Recognition of patient-reported impairment in oral aesthetics

Developing diagnostic criteria for tooth wear, a preliminary beta version based on expert opinion, and a narrative literature review

BACKGROUND

Tooth wear is a multifactorial condition, leading to the irreversible loss of dental hard tissues. The availability of an unambiguous, universally applicable assessment protocol remains lacking.

OBJECTIVES

The goal of the authors is to develop a set of diagnostic criteria for the assessment of tooth wear (DC-TW). A two-step approach will be used to achieve this objective: (1) to develop a preliminary beta version of the DC-TW, based on the authors' clinical experience and their shared expertise and supported by a narrative review of the existing literature, and (2) to develop the final DC-TW, with input from a larger group of experts using an international Delphi process. This paper relates to the first step.

METHODS

The authors outlined the components that should be incorporated into the DC-TW. The literature search was performed to investigate if their concept was in line with the available literature. The search was conducted to identify eligible publications from inception to July 11, 2022. Two authors independently screened all publications, and differences in judgements were resolved through a consensus procedure.

RESULTS

The search yielded 5362 publications, resulting in the final inclusion of 383. These publications were divided into four main topics: (1) nomenclature/taxonomies; (2) self-report tools; (3) clinical assessment tools; and (4) clinical decision-making.

CONCLUSIONS

The information from the publications was used and fused with the clinical experience and shared expertise of the authors to contribute to the development of a preliminary beta version of the DC-TW.

Measuring Patient’s Orofacial Estheticsin in Prosthodontics: A Scoping Review of a Current Instrument

Objective:

Although prosthodontic treatment is aimed at improving oral function, esthetics has become the most common motivation for treatment. To ensure successful outcomes, valid and reliable instruments for comprehensively evaluating the esthetic aspects of prosthodontic treatment from both clinician perspective and patient self-assessment are needed. The literature on measurement tools used in prosthodontics to evaluate orofacial esthetic aspects was also studied.

Methods:

A scoping review was conducted to map existing instruments such as a questionnaire, index, or scale designed to evaluate orofacial esthetics by clinician and patient for prosthodontic treatment.

Results:

Of the 27 studies evaluated, the Orofacial Esthetic Scale (OES) was used mostly for evaluating a patient’s esthetic perception. The ‘Dental Esthetic Screening Index’ (DESI) was found as the most currently developed instrument with objective quantification for the clinical situation having good reliability and validity. The Prosthetic Esthetic Index (PEI) also has sufficient psychometric properties as an objective assessment tool for clinicians. But the PEI and the DESI are still rarely used in research and practice. Teeth color and position were determined to be the most important factors in recognizing esthetic impairment. Following tooth analysis (appearance, color, alignment, space, proportion, and wear), gingival appearance, smile analysis, facial analysis, and unaesthetic restoration or prosthesis were the most important esthetic factors identified.

Conclusion:

Esthetics is subjective and is influenced by many factors. Instruments for subjective and objective evaluation are needed to determine the esthetic perceptions of clinicians and patients. OES, PEI and DESI were found to be relevant instruments for this.

Associations between tooth loss, prostheses and self-reported oral health, general health, socioeconomic position and satisfaction with life

OBJECTIVES

To investigate whether the location of tooth loss and prosthesis are associated with self-reported oral health, general health, socioeconomic position and satisfaction with life.

METHODS

From the Copenhagen Aging and Midlife Biobank (CAMB) investigation, 1517 persons had their oral status ranked (full dentition, fixed prosthesis in the masticatory zone, tooth loss in the masticatory zone, fixed prosthesis in the aesthetic zone, removable prosthesis, tooth loss in the aesthetic zone). Self-reported oral health, general health, socioeconomic position and satisfaction with life were obtained. Information on gender, normative socioeconomic position, frequency of seeing a dentist, acute dental treatment within the last 5 years and general diseases was also recorded.

RESULTS

Patients with tooth loss in the aesthetic zone and removable prosthesis showed high odds ratios for reporting poor rather than good oral health compared to patients having a full dentition. Having a removable prosthesis was further associated with rating socioeconomic position as low rather than high (odds ratio = 27.7 [95% CI: 5.07; 151.6]) compared to a full dentition after controlling for normative socioeconomic position and gender. In the bivariate analyses, a tendency towards poorer general health and poorer satisfaction with life was found with worse oral status, meanwhile the multiple regression analyses did not show significant associations between oral status and general health and satisfaction with life.

CONCLUSIONS

Missing teeth and having prostheses are associated with worse self-reported oral health compared to having a full dentition. Removable dental prosthesis may be associated with a worse self-perception of socioeconomic status.

Analysis of gaze points for mouth images using an eye tracking system

PURPOSE

We aimed to clarify whether people stare at non-esthetic restorations by analyzing the gaze point of laypersons looking at mouth images with intraoral non-esthetic restoration.

METHODS

The gaze points of 47 laypersons who do not visit dentists were measured using an eye tracker. The stimuli were 18 photographs of mouths with or without a non-esthetic tooth restoration, each randomly shown for 5s. The analysis sites included a tooth with non-esthetic restoration and the same tooth on the opposite side of the mouth. We measured the proportion of participants who first fixated on each analysis site, and total fixation time for each site.

RESULTS

In images without non-esthetic restorations, a similar proportion of participants first fixated on each analysis site. However, more participants first fixated on non-esthetic restorations when the images contained them. Total fixation time for each site did not differ significantly between the left and right sides in the images without non-esthetic restoration (P>0.05). Participants fixated on the non-esthetic restoration significantly more in the images containing them (P<0.01).

CONCLUSIONS

Within the limitations of this study, the present findings suggest that in photographs of the mouth with non-esthetic restoration on either side, the non-esthetic restoration is first gazed before the opposite side. In addition, the non-esthetic restoration is gazed longer than the opposite side, and there was no major difference in the fixation time regarding the state of non-esthetic restoration.