Medically compromised patients in orthodontic practice: Review of evidence and recommendations

Guidelines for Orthodontic Management of Individuals With Mental Illness Using Psychiatric Medication: A Systematic Review

The majority of mentally challenged individuals anticipate treatment with inflated levels of concern more than conventional orthodontic patients. However, there are no systematic reviews on behavioral modification techniques and orthodontic therapy for people with mental illness. Therefore, the goal of the review was to highlight the orthodontic concerns for people with mental disabilities with the intent to address the problems that emerge when providing orthodontic care. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and population, exposure, and outcome (PEO) criteria were followed in conducting the review. An electronic search was performed in the PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases searched through EBSCO and Google Scholar for potentially relevant publications in the English language from January 2002 to December 2022. Studies reporting behavioral modification strategies and/or physical constraints used during orthodontic treatment of mentally challenged patients were included in the review. The quality of the included studies was evaluated using the Joanna Briggs Institute (JBI) critical appraisal checklist for case reports and research reviews and synthesis. The initial electronic and manual search yielded 233 articles. After eliminating duplicates and reviewing the title/abstracts, 75 articles were selected for independent full-text review. Based on the eligibility criteria, 12 studies were finally chosen for qualitative synthesis. Four of these studies were case reports, while eight were comprehensive reviews. The JBI critical assessment criteria for case reports revealed that two studies had moderate-quality evidence, one case report with high-quality evidence and the other with low-quality evidence. The quality of the selected comprehensive literature reviews assessed using JBI critical assessment for reviews and research syntheses was judged to have poor-quality evidence. A thorough literature search on the topic did not reveal a single systematic review, and all of the reviews that were chosen were exhaustive. Parental cooperation and patient motivation are crucial components of a successful treatment regimen. A better prognosis is determined by the choice of appropriate orthodontic mechanotherapy along with the utilization of an array of behavior modification modalities and the availability of a team with expertise.

Is There an Association Between Fixed Orthodontic Treatment and Initiation of Eating Disorders? A Review of Currently Available Evidence

Objectives: The aim was to review the available literature regarding the potential association between fixed orthodontic treatment (OT) and the onset of eating disorders (EDs).

Method and Materials: Six indexed databases were searched until November 2020. The inclusion criteria were as follows: (a) patients undergoing fixed OT and (b) EDs in relation to fixed OT. Commentaries, letters to the Editor, reviews, and studies in patients with EDs not undergoing fixed OT were excluded. The pattern of the present review was customized to summarize the pertinent information.

Results: Four out of 10,076 initially-identified studies were included, and all of them were case reports. All patients were females, and the EDs reported were either anorexia nervosa (AN) or bulimia nervosa (BN). In three case reports, patients developed EDs after the initiation of OT. Fixed OT was performed in all the studies, and a variety of oral complications such as sore mouth, gingivitis, tooth surface demineralization, and others were reported.

Conclusion: Based upon the limited available evidence, the association between OT and the onset of EDs remains unclear. Further well-designed observational clinical studies are needed in this regard.

Managing Cardiac Patients: Dentists' Knowledge, Perceptions, and Practices

OBJECTIVES

Dental patients may require invasive treatment, and awareness of their medical conditions is essential for optimal care. We assessed the knowledge, perceptions, and attitudes of dentists practicing in Saudi Arabia (SA) and their associations with managing patients with common cardiac conditions.

METHODS

A national survey of knowledge and attitudes of practicing dentists towards patients with common cardiac conditions was conducted from May 2019 to July 2020 in SA. The survey comprised a newly developed, validated, electronic, self-administered English questionnaire.

RESULTS

Overall, 282 dentists completed the survey, of whom 45.5% perceived cardiac patients as difficult to manage, while 64.5% stated that they refer these patients to cardiologists before dental intervention. Regarding knowledge about cardiac conditions, 72% achieved an overall knowledge score <55%; however, their infective endocarditis scores were better. Consultants and specialists (P < .001), those with a PhD/board certification (P = .013), dentists with prior education on cardiac patient management (P = .002), and those working with a cardiologist (P = .016) scored higher on knowledge. Conversely, private dentists (P = .003) and those referring patients to cardiologists before treatment (P = .003) scored lower. Dentists' knowledge of cardiovascular diseases in women was low; only those who believed women experience a greater risk of cardiac complications achieved a higher score. Approximately 90.1% wished to receive education regarding cardiac patient management.

CONCLUSIONS

Knowledge of cardiac patient management was suboptimal in this study. Dentists perceived cardiac patients as difficult to manage, but wished to learn more regarding optimal management. Thus, postgraduate education programmes that promote optimal dental management strategies for cardiac patients are necessary.

Prevalence of Malocclusion and Occlusal Traits in Children with Autism Spectrum Disorders

Background

The purpose of this cross-sectional study was to evaluate the prevalence of malocclusion in children with autism spectrum disorders (ASDs) and to determine the most common occlusal traits.

Materials and Methods

The present cross-sectional study was conducted among 7–15 years old children with ASDs and randomly selected healthy children with the same demographic characteristics. Molar relationship, lip incompetence, overbite, overjet, midline deviation, crossbite, and crowding/spacing were recorded. A descriptive analysis was performed for all variables. A comparison of the presence or absence of malocclusion traits between children with and without ASDs was assessed using the chi-square test. Univariate and multivariate logistic regressions were used to calculate odds ratio (OR) and 95% confidence intervals (95% CI) to assay various parameters between autism and non-autism group.

Results

A total of 96 patients were assessed, 47 patients in the ASD group, and 49 in the control (non-ASD) group. The results showed no significant difference between the ASD and control groups in terms of the overall prevalence of malocclusion (P>0.05). However, the prevalence of increased overjet and Class II molar relationship was significantly higher in the ASD group compared to the control group (P=0.03). Patients in the control group showed a higher prevalence of midline deviation (P=0.001).

Conclusion

Despite a higher prevalence of overjet and Class II molar relationship in children with ASDs, the prevalence of malocclusion was not higher in this group of patients.