Oro-facial function and quality of life in children and adolescents with large horizontal maxillary overjet-A case-control study

BACKGROUND

Large horizontal maxillary overjet (overjet) is associated with reduced bite force (BF) and number of contacts, which influence the chewing effectivity (CE). Oral health, oro-facial function (OF) and malocclusion have great impact on psychological well-being and quality of life (QoL).

OBJECTIVES

The aims of the study were to examine OF, temporomandibular disorders (TMD), BF, CE, QoL and well-being in children and adolescents with large overjet.

METHODS

The study was a case-control study including healthy children with large overjet in the study group compared to a control group of healthy children with neutral occlusion, all 9-14 years old. OF was examined by use of Nordic Orofacial Test-Screening (NOT-S), Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) and registration of morphological and functional occlusion. QoL and well-being were examined using KIDSCREEN-10 and Strengths and Difficulties Questionnaire.

RESULTS

The study and control groups included 37 and 32 participants, respectively. Significantly increased NOT-S score (p < .001) and reduced BF (p = .011), numbers of contacts (p < .001) and CE (p = .005) were found in the study group. BF, numbers of contacts and CE were negatively associated with erupting canines and premolars. No significant difference was found in age, gender, dental eruption, TMD diagnosis or QoL between the groups. Significantly increased emotional symptoms (p = .007), hyperactivity (p = .043) and total difficulties score (p = .009) were found in the study group.

CONCLUSION

The study group showed higher NOT-S score and reduced BF, number of contacts and CE. No difference in QoL were found between the groups, although reduced well-being and increased emotional symptoms, hyperactivity and total difficulties were found in the study group.

The impact of craniofacial and dental osteogenesis imperfecta manifestations on oral health-related quality of life of children and adolescents

OBJECTIVE

Craniofacial and oral manifestations of Osteogenesis Imperfecta (OI) can affect the functioning of the stomatognathic system and impact the patient's quality of life. The objective of the study was to evaluate the relationship between craniofacial and oral manifestations and the Oral Health-related Quality of Life (OHRQoL) of OI children and adolescents.

MATERIAL AND METHODS

A total of 30 OI patients aged eight to fourteen years old followed up at the Oral Care Center for Inherited Diseases were enrolled in the research. OHRQoL was assessed using the short form of the Child Perceptions Questionnaire (CPQ) for eight to ten-year-olds (CPQ8-10) and 11 to 14-year-olds (CPQ11-14). The relationship between the OHRQoL index and its assessment domains, OI types, and the presence of dentinogenesis imperfecta (DI), class III malocclusion, and dental agenesis were evaluated.

RESULTS

The median CPQ score of patients was 5, and there was no significant difference in OHRQoL between children and adolescents, nor associated with the disease severity or the presence of DI. The oral manifestations evaluated did not directly impact the patients' OHRQoL.

CONCLUSIONS

The study demonstrated that the perception of OHRQoL is similar for both adolescents and children. The oral symptom was the most relevant domain for the index among patients aged eight to fourteen years while the emotional well-being was the most impacted.

CLINICAL RELEVANCE

this study makes contributions by indicating that addressing dental care for children and adolescents with OI is important in clinical management and better OHRQoL for this population.

Impact of malocclusions on oral health-related quality of life among adolescents

DESIGN

Systematic review and meta-analysis of randomized controlled trials, non-randomized and observational studies, and previous systematic reviews if matching PECOS strategy. The protocol of the study was registered on PROSPERO.

DATA SOURCES

An electronic search was conducted in the following five databases: The Cochrane Library, PubMed, Web of Science, Scopus, and CINAHL. The search was carried out to cover the literature up to June 15, 2022. In addition, ClinicalTrials.gov and PROSPERO were searched for detecting any relevant unpublished data and ongoing studies.

STUDY SELECTION

The review was defined in PECOS format as follows: population (P), healthy adolescents (ASA Class I or II; age 10-19); Exposure (E), malocclusion and/or need of orthodontic therapy as determined by professionals utilizing validated standardized tools such as Index of Orthodontic Treatment Need, Index of Complexity, Outcome and Need, Peer Assessment Rating, Dental Aesthetic Index, or any well-described tool; comparison (C), no malocclusion and/or need of orthodontic therapy as determined by professionals utilizing validated standardized tools; outcome (O), self-reported oral health-related quality of life (OHRQoL) using validated tools; study design (S), randomized clinical trials, non-randomized/observational studies (prospective and cross-sectional studies with untreated/no-malocclusion controls), and previous systematic reviews if matching PECOS strategy. Studies assessing ASA Class III or higher, craniofacial conditions, previous or ongoing orthodontic or surgical treatment, and case studies were excluded.

DATA ANALYSIS

Screening and data extraction and management, risk of bias (RoB), and quality assessments were conducted by four independent investigators. RoB was assessed based on the guidelines of the Swedish Agency for Health Technology Assessment and Assessment of Social Services.

RESULTS

A total of 13 studies (non-randomized studies of cross-sectional design) were included in the qualitative synthesis, of which, 4 studies were included in the quantitative synthesis. Meta-analysis showed that malocclusions (measured with DAI) in adolescents aged 11-14 years old have a negative impact on OHRQoL (measured with CPQ 11-14 short form) (number of studies = 4, rate ratio/prevalence ratio = 1.15, 95% confidence interval = 1.12-1.18, I2 = 0.03%, Q3 = 0.09, certainty level = moderate).

CONCLUSIONS

Moderate level of evidence suggests that malocclusions in adolescents have a negative impact on the oral health-related quality of life.

Cross-Bite and Oral-Health-Related Quality of Life (OHRQoL) in Preadolescents Aged 11 to 14 Years Old: A Pilot Case-Control Study

INTRODUCTION

Malocclusions have a negative impact on oral-health-related quality of life (OHRQoL). Posterior cross-bite is one of the most prevalent malocclusions in the preadolescent population. This study investigated the influence of posterior cross-bites (unilateral or bilateral) on OHRQoL in an 11- to 14-year-old population.

MATERIALS AND METHODS

A pilot case-control study was carried out at the Dental Clinic of the University of Salamanca between 2021 and 2023. A consecutive sample of 120 preadolescent patients aged 11 to 14 years old was recruited. Three groups were analyzed: a control group (no posterior cross-bite) (n = 40), a group with unilateral posterior cross-bite (n = 40), and a group with bilateral posterior cross-bite (n = 40). To analyze the OHRQoL, the Spanish version of the Child Perception Questionnaire (CPQ-Esp11-14) was used.

RESULTS

The mean age of the sample was 12.2 years old (±0.96 years). The group of patients with a bilateral posterior cross-bite was shown to have higher scores in all dimensions of the CPQ-Esp11-14, as well as a higher total score. Sex only influenced the oral symptom dimension of the CPQ-Esp11-14 questionnaire; in this dimension, the girls described a greater impact. Age did not influence OHRQoL.

CONCLUSION

The presence of a posterior cross-bite had a negative impact on OHRQoL in the preadolescent population that was studied.

Malocclusions and quality of life among adolescents: a systematic review and meta-analysis

BACKGROUND

Malocclusions in adolescents might have a negative impact on oral health-related quality of life (OHRQoL). Potential confounding variables (confounders) such as age, gender, caries, and socioeconomic status may skew the real relationship between malocclusions and OHRQoL.

OBJECTIVES

To analyse the effect of malocclusions in adolescents on OHRQoL, when controlled for potential confounders.

SEARCH METHODS

Five databases (PubMed, Cochrane Library, Cinahl, Scopus, and Web of Science) were searched up to 15 June 2022.

SELECTION CRITERIA

Studies in which OHRQoL in 10-19-year olds with and without malocclusions were compared.

DATA COLLECTION AND ANALYSIS

Screening, data extraction, and quality assessments were performed by four investigators independently. Risk of bias was assessed according to the Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU) guidelines. To be included, studies had to control for confounders. Certainty of evidence was assessed with GRADE.

RESULTS

Thirteen cross-sectional studies with low and moderate risk of bias were included in the qualitative synthesis. Four of these were also included in the quantitative synthesis (meta-analysis). The 13 studies in the qualitative synthesis displayed a large variation among the indices used for malocclusion ratings, as well as in instruments measuring OHRQoL. There was moderate quality of evidence that malocclusions have a negative effect on OHRQoL. The four articles included in the quantitative synthesis (meta-analysis) measured malocclusions with DAI and OHRQoL with CPQ 11-14 short form. There was moderate quality of evidence that malocclusions have a negative effect on OHRQoL (RR/PR 1.15, 95% CI 1.12-1.18, 3672 participants).

CONCLUSIONS

There is moderate quality of evidence that malocclusions in adolescents have a negative impact on OHRQoL, after taking relevant confounders into consideration. Future studies should ideally use standardized measures for malocclusion ratings and OHRQoL.

REGISTRATION

PROSPERO. CRD42020186152.

Should we recommend early overjet reduction to prevent dental trauma?

There is an association between increased overjet and risk of trauma to the maxillary incisor teeth in children and adolescents. It would therefore seem sensible to recommend overjet reduction as early as possible to help reduce this risk. However, orthodontic outcomes are essentially the same whether you start treatment in the early or late mixed dentition, while early treatment carries a heavier burden on compliance - taking longer and involving more appointments. This article explores the complex association between early overjet reduction and dental trauma in the context of current best evidence. Careful case selection is advised when justifying early intervention for increased overjet based on reducing trauma risk.

Patient compliance with Twin Block appliance during treatment of Class II malocclusion: a randomized controlled trial on two check-up prescriptions

BACKGROUND

Compliance is crucial for the treatment outcome with removable appliances. Previous studies on treatment with the Twin Block appliance have focused on effectiveness in relation to other treatment methods or wear-time. Studies on different check-up intervals to improve compliance seem to be lacking.

OBJECTIVES

To compare the impact of two different check-up prescriptions on patient compliance and treatment outcome during treatment with Twin Block.

TRIAL DESIGN

Two-arm parallel group, single-centre, randomized controlled trial.

MATERIALS AND METHODS

Seventy-three patients, 38 boys, and 35 girls, mean age 11.2 years, were included and block-randomized into two groups treated with a Twin Block appliance. Group 1 was called for check-up visit every sixth week and group 2 every fourth week. Compliance was evaluated with a TheraMon® microsensor, moulded into the appliance, measuring wear-time. Overjet, overbite, and molar relationships were assessed on study casts before and after treatment. The treatment outcomes were analysed on an intention-to-treat basis.

RESULTS

In group 1, the reduction of overjet was 5.2 mm and the mean wear-time was 6.9 hours. In group 2, the reduction was 4.7 mm and the wear-time was 6.1 hours. Seventy-four per cent of the patients presented an overjet of 4 mm or less. Wear-time did not correlate to age, gender, or severity of malocclusion.

HARMS

No harm was observed in any patient. Lateral open bites were registered during treatment but were normalized at the end of the treatment.

LIMITATIONS

The trial was a single-centre study and long-term effects were not evaluated.

CONCLUSIONS

During treatment with the Twin Block appliance, a 4-week check-up interval did not improve treatment outcome or increase wear-time, compared to a 6-week check-up interval. The mean wear-time was 6.5 hours per day, even if the recommendation was 12 hours.

CLINICAL TRIAL REGISTRATION

NCT05155774.

Parental perception of malocclusion, its severity and aesthetic concerns in children with mixed dentition: A cross-sectional study

OBJECTIVE

This study aimed to associate the parents' perception of the need for treatment and the children's aesthetic concern, considering the influence of malocclusion severity levels.

METHODS

A population-based cross-sectional study was conducted with 770 children aged 8 to 10 years in the mixed dentition stage. A closed question sent to parents assessed the subjective orthodontic treatment need (outcome). Orthodontic Aesthetic Subjective Impact Score (OASIS) evaluated children's aesthetic concerns, and the Dental Aesthetic Index (DAI) diagnosed the anterior characteristics and malocclusion severity levels. Individual analyses were performed relating the outcome as independent variables. The variables with P<0.20 in the individual analyses were tested in multiple logistic regression models, and those with P<0.10 remained in the model. The adjusted odds ratio was estimated with a 95% confidence interval.

RESULTS

Parents of children with higher aesthetic concerns are 1.82 times more likely to believe that their child needs orthodontic treatment (P<0.05). Parents of children with very severe malocclusion are 1.91 times more likely to perceive their child's need for orthodontic treatment (P<0.05).

CONCLUSION

Parents of children with greater aesthetic concerns are more likely to perceive the need for orthodontic treatment, and very severe malocclusion also influences parents' perception of the need for orthodontic treatment.

Concern of adolescents in conflict with the Law about their oral health

Objective: To assess the self-perception of adolescents in conflict with the law about their concern with oral health, in addition to tracing their relationship with other related variables. Methods: A cross-sectional study involving male institutionalized adolescents in a city in southern Brazil who underwent clinical examination and interviews to understand their concern for their oral health and the relationship between this outcome and associated factors. Concern about oral health was obtained through a validated questionnaire. Two fitted models were performed using Poisson regression (α < 0.05). One of them used the decayed, missing, and filled teeth index (DMF-D), and another considered the components of this index as exploratory variables. Results: Sixty-eight adolescents were included, and a high occurrence (75%) of concern about their oral health was observed. In the final multivariate analysis that included DMFT, this index (prevalence ratio [PR]: 1.033; 95% confidence interval [95%CI]: 1.004 – 1.063) and concern about tooth color (PR: 2.208; 95%CI: 1.028 – 4.740) were significantly associated with oral health concerns. When the various index components were included in the multivariate model, only the number of decayed teeth (PR: 1.073; 95%CI: 1.007 – 1.144) and concerns about tooth color (PR: 2.250; 95%CI: 1.057 – 4.793) were associated with the outcome. Conclusion: Institutionalized adolescents are highly concerned about their oral health, being associated with a DMF index, especially the decayed component, and a concern with the color of their teeth.

Comparing oral health-related quality of life, oral function and orofacial aesthetics among a group of adolescents with and without malocclusions

OBJECTIVE

The aim was to analyze how malocclusion relates to perception of oral health-related quality of life (OHRQOL), oral function and orofacial aesthetics among a group of adolescents in Sweden.

MATERIAL AND METHODS

Thirty patients with a need for orthodontic treatment (IOTN-DHC grade 4 and 5) and 30 patients with normal occlusion (IOTN-DHC grade 1), aged 13-17 years, were included in the study. A questionnaire containing three parts was used; The Oral Health Impact Profile (OHIP-S14), Jaw Functional Limitational scale (JFLS-20) and Orofacial Aesthetic scale (OES). Malocclusions, orthodontic treatment need and confounders, such as earlier dental treatment and temporomandibular disorders, were registered.

RESULTS

Adolescents with malocclusions were more often embarrassed by their mouth and teeth compared to controls (p < .05). Aesthetically, adolescents with malocclusions were more negatively affected by the appearance of the mouth and teeth as well as the over-all facial appearance (p < .05).

CONCLUSIONS

Malocclusions clearly affects the adolescents with need for orthodontic treatment in this study. It influences their OHRQOL in the psychosocial impact dimension. Aesthetically they perceive their oral and facial appearance as worse compared to controls. Although embarrassed and unpleased with their oral appearance they still rate themselves as having a good oral health with low jaw function limitations.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid

BACKGROUND

The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions.

METHODS

The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated.

RESULTS

The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318.

CONCLUSIONS

MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage.

PRACTICAL IMPLICATIONS

MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

Early headgear activator treatment of Class II malocclusion with excessive overjet: a randomized controlled trial

OBJECTIVES

To compare early headgear activator treatment of Class II malocclusion with excessive overjet with untreated control subjects in terms of the primary outcomes overjet and overbite as well as the effect regarding oral-health-related quality of life (OHRQoL), lip closure, incidence of trauma, and skeletal changes.

TRIAL DESIGN

Two-arm parallel group single-centre randomized controlled trial.

MATERIAL AND METHODS

A total of 60 children (mean age 9.5 years) presenting a Class II malocclusion with excessive overjet were recruited. The trial was designed as intention-to-treat and the participants randomized by an independent person not involved in the trial to either early treatment with headgear activator or to an untreated control group (UG). Dental and skeletal variables as well as registrations of OHRQoL, lip closure, and incidence of trauma were recorded. For the treatment group, data were registered at baseline before treatment and when treatment was finished, corresponding to approximately 2 years. For the UG, registrations were made at baseline and at 11 years of age. Observers were blinded to treatment allocation when assessing outcomes.

RESULTS

Early treatment with headgear activator significantly decreased overjet and improved molar relationship when compared with untreated controls. The effects were primarily due to dentoalveolar changes. Early treatment had no evident effect regarding OHRQoL, lip closure, or incidence of trauma. Lack of cooperation resulted in unsuccessful treatments for 27% of the patients.

LIMITATIONS

The trial was a single-centre trial and can thus be less generalizable.

CONCLUSIONS

The main treatment effect of early headgear activator treatment of Class II malocclusion with excessive overjet is reduction of overjet.

TRIAL REGISTRATION

NCT04508322.

Morphological features of Class I, II and III malocclusions of Saudi adolescents

Aims

This cross-sectional study compared and contrasted the morphological characteristics of Class I, II and III malocclusions in an adolescent Saudi population.

Methods

Adolescent Saudis with Angle’s Class I, II and III malocclusions were selected from orthodontic patients’ records. Angular and linear measurements were compared between the three groups. Cephalometric analysis was performed using the VistadentOC® software. Multifactorial ANOVA for angular and linear measurements between and within groups.

Results

Orthodontic records of 300 patients were included. There was no significant difference between and within groups in age and distribution of Angle’s classification, p > 0.05. Multifactorial ANOVA showed that there were significant interactions between gender and malocclusions in skeletal, dental and soft tissue measurements, p < 0.05. There were significant differences in the sagittal and vertical skeletal measurements between groups, p < 0.05. The dental measurements were also significantly different in most of the measurements (p < 0.05). Moreover, there were significantly different readings among the groups in the soft tissue analysis.

Conclusion

Morphological characteristics of adolescent Saudis show unique differences between gender and malocclusions, more so in Class III malocclusions. Class II and III malocclusions also show skeletal differences amongst the groups.

Comparisons of costs and treatment effects-an RCT on headgear activator treatment of excessive overjet in the mixed and late mixed dentition

OBJECTIVES

To compare the costs and treatment effects of headgear activator treatment of Class II malocclusion with excessive overjet between treatments started in the mixed (MD) and late mixed dentition (LMD).

TRIAL DESIGN

Two-arm parallel-group single-centre randomized controlled trial (RCT).

MATERIAL AND METHODS

A total of 56 children presenting Class II malocclusion with excessive overjet were assessed and invited to an RCT designed as intention-to-treat. The children were randomized, by an independent person not involved in the trial into two groups, treatment with headgear activator in the MD starting at the age of 9 or to treatment with a headgear activator in LMD, starting at the age of 11. The primary outcome measure was to compare the treatment costs between the two groups. Societal costs (the sum of direct and indirect costs) were calculated for successful treatments only and when unsuccessful treatments were included. Secondary outcomes were comparisons of oral health-related quality of life (OHRQoL), dental and skeletal treatment effects, lip closure, and trauma incidence. Data collections were performed before and after treatment, corresponding to a treatment period of 2 years. Blinding was accomplished when assessing outcomes.

RESULTS

No group differences in costs were found of successful treatments or when unsuccessful treatments were included. The most pronounced treatment effects in both groups were the reduction of overjet and improved molar relation. Treatment started in MD or in LMD were equal and without significant differences regarding effects on OHRQoL, skeletal effects, lip closure, and incidence of trauma.

HARMS

No harm was observed, but 8 of 30 children (27%) in the MD and 6 of 21 children (29%) in the LMD group showed unsuccessful results.

LIMITATIONS

Costs depend on local factors and can thereby not be directly transferred to other settings. It was a single-centre trial and can thus be less generalizable.

CONCLUSIONS

Regarding costs and treatment effects, there is no difference if headgear activator treatment of excessive overjet starts in the MD or LMD.

CLINICAL TRIAL REGISTRATION

NCT04508322.

Esthetic impact of malocclusions in the anterior segment on children in the mixed dentition

INTRODUCTION

To assess the esthetic subjective effect of malocclusions in the anterior segment on children in the mixed dentition.

METHODS

A cross-sectional study was carried out with a population-based sample of 787 children aged 8-10 years in the late mixed dentition (n = 787). Orthodontic Aesthetic Subjective Impact Score determined the esthetic subjective effect. For assessing the malocclusions in the anterior segment (anterior crowding, anterior spacing, diastema, anterior open bite, and anterior maxillary overjet), the following Dental Aesthetic Index criteria were used. Sex, family income, and education level were used as control variables. The variables were analyzed using a simple logistic regression model, estimating crude odds ratios. The variables with P <0.20 in the simple analyses were tested in multiple regression models, estimating adjusted odds ratios with the respective 95% confidence intervals.

RESULTS

Increased overjet was 1.54 (95% CI: 1.08-2.17) times more likely to cause greater esthetic concern (P <0.05), especially in girls (P <0.05).

CONCLUSIONS

Increased overjet negatively affected children's esthetic self-perception in the mixed dentition.

Impact of anterior occlusal conditions in the mixed dentition on oral health-related quality-of-life item levels

OBJECTIVES

To evaluate the impact of anterior occlusal conditions in the mixed dentition on item-level analysis of oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

A population-based cross-sectional study of 787 children aged 8 to 10 years was conducted. The Child Perceptions Questionnaire (CPQ8-10) was used to evaluate OHRQoL, and the analysis of item levels was performed on CPQ8-10 domains. Anterior occlusal characteristics were diagnosed according to the Dental Aesthetic Index criteria. Individual analyses were performed relating the outcome as independent variables. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI).

RESULTS

No associations were found with regard to anterior occlusal characteristics (P < .001) after the variables of the previous determinants were adjusted for multivariate analysis. However, the following variables were significantly associated with negative impact on OHRQoL item levels: sex, in oral symptoms (OR = 1.42; CI, 1.07-1.89) and emotional well-being (OR = 1.34; CI, 1.00-1.79); race, in oral symptoms (OR = 1.48; CI, 1.10-1.98), emotional well-being (OR = 1.54; CI, 1.14-2.06), and social well-being (OR = 1.34; CI, 1.00-1.80); and family income in functional limitation (OR = 1.46; CI, 1.06-2.02), emotional well-being (OR = 1.71; CI, 1.21-2.42), and social well-being (OR = 1.59; CI, 1.14-2.21).

CONCLUSIONS

Anterior occlusal conditions did not affect the levels of OHRQoL items.

The implementation of the Handicapping Labio-Lingual Deviation index on access to orthodontic care

OBJECTIVES

In 2017, the state of Illinois changed the system by which they define severe malocclusion from the DentaQuest Orthodontic Criteria Index to the Handicapping Labio-Lingual Deviation Index (HLD). The purpose of this study was to compare subjects who were submitted for coverage under either the DentaQuest Orthodontic Criteria Index or the HLD index to see if a difference exists in the number of subjects who received coverage and the type of malocclusions that were covered.

METHODS

All subjects evaluated for orthodontic coverage by the Illinois Department of Human Services for treatment at the University of Illinois, College of Dentistry during the years 2016 and 2017 were included in this study. One hundred consecutively approved and 100 consecutively denied subjects from both 2016 and 2017 were selected for further analysis.

RESULTS

There was a statistically significant decrease in the overall rate of approval in 2017 compared to 2016. No difference was found in the approval rate of Class I, II, or III subjects, but there was a significant decrease in the approval rate of subjects with impacted teeth.

CONCLUSIONS

The implementation of the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois.

Impact of specific orthodontic parameters on the oral health-related quality of life in children and adolescents : A prospective interdisciplinary, multicentre, cohort study

PURPOSE

The aim of the present study was to analyse the impact of specific orthodontic findings on oral health-related quality of life (OHRQoL) when taking into consideration age and psychological factors in children and adolescents.

METHODS

In all, 250 children and adolescents with an indication for orthodontic diagnostics were recruited using a multicentre study design. Using validated and internationally acknowledged questionnaires, we assessed OHRQoL, health-related quality of life (HRQoL), self-esteem and behavioural problems. We also examined a selection of specific orthodontic findings using photos, model casts and cephalometric analyses, and investigated the impact of these parameters on OHRQoL using simple linear regression analyses. Thereafter, we added all the significant specific orthodontic and psychological parameters to a multiple linear regression model using a stepwise forwards selection procedure.

RESULTS

We were able to identify different specific orthodontic findings that have a significant impact on OHRQoL. These were the type of lip closure, the position of the chin, the Little-index of the upper jaw, the overjet, the overbite and the ANB angle. Moreover, we were able to demonstrate that psychological and some specific orthodontic parameters have a significant impact on OHRQoL.

CONCLUSION

Specific orthodontic findings have a significant impact on patients' perceived OHRQoL. Further longitudinal studies are required to investigate whether the treatment and correction of these malocclusions also improve the OHRQoL of children and adolescents.