The relation of severe malocclusion to patients' mental and behavioral disorders, growth, and speech problems

Comparison of Speech Defects in Different Types of Malocclusion

Introduction Speech has a great impact on human evolution, allowing for the widespread knowledge and advancement of tools. Difficulty in pronouncing one or more sounds is the most common speech impairment. Speech defects are more commonly associated with class III malocclusion patients (difficulty in pronouncing 's' and 't' sounds), the second in line is class II malocclusion (difficulty in pronouncing 's' and 'z' sounds), and speech distortions are least affected in class I malocclusion (difficulty in pronouncing 's' and 'Sh'). Most patients with dentofacial disharmonies and speech distortions need orthodontic care and orthognathic surgery to resolve their issues with mastication, aesthetics, and speech. Aims and objectives To compare and assess speech difficulties in different types of malocclusion. Materials and methods The study was conducted over 160 subjects for three and half months. All of them were evaluated for speech defects before they received orthodontic treatment. The main basis of this study is according to Angle's classification of malocclusion. The subjects were segregated according to Angle's classification of malocclusion. Malocclusion traits that are included in this study are Angle's class I, Angle's class II division I and division II, and Angle's class III. Results According to the results, out of 160 subjects, labio-dental speech defects are observed in 8% where n=13 of the study participants, linguodental speech defects are observed in 2% where n=3, lingua-alveolar speech defects are present in 54% where n=86, and bilabial speech defects are observed in 2% where n=3 of the study participants. Here 'n' represents the frequency of the subjects. Severe speech defects are seen in Angle's class III malocclusion. Results according to the type of malocclusion include: labio-dental speech defects are seen in 37.5% in class I, 25% in class II division I, 0% in class II division II, and 37.5% in class III. Linguodental speech defects are seen in class III malocclusion subjects only. Lingua-alveolar sounds are seen in 27.8% of class I, 29.6% of class II division I, 1.9% of class II division II, and 40.7% of class III. Bilabial speech defects are only seen in class II division I subjects. According to the results, only lingua-alveolar speech defects are statistically significant, and more severe speech defects were observed in class III malocclusion. Conclusion Speech plays an important role in affecting the quality of life of people. Different types of malocclusion traits are associated with different types of speech defects.

The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients

OBJECTIVES

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort.

MATERIALS AND METHODS

Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14).

RESULTS

Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect.

CONCLUSION

Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression.

CLINICAL RELEVANCE

Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Effect of socioeconomic and malocclusion-related factors on duration of orthodontic treatment by fixed appliance: A retrospective study

OBJECTIVES

The aims of this study were to evaluate the effect of related factors that influence orthodontic treatment time and to identify the predictors of orthodontic treatment duration in a Chinese population.

MATERIALS AND METHODS

Information for 29 sociodemographic, malocclusion and orthodontic treatment characteristics was collected. Patients were divided into two groups: the duration ≤24 months group and duration >24 months group. The treatment dates of the initial visit and end of orthodontic treatment were obtained to calculate duration. The data were subjected to univariate and multivariate logistic regression modelling to quantify the association between characteristics and the treatment duration; odds ratios (ORs) and 95% confidence intervals (95% CIs) are reported.

RESULTS

Of 2120 patients, 704 patients (mean age, 15.9 ± 6.0 years) were included. Age, extraction, Bolton ratio (overall), rotated teeth, overjet and crowding (lower arch) were predictors for duration. The nomogram based on predictive factors exhibited strong discrimination ability, with concordance indices of 0.755 (95% CI = 0.712-0.798) in the training cohort model and 0.717 (95% CI = 0.647-0.787) in the validation cohort model. The calibration curves for the training and validation cohorts showed that the probabilities of the nomogram agreed well with actual probabilities.

CONCLUSIONS

Young age, non-extraction and severe crowding (lower arch) can increase the chance of durations of ≤24 months. Rotated teeth, excessive overjet and Bolton ratio (overall) can increase the chance of durations of >24 months.

Influence of social media and corrected smile photographs in patients with malocclusion

INTRODUCTION

The increased use of social networking sites, such as Instagram (Meta Platforms, Menlo Park, Calif), has been silently affecting facial satisfaction among patients. However, the potential of Instagram to motivate participants for orthodontic treatment when used with an adjunct, a photograph editing software, is yet to be assessed.

METHODS

From the initial 300 participants, 256 were included and randomly divided into an experimental group (participants were asked to provide their frontal smiling photograph) and a control group. The photographs received were corrected using photograph editing software and were shown along with other ideal smile photographs in an Instagram account to the experimental group, whereas the control group participants had access to only the ideal smile photographs. After browsing, the participants were given a modified version of the Malocclusion-Related Quality of Life Questionnaire.

RESULTS

Questions assessing the general perception about one's smile, comparison with peers, desire to undergo orthodontic treatment, and the role of socioeconomic status showed a statistically significant difference (P <0.05) as most of the control group participants were unsatisfied with their teeth, had less desire to undergo orthodontic treatment and did not feel family's financial income to be a hurdle, contrary to the experimental group participants. A statistically significant difference (P <0.05) was also seen in assessing external acceptance, speech difficulties, and the influence of Instagram on orthodontic treatment, whereas the influence of photograph editing software did not show the same.

CONCLUSIONS

The study concluded that the experimental group participants were motivated to undergo orthodontic treatment after viewing their corrected photograph.

Unilateral Cleft Lip and Palate Has Asymmetry of Bony Orbits: A Retrospective Study

Facial asymmetry is common in unilateral clefts. Since virtual surgical planning (VSP) is becoming more common and automated segmentation is utilized more often, the position and asymmetry of the orbits can affect the design outcome. The aim of this study is to evaluate whether non-syndromic unilateral cleft lip and palate (UCLP) patients requiring orthognathic surgery have asymmetry of the bony orbits. Retrospectively, we analyzed the preoperative cone-beam computed tomography (CBCT) or computed tomography (CT) data of UCLP (n = 15) patients scheduled for a Le Fort 1 (n = 10) or bimaxillary osteotomy (n = 5) with VSP at the Cleft Palate and Craniofacial Center, Helsinki University Hospital. The width, height, and depth of the bony orbit and the distance between the sella turcica and infraorbital canal were measured. A volumetric analysis of the orbits was also performed. The measurements were tested for distribution, and the cleft side and the contralateral side were compared statistically with a two-sided paired t-test. To assess asymmetry in the non-cleft population, we performed the same measurements of skeletal class III patients undergoing orthognathic surgery at Päijät-Häme Central Hospital (n = 16). The volume of bony orbit was statistically significantly smaller (p = 0.014), the distance from the infraorbital canal to sella turcica was shorter (p = 0.019), and the anatomical location of the orbit was more medio-posterior on the cleft side than on the contralateral side. The non-cleft group showed no statistically significant asymmetry in any measurements. According to these preliminary results, UCLP patients undergoing orthognathic surgery show asymmetry of the bony orbit not seen in skeletal class III patients without a cleft. This should be considered in VSP for the correction of maxillary hypoplasia and facial asymmetry in patients with UCLP.

Craniofacial structures, occlusal features, and TMD symptoms in juvenile idiopathic arthritis patients: a retrospective study

BACKGROUND

Juvenile idiopathic arthritis (JIA) is a chronic inflammatory disease in which temporomandibular joint (TMJ) arthritis commonly occurs. It may be asymptomatic and could cause problems in the growing joints. Our aim was to evaluate the craniofacial structures, occlusal features and temporomandibular dysfunction (TMD) symptoms of patients with JIA.

METHODS

The study consisted of 195 JIA patients treated at the Department of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Finland between 2015 and 2019. We retrospectively screened their medical and dental records and classified them according to age at JIA diagnosis (<7 and ≥7 years).

RESULTS

Most of the patients had Angle Class I occlusion in both sides. Among all the patients, the mean overjet, and overbite were 3.3 mm and 2.4 mm, respectively. There were more open bite patients in the ≥7 years old group than in the <7 years old group (P = 0.010). Of all patients, 47% reported at least one TMD symptom. The TMD symptoms were more common in participants ≥7 years old than those <7 years old (P = 0.005).

CONCLUSION

Occlusal features and the incidence of malocclusions seem to have similar tendency among the JIA patients with systematic visits in rheumatologist and orthodontist as in the healthy population, except for open bite that is more common with JIA patients. While treating JIA patients, a well-functioning collaboration between paediatric rheumatologists and orthodontists is essential, as well as a clear screening protocol to detect potentially asymptomatic TMJ arthritis. Particular attention should be paid to children with JIA under school age.

Malocclusion characteristics amongst individuals with autism spectrum disorder: a systematic review and meta-analysis

Background

To estimate the prevalence of malocclusion in individuals with autism spectrum disorders (ASD) and to assess the relationship between ASD and malocclusion.

Methods

We searched electronic databases including PubMed, Scopus, Web of Science, Cochrane, Embase, SciELO LILACS, Proquest, OpenGrey and Google Scholar. There were no language or publication dates restrictions. Two researchers independently performed selection, data extraction and quality assessment. Quality assessment and risk of bias were evaluated through the Newcastle–Ottawa scale and ROBINS-E tool. Meta-analyses using random effect models were used to estimate pooled measures of prevalence of malocclusion characteristics in individuals with ASD and pooled odds ratio (OR) on the relationship between ASD and malocclusion characteristics. Subgroup meta-analyses were conducted according to children and adolescents, history of orthodontic treatment, and occurrence of other syndromes and medical conditions.

Results

Searching identified 5549 papers with 238 were selected for full assessment. Eighteen cross-sectional studies were included according to inclusion criteria. Of them, eleven studies were considered of moderate quality. A judgement of critical risk of bias occurred for thirteen studies. The most prevalent malocclusion characteristics in individuals with ASD were crowding (33%; 95% CI 22 to 44%) and increased maxillary overjet (39%; 95% CI 23 to 54%). Individuals with ASD had higher odds of Angle’s Class II (OR 1.92; 95% CI 1.36 to 2.72), Angle’s Class III (OR 2.33; 95% CI 1.29 to 4.23), open bite (OR 1.96; 95% CI 1.21 to 3.16), and increased maxillary overjet (OR 1.53; 95% CI 1.06 to 2.21) than individuals without ASD.

Conclusions

Angle’s Class II, Angle’s Class III, anterior open bite and increased maxillary overjet were more prevalent in individuals with ASD than those without ASD. Further high-quality studies are needed.

Malocclusion in children with speech sound disorders and motor speech involvement: a cross-sectional clinical study in Swedish children

OBJECTIVES

The objectives of this study were to investigate the occurrence, types and severity of malocclusions in children with speech sound disorder (SSD) persisting after 6 years of age, and to compare these findings to a control group of children with typical speech development (TSD).

METHODS

In total, 105 children were included: 61 with SSD and motor speech involvement (mean age 8:5 ± 2:8 years; range 6:0-16:7 years, 14 girls and 47 boys) and 44 children with TSD (mean age 8:8 ± 1:6; range 6:0-12:2 years, 19 girls and 25 boys). Extra-oral and intra-oral examinations were performed by an orthodontist. The severity of malocclusion was scored using the IOTN-DHC Index.

RESULTS

There were differences between the SSD and TSD groups with regard to the prevalence, type, and severity of malocclusions; 61% of the children in the SSD group had a malocclusion, as compared to 29% in the TSD group. In addition, the malocclusions in the SSD group were rated as more severe. Functional posterior crossbite and habitual lateral and/or anterior shift appeared more frequently in the SSD group. Class III malocclusion, anterior open bite and scissors bite were found only in the SSD group.

CONCLUSION

Children with SSD and motor speech involvement are more likely to have a higher prevalence of and more severe malocclusions than children with TSD.

Autism Spectrum Disorders and Malocclusions: Systematic Review and Meta-Analyses

Studies heretofore have shown inconsistent results on the link of ASD to malocclusion. Herein, we aimed to compare the prevalence of malocclusion among children and adolescents with ASD compared with non-ASD healthy counterparts through a systematic review. The electronic search focused on five databases, PubMed, Web of Science, EMBASE, LILACS, and OpenGrey until January 2022, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No. CRD42022298023). Observational and intervention studies that compared occlusion characteristics of ASD individuals under 18 years old with healthy controls were included. Pairwise random effects meta-analyses of odds ratio (OR) were performed. Methodological quality was assessed by using the Joanna Briggs Institute Critical Appraisal Checklist for cross-sectional studies. A total of thirteen studies were included for qualitative analysis, and seven for quantitative analysis. The results presented a great heterogeneity and moderate risk of bias; thus, it was not possible to state that there is a risk of malocclusion in individuals with ASD. Future studies should be carried out with strict criteria in the choice of samples, control group, and diagnosis of malocclusion in order to meet the necessary requirements for greater methodological quality.

Three-dimensional evaluation of soft tissues in hyperdivergent skeletal class II females in Guangdong

Objectives

To establish the three-dimensional facial soft tissue morphology of adolescent and adult females in the Guangdong population and to study the morphological characteristics of hyperdivergent skeletal class II females in Guangdong compared with that of normodivergent class I groups.

Materials and methods

The 3dMDface system was used to capture face scans of 160 patients, including 45 normal and 35 hyperdivergent skeletal class II adolescents (aged 11–14 years old) and 45 normal and 35 hyperdivergent skeletal class II adults (aged 18–30 years old). Thirty-two soft tissue landmarks were mapped, and 21 linear, 10 angular and 17 ratio measurements were obtained by 3dMDvultus analysis software. Data were assessed with a t-test of two independent samples between the normal adolescent and adult groups and between the normal and hyperdivergent skeletal class II groups.

Results

The linear measurements of the Guangdong adult females were larger than those of the adolescents in both Class I and Class II groups. However, the angular and ratio measurements had no significant difference. The vertical linear measurements were higher and the sagittal and transverse linear measurements were smaller in the hyperdivergent class II group (p < 0.05). The soft tissue ANB angle, chin-lip angle, and mandibular angle were significantly larger and the soft tissue facial convexity angle and nasal convexity angle were significantly smaller in the hyperdivergent class II group (p < 0.05). Additionally, there were significant differences in the ratio measurements between the hyperdivergent class II groups and the control groups (p < 0.05).

Conclusions

The three-dimensional facial morphology of Guangdong adolescent and adult females was acquired. The facial soft tissue measurements of the adults were higher in the three dimensions except for the facial convexity and proportional relationships which were similar, suggesting that the growth pattern remained the same. The three-dimensional facial soft tissue features of hyperdivergent skeletal class II were characterized by the terms “long, convex, and narrow”. Three-dimensional facial measurements can reflect intrinsic hard tissue characteristics.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12880-022-00782-w.

Three-dimensional analysis of upper airway and craniofacial morphology in orthodontic adolescents with Attention Deficit Hyperactivity Disorder (ADHD): A comparative retrospective study

PURPOSE

The aim of this study is to evaluate craniofacial characteristics and upper airway morphology in adolescents with Attention Deficit Disorder with Hyperactivity (ADHD) compared to controls (CON).

MATERIALS AND METHODS

Records from July 2014 to May 2018 of patients who were seeking orthodontic treatment at a single institute and had full pre-treatment orthodontic records including cone-beam computed tomography (CBCT) were reviewed. Comprehensive cephalometric variables were measured to determine craniofacial morphology. Upper airway volume (UAV), minimum cross-sectional area (MCA), and linear measurements were calculated at multiple planes.

RESULTS

A total of 87 adolescents (ADHD, 29; CON, 58) were included in the study. Overall, UAV and MCA in ADHA group were smaller than CON. Statistical significance was evident in airway widths at planes A (P=0.002), C (P=0.042), and D (P<0.001), and airway area at plane D (lower hypopharynx) (P<0.001), with the ADHD group showing narrower widths and area compared to CON. The most common skeletal classification in the ADHD group was sequenced as Class II, Class I then Class III, with percentages of (58.6%), (31%) and (10.3%), respectively. No significant differences were found between the groups for any of the skeletal, dental, and soft tissue cephalometric variables.

CONCLUSIONS

ADHD affected adolescents have similar craniofacial characteristics, but narrower upper airway dimensions compared to controls. Further investigations with larger samples are warranted to further elucidate the relationship between SDB and ADHD.

[Health relevance of malocclusions and their treatment]

Zahn- und Kieferfehlstellungen gehören zu den häufigsten Mundgesundheitsbeeinträchtigungen beim Menschen. Der vorliegende Beitrag gibt eine Übersicht zu deren Ursachen, Häufigkeit und Folgen. Er zeigt die präventiven und kurativen Möglichkeiten kieferorthopädischer Behandlungen auf und gibt Informationen zu deren rechtlichen Rahmenbedingungen in Deutschland. Inanspruchnahme und Qualität der kieferorthopädischen Versorgung werden im internationalen Vergleich dargestellt.

Bei den Ursachen für Zahn- und Kieferfehlstellungen spielen genetische, epigenetische, funktionelle und umweltbedingte Faktoren eine Rolle, die individuell meist nicht eindeutig feststellbar sind. Bisher zeigen nur kleinere Querschnittsstudien, dass bis zu 80 % der Kinder in Deutschland betroffen sind. Essen, Trinken, Kauen, Sprechen und Atmen können beeinträchtigt sein, die Neigung zu Parodontalerkrankungen sowie Überlastungsschäden von Kiefergelenk und Kaumuskulatur sind erhöht. Bei einer Proklination der oberen Schneidezähne steigt die Gefahr von Frontzahntraumata. Fehlstellungen können zudem negative psychosoziale Folgen oder Einschränkungen der Lebensqualität zur Folge haben. Kieferorthopädische Behandlungen leisten in Kooperation mit anderen (zahn-)medizinischen Fachdisziplinen einen wichtigen präventiven bzw. kurativen Beitrag zur Verbesserung der Mundgesundheit, der Allgemeingesundheit und der Lebensqualität.

Die Kieferorthopädie bietet ein erhebliches Potenzial für die Stärkung der zahnärztlichen Prävention im Gesundheitswesen, zumal die gesetzliche Krankenversicherung (GKV) eine breitflächige Versorgung der Bevölkerung mit kieferorthopädischen Leistungen auf international anerkanntem, hohem Niveau ermöglicht. Um die Prävention weiter zu verbessern, wird die Einführung eines kieferorthopädischen Screenings im 7.–8. Lebensjahr als systematische Vorsorge empfohlen.