Relationship between malalignment of the teeth and periodontal disease

A Study to Assess and Evaluate the Gingival Response During and after the Fixed Orthodontics Treatment Experienced by Adult Patients

Objective

The purpose of this research was to examine patients' periodontal health before, during, and after treatment using a fixed orthodontic device.

Methods

Forty normal teenagers with full sets of permanent teeth and a clinical need for fixed orthodontics participated. Individuals were chosen from the Class I population who would benefit from utilizing traditional orthodontic braces and techniques that did not need extractions. Respondents were sent to the periodontist for required checkups after the placement of a fixed orthodontic device at 3-, 6-, 12-, and 24-month intervals, respectively, till the conclusion of orthodontic treatment.

Results

After having a fixed orthodontic device put in place, patients had a rise in the average values of the Plaque Index and Sulcus Bleeding Index at each checkup. Keeping an eye on the progression three months, six months, a year, and two years after the initiation of orthodontic treatment reveals a statistically significant difference in the presence of gingival hyperplasia.

Conclusion

Patients' periodontal health before, during, and after fixed orthodontic treatment shows the need for close collaboration between the orthodontist and the periodontist.

The consequences of living with a severe malocclusion: A review of the literature

AIM

To facilitate the orthognathic shared decision-making process by identifying and applying existing research evidence to establish the potential consequences of living with a severe malocclusion.

METHODS

A comprehensive narrative literature review was conducted to explore the potential complications of severe malocclusion. A systematic electronic literature search of four databases combined with supplementary hand searching identified 1024 articles of interest. A total of 799 articles were included in the narrative literature review, which was divided into 10 themes: Oral Health Related Quality Of Life; Temporomandibular Joint Dysfunction; Masticatory Limitation; Sleep Apnoea; Traumatic Dental Injury; Tooth Surface Loss; Change Over Time; Periodontal Injury; Restorative Difficulty; and Functional Shift and Dual Bite. A deductive approach was used to draw conclusions from the evidence available within each theme.

RESULTS

The narrative literature review established 27 conclusions, indicating that those living with a severe malocclusion may be predisposed to a range of potential consequences. With the exception of Oral Health Related Quality Of Life, which is poorer in adults with severe malocclusion than those with normal occlusions, and the risk of Traumatic Dental Injury, which increases when the overjet is >5 mm in the permanent and 3 mm in the primary dentition, the evidence supporting the remaining conclusions was found to be of low to moderate quality and at high risk of bias.

CONCLUSION

This article summarises the findings of a comprehensive narrative literature review in which all of the relevant research evidence within a substantive investigative area is established and evaluated. Notwithstanding limitations regarding the quality of the available evidence; when combined with clinical expertise and an awareness of individual patient preferences, the conclusions presented may facilitate the orthognathic shared decision-making process and furthermore, may guide the development of the high-quality longitudinal research required to validate them.

Incisor malalignment and the risk of periodontal disease progression

INTRODUCTION

The objective of this study was to investigate the association between incisor crowding, irregularity, and periodontal disease progression in the anterior teeth.

METHODS

Data collected over 35 years from men enrolled in the Veterans Affairs Dental Longitudinal Study included information concerning pocket depth and alveolar bone loss. Plaster casts of the maxillary (n = 400) and mandibular (n = 408) arches were available for baseline measurements. Periodontal disease in the anterior teeth was defined as per arch sum of pathologic pocket depth and sum of teeth with any alveolar bone loss in the anterior sextants. Incisor malalignment status was defined by the anterior tooth size-arch length discrepancy index and Little's Irregularity Index. Adjusted mixed effects linear models computed the beta (β) estimates and 95% confidence intervals (95% CI) of the amounts of change in periodontal disease outcomes by the level of malalignment.

RESULTS

In the anterior maxillary arch, crowding and spacing were significantly associated with an increased per-arch sum of pathologic pocket depth (β, 0.70 mm; 95% CI, 0.20-1.21, and β, 0.49 mm; 95% CI, 0.06-0.91, respectively). In the anterior mandibular arch, incisor crowding and irregularity were significantly associated with an increased per-arch sum of pathologic pocket depth (mild crowding: β, 0.47 mm; 95% CI, 0.01-0.93; severe irregularity: β, 0.94 mm; 95% CI, 0.50-1.38), and the sum number of teeth with alveolar bone loss (mild and moderate-to-severe crowding: β, 0.45 teeth; 95% CI, 0.08-0.82; and β, 0.45 teeth; 95% CI, 0.13-0.83, respectively; moderate irregularity: β, 0.34 teeth; 95% CI, 0.06-0.62).

CONCLUSIONS

Certain incisor malalignment traits (ie, maxillary incisor crowding, maxillary incisor spacing, mandibular incisor mild crowding, mandibular incisor moderate-to-severe crowding, mandibular incisor moderate irregularity, and mandibular incisor severe irregularity) are associated with significant periodontal disease progression.

Dental health awareness, attitude, and dental health-care seeking practices as risk indicators for the prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district, Kerala, India

Background

Periodontal disease prevalence in children is an indicator of future disease burden in the adult population. Knowledge about the prevalence and risk status of periodontal disease in children can prove instrumental in the initiation of appropriate preventive and therapeutic measures.

Aim

This school-based cross-sectional survey estimated the prevalence and severity of periodontal disease among 15-17-year-old children in Kozhikode district and assessed the risk factors.

Materials and Methods

Multistage stratified random sampling and randomized cluster sampling were used in the selection of schools and study participants, respectively, in three educational districts of Kozhikode. Periodontal disease was assessed among 2000 school children aged 15-17 years, by community periodontal index. A content validated questionnaire was used to evaluate the sociodemographic characteristics and other risk factors.

Results

The prevalence of periodontal disease was estimated as 75% (72% gingivitis and 3% mild periodontitis). The prevalence was higher in urban population (P = 0.049) and males had significantly (P = 0.001) higher prevalence. Lower socioeconomic strata experienced slightly more periodontal disease burden. Satisfactory oral hygiene practices (material and frequency) were observed, but oral hygiene techniques were erroneous. Unhealthy dental treatment-seeking practices and unfavorable attitude toward dental treatment (ATDT) significantly influenced periodontal health status. Overall awareness about dental treatment was poor in this study population.

Conclusion

The prevalence of periodontal disease among 15-17-year-old school children in Kozhikode district is 75% and is influenced by sociodemographic characteristics. Other risk factors identified were unhealthy dental treatment-seeking practices and unfavorable ATDT. Implementation of well-formulated oral health education programs is thus mandatory.

The association between childhood obesity and tooth eruption

Obesity is a growth-promoting process as evidenced by its effect on the timing of puberty. Although studies are limited, obesity has been shown to affect the timing of tooth eruption. Both the timing and sequence of tooth eruption are important to overall oral health. The purpose of this study was to examine the association between obesity and tooth eruption. Data were combined from three consecutive cycles (2001-2006) of the National Health and Nutrition Examination Survey (NHANES) and analyzed to examine associations between the number of teeth erupted (NET) and obesity status (BMI z-score >95th percentile BMI relative to the Centers for Disease Control and Prevention (CDC) growth reference) among children 5 up to 14 years of age, controlling for potential confounding by age, gender, race, and socioeconomic status (SES). Obesity is significantly associated with having a higher average NET during the mixed dentition period. On average, teeth of obese children erupted earlier than nonobese children with obese children having on average 1.44 more teeth erupted than nonobese children, after adjusting for age, gender, and race/ethnicity (P < 0.0001). SES was not a confounder of the observed associations. Obese children, on average, have significantly more teeth erupted than nonobese children after adjusting for gender, age, and race. These findings may have clinical importance in the area of dental and orthodontic medicine both in terms of risk for dental caries due to extended length of time exposed in the oral cavity and sequencing which may increase the likelihood of malocclusions.

Interdisciplinary approach for the treatment of periodontally compromised malpositioned anterior teeth: a case report

Today many adult patients with periodontal disease demonstrate positioning of teeth that comprise their ability for proper mechanical tooth cleaning of approximal tooth surfaces. With adequate combined periodontal-orthodontic treatment it is possible to re-establish a healthy and well-functioning dentition. However, while orthodontic treatment can realign periodontally affected teeth, esthetic appearance may be compromised by gingival recession due to alveolar bone dehiscences or fenestrations in combination with a thin gingival biotype. This article reports an interdisciplinary (periodontic, orthodontic, restorative) approach for the treatment of a periodontally compromised patient with anterior dental malalignment. Periodontal therapy, including periodontal plastic surgery to obtain root coverage as well as orthodontic treatment by means of a miniscrew implant anchorage were used to achieve stable periodontal conditions and successful esthetic and functional final results.

Accelerated tooth eruption in children with diabetes mellitus

OBJECTIVE

The objective of this study was to evaluate tooth eruption in 6- to 14-year-old children with diabetes mellitus.

METHODS

Tooth eruption status was assessed for 270 children with diabetes and 320 control children without diabetes. Data on important diabetes-related variables were collected. Analyses were performed using logistic regression models.

RESULTS

Children with diabetes exhibited accelerated tooth eruption in the late mixed dentition period (10-14 years of age) compared to healthy children. For both case patients and control subjects the odds of a tooth being in an advanced eruptive stage were significantly higher among girls than boys. There was also a trend associating gingival inflammation with expedited tooth eruption in both groups. No association was found between the odds of a tooth being in an advanced stage of eruption and hemoglobin A(1c) or duration of diabetes. Patients with higher body mass index percentile demonstrated statistically higher odds for accelerated tooth eruption, but the association was not clinically significant.

CONCLUSIONS

Children with diabetes exhibit accelerated tooth eruption. Future studies need to ascertain the role of such aberrations in dental development and complications such as malocclusion, impaired oral hygiene, and periodontal disease. The standards of care for children with diabetes should include screening and referral programs aimed at oral health promotion and disease prevention.

Effects on dental health of spacing of teeth in anterior segments

The purpose of the study was to examine the relationship between spacing and dental health in 15-year-old adolescents. The whole sample consisted of 156 subjects. Out of them, 74 females and 73 males with 6 anterior teeth made up the study group for examination of the upper jaw. 75 females and 75 males had 6 anterior teeth in the lower jaw and made up the study group for examination of the lower jaw. The Plaque Index (PlI) and the Gingival Index (GI) were recorded. Probing depths (PD) were measured as explained by Glavind & Løe. Filled surfaces (FS) were taken from the individual case sheets and controlled clinically. The spacing of the individuals was assessed by counting the number of proximal surfaces without visible contact with the adjacent proximal surfaces, on model casts. The sum of proximal surfaces without contact made up the Space Index (SpI) of the individual jaw. Parametric and non-parametric statistical methods were used to analyze the data. In both sexes and both jaws proximal surfaces without interdental contact had a more favourable periodontal condition than surfaces with contact. In the upper jaw of both sexes, proximal surfaces without interdental contact had a reduced number of filled surfaces compared to surfaces with contact. The linear relationship between SpI and FS was significant, i.e., an increased number of surfaces without contact was accompanied by a reduced number of filled surfaces. In the lower jaw, the differences between the SpI groups and the linear relationship between SpI and FS did not reach significance. In both sexes and both jaws, proximal surfaces without fillings had a more favourable periodontal state compared to surfaces with fillings. Indications are that the summation effect of the presence of interdental contact and the presence of fillings contributed to the differences in periodontal condition between surfaces with and without interdental contact.