Effects of Malocclusions and Orthodontics on Periodontal Health: Evidence from a Systematic Review

Microbial Changes in the Periodontal Environment Due to Orthodontic Appliances: A Review

Orthodontic appliances significantly influence the microbiological dynamics within the oral cavity, transforming symbiotic relationships into dysbiotic states that can lead to periodontal diseases. This review synthesizes current findings on how orthodontic treatments, particularly fixed and removable appliances, foster niches for bacterial accumulation and complicate oral hygiene maintenance. Advanced culture-independent methods were employed to identify shifts toward anaerobic and pathogenic bacteria, with fixed appliances showing a more pronounced impact compared to clear aligners. The study underscores the importance of meticulous oral hygiene practices and routine dental monitoring to manage these microbial shifts effectively. By highlighting the relationship between appliance type, surface characteristics, treatment duration, and microbial changes, this review aims to enhance dental professionals' understanding of periodontal risks associated with orthodontic appliances and strategies to mitigate these risks. The findings are intended to guide clinicians in optimizing orthodontic care to prevent plaque-associated diseases, ensuring better periodontal health outcomes for patients undergoing orthodontic treatment.

Awareness and Periodontal Health Practices of Fixed Orthodontic Appliance Patients: A Questionnaire-Based Survey

A well-aligned dentition is more conducive to periodontal health, which is necessary for successful orthodontic therapy. Maintaining good dental hygiene is crucial for effective treatment, and patient cooperation, education, motivation, and attitude are all important components. Orthodontists must routinely check in with their patients to see whether they are maintaining their oral hygiene and if they are using any additional assistance. Negligence on the part of the patient may be the cause of poor treatment outcomes. This study aims to show how patient education can affect treatment outcomes and the development of a functional, aesthetically pleasing, and healthy dentition. Aim This study aims to investigate awareness, attitude, and periodontal health knowledge among orthodontic patients. Objectives The study explores the level of awareness and knowledge regarding periodontal health among orthodontic patients, examining its correlation with factors such as age, attitude, and duration of orthodontic treatment. Additionally, it aims to gauge the extent of education received by orthodontic patients regarding proper oral hygiene practices and the potential repercussions of neglecting them. Methods A questionnaire-based study with a cross-sectional design was performed in Jeddah, Saudi Arabia. A total of 428 participants were randomly selected from several private orthodontic clinics and hospitals. The participants in the study were individuals currently undergoing treatment with fixed orthodontic appliances. Information was gathered using a self-administered questionnaire. Results The patients undergoing orthodontic treatment have a moderate understanding of periodontal disease about dental plaque. The level of awareness of periodontal health was 41%, and the level of knowledge about periodontal health was 51%. When it came to periodontal health, adult orthodontic patients had a positive attitude toward fixed orthodontic treatment (mean score = 0.75). Subjects' attitudes regarding fixed orthodontic treatment were significantly impacted by the patient's consistency with his/her dental checkups (p value = 0.02). Conclusion The patients' periodontal health awareness was moderate, while their periodontal health knowledge was fair. Orthodontic patient's awareness levels, as well as knowledge levels, showed significant differences in age and duration but not sex. Results showed no significant difference among the attitude levels of orthodontic patients and age, sex, and duration.

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.

Optimal Treatment Timing in Orthodontics: A Scoping Review

The appropriate timing for orthodontic intervention has been a subject of debate for a long time, concerning not only the immediate effects but also the long-term benefits of such treatment. This review aimed to find the appropriate treatment timing for the intervention of various orthodontic problems. A literature search was performed in all major databases, including PubMed and Cochrane Library, until February 20, 2023. All observational and experimental studies published in English that compared early versus late orthodontic treatment in different types of orthodontic problems were included. Data selection and charting were undertaken by a single investigator. A total of 32 studies were identified that discussed various aspects of interventions, including Class II and Class III malocclusion, pseudo-Class III malocclusion, anterior and posterior crossbite, extractions, and long-term benefits. Overall, early intervention was not found to be superior in terms of effectiveness, overall duration of appliances, and cost-benefit ratio. Early intervention should be reserved for specific conditions or localized malocclusions that have psycho-social benefits, or to significantly reduce the severity of problems to be dealt with in comprehensive treatment in the permanent dentition.

Profile of Orthodontic Use across Demographics

OBJECTIVES

Population-based studies have focused on patients' rendering of orthodontic treatment due to their malocclusion and medical needs. However, there is a scarcity of data from national sources on the prevalence of orthodontic visits and associated patient characteristics, as well as their effect on dental health. This study evaluated the demographic differences of orthodontic patients and examined the association between orthodontics use and risk of periodontal disease and oral surgical intervention.

METHODS

This study used data collected from the 2019 Medical Expenditure Panel Survey. Descriptive statistics were used to evaluate socio-demographics and covariates by the use of orthodontics. Chi-square tests were used to assess demographic differences among respondents who stated whether or not they used orthodontics. Logistic regression models were then used to examine the association of orthodontics and oral health outcomes.

RESULTS

The sample size was 12,422, of which 491 respondents indicated a usage of orthodontics. There were significant differences among demographic variables (p < 0.05) that included 61.1% females, 60.8% Whites, 67.6% participants under the age of 18 years old, and a family total income of $100,000 or more (52.7%). After controlling for socio-demographics and covariates, individuals who used orthodontics were less likely to have periodontal disease (AOR = 0.623, 95% CI = 0.610 to 0.637) and tooth extractions (AOR = 0.071, 95% CI = 0.070 to 0.073) than those who did not.

CONCLUSIONS

Our findings indicate orthodontics usage was higher in females, younger patients, and Whites, highlighting the possible demographic disparities in orthodontics use. Additionally, those who used orthodontics were less likely to have oral health issues.

The Efficacy of the Three Types of Plaque Control Methods During Fixed Orthodontic Treatment: A Randomized Controlled Trial

BACKGROUND

When intraoral orthodontic devices are used, it becomes significantly more difficult to remove plaque effectively. Dentists and orthodontic specialists can come up with more effective preventive strategies while patients are undergoing fixed orthodontic work if they have a deeper understanding of the present scenario. In addition, individuals will become more aware of the importance of good dental hygiene habits as a result of this.

OBJECTIVE

To assess and compare the effectiveness of a manual toothbrush, machine-driven toothbrush, and conventional mechanical toothbrush coupled with mouth rinse in removing plaque and maintaining gingival health in patients undergoing fixed orthodontic treatment.

METHODS AND MATERIALS

In this research, a total of 222 individuals who met the eligibility and exclusion requirements were randomly selected and offered their written consent. There were a total of 74 participants for each of the three different categories. Category A used a physically driven toothbrush. Category B used a motorized toothbrush. Category C used a physically driven toothbrush together with mouthwash containing 0.2% chlorhexidine gluconate. All study participants were assessed at baseline, one-month follow-up, and two-month follow-up to document the preliminary information, including that of the modified papillary bleeding index (MPBI) by Muhlemann, plaque index (PI) introduced by Silness and Loe, and gingival index (GI) introduced by Loe and Silness.

RESULTS

In this study, the mean PI scores at the one-month and two-month follow-ups were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean GI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A at the two-month follow-up. The mean MPBI scores at the two-month follow-up were minimum in Category C, while it was maximum in Category A. It was observed that participants in this trial who only used a typical mechanical brush experienced an increase in PI and GI scores after one and two months of follow-up. At the one-month and two-month follow-ups, it was noted that the values of PI, GI, and MPBI significantly decreased in the study participants using automated toothbrushes as well as in study participants using manual toothbrushes in conjunction with chlorhexidine mouthwash as compared to baseline values. However, when the three categories were compared, it was found that the research participants utilizing both a manual toothbrush and 0.2% chlorhexidine experienced the highest decreases in PI, GI, and MPBI values.

CONCLUSION

The reduction in the scores of PI, GI, and MPBI was maximum in orthodontic patients after two months when they apply manual toothbrushing along with 0.2% chlorhexidine.

Periodontal status of students living with disability in Amhara region, Ethiopia: a cross-sectional study

Background

Periodontal disease is the most common oral health problem among individuals living with disabilities. Any physical impairment and/or mental handicap can compromise the capability to perform oral health care. Individuals with poor oral hygiene practice were prone to dental caries, periodontal disease, and upper respiratory tract infections. Despite the high prevalence of disabled people in Ethiopia, data are scarce about their periodontal status. The aim of this study was to determine the prevalence and determinant factors of periodontal disease among students living with disability in the Amhara region.

Methods

A school-based cross-sectional study was done on eight special needs schools in Amhara regional state from November 30, 2020, to April 10, 2021. A simple random sampling technique using a computer random generator was employed to recruit the study participants. The participants were interviewed for sociodemographic characteristics, oral hygiene practice, type of disability, and medical condition through a pre-tested semi-structured questionnaire. The periodontal status of the participants was evaluated using the community periodontal index (CPI). Data entry was done using the Epi-data and analyzed using SPSS 26. Binary logistic regression analysis was used to identify the predictors of periodontal disease at a 5% level of significance.

Results

A total of 443 study participants were involved with a mean age of 15.84 ± 3.882. Among these, 27.5% (95%CI 23.4–32.0) had a periodontal pocket depth of ≥ 4 mm, and 56.7% had bleeding on probing. The prevalence of periodontal disease was higher in participants with poor oral health status (52.2%), dental caries (34.8%), class-2 malocclusion (46.1%), and low monthly income (30.4%), visually impaired (30%), and mentally disorder (29.9%). Age of above 18 years (AOR = 3.41, 95%CI 1.40, 8.28), low family monthly income (AOR = 2.21; 95%CI 1.22, 4.03), malocclusion (AOR = 1.59, 95%CI 1.01, 2.54), poor oral health status (AOR = 9.41; 95%CI 4.92, 17.98), and dental caries (AOR = 1.85, 95%CI 1.21, 2.82) were independent predictors of periodontal disease.

Conclusions

A substantial amount of disabled school students in the study area had periodontal disease. The study found that there was a statistically significant association between age, family monthly income, malocclusion, oral health status, and dental caries with periodontal disease. The implementation of school oral health programs has a great benefit for the oral health status of disabled school students.

Knowledge on Applications of 3D Design and Printing in Dentistry Among Dental Practitioners in Saudi Arabia: A Questionnaire-Based Survey

Background: This knowledge, attitude, and practices (KAP) survey will provide baseline data and identify gaps that may facilitate understanding and further action to plan, implement, and evaluate practice toward 3D-printing technology among dental practitioners in Saudi Arabia.

AIMS AND OBJECTIVES

The present study aims to assess dental practitioners' self-reported knowledge, attitude, and practice of 3D printing in Saudi Arabia.

METHODOLOGY

A cross-sectional, closed-ended questionnaire of registered dental practitioners in Saudi Arabia was conducted. A sample size of 156 was considered for analysis. After obtaining approval from the Institutional Review Board, Riyadh Elm University, the research was conducted during the month of April 2022 amongst 154 registered dental practitioners. The research was distributed among dental health specialists either working in dental colleges, dental clinics, or both in government as well as private settings. Dentists who were not actively involved in 3D printing were excluded. SPSS software, version 25.0, (IBM Corp., Armonk, NY) was used to analyze the data.

RESULTS AND CONCLUSION

Of all dentists included in the study, 98% were found to be aware that 3D printing in dentistry is used in Saudi Arabia and 2 % were not aware of its usage in Saudi Arabia. In total, 78.60% of the dentists felt that 3D-printed implant guides made the placement of implants the most accurate and least complicated procedure, and 21.40% of the dentists felt it was the least accurate and most complicated procedure.

Knowledge, attitudes and professional practices of ortho-periodontal care of adults: a cross-sectional survey in France

BACKGROUND

Due to increasing numbers of adult patients, orthodontists are being confronted more and more with periodontal problems. Coordination amongst orthodontists, periodontists and general dentists is useful in preventing and stopping periodontal disease. The main objectives of this survey were to evaluate the technical knowledge, techniques and attitudes employed by French orthodontists, periodontists and general dentists in adult dental care.

METHODS

A cross-sectional online survey was distributed to French dentists. The questionnaire, consisting of 30 questions, was divided into six sections covering treatment programs and the forensic environment.

RESULTS

One thousand one hundred twenty-two complete answers were recorded. Adults undergoing orthodontic treatment represented 19.9% of the orthodontists' patients, but only 2.67% of the general dentists' patients. Communication between clinicians was rated as good, greater than 3 out of 5. Before treatment, orthodontists were less alarmed than generalists regarding bleeding, recessions, increased probing depths, halitosis and hyperplasia. During treatment, orthodontists never or only occasionally performed palpation or probing in 54.2% and 84.6% of cases. Gingivitis and recessions were the main reasons for consultations for 22.0% and 20.1% of general dentists and periodontists after orthodontic treatment. Of the practitioners surveyed, 43% felt that they experienced a setback in the ortho-periodontal treatment.

CONCLUSIONS

This study revealed discrepancies in the knowledge and attitudes of practitioners. Therapeutic management remains one of the major challenges of multidisciplinary treatments. Continuing education needs to be further developed in this field.

Comprehensive evaluation of factors that induce gingival enlargement during orthodontic treatment: A cross-sectional comparative study

Background

Gingival enlargement (GE) is one of the most common soft tissue problems encountered during fixed orthodontic treatment. Aims: This study aimed to evaluate the factors affecting GE in adolescents and young adults, compared with their normal peers.

Subjects and Methods

This is a cross-sectional comparative study. The sample consisted of 329 subjects (ages 10-30 years) of both genders, which was divided into four main groups: The control group (G0) with no orthodontic treatment; subjects who underwent orthodontic treatment were divided according to treatment duration into G1 (4-12 months), G2 (13-24 months), and G3 (>24 months). The clinical examinations included the level of debris, calculus (simplified oral hygiene), and GE indices. Regression analyses were used to assess the GE association in all the studied groups.

Results

The mean GE score increased significantly with increased treatment duration (0.42 ± 0.29 for G0 and 1.03 ± 0.52 for G3). GE scores of the lower arch were significantly higher in the anterior segment than in the posterior segment among all treatment groups. Regression analysis revealed that gender, age, oral hygiene, and treatment duration had a significant effect on GE (P < 0.05), while angle classification, overjet, overbite, treatment stage, bracket type, and therapeutic extraction did not show significant associations (P > 0.05).

Conclusion

Gender, age, oral hygiene, and treatment duration were the most important risk factors for GE during fixed orthodontic treatment.

Periodontal status in long-term orthodontic retention patients up to 10 years after treatment - a cross-sectional study

OBJECTIVE

To assess periodontal status in long-term orthodontic retention patients and investigate possible risk indicators.

MATERIALS AND METHODS

Plaque index (PI), gingival index (GI), probing pocket depth (PPD), gingival recessions (GR) and calculus were recorded in 211 patients with or without fixed retainers.

RESULTS

Periodontal parameters were within the limits of clinically healthy periodontium. The use of fixed retainers was associated with higher PI in the maxilla (ß = 1.10 [0.37]; p <.05). Older age was associated with higher PI in the mandible (ß = 0.27 [0.11]; p <.05). Smoking was associated with gingival bleeding on both palatal (ß = 0.63 [0.16]; p < .01) and labial sides in the maxilla (ß = 0.46 [0.20]; p <.05). Smoking was also associated with increased prevalence of GR in the mandible (ß = 0.24 [0.07]; p <.01), while use of snuff had similar effect on the labial side in the maxilla (ß = 0.35 [0.08]; p <.01). Higher age (ß = 0.05 [0.02]; p <.05) and the presence of a retainer (ß = 0.23 [0.07]; p < .05) were associated with calculus accumulation on the lingual side in the mandible.

CONCLUSION

The present observational study suggest that long-term fixed retainers alone have no detrimental effect on the periodontium. Additional factors may increase the risk of plaque deposits and increased probing pocket depths. Further prosepective studies are needed to confirm the present outcome.

Bacterial composition of subgingival plaque in crowded and noncrowded teeth

INTRODUCTION

Patients with dental crowding, even with good oral hygiene, may show increased bacterial presence in the crowded area. This study aimed to determine the microbial composition of subgingival plaque in crowded and noncrowded dental regions.

METHODS

Forty dental students with anterior dental crowding, who were aware of correct brushing techniques and oral hygiene, were enrolled in this study. After orthodontic records were taken and the periodontal examination was performed, subgingival plaque samples were collected from the crowded (experimental) and noncrowded regions (control) of each patient. Colony counting was performed for Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), and streptococcus species.

RESULTS

The mean amount of Aa and Pg colonies was significantly higher in crowded areas (P <0.0001), but there was no significant difference between streptococcus species colonization and crowding. Aa and Pg colonization had a significant direct relation with the amount of crowding. (P <0.0001).

CONCLUSIONS

Crowded dental areas, even with good oral hygiene, are more suitable environments for Aa and Pg colonization.

Alterations in subgingival microbiota during full-fixed appliance orthodontic treatment-A prospective study

BACKGROUND

Full-fixed appliance orthodontic treatment (commonly called braces) increases plaque accumulation and the risk of gingivitis and periodontitis. However, little consensus exists on changes to subgingival microbiota and specific periodontopathogens during treatment with braces. Prior studies have been hampered by selection biases due to dependence on culture conditions, candidate-based PCR and shallow sequencing methods.

OBJECTIVE

The objective was to provide the first longitudinal, culture-free and deep-sequence profiling of subgingival bacteria in subjects during early stages of full-fixed orthodontic treatment.

METHODS

We performed 16S rRNA next-generation sequencing (NGS) on 168 subgingival samples collected at 4 distinct mandibular tooth sites per subject before (0 weeks) and during (6 and 12 weeks) orthodontic intervention in 9 experimental and 5 control subjects not undergoing treatment.

RESULTS

Overall, we noted that orthodontic intervention led to increased microbial richness, accompanied by an increased incidence of localized gingivitis/mild periodontitis in subjects requiring orthodontic treatment compared to controls, as well as significant baseline variations in subgingival microbiomes in all subjects. Moreover, we confirmed individual- and site-dependent microbiome variability (in particular, the lingual site harboured higher microbiome diversity than buccal sites) that orthodontic bands may lead to more prolonged shifts in microbial changes compared to brackets, and evidence of adaptive enrichment of consensus bacteria with orthodontic intervention (12 novel, consensus bacterial species were identified).

CONCLUSION

Our study, along with evolving global profiling methods and data analyses, builds a strong foundation for further analyses of subgingival microbiomes during full-fixed orthodontic treatment.

Effectiveness of orthodontic toothbrush versus conventional toothbrush on plaque and gingival index reduction: A systematic review and meta-analysis

OBJECTIVE

In orthodontic patients submitted to oral hygiene instruction, what is the efficacy of orthodontic toothbrush (O-TB) versus conventional toothbrush (C-TB) on plaque and gingival index reduction in randomized and non-randomized controlled clinical trials?

METHODS

Electronic database search was performed on PubMed, ClinicalTrials.gov, Cochrane Library and Google Scholar. Database research, study selection, data extraction and ROBINS-I and Risk of Bias Tool 2.0 analysis were conducted by two independently examiners in duplicate. Two different meta-analyses were performed for plaque index and gingival index, followed by the analysis of overall quality of the evidence using GRADE.

RESULTS

A total of 158 studies were identified for screening; six articles were included in qualitative synthesis, and of those, three were subjected to a quantitative synthesis (meta-analysis). Three non-randomized studies presented an overall 'low', 'moderate' and 'high' risk of bias for each one of the articles, and the three randomized clinical trials presented 'low risk' for two articles and 'some concerns' quality for the other one. The overall strength of evidence was ranked 'very low' quality for plaque index and gingival index subgroups.

CONCLUSIONS

Gingival bleeding is not modified by orthodontic design toothbrush, but there is circumstantial scientific evidence for recommending the use of an O-TB instead a C-TB based on the analysis of plaque index control. Although major plaque removal of the O-TB was validated by meta-analysis, this improvement is not completely clarified which calls for further clinical studies to assess the effects of using an O-TB compared with a C-TB.

Direct 3D Printing of Clear Orthodontic Aligners: Current State and Future Possibilities

The recent introduction of three-dimensional (3D) printing is revolutionizing dentistry and is even being applied to orthodontic treatment of malocclusion. Clear, personalized, removable aligners are a suitable alternative to conventional orthodontic appliances, offering a more comfortable and efficient solution for patients. Including improved oral hygiene and aesthetics during treatment. Contemporarily, clear aligners are produced by a thermoforming process using various types of thermoplastic materials. The thermoforming procedure alters the properties of the material, and the intraoral environment further modifies the properties of a clear aligner, affecting overall performance of the material. Direct 3D printing offers the creation of highly precise clear aligners with soft edges, digitally designed and identically reproduced for an entire set of treatment aligners; offering a better fit, higher efficacy, and reproducibility. Despite the known benefits of 3D printing and the popularity of its dental applications, very limited technical and clinical data are available in the literature about directly printed clear aligners. The present article discusses the advantages of 3D printed aligners in comparison to thermoformed ones, describes the current state of the art, including a discussion of the possible road blocks that exist such as a current lack of approved and marketed materials and limited existence of aligner specific software. The present review suggests the suitability of 3D direct printed aligners is superior to that of thermoformed manufactured aligners because of the prior’s increased accuracy, load resistance, and lower deformation. It is an overall more stable way to produce an aligner where submillimeter movements can make a difference in treatment outcome. Direct 3D printing represents a complex method to control the thickness of the aligner and therefore has a better ability to control the force vectors that are used to produce tooth movement. There is currently no other approved material on the market that can do this. The conclusion of this article is that we encourage further in vitro and in vivo studies to test these new technologies and materials.

Changes of Periodontal Tissues Because of Orthodontic Treatment: A Retrospective Study

Aim:

To evaluate the periodontal status before and after orthodontic treatment and to analyze the confounding factors associated with it.

Materials and Methods:

The present retrospective study analyzed pre- and posttreatment records of a total of 60 patients. Intraoral digital photographs before and after the orthodontic treatment were used to measure the following three periodontal variables: (a) width of the keratinized gingiva, (b) gingival recession, and (c) the status of interdental papilla. The ImageJ 46 software imaging program was used to perform the required measurements. The clinical data were then analyzed in an association with the participants’ demographic data, the type of orthodontic tooth movement, and other confounding factors. The data obtained were manually entered into the statistical package and analyzed using a significance level set at P < .05. Descriptive statistics, paired t-tests, and Pearson’s correlation analysis were used to identify differences among the studied variables.

Results:

Among the 60 patients, the majority (66.7%) were females. Most cases of the treated malocclusion were Class II, and most patients underwent intrusion and retrusion movements. The width of keratinized gingiva increased for most sites of upper teeth. In contrast, the lower teeth showed a mix of improvement and compromised width of keratinized gingiva. As a measure of gingival recession, the difference of clinical crown height revealed the tendency toward a reduced clinical crown height for most sites. Upper left lateral incisors and canines showed significant values with regard to keratinized gingival width measurements and tooth movements such as extrusion and intrusion movements. Likewise, with regard to the clinical crown height, upper right central incisors showed significant differences when correlated with the interincisal angle, lower incisors to the mandibular plane, and upper incisors to the NA line. The upper lateral incisors also showed significant correlations to certain cephalometric measurements.

Conclusions:

The orthodontic treatment was found to exert a significantly positive impact on the surrounding periodontium, particularly in the upper canine areas. Likewise, various types of tooth movement were found to positively affect the periodontium.

Professional consensus on orthodontic risks: What orthodontists should tell their patients

INTRODUCTION

Effective communication of risk is a requisite for valid consent, shared decision-making, and the provision of person-centered care. No agreed standard for the content of discussions with patients about the risks of orthodontic treatment exists. This study aimed to produce a professional consensus recommendation about the risks that should be discussed with patients as part of consent for orthodontic treatment.

METHODS

A serial cross-sectional survey design using a modified electronic Delphi technique was used. Two survey rounds were conducted nationally in the United Kingdom using a custom-made online system. The risks used as the prespecified items scored in the Delphi exercise were identified through a structured literature review. Orthodontists scored treatment risks on a 1-9 scale (1 = not important, 9 = critical to discuss with patients). The consensus that a risk should be discussed as part of consent was predefined as ≥70% orthodontists scoring risk as 7-9 and <15% scoring 1-3.

RESULTS

The electronic Delphi was completed by 237 orthodontists who reached a professional consensus that 10 risks should be discussed as part of consent for orthodontic treatment; demineralization, relapse, resorption, pain, gingivitis, ulceration, appliances breaking, failed tooth movements, treatment duration, and consequences of no treatment.

CONCLUSIONS

A professional orthodontic consensus has been reached that 10 key risks should be discussed with patients as part of consent for orthodontic treatment. The information in this evidence base should be tailored to patients' individual needs and delivered as part of a continuing risk communication process.

Proposal of Dental Hygiene Diagnosis for Cancer Patients Based on Dental Hygiene Process of Care in Acute Care Hospitals: A Narrative Review

A narrative review was conducted to propose dental hygiene diagnoses for cancer patients based on dental hygiene process of care in acute care hospitals. Six researchers, including three dental hygienists, all with expertise in oral healthcare for patients with cancer, decided the review outline. All researchers reviewed the literature and developed terminology for dental hygiene diagnoses. The team then modified the terminology and discussed its clarity and acceptability to develop an initial list of dental hygiene diagnosis names according to the dental hygiene human needs conceptual model subscales. In wholesome facial image, one new diagnosis was developed. In protection from health risks, 15 new diagnoses were developed. In biologically sound and functional dentition, 10 new diagnoses were developed. In skin and mucous membrane integrity of the head and neck, 10 new diagnoses were developed. In freedom from head and neck pain, two new diagnoses were developed. In freedom from anxiety and stress, eight new diagnoses were developed. In responsibility for oral health, five new diagnoses were developed. In conceptualization and understanding, three new diagnoses were developed. Based on this study, it is necessary for the academic community to develop a better taxonomy of dental hygiene diagnoses pertaining to dental hygienist clinical practice.

Microbial profile in different orthodontic appliances by checkerboard DNA-DNA hybridization: An in-vivo study

INTRODUCTION

The design of the orthodontic bracket or appliance is 1 of the most important factors for creating retentive areas for biofilm formation. In orthodontics, this would be the first study to compare the microbial level changes in 3 different types of orthodontic appliances using checkerboard DNA-DNA hybridization technique. The purpose of this study was to evaluate and compare the extent of appearance of orange and red microbial complexes in patients undergoing orthodontic treatment using aligners, conventional metallic fixed labial appliances, and lingual fixed appliances.

METHODS

A total of 60 patients, of which 20 patients were undergoing treatment with aligners, 20 patients with labial fixed appliances, and 20 patients with lingual fixed appliances, were included in our study. After 30 days, debonded brackets and rinsed aligners were stored and processed for analysis with checkerboard DNA-DNA hybridization.

RESULTS

Most bacterial species showed moderate counts, with the exception of Treponema denticola, which showed a higher count in all 3 types of appliances. Fusobacterium nucleatum, Porphyromonas gingivalis, and T denticola were present in a higher percentage in the lingual appliance. Fusobacterium periodontium and Prevotella intermedia were present in a higher percentage in the labial fixed appliance. Campylobacter rectus, Tannerella forsythia, and Prevotella melaninogenica counts were moderate in all 3 appliances, with the first 2 microbes showing slightly higher counts in aligners. The association between all the microorganisms were statistically insignificant, with the exception of F nucleatum, which showed a strong statistically significant association in all 3 types of appliances.

CONCLUSIONS

The microbial contamination in metallic brackets was higher than that of aligners, when used for a month. Lingual fixed appliances showed more microbial contamination than labial fixed appliances followed by aligners.

Systematic reviews in orthodontics: Impact of the PRISMA for Abstracts checklist on completeness of reporting

INTRODUCTION

This study evaluated and compared the completeness of reporting of abstracts of orthodontics systematic reviews before and after the publication of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for Abstracts Checklist (PRISMA-A).

METHODS

Abstracts of systematic reviews and meta-analyses in orthodontics published in PubMed, Latin American and Caribbean Health Sciences Literature, and the Cochrane Database of Systematic Reviews databases before March 23, 2018, that met the predefined inclusion and exclusion criteria, were evaluated using the 12 items of PRISMA-A, scoring each item from 0 to 2. Abstracts were classified into 2 groups: before and after publication of the PRISMA-A checklist. Three calibrated evaluators (intraclass correlation coefficient and kappa > 0.8) assessed the scores for compliance with the checklist. The number of authors, country of affiliation of the first author, performance of meta-analysis, and topic of the article were recorded. A regression analysis was performed to assess the associations between abstract characteristics and the PRISMA-A scores.

RESULTS

Of 1034 abstracts evaluated, 389 were included in the analysis. The mean PRISMA-A score was 53.39 (95% CI, 51.83-54.96). The overall score for studies published after the publication of the checklist was significantly higher than for studies published before (P ≤ 0.0001). The components returning significantly higher scores after publication of PRISMA-A were title (P = 0.024), information from databases (P = 0.026), risk of bias (P ≤ 0.0001), included studies (P ≤ 0.0001), synthesis of results (P ≤ 0.0001), interpretation of results (P = 0.035), financing and conflict of interest (P ≤ 0.0001), and registration (P ≤ 0.0001). These results showed the positive effect of PRISMA-A had on the quality of reporting of orthodontics systematic reviews. Nevertheless, the poor adherence revealed that there is still need for improvement in the quality of abstract reporting.

CONCLUSIONS

The quality of reporting of abstracts of orthodontic systematic reviews and meta-analyses increased after the introduction of PRISMA-A.

Influence on interradicular bone volume of Invisalign treatment for adult crowding with interproximal enamel reduction: a retrospective three-dimensional cone-beam computed tomography study

BACKGROUND

The aim of this study was to use three-dimensional datasets to identify associations between treatment for adult crowding, using Invisalign aligner and interproximal enamel reduction (IER), and changes in the volume of interradicular bone.

METHODS

A total of 60 cone-beam computed tomography (CBCT) scans from 30 adult patients (28 women, two men; 30 CBCTs pre-treatment, 30 post-treatment) were examined retrospectively in order to measure bone volume three-dimensionally. The patients' average age was 36.03 ± 9.7 years. The interradicular bone volume was measured with OsiriX at four levels in the anterior tooth areas of the maxilla and mandible. Differences in bone between T0 and T1 were analyzed with IBM SPSS 21.0 using the Wilcoxon test for paired samples.

RESULTS

Overall, a slight increase in the quantity of bone was found (0.12 ± 0.73 mm). There was a highly significant increase in bone in the mandible (0.40 ± 0.62 mm; P <  0.001), while in the maxilla there was a slight loss of bone, which was highly significant in the apical third (- 0.16 ± 0.77 mm; P = 0.001).

CONCLUSIONS

Overall, treatment for adult crowding using an aligner and IER appears to have a positive effect on interradicular bone volume, particularly in patients with severe grades of the condition (periodontally high-risk dentition). This effect is apparently independent of IER. This is extremely important with regard to the treatment outcome, since IER and root proximity have been matters of debate in the literature and teeth should remain firmly embedded in their alveolar sockets.

Gingival recession in orthodontic patients 10 to 15 years posttreatment: A retrospective cohort study

INTRODUCTION

The aims of this study were to retrospectively investigate the long-term development of gingival recession in a cohort of orthodontic patients and to compare the prevalence of gingival recession in orthodontically treated patients 10 to 15 years posttreatment to that of untreated subjects with malocclusion.

METHODS

The sample included 88 patients with mean ages of 12.1 years (SD, 2.4 years) at pretreatment, 15.1 years (SD, 2.4 years) at posttreatment, and 27.9 years (SD, 2.5 years) 10 to 15 years posttreatment. The control group comprised 102 untreated patients seeking orthodontic treatment with a mean age of 28.7 years (SD, 3.1 years). Gingival recession was evaluated on study models.

RESULTS

The prevalence of both labial/buccal and lingual/palatal gingival recession increased during orthodontic treatment with further increases during the long-term posttreatment period; 98.9% of the orthodontically treated participants had at least 1 labial/buccal recession, and 85.2% of the patients had at least 1 lingual/palatal recession 10 to 15 years posttreatment. In addition, the proportion of patients with multiple labial/buccal or lingual/palatal recession sites increased considerably in the same time period. The prevalences of labial/buccal gingival recession were similar in the orthodontically treated patients 10 to 15 years posttreatment and the untreated controls. Study group patients with a crossbite before treatment showed 2.73 more recessions (95% CI, 0.28-5.17; P = 0.029) than did those without a transverse discrepancy. Untreated subjects with crowding greater than 3 mm per arch had 3.29 more recessions (95% CI, 0.73-5.68; P = 0.012) to 4.92 more recession sites (95% CI, 1.70-8.15; P = 0.003) than did those with mild or no crowding.

CONCLUSIONS

Within the limitations of this study, it seems that, in regard to the prevalence of gingival recession, orthodontically treated patients are not compromised in the long term compared with those with malocclusion that was untreated for many years.

Interceptive Correction of Anterior Crossbite Using Short-Span Wire-Fixed Orthodontic Appliance: A Report of Three Cases

Anterior crossbite is relatively a common presentation in the mixed dentition stage. If left untreated, it can lead to a host of problems and may complicate future orthodontic treatment. One of the major difficulties in performing anterior crossbite correction in young children is treatment compliance. In most cases, poor compliance is due to the unacceptability of the removable appliance used. This article describes three cases of successful correction of anterior crossbite of patients in mixed dentition using short-span wire-fixed orthodontic appliances. This sectional appliance provides an alternative method of correcting anterior crossbite of dental origin and offers many advantages compared to the use of removable appliances.

Long-term effects of Class II orthodontic treatment on oral health

AIM

To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH).

SUBJECTS AND METHODS

All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence.

RESULTS

Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm).

CONCLUSION

Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).

Association between orthodontic treatment and periodontal diseases: Results from a national survey

OBJECTIVE

To investigate the association between orthodontic treatment and periodontitis in a nationally representative sample of South Korea.

MATERIALS AND METHODS

Data from the Fifth and Sixth Korean National Health and Nutrition Examination Survey (KNHANES V, VI-1, and VI-2), conducted from 2012 to 2014, were used in this study. The final sample size consisted of 14,693 adults aged ≥19 years. Logistic regression analysis was performed to assess the association between orthodontic treatment and periodontitis.

RESULTS

The orthodontic treatment group exhibited a lower prevalence of periodontitis compared with the nonorthodontic treatment group. The adjusted odds ratios for periodontitis in subjects with a history of orthodontic treatment compared with those with no history of orthodontic treatment were 0.553, 0.614, and 0.624, when adjusted for various confounding variables (P < .0001). The subjects with periodontitis were of higher age, body mass index, waist circumference, and white blood cell counts compared with the subjects without periodontitis regardless of history of orthodontic treatment.

CONCLUSIONS

History of orthodontic treatment was associated with a decreased rate of periodontitis.

The microbial changes in subgingival plaques of orthodontic patients: a systematic review and meta-analysis of clinical trials

Background

Orthodontic treatment was found to have an impact on the quantity and constitution of subgingival microbiota. However, contradictory findings regarding the effects of fixed appliances on microbial changes were reported. The aim of this systematic review was to investigate the microbial changes in subgingival plaques of orthodontic patients.

Methods

The PubMed, Cochrane Library, and EMBASE databases were searched up to November 20, 2016. Longitudinal studies observing microbial changes in subgingival plaques at different time points of orthodontic treatment are included. The methodological quality of the included studies was assessed by Methodological index for non-randomized studies (MINORS). The studies that reported the frequency of subgingival periodontopathogens were used for quantitative analysis. Other studies were analysed qualitatively to describe the microbial changes during orthodontic treatment.

Results

Thirteen studies were selected, including two controlled clinical trials, three cohort studies and eight self-controlled studies. Four periodontopathogens, including Aggregatibacter actinomycetemcomitans (Aa), Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi) and Tannerella forsythia (Tf), were analysed. Following orthodontic appliance placement, the frequencies of Pg and Aa showed no significant change (P = 0.97 and P = 0.77), whereas the frequency of Tf significantly increased (P < 0.01) during short-term observation (0–3 months). The frequency of Pi showed a tooth-specific difference, as it presented no significant difference (P = 0.25) at the site of the first molar but was significantly increased (P = 0.01) at the incisor. During long-term observation (> = 6 months), two studies reported that the levels of subgingival periodontopathogens exhibited a transient increase but decreased to the pretreatment levels afterwards. After removal of the orthodontic appliance, the four periodontopathogens showed no significant difference compared with before removal.

Conclusion

The levels of subgingival pathogens presented temporary increases after orthodontic appliance placement, and appeared to return to pretreatment levels several months later. This indicates that orthodontic treatment might not permanently induce periodontal disease by affecting the level of subgingival periodontal pathogen levels. Further studies of high methodological quality are required to provide more reliable evidence regarding this issue.

The effect of fixed appliances on oral malodor from beginning of treatment till 1 year

BACKGROUND

Orthodontic appliances can enhance plaque accumulation, and this can cause gingival inflammation. Halitosis of oral origin is associated with microbial metabolism on the tongue and in the saliva, dental plaque, and the amount of volatile sulfide-containing compounds. This study used a Halimeter to investigate fixed orthodontic therapy-associated increases in the oral malodor over a year.

METHODS

Thirteen orthodontic patients with Angle Class I malocclusions receiving fixed orthodontic therapy formed the study group, and 12 dental students without any dental treatment formed the control group. The Halimeter was used to examine oral malodor by detecting volatile sulfur compounds (VSC). Plaque index (PI), gingival index (GI), and probing pocket depth (PPD) were also measured in both groups. The subjects in the study group had one visit before the orthodontic treatment started and seven visits during orthodontic therapy (1, 3, 5, 7, 9, 11, and 13 months after bonding), while the subjects in the control group had three visits, once per subsequent month.

RESULTS

Oral malodor was significantly increased in the fixed orthodontic treatment group during treatment (p < .05). Increases were also observed in the PI, GI, and PPD measures (p < .05). The results of the control group were stable (p > .05).

CONCLUSION

Oral malodor increased during fixed orthodontic treatments and reached a critical level 7 months later.

Orthodontic management of a periodontally compromised dentition

Malocclusion superimposed with severe periodontitis may present a great challenge to clinicians while providing orthodontic treatment due the episodic and site-specific nature of the disease with risk of rapid tissue breakdown. However, orthodontic treatment in such situation may contribute significantly to the overall rehabilitation both functionally and esthetically. In this article, a case report outlines a combined periodontic-orthodontic management of compromised dentition. A 37-year-old female patient with significant medical history was treated for Class II Division 1 type of malocclusion associated with spaced upper and lower anterior teeth, deep overbite, and increased overjet, superimposed with chronic generalized periodontitis and bone loss. Treatment was completed using temporary anchorage devices assisted strategically applied force and modified tandem retraction biomechanics amidst management of acute inflammatory episodes during and mucogingival complication after treatment. Affected areas healed very well after post-orthodontic periodontal treatment with minimal pocket depth, and bleeding on probing, and a healthy zone of attached gingiva at the follow up visits. The orthodontic results lead to improvement in patient’s facial profile, lip posture, and correction of protrusion which addressed her main concern. One year follow-up shows good orthodontic and periodontic stability. The report highlights the importance of identifying “at risk” individuals and continuous monitoring of disease status during treatment. Despite all precautionary measures, a flare-up during the treatment can be anticipated.

Malocclusion in elementary school children in beirut: severity and related social/behavioral factors

Aim. To assess severity of malocclusion in Lebanese elementary school children and the relationship between components of malocclusion and sociodemographic and behavioral factors. Methods. Dental screening was performed on 655 school children aged 6-11 from 2 public (PB) and 5 private (PV) schools in Beirut. A calibrated examiner recorded occlusion, overjet, overbite, posterior crossbite, midline diastema, and crowding. Another examiner determined the DMFT (Decayed/Missing/Filled Teeth) score. A questionnaire filled by the parents provided data on sociodemographic and behavioral factors. Multinomial, binomial, and multiple linear regressions tested the association of these factors with occlusal indices. Results. Malocclusion was more severe in PB students. Age and sucking habit were associated with various components of malocclusion. Crowding was more prevalent among males and significantly associated with the DMFT score. Income and educational level were significantly higher (P < 0.05) in PV pupils and deleterious habits were more frequent in PB children. Conclusions. Children of lower socioeconomic background had more severe malocclusions and poorer general dental health. Compared to Western and WHO norms, the findings prompt health policy suggestions to improve dental care of particularly public school children through regular screenings in schools, prevention methods when applicable, and cost effective practices through public and private enabling agencies.

Transparent magnesium aluminate spinel: a prospective biomaterial for esthetic orthodontic brackets

Adult orthodontics is recently gaining popularity due to its importance in esthetics, oral and general health. However, none of the currently available alumina or zirconia based ceramic orthodontic brackets meet the esthetic demands of adult patients. Inherent hexagonal lattice structure and associated birefringence limits the visible light transmission in polycrystalline alumina and make them appear white and non transparent. Hence focus of the present study was to assess the feasibility of using magnesium aluminate (MgAl2O4) spinel; a member of the transparent ceramic family for esthetic orthodontic brackets. Transparent spinel specimens were developed from commercially available white spinel powder through colloidal shaping followed by pressureless sintering and hot isostatic pressing at optimum conditions of temperature and pressure. Samples were characterized for chemical composition, phases, density, hardness, flexural strength, fracture toughness and optical transmission. Biocompatibility was evaluated with in-vitro cell line experiments for cytotoxicity, apoptosis and genotoxicity. Results showed that transparent spinel samples had requisite physico-chemical, mechanical, optical and excellent biocompatibility for fabricating orthodontic brackets. Transparent spinel developed through this method demonstrated its possibility as a prospective biomaterial for developing esthetic orthodontic brackets.

Cone-beam computed tomography evaluation of periodontal and bone support loss in extraction cases

Background

The aim of this study was to evaluate, in particular, whether bone resorption occurred at the extraction sites of a group of patients under orthodontic treatment, and, in general, whether extraction treatment predisposes patients to a greater degree of root resorption.

Methods

The study group comprised 12 class II division 1 malocclusion patients who underwent orthodontic treatment and extraction, and the control group comprised 10 class II division 1 patients who underwent orthodontic treatment without extraction. In both groups, treatments were carried out by the same operator using the same techniques. Cone-beam computed tomography performed before (T1) and after (T2) treatment was used to determine and compare the root length, the distance from the cementoenamel junction to the base of the defect and to the bone peak, the width of the defect and the buccolingual bone thickness.

Results

Root length was reduced following treatment in both groups, although to a statistically significantly greater extent in the study group. The buccolingual bone thickness was reduced after treatment in both groups, with no differences found between the study and control groups. The bone loss at the sites assessed was greater in the patients after extraction treatment, with a statistically significant difference revealed between the two groups. The site that showed the greatest variation in both groups was distal to the upper canines.

Conclusions

In the present study, extractive orthodontic treatment appeared to predispose patients to a greater degree of root resorption. Indeed, the bone at the extraction site showed greater resorption in the study group with respect to the control group, and the appearance of intraosseous defects was noted in the former.

A review of the oral health-related evidence that supports the orthodontic treatment need indices

BACKGROUND AND OBJECTIVES

To date, there is no evidence-based method of quantification for malocclusion. Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports the cut-off points and the rationale used for OTNI.

MATERIALS AND METHODS

The relevant cited studies and reviews from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar.

RESULTS

So far, the evidence for harmful effects of deviated occlusal traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-term) studies. When an association was reported between a deviated occlusal trait and an oral health problem, either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Consequently, establishing a cause and effect relationship is difficult. Further, commonly used OTNI do not record a full spectrum of occlusal traits, and relating their ranking or scoring systems to the available evidence is difficult. Therefore, there is little evidence to suggest that individuals with a high need (high score), as measured by OTNI, will necessarily put at risk their oral health if they turn down orthodontic therapy.

CONCLUSION

OTNI have a role in the epidemiology and can be used for resource planning, but their predictive value to detect the future objective functional deficits or oral health problems is questionable. OTNI will need revalidation over time with emerging research findings.

Complexities associated with orthodontic services in the National Health Service

AIM

To detail orthodontic provision in Wales.

BACKGROUND

In 2006 the new orthodontic contract was introduced in the NHS in England and Wales. Since the introduction of the new contract there have been recent reports of inefficiencies in orthodontic provision in Wales in terms of: orthodontic provision reaching those who need it, type of orthodontic activities undertaken, who is providing orthodontic care, the relative cost-efficiency of the orthodontic services, contracting and performance management of the services and robustness of the orthodontic database.

MATERIALS AND METHODS

2008/09 orthodontic data on contracted services were analysed. Data from the salaried services was collected through a questionnaire. Normative orthodontic treatment need was estimated from mid-year population estimates.

RESULTS

In 2008/09, there were considerable inefficiencies in the orthodontic services in Wales with varied level of access by children living in 22 former local health boards, co-terminus with local authorities in Wales. Total spend on orthodontics in Wales was around £12,718,370. It was estimated that 11,539 (30%) of 12-17-year-olds required orthodontic treatment. In 2008/09, 11,031 children received orthodontic treatment in all NHS services in Wales indicating a potential shortfall of 508 treatments. Out of 135 GDS/PDS orthodontic contracts, 27 provided no active treatment (only assessments) and 62 provided less than 50 treatments annually. Cost per units of orthodontic activity (UOA) ranged from £58 to £74. With improved contracts and efficiency, the orthodontic budget seems sufficient to meet the orthodontic need of the population.

CONCLUSIONS

As with any type of NHS provision, it is important that orthodontic services are competitive, highly efficient and provided on the basis of need. Performance management of orthodontic services should focus on the number of successful orthodontic treatments delivered annually. The personal dental services (PDS) orthodontic contract will need to be modified accordingly.

Impact of social and economic characteristics on orthodontic treatment among children and teenagers in France

OBJECTIVES

This study aimed to estimate the prevalence of orthodontic treatment in France among children and teenagers aged 8-18 years, by sex and by age, and to investigate the specific role of social and economic characteristics on use of orthodontic treatment.

METHODS

We analyzed data from the cross-sectional national health survey conducted in France in 2002-2003, which included a sample of 5988 children aged 8-18 years. All data were collected by interview including the question on orthodontic treatment. Other data used in our study were family social status and income, maternal educational attainment and place of birth, whether the child was covered by a supplementary health insurance and whether the residence was urban or rural. We also calculated the density of orthodontists in the district. Multivariate logistic regression analyses were used to study the relationships between these social and economic factors and orthodontic treatment.

RESULTS

The prevalence of orthodontic treatment was 14% of all children aged 8-18, 15% for girls, and 13% for boys, and 23% in the 12 to 15-year age group. Children were less likely to have orthodontic treatment when parents were service or sales workers compared with children whose parents were managers or professionals (aOR = 0.50; 95%CI: [0.34;0.76]), when family income was in the lowest, compared with highest quartile (aOR = 0,62; 95% CI: [0.45;0.85]), when children had no supplementary insurance compared with children covered by private insurance (aOR = 0.53; 95% CI: [0.34; 0.81]), or when they lived in rural compared with urban areas (aOR = 0.70; 95% CI: [0.54; 0.91]).

CONCLUSION

There are social inequalities in orthodontic treatment in France, associated mainly with social status, annual income, supplementary insurance, and the residence area.