T3) im Normbereich der gesunden Allgemeinbevölkerung lag. Hinsichtlich der Kernfrage dieser Studie konnte kein Zusammenhang zwischen Behandlungsdauer und MLQ gezeigt werden. Das Anstreben eines guten Behandlungsergebnisses im Rahmen einer differenzierten kieferorthopädischen Therapie sollte daher nach Möglichkeit einem raschen Abschluss der Behandlung vorangestellt werden.

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis

BACKGROUND

Although there are previous systematic reviews about the oral health-related quality of life (OHRQoL) impact among children and adolescents after orthodontics treatment, there is no definition for the magnitude of these impacts during the therapy.

OBJECTIVE

To systematically analyse the literature on changes in the quality of life of children and adolescents during orthodontic treatment.

LIMITATIONS

Almost all the studies included in this review are non-randomized clinical trials, which are susceptible to several biases that affect the certainty of evidence obtained, especially by confounding factors and the lack of a control group.

CONCLUSIONS AND IMPLICATIONS

Based on very low certainty of evidence, wearing appliances does not seem to have a significant negative impact during the first year of orthodontic treatment. However, the meta-analytic results suggest that functional limitations in the first 3 months of treatment can be slightly more critical for the impact on the oral health quality of life and consequent patient adherence to treatment.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - Brazil (FAPEMIG).

REGISTRATION

CRD42021234407.

Anxiety and depression mediate the relationship between digestive tract conditions and oral health-related quality of life in orthodontic patients

Background

Anxiety and depression are common psychological problems in orthodontic patients whose diet habits and oral health status change frequently during treatment. However, relationships between anxiety and depression, digestive tract condition, and impaired oral health-related quality of life remain unknown.

Materials and methods

In this study, clinical assessments, including anxiety, depression, digestive tract condition, and oral health-related quality of life, were collected from 769 outpatients in the orthodontic department using three self-reported questionnaires. Correlation analysis was used to investigate the relationships among different clinical assessments. A chained mediation analysis model was further conducted to explore the direct and indirect effects of these various clinical factors.

Results

Changes in digestive tract conditions were positively correlated with the psychological status and oral health-related quality of life. Anxiety and depression partially mediated the relationship between them, and the indirect effect was 0.68 (30%), of which the mediation effect of anxiety accounted for 56%.

Conclusion

Anxiety and depression mediate the relationship between gastrointestinal conditions and oral health. In particular, anxiety seems to play a significant mediating role. Our findings indicate that psychological status must be paid more attention to in future clinical practices and supervision for digestive tract symptoms of orthodontic patients.

Quality of life in an adolescent orthodontic population: Invisalign versus fixed appliances

OBJECTIVES

To investigate adolescent orthodontic patient experiences and quality of life with fixed appliances compared to Invisalign.

MATERIALS AND METHODS

Adolescent patients in active treatment with Invisalign or fixed appliances for a minimum of 6 months were provided with the Child Oral Health Impact Profile-Short Form 19 questionnaire, along with additional items of interest that were assessed separately. Pearson's χ2 test was used to compare responses (P < .05), and unpaired t-tests (P < .05) were used to test for differences in mean satisfaction, quality of life, and domain scores.

RESULTS

In total, 74 patients (37 in each treatment group) participated. Overall, no significant differences were noted in the mean quality of life, satisfaction, or domain scores between the two groups. A significant difference was noted in the time taken to adjust to appliances, with the Invisalign group demonstrating faster adaptation. Additionally, the fixed appliance group was 3.8 times more likely to report missing school because of their appliance (95% confidence interval [CI]: 1.2, 12.5) and 2.7 times more likely to report having difficulty eating certain foods (95% CI: 1.1, 7.1). When the sample of females between the ages of 14 and 18 was analyzed, the Invisalign group reported feeling attractive more often than the fixed appliance group.

CONCLUSIONS

Both treatment groups were generally very satisfied with their treatment modality. The overall quality of life of adolescent orthodontic patients undergoing treatment with fixed appliances and Invisalign for a minimum of 6 months was similar.

The Sheldon Friel Memorial Lecture 2020 It's not just about the teeth: Patient-centred Orthodontics

The provision of high-quality health care involves many different aspects, including safety, effectiveness, efficiency, and patient centredness. In order for care to be truly patient centred requires patients' views being sought and considered, and this may be achieved through patient-centred research. Patient-centred research is fundamentally important in contemporary health care and has many benefits; for example, it ensures that research is relevant, identifies those aspects of care that are important to patients, provides information that is important to current and future patients, and allows the integration of patients' views regarding how services may be enhanced in the future. This paper provides an overview of how we currently involve patients in orthodontic research, what this means to the specialty and how we can enhance patient involvement in the future.

Impact of the onset of fixed appliance therapy on adolescents' quality of life using a specific condition questionnaire: A cross-sectional comparison between male and female individuals

OBJECTIVE

To evaluate the impact of the first six months of orthodontic treatment with fixed appliances on the oral health-related quality of life (OHRQoL) of adolescents, comparing boys and girls, using a specific condition questionnaire.

DESIGN

Cross-sectional.

SETTING

School of Dentistry of the Federal University of Minas Gerais, Belo Horizonte, Brazil.

PARTICIPANTS

Adolescents aged 10-17 years.

METHODS

Forty-six adolescents participated in this study. Adolescents' OHRQoL was evaluated using the Brazilian version of the questionnaire Impact of Fixed Appliances Measure. This questionnaire comprises 43 questions distributed across nine domains: aesthetics; functional limitation; dietary impact; oral hygiene impact; maintenance impact; physical impact; social impact; time constraints; and travel/cost/inconvenience implications. The answer options follow the Likert scale, in the range of 1-5. A higher score indicates a more negative impact on the OHRQoL. Adolescents' malocclusion was assessed using the Dental Aesthetic Index. Information on family income, adolescents' age and tooth extraction was also collected. A directed acyclic graph was used to identify potential confounders. Statistical analysis involved the chi-square test, the Student's t test and the analysis of covariance. The minimal clinically important difference was also calculated.

RESULTS

Of the 46 participants, 25 were girls and 21 were boys. The female adolescents presented a more negative impact from the orthodontic treatment on the quality of life when compared to the male adolescents (P < 0.001), regardless of the influence of the confounding variables. The most negative repercussions were identified in the domains of oral hygiene (P = 0.002), physical impact (P < 0.001) and social impact (P < 0.001).

CONCLUSION

The impact of the first six months of orthodontic treatment on OHRQoL is more negative in female individuals than in male individuals. The results of this study may be useful for the oral healthcare provider during the counselling of adolescents undergoing fixed appliance therapy.

Oral health status and oral health related quality of life in adolescent workers

Background and aim

Oral health status and oral health related quality of life (OHRQoL) of working adolescents has been very little reported in literature. Therefore, this study aimed to determine oral health status and OHRQoL in a group of adolescent workers.

Methods

This cross-sectional study was conducted in an apprentice training center in western Turkey between December 2016 and January 2017. The study group population was 585, and the sample size was 514 students between 14 and 18 years old. The Decayed, Missing, and Filled Teeth (DMFT) Index, the Turkish version of the Oral Health Impact Profile-14 (OHIP-14), and a form requesting the socio-demographic information of the students were used as data collection tools. Permissions were obtained from the relevant school, parents, students, and ethical committee. The data were analyzed using descriptive statistics, the Student's t-test, and the Pearson correlation coefficient.

Results

The results showed significant relationships between the tooth brushing frequency, dental visit frequency, dental trauma history, smoking, and the OHIP-14 subdomains (p < 0.05).

Conclusion

Poor oral health and a lack of good oral health attitudes may have negative impact on the oral health related quality of life (OHRQoL) of working adolescents. Dental health education programs in collaboration with schools and dental health services may be beneficial for promoting oral health and improving the OHRQoL of working adolescents.