Gastroesophageal reflux symptoms in adults with skeletal Class III malocclusion examined by questionnaires

Current Trends in Pediatric Orthodontics: A Comprehensive Review

Pediatric orthodontics is a critical field focusing on the diagnosis, prevention, and treatment of dental and facial irregularities in children. This comprehensive review explores current trends and methodologies in pediatric orthodontics and discusses the multifactorial etiology of malocclusions, including genetic, environmental, and disease-related factors. The importance of proper diagnosis is highlighted, and the extraoral, intraoral, and functional evaluations essential for effective treatment planning are detailed. Various orthodontic conditions such as Class III and Class II malocclusions, abnormal oral habits, arch length discrepancies, anterior and posterior crossbites, open bites, and deep bites are examined in depth. The review also addresses the role of temporomandibular joint disorders (TMDs) and obstructive sleep apnea (OSA) in pediatric patients, emphasizing the need for early and accurate diagnosis to facilitate appropriate intervention. The use of clear aligners in early orthodontic intervention is evaluated given their efficacy and improved patient satisfaction compared to traditional appliances. Additionally, the article discusses the non-advisability of early interception for certain self-correcting malocclusions and the limitations of pediatric orthodontic treatment, including compliance-related issues and the unique anatomical considerations of deciduous dentition. This review aims to provide a detailed understanding of contemporary practices and challenges in pediatric orthodontics, offering insights for clinicians to enhance treatment outcomes and patient care.

Expert consensus on pediatric orthodontic therapies of malocclusions in children

Malocclusion, identified by the World Health Organization (WHO) as one of three major oral diseases, profoundly impacts the dental-maxillofacial functions, facial esthetics, and long-term development of ~260 million children in China. Beyond its physical manifestations, malocclusion also significantly influences the psycho-social well-being of these children. Timely intervention in malocclusion can foster an environment conducive to dental-maxillofacial development and substantially decrease the incidence of malocclusion or reduce the severity and complexity of malocclusion in the permanent dentition, by mitigating the negative impact of abnormal environmental influences on the growth. Early orthodontic treatment encompasses accurate identification and treatment of dental and maxillofacial morphological and functional abnormalities during various stages of dental-maxillofacial development, ranging from fetal stages to the early permanent dentition phase. From an economic and societal standpoint, the urgency for effective early orthodontic treatments for malocclusions in childhood cannot be overstated, underlining its profound practical and social importance. This consensus paper discusses the characteristics and the detrimental effects of malocclusion in children, emphasizing critical need for early treatment. It elaborates on corresponding core principles and fundamental approaches in early orthodontics, proposing comprehensive guidance for preventive and interceptive orthodontic treatment, serving as a reference for clinicians engaged in early orthodontic treatment.

Towards Genetic Dissection of Skeletal Class III Malocclusion: A Review of Genetic Variations Underlying the Phenotype in Humans and Future Directions

INTRODUCTION

Skeletal abnormalities and malocclusions have varied features that impact populations globally, impairing aesthetics and lowering life quality. The prevalence of the Skeletal Class III disease is the lowest among all angle malocclusions, with varied prevalence across nations. Environmental, genetic, and societal factors play a role in its numerous etiologies. In this study, we conducted a thorough search across the published data relating to quantitative trait loci (QTL) and the genes associated with Class III progression in humans, discussed these findings and their limitations, and proposed future directions and strategies for studying this phenotype.

METHODS

An inclusive search of published papers in the PubMed and Google Scholar search engines using the following terms: 1. Human skeletal Class III; 2. Genetics of Human skeletal Class III; 3. QTL mapping and gene associated with human skeletal Class III; 4. enriched skeletal Class-III-malocclusion-associated pathways.

RESULTS

Our search has found 53 genes linked with skeletal Class III malocclusion reported in humans, genes associated with epigenetics and phenomena, and the top 20 enriched pathways associated with skeletal Class III malocclusion.

CONCLUSIONS

The human investigations yielded some contentious conclusions. We conducted a genome-wide association study (GWAS), an epigenetics-wide association study (EWAS), RNA-seq analysis, integrating GWAS and expression quantitative trait loci (eQTL), micro- and small-RNA, and long non-coding RNA analysis in tissues connected to skeletal Class III malocclusion phenotype in tissues connected with the skeletal phenotype. Finally, we invite regional, national, and international orthodontists and surgeons to join this effort by contributing human samples with skeletal Class III malocclusion following the accepted Helsinki ethical protocol to challenge these phenomena jointly.

Anxiety and depression mediate the relationship between digestive tract conditions and oral health-related quality of life in orthodontic patients

Background

Anxiety and depression are common psychological problems in orthodontic patients whose diet habits and oral health status change frequently during treatment. However, relationships between anxiety and depression, digestive tract condition, and impaired oral health-related quality of life remain unknown.

Materials and methods

In this study, clinical assessments, including anxiety, depression, digestive tract condition, and oral health-related quality of life, were collected from 769 outpatients in the orthodontic department using three self-reported questionnaires. Correlation analysis was used to investigate the relationships among different clinical assessments. A chained mediation analysis model was further conducted to explore the direct and indirect effects of these various clinical factors.

Results

Changes in digestive tract conditions were positively correlated with the psychological status and oral health-related quality of life. Anxiety and depression partially mediated the relationship between them, and the indirect effect was 0.68 (30%), of which the mediation effect of anxiety accounted for 56%.

Conclusion

Anxiety and depression mediate the relationship between gastrointestinal conditions and oral health. In particular, anxiety seems to play a significant mediating role. Our findings indicate that psychological status must be paid more attention to in future clinical practices and supervision for digestive tract symptoms of orthodontic patients.

Genes and Pathways Associated with Skeletal Sagittal Malocclusions: A Systematic Review

Skeletal class II and III malocclusions are craniofacial disorders that negatively impact people’s quality of life worldwide. Unfortunately, the growth patterns of skeletal malocclusions and their clinical correction prognoses are difficult to predict largely due to lack of knowledge of their precise etiology. Inspired by the strong inheritance pattern of a specific type of skeletal malocclusion, previous genome-wide association studies (GWAS) were reanalyzed, resulting in the identification of 19 skeletal class II malocclusion-associated and 53 skeletal class III malocclusion-associated genes. Functional enrichment of these genes created a signal pathway atlas in which most of the genes were associated with bone and cartilage growth and development, as expected, while some were characterized by functions related to skeletal muscle maturation and construction. Interestingly, several genes and enriched pathways are involved in both skeletal class II and III malocclusions, indicating the key regulatory effects of these genes and pathways in craniofacial development. There is no doubt that further investigation is necessary to validate these recognized genes’ and pathways’ specific function(s) related to maxillary and mandibular development. In summary, this systematic review provides initial insight on developing novel gene-based treatment strategies for skeletal malocclusions and paves the path for precision medicine where dental care providers can make an accurate prediction of the craniofacial growth of an individual patient based on his/her genetic profile.

Assessment of the relationship between masticatory performance, occlusal contact area, chewing time and cycles, and gastric emptying scintigraphy in dentate subjects

BACKGROUND

Good mastication is thought to help digestion in the stomach, hence promoting the health of the gastrointestinal system. However, the correlation between masticatory and gastric function has been controversial. This is partly explained by different food types used to assess the performance of the two organs. Recently, frankfurter sausage has been proposed to be suitable for both masticatory performance and gastric emptying tests.

OBJECTIVES

To examine the relationship between masticatory performance, occlusal contact area, chewing time and cycles, and gastric emptying scintigraphy parameters in healthy dentate adults.

MATERIALS AND METHODS

Forty healthy subjects (15 men: 25 women, age 23.9 ± 3.8 years) underwent masticatory performance tests and gastric emptying scintigraphy using frankfurter sausage as a test food. Masticatory performance was calculated as the median particle size (MPS) of chewed frankfurter sausage cubes after 30 chewing cycles. Gastric emptying scintigraphy was performed using frankfurter sausage mixed with technetium-99 m-labelled microwaved egg meal. Cumulative occlusal areas of contact-near contact (cACNC) were determined by silicone bite registration and image-analysed. Chewing time and cycles before swallowing were also recorded.

RESULTS

No significant differences in MPS, cACNC, chewing time and cycles, or gastric emptying parameters were observed between gender. Bivariate correlation showed masticatory performance, occlusal contact area, chewing time and cycles were not correlated with gastric emptying parameters (P > 0.05).

CONCLUSION

Using the same test food to assess the masticatory and gastric function in dentate subjects, the present study showed that masticatory performance, occlusal contacts, chewing time and cycles did not affect gastric emptying.

Gastric emptying rate before and after orthodontic treatment examined with the [13C] breath test: A pilot study

INTRODUCTION

Orthodontic patients with malocclusion have significantly lower masticatory and gastrointestinal digestive function than persons with normal occlusion. Although several studies have suggested that masticatory function is improved after orthodontic treatment, the relationship between such improvement and change in gastrointestinal symptoms has not been quantitatively evaluated. In this study, we aimed to investigate the change in masticatory function and the gastric emptying rate in patients with malocclusion, before and after orthodontic treatment.

METHODS

Seven women with malocclusion, before (pretreatment group) and after orthodontic treatment (posttreatment group), and 7 healthy dentate female volunteers (control group) underwent a ¹³C-acetate breath test (¹³CO₂) with a liquid meal and the color changeable gum test, along with completing the frequency scale for symptoms of gastroesophageal reflux and a questionnaire on food intake. Between-group differences were evaluated.

RESULTS

The pretreatment group had significantly longer maximum ¹³CO₂ exhalation time and lower masticatory function, quantified using a higher red-color value on the gum test and the questionnaire on food intake, than did the posttreatment and control groups. No significant differences were identified between the posttreatment and the control groups.

CONCLUSIONS

We provide evidence of improvement of masticatory function after orthodontic treatment, which was associated with a faster rate of gastric emptying.

Evaluation of a Proton Pump Inhibitor for Sleep Bruxism

Bruxism is a repetitive jaw-muscle activity characterized by clenching or grinding of the teeth and/or bracing or thrusting of the mandible. Recent advances have clarified the relationship between gastroesophageal reflux and sleep bruxism (SB). However, the influence of pharmacological elimination of gastric acid secretion on SB has not been confirmed. The authors aimed to assess the efficacy of a proton pump inhibitor (PPI) on SB and to examine the gastrointestinal (GI) symptoms and endoscopic findings of the upper GI tract in SB patients. The authors performed a randomized double-blind placebo-controlled crossover study at Kagoshima University Hospital. Twelve patients with polysomnography (PSG)–diagnosed SB underwent an assessment of GI symptoms using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) and esophagogastroduodenoscopy. At baseline (i.e., before interventions), the mean frequencies of electromyography (EMG) bursts and rhythmic masticatory muscle activity (RMMA) episodes were 65.4 ± 49.0 bursts/h and 7.0 ± 4.8 episodes/h, respectively, and at least 1 RMMA episode with grinding noise was confirmed in all participants. The mean FSSG score was 8.4 ± 5.6, and 41.7% of patients were diagnosed with gastroesophageal reflux disease. Mild reflux esophagitis was confirmed in 6 patients. PSG, including EMG of the left masseter muscle and audio-video recording, was performed on days 4 and 5 of administration of 10 mg of the PPI (rabeprazole) or placebo. PPI administration yielded a significant reduction in the frequency of EMG bursts, RMMA episodes, and grinding noise. No significant differences were observed regarding the swallowing events and sleep variables. Since the clinical application of PPI for SB treatment should remain on hold at present, the results of this trial highlight the potential application of pharmacological gastroesophageal reflux disease treatment for SB patients. Larger scale studies are warranted to corroborate these findings. (UMIN Clinical Trials Registry: UMIN000004577).

Development and evaluation of a modified Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease to distinguish functional dyspepsia from non-erosive reflux disease

BACKGROUND AND AIM

The Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) is the standard questionnaire used in Japan for the diagnosis of gastroesophageal reflux disease (GERD) and assessment of the response to treatment. We modified the FSSG in order to assess dyspepsia symptoms, and evaluated the modified questionnaire.

METHODS

We modified the FSSG by adding two questions on interdigestive and postprandial epigastric pain. We then assessed the modified FSSG with 100 new untreated symptomatic patients presenting to hospital and in 200 subjects undergoing health checks. Endoscopic assessment of the esophagogastric junction was performed according to the modified Los Angeles classification with addition of Grade N (normal appearance) and Grade M (minimal change). Endoscopic images were assessed by five experienced endoscopists blinded to the questionnaire results.

RESULTS

The 100 new patients included 16 with erosive GERD (>Grade A), 12 with peptic ulcer, and two with gastric cancer. Among the 70 patients with no evidence of organic disease, the modified FSSG diagnosed functional dyspepsia (FD) in 41 and non-erosive gastric disease (NERD) in 29. A significant difference was seen in the dyspepsia score between patients with FD and NERD. Subjects with endoscopic GERD undergoing health checks had significantly higher scores for all symptoms, reflux symptoms, and dyspeptic symptoms on the modified FSSG.

CONCLUSION

The modified FSSG can clearly distinguish FD from NERD, and is useful for the assessment of dyspeptic symptoms.