Bullying among Jordanian schoolchildren, its effects on school performance, and the contribution of general physical and dentofacial features

Pathways between oral health conditions and bullying on adolescents: A 10-year cohort study

OBJECTIVE

To assess the pathways in which oral health conditions, socioeconomic, and psychosocial factors in childhood can lead to the occurrence of bullying in adolescence.

METHODS

This is a 10-year cohort study conducted with a sample of 639 children in southern Brazil. Oral health conditions (dental caries, dental trauma and malocclusion), sociodemographic and psychosocial characteristics were obtained at baseline (T1) and at follow-up (T2). General and dental bullying were assessed at T2 using the Bullying Olweus questionnaire and through a question contained in the Child Perception Questionnaire 11-14. Structural equation modelling was used to evaluate the pathways between oral health measures and bullying episodes over time.

RESULTS

A total of 429 students were evaluated at follow-up. Untreated dental caries were direct and indirectly related with the occurrence of dental bullying at follow-up and indirectly associated with general bullying at T2. Low socioeconomic status, low sense of coherence and dental bullying presented a direct impact on the occurrence of general bullying at T2.

CONCLUSIONS

Untreated dental caries are presented as the main oral health predictor of the occurrence of bullying episodes in adolescence.

Oral health-related quality of life, adaptation/discomfort during open bite treatment with spurs: complementary analysis from a randomized clinical trial

This single-center trial aimed to longitudinally compare the oral health-related quality of life (OHRQOL), adaptation and discomfort during anterior open bite (AOB) treatment with lingual spurs and build-ups (SBU) versus spurs only (S) approaches. Children (7-11 years) with AOB were randomly allocated into two treatment groups (SBU or S). The Child Perception Questionnaire (CPQ8-10) was applied 1 and 12 months after installation of the appliances. Questionnaires evaluating functional adaptation and discomfort during the first month of treatment were also applied. A visual analog scale (VAS) was used in these questionnaires. Generalized mixed models were used for analyzing OHRQOL and discomfort data. Generalized linear models were used to assess adaptation outcomes (α = 0.05). The SBU group included 24 patients (7 males and 17 females; mean age 8.2 years) and the S group included 25 patients (11 males and 14 females; mean age 8.3 years). Regardless of the treatment type, overall OHRQOL scores at 12 months were 0.69 times those recorded at 1 month after the appliances installation (i.e., ~ 31% reduction; exp (β) = 0.69; 95% CI: 0.55, 0.88). A significant interaction between treatment and time was detected for the 'functional limitations' domain. For this domain, a significant improvement from the first to the twelfth month was observed in the S group (P < 0.001). Patients in both treatment groups showed similar and easy adaptation to the appliances. Independent of the type of treatment, tongue-related discomfort decreased over time. One week and one month after the appliance's delivery, the discomfort scores were 0.19 (i.e., ~ 81% reduction; exp (β) = 0.19; 95% CI: 0.13, 0.28; P < 0.001) and 0.02 (i.e., ~ 98% reduction; exp (β) = 0.02; 95% CI: 0.01, 0.07; P < 0.001) times, respectively, those issued immediately after the installation of the appliances. Regardless of treatment type; overall OHRQOL improved from the first to the twelfth month of AOB treatment. The functional limitations score decreased in the S group. Children showed easy adaptation, and their discomfort decreased 1 week after the installation of the appliances.Trial registration: Clinicaltrials.gov; NCT03702881, date of registration: October 11, 2018.

Prevalence and factors influencing bullying among Egyptian schoolchildren

OBJECTIVE

To evaluate the prevalence of bullying among schoolchildren and to study the correlation between bullying and a specific type of malocclusion, self-esteem, oral health-related quality of life (OHRQoL), the need for orthodontic treatment and socioeconomic status.

DESIGN

A cross-sectional study.

SETTING

Low, middle and high socioeconomic-class schools in the same educational district in Cairo, Egypt.

PARTICIPANTS

A total of 324 Egyptian schoolchildren aged 11-14 years.

METHODS

Validated questionnaires were used to assess self-reported bullying frequency and intensity, self-esteem and OHRQoL. The Index of Orthodontic Treatment Need (IOTN) was used to assess the orthodontic treatment need and the participants' occlusion was classified according to the British Standard Incisors (BSI) classification.

RESULTS

Bullying was found to be prevalent in 61.7% of the sample. Regression analysis revealed that participants with a Class II division 1 incisor relationship had the highest odds ratio (OR) for predicting bullying (OR = 1.86, 95% confidence interval [CI] = 1.38-2.15). Being bullied was significantly associated with lower self-esteem (OR = 0.47, 95% CI = 0.13-0.78), worse OHRQoL (OR = 2.73, 95% CI = 1.95-3.15) and a high need for orthodontic treatment, as determined by the IOTN Dental Health Component score (OR = 1.33, 95% CI = 1.05-1.95) and IOTN Aesthetic Component score (OR = 1.52, 95% CI = 1.12-1.88). Moreover, participants in high and middle socioeconomic-class groups had a lower OR for predicting bullying than those in the low socioeconomic-class group (OR = 0.27, 95% CI = 0.13-0.54).

CONCLUSION

The bullying prevalence among Egyptian schoolchildren aged 11-14 years was very high. The prevalence of bullying was higher in schoolchildren with higher orthodontic treatment need and Class II division 1 incisor relationship. Bullying was correlated to poor self-esteem as well as poor OHRQoL. In addition, low socioeconomic status was found to be a potential predictor for bullying.

Pathways between verbal bullying and oral conditions among school children

PURPOSE

To investigate the direct and indirect pathways between verbal bullying and adverse oral conditions among school-aged children.

METHODS

A cross-sectional survey was conducted with 8- to 10-year-old children, enrolled in public schools in Southern Brazil. Verbal bullying was collected by self-reports. Independent variables included sociodemographic characteristics (sex, age, household income, and caregivers' educational level) and oral conditions (anterior open bite, anterior teeth crowding, upper anterior diastema, large overjet, untreated dental caries, and PUFA index). The pathways between verbal bullying and the independent variables were analysed through structural equation modelling.

RESULTS

1369 children were included. The prevalence of verbal bullying was 26.2% (95% confidence interval [CI] 23.9-28.6%). Verbal bullying was directly influenced by large overjet (standard coefficient [SC] 0.13, P < 0.01), untreated dental caries (SC 0.63, P = 0.01) and PUFA index (SC 0.75, P = 0.02). Sex (SC - 0.005, P = .04) and age (SC - 0.006, P < 0.01) indirectly influenced verbal bullying via untreated dental caries.

CONCLUSIONS

Verbal bullying was directly influenced by large overjet, untreated dental caries and PUFA index. Sex and age indirectly impacted verbal bullying through untreated dental caries.

Association between Dentofacial Features and Bullying from Childhood to Adulthood: A Systematic Review

Bullying occurs when an individual is repeatedly victimised by negative actions performed by peers. As oral features, like malocclusion and dental structural defects, can promote psychological distress, which is also found in those who are bullied, we aimed to study the association between orofacial conditions and bullying. A systematic review (PROSPERO CRD42022331693), including articles dealing with bullying and dentofacial traits, was performed following the PRISMA chart. The iterative search of eligible publications was carried out on 27 March 2023 on four databases (PubMed, PubPsych, Web of Science and Cochrane Reviews) and in the grey literature. Among the 25 articles included, 4 referred to qualitative studies, which analysed 632 interviews with children, 8 interviews with parents, 292 letters, and 321 Twitter posts. The other 21 were cross-sectional studies, which included 10,026 patients from 7 to 61 years old. Two of the qualitative studies and seven of the cross-sectional studies rated a low risk of bias, according to Joanna Briggs Institute's Critical Appraisal Tools. The majority of studies (88%) reported a relationship between malocclusion or structural defects and exposure to bullying among young adolescents. Structural dental abnormalities and severe malocclusion should be managed, among others, for psychological questions because they crystallise the loss of self-confidence and increase the risk of bullying.

Impact of dental fluorosis on the oral health related quality of life of adolescents in an endemic area

Introduction

Oral diseases and conditions affect the physical, social, and psychological well-being of an individual. The aim of this study was to determine the association between the severity of dental fluorosis and oral health related quality of life (OHRQoL) among 15-year-old school children residing in an endemic area for dental fluorosis in Sri Lanka.

Design

A cross-sectional study was conducted among 989, 15-year-old school children who were lifetime residents of Kurunegala district. A validated Sinhala version of the Child Perception Questionnaire (CPQ 11-14) was used to assess OHRQoL. Dental fluorosis was assessed using the Thylstrup and Ferjeskov index (TF index) while dental caries and malocclusion were assessed using the WHO Basic Methods and Dental Aesthetics Index (DAI) respectively. In addition, information pertaining to parental level of education, type of toothpaste used, frequency of toothbrushing and use of dental services was also gathered.

Results

The prevalence of dental fluorosis was 52%. The overall prevalence of impacts based on the CPQ was 38.2%. The severity of dental fluorosis was not significantly associated with the overall prevalence of impacts. However, the severity of dental fluorosis was significantly associated with three oral impacts namely "having pain in teeth, lips, jaws, or mouth", "felt irritable or frustrated" and "other children teased or called names". According to the multiple logistic regression analysis, use of dental services and moderate to severe malocclusion were significantly associated with poor OHRQoL but not dental fluorosis.

Conclusion

The severity of dental fluorosis was not associated with OHRQoL of the participants.

Prevalence of bullying in orthodontic patients and its impact on the desire for orthodontic therapy, treatment motivation, and expectations of treatment

PURPOSE

This study aims at investigating the prevalence of bullying due to malocclusions in a sample of German orthodontic patients. Thereby, we analyzed the influence of self-reported bullying on initiation, desire and motivation, and expectations of orthodontic therapy.

PATIENTS AND METHODS

Patients completed questionnaires by themselves in three orthodontic practices (n = 1020, mean age 11.8 years). The sample was divided into three groups: (1) subjects bullied due to dentofacial features, (2) subjects bullied due to physical features, and (3) non-bullied control group. The effect of bullying on initiation, desire and motivation, and expectation from orthodontic treatment was assessed and compared between these groups.

RESULTS

Overall prevalence of bullying was 23.7% with male subjects revealing significantly higher values than females (p < 0.001). Subjects from the dentofacial features group (6.3%) initiated orthodontic therapy themselves significantly more often than subjects from the physical features (17.4%; p = 0.030) and control group (76.3%; p < 0.001). The dentofacial features group reported significantly more frequently that 'ugly teeth' were the major motivating factor to seek orthodontic treatment (40.4%). Within this group significantly higher mean scores for the expectation 'keep me from being bullied' were obtained compared with subjects in the physical features (p < 0.001) or control group (p < 0.001).

CONCLUSION

This analysis demonstrated that bullying due to malocclusion impacts attitude towards orthodontic treatment. Victims who experienced bullying due to malocclusion initiate orthodontic treatment more often themselves and expect therapy to prevent them from experiencing further bullying.

Anxiety, Depression, Self-Esteem, Internet Addiction and Predictors of Cyberbullying and Cybervictimization among Female Nursing University Students: A Cross Sectional Study

BACKGROUND

Cyberbullying and cybervictimization, which have been linked to the growth of the Internet and issues with mental health, can have serious psychological and academic consequences for young individuals, yet they have received relatively little scientific attention at universities. These phenomena have become an alarming social issue due to their rising rate and devastating physical and psychological effects on undergraduate university students.

AIM

to estimate the prevalence of depression, low self-esteem, cybervictimization, anxiety, cyberbullying, and Internet addiction among Saudi female nursing university students and to identify the factors that predict cybervictimization and cyberbullying.

METHODS

Convenience sampling was used to select 179 female nursing university students with an average age of 20.80 ± 1.62 years for the purpose of conducting a descriptive cross-sectional study.

RESULTS

The percentage of students who reported having low self-esteem was 19.55%, depression (30.17%), Internet addiction (49.16%), anxiety (34.64%), cyberbullying (20.67%), and cybervictimization (17.32%). There was an inverse relationship between students' self-esteem and their risk of engaging in cyberbullying (AOR = 0.782, 95% CI: 0.830-0.950, p = 0.002) or becoming cybervictims (AOR = 0.840, 95% CI: 0.810-0.920, p < 0.001). Further, Internet addiction predicted both cyberbullying (AOR = 1.028, 95% CI: 1.012-1.049, p = 0.003) and cybervictimization (AOR = 1.027, 95% CI: 1.010-1.042, p < 0.001). The likelihood of experiencing anxiety was linked to cyberbullying (AOR = 1.047, 95% CI: 1.031-1.139, p < 0.001) and cybervictimization (AOR = 1.042, 95% CI: 1.030-1.066, p < 0.001).

CONCLUSION

Importantly, the findings suggest that programs designed to help university students avoid participating in cyberbullying activities or becoming cybervictims should take into account the influence of Internet addiction, mental health issues, and self-esteem.

Amelioration Strategies for Silver Diamine Fluoride: Moving from Black to White

Topical cariostatic agents have become a reasonable alternative for managing dental caries in young children. Silver diamine fluoride (SDF) is a practical topical approach to arrest caries and avoid extensive and risky dental treatment. However, the literature demonstrates a parental hesitation towards accepting SDF because of black unaesthetic tooth discolouration following application. The rapid oxidation of ionic silver darkens demineralised tooth structure permanently. In this regard, nano-metallic antimicrobials could augment or substitute for silver, and thereby enhance SDF aesthetic performance. Recently, biomedical research has drawn attention to selenium nanoparticles (SeNPs) due to their antimicrobial, antioxidant, and antiviral potencies. Various in vitro studies have examined the effect of SeNPs on the virulence of bacteria. This narrative review explores practical issues when using SDF and suggests future directions to develop it, focusing on antimicrobial metals. Several methods are described that could be followed to reduce the discolouration concern, including the use of nanoparticles of silver, of silver fluoride, or of selenium or other metals with antimicrobial actions. There could also be value in using remineralising agents other than fluoride, such as NPs of hydroxyapatite. There could be variations made to formulations in order to lower the levels of silver and fluoride in the SDF or even to replace one or both of the silver and fluoride components completely. Moreover, since oxidation processes appear central to the chemistry of the staining, adding SeNPs which have antioxidant actions could have an anti-staining benefit; SeNPs could be used for their antimicrobial actions as well. Future research should address the topic of selenium chemistry to optimise how SeNPs would be used with or in place of ionic silver. Incorporating other antimicrobial metals as nanoparticles should also be explored, taking into account the optimal physicochemical parameters for each of these.

The associations of dental aesthetics, oral health-related quality of life and satisfaction with aesthetics in an adult population

AIM

The aim of this study was to investigate the gender-specific associations between dental aesthetics, oral health-related quality of life (OHRQoL), and satisfaction with dental aesthetics in an adult population.

MATERIALS AND METHODS

The study population consisted of 1780 individuals (822 males and 958 females) from the Northern Finland Birth Cohort 1966 (NFBC1966). Dental aesthetics were evaluated from digital 3D dental models using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Layperson and orthodontist panels evaluated the dental aesthetics of a smaller sample (n = 100). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14) questionnaire. Satisfaction with dental aesthetics was asked with one separate question. Gender-specific analyses consisted of Mann-Whitney U-tests and Spearman's correlation coefficients.

RESULTS

More than half of the population had an aesthetically acceptable occlusion, and most of the individuals were satisfied with the aesthetics. The most severe aesthetic impairments were associated with the psychological dimensions of OHIP-14. There were significant but weak associations of AC and satisfaction with aesthetics, and satisfaction with aesthetics and OHRQoL. Significant gender differences were found, men having higher mean AC scores but women reporting lower OHRQoL.

CONCLUSION

At the population level, most of the individuals were satisfied with their aesthetics, despite different dental aesthetic conditions. The most severe aesthetic impairments were associated with decreased psychological well-being, women reporting more impacts compared to men.

Impact of dental bullying on bruxism associated with poor sleep quality among adolescents

This study aimed to investigate the impact of school bullying and oral health-related verbal bullying on the occurrence of bruxism associated with poor sleep quality among adolescents. This cross-sectional study was nested in a cohort study performed with a sample of children from southern Brazil. Possible sleep bruxism was determined by the question: "Has anyone told you that you grind your teeth in your sleep?" Sleep quality was determined by answering the following question: "How would you classify the quality of your sleep?". The outcome was created by combining occurrence of sleep bruxism and poor sleep quality. The Sense of Coherence (SOC) was assessed using the SOC-13 scale. Bullying was investigated using the victim scale of the Olweus Bullying Questionnaire and oral health-related verbal bullying using an item from the Child Perceptions Questionnaire-11-14. Demographic, socioeconomic, psychosocial, and clinical data were also collected. Poisson regression models with robust variance were used. Results were expressed as prevalence ratio (PR) and 95% confidence intervals (95% CI). A total of 429 adolescents with a mean age of 12.6 (standard deviation 1.3) years were evaluated. The prevalence of bruxism associated with poor sleep quality was 23.7%. Victims of school bullying (PR 2.06; 95%CI: 1.01-4.22) and oral health-related verbal bullying (PR 1.87; 95%CI: 1.18-2.95) presented higher prevalence of bruxism associated with poor sleep quality. Factors such as skin color and SOC were also associated with the outcome. These findings suggest an association between episodes of bullying and bruxism related to poor sleep quality.

Impact of bone-anchored maxillary protraction on the quality of life of subjects with complete unilateral cleft lip and palate

INTRODUCTION

This study aimed to evaluate the influence of bone-anchored maxillary protraction (BAMP) on the oral health-related quality of life (OHRQOL) in subjects with complete unilateral cleft lip and palate (UCLP) and moderate-to-severe maxillary deficiency.

METHODS

A longitudinal observational study was conducted with a sample of 20 patients (13 males, 7 females) aged 10-14 years (mean age, 11.8 years) with Goslon 3, 4, and 5. To assess the patient's perception of their OHRQOL, the Quality of Life Questionnaire for Orthosurgical Patients was administered in 2 stages: after the installation of the protraction plates (T1) and 18 months after the protraction therapy started (T2). The questionnaire was composed of 4 domains, distributed over 22 questions: social aspects, facial esthetics, oral function, and awareness of facial deformity.

RESULTS

The treatment protocol improved the OHRQOL in 75% of the patients who presented UCLP. The domain social aspects of the deformity were the only one that showed a significant difference from T1 to T2 and indicated an improvement in self-esteem. The girls had worse OHRQOL than boys at T1, which was statistically significant only for the domains of social aspects of deformity and awareness of deformity. After BAMP therapy, the effect size indicated a larger change in OHRQOL in girls than in boys.

CONCLUSIONS

BAMP therapy positively impacted the OHRQOL and self-esteem of patients with UCLP during adolescence.

Oral Health Literacy, Sense of Coherence and Associations With Poor School Performance

BACKGROUND

This study aimed to investigate the associations of oral health literacy (OHL), sense of coherence (SOC) and other covariates with self-reported school performance (SRSP) in adolescents enrolled in public schools in Brazil.

METHODS

This was a cross-sectional study conducted with adolescents aged from 14 to 18 years enrolled in 6 public schools in Piracicaba, São Paulo, Brazil. Researchers carried out data collection at schools using a self-administered structured questionnaire. The dependent variable was SRSP. The explanatory factors included were sociodemographic characteristics, OHL, SOC, self-rated oral health, health behaviors, and experience of bullying. Analyses included simple and multiple logistic regression models.

RESULTS

The final sample consisted of 385 adolescents with a mean age of 16 years. Poor school performance was associated (95%CI) with being male, with more than 1 sibling, individual whose last visit to the dentist was due to dental pain, with a lower level of OHL and SOC.

CONCLUSIONS

OHL and SOC were important factors associated with SRSP performance together with other sociodemographic and oral health-related variables in high school students. Our findings reinforce the importance of intersectoral actions between the health and education sectors to promote better school performance among adolescents, including actions to improve OHL and SOC.

Post-trauma complex orthodontic approach: the impact of psychological issues of bullying on treatment decision

Objective:

This article aims to discuss the multidisciplinary approach required in the treatment of cases of impaction and ankylosis of permanent teeth, associated with a history of trauma, considering the psychological state of the child and family when faced with a traumatic case of bullying, by reporting the complex treatment of a central incisor needing to be orthodontically moved across the midline.

Conclusion:

This clinical case was a major challenge, which included complex multidisciplinary procedures. Results and stability after 26 months of retention indicated successful orthodontic space closure of two maxillary teeth, without the use of implants or prostheses, in an adolescent patient who had a history of dental trauma, alveolar bone loss, and an uncertain initial prognosis.

Meneghim M, Vedovello SAS. Correlation between malocclusion and history of bullying in vulnerable adolescents

OBJECTIVES

To assess the correlation between malocclusion and a history of bullying.

MATERIALS AND METHODS

A cross-sectional study of 494 adolescents aged 12 to 15 years was conducted. The National School Health Survey questionnaire (PeNSE 1 and 2) was used to determine history of bullying by identifying the victim and the abuser. Variables were evaluated based on the individual (age), environment (income, father's and mother's education, housing, government assistance, and parents' occupation), social and emotional well-being (CPQ11-14 domains), self-perceived need for orthodontic treatment, and clinical conditions (crowding, diastema, maxillary and mandibular overjet, and anterior open bite). Data were analyzed by Spearman correlation and by multivariate analysis, which allowed graphical representation of the eight variables studied in only two dimensions.

RESULTS

There was no correlation between bullying and variables related to the individual and the environment. Maxillary overjet and self-perception related to the need for orthodontic treatment were important to explain the data variability.

CONCLUSIONS

Malocclusion did not correlate with bullying history. However, increased maxillary overjet influences adolescent self-perception, suggesting a potential condition for bullying events.

Eye movement analysis of children's attention for midline diastema

No previous studies have investigated eye-movement patterns to show children's information processing while viewing clinical images. Therefore, this study aimed to explore children and their educators' perception of a midline diastema by applying eye-movement analysis using the hidden Markov models (EMHMM). A total of 155 children between 2.5 and 5.5 years of age and their educators (n = 34) viewed pictures with and without a midline diastema while Tobii Pro Nano eye-tracker followed their eye movements. Fixation data were analysed using data-driven, and fixed regions of interest (ROIs) approaches with EMHMM. Two different eye-movement patterns were identified: explorative pattern (76%), where the children's ROIs were predominantly around the nose and mouth, and focused pattern (26%), where children's ROIs were precise, locating on the teeth with and without a diastema, and fixations transited among the ROIs with similar frequencies. Females had a significantly higher eye-movement preference for without diastema image than males. Comparisons between the different age groups showed a statistically significant difference for overall entropies. The 3.6-4.5y age groups exhibited higher entropies, indicating lower eye-movement consistency. In addition, children and their educators exhibited two specific eye-movement patterns. Children in the explorative pattern saw the midline diastema more often while their educators focussed on the image without diastema. Thus, EMHMMs are valuable in analysing eye-movement patterns in children and adults.

Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children

Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10−15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.

Understanding children’s attention to dental caries through eye-tracking

Visual attention is a significant gateway to a child's mind, and looking is one of the first behaviors young children develop. Untreated caries and the resulting poor dental aesthetics can have adverse emotional and social impacts on children's oral health-related quality of life due to its detrimental effects on self-esteem and self-concept. Therefore, we explored preschool children's eye movement patterns and visual attention to images with and without dental caries via eye movement analysis using hidden Markov models (EMHMM). We calibrated a convenience sample of 157 preschool children to the eye-tracker (Tobii Nano Pro) to ensure standardization. Consequently, each participant viewed the same standardized pictures with and without dental caries while an eye-tracking device tracked their eye movements. Subsequently, based on the sequence of viewed regions of interest (ROIs), a transition matrix was developed where the participants' previously viewed ROI informed their subsequently considered ROI. Hence, an individual's HMM was estimated from their eye movement data using a variational Bayesian approach to determine the optimal number of ROIs automatically. Consequently, this data-driven approach generated the visual task participants' most representative eye movement patterns. Preschool children exhibited two different eye movement patterns, distributed (78%) and selective (21%), which was statistically significant. Children switched between images with more similar probabilities in the distributed pattern while children remained looking at the same ROI than switching to the other ROI in the selective pattern. Nevertheless, all children exhibited an equal starting fixation on the right or left image and noticed teeth. The study findings reveal that most preschool children did not have an attentional bias to images with and without dental caries. Furthermore, only a few children selectively fixated on images with dental caries. Therefore, selective eye-movement patterns may strongly predict preschool children's sustained visual attention to dental caries. Nevertheless, future studies are essential to fully understand the developmental origins of differences in visual attention to common oral health presentations in children. Finally, EMHMM is appropriate for assessing inter-individual differences in children's visual attention.

Periodontal status of maxillary central incisors after orthodontic traction: a longitudinal follow-up

BACKGROUND

The aim of this study was to evaluate the clinical and radiographic periodontal status of impacted permanent maxillary central incisors (Mx.1) after a long term of orthodontic traction.

METHODOLOGY

This split-mouth study evaluated a sample of 11 patients (five females, six males) treated with Mx.1 unilateral traction one to 28 years after the removal of orthodontic appliances. The traction Group (TG) consisted of 11 Mx.1 and the Comparison Group (CG) comprised 11 spontaneously erupted contralateral Mx.1. High-resolution CBCT exams of central incisors were performed using Accuitomo (J. Morita, Kyoto, Japan). Cross-section imagens passing through the center of maxillary central incisors were used to measure buccal and lingual alveolar bone level. Presence of fenestration, root dilacerations, root coverage, and position of the root apex were also assessed in the same images. Clinical parameters included periodontal probing depth, attachment level, gingival bleeding index, plaque index, degree of gingival recession, amount of gingival mucosa, and evaluation of interproximal papilla and black triangle. Digital model analysis included an assessment of clinical crown height and width. Intergroup comparisons were performed using paired t-, McNemar's, and Wilcoxon tests (p<0.05).

RESULTS

Compared to CG, we found a significantly thinner labial bone plate thickness in TG at the middle (p=0.000) and apical (p=0.009) root level. We also observed an apical displaced labial bone crest level in TG (p=0.000). The Traction Group showed a greater frequency of root dilacerations and gingival recessions, a decreased amount of keratinized mucosa, and a decreased clinical attachment level at the labial aspect compared to contralateral teeth.

CONCLUSIONS

A decreased thickness and height of labial alveolar bone and gingival recessions were found in maxillary central incisors 15 years after orthodontic traction. Though incisor traction might cause some periodontal impact, differences are acceptable under a clinical point of view considering the cost-benefit ratio.

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES

To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05.

RESULTS

Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year.

CONCLUSIONS

Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Influence of clinical and demographic factors on the oral health-related quality of life of patients with cleft lip and palate undergoing orthodontic treatment: a systematic review and meta-analysis

OBJECTIVE

The purpose of this study was to evaluate the influence of orthodontic treatment on the oral health-related quality of life (OHRQoL) of patients with cleft lip and palate.

SEARCH METHODS

Electronic searches were conducted in Pubmed, Scopus, Web of Science, Cochrane Library, VHL, and OpenGrey databases, completed in January 2021.

SELECTION CRITERIA

Cross-sectional and longitudinal observational studies that presented an assessment of OHRQoL in cleft patients undergoing orthodontic treatment were included, according to PRISMA guidelines. Contacts via email were made with authors, to clarify inaccuracies or request additional data.

DATA COLLECTION AND ANALYSIS

The entire process was accomplished by two authors, in case of disagreement, a third author mediated the discussion until there was a consensus. Risk assessment was performed by the Fowkes and Fulton qualifier, and the quality of evidence, assessed by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) tool. A meta-analysis was performed considering the domains combined into three large groups (physical, psychological, and social). The questionnaires were standardized as to the scores and their direction.

RESULTS

A total of 3822 studies were retrieved. After excluding duplicates, the titles and abstracts of the remaining articles were analysed. Twenty-eight articles were read in full; 13 met the eligibility criteria; 12 articles showed sufficient methodological quality and 7 were included in the quantitative assessment. The included studies were published between 2011 and 2019. The samples comprised 19 to 183 patients of both sexes. GRADE showed low evidence when compared to the control group, sexes, age, and types of cleft and very low evidence among longitudinal articles.

CONCLUSIONS

The OHRQoL is lower in orthodontic patients with cleft than in those without. The OHRQoL of patients with cleft undergoing orthodontic treatment is not influenced by gender or age group, considering children and adolescents, but it is influenced by the type of cleft. The OHRQoL of patients with CLP does not undergo significant changes during orthodontic treatment.

LIMITATIONS

The variety of instruments for measuring OHRQoL rendered meta-analysis difficult.

REGISTRATION

PROSPERO database number CRD42017054764.

Beyond oral hygiene, are capacity-altering, biologically based interventions within the moral domain of dentistry?

Oral diseases such as dental caries (DC) and periodontitis are widely prevalent, and existing approaches to managing these conditions have only a limited effect. Accordingly, there is growing interest in the development of novel biological interventions (including, among others, CRISPR-Cas9) that might, in the future, be used to prevent the development of or cure these conditions. However, in addition to familiar concerns about using biological interventions in children who cannot provide valid consent, it is not clear whether the provision of these interventions would fall within the proper domain of dentistry. In this opinion paper, we defend the view that the provision of reasonably safe and effective novel biological interventions aimed at preventing DC and periodontitis should be understood to fall within the proper domain of dentistry. To do so, we first argue that their use would be consistent with existing practice in dentistry. We then argue that: i) they may substantially increase the recipient's wellbeing and future autonomy; and ii) that their use could constitute a form of indirect preventative medicine by addressing a threat to systemic health.

Associations among bullying role behaviors and academic performance over the course of an academic year for boys and girls

Although some research has evidenced a negative association between involvement in bullying and academic performance, more work is needed to understand the associations between academic performance and involvement in a more comprehensive range of bully role behaviors. The goals of the current study were to determine (a) the associations among a broader range of bully role behaviors (i.e., bullying, assisting, victimization, defending, and outsider behavior) and academic performance (i.e., grade point average; GPA), and (b) gender differences within these associations. The current study investigated these issues over the course of an academic year with 7794 students in middle through high school. Bullying behaviors were assessed in the fall and GPA data were gathered from school records from the spring of the same academic year. The results identified significant negative associations between bullying (b = -0.07, p = .001), assisting (b = -0.16, p < .001), victimization (b = -0.06, p < .001), and defending (b = -0.04, p < .001) with student GPA, whereas no significant association emerged for outsider behavior and GPA (b = -0.02, p = .13). In addition, several gender differences were found in these associations, including a stronger negative association between assisting and GPA for girls (b = -0.23, p = .001) than for boys (b = -0.08, p = .014) and a significant negative association between victimization and GPA for girls (b = -0.09, p < .001), but not boys (b = -0.02, p = .117). Differences in results across schools were also examined in an exploratory manner. The educational impact associated with bullying behaviors, limitations of the current study, and suggestions for future research are discussed.

Dental anomaly patterns in mixed dentition: Illustrating the role of interceptive orthodontics in the management of mandibular lateral incisor-canine transpositions and palatally displaced maxillary canines

Dental anomalies of size, number, and position have been suggested to have a genetic background and frequently complicate the orthodontic treatment. Early intervention is a paramount step in managing patients with dental anomaly patterns (DAPs) to decrease the complexity of the case during the later stages of comprehensive orthodontic care. This case report highlights the importance of the detailed diagnosis in a case with several dental anomalies (mandibular lateral incisor-canine transposition, palatally displaced canines, small-sized maxillary lateral incisors and congenitally missing second premolar), utilizing interceptive orthodontic management in the mixed dentition stage in order to minimize the complexity and complications of comprehensive orthodontic care in the permanent dentition stage.

Dentoskeletal changes in open bite treatment using spurs and posterior build-ups: A randomized clinical trial

INTRODUCTION

This single-center 2-arm parallel randomized clinical trial aimed to compare the dentoskeletal effects of bonded spurs combined with posterior build-ups vs conventional bonded spurs in the treatment of anterior open bite malocclusion in the mixed dentition.

METHODS

Patients aged from 7 to 11 years with anterior open bite, recruited at a university orthodontic clinic, were randomly allocated into 2 groups. The experimental group consisted of patients treated with bonded spurs combined with posterior build-ups. The comparison group comprised patients treated with conventional bonded spurs. Lateral headfilms were obtained at pretreatment and after 12 months of treatment. The primary outcome was the change in the overbite. Randomization was performed using the Web site www.randomization.com. Sequentially numbered opaque and sealed envelopes were used for allocation concealment. Blinding was applicable for outcome assessment only. Intergroup comparisons were performed using t or Mann-Whitney U tests (P <0.05). Mean difference (MD) and 95% confidence interval (CI) were obtained.

RESULTS

The experimental group included 24 patients (17 female, 7 male; mean age, 8.22 ± 1.06 years) and the comparison group comprised 25 patients (14 female, 11 male; mean age, 8.30 ± 0.99 years). Baseline demographic and cephalometric characteristics were similar between groups. After 12 months, all patients showed improvements. Both groups showed similar improvements of the overbite (MD, 0.00 mm; 95% CI, -0.92 to 0.91), similar slight decreases of the gonial (MD, 0.02°; 95% CI, -1.11 to 1.15) and mandibular plane (MD, 0.15°; 95% CI, -0.64 to 0.93) angles, and similar mandibular molar extrusion (MD, 0.14 mm; 95% CI, -0.27 to 0.56). The experimental group showed significantly smaller extrusion of the maxillary first molar than the comparison group (MD, -0.70 mm; 95% CI, -0.92 to -0.49). The other dentoskeletal variables showed similar changes without statistically significant intergroup differences. No serious harm was observed other than plaque accumulation around the spurs.

CONCLUSIONS

Similar overbite increases and dentoskeletal changes were observed in both groups after 12 months of treatment. Although the experimental group showed significantly smaller extrusion of the maxillary molars, no greater counterclockwise rotation of the mandible than the comparison group was observed.

REGISTRATION

This trial was registered at Clinicaltrials.gov (Identifier NCT03702881).

PROTOCOL

The protocol was not published.

FUNDING

This trial was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES), Finance Code 001; and by grants: no. 2017/06440-3, no. 2018/05238-9 and no. 2018/24003-2, São Paulo Research Foundation (FAPESP).

Parental Reported Bullying among Saudi Schoolchildren: Its Forms, Effect on Academic Abilities, and Associated Sociodemographic, Physical, and Dentofacial Features

Aim

To determine the prevalence of bullying, its forms, and its effect on academic abilities and school attendance, as well as associated sociodemographic, physical, and dentofacial features among Saudi schoolchildren.

Methods

This cross-sectional study recruited a sample of 1131 parents of schoolchildren 8-18 years old and requested them to complete internationally accepted questionnaires for their children. Chi-squared test and logistic regression analysis were used to analyze the data (p < 0.05).

Results

A majority (89.2%) of schoolchildren were bully victims. Physical bullying (48.9%) was the most common form of bullying. The youngest schoolchildren (8-11 years) and those who disliked school classes or neither liked nor hated them, as well as those who were truant from school, were more likely to be victims. In addition, those who had worse grades because of bullying and those who were very often bullied because of good grades or because they showed an interest in school were more likely to be victims. With regard to targeted physical features, teeth were the number one target, followed by the shape of the lips and strength, while tooth shape and color were the most common dentofacial targets, followed by anterior open bite and protruded anterior teeth. Boys and the youngest schoolchildren were more often subjected to bullying because of these features (p < 0.05).

Conclusions

The prevalence of bullying, mainly in a physical form, was high among Saudi schoolchildren, with a negative influence on students' academic abilities. Problems related to teeth, in particular, which can be treated, were targets, mainly for boys and the youngest schoolchildren. More studies are required in Saudi Arabia to explore the issue further among schoolchildren themselves.

Is there a relationship between malocclusion and bullying? A systematic review

Background

Malocclusion is a highly prevalent public health problem, and several studies have shown its negative correlation with quality of life, self-esteem, and social perceptions. However, its association with bullying is still controversial.

Objectives

To evaluate the relationship between malocclusion and bullying in children and adolescents.

Search methods

The databases used for the electronic researches were PubMed, Scopus, Lilacs/BBO, Web of Science, and Cochrane Library. Grey literature was reviewed through Open Grey literature with no language or date restrictions. Selection criteria, based on the PECO strategy, were considered eligible observational studies that included schoolchildren or adolescents (P) with malocclusion (E), compared to those with normal occlusion (C), in which the relationship between malocclusion and bullying was determined (O).

Data collection and analysis

Risk of bias evaluation was made for the qualitative synthesis by the Fowkes and Fulton criteria. Data regarding the age of participants and types of malocclusion and of bullying were extracted among other reported data. The quality of the evidence analyzed was evaluated through the GRADE approach.

Results

From 2744 articles identified in databases, nine met the eligibility criteria and were included in present systematic review, of which two studies were judged with methodological soundness. The quality of the evidence was classified as very low due to very serious problems for “risk of bias” and “other considerations” and serious problems of “indirectness”. The age of participants ranged from 9 to 34 years considering a cohort study, with a bullying recalling perspective. Malocclusion was both evaluated by researchers and self-reported by participants addressing dentofacial characteristics mostly related to the incisors relationship. All studies evaluated the verbal type of bullying, while 3 also considered physical type. Both types were reported as related to malocclusion, although the results showed that extreme maxillary overjet (> 4 mm, > 6 mm, > 9 mm), extreme deep overbite, and having space between anterior teeth or missing teeth were the types of malocclusion with the strongest relations to bullying.

Conclusions

With very low certainty of evidence, the results of this systematic review suggest that conspicuous extreme malocclusion may be related to the occurrence of bullying among children and adolescents.

Relationship between gingival bleeding and associated factors with reports of verbal bullying in adolescents

BACKGROUND

Dentofacial features are related to increased bullying episodes in young people. The aim of this study was to assess the association between gingival bleeding and reports of verbal bullying among adolescents.

METHODS

This is a cross-sectional study conducted with a representative sample of 608 12-year-old adolescents from southern Brazil. The occurrence of verbal bullying was verified through adolescents' self-report. Oral health measurements included the presence of gingival bleeding, dental fracture, dental fluorosis, and dental caries experience. Gingival bleeding was assessed through adolescent self-perception by the following question: "Did you notice any bleeding in your gums?" Demographic, socioeconomic, and psychosocial variables were also evaluated. Poisson regression models with robust variance were used to evaluate the influence of gingival bleeding on the occurrence of verbal bullying. Results are presented as prevalence ratio (PR) and 95% confidence interval (95% CI).

RESULTS

Out of 608 adolescents evaluated, 577 answered bullying questions. The prevalence of self-reported verbal bullying was 12.8%. Adolescents who presented gingival bleeding had an 80% higher prevalence of verbal bullying than their counterparts (PR 1.80; 95% CI 1.01 -3.19). Dental shame, speech difficulties and influence of dental condition on studies also impacted the higher prevalence of bullying.

CONCLUSION

Our results suggest that the presence of gingival bleeding negatively impacts the social life of adolescents, causing more episodes of verbal bullying. These findings encourage public health policies aimed at reducing oral health inequities, thus reflecting on the well-being and quality of life of this target population.

Prevalence, correlates, and experiences of school bullying among adolescents: A national study in Jordan

School bullying is recognized as a global problem and sparks public concerns for students’ safety. While it has recently emerged as a critical concern in the Arab world, particularly in Jordan, no national studies have yet investigated the extent of bullying in Jordanian schools. The purpose of this study was to investigate the prevalence, correlates, and experiences of bullying among a national sample of Jordanian adolescent students. A stratified random sampling procedure was used to select schools that represent the three main regions of Jordan (i.e. north, middle, and south) and a weighted sample of schools was randomly selected using Statistical Analysis System 9.4 based on provinces’ density. A nationally representative sample of 1083 adolescents aged 12 to 17 was included in the study. Data were collected using self-administered questionnaires on school bullying and adolescent sociodemographics. The prevalence of bullying among Jordanian adolescents was consistent with international studies; 7% reported their involvement in bullying as a victim, 7.6% as a bully, and 1.7% as both. Verbal bullying was the most common form of bullying among victims and bully-victim, while relational bullying was the most prevalent bullying for bullies. Being a perpetrator was more prevalent among boys than girls. Adolescent students who came from low socioeconomic status or whose fathers were illiterate reported more victimization experience. The majority of students who experienced bullying reported negative attitudes of bystanders, parents, and teachers towards intervening or responding to the bullying experience. Bullying exists among Jordanian students and active steps towards addressing this phenomenon are discussed. This is the first known Jordanian study representing a national sample of adolescent students’ experience of bullying. Findings present valuable information for school professionals, parents, and students regarding bullying and its associated factors. These findings also provide an avenue for the adoption and implementation of available anti-bullying programs to ameliorate bullying behaviors among Jordanian school students.

Perception of Dentofacial Aesthetics in School Children and Their Parents

OBJECTIVE

 The aim of this research was to examine the attitudes and perceptions of dentofacial aesthetics among different age groups.

MATERIALS AND METHODS

 The sample consisted of elementary-school students from the city of Sarajevo, Bosnia and Herzegovina, and their parents. This study included 314 subjects: 157 children and 157 parents. The children's group consisted of 85 (54.14%) males and 72 (45.85%) females, aged 9 to 15 years.

STATISTICAL ANALYSIS

 Descriptive statistics were used to determine frequency distribution and percentages for all variables. A chi-squared (x ²) test was used to determine the association between variables and a p-value < 0.05 was considered significant for all the differences and associations.

RESULTS

 For the dentofacial appearance with no teeth irregularity or with severe teeth irregularity, an analysis of variance (ANOVA) (post-hoc tests-Tukey's HSD) indicated that the difference is not statistically significant (p = 0.06) relative to rank matching between all three subject groups.For dentofacial appearance with mild teeth irregularity, an ANOVA (post-hoc tests-Tukey's HSD) showed statistical difference (p = 0.07) between the teenage group of subjects relative to pre-teenage group of subjects and adult group of subjects.

CONCLUSION

 Attitudes about desirable and acceptable dental aesthetics differ in younger children compared with older children and parents. Ten years old children find good function with poor aesthetics more pleasing, while 14 years old children find aesthetics with bad function as more pleasing.

Oral disorders associated with the experience of verbal bullying among Brazilian school-aged children: A case-control study

BACKGROUND

Dental features have been considered a potential target of verbal bullying (VB) among school-aged children. The authors conducted a study to investigate the association between the presence of oral disorders and the occurrence of VB among 8- through 10-year-old school-aged children.

METHODS

The study included 445 school-aged children 8 through 10 years old. VB was verified by a specific validated question from the Child Perceptions Questionnaire 8-10 index. Oral disorders such as untreated caries, fluorosis, clinical consequences of untreated caries, and malocclusion were evaluated. The Pearson χ² test and bivariate and multivariate conditional logistic regression analyses were used for statistical analysis.

RESULTS

A total of 390 school-aged children completed the study. The results of the multivariate logistic regression model showed that a severe malocclusion (odds ratio [OR], 2.29; 95% confidence interval [CI], 1.03 to 5.10), a greater maxillary misalignment (OR, 2.23; 95% CI, 1.05 to 4.73), and the presence of a tooth with pulp exposure (OR, 2.93; 95% CI, 1.58 to 5.45) were significantly associated with the occurrence of VB.

CONCLUSION

Children aged 8 through 10 years with a severe malocclusion, larger maxillary misalignment, or the presence of pulp exposure had increased odds of experiencing VB compared with children without those oral health conditions.

PRACTICAL IMPLICATIONS

Once oral disorders involved in VB are identified, appropriate approaches should be used to address this issue. With this course of action, oral health care professionals may use the treatment and preventive care to eliminate potential factors for peer aggression.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria

BACKGROUND

Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases.

METHODS

This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression.

RESULTS

Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03).

CONCLUSION

There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.

Dental anomaly pattern and multiple ectopic teeth

Treatment for a patient with a dental anomaly pattern is challenging and complex. This article presents a rare case with an association of multiple ectopic eruptions treated in 2 phases. An 8-year-old boy in the early mixed dentition showed a Class II, Division 2 malocclusion, and an ectopic eruption of the mandibular right lateral incisor. The treatment plan included extractions of the deciduous mandibular right lateral incisor and canine, followed by partial mandibular fixed appliances and a lingual arch. In the late mixed dentition, the panoramic radiograph showed bilateral ectopic eruptions of the maxillary canines. The deciduous maxillary canines were extracted, and a cervical headgear was installed. Within 12 months, both permanent maxillary canines spontaneously erupted. Comprehensive orthodontic treatment was initiated when the patient was aged 13 years to level the curve of Spee and reduce the overbite. Phase 2 lasted 15 months. In patients with dental anomaly patterns, longitudinal follow-up during the mixed dentition is highly important and might contribute to simplifying comprehensive orthodontic treatment and reducing complications and adverse effects.

Dentoskeletal effects of the maxillary splint headgear in the early correction of Class II malocclusion

Background

To compare dentoskeletal changes produced by the maxillary splint headgear and cervical headgear appliance during the early phase of Class II treatment, specially the initial overjet and upper incisors position.

Subjects and methods

In this retrospective study, 28 Class II patients treated with the maxillary splint headgear (MSG, mean age 10.1 ± 1.9 years) and 28 Class II patients treated with cervical headgear (CHG, mean age 9.5 ± 1.9 years) were evaluated before and after treatment. Statistical comparisons between the two groups for cephalometric measurements at T1 and for T2-T1 changes were performed by means of independent sample t tests.

Results

The MSG showed a significantly greater reduction of the overjet in comparison to the CHG (− 2.4 mm and − 0.7 mm, respectively) and a significantly greater maxillary incisor uprighting (− 1.8 mm and 0.4 mm, respectively). In the MSG, overjet correction was due mainly to mandibular advancement (3.5 mm), while the correction of molar relationship (3.9 mm) was 64% skeletal and 36% dentoalveolar. In the CHG, the overjet correction was also more skeletal, due to mandibular growth (1.8 mm), while correction of molar relationship (3.5 mm) was 63% dentoalveolar and 37% skeletal.

Conclusions

Both groups showed favorable skeletal mandibular changes, which was more significant in the MSG. Regarding tooth movement, the maxillary splint headgear was more effective in uprighting upper incisors and reducing the overjet than cervical headgear appliance.

Effectiveness of prefabricated myofunctional appliances in the treatment of Class II division 1 malocclusion: a systematic review

BACKGROUND

Prefabricated myofunctional appliances (PMAs) are widely advocated for correcting Class II division I malocclusion. However, their effectiveness is associated with a high amount of uncertainty within contemporary literature.

OBJECTIVES

The aim of this review was to systematically examine the available literature regarding the effectiveness of PMAs in treating Class II division 1 malocclusion in children and adolescents.

SEARCH METHODS

Comprehensive unrestricted electronic searches in multiple databases as well as manual searches were conducted up to August 2018.

SELECTION CRITERIA

Randomized controlled trials (RCTs) and non-randomized studies (NRS) matching the eligibility criteria.

DATA COLLECTION AND ANALYSIS

Two independent review authors were directly involved in study selection, data extraction, and bias assessment. The Cochrane risk of bias tool and the ROBINS-I tool were used for assessing the risk of bias. Quantitative pooling of the data was undertaken with a random-effects model with its 95% confidence interval (CI).

RESULTS

Three RCTs comparing PMAs to activators and three NRS comparing PMAs to untreated controls met the inclusion criteria. On a short-term basis, exploratory quantitative synthesis indicated that the activators were more effective than the PMAs in correcting overjet with a mean difference of (1.1 mm; 95% CI: 0.44 to 1.77). On a long-term basis, there were no significant differences between the two appliances. Qualitative synthesis indicated less favorable soft tissue changes as well as patient experiences and compliance with the PMAs when compared to the activators. However, PMAs were associated with reduced costs compared to customized activators and modest changes when compared to untreated controls.

CONCLUSIONS

On a short-term basis, low quality of evidence suggests that PMAs were generally less effective than the activators in treating Class II division 1 malocclusion. The main advantage of PMAs seems to be their reduced costs. These results should be viewed with caution, as a definitive need for high-quality long-term research into this area is required.

REGISTRATION

PROSPERO (CRD42018108564).

Self-perceived dental treatment need among adolescents: A hierarchical analysis

OBJECTIVES

The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents.

METHODS

A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model.

RESULTS

Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001).

CONCLUSIONS

The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.

Association between social conditions and oral health in school failure

OBJECTIVE

To evaluate the association of school failure among Brazilian adolescents with social conditions and aspects of oral health through hierarchical analysis.

METHODS

A state-wide survey of 5,558 adolescents from the state of São Paulo, Brazil, inquired about the sociodemographic and social capital of participants by using a structured questionnaire. Trained and calibrated professionals performed intraoral examinations and interviews in the households. Questions about the access to dentist, reason for and frequency of using dental services, toothache episodes and impact of oral conditions on daily activities (OIDP) were applied. Oral examinations evaluated caries experience, tooth losses, periodontal problems, presence of open bite, and maxillary and mandibular overjet. School failure was estimated according to the teenagers' years of schooling. The independent variables were grouped into three blocks: sociodemographic and economic characteristics, social capital and oral health aspects. The multiple hierarchical logistic regression model was used to identify the factors associated with school failure.

RESULTS

Of the total sample, information about schooling of 5,162 adolescents was obtained, of whom 29.6% presented school failure. We found that adolescents over the age of 16 years who did not declare themselves as white, female, with feelings of insecurity, unhappiness, with toothache, caries, tooth losses, affected by dentofacial and/or periodontal changes, were more likely to fail at school.

CONCLUSION

Oral disorders and social factors were associated with school failure in adolescents. A successful school trajectory was a strong determinant of health, therefore actions between the educational and health sectors must be developed for adolescents, especially those with this profile.

Spontaneous Eruption of Severely Impacted teeth: The Report of Two Cases

The unerupted and impacted tooth is a common problem and the reason for many orthodontic and pediatric dental referrals, yet the approach to their management is still an area of controversy. This article presents two cases of severely impacted teeth that spontaneously erupted in the maxillary and mandibular arches. The first patient, a 9-year-old girl, presented a severe impaction of mandibular right and left second premolars. The second patient, a 7-year-old girl, presented with a severely impacted maxillary central incisor. In both cases, the teeth spontaneously erupted into excellent positions without surgical procedures and orthodontic traction. This raises important questions concerning the possible treatment options for such teeth as well as the timing of any interceptive treatment. In cases of unerupted or impacted teeth, a multidisciplinary approach is indicated involving orthodontics, paedodontics and oral surgery to establish the optimal treatment plan.

Key words:Tooth eruption, tooth, impacted, orthodontics, interceptive, case reports.

Does dental trauma influence the social judgment and motivation to seek dental treatment by children and adolescents? Development, validation, and application of an instrument for the evaluation of traumatic dental injuries and their consequences

BACKGROUND

One's smile clearly plays a significant role in the perception and judgment that others have of one's appearance and personality.

AIM

We sought to develop and validate a questionnaire related to the social judgment of children and adolescents and to evaluate, through its application, the perceptions and judgment of children and adolescents regarding their view of different traumatic dental injuries and their consequences (TDIs-Cs) as well as the motivation to seek dental treatment.

DESIGN

The aspects of acceptability, discriminative properties, internal consistency, test-retest reliability, and construct validity were evaluated in the developed questionnaire. A cross-sectional study was conducted involving 100 boys and girls aged 10-15 years. Images of an adolescent male and female were either manipulated or not (control) to create different types of TDI-C (eg, enamel fracture, enamel and dentin fracture, crown colour change, and tooth loss/avulsion). These images were analysed by the participants, using a previously validated questionnaire with a six-positive-point and six-negative-point scale, in relation to their social physical and psychosocial characteristics. The data were analysed with the Friedman, Wilcoxon, and Mann-Whitney tests (P < 0.05).

RESULTS

The developed questionnaire presented high acceptability, strong discriminative properties, satisfactory internal consistency, and satisfactory test-retest reliability, but weak construct validity. The presence of TDI-C had a negative effect on all characteristics evaluated (P < 0.001). Tooth loss had the highest level of rejection. Additionally, the presence of TDI-C had a greater negative impact on the aspects of 'starting fights', 'being given a nickname', and 'being ashamed to smile' in males than in females (P < 0.05). Children and adolescents with TDI-C were judged as needing to seek dental treatment (P < 0.001).

CONCLUSION

The questionnaire developed showed properties of validity and reliability in its administration in a child and adolescent population. TDIs-Cs have a negative influence on the social judgment of children and adolescents.

Impact of the need for orthodontic treatment on academic performance, self-esteem and bullying in schoolchildren

Objective: The aim of this study was to evaluate the impact of the need for orthodontic treatment on academic performance, self-esteem and bullying in schoolchildren. Material and methods: This cross-sectional study included a total of 147 school children between 12 and 18 years of age. Academic performance was measured taking into account the final average grades for all the courses; for self-esteem and bullying, scores obtained with validated questionnaires were used. The Dental Aesthetic Index was used to determine the need for orthodontic treatment. The Kruskal Wallis test was used for the comparisons between the scores for academic performance, self-esteem and bullying according to each category of need for orthodontic treatment; a level of significance of 5% was considered.Results: The results showed mean academic performance scores of 13.6, 12.5, 12.9, 13.2 for those who did not need orthodontic treatment, those with defined malocclusion, severe malocclusion and very severe malocclusion, respectively; for self-esteem the scores were 21.6, 20.9, 21.0 and 20.5; and for bullying, 14.2, 15.4, 14.5 and 13.0. No statistically significant differences were found between the scores in the different groups evaluated (p>0.05). Conclusion: The need for orthodontic treatment in schoolchildren showed no impact on academic performance, self-esteem and bullying. The need for orthodontic treatment, as measured by the Dental Aesthetic Index, did not prove to be a determining factor in the presence of such variables in schoolchildren.

Correlates of bullying and its relationship with psychiatric disorders in Lebanese adolescents

Understanding the contextual determinants of bullying behavior is pivotal for effective interventions. This paper describes the prevalence of bullying, its socio-demographic correlates and factors influencing its relationship with psychiatric disorders among a population-based sample of adolescents from Beirut recruited through a two-stage cluster sampling design. Recruited participants (n = 510) and their parents completed a battery of questionnaires and interviews including the Development and Wellbeing Assessment (DAWBA) and the Peer-Relations Questionnaire (PRQ). We found that around 30% of the adolescent participants were involved in bullying. Younger age, lower family income, lower parental education, receiving private tutoring, having an anxiety disorder and having a disruptive behavior disorder were correlated with being bullied by peers while lower family income, repeating a school-grade, and having a disruptive behavior disorder were associated with bullying others. Several factors including gender, age group, family income, and attending private versus public schools moderated the relationship between bullying behavior and having psychiatric disorders. Our findings thus highlight the complexity of the association between psychiatric disorders and bullying in settings like Lebanon.

Factors Affecting Jordanian School Adolescents' Experience of Being Bullied

PURPOSE

The purpose of this study was to identify the Jordanian school adolescents' experience of being bullied, and to examine its association with selected socio-demographic variables.

DESIGN AND METHODS

This cross sectional descriptive study used multi-stages cluster sampling technique to recruit a sample of in-school adolescents in Jordan (N=436). The Personal Experiences Checklist was used to measure the experience of bullying. Descriptive statistics and parametric tests were used in the analysis.

RESULTS

Relational-verbal bullying was the most common form of bullying while cyber bullying was the least common type. Male adolescents experienced bullying more than females. In addition, adolescents belonging to low-income families experienced bullying more than those from moderate-income families. Finally, being bullied was negatively correlated with academic performance of students.

CONCLUSIONS

This study indicated that risk factors for bullying are multifaceted which necessitate the development of prevention and intervention strategies to combat bullying taking into consideration these factors.

PRACTICE IMPLICATIONS

Schools should introduce environmental changes to discourage bullying and establish a policy with specific guidelines of what constitutes bullying behavior and expected disciplinary procedures. Staff training on information about the definition of bullying, current trends, and the effects of bullying is also recommended.

Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment

Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying.

Untreated Dental Caries Is Associated with Reports of Verbal Bullying in Children 8-10 Years Old

The objective of this research was to verify the association between verbal bullying and untreated dental caries. The present cross-sectional study had a representative sample of 1,589 children, aged 8-10 years, from public schools. Information on verbal bullying related to the oral condition was obtained through a questionnaire directed to the students. Clinical data were collected by 4 calibrated examiners (kappa > 0.70) using the DMFT/dmft and PUFA/pufa indexes for caries. Socioeconomic issues were answered by those responsible. The prevalence of verbal bullying related to the oral condition was 27%. The results of the Poisson regression, in an adjusted multiple model, showed a significant association between bullying and untreated caries lesions (prevalence ratio, PR: 1.27; 95% CI: 1.07-1.52), PUFA/pufa index (PR: 1.34; 95% CI: 1.11-1.61), pulp involvement (PR: 1.35; 95% CI: 1.09-1.67), and abscess (PR: 1.74; 95% CI: 1.18-2.56). It was concluded that children with untreated dental caries had a higher prevalence of verbal bullying when compared to caries-free or disease-treated children.

Relationship between childhood bullying and addictive and anti-social behaviors among adults in Saudi Arabia: a cross-sectional national study

Background Bullying is a widespread public health problem among youth with potentially far reaching negative implications. Objective To determine the prevalence of childhood bullying and its association with addictive and anti-social behaviors among adults. Subjects Adults (n = 10,156) aged ≥18 years were invited to participate. Methods A cross-sectional, national study utilizing Adverse Childhood Experiences International Questionnaire (ACE-IQ) was conducted in Saudi Arabia (SA). Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for bullying in relation to the outcome. Results Participant's mean age was 34.3 ± 11.3 years and 52% were male. Thirty-nine percent of the participants reported being bullied. Significant gender differences were found in terms of prevalence of different types of bullying. Men reported higher prevalence of physical (40% vs. 33%, p < 0.01) and sexual (19% vs. 10%, p < 0.01) types of bullying. In contrast, women tend to report higher prevalence of psychological (16% vs. 9%, p < 0.01) and social (14% vs. 10%, p < 0.01) types of bullying. Bullying victims were 1.8 (95% CI 1.6-2.1) times more likely to smoke, 2.3 (95% CI 1.9-2.7) times more likely to drink alcohol, 2.9 (95% CI 2.4-3.4) times more likely to use drugs, 2.1 (95% CI 1.8-2.4) times more likely to have ever had out of wedlock sexual relations, and 2.5 (95% CI 2.1-3.0) times more likely to have suicidal thoughts compared to those who were not bullied. Conclusion Childhood bullying increases the chances of risky behaviors among adults in SA. Prevention of bullying should be in the national agenda of the Ministry of Education.

Oral and Dental Aspects of Child Abuse and Neglect

In all 50 states, health care providers (including dentists) are mandated to report suspected cases of abuse and neglect to social service or law enforcement agencies. The purpose of this report is to review the oral and dental aspects of physical and sexual abuse and dental neglect in children and the role of pediatric care providers and dental providers in evaluating such conditions. This report addresses the evaluation of bite marks as well as perioral and intraoral injuries, infections, and diseases that may raise suspicion for child abuse or neglect. Oral health issues can also be associated with bullying and are commonly seen in human trafficking victims. Some medical providers may receive less education pertaining to oral health and dental injury and disease and may not detect the mouth and gum findings that are related to abuse or neglect as readily as they detect those involving other areas of the body. Therefore, pediatric care providers and dental providers are encouraged to collaborate to increase the prevention, detection, and treatment of these conditions in children.

Bullying, its effects on attitude towards class attendance and the contribution of physical and dentofacial features among adolescents in Northern Nigeria

Background Bullying is a worldwide problem with varying consequences. Victims of school bullying may be targeted for many reasons including their appearance. They may also fear school and have difficulties in concentration. Objective This study aimed to determine the prevalence of bullying amongst adolescents in Kano, Northern Nigeria, the contribution of physical features and the perceived effect of bullying on their academic performance and school attendance. Subjects and methods Eight hundred and thirty-five students aged between 12 years and 17 years from eight randomly selected secondary schools in Kano, Nigeria took part in this study. Data collection was by self-administered questionnaires and analysis was by SPSS version 17. Results The pupils' mean age and standard deviation was 14.79 + 1.53 years. There were more male and private school pupils with 55.1% and 62%, respectively. About 43% of respondents reported being victims of bullying while about 32% had bullied someone else. There was more bullying in public schools than in private schools (p-value = 0.003). However, there was no significant gender difference (p > 0.05). More bullied pupils hated being in or outside the classroom (p < 0.05). Similarly, significantly higher number of bullied pupils played truant than non-bullied (p < 0.001). One-fifth of the victims of bullying felt it had consequences on their academic performance. Bullies frequently targeted general physical and dento-facial appearance. Conclusion The prevalence of bullying was high among the sampled population especially within public schools. This also had a significant negative effect on the students' academic performance.