Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis

Effects of individuals' esthetic expectations and the classifications of dentofacial deformities on patients' depression: a cross-sectional study

Background

Dentofacial deformity (DFD) is a disease in which the maxillary complex markedly diverges from normal proportions. The incidence of DFD is approximately 20% worldwide, and patients with DFDs are at increased risk for depression. Attention should be given to depression in patients with DFDs. However, factors affecting depression in patients with DFDs remain unclear. Previous studies have suggested that the type of DFD and esthetic expectations may influence patient depression, but few studies have clarified the effects of the type of DFD and esthetic expectations on patient depression.

Methods

A total of 471 patients with DFDs were enrolled. The diagnosis of DFD was made by two maxillofacial surgeons according to the Angle's classification. The visual analog assessment scale of esthetic expectations was used to assess patients' esthetic expectations. The 9-item Patient Health Questionnaire depression module was utilized to explore patient depression. SPSS 26.0 was used to analyze the data in this study.

Results

Compared with DFD patients who had a master's degree or above, those who had a high school education were more prone to depression (OR=3.848, 95% CI: 1.546-9.574). Compared with Class II DFDs, Class III DFDs were associated with a greater risk of depression (OR=1.458, 95% CI: 1.007-2.078). Compared with those who had extremely low esthetic expectations, those who had extremely high esthetic expectations (OR: 2.25, 95% CI: 1.053-4.086) were more prone to depression.

Conclusions

Patients who had a high school education, were diagnosed with Class III DFDs, and had higher esthetic expectations had a greater risk of depression. The above populations may need more psychological support.

Orthodontic aligner therapy outcomes in children with autism spectrum disorder

BACKGROUND

Children with autism spectrum disorder (ASD) face unique challenges in oral care. Aligner therapy offers a promising alternative to conventional approaches for this patient group.

AIM

To evaluate orthodontic aligner therapy outcomes in children with ASD using the Peer Assessment Rating (PAR) Index and the Index of Complexity, Outcome, and Need (ICON), and to investigate whether concomitant disorders affect ICON, PAR scores, and treatment duration.

DESIGN

Two calibrated observers assessed digital dental casts and intraoral pictures of 37 children with ASD before (T0) and after (T1) their treatment. At T0, the participants' average age was 12.9 years (SD = 1.68); at T1, post-therapy, the average age was 14.9 years (SD = 1.51). All participants underwent orthodontic aligner therapy. Statistical methods employed in this study included descriptive analysis, Wilcoxon tests, and univariate linear regression.

RESULTS

Posttreatment, median ICON scores decreased significantly from 74 to 14, and median PAR scores from 36 to 8 (p < .0001), demonstrating "excellent to substantial" improvement in 89.2% (n = 33) of the children. Comorbidities, present in 62% of patients, did not significantly affect treatment duration (22.6 ± 11.02 months).

CONCLUSION

Children with ASD significantly benefit from orthodontic aligner therapy, emphasizing the need for tailored orthodontic care.

Orthodontic Treatment of Patients With Disabilities in Norway: A Survey Among Orthodontists

AIM

The objective of this study was to examine orthodontic treatment of patients with disabilities in Norway, as perceived by orthodontists.

METHODS AND RESULTS

A digital questionnaire was sent out to the 220 registered members of the Norwegian Orthodontic Society and a response rate of 41% (n = 90) was achieved. The majority (92%) had received referrals for patients with disabilities, 53% reported treating up to 10 patients, while 37% reported treating up to 50 patients in the last 5 years. Most of the participants (64%) showed a willingness to treat more patients with disabilities, with this interest significantly and conversely linked to years in practice (p = 0.02, chi-squared test). Orthodontists desire more referrals to increase patient intake, and also financial incentives play a relevant role in this context. Regarding the preferred location for orthodontic treatment for patients with disabilities, 34% prefer treatment in specialized centers rather than the current setup in optional private practices. An association exists between this perspective and the readiness to treat additional patients (p = 0.009) CONCLUSION: Most orthodontists in Norway have treated patients with disabilities. Among the surveyed orthodontists, a notable 64% expressed a positive inclination toward treating more patients with disabilities or initiate such services. To enhance their acceptance of these patients, it seems crucial to increase referrals and provide improved financial incentives.

Bruxism associated with short sleep duration in children with autism spectrum disorder: The Japan Environment and Children's Study

Bruxism, the involuntary activity of masticatory muscles, is common among individuals with autism spectrum disorders (ASD). Although bruxism is bidirectionally associated with sleep issues, whether an infant's sleep duration contributes to the development of bruxism remains unknown. In this study, a dataset (n = 83,720) obtained from the Japan Environment and Children's Study, a nationwide birth cohort study, was subjected to multiple imputations using logistic regression analysis with adjustments for several maternal and child-related variables. The aim of this study was to assess whether shorter sleep duration in the neonatal period additively affected the high prevalence of parent-reported bruxism (PRB) among children with ASD. The prevalences of ASD and PRB in the participants were 1.2% and 7.2%, respectively, and the odds ratio of the increased risk of PRB prevalence in individuals with ASD (95% confidence interval) was 1.59 (1.31-1.94) after covariate adjustments. Importantly, shorter sleep duration in the neonatal period (at one month of age) was significantly associated with an increased risk of PRB prevalence in individuals with ASD. The increased occurrence of bruxism, known to be highly prevalent among children with ASD, is associated with shorter sleep duration, particularly in the neonatal stage. Based on our results, a better understanding of the development of bruxism in individuals with ASD would provide valuable information for the prevention of oral diseases.

Oral health status of children with intellectual and developmental disabilities in India: a systematic review and meta-analysis

INTRODUCTION

India has committed to the Sustainable Development Goals (SDGs) 2030 principle of "Leave No One Behind", which seeks to reduce disparities and vulnerabilities. The dearth of data on the oral health conditions of children with intellectual and developmental (IDD) disabilities in India is significant. Our systematic review intended to collate and synthesise data on the oral health status of children with IDD.

METHODS

Online electronic databases such as PubMed-MEDLINE, Embase, and Scopus were searched using appropriate keywords from the earliest available data until 31st March 2024, with no language restriction. Cross-sectional studies conducted amongst individuals below 18 years of age with intellectual, or developmental disabilities, in India were included. Quality assessment and meta-analysis using a random-effects model for variables reported from four or more studies and a prediction interval was calculated.

RESULTS

Out of 2388 studies, a total of 15 studies were included. Our study showed that 91% (95% [confidence interval] CI: 0.80-0.96) of IDD children use toothbrushes regularly. However, poor oral hygiene was found among 38% (95% CI = 0.21-0.59) of IDD children. The pooled prevalence of dental caries among children was found to be 64% (95% CI: 0.45-0.79). Periodontal disease was reported in only one study among 54.20% of IDD children.

CONCLUSIONS

Our findings suggest that despite brushing regularly the incidence of caries and poor oral hygiene in children with IDD is high. Flexible, tailored interventions that go beyond a uniform approach must be implemented to effectively address oral health requirements of children with IDD. Specific Health Programmes should be established for their preventive oral care.

Cross-bite and oral habits among Albanian autistic children according to the stages of occlusal development

This study had two aims. First, we aimed to investigate the prevalence of ACB, PCB, and oral habits among a group of Albanian children with ASD compared with a group of children without ASD. Second, we aimed to identify the associations of ASD with ACB, PCB, and oral habits. The sample inlcuded 125 children with ASD (91 males, 34 females) from 2 special schools for children with disabilities and 2 daily residential centers in Tirana. The control group included 125 children without ASD. The relationships between categorical variables were evaluated via the chi-square test. To identify the potential risk factors for ASD, we performed binary logistic regression. No statistically significant differences were found for CB or oral habits between the primary and adolescent dentition stages. A comparison of children with ASD with CB and oral habits revealed a significant difference in the prevalence of PCB. Binary logistic regression revealed that ACB, PCB and oral habits were not associated with ASD. CB was more prevalent among children with ASD in the primary and mixed dentition stages. Oral habits were more prevalent in the mixed and adolescent dentition stages. However, ASD is not a risk factor for CB or other oral habits.

Major depressive disorder elevates the risk of dentofacial deformity: a bidirectional two-sample Mendelian randomization study

Background

The association between psychiatric disorders and dentofacial deformities has attracted widespread attention. However, their relationship is currently unclear and controversial.

Methods

A two-sample bidirectional MR analysis was performed to study the causal relationship between dentofacial deformity and eight psychiatric disorders, including major depressive disorder, panic disorder, schizophrenia, bipolar disorder, attention deficit hyperactivity disorder, Alzheimer's disease, autism spectrum disorder, and neuroticism. Inverse variance weighted, weighted median, MR-Egger regression, weighted mode four methods, and further sensitivity analyses were conducted.

Results

The major depressive disorder affected dentofacial deformity, with an OR = 1.387 (95% CI = 1.181-1.629, P = 6.77×10-5). No other psychiatric disorders were found to be associated with dentofacial deformity. In turn, dentofacial deformity were associated with neuroticism, with an OR = 1.050 (95% CI = 1.008-1.093, P = 0.018). And there was no evidence that dentofacial deformity would increase the risk of other psychiatric disorders.

Conclusions

Major depressive disorder might elevate the risk of dentofacial deformities, and dentofacial deformity conditions would increase the risk of the incidence of neuroticism.

Oral Health Statuses of Children and Young Adults with Autism Spectrum Disorder: An Umbrella Review

This study aimed to comprehensively evaluate the oral health statuses of children and adults within the autism spectrum disorder (ASD) population through an umbrella review approach. The prevalence of dental caries, periodontal disease, and associated variables were investigated across selected studies. A systematic search was conducted across databases including PubMed, Scopus, EMBASE, Science Citation Index, Science Direct, Web of Science, MEDLINE, and Wiley Online Library to identify relevant studies. The assessed variables included dental caries prevalence, periodontal disease prevalence, oral hygiene indicators, and the necessity of dental treatment. The pooled prevalence rates, odds ratios, and standardized mean differences were calculated where applicable. The pooled prevalence of dental caries among ASD individuals ranged from 60.6% to 67.3%, while the periodontal disease prevalence ranged from 59.8% to 69.4%. High rates of dental treatment under general anesthesia were reported. Heterogeneous dental caries and periodontal disease prevalence rates were identified, highlighting the need for collaboration and preventive care. Several studies also reported higher prevalence rates of dental trauma and self-inflicted oral injuries among individuals with ASD. However, the review also identified significant methodological limitations in the included studies, including inconsistency in oral health assessment methods and potential bias. The necessity for targeted policies due to high prevalence rates and the requirement for integrated care systems in high DMFT regions were also observed. The umbrella review synthesized diverse findings, revealing variations in dental caries and periodontal disease prevalence among ASD individuals. This review underscores the need for tailored interventions and policies to address oral health disparities. It highlights the necessity of integrated care systems, methodological improvements, and longitudinal studies to comprehensively address the multifaceted oral health challenges within the ASD population.