White spot lesion-related perception of aesthetics and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists

OBJECTIVE

To investigate the impact of various degrees of white spot lesions (WSLs) of maxillary anterior teeth on the aesthetic perception and treatment satisfaction among orthodontic patients, orthodontists and other dental specialists and to evaluate the differences among the three groups.

METHODS

A total of 45 orthodontic patients (OP), 45 orthodontists (OR) and 45 other dental specialists (OS) were recruited. Subjective evaluations of perceived aesthetics and treatment satisfaction were performed towards eight digitally generated photographs of maxillary anterior teeth with incremental degrees of WSLs using a numerical visual analogue scale (VAS) from 0 to 100. Data were collected and analysed with descriptive statistics, repeated one-way analysis of variance and multivariable generalized estimating equations.

RESULTS

A total of 135 valid questionnaires were collected. Regarding aesthetic scores for WSLs, OP gave more positive scores than OR and OS (p < .05) towards excessive white spot formation without colouration and were more tolerant than OR (p < .05) towards excessive white spot formation with slight colouration. The level of treatment satisfaction for slight to severe WSLs without cavitation was higher in OP than OR. Patients with higher education levels had more negative scores for aesthetic perception and treatment satisfaction (p < .05). Patients who brushed teeth more frequently scored lower in treatment satisfaction (p < .05).

CONCLUSIONS

Orthodontists were the most critical when evaluating aesthetics and treatment satisfaction for slight to severe WSLs without cavitation. For orthodontic patients, better oral hygiene habits and higher education levels were associated with more critical attitudes towards WSLs.

The effectiveness of dental water jet in reducing dental plaque and gingival bleeding in orthodontic patients: A systematic review and meta-analysis of randomized clinical trials

INTRODUCTION

This systematic review and meta-analysis tests the effectiveness of dental water jet (DWJ) with manual toothbrushes (MTB) compared to MTB alone in oral health maintenance in orthodontic patients.

METHODS

Four databases were systematically searched: PubMed, Scopus, Web of Science (WoS) and Cochrane Library until 6 January 2022 using a combination of medical subject heading (MeSH) terms and keywords. Randomized clinical trials (RCTs) were only included and critically appraised using the Cochrane Risk of Bias (ROB) tool. The mean difference (MD) effect measure was calculated using the Mantel-Haenszel statistical test (95% confidence interval [CI]) to compare both study groups (p-value < 0.05).

RESULTS

After reviewing 5881 studies from a systematic search, six were selected for inclusion, with four involved in the quantitative analysis. The risk of bias was low in two studies, moderate in two studies and high in the remaining two studies. The meta-analysis showed a significant improvement in plaque index and bleeding scores in DWJ + MTB group compared MTB alone group in orthodontic patients with generalized gingivitis (MD = -0.75, 95% CI [-1.29, -0.22], p = 0.006) and (MD = -0.17, 95% CI [-0.27, -0.08], p = 0.0003), respectively. However, no significant improvement was detected between both groups in the gingival index.

CONCLUSIONS

The use of DWJ as an adjunctive device in addition to MTB can be an effective strategy for maintaining oral hygiene in orthodontic patients with gingivitis. However, more high-quality RCTs are needed to confirm the findings.

Creating and Testing a New Computer Vision System for Detecting Dental Problems in Orthodontic Patients

Aim

The research project focuses on the creation and assessment of an innovative computer vision system designed to identify dental irregularities in individuals undergoing orthodontic treatment.

Materials and Methods

To establish the computer vision system, a comprehensive dataset of dental images was collected, encompassing various orthodontic cases. The system's algorithm was trained to recognize patterns indicative of common dental anomalies, such as malocclusions, spacing issues, and misalignments. Rigorous testing and refinement of the algorithm were conducted to enhance its accuracy and reliability.

Results

The validation of the system was carried out using the dental records and images of the 40 patients. The computer vision system's performance was evaluated against assessments made by experienced orthodontists. The results demonstrated a commendable level of concurrence between the system's automated detections and the orthodontists' evaluations, suggesting its potential as a valuable diagnostic tool.

Conclusion

In conclusion, the development and validation of this novel computer vision system exhibit promising outcomes in its ability to automatically detect dental anomalies in orthodontic patients.

Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study

Objective

This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients.

Methods

A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05.

Results

The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001).

Conclusion

Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.

[Characteristics of white spot lesions associated with orthodontic treatment: a review]

Introduction

The purpose of this literature review is to provide scientific evidence on the characteristics of white spot lesions (WSL) during orthodontic treatment, their incidence, prevalence, risk factors related to their development, progression, and regression, as well as explain the most used diagnostic methods.

Materials and methods

An exhaustive search was carried out in the databases of Pubmed, Scopus, Science Direct and Embase up to the date of November 30, 2022. Cross-sectional studies that evaluated white spot lesions before and after orthodontic treatments were included. Two researchers carefully selected the articles evaluated and analyzed different key topics on the subject.

Results

It was found that the prevalence and incidence of white spots during orthodontic treatment varies widely depending on the diagnostic method used, the type of orthodontic technique used and the time of orthodontic treatment. The incidence of white spot lesions is highest in patients treated with conventional braces, followed by those who used self-ligating braces, and was lowest in patients who used aligners. The most affected teeth are the upper lateral incisors and upper maxillary canines at the level of the gingival third.

Conclusions

The incidence of white spots is associated with orthodontic treatment, being closely related to the treatment technique used and the treatment time. There is a regression of the LMB during the first year after removal of the appliance.

Oral hygiene awareness and practice in orthodontic patients in Makkah city: A cross sectional study

OBJECTIVES

To evaluate the level of oral hygiene awareness and practice among orthodontic patients that have fixed appliances and investigate the differences in awareness as per age, gender, and education qualification.

MATERIALS AND METHODS

A cross-sectional study with 250 patients was included. A questionnaire was used to collect information regarding the patient's oral hygiene.

RESULTS

The level of awareness and oral hygiene practice was significantly higher among females, with a consistent stepwise increase toward older ages. Also, increased with higher education level, longer duration since getting the appliance, and receiving instructions from the orthodontist.

CONCLUSIONS

Oral hygiene instructions received by the orthodontist play an important role in the patient's awareness level. Also, many predictors have a significant effect on the patient's cooperation in practicing oral hygiene measures.

Masticatory Efficiency in Orthodontic Patients with Craniofacial Disorder

This study evaluates the masticatory efficiency in patients with craniofacial disorders (CD) compared to controls (C). A total of 119 participants (7-21 years), divided into CD group (n = 42, mean age 13.45 ± 5.2 years) and C group (n = 77, mean age 14.3 ± 3.27 years) under an orthodontic treatment were included. Masticatory efficiency was assessed using a standard food model test. The masticated food was examined according to its number of particles (n) and area (mm²), wherein a higher number of particles alongside a smaller area was an indication of better masticatory efficiency. Additionally, the influence of cleft formation, chewing side, dentition stage, age and sex were evaluated. Patients with CD chewed the standardized food in fewer particles (n_CD = 61.76 vs. n_C = 84.58), with a significantly higher amount of area than the controls (A_CD = 192.91 mm² vs. A_C = 146.84 mm²; p = 0.04). In conclusion, patients with CD showed a significantly decreased mastication efficiency compared to healthy patients. Factors such as stage of cleft formation, chewing side, dentition stage and age showed an influence on masticatory efficiency, whereas no gender effect on the masticatory efficiency of CD patients was found.

Estimation and correlation of salivary calcium, phosphorous, alkaline phosphatase, pH, white spot lesions, and oral hygiene status among orthodontic patients

Introduction:

The initial carious lesions are the so-called “white spot” lesions (WSLs), which implies that there is a subsurface area with most of the mineral loss beneath a relatively intact enamel surface. It is common in patients who are taking orthodontic treatment. Salivary reservoir of calcium and phosphorous counteracts the demineralization and encourages re-mineralization providing protection against caries challenge. This study was aimed to estimate and correlate the oral hygiene status, WSLs and salivary calcium, phosphorus, alkaline phosphatase (ALP), and pH in patients undergoing fixed orthodontic therapy.

Materials and Methods:

All clinical and biochemical parameters were recorded in 27 patients before starting orthodontic treatment and at 6 months of orthodontic treatment. The salivary calcium, phosphorous, ALP, and pH were determined by Arsenazo III method, Molybdate – UV and the International Federation of Clinical Chemistry method, respectively. International caries detection and assessment system index for WSL, orthodontic plaque index, bleeding on probing, and gingival index were recorded. Shapiro–Wilk's test and Wilcoxon test were applied to the data collected for statistical analysis.

Results:

There was a statistically significant increase with ALP levels, orthodontic plaque index score, gingival index score, and bleeding on probing index score. A statistically significant reduction was seen with respect to levels of calcium and pH.

Conclusion:

Maxillary canines and lateral incisors were the most affected teeth with WSLs (78.84%). There is a need for more stringent prevention programs and oral hygiene practices prior to initiation of orthodontic treatment and also during orthodontic treatment.

Prevalence and Characteristics of Supernumerary Teeth in Israeli Orthodontic Patients

BACKGROUND

Supernumerary teeth are one of the most common anomalies in the human dentition, found most frequently in the maxillary anterior region causing impaction or displacement of the adjacent permanent teeth.

AIM

The purpose of this retrospective study was to determine the prevalence and characteristics of supernumerary teeth in orthodontically treated patients.

STUDY DESIGN

Pre-treatment facial and intraoral photographs, study models, panoramic and periapical radiographs of 3,000 consecutively treated orthodontic patients (mean age 12.2 years) from the Department of Orthodontics Tel Aviv University, were examined to detect supernumerary teeth in both arches. They were recorded according to gender, age, number, location, position and morphology.

RESULTS

Thirty-six patients, 22 (61%) males and 14 (39%) females with 50 supernumerary teeth, of which 42 (84%) were found in the maxillary anterior region, and 8 (16%) in the mandible, presenting a prevalence of 1.2%.

CONCLUSIONS

A prevalence of 1.2% was found in our study. The most common supernumerary tooth is mesiodens located at the maxillary anterior region. The characteristics of supernumeraries were based on their morphology, location and position. The most frequent complications caused were rotations, displacement and arrested eruption of maxillary incisors.

Impulsiveness in Reactive Dieters: Evidence From Delay Discounting in Orthodontic Patients

Introduction: Researchers have made efforts to distinguish the behavioral differences and underlying mechanisms that explain the various possible outcomes of dieting (success, failure and relapse). Although extensive research has demonstrated that eating behavior and individual impulsiveness are closely related to subjective appetite and decision making, very few studies have investigated how subjective and appetite impulsiveness is affected by reactive dieting. Methods: In the present study, we utilized the power of food scale (PFS) and the intertemporal choice task and to examine subjective appetite and impulsivity of decision making in orthodontic patients. As a result of their orthodontic devices and the subsequent pain and discomfort caused by eating, these patients become reactive dieters. In order to explore the dynamic influence of orthodontic treatment on appetite and impulsiveness, we collected data for both patients and control participants across three testing sections. We also computed a regression model for further exploration in explaining how potential factors contributed to different choices. Results: We found that the orthodontic group scored significantly lower in PFS than the control group, which indicated a suppression in appetite. Besides, reward and waiting time were significant factors in computational perspective. Moreover, although patients showed a bias in choosing smaller, immediate reward options, they exhibited a decrease in the delay discounting rate as treatment progressed. These findings confirm that subjective appetite and impulsiveness were inhibited due to reactive dieting.

Kinetics of salivary pH after acidic beverage intake by patients undergoing orthodontic treatment

The saliva of patients undergoing orthodontic treatment with fixed appliances can potentially present a delay in the diluting, clearing, and buffering of dietary acids due to an increased number of retention areas. The aim of this clinical trial was to compare salivary pH kinetics of patients with and without orthodontic treatment, following the intake of an acidic beverage. Twenty participants undergoing orthodontic treatment and 20 control counterparts had their saliva assessed for flow rate, pH, and buffering capacity. There was no significant difference between salivary parameters in participants with or without an orthodontic appliance. Salivary pH recovery following acidic beverage intake was slower in the orthodontic subjects compared to controls. Patients with fixed orthodontic appliances, therefore, seem to be at higher risk of dental erosion, suggesting that dietary advice and preventive care need to be implemented during orthodontic treatment.

The effects of TMJ symptoms on skeletal morphology in orthodontic patients with TMJ disc displacement

OBJECTIVE

The aim of this study was to investigate the effects of temporomandibular joint (TMJ) symptoms on skeletal morphologies of orthodontic patients with TMJ disc displacement (DD).

MATERIALS AND METHODS

The sample consisted of 197 women seeking orthodontic treatment. The subjects were divided into two groups according to the presence of TMJ symptoms: the presence and absence of TMJ symptoms. Each group was sub-divided into three groups based on magnetic resonance images of bilateral TMJs: bilateral normal disc position (BN), bilateral disc displacement with reduction (DDR) and bilateral disc displacement without reduction (DDNR). Seventeen variables from lateral cephalograms were analyzed by two-way analysis of variance to identify differences in skeletal morphologies with respect to TMJ symptoms and TMJ DD status.

RESULTS

Patients with TMJ DD were more likely to have short ramus height, short mandibular body length and backward positioning of the ramus and mandible. These skeletal morphologies became more severe as TMJ DD progressed to DDNR. However, the skeletal morphologies associated with TMJ DD were not significantly different between symptomatic and asymptomatic patients. As a result, patients with TMJ DD had backward positioning and clockwise rotation compared to those with bilateral normal TMJs, irrespective of the presence of TMJ symptom.

CONCLUSIONS

This study suggests that TMJ DD is associated with altered skeletal morphology, but TMJ symptoms do not significantly influence the relationships between TMJ DD and skeletal morphology.

A Retrospective Evaluation of the Class of Malocclusion amongst Orthodontic Patients at the University Of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria

OBJECTIVES

The aim of this study was to evaluate the type of malocclusion amongst orthodontic patients in the UNTH.

METHODS

A retrospective evaluation of patients who attended the Orthodontic unit of the University of Nigeria Teaching Hospital from January 2008 to January 2010 was carried out to determine the type of malocclusion. Demographic dat a of the patients and information on first molar relationship were obtained from the patient's record file.

RESULTS

A total of 75 patients, 21 males (28%) and 54 females (72%) were seen. The age range of the patients studied was 6 to 63years with the most frequent age group being 6 to 15 years, consisting 52.1% of the total patients seen. Class 1 molar relationship was the most prevalent occurring in 60% of the cases.

CONCLUSION

There were more females who attended the Orthodontic unit within this 2 year period. Class 1 malocclusion was the most common type of malocclusion.