The Psychosocial Impact of Dental Esthetics in Undergraduates with Borderline Malocclusion

Background

The study investigates the existing correlation between self-perceived malocclusion, the psychosocial impact of dental esthetics, and whether this link involves personality traits.

Methods

The 179 questionnaires from 615 undergraduates in Wenzhou were used for analysis after applying the exclusion criteria. The Psychosocial Impact of the Dental Aesthetics Questionnaire (PIDAQ) was administered to evaluate participants' perceptions of the psychosocial impacts of malocclusion. The need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN). The Chinese version of the Eysenck Personality Questionnaire-Short Scale (EPQ-RSC) evaluated participants' personality characteristics. The Kruskal-Wallis test was used to assess differences between the IOTN-Dental Health Component (DHC) and expectations of orthodontic treatment. Linear regression was applied with PADAQ and its subscale scores against possible variables.

Results

The total and subscale PIDAQ scores were positively correlated with neuroticism. Total PIDAQ scores, the DHC, and the Aesthetic Component (AC) were significantly positively correlated with the subjective AC. The DHC was significantly negatively correlated with extroversion.

Conclusions

We confirmed a modest link between the need for orthodontic treatment and the psychosocial impact of dental esthetics.

Comparison of clinical esthetic outcomes of immediately placed implants with and without immediate provisionalization in single-tooth implants of the esthetic area: A protocol for systematic review and meta-analysis

BACKGROUND

Immediately placed implants with immediate provisionalization have become attractive options for patients and clinicians. However, there is no agreement on the esthetic advantages of immediately placed implants with immediate provisionalization. The aim of this systematic review and meta-analysis will be to assess the effect of immediate provisionalization on the clinical esthetic outcomes of immediately placed implants in a single-tooth implant of the esthetic area.

METHODS

An electronic search of MEDLINE/PubMed, EMBASE, Web of Science, Clinicaltrials.org., Cochrane Library, China Biology Medicine (CBM), Wan Fang Database, China National Knowledge Infrastructure Database (CNKI), and VIP Science Technology Periodical Database will be performed. The search will be carried out in the databases for articles published until May 2021. Two researchers will independently perform the literature selection, data extraction and quality assessment. Only randomized controlled trials (RCTs) reporting on the impact of immediate provisionalization on the clinical esthetic outcomes of implants immediately placed in a single-tooth implant of the aesthetic area will be included. The primary outcome of this study will be the esthetic outcome assessed by the objective index and patient satisfaction. The survival rate of implants and restorations and the changes in mucosa and bone around implants will also be analyzed. The included studies will be analyzed by Review Manager 5.3, and a meta-analysis will be performed.

RESULTS

The study will evaluate the clinical esthetic outcomes of immediately placed implants with and without immediate provisionalization in single-tooth implants of the esthetic area. The results will provide clinicians with a better treatment approach in their application.

CONCLUSION

This systematic review and meta-analysis will provide more reliable, evidence-based data for the impact of immediate provisionalization on the clinical esthetic outcomes of immediately placed implants, which may or may not be beneficial.

REGISTRATION NUMBER

PROSPERO registration number: CRD42021221669.

Oral status and aesthetics after nonsurgical periodontal treatment: Do patient's perception and dentist's evaluation agree?

Objectives

Periodontal healing is often accompanied by side effects, which may cause an aesthetic deficit. The present investigation was focussed to compare patient's subjective perception of their posttherapy aesthetics with the objective measures of the results.

Materials and methods

Survey results from patients (subjective parameters) on oral status and aesthetics were compared against routine clinical parameters and corresponding survey results from treating dentists (objective parameters), both before and after periodontal treatment. Subjective outcome parameters were then suitably transformed and compared with the objective ones to investigate the agreement between patients' perception and actual outcomes.

Results

Objective recordings of periodontal status by the dentist and subjective awareness of the patient are quite contradictory to each other for almost all participants. Further, it was found that their aesthetics in the front were better after treatment, but dentist professionals targeted for future treatment needs.

Conclusions

In this study, it was found that patients improved aesthetically on the upper jaw front after the therapy, which was not shared by the dentists. This discrepancy was due to the clinicians' view on more aesthetic corrective procedures than on patients' need.

Esthetic perception of smiles with different gingival conditions

This study aimed to compare the perceptions of smile esthetics among general practitioners, periodontists, and laypeople. Photographs of smiles were taken and digitally modified to create different gingival conditions: gingival asymmetry, unilateral gingival recession, and bilateral gingival recession. These photographs were evaluated by 150 volunteers (19-70 years old) using a 100.0-mm visual analog scale. The volunteers consisted of 50 laypeople with no knowledge of dentistry, 50 general dentists, and 50 periodontists. Analysis of variance and Student t test were performed when data presented a normal distribution. If the hypothesis of normality was rejected, the Newman-Keuls test was applied to the data. Results showed that laypeople noticed gingival asymmetry only when it reached 2.0 mm, while periodontists and general dentists noticed it at 1.0 mm. Periodontists and general dentists considered smiles with unilateral recession of ≥1.0 mm to be less attractive, while the smallest modification that was deemed unesthetic by the laypeople was 2.0 mm. In the evaluation of bilateral gingival recession, general dentists and periodontists found smiles with a 1.0-mm modification less attractive, while the changes were not noticed by laypeople until the modification reached 1.5 mm. It can be concluded that laypeople perceived changes in smile esthetics differently than did dental professionals, which suggests that laypeople may be less concerned about the esthetic effects of minor gingival alterations than are dental professionals. Therefore, it is important for the dentist to understand the individual patient's perception of what constitutes an esthetic smile before recommending a dental treatment plan.

Dentogingival Alterations and Their Influence on Facial and Smile Attractiveness

AIM

This study aimed to evaluate the influence of labial and dentogingival characteristics on facial and smile attractiveness.

MATERIALS AND METHODS

Four different close-up photographs each of six women models with different labial and dentogin-gival characteristics were obtained. One of the models was considered standard. Photographs were arranged in an album were evaluated by 100 laypersons, and 30 dentists who ranked each close-up of the models from according to the degree of attractiveness from first to sixth place, with first being the model considered most attractive and justified the reasons for choosing.

RESULTS

The standard model received the best scores for both lips (7.75) and face (5.18). Medium-sized lips were preferred (p < 0.05), and the smile positively or negatively interfered with esthetic perception depending on the dentogingival alteration present. Diastema was the alteration that had the greatest negative influence.

CONCLUSION

Not all dentogingival alterations interfere with esthetic evaluation. The lips are not decisive in facial attractiveness. Attraction is assessed significantly differently by laypeople than by dentists. The smile directly influences the analysis of facial beauty.

CLINICAL SIGNIFICANCE

Dentogingival alterations may be imperceptible, especially when evaluating the facial joint, so its correction will not always be necessary.

[Wish fulfilling medicine and wish fulfilling dentistry: what does this mean?]

Wish fulfilling medicine refers to medical procedures applied without a direct medical need. In wish fulfilling medicine, the wish of the patient is dominant, but wish fulfilling medicine is also promoted indirectly by healthcare providers, (pharmaceutical) companies and healthcare insurers. Wish fulfilling medicine often concerns the enhancement of appearance or performance; therefore, wish fulfilling medicine is also referred to as (human) enhancement (therapy). The line between traditional and wish fulfilling medicine is vague: the border between illness and health, normal and abnormal functioning is not sharply defined and is relative to time and place. In the Netherlands, wish fulfilling medicine is not covered in the basic package provided by healthcare insurers and is paid for by the patients themselves. However, 'pay yourself' is not a decisive criterion for wish fulfilling medicine. With new biotechnological developments the domain of wish fulfilling medicine is expanding. Some dental treatments can be considered as wish fulfilling dentistry, for example in the context of cosmetic dentistry, orthodontics, or dental implantology. Although wish fulfilling medical treatments do not cure disease, they can promote health.

From Improving Egos to Perfecting Smiles: Orthodontics and Psychology, 1945-2000

From World War II to the end of 20^th century, the types of patients undergoing orthodontic treatment and their reasons for doing so changed significantly. In the 1950s and 1960s, Canadian parents were told that orthodontics would "cure" inferiority complexes and protect children with crooked teeth, especially girls, from a life of delinquency and missed opportunities. By the last two decades of the 20^th century, the consumer health movement and rising incomes empowered patients to decide which treatments were right for them, and an increasing number of adult patients sought orthodontic treatment to improve their appearance. Orthodontists never abandoned their claim that orthodontic treatment could improve psychological health, as while health psychologists and other researchers increasingly called this into question. But orthodontists did begin to place greater emphasis on aesthetics as a reason for treatment, and orthodontics became part of a much larger explosion in "cosmetic dentistry" procedures that came to include tooth whitening and veneers.

Quality of life and stability of tooth color change at three months after dental bleaching

PURPOSE

Intracoronary bleaching is a minimally invasive, alternative treatment that addresses aesthetic concerns related to non-vital teeth discoloration. However, to the best of our knowledge, no studies have assessed the psychosocial impacts of such procedures on patients' aesthetic perceptions. The aim of this study was to evaluate aesthetic perceptions and the psychosocial impact of patients up to 3 months after their teeth had been bleached with hydrogen peroxide (35%) and carbamide peroxide (37%) using the walking bleach technique.

METHODS

The patients were randomly divided into two groups according to the bleaching agent used: G1 = hydrogen peroxide 35% (n = 25) and G2 = carbamide peroxide 37% (n = 25). Non-vital bleaching was performed in four sessions. Color was objectively (ΔE) and subjectively (ΔSGU) evaluated. Aesthetic perception and psychosocial factors were evaluated before, 1 week and 1 month after the bleaching using the Oral Health Impact Profile (OHIP) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) questionnaires.

RESULTS

The color change (ΔE) values at 1 month were G1 = 16.80 ± 6.07 and G2 = 14.09 ± 4.83. These values remained stable until the third month after treatment (p > 0.05). There was a decrease in the values of OHIP-aesthetics and PIDAQ after treatment versus baseline (p < 0.05). This status was maintained through the third month after treatment.

CONCLUSIONS

Both agents were highly effective and had a positive impact on the aesthetic perception and psychosocial impact of patients, values that also remained stable over time. Non-vital bleaching yields positive and stable impacts on aesthetic perception and psychosocial factors. ClinicalTrials.gov identifier NCT02718183.

Effectiveness and Impact of the Walking Bleach Technique on Esthetic Self-perception and Psychosocial Factors: A Randomized Double-blind Clinical Trial

OBJECTIVE

This trial evaluates the impact of psychosocial and esthetic self-perceptions of patients undergoing nonvital tooth bleaching using the walking bleach technique. We also assessed the clinical effectiveness of bleaching tooth discoloration.

METHODS

Fifty volunteers with nonvital tooth discoloration were enrolled. Teeth were randomized into two groups: 35% hydrogen peroxide (n=25) and 37% carbamide peroxide (n=25). Intracoronal bleaching was performed over four sessions using the walking bleach technique. Tooth color was evaluated at each session to measure total color variation. The shade guide was arranged from highest (B1) to lowest (C4) values to assess the color and calculate the color change in the number of shade guide units. Subjective and objective assessments were compared with the tooth counterpart. Esthetic self-perception and psychosocial factors were assessed before and after treatment.

RESULTS

Color change was 15.48<5.17 for hydrogen peroxide and 14.02<4.85 for carbamide peroxide. There was no significant difference at any time point (p>0.05) except at sessions 3 and 4 (p<0.05). Overall, whitened teeth values were similar to those of counterpart teeth (p>0.05). There was a decrease in Oral Health Impact Profile and Psychosocial Impact of Dental Esthetics questionnaire scores after treatment compared with baseline (p<0.05).

CONCLUSION

The walking bleach technique was highly effective on nonvital teeth and had a positive effect on self-esthetic perception and psychological impact for the patients.

Influence of functional dentition on satisfaction with oral health and impacts on daily performance among Brazilian adults: a population-based cross-sectional study

BACKGROUND

Dental esthetics, chewing and speech should be preserved in a dentition denominated functional and are closely related to satisfaction with oral health (SOH), impacts caused by oral problems and have a possible association with Oral Health-Related Quality of Life. Thus, the purpose of the present study was to investigate the influence of different concepts of functional dentition (FD) on both SOH and impacts on daily performance (IDP) among Brazilian adults.

METHODS

A cross-sectional study was conducted with 9564 adults (35-44 years). SOH and IDP were evaluated using the Oral Impacts on Daily Performance (OIDP) questionnaire. FD was considered based on four different definitions: I-classification of the World Health Organization (FDWHO = ≥20 teeth); II-well-distributed teeth (WDT = ≥10 teeth in each arch); III-classified by esthetics and occlusion (FDClass5 = sequential presence of one tooth in each arch, ≥10 teeth in each arch, 12 anterior teeth, ≥three posterior occluding pairs [POPs] of premolars and ≥one POP molar bilaterally); and IV-classified by esthetics, occlusion and periodontal status (FDClass6 = FDClass5 plus all sextants with CPI ≤ 3 and/or CAL ≤ 1). The proportion of adults satisfied with oral health and without overall impact (OIDP = 0) was calculated for each definition of FD. Multiple Poisson regression models were adjusted by demographic-socioeconomic characteristics, self-reported oral problems and the use of dental services for each dependent variable.

RESULTS

When FDClass5 and FDClass6 were considered a greater proportion of adults reported being satisfied (52.1 and 53.1%, respectively) and have OIDP = 0 (52.4 and 53.3, respectively). In the multiple models, SOH was associated with FDClass5 (RP = 1.21) and FDClass6 (RP = 1.24) and OIDP = 0 was associated with WDT (RP = 1.14) and FDClass6 (RP = 1.21).

CONCLUSIONS

The greater influence of WDT, FDClass5 and FDClass6 on aspects related to quality of life in comparison to FDWHO demonstrates the need for the establishment of a broader definition of FD that encompasses subjective aspects.

Subjective Differences between Dentists and Patients about Relative Quality of Metal Ceramic Restorations placed in the Esthetic Zone

INTRODUCTION

Esthetic perceptions could differ between the dentist and his patients among various regions and cultures.

AIM

The aims of this study were to evaluate the subjective differences between the dentist and the patient in terms of esthetics of metal-ceramic crowns (MCcs). The study also aims to compare the mesiodistal (MD) and buccolingual (BL) dimensions of the cemented crown with its respective natural antimeric tooth.

MATERIALS AND METHODS

A total of 85 patients seeking treatment for a single crown (MC) were treated by the undergraduate students under supervision of respective academic staff. After cementation of the crowns, a 9-point questionnaire was given to patient and different dentists. A treatment cast for every single crown was poured. Then, the MD and BL dimensions of the crowns were compared against their respective antimeric tooth.

RESULTS

The dentists and the patients agreed in the range of 50.5 to 90.5%. Least subjective differences were found for the length and width of the cemented crowns. The highest differences were noted for symmetry between the cemented crown and its antimeric natural tooth. A total of 31 to 38% of the patients differed from the dentist's evaluation for shade of the crown, color of the crown at the margin, contour of the crown, and the relationship of the crowns with the surrounding gingiva. The highest MD and BL dimensions were in the cemented crown of canines, while the lowest MD and BL diameters were for the cemented crowns of the lateral incisor crowns.

CONCLUSION

Dentist and patient mostly agreed in terms of length (90%), width (81%) and relation of crown with free gingiva (74%). However, they differed mostly on the symmetry of the cemented crowns. The highest MD dimensions and BL diameter were in the cemented MCcs of canine, while the lowest were with lateral incisors.

CLINICAL SIGNIFICANCE

While fabricating a dental prosthesis, the dentist must know about patients' perception of esthetics; otherwise both clinical and laboratory efforts would not be enough to satisfy the esthetic needs of the patient even if the restoration is technically correct. Perceptions related to symmetry differ mostly between dentist and patient.

Association of overjet and overbite with esthetic impairments of oral health-related quality of life

OBJECTIVE

Esthetics is an important part of quality of life and a frequent reason for orthodontic treatment demand. It was the aim of this study to investigate whether esthetic impairments, related to overjet and overbite, can be assessed with an established oral health-related quality of life instrument.

MATERIALS AND METHODS

Data from 1968 participants (age: 16-90 years; 69.8% female) from three German surveys were analyzed. Esthetic impairments of oral health-related quality of life were measured with four questions of the Oral Health Impact profile (OHIP), which comprise esthetic aspects of oral health-related quality of life. Higher values represent greater esthetic impairment (sum score: 0-16). Overbite and overjet values were categorized (≤ - 1 mm, 0-1 mm, 2-3 mm, 4-5 mm, ≥ 6 mm). The specific impact of each category on esthetic impairment, in relation to the reference category (2-3 mm), was calculated in linear regression analyses. The type of relationship and the specific impact of overbite and overjet were evaluated in regression analyses with fractional polynomials.

RESULTS

Overbite ranged from - 5 to 15 mm (mean: 3.2 mm) and overjet from - 7 to 19 mm (mean: 3.1 mm). Both an increase and a decrease in overjet, in relation to the reference category, resulted in more esthetic-related oral health-related quality of life impairments. However, in this model, only the effect for increased overjet was statistically significant (4-5 mm: + 0.4 OHIP points; ≥ 6 mm: + 0.9 OHIP points). In the regression analysis with fractional polynomials, both an increase and a decrease in overjet resulted in more esthetic impairments, characterized by a U-shaped relationship. No association could be verified for overbite.

CONCLUSION

A substantial increase or decrease of overjet from the reference values is associated with esthetic impairments of oral health-related quality of life, whereas the extent of overbite seems to have no impact on esthetics.

Self-perception and satisfaction with dental appearance and aesthetics with respect to patients’ age, gender, and level of education

INTRODUCTION

Patient’s subjective evaluation of dental appearance and aesthetics is becoming an increasingly important factor in aesthetic treatments and prosthetic therapy.

OBJECTIVE

The aim of this study was to investigate the influence of age, education level, gender, and different dental status and the appearance of the upper anterior teeth (color, size, shape, position and alignment of the anterior teeth) on the satisfaction of the respondents with dental appearance and aesthetics of their upper anterior teeth and their desire for improvement.

METHODS

The study encompassed 480 people aged 20 to 50 years with an average age of 30.84 years. There were 236 male and 244 female subjects. The respondents were interviewed using a questionnaire specially designed for the purpose of this research. For the study, the subjects were divided into the following three age groups: the younger age group (20–30 years of age), the middle age group (31–40 years of age), and the older age group (41–50 years of age).

RESULTS

The conducted study did not reveal statistical significance with respect to gender in any of the examined parameters (p > 0.05). A little more than one half of the respondents in each age group were satisfied with their dental appearance and aesthetics (60.3% of the respondents in the age group of 20–30 years, 55.7% in the age group of 31–40, and 53.7% in the age group of 41–50 years of age). Satisfaction with dental appearance and aesthetics increases linearly with the increase in the level of education and was the highest among the respondents with university degree (33.3%).

CONCLUSION

Female respondents were more dissatisfied with their dental appearance and aesthetics as compared with male respondents, but the difference was found to be non-significant. Patients with higher education level were more satisfied with their dental appearance and aesthetics than those with lower education.

Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: A systematic review

BACKGROUND

The authors conducted a systematic review to assess changes in patients' facial profiles resulting from orthodontic treatment with and without extraction of 4 premolars and to identify cephalometric parameters that can assist decision making in borderline cases.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic review of randomized clinical trials and observational studies comparing the 2 types of treatment (with and without premolar extraction) in terms of the changes in facial profile. The authors conducted an electronic search of the databases the Cochrane Library, PubMed MEDLINE, Embase, and Latin-American and Caribbean Health Sciences Literature.

RESULTS

The authors identified 1 clinical trial with 26 participants and 5 observational cohort studies, collectively involving 362 participants. The authors assessed cephalometric parameters and esthetic outcomes. Four studies used linear regression analysis to investigate esthetic interaction between treatment strategy and initial lower lip protrusion. The 4 studies determined that if the initial lip protrusion was beyond a determined point, esthetic preferences favored extraction, and if the initial lip protrusion was not to that point, esthetic preferences favored conservative treatment.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results of the authors' systematic review found no significant differences between the groups in terms of the esthetic outcomes. The cephalometric parameter of initial lip protrusion can help with decision making in borderline cases.

Dental aesthetics perception and eating behavior in adolescence

BACKGROUND

This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment.

METHODS

Sixty-one adolescents, aged between 12 and 22 years (mean=15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire.

RESULTS

Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student's t-test and using Pearson's correlation analysis.

CONCLUSION

Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

Psychosocial impact of anterior dental esthetics on periodontal health, dental caries, and oral hygiene practices in young adults

This study sought to determine whether the self-perceived image of a young adult's anterior dental esthetics is linked with periodontal health, dental caries, and oral hygiene practices. Two hundred subjects were assessed via a clinical examination, including intraoral photographs. The subjects were questioned about their demographics and oral hygiene practices and given the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) to measure their self-perceived variables related to dental esthetics. A high PIDAQ score indicates a negative image of one's own dental esthetics, while a low PIDAQ score indicates a positive outlook. A self-perceived negative psychosocial impact of anterior dental esthetics was detected in subjects with higher levels of dental caries and visible gingival inflammation in the anterior region of the mouth.

Altered Esthetics in Primary Central Incisors: The Child's Perception

PURPOSE

This study's purpose was to determine preschool-age children's social perceptions and self-perceptions regarding altered dental esthetics.

METHODS

A cross-sectional study was carried out involving 431 four- to five-year-olds. The participants were shown four photographs of children with incisors exhibiting discoloration, crown fracture, missing tooth, or normal teeth. The children were asked four questions for analysis of social perceptions and two additional questions for analysis of self-perceptions. Binary logistic regression was used for the statistical analysis.

RESULTS

Children had negative social perceptions, as a significant association was found between their negative feelings and the altered dental esthetics in children pictured in the photographs. The affected anterior incisor was indicated as the main reason for this feeling (odds ratio equals 4.68, 95 percent confidence interval [CI] equals 2.39 to 9.15). When analyzing self-perceptions, a significant association was found between negative feelings and the child's own altered dental esthetics. Children with altered esthetics felt 1.92-fold sadder than those without altered esthetics (95 percent CI equals 1.22 to 3.02). Again, the affected teeth were indicated as the main reason for this feeling (prevalence ratio equals 1.22) in comparison to reasons cited.

CONCLUSIONS

Four- to five-year-olds have negative social perceptions and self-perceptions regarding altered dental esthetics.

Prevalence of artificially created maxillary midline diastema and its complications in a selected nigerian population

BACKGROUND

Maxillary midline diastema (MMD) is generally regarded as a symbol of beauty in Nigeria. The desperation to look beautiful has caused many individuals to seek the creation of artificial midline diastema and that comes often with undesirable side effects.

AIM

To determine the prevalence of artificially created maxillary midline diastema (MMD) and its complications in a selected Nigerian population.

METHOD

A cross-sectional study using a semi-structured questionnaire as the instrument for data collection was done among patients attending a private clinic in Owerri the capital of Imo state in Nigeria over a period of 18 months. The data were retrieved from the questionnaires and analyzed using the SPSS version 20.

RESULTS

There were 141 respondents comprising 58(41.1%) males and 83(58.9%) females, giving a male to female ratio of 1:1.4. The prevalence of artificially created MMD was 34.0% with increased frequency in: the 21-30 years age group; among the females and in respondents with tertiary level of education. Majority of the respondents (69.5%) desire MMD and 20.8% of those without it wanted it created through cosmetic dentistry. Twenty of the 48 respondents with artificial MMD had it done to enhance personal beauty and aesthetics. The commonest complication was tooth sensitivity (44.8%), followed by toothache (41.4%).

CONCLUSION

The prevalence of artificially created MMD was 34.0% in this study; and it is commoner in females and younger age group .The commonest complication was tooth sensitivity. Enhancement of personal beauty and aesthetic was the major reason for having it done.

[Psychological aspects of orthognathic surgery]

Corrective jaw surgery, for patients with malocclusion and dysgnathia, is primarily performed to rehabilitate oral functions. However, the patients' motivation for orthognathic surgery often seems to be influenced as well by the desire for aesthetic correction of a facial anomaly. Preoperative screening for psychiatric problems such as body dysmorphic disorder is requisite. The majority of orthognathic patients experience a negative influence of their appearance on their psychosocial well-being. In addition, the hope for aesthetic improvement is not seldom an important incentive for visiting an oral and maxillofacial surgeon. In the literature, in addition to a positive effect of corrective jaw surgery on the patient's perceived appearance, an associated improvement in quality of life is described. Correction of a disharmonious face is at least as important to patients as oral function recovery.

Aesthetic perceptions regarding fluorosis by children from an area of endemic fluorosis in India

OBJECTIVES

To assess the perceptions of and concerns regarding dental fluorosis among 12-15 year-old schoolchildren in an area where fluorosis is endemic and to find any association with Tooth Surface Index of Fluorosis (TSIF) scores.

BASIC RESEARCH DESIGN

A cross sectional study.

PARTICIPANTS

316 children aged 12-15 years with varying level of dental fluorosis selected from 696 children screened for fluorosis.

METHODS

The study was undertaken in three villages in rural Gadag, Karnataka, India, with fluoride levels in the drinking water ranging from 2.2 to 4.5 ppm as estimated by the SPADNS spectrophotometric method. Children's fluorosis was assessed under natural lighting conditions on the labial surface of upper anterior teeth using the TSIF 8-point scale. A self-administered questionnaire assessed knowledge, perceptions and concerns. Data were analysed by frequency distributions and Spearman's correlation coefficients.

MAIN OUTCOME MEASURES

Aesthetic perceptions and TSIF scores.

RESULTS

The children were aware of the fluoride presence and its health effects. TSIF scores correlated with: the appearance of front teeth (r = 0.135, p = 0.015); feeling fluorosis would hinder smiling (r = 0.116, p = 0.040); feeling distress due to fluorosis (r = 0.111, p = 0.048).

CONCLUSION

Children were aware of fluoride and its health effects. They also perceived dental fluorosis as an aesthetic problem.

Effect of orthodontic treatment on oral health-related quality of life

OBJECTIVE

To assess changes in oral health-related quality of life (OHQoL) in children undergoing fixed orthodontic treatment and compare it to that of two groups not receiving treatment.

MATERIALS AND METHODS

Two hundred eighty-four subjects aged 12-15 years were followed for 2 years; 87 were undergoing treatment at a university clinic (TG), 101 were waiting for treatment at this clinic (WG), and 96 were attending a public school and had never sought treatment (SG). OHQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T1), 1 year later (T2), and 2 years later (T3). OHIP-14 scores were analyzed using negative binomial regression in generalized estimating equations for correlated data.

RESULTS

During the follow-up period, the WG and TG OHIP-14 scores showed a statistically significant increase and decrease, respectively (P < .001). At T1, the TG had an OHIP-14 score that was 1.9 times higher than that of the SG; however at T3, the TG score was 60% lower than the initial score of the SG. Adjusting for age, gender, dental health status (DMFT), socioeconomic position, malocclusion severity, and self-perceived esthetics did not change the effect of orthodontic treatment on OHQoL.

CONCLUSION

Fixed orthodontic treatment in Brazilian children resulted in significantly improved OHQoL after 2 years.

Patients with oral tumors. Part 2: Quality of life after treatment with resection prostheses. Resection prosthetics: evaluation of quality of life

In the present study, the oral health-related quality of life of 18 patients (13 men and 5 women) was evaluated using validated questionnaires as proposed by the European Organization of Research and Treatment of Cancer (EORTC). The patients belonged to a cohort of 48 patients, whose prosthetic treatment was performed during the years 2004-2007. In the course of tumor resection, 12 patients underwent graft surgery and 14 patients radiotherapy. One patient required a nasal epithesis since resection of the nose became necessary. Five patients underwent a full block resection of the mandible, and tumor resection in 3 patients resulted in a large oronasal communication. Prosthetic rehabilitation was performed in all patients, and the follow-up period with regular care covered a minimum of 3 years. Eleven patients received dental implants for better support and retention of the prostheses. In spite of compromised oral conditions, functional restrictions, and some difficulties with the prostheses, the answers to the questionnaire were quite positive. The majority judged their general health as good or even excellent. The subjective perception of the patients may contradict the objective view by the dentist. In fact, the individual patient's history and experience provide a better understanding of the impact of oral tumors on daily life. The overall assessment identified 4 items that were perceived as major problems by all patients: swallowing solid food, dry mouth, limited mouth opening, and appearance. Prosthetic rehabilitation has only a limited influence on such problems.

[Light reflection zone on the incisors' surface--a new parameter for smile esthetics evaluation]

The light reflection zone (LRZ) is a bright white dot or area that appears on the surface of the maxillary central incisors and/or the gingiva of the front teeth, visible in intra-oral and smile extra-oral photographs. Previously, a positive correlation between the location of the LRZ as observed in intra-oral frontal photographs and the inclination of the upper central incisors as measured on lateral headfims was found. The purpose of this study was to find whether this LRZ location can serve as a new parameter influencing the level of smile esthetics. Twelve pairs of facial photographs, including 10 of ordinary smiling persons and 2 of smiling models, were presented to 138 participants. The only difference between each pair was the location of the LRZ that was moved, compared to the original photograph, gingivally or incisally respectively, using Photoshop (Adobe). Each participant was asked to mark whether he/she noticed a difference between the 2 pictures, and if so, to score the nicer smile. Data analysis was carried out using Chi square test and Fisher's exact test (SPSS v17). The results showed that most of the participants did not recognize the differences between the pairs however, when differences were recognized, most of the participants pointed on the smile where the LRZ was located gingivally as the nicer one. This result was with statistical significance for the 2 models (p < 0.05), In conclusion, the LRZ is a new, yet unrecognized, parameter that can serve as a tool for the diagnosis of esthetic smile. The general population defines a nicer smile when the LRZ is located in the gingival area of the upper central incisors' surface rather than the incisal third. The LRZ should probably be studied not only in Orthodontics but also in other branches of dentistry.

Psychometric properties of the Croatian version of the Orofacial Esthetic Scale and suggestions for modification

PURPOSE

The aims of this study were to develop a Croatian version of the Orofacial Esthetic Scale (OES) and to test its psychometric properties.

MATERIALS AND METHODS

The English version of the OES was translated into Croatian (forward-backward method). The original 11-point scale as well as a 5-point scale (1 = unsatisfactory, 5 = excellent) were used. Convergent validity was tested on 126 subjects, and discriminative validity was tested on the same subjects divided into four groups: esthetically normal patients (n = 25), esthetically impaired patients (n = 42), esthetically normal controls (n = 37), and esthetically impaired controls (n = 22). Test-retest reliability was tested on 43 subjects. Responsiveness was tested on 32 esthetically impaired patients who received prosthodontic treatment.

RESULTS

An additional explanation was added to the first two items of the OES. Convergent validity was confirmed by the association between OES scores and self-reported oral esthetics and three questions from the Oral Health Impact Profile related to esthetics (correlation coefficients ranged from 0.734 to 0.811, P < .001). Discriminative validity showed the results as predicted. Test-retest reliability showed high intraclass correlation (0.79 to 0.95) and no significant differences between the two administrations of the 5-point OES scale (P > .05). The 11-point OES scale showed significant differences for questions 3 and 8 (P < .01). Internal consistency showed high Cronbach alpha values (0.802 to 0.962). Responsiveness was confirmed by a significant difference between baseline and follow-up (P < .001) and a high effect size.

CONCLUSION

Psychometric properties of the Croatian version of the OES render the instrument suitable for the assessment of esthetics in Croatia. The authors recommend changing the first two items by adding the explanation that the questions are related to the lower third of the face and using the 5-point scale for rating.

[Cosmetic dental treatment. Its impact on happiness and quality of life]

This study assessed the impact on happiness and quality of life of the cosmetic treatment of frontal teeth. This was compared with the impact of a restorative, not primarily cosmetic, treatment in the (pre)molar region on happiness and quality of life. The hypothesis that a cosmetic dental treatment makes a person happier or improves the quality of one's life was not supported by the results of the present study. In fact, oral health-related quality of life appeared to decline after the dental cosmetic treatment. Further research is needed to assess whether the results of the present study can be replicated in a larger sample and how the findings can be explained.

[Quality of life and oral health in children]

In recent years, research on the influence of oral health on quality of life among children has become increasingly popular Half of the children and adolescents will have had moments of diminished oral health and that can lead to functional problems, pain and decreased quality of life. While measuring oral health-related quality of life of children, reports of parents are frequently used as a proxy. Diminished oral health not only has an impact on the child's quality of life, but also on that of his family members. Results from studies on oral health-related quality of life in children may be used as the basis for useful guidance for parents and children on improving oral health and quality of life.

Dental aesthetic self-perception and desire for orthodontic treatment among school children in Benin City, Nigeria

BACKGROUND

The availability of information on the individual perception of own's dental appearance and desire to uptake orthodontic treatment is of importance in the planning of orthodontic care within a population.

OBJECTIVE

The subjective assessment of personal dental appearance and desire for orthodontic treatment was appraised among Nigerian children.

METHODS

The study was conducted among 91 school children (33 boys, 58 girls) aged 12 years old in Benin City, south-southern region of Nigeria. The satisfaction of the subjects with the arrangement of their anterior teeth and desire to straighten their teeth was determined using a questionnaire. The subjects were further asked to rank their dental attractiveness in relation to the photographs in the Aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). The need for orthodontic treatment among the subjects was also assessed by the examiner with the Aesthetic component of IOTN. Chi-square tests were used for data analysis.

RESULTS

The result revealed that more than three-quarters (76.9%) of the subjects were satisfied with their dental aesthetics while 23.1% desired to have orthodontic treatment. The boys expressed significantly higher level of dissatisfaction with their dental aesthetics and a greater desire to have orthodontic treatment (P < 0.05). Most subjects (92.3%) rated their dental attractiveness in the "little to no need" orthodontic treatment grade on the AC scale. The normative borderline treatment need was higher than subjective borderline need but there was consistency in distribution of 4.4% in definite need treatment grade by the subjects and examiner.

CONCLUSION

The majority of the children rated their teeth as aesthetically satisfactory but there were gender differences in perception of dental aesthetics and desire for orthodontic treatment among this sample of Nigerian children.

Fears and concerns of individuals contemplating esthetic restorative dentistry

Questionnaires that focus on the fear of dental treatment typically include a narrow list of previous treatment-related factors. By omitting items concerned with psychologic, emotional, and interpersonal traits that impact treatment, practitioners often fail to gain additional valuable information on related anxiety issues. This study was undertaken to identify previously unrecognized or poorly discussed sources of fear and anxiety in patients seeking esthetic dental treatment. The Esthetic Clinic at Tufts University School of Dental Medicine recruited 62 participants who were asked to score their level of anxieties and concerns based on 24 different items on a 0 to 5 Likert scale. In addition, age, gender, and type of procedure in consideration were the only other variables recorded. The item that elicited the highest level of anxiety was "not feeling happy with my new smile." Thirty-eight respondents (61.3%) said they feel "markedly anxious"or "severely anxious" or answered "avoid completely." Concerns "that the outcome might look false and unnatural" or "that the dentist might not redo it if I am not satisfied with the outcome" both received 37 out of 62 (59.7%) similar responses. These results suggest obstacles to treatment exist not only in areas typically investigated but also in factors rarely discussed during the patient-practitioner encounter. The practitioner needs to consider a broader range of issues when addressing the patient's concerns.

Patients' self-perception of tooth shade in relation to professionally objective evaluation

OBJECTIVE

Self-assessment of teeth shade was compared with professional assessment.

METHOD AND MATERIALS

Patients' anterior teeth shade evaluation was conducted first by the patient (n = 193) and then by the clinician using the Vita shade guide.

RESULTS

In 18.7% of participants, self-assessment of teeth shade matched in hue and chroma to the clinician's evaluation. A positive correlation was found between participants' self-assessment of their shade and the clinician's assessment (P = .014; Pearson product moment correlation). Participants assessed their shade darker than the clinician (P < .001; chi-square test). Only 3.6% were highly satisfied with the shade of their teeth, and 83.4% were interested in a future bleaching procedure. Tooth shade was more accurately assessed by women (P = .02) and nonsmokers (P = .03; chi-square test).

CONCLUSION

A patient's preference toward a lighter shade should be addressed during treatment planning to match the patient's expectations for esthetics and increase patient satisfaction of treatment outcome. Patients may prefer white and shiny rather than a natural appearance.

Reliability and validity of the Orofacial Esthetic Scale in prosthodontic patients

PURPOSE

This study evaluated the reliability and validity of the Orofacial Esthetic Scale (OES)-an instrument assessing self-reported orofacial esthetics in prosthodontic patients.

MATERIALS AND METHODS

The OES has seven items addressing direct esthetic impacts in the orofacial region, as well as an eighth global assessment item. The response format was a 0 to 10 numeric rating scale (very dissatisfied to very satisfied with appearance, respectively). OES summary scores ranged from 0 (worst score) to 70 (best score). Test-retest reliability (n = 27) and internal consistency (n = 119) were assessed. Content validation (asking patients about their satisfaction with the questionnaire content, n = 119) and discriminative validation (comparing OES scores between patients and healthy controls, n = 119) were performed. Convergent validity was assessed by correlating patients' own OES scores (n = 29) with ratings from a consensus expert group (n = 4) and with the Oral Health Impact Profile (OHIP) esthetic-item summary score (n = 119).

RESULTS

Test-retest reliability was excellent for the OES scores (intraclass correlation coefficient = .96). Internal consistency was satisfactory for esthetically impaired patients (n = 27, Cronbach alpha = .86). Patients rated their satisfaction with the questionnaire content as 7.8 +/- 1.3 units on a 0 to 10 numeric rating scale (0 = very dissatisfied, 10 = very satisfied). OES scores discriminated esthetically impaired patients (31.4 units) from healthy controls (45.9 units, P < .001). OES scores correlated well with other measures of the same construct (r = .43 for patients' own assessment with an assessment by experts using the OES, r = -.72 for a correlation with the OHIP's three esthetic-related items).

CONCLUSIONS

The OES, developed especially for prosthodontic patients, exhibited good score reliability and validity.

Development of an Orofacial Esthetic Scale in prosthodontic patients

PURPOSE

Despite the interest and need to assess orofacial esthetics in prosthodontic patients, few self-reporting instruments are available to measure this construct, and none describe how prosthodontic patients perceive the appearance of their face, mouth, teeth, and dentures. The development of the Orofacial Esthetic Scale (OES) is reported in this article, in particular its conceptual framework, how questionnaire items were generated, and the scale's measurement model.

MATERIALS AND METHODS

After test conceptualization, the authors solicited esthetic concerns from 17 prosthodontic patients by asking them to evaluate their own photographs. A focus group of 8 dental professionals reduced the initial number of concerns/items and decided on an item response format. Pilot testing in 9 subjects generated the final instrument, the OES. Exploratory factor analysis was performed to investigate OES dimensionality and item analysis to investigate item difficulty and discrimination in 119 subjects.

RESULTS

Prosthodontic patients generated an initial 28 esthetic concerns. These items were reduced to 8 preliminary representative items that were subsequently confirmed during pilot testing. Analysis supported 8 items assessing appearance: face, profile, mouth, tooth alignment, tooth shape, tooth color, gums, and overall impression, measured on an 11-point numeric rating scale (0 = very dissatisfied, 10 = very satisfied). Exploratory factor analysis found only 1 factor and high positive loadings for all items (.73 to .94) on the first factor, supporting the unidimensionality of the OES.

CONCLUSIONS

The OES, developed especially for prosthodontic patients, is a brief questionnaire that assesses orofacial esthetic impacts.

Adaptation of the Oral Aesthetic Subjective Impact Score (OASIS) questionnaire for perception of oral aesthetics in Brazil

PURPOSE

The aim of the present study was to assess the cross-cultural adaptation and reliability and validity of the Oral Aesthetic Subjective Impact Score (OASIS) for the perception of oral aesthetics in Brazilian adolescents.

MATERIALS AND METHODS

The cross-cultural adaptation was developed in agreement with internationally recommended methodology. The psychometric properties were assessed by application of the Brazilian version of the OASIS in 304 adolescents aged 13 to 19 years who were enrolled at two public schools and one private school in Tubarão, Brazil. The internal consistency of the instrument was measured using Cronbach's alpha. The reliability was estimated through stability and homogeneity, using the Intraclass Correlation Coefficient and the Bland-Altman agreement. Validity was determined by comparing the OASIS-Brazil with the aesthetic component of the instrument Oral Impact on Daily Performance (OIDP) using the Spearman Rank Correlation Coefficient.

RESULTS

The internal consistency obtained was 0.52. Inter-observer and intra-observer correlations were strong, 0.87 and 0.83, respectively. The correlation with the aesthetic part of OIDP was 0.44.

CONCLUSIONS

The results showed that the process of cross-cultural adaptation was successful and the adapted instrument showed good psychometric properties.

Self-perception regarding the need for orthodontic treatment among impoverished schoolchildren in Brazil

AIM

The objectives of the present study were to assess predictive factors associated to self-perception regarding the need for orthodontic treatment among 170 impoverished schoolchildren.

MATERIALS AND METHODS

A cross- sectional study was conducted in public schools in the city of Belo Horizonte-MG (Brazil). Children's self-perception regarding the need for treatment was assessed using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a questionnaire addressing biopsychosocial factors. The chi-square test and multiple logistic regression were used in the data analysis.

RESULTS

The predictive factors for the self-perception of orthodontic treatment need on the part of the impoverished schoolchildren included ridicule from persons close to the children regarding the appearance of the teeth (OR 2.81; 95%CI 1.2 to 6.4), dissatisfaction with oral aesthetics due to the alignment of the teeth (OR 2.45; 95%CI 1.1 to 5.4) and missing teeth (OR 3.02; 95%CI 1.0 to 9.23).

CONCLUSION

The alignment of the teeth, missing teeth and ridicule from others regarding the appearance of the teeth are the factors that most strongly influence self- perception regarding the need for orthodontic treatment among impoverished schoolchildren.

Perception of dental aesthetics in paediatric dentistry

AIM

Assessing the perception of the aesthetic components of the oral health by paediatric patients at different stages of the child psychological development of Piaget.

MATERIALS AND METHODS

Twenty children aged between 21 months and 11 years, of both sexes, patients of a private clinic, were selected. The present study group consisted of patients treated for oral pathologies. A set of similar supplies was given to all children and they were asked to do a drawing, whose theme was "beautiful teeth and ugly teeth". The drawings were evaluated according to the classification of the cognitive development of Piaget.

RESULTS

Children of all ages clearly represent their perception of what "beautiful teeth" and "ugly teeth" are. These representations provide the dental professional a clear vision of the child's feeling about dental aesthetics.

CONCLUSION

The drawings are a useful source of information for assessing the aesthetic perception of paediatric patients. The knowledge of the children's aesthetic perception is relevant to paediatric dentists because children are conscious about their dental aesthetic appearance and that of the other children.

Oral health-related quality of life and dental esthetics in Amsterdam schoolchildren

PURPOSE

The purpose of this study was to examine the oral health-related quality of life (OHRQoL) of schoolchildren in Amsterdam, The Netherlands, and to assess the relationship between OHRQoL and self-reported dental esthetics.

METHODS

The Child Oral Health Impact Profile (COHIP) was completed by 510 seventh and eighth graders of public primary schools. Subjects also assessed their own dentition with the Esthetic Component of the Index of Orthodontic Treatment Need (AC-IOTN). Gender differences on COHIP subscales and the AC-IOTN were examined using Mann-Whitney U tests. Correlations between the COHIP subscales and the AC-IOTN were assessed with Spearman's rank correlation coefficient.

RESULTS

Boys scored significantly lower on the subscales "oral symptoms" and "emotional well-being" than girls. Correlations between OHRQoL and the AC-IOTN were low but significant for boys for the domains "oral symptoms" (0.137) and "emotional well-being" (0.186) and for girls for the domains "functional well-being" (0.148), "emotional well-being" (0.195), and "peer interaction" (0.215).

CONCLUSIONS

Dutch schoolchildren in Amsterdam generally reported good oral health-related quality of life. Boys seemed to experience a slightly lower impact of oral symptoms and better emotional well-being than girls. Children's self-perceived dental esthetics did not seem to constitute a relevant variable to explain their level of OHRQoL.

Agreement of quantitative subjective evaluation of esthetic changes in implant dentistry by patients and practitioners

PURPOSE

To evaluate the agreement of quantitative subjective evaluation of esthetic changes in implant dentistry and differences in perception among patients and practitioners.

MATERIALS AND METHODS

Four standardized clinical preoperative and postoperative pictures placed in random order were shown to 30 patients treated with dental implants, on two separate occasions, to subjectively evaluate the esthetic changes using both a graded scale and a visual analogue scale (VAS). The photographs included the front views of the overall smile and, when available, magnified pictures of the area treated including the two neighboring teeth. The same photographs were shown to 10 independent clinicians, who used the same scoring system. Agreement was assessed by evaluating intraobserver and interobserver agreement with a weighted Kappa statistic.

RESULTS

In general, agreement was moderate to substantial among patients but only fair among clinicians, with only one practitioner being consistently reproducible. Patients had better agreement than clinicians, but they only evaluated themselves, whereas the clinicians each had to evaluate 30 patients. The agreement of all patients together compared to each individual clinician was poor. The overall agreement between clinicians was also poor.

CONCLUSIONS

This study of evaluations of pretreatment and posttreatment photographs by 30 patients and clinicians showed that: (1) patient responses were more in agreement, but patients evaluated only their own results; (2) practitioner responses were less in agreement than patient response, but clinicians evaluated all 30 patients; and (3) agreement between patients and clinicians was poor.

The factors effecting satisfaction of dental appearance and self-perceived need for orthodontic treatment in 10-11 and 14-15 year-old Lithuanian schoolchildren

Assessment of need for orthodontic treatment is complex and the opinion about it might differ between the orthodontist and children. Personal perception of the need for orthodontic treatment may be influenced by a variety of social, economical and cultural factors. The aim of this study was to investigate whether there is an association between normative and self-perceived orthodontic treatment need, and to evaluate the influence of age, gender and socioeconomic background on satisfaction of dental appearance and demand for orthodontic treatment. The study included 2024 schoolchildren: 1193 (657 girls and 536 boys) 10-11 year-old and 831 (450 girls, 381 boys) 14-15 year-old. The objective need for orthodontic treatment was found to be 42.6 percent while self-perceived need 35.3 percent among Lithuanian schoolchildren. Girls thought that they needed treatment more frequently than boys independent of age and living area.

[Does Jesus have metal-free teeth in a country of the toothless?: dentistry of vanities and desires]

This paper describes how dentistry in Brazil currently participates in the transformations of the object of its activity into commodities with which consumers can indulge their aesthetic desires. It explores the construction of the dental object of desires and its relationship with the dentist and the patient-consumer in the contemporary world. The paper makes explicit the role of the mega-dental congresses, which provide a biotechnological self-service that allure and seduce, creating uniform consumer values eager for the new offerings from dental surgeons. Also analyzes the role of the media in dental practices. It concludes that the individuation of the dental surgeon has generated a petrified ontology and fragmented epistemology. The paper presents some pressing tasks for the academic and professional sectors and society as a whole, such as the development of strategies and discussion about communication related to oral health.

[The dentist between medicine and cosmetology. Ethical shortcomings of the esthetics boom in dentistry]

Dentistry has evolved from a genuine medical practice to a mere business. From an ethical point of view it is asked whether this evolution creates more problems than it solves. The paper elaborates four arguments against this evolution and shows that aesthetics in dentistry which works only according to market categories runs the risk of loosing the view for the real need of patients. Dentistry which comprehends itself as part of a market will be nothing else than a part of a beauty industry which has the only aim to sell something, but not the aim to help people. Such a dentistry makes profit from the ideology of a society which serves only vanity, youthfulness and personal success and which is losing the sight for real values. The real value of man cannot be reduced to his appearance and medicine as an art should feel the obligation to resist these modern ideologies and should help people to get a more authentic attitude to themselves. If modern dentistry fails to think about these implications it will lose its identity as medicine, which would be too great a loss.

Correlations between the changes in patients' dental-facial morphology at the end of the orthodontic treatment and the psychological variables

The purpose of this research was to assess the impact that the improvement of patients' dental-facial morphology has at the end of the orthodontic treatment upon the following psychological variables: self-esteem, current self-related thoughts as well as upon the variables of social self-esteem and performance. The number of patients included in the study was of 168 (82 children and 86 adolescents) who carried out the orthodontic treatment. At the end of the active treatment, we applied to all patients the assessment instruments for the level of self- esteem and self-related current thoughts: the Rosenberg's Self-Esteem Scale and the Heatherton & Polivy Current Thoughts Scale. As far as the patients in the study are concerned, the improvement of their facial aspect at the end of the treatment showed a significantly positive correlation with the variables of global self-esteem, self-related current thoughts, social self-esteem and performance, with the exception of the girls in children study group who showed no correlations between physical aspect and the performance variable.

Multivariate analysis of patient satisfaction factors affecting the usage of removable partial dentures

The purpose of this retrospective cohort study was to investigate patient satisfaction factors that affect the usage of removable partial dentures (RPDs) using a multivariate analysis. Sixty-seven patients, who had RPDs inserted at the Tohoku University Hospital between 1996 and 2001, participated in this study. Data were collected from patients' clinical records and a questionnaire. Of the 15 factors examined, significant associations were found between RPD usage and pain, color of the artificial teeth, and arrangement of the artificial teeth. These findings suggest that RPD usage is related to patient satisfaction with esthetics and an absence of pain.

Are ratings of dentofacial attractiveness influenced by dentofacial midline discrepancies?

AIMS

To assess the attractiveness of dentofacial midline discrepancies during smiling, and to determine if the ratings were influenced by the gender of the judges.

METHODS

Twenty non-dental undergraduate students (10 males, mean age: 33.5 years; 10 females, mean age: 31.2 years) and 20 orthodontists (10 males, mean age: 36.6 years; 10 females, mean age: 34.3 years) assessed frontal photographs of the same smiling adult female with coincident midlines, and images of the same person with the upper dental midline shifted 2 mm and 4 mm to the right and left of the facial midline. The judges scored the attractiveness of the smile using 5-point scale.

RESULTS

Both the students and the orthodontists considered that the images were less attractive as the dentofacial midline discrepancy increased. More orthodontists than undergraduate students, and more female orthodontists than male orthodontists, considered a 4 mm discrepancy between the dental and facial midlines as unattractive.

CONCLUSION

Dental to facial midline discrepancies reduce dentofacial attractiveness. Discrepancies of 2 mm or more are likely to be noticed by both orthodontists and non-dental university students. Orthodontic treatment objectives should include correction of the dental midline discrepancies to within 2 mm of the facial midline.

[Satisfaction about physical appearance and teeth. Results of a nationwide study]

In a study involving a group of 907 randomly selected Dutch individuals, satisfaction about one's physical appearance and satisfaction about the appearance of one's teeth were assessed. Furthermore, the relationship between body esteem and happiness was explored. Three quarters of the respondents were satisfied about their physical appearance, while 70% was satisfied about the appearance of their teeth. Women and people with a non-Dutch background were significantly less likely to be satisfied about their physical appearance than men and those with a Dutch background. Individuals 30 years old and younger were more likely to be satisfied about their teeth than those who were older. Almost two third of the respondents (64%) reported that the appearance of their teeth contributed positively to their happiness. Women and people with a non-Dutch background were most likely to indicate that the appearance of their teeth contributed to their happiness. Satisfaction about general physical appearance and appearance of the teeth were significantly associated with happiness. Prospective studies are needed to examine to what extent esthetically motivated dental treatments make people happy and enhance their general well-being.

Awareness of malocclusion and desire for orthodontic treatment in 11 to 14 year-old Nigerian schoolchildren and their parents

OBJECTIVES

To investigate Nigerian children's and their parents' satisfaction with the children's facial and dental appearances and their desire for orthodontic treatment, and to compare their assessments of treatment need with those determined by an orthodontist.

METHODS

The subjects were 242 11-14 year-old schoolchildren randomly selected from private and public schools in the Ife Central Local Government area, Nigeria. A questionnaire was used to obtain information from the children and their parents of their liking of the facial and dental appearances of the children and the need and desire for orthodontic treatment. The children, the parents and an orthodontist used the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to assess the need for treatment.

RESULTS

More parents liked their child's facial and dental appearances than the children liked themselves. Almost twice as many schoolchildren thought they needed (27 per cent) and desired (29 per cent) orthodontic treatment than their parents (115 per cent). Low, but statistically significant correlations, were found between the children's, their parents' and an orthodontist's assessments of treatment need using the AC scale. Only 8 per cent of the children and 3 per cent of the parents considered that there was a 'moderate-definite' need of treatment. The orthodontist considered 38 per cent of the children had a 'moderate-definite' need of treatment.

CONCLUSIONS

The children's responses suggest greater concern about their facial and dental appearances, a greater perception of the need for orthodontic treatment and greater desire for treatment than their parents. These findings require further investigation as previous studies have reported that parents are usually more motivated for orthodontic treatment than their children.

Bimaxillary protrusion in the Palestinian population

OBJECTIVE

To study the prevalence of bimaxillary protrusion among Palestinians.

MATERIALS AND METHODS

Cephalometric radiographs for 79 normal occlusion adult Palestinian university students were traced.

RESULTS

The interincisal angle was decreased in the Palestinian women compared to the Caucasian means, but this had no impact on lip protrusion.

CONCLUSION

Relative to Caucasian cephalometric norms, Palestinians show no extraoral bimaxillary protrusion features, and therefore, these norms can be applied to Palestinian faces.

Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults

OBJECTIVE

To determine the individual and combined influence of some anterior occlusal characteristics on self-perceived dental appearance in a sample of young adults.

MATERIALS AND METHODS

This cross-sectional study was conducted at a dental clinic of a private university in Lima, Peru. A total of 267 first-year students (16 to 25 years old) were randomly selected. A visual analog scale (VAS) was used to determine the self-perceived dental appearance. Clinical examinations were conducted to determine incisal irregularity, anterior dentoalveolar spacing, midline diastema, anterior missing teeth, overjet, and overbite. Simple and multiple linear regression analyses were performed to determine the individual and combined influence of each anterior occlusal characteristic on self-perceived dental appearance.

RESULTS

From the eight occlusal characteristics and two covariables evaluated, only maxillary and mandible incisal irregularity (P=.001 and .002 respectively), presence of anterosuperior spacing (P<.001), and number of missing anterior teeth (P=.003) were inversely associated with self-perceived dental appearance, whereas gender (male) was directly associated to the dependent variable (P=.021). Specifically, anterior maxillary spacing, maxillary incisal irregularity, mandible incisal irregularity, and the number of missing teeth were, in that order, the anterior occlusal characteristics with the most negative influence on self-perceived dental appearance.

CONCLUSIONS

This study confirmed that occlusal characteristics in the anterior portion of the mouth play a role on dental esthetics. However, it should be emphasized that their grouped influence is minimal (less than 20%).