Malocclusion – a term in need of dropping or redefinition?

What is occlusion? Part 2

Some dentists choose to ignore the subject of occlusion, while others propose a set of doctrinal rules. It is of little wonder therefore that it can become a source of confusion and even controversy. This series of two papers aims, firstly, to answer the very simple question of 'what is occlusion?'. It will put occlusion into the context of the articulatory system because that is the bio-mechanical environment where the majority of dentists do their work. The concept of jaw relation will also be discussed but within the context of this locomotive system. Ideal occlusion will be described but only after answering the question: for whom or what might an occlusion be considered ideal? Although, in the book of which this is the first chapter, he presents what has worked for him during many years as a general dental practitioner, university lecturer and specialist in restorative dentistry, he has tried not to be didactic because he feels that, in a profession, there are no right answers, only the right questions.

Functional and aesthetical full-mouth rehabilitation of a patient with severely worn dentition and deep bite using minimally invasive approach in current vertical dimension: A 3-year follow-up

Key Clinical Message

Regaining restorative space for fullmouth reconstruction in a patient with deep bite and worn dentition by conservative approach in current vertical dimension and also using minimally invasive concept is recommended.

Abstract

Full mouth reconstruction of a deep bite patient with severely worn dentition is a challenging situation for the prosthodontists. This study represents minimally invasive procedures in mentioned condition without increasing vertical dimension. After 3 years of follow up no complication was observed.

Comparative Study of Malocclusions between Cancer Patients and Healthy Peers

Background. There is lack of data related to dental occlusion among children cured from cancer. The aim of our study was to compare the prevalence of malocclusion in cancer survivors and in healthy peers. Methods. A cross-sectional study was conducted on 225 children aged between 4 and 18 years, including 75 cancer survivors, and 150 sex and age-matched controls. All patients were orthodontically examined and malocclusion traits were recorded. In the cancer group, 75 panoramic radiographs were used to evaluate the prevalence of dental anomalies and dental age using the Demirjian scale. Data were analyzed by univariate statistical analysis with p-values p < 0.05 considered as statistically significant. Results. Malocclusion was found in 49 (65.33%) cancer survivors and 99 (65.56%) controls (p > 0.05). The cancer group demonstrated significantly higher likelihood of crossbite (p < 0.01) and malalignment of teeth (p = 0.031). The healthy controls were more likely to demonstrate open bite (p = 0.038). Cancer patients with posterior crossbite (p = 0.023) or dental malalignment had a more advanced dental age (p = 0.022). Survivors with crossbite had more teeth with short roots (p = 0.016). Those who were older when they started their cancer therapy were more likely to suffer from tooth disturbances (p = 0.019). Conclusion. Oncological treatment can alter the development of occlusion in cancer patients.

Prevalence of oral conditions and associated factors among schoolchildren in Accra, Ghana: a cross-sectional study

OBJECTIVE

The impact of oral diseases on children cannot be overemphasized because their effects may go beyond the individual to the household and the community at large. This study aimed to determine the prevalence of common oral conditions in children between the ages of 9 and 16 years in Accra.

METHODS

A cross-sectional study was carried out among participants from 16 selected junior high schools in Accra. Their caries experience was assessed using the decayed, missing, and filled teeth (DMFT) index. Other variables recorded were age, sex, previous history of a dental visit, and the presence of other common oral conditions (ie, periodontal disease, traumatised teeth, oral mucosal lesions, neoplasia, cysts, and malocclusion). Summaries and descriptive statistics were generated and reported. The DMFT was compared between subgroups, and the χ² test was used to compare outcomes of categorical variables.

RESULTS

A total of 1118 students participated in the study. This consisted of 37.8% males and 62.2% females. The mean age was 12.8 (standard deviation = 1.7) years. Common oral conditions were found in 49.7% of the participants and the prevalence of caries, periodontal disease, and malocclusion were found to be 13.3%, 30.4%, and 11.3%, respectively. The population's mean DMFT was found to be 0.27 (standard deviation = 0.76).

CONCLUSIONS

The prevalence of caries and periodontal disease calls for additionaleffort to reduce the burden of common oral conditions in Ghanaian children.

Pediatric Quality of Life Instruments in Oral Health Research: A Systematic Review

OBJECTIVE

To identify the generic or disease-specific pediatric quality of life (QoL) instruments used in oral health research among children and adolescents and to provide an overview of these QoL instruments.

METHODS

A systematic literature search was performed with multiple databases to identify the pediatric QoL instruments used in oral health research.

RESULTS

The literature search yielded 872 records; from these, 16 pediatric QoL instruments were identified that had been used among children and adolescents in oral health research. Of these, 11 were oral health-specific QoL instruments and five were generic instruments. Of the 11 oral health-specific QoL instruments, none were multiattribute utility instruments (MAUI), whereas of the five generic instruments, two (Child Health Utility 9D index and EuroQoL-5D youth) were classified as an MAUI. Except for one, all pediatric QoL instruments were published after the year 2000 and the majority originated from the USA (n = 8). Of the 11 oral health-specific QoL instruments, five instruments are designed for the respondent to be a child (i.e., self-report), one uses proxy responses from a parent or guardian, and five instruments have both self and proxy versions. Of the five generic QoL instruments, one uses proxy responses and the other four instruments have both self and proxy versions.

CONCLUSIONS

This review identified a wide variety of pediatric oral health-specific and generic QoL instruments used in oral health research among children and adolescents. The availability of these QoL instruments provides researchers with the opportunity to select the instrument most suited to address their research question.

Establishing better biological models to understand occlusion. I: TM joint anatomic relationships

Belief in and rejection of a relationship of occlusion and temporomandibular joint (TMJ) condyle-fossa position with normal and abnormal function are still contentious issues. Clinical opinions can be strong, but support in most published data (mostly univariate) is problematic. Distribution overlap, low sensitivity and specificity are a common basis to reject any useful prediction value. Notwithstanding, a relationship of form with function is a basic tenet of biology. These are multifactor problems, but the questions mostly have not been analysed as such. This review moves the question forward by focusing on TM joint anatomic organisation as the multifactor system it is expected to be in a closed system like a synovial joint. Multifactor analysis allows the data to speak for itself and reduces bias. Classification tree analysis revealed useful prediction values and usable clinical models which are illustrated, backed up by stepwise logistic regression. Explained variance, R(2), predicting normals from pooled TMJ patients was 32·6%, sensitivity 67·9%, specificity 85·7%; 37% versus disc displacement with reduction; and 28·8% versus disc displacement without reduction. Significant osseous organisational differences between TM joints with clicking and locking suggest that this is not necessarily a single disease continuum. However, a subset of joints with clicking contained characteristics of joints with locking that might contribute to symptom progression versus resistance. Moderately strong models confirm there is a relationship between TMJ osseous organisation and function, but it should not be overstated. More than one model of normals and of TM derangement organisation is revealed. The implications to clinical decision-making are discussed.