A longitudinal pilot study examining the influence of the orthodontic system chosen in adult patients (brackets versus aligners) on oral health-related quality of life and anxiety

BACKGROUND

In recent years, the demand for orthodontic treatment with aligners has increased, led by patient need, as aligners typically provide them with improved aesthetics and less physical discomfort. In deciding with the patient on an appropriate orthodontic system, it is important to take into account the potential discomfort and the perceptions that patients have in relation to their treatment. The objective of this study was to analyze the influence of brackets or aligners on oral health-related quality of life (OHRQoL) and anxiety levels in a sample of adult patients during the first month of treatment.

METHODS

The pilot study was carried out at the Dental Clinic of the University of Salamanca between November 2023 and February 2024. Eighty adult patients who initiated orthodontic treatment were selected and divided into two groups: the brackets group (Victory®; 3 M Unitek, California, USA) (n = 40) and the aligners group (Invisalign®; Align Technology, California, USA) (n = 40). OHRQoL was analyzed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire, and anxiety was analyzed using the State-Trait Anxiety Inventory (STAI). The follow-up time was one month, with scores recorded at the beginning (T0) and one month after starting treatment (T1).

RESULTS

The mean patient age was 33.70 (± 5.45) years old. The total sample (n = 80) consisted of 66.2% men and 33.8% women. In the brackets group, one month after starting treatment, the dimension with the highest impact was that of physical pain (5.62 ± 1.51). In the aligners group, where the dimension of psychological disability had the highest score (4.22 ± 1.02). In the brackets group the total OHIP score was higher at one month (T1) (33.98 ± 6.81) than at the start of treatment (T0) (21.80 ± 3.34); this greater impact on OHRQoL one month after starting treatment was not observed in the aligners group (T1 = 27.33 ± 6.83; T0 = 27.33 ± 6.22). The orthodontic system used did not influence participants' anxiety (p > 0.05). Age and sex were not influential factors in either OHRQoL or anxiety.

CONCLUSIONS

The bracket system significantly influenced patients' OHRQoL. In the sample studied, no influence of the orthodontic system (brackets versus aligners) on anxiety was observed.

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.

Influence of malocclusion on OHRQoL in adolescents in initial orthodontic treatment phase

OBJECTIVES

Besides correcting malocclusions, another main objective of orthodontic treatment is to improve patients' oral health-related quality of life (OHRQoL). This study aimed to assess changes in OHRQoL of children within the first six months of orthodontic therapy with fixed orthodontic appliances.

METHODS

85 patients aged 11 to 14 years requiring fixed orthodontic appliance therapy were included. The children completed the German version of the Child Perceptions Questionnaire (CPQ-G-11-14) before (T0), 1 month (T1) and 6 months (T2) after the start of orthodontic treatment. The type of malocclusion was categorized according to the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The initial type of malocclusion affected the children's OHRQoL, whereas gender and age did not. The IOTN dental health component (DHC) had a significant impact on the CPQ score (median CPQ of 15.00 for the group DHC 4 vs. 22.50 for DHC 5, p = 0.032). The onset of orthodontic treatment initially affected the CPQ domains "Oral symptoms" and "Functional limitations, with a change versus baseline of 2.00 (p = 0.001), but improved again after 6 months. Regression analysis demonstrated that children with an IOTN DHC 5 malocclusion experienced a greater impact on their ORHQoL, as indicated by a CPQ score 7.35 points higher than that of children with an IOTN DHC 4 malocclusion (p = 0.015).

CONCLUSIONS

At the beginning of orthodontic treatment, the OHRQoL slightly worsens, probably due to the discomfort and appearance of the appliances. However, 6 months after the start of orthodontic treatment, OHRQoL improved again in patients with severe malocclusion (IOTN 4 and 5), and approached baseline values.

CLINICAL RELEVANCE

The results help the clinician to better understand specific aspects of oral health that may be affected by different malocclusions, thereby improving the child's satisfaction and overall quality of life.

Enhancing Orthodontic Renewal and Retention Techniques: A Systematic Review

Orthodontists have a variety of options available for retainers. Research in Orthodontics focuses on assessing outcomes important to clinicians; however, there is inconsistency in how these outcomes are selected and evaluated. This review sought to assess the effects of different orthodontic retainers on patients' quality of life (QoL). Various approaches were employed in this systematic review, and a thorough search was conducted across six databases. The review involved a comprehensive evaluation of six included studies, highlighting changes in dental structure post-treatment, emphasizing the role of extraction procedures and the quality of debonding in improving retention. The study identified key outcomes for orthodontic clinical trials, highlighting orthodontists' preferences for specific retainer types. Moreover, it discussed the impact of sociocultural influences on retention care. Involving patients actively in discussions about whether to end or extend the retention phase was deemed essential. Noteworthy improvements in occlusal outcomes were linked to extraction treatments. Gender and malocclusion severity influenced QoL before and after orthodontic treatment. The degree of improvement observed in the Class III malocclusion group was comparatively lower than that in the Class I and Class II groups. Orthodontic treatment was found to yield favorable psychological outcomes, as evidenced by notable enhancements in self-esteem and social engagement among individuals. Fixed appliances were shown to negatively affect oral health-related quality of life (OHRQoL), particularly for those with aesthetic and functional concerns. A consensus has been reached on the essential themes and outcomes that should be incorporated in clinical trials related to orthodontic retention for non-cleft and non-surgical cases.

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).

METHODS

A systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.

RESULTS

Overall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.

CONCLUSIONS

Patients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.

Gender differences in the association between malocclusion traits and oral health-related quality of life in Finnish adults

We aimed to evaluate the gender-specific associations of malocclusion traits with oral health-related quality of life (OHRQoL) among Finnish adults. Data were obtained from the Health 2000 Survey, Finland. Included participants (n = 3993) were ≥30 years old with OHRQoL and occlusion data. OHRQoL was measured using the 14-item Oral Health Impact Profile (OHIP-14). OHIP-14 severity mean score, prevalence of impacts, and means of seven dimensions were outcomes. Explanatory variables were any malocclusion trait, increased overjet, negative overjet, open bite, deep bite, and crossbite/scissor bite. Logistic (prevalence) and cumulative (severity) regression models were adjusted for age, decayed teeth, deep periodontal pocket, occluding pairs, orthodontic treatment, and self-perceived health. Gender modified the association between any malocclusion trait and OHRQoL, with the association being stronger in females. Females without any malocclusion trait (OR = 1.62, 95% CI = 1.14-2.28) or without crossbite/scissor bite (OR = 1.68, 95% CI = 1.16-2.43) had better OHRQoL (lower prevalence) than those with malocclusions. Males without increased overjet (OR 1.50, 95% CI = 1.04-2.17) had lower mean OHIP-14 severity score than males with increased overjet, after adjustments. The association between psychological and physical disability and malocclusion traits was different between males and females. Gender differences in the impact of malocclusion traits should be considered when assessing orthodontic treatment need.

Spontaneous changes in mandibular incisor crowding from mixed to permanent dentition: a systematic review

INTRODUCTION

Dental crowding is the most prevalent malocclusion in the mixed and permanent detitions and can have a major impact on dentofacial esthetics. However, adjustments to the development and growth of the dentition can potentiate self-correction of dental crowding during childhood.

OBJECTIVE

To evaluate the physiological behavior of mandibular incisor crowding in the transition from mixed to permanent dentition.

METHODOLOGY

Five electronic databases (PubMed, Scopus, Web of Science, LILACS and LIVIVO) and part of the gray literature (Proquest and Google Scholar) were investigated, based on the eligibility criteria associated with the acronym PECO, until June 2022. The risk of bias was assessed using the ROBINS-E tool and the certainty of evidence, the GRADE tool.

RESULTS

Among the 2.663 studies identified, five were selected for qualitative analysis, of which one have a low risk of bias, and four, a moderate risk. A total of 243 patients were evaluated. Evidence with a high level of certainty was generated indicating a tendency for improvement in mandibular incisor crowding from mixed to permanent dentition, with mandibular incisor crowding decreasing from 0.17 to 4.62 mm on average. The mandibular incisor crowding reduction seems to be associated with the amount of initial crowding and spontaneous dental arch dimensional changes that occur in the mixed dentition and culminate in the increase in arch perimeter, leeway space, incisor protrusion and transverse growth of the maxillary and mandibular arch.

CONCLUSION

Based on moderate scientific evidence, spontaneous longitudinal changes in dental arch in the transition from the mixed to the permanent dentition demonstrate a spontaneous improvement in mandibular incisor crowding by up to 4.62 mm. These evidence provide a scientific basis for planning only longitudinal follow-up in patients with mild to borderline moderate mandibular incisor crowding in the mixed dentition avoiding overtreatment.

Assessment of Orthodontic Treatment Need and Oral Health-Related Quality of Life in Asthmatic Children Aged 11 to 14 Years Old: A Cross-Sectional Study

This study investigated the need for orthodontic treatment in asthmatic children aged 11 to 14 years and how the treatment affected their oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This cross-sectional study was conducted at the dental clinic of the University of Salamanca in 2020-2022. The study selected a consecutive sample of 140 children with asthma (52.1% girls; 47.9% boys). This study used the Orthodontic Treatment Needs Index (OTN) to analyze the need for orthodontic treatment and the Children's Perception Questionnaire (CPQ11-14) to assess OHRQoL.

RESULTS

Sex and age did not significantly influence the need for orthodontic treatment, although age may be considered influential for OHRQoL concerning oral symptoms (p < 0.01), functional limitations (p < 0.05), and total score on the CPQ_11-14 questionnaire (p < 0.05): the younger the age, the greater the effect of the need for orthodontic treatment on OHRQoL. The social well-being of the patients was much more significantly impacted by the need for orthodontic treatment (15.7 ± 1.91) than by oral symptoms (7.64 ± 1.39), which were the least impacted. In all parts of the CPQ_11-14 questionnaire and in the patients' total scores, we observed significant agreement (p < 0.01) that treatment influenced OHRQoL.

CONCLUSION

An inverse relationship exists between the severity of the treatment needed and OHRQoL.

Aligner therapy in adolescents: first-year results on the impact of therapy on oral health-related quality of life and oral hygiene

OBJECTIVES

The aim of this multicenter clinical study was to examine the oral health-related quality of life and oral hygiene in adolescents before and during aligner therapy.

MATERIALS AND METHODS

Forty subjects (18 ♀, 22 ♂; mean age: 13.6 years) scheduled for aligner therapy (Invisalign® Teen) were given oral health-related quality of life questionnaires, Oral Health Impact Profile (OHIP-G14) and Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ), to complete within their treatment (visit 1: 0 start of therapy; visit 2: 0 + 4 weeks; visit 3: 0 + 10 weeks; visit 4: 0 + 6 months; visit 5: 0 + 1 year). To assess oral hygiene, a questionnaire to take home was used, and plaque level was evaluated with the Quigley-Hein Plaque Index (TMQH) modified by Turesky et al. RESULTS: The OHIP-G14 mean score before aligner therapy was 3.3 ± 3.2, and 4.9 ± 5.4 after 1 year. The PIDAQ showed a positive psychological change in the well-being, as well as a more effective at-home oral hygiene regime. On average, the TMQH remained at a low level (grade 2 of 0-5). The initial insertion of the aligners caused the most significant changes in all parameters (except TMQH).

CONCLUSION

Oral health-related quality of life is only slightly affected during the first year of aligner therapy in adolescents. Oral hygiene at home is intensified and there is no increased dental plaque accumulation.

CLINICAL RELEVANCE

Dentofacial esthetics is a subset of the so-called Oral H-Related Quality of Life (OHRQoL) which should be considered more during orthodontic therapy.

Comparison of the psychosocial impact on patients affected by cranio facial anomalies between traditional orthodontic brackets and aligners

OBJECTIVES

Malocclusion affects the psychological wellness and social interaction, impacting negatively on adolescents' quality of life and self-esteem. Facial attractiveness is mostly based on the esthetics of the smile and patients seek orthodontic treatment mainly to improve aesthetics. The aim of this prospective clinical study is to compare the psychosocial impact of aligners (AL) and fixed appliances (FA) as orthodontic treatments in patients affected by craniofacial anomalies (CFA).

METHODS

100 syndromic Caucasian patients with CFA followed in two different hospitals were divided in two groups: 50 patients treated with AL and 50 patients treated with FA. The two groups were matched for gender, age and CFA and filled out a modified psychosocial impact of dental aesthetics questionnaire (mPIDAQ).

RESULTS

Patients affected by CFA treated with AL reported a better psychosocial impact than patients treated with FA, showing higher esthetic self-perception and self-esteem, lower social interaction impairments, and lower physical/practical disturbances.

CONCLUSIONS

The results of this study suggest that AL could be a valid alternative, especially in complex patients with CFA. Since AL application requires more cooperative patients the orthodontist should dedicate more time to motivate the patient to adhere to the treatment schedule.

Association of Craniofacial Patterns with the Curve of Spee and the Time Required for Orthodontic Levelling

The curve of Spee (CoS) is an important parameter for an individualized treatment plan. The available information regarding a potential association of the depth of the curve of Spee with various skeletal craniofacial characteristics is conflicting and it is also unknown whether certain craniofacial parameters affect the duration of the levelling phase of orthodontic treatment. A prospective sample of 32 patients with mild to moderate crowding that underwent orthodontic treatment with full fixed appliances was used to study these topics. The craniofacial characteristics were captured on pre-treatment lateral cephalometric radiographs and measurements of the CoS were performed on the initial 3D digital dental models using the Viewbox 4 software. Non-parametric statistics and Spearman’s correlations were applied. Weak negative correlations were detected between the CoS depth and the SNA and SNB angles. There was no other association between the CoS and craniofacial parameters, including various anteroposterior measurements. Furthermore, there was no significant association of any craniofacial parameter with the duration of the levelling. Contrary to certain clinical beliefs, it can be argued that the craniofacial characteristics are not associated with the CoS and the time required for its levelling in subjects with moderate pre-treatment CoS depth.

Oral-Health-Related Quality of Life and Anxiety in Orthodontic Patients with Conventional Brackets

The aim of this study was to evaluate the oral-health-related quality of life (OHRQoL) and anxiety levels of adult patients undergoing orthodontic treatment with fixed multibracket appliances.

MATERIALS AND METHODS

The study was carried out at the Dental Clinic of the University of Salamanca in 2021. It included 120 adult patients between 19 and 45 years of age undergoing orthodontic treatment with conventional metal brackets. The data collection instruments chosen were the state-trait anxiety inventory (STAI) to assess anxiety levels and the OHIP-14 questionnaire to measure the OHRQoL. Anxiety levels and OHRQoL were analyzed one month after starting treatment.

RESULTS

The mean age was 31.7 years ± 6.5 years; 68 patients were women (56.7%) and 52 were men (43.3%). Psychological disability was the dimension of the OHIP-14 questionnaire that was found to have the greatest impact (3.20 ± 1.08) on patients, as compared to the dimension of disability, which had the lowest impact on the oral-health quality of life (0.37 ± 0.56). The mean total score of the OHIP-14 questionnaire was 11.93 (±2.19). There was no statistically significant influence from either sex or age on the anxiety and oral-health quality of life of the participants; however, there was a significant relationship between the dimensions of physical disability and anxiety traits.

CONCLUSIONS

The physical disability dimension of the OHIP-14 questionnaire increased the anxiety level of adult patients treated with conventional brackets. The impact of orthodontic treatment on adult patients may negatively influence their levels of anxiety.

Looking good but tweeting bad? The social perception of orthodontic-related posts on Twitter and Instagram

BACKGROUND

Social media plays a major role in the daily life of adolescents and has become highly interesting for healthcare research as well. The aim of this study was to explore the social perception of orthodontic-related posts on Twitter and Instagram by young adults.

METHODS

401 orthodontic-related posts were collected during a 30-day period and categorized with regard to specific characteristics - their content and the social networking site (SNS) being used as well as the presence or absence of a selfie. In order to investigate the social perception of these posts, 42 young adults rated the emotional states of the SNS users using the Self-Assessment Manikin (SAM)-Tool. A total of 4211 poster-rater observations pertaining to the three SAMs dimensions pleasure, arousal and dominance were analyzed by using linear and multinomial logistic regression analyses.

RESULTS

The investigated characteristics of the collected posts had significant effects on the perceived emotional state of the SNS users. Besides significant SNS-associated differences, there were also effects that were independent of the SNS being used: Receiving orthodontic appliances was more often associated with rather negative emotions (p < 0.001), while users who posted about the removal of such braces were more often perceived as joyful (p < 0.001). Interestingly, users whose posts contained selfies with visible braces were perceived as significantly more positive and stronger in comparison to users who did not post a picture of themselves (p < 0.05).

CONCLUSION

This research gives insights into the social perception of orthodontic-related posts on SNS. While users' emotional states were perceived highly differential on both SNS, orthodontic-related content also revealed significant effects on social perception. Because selfies with visible braces were associated with positive feelings by young adults, a modern and SNS-related way of coping with a temporary supposed impairment like fixed orthodontic appliances might have been revealed through this research.

A qualitative study of orthodontic patients' experiences in quarantine during the COVID-19 pandemic outbreak

Introduction

Methods

Results

Conclusions

Orthodontic treatment with clear aligners and enamel remineralization in adolescents

Relevance. The effectiveness of the new remineralizing agent PRESIDENT®PROFI REM "MINERALS GEL" was assessed at different stages of clear aligner orthodontic treatment in adolescents with reduced enamel resistance.Materials and methods. PRESIDENT®PROFI REM "MINERALS GEL" was evaluated in a one-month open, single center, non-comparative study where 20 adolescents took part (mean age 14.9 ± 1.1 years).Results. OHI-S decreased by 24.75%, PMA and ERT reduced by 44.33% and 17.11% respectively, after one month of the orthodontic treatment with clear aligners and simultaneous use of the remineralizing gel. The pH in the mixed saliva increased from 6.97 ± 0.16 to 7.69 ± 0.11, calcium went up by 48.5%, and the total antioxidant activity decreased by 29.36% (according to the mixed saliva biochemical parameters). The OHIP-14 questionnaire revealed that the quality of life decreased in 75% of adolescent patients during the orthodontic treatment with aligners due to "communication problems". The quality of life was significantly higher during the aligner treatment with simultaneous remineralizing therapy than during the conventional treatment with fixed appliances (4.25 ± 0.86 points in the aligner group versus 7.05 ± 1.16 points – the brackets group).Conclusions. The remineralizing gel PRESIDENT®PROFI REM "MINERALS GEL" has an anti-plaque and mineralizing effect. The quality of life is significantly higher during the clear aligner treatment with simultaneous remineralizing therapy than during the conventional treatment with fixed appliances.

Effect of the timing of second molar bonding on the duration of the mandibular arch levelling: a randomized clinical trial

INTRODUCTION

This study investigated the effect of the timing of second molar bonding on the time required for the levelling of the mandibular dental arch.

TRIAL DESIGN

Single-centre two-arm parallel randomized clinical trial using random permuted blocks. Allocation concealment was achieved through sealed envelopes. There was blinding in outcome assessment, but not of patient or operator.

METHODS

Thirty-six patients (12-18 years old) with mild to moderate crowding and fully erupted mandibular second molars were assigned randomly (1:1 ratio) in two groups. Group A started fixed orthodontic treatment by bracket bonding in both jaws. Initial wire was 0.014" NiTi. Lower second molar tubes were bonded at the time of 0.016" x 0.022" NiTi wire placement. Group B was same as Group A, but second lower molars were bonded at the first appointment. Placement of the 0.017" x 0.025" stainless steel wire in the mandibular arch was considered the primary endpoint of the trial, indicating the completion of the levelling phase. The days required from bonding to the endpoint comprised the main outcome. Non-parametric statistics were applied.

RESULTS

There were two dropouts in each group. The compared groups had similar baseline characteristics regarding age, sex, overjet, overbite, space in the dental arch, average Curve of Spee (CoS), and maximum CoS. Group A tended to require more days for levelling (median: 203 days) than Group B (median: 168 days). However, this difference was not statistically significant (P = 0.128). From the tested occlusal factors, only initial overjet was found to be moderately associated with the days required to complete levelling of the mandibular arch (r = 0.45, P = 0.009).

CONCLUSIONS

In the frame of the current study, the duration of the levelling phase of orthodontic treatment with fixed appliances was not affected by the timing of second molar inclusion in the appliance. Future research could aim in cases with deep CoS to generalize the present findings and in larger sample sizes.

Psychological status of TMD patients, orthodontic patients and the general population during the COVID-19 pandemic

Confronting the outbreak of COVID-19, this cross-sectional study was aimed to assess psychological status of temporomandibular disorders (TMD) patients, orthodontic patients and the general population in China during the pandemic. An online anonymous questionnaire was developed in Chinese, including the individual background information, the perception of the epidemic, and level of anxiety and depression through Kessler Psychological Distress Scale (K10). The respondents were divided into ORTHO group, TMD group and Control group. Descriptive analysis and multiple linear regression modelling were performed. In total, 1241 valid questionnaires were collected, covering 587 orthodontic patients and 220 TMD patients. It is shown that the overall mental health is not quite optimistic during the COVID-19 pandemic with the mean score of K10 being 18.65. TMD patients have higher level of anxiety and depression than orthodontic patients as well as the general population. Younger age, female gender, having close contact with individuals from Hubei province, higher self-rated infection possibility, concern about psychological barriers and distrust are negatively affecting patients' psychological status. Mental health care should be emphasized when hospitals and clinics reopen after the COVID-19 pandemic, especially to patients with these relevant characteristics.

Mental distress in orthodontic patients during the coronavirus disease 2019 pandemic

Introduction

The ongoing coronavirus disease 2019 (COVID-19) outbreak impacts the mental health of patients, health workers, and the public. The level of impact on the mental health of orthodontic patients in treatment is unknown. The objective of the study was to evaluate the mental health of orthodontic patients in China during the early stage of the pandemic.

Methods

An online survey was conducted on a convenience sample of anonymous participants. The questionnaire, in Chinese (Mandarin), comprised 5 sections. Sections 1-3 included demographic, epidemical, and orthodontic status of the patients. Section 4 assessed mental health-related to orthodontics. Section 5 was the Kessler-10 Mental Distress Scale. A total of 48 orthodontists were invited to distribute the questionnaires to their patients. Descriptive statistics, principal component analysis, K-means cluster analysis, and bivariate logistics regression analysis were performed with significance set at P <0.05.

Results

Questionnaires were collected from 558 patients (104 males, 354 females; mean age 24.78 ± 6.33 years). The prevalence of mental distress was 38% (174/458). Higher odds ratios were associated with female participants, missed appointments, and Hubei residence. The type of orthodontic appliance was associated with the anxiety of prolonged treatment duration. The manner of communication with patients regarding the postponement of appointments was associated with patients' concerns of prolonged treatment duration. The frequency of contact from dentists was associated with patients' independence.

Conclusions

Over one-third of orthodontic patients experienced mental distress during the pandemic. Multiple factors affected the level of anxiety of orthodontic patients, such as the type of orthodontic appliance, time since last dental visit, manner of communication with the orthodontist, and the localities of the pandemic progression.

•

Thirty-eight percent of patients had orthodontic-related mental distress during the pandemic.

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Orthodontic patients in the epicenter revealed higher odds of mental distress.

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Orthodontists who contact patients personally might relieve their anxiety.

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Patients with invisible appliances felt less anxiety about the duration of treatment.

•

The results could guide orthodontists from other countries with similar situations.

Temporary deterioration of oral health-related quality of life (OHRQoL) in nonextraction and extraction modalities of comprehensive orthodontic treatment in adolescents

OBJECTIVE

To evaluate the effects of nonextraction and all first premolar extraction modalities of orthodontic treatment on oral health-related quality of life (OHRQoL) among adolescents.

MATERIALS AND METHODS

Sixty-eight adolescents of aged 12-18 years were chosen. Subjects who required nonextraction orthodontic treatment were included in group I, and those who required all first premolar extractions for orthodontic treatment were included in group II. Baseline OHRQoL data (T0) were recorded before the start of treatment. To evaluate the impact of orthodontic treatment on OHRQoL, the Oral Health Impact Profile-14 (OHIP-14) questionnaire was presented to all subjects for retrospective evaluation at 1 month (T1), 3 months (T2), 6 months (T3) and 1 year (T4) after the start of orthodontic treatment and 1 week after completion of orthodontic treatment (T5).

RESULTS

At T1 and T2, the physical pain and physical disability domains of OHIP-14 were impacted significantly by comprehensive orthodontic treatment in both groups (P < .001). The negative impact of orthodontic treatment on OHRQoL was maximum at T1 and then slowly recovered to the pretreatment level at T3 in both groups. Recovery of OHIP-14 scores was relatively faster in group I subjects compared to group II subjects. At T1 and T2, social disability and handicap domains were deteriorated significantly in group II subjects compared to group I subjects (P < .01).

CONCLUSIONS

The severity of OHRQoL deterioration was similar in both modalities of orthodontic treatment, but recovery from negative impacts was relatively slower in the first premolar extraction subjects.

Patient-reported experience and outcomes from orthodontic treatment

OBJECTIVE

To measure patient-reported impact of orthodontic treatment in terms of pre-treatment concerns, treatment experience and treatment outcome.

SETTING

Four sites in Yorkshire, including two secondary care settings (Leeds Dental Institute and St Luke's Hospital, Bradford) and two specialist orthodontic practices.

DESIGN

Cross-sectional survey.

PARTICIPANTS

NHS orthodontic patients (aged 12+ years) who have completed comprehensive orthodontic treatment, excluding orthognathic surgery and craniofacial anomalies.

METHODS

Participants were opportunistically identified by the direct clinical care team during scheduled appointments and those eligible were invited to participate. Data were collected using the Orthodontic Patient Treatment Impact Questionnaire (OPTIQ), a validated 12-item measure with questions relating to pre-treatment experience, impact of treatment and outcome from treatment.

RESULTS

Completed questionnaires for analysis included 120 from primary care and 83 from secondary care. The most common pre-treatment concerns were alignment (89%) and being embarrassed to smile (63%). The most common expectations from orthodontic treatment were improved confidence to eat (87%) and smile (72%) in front of others, improved appearance of teeth (85%) and reduced teasing/bullying (63%). Only 67% respondents recalled receiving written information and the lowest recall related to retainer type and length of retention. The most commonly reported complications were sore mouth (68%), fixed appliance breakage (61%) and gingivitis (39%). Treatment caused greatest impact in relation to pain, limitations in eating and effect on speech. Overall satisfaction with orthodontic treatment was reported by 96% of respondents, 87% would have orthodontic treatment again (if needed) and 91% would recommend treatment to a friend.

CONCLUSIONS

The OPTIQ is a useful patient-reported tool to identify pre-treatment concerns and expectations, treatment experience and outcome. Orthodontic treatment leads to high levels of satisfaction.