Managing orthodontic appliances in everyday life: A qualitative study of young people's experiences with removable functional appliances, fixed appliances and retainers

Capturing the smile: Exploring embodied and social acts of smiling

Smiling is an embodied and complex social act. Smiling is presented as facilitating individual health and wellbeing, but the value placed on smiling raises questions about structural conditions acting on the body. While smiling has been considered sociologically, psychologically and historically, we argue that further exploration of the embodied smile offers fruitful avenues for future research. This article attempts to advance understanding of the smile and its importance by: (I) Bringing together literature on smiling as a social act and smiling as embodied. (II) Systematically identifying key themes, which recognise sociological insights and the relevance of oral health. (III) Pointing to useful directions for future sociological research into smiling. In this article, we review literature on body techniques; impression management and social interaction; gender, race and smiling; and emotional, aesthetic and affective labour. We move on to embodiment, considering the mouth as a body project and in relation to the ageing body, before reflecting on the significance of oral health and dentistry. We highlight future directions for sociological research on smiling, building on eight interrelated and cross-cutting themes: norms and expectations, aesthetic ideals, self and identity, health and wellbeing, body work, commodification and labour, inclusion and exclusion and resistance.

Contemporary Twin Block appliance wear protocols: A survey of UK orthodontists

OBJECTIVE

This study was undertaken to determine contemporary trends in the use of the Twin Block appliance among UK orthodontists, including the wear time currently prescribed. In addition, the study explored if there had been any change in wear time prescribed, considering recent research evidence proposing part-time wear.

DESIGN

Cross-sectional, online survey.

PARTICIPANTS

Members of the British Orthodontic Society (BOS).

METHODS

The questionnaire was emailed to all BOS members in November 2021 and hosted on the QualtricsXM platform. The questionnaire was piloted for content validity and tested for reliability.

RESULTS

A response rate of 19% was attained. Nearly all (n = 244, 99%) participants used the Twin Block, and 90% (n = 218) prescribed full-time wear including/excluding eating. Although the majority (n = 168, 69%) had not made changes to their wear time prescriptions, nearly one-third (n = 75, 31%) had. Those who reported a change in their prescriptions currently prescribe less wear time than before, and commonly quoted 'research evidence' as the reason. A wide range in success rates (41%-100%) was reported, with patient compliance as the main reason for treatment discontinuation.

CONCLUSION

The Twin Block is a popular functional appliance among orthodontists in the UK, originally designed by Clark to be worn full time to maximise functional forces applied to the dentition. However, this wear regime may place considerable strain on patient compliance. Most participants prescribed full-time Twin Block wear excluding eating. Approximately one-third of orthodontists made changes to their wear time prescriptions during their practising career, and currently instruct less wear time than before.

A comparison of children's experiences with fixed and removable functional appliances: A qualitative study

INTRODUCTION

The objective of this study was to compare children's experiences and perceptions of treatment with Hanks-Herbst (HH) and modified Twin-block (MTB) functional appliances.

METHODS

A pragmatic nested qualitative study was undertaken in a single hospital setting. Participants from a randomized controlled trial (International Standard Randomised Controlled Trial Number 11717011) wearing HH and/or MTB appliances were interviewed using a topic guide in a one-to-one, semistructured format. Interviews were recorded and transcribed verbatim for framework methodology analysis until data saturation was reached.

RESULTS

Eighteen participants (HH, 7: MTB, 4; switched group, 7) were interviewed. Thirteen codes were constructed and grouped into 3 themes: (1) functional impairment and symptoms, (2) psychosocial factors and impacts, and (3) feedback on appliances and patient care. Both appliances had a negative impact on quality of life, with disruption to children's daily routines and psychological well-being. Speaking was more problematic for MTB participants, whereas HH participants encountered mastication and breakage issues. HH was preferred by most participants, as its nonremovable feature meant less managing and self-discipline was required. MTB was considered a suitable option for children with good self-discipline and who preferred a versatile lifestyle. Feedback included wishes for the availability of multiple appliance options and a degree of autonomy in decision-making processes.

CONCLUSIONS

HH and MTB can negatively affect children's quality of life. Participants preferred HH over MTB because of its nonremovable feature, and children requested to be empowered during decision-making processes.

Oral Health Self-Management Ability and Its Influencing Factors among Adolescents with Fixed Orthodontics in China: A Mixed Methods Study

Objective. To understand the oral health self-management ability status and influencing factors among adolescent patients with fixed orthodontics in Nanjing and to provide a reference for formulating targeted intervention measures. Methods. A mixed research method was used. First, the convenience sampling method was used to select adolescent patients with fixed orthodontics admitted to the orthodontic department of a dental hospital in Nanjing from November 2021 to March 2022. The oral health self-management ability questionnaire was used for the investigation; then, 15 children with poor oral health management ability were selected for in-depth interviews. Results. The total score of oral health self-management ability of 290 adolescent children with fixed orthodontics was 45.6-90.8 points, with an average score of $69.63\pm 7.40$ of which knowledge, belief, and behavior dimension scores were $72.09\pm 10.47,68.50\pm 10.13,\text{and}67.63\pm 8.67$ , respectively, and the environmental score was $69.91\pm 12.50$ . Multiple regression analysis showed that sex, age, bracket wearing time, grade, and place of residence were related to the scores of each dimension of self-management. Qualitative research shows that the main reasons for the poor oral health self-management ability of adolescents with fixed orthodontics are the lack of awareness during fixed orthodontics, lack of knowledge channels, low compliance, inability to solve oral problems during treatment, difficulty in adhering to oral care behaviors, and lack of motivation to treat. Conclusion. The oral health self-management ability of adolescent children with fixed orthodontics needs improvement, and a precise health intervention plan should be formulated.

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis

BACKGROUND

Although there are previous systematic reviews about the oral health-related quality of life (OHRQoL) impact among children and adolescents after orthodontics treatment, there is no definition for the magnitude of these impacts during the therapy.

OBJECTIVE

To systematically analyse the literature on changes in the quality of life of children and adolescents during orthodontic treatment.

LIMITATIONS

Almost all the studies included in this review are non-randomized clinical trials, which are susceptible to several biases that affect the certainty of evidence obtained, especially by confounding factors and the lack of a control group.

CONCLUSIONS AND IMPLICATIONS

Based on very low certainty of evidence, wearing appliances does not seem to have a significant negative impact during the first year of orthodontic treatment. However, the meta-analytic results suggest that functional limitations in the first 3 months of treatment can be slightly more critical for the impact on the oral health quality of life and consequent patient adherence to treatment.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - Brazil (FAPEMIG).

REGISTRATION

CRD42021234407.

Development of the Orthodontic Treatment Impact Questionnaire: Cross-sectional validation

INTRODUCTION

The need to involve patients in developing and evaluating health care interventions is now well-recognized. This study assesses and refines the Orthodontic Treatment Impact Questionnaire for use as a patient-reported outcome in an interventional clinical trial to evaluate and compare any orthodontic interventions.

METHODS

The face and content validity of a previously developed questionnaire were tested in 2 focus groups involving adolescents aged 11-17 years. They were wearing a range of orthodontic appliances and at different treatment stages. A similar cross-sectional convenience sample completed the questionnaire during routine appliance adjustment appointments. A Rasch model, using item response theory, was used for item reduction, assessment of the response format, and differential item functioning. Spearman's rank correlation was used to assess construct validity, Cronbach α for internal consistency and reliability, and intraclass correlation coefficient for test-retest reliability.

RESULTS

Seven adolescents (4 females, 3 males) were involved in the initial testing; 181 (117 females, 64 males; mean age, 14.7 ± 1.5 years) completed the questionnaire once and 41 twice. The initial measure demonstrated a misfit to the Rasch model. Ten of the original 31 items had disordered thresholds and were removed. The 5-point scale was changed to a 3-point scale. None of the participants demonstrated a misfit to the model. Construct validity (P = 0.480), internal consistency (Cronbach α = 0.827) and test-retest reliability (intraclass correlation coefficient = 0.85; 95% confidence interval, 0.73-0.92) were good.

CONCLUSIONS

The initial Orthodontic Treatment Impact Questionnaire was tested and modified using item response theory. The modified questionnaire demonstrated good construct validity, reliability, and internal consistency. Further testing to assess generalizability and longitudinal responsiveness is required.

Alkyl trimethyl ammonium bromide for the formulation of antibacterial orthodontic resins

OBJECTIVES

This study aimed at formulating antibacterial orthodontic resins containing alkyl trimethyl ammonium bromide (ATAB) and evaluating their physicochemical and biological properties.

MATERIALS AND METHODS

The chemical composition and microstructure of ATAB was characterized through FTIR and SEM, respectively. Experimental orthodontic BisGMA/TEGDMA-based resins were formulated, and the ATAB filler was incorporated at 1wt%, 5wt%, and 10wt%, along with colloidal silica (5wt%). The degree of conversion, softening in solvent, and flexural strength of the experimental resins were analyzed. Biological properties were also assessed through cytotoxicity and antibacterial analyses.

RESULTS

The incorporation of ATAB, due to the presence of ⎯N⁺(CH₃)₃ alkyl groups, had no adverse effect on the degree of conversion of the resins (p > 0.05). The %ΔKHN values at 5wt% and 10wt% were comparable to those of the control group, while the flexural strength was reduced at all concentrations of ATAB. The viability of the gingival fibroblast was reduced with the addition of ATAB (p < 0.05). The viability of biofilm and planktonic bacteria was reduced when ATAB was incorporated at 5wt% and 10wt%.

CONCLUSIONS

The addition of ATAB at 5wt% resulted suitable for the formulation of orthodontic resins with the ability to control the biofilm formation and planktonic activity of S.mutans, without jeopardizing some specific physicochemical properties.

CLINICAL RELEVANCE

White spot lesions in orthodontic patients may be controlled by preventive treatments. Non-patient-dependent strategies, such as the use of orthodontic resins containing ATAB, may avoid accumulation of bacteria, especially in those areas surrounding orthodontic appliances.

Young people's experiences of orthodontic retainers: A qualitative study

OBJECTIVE

To investigate young people's experiences of retainers, the associated impact of retainers on their lives and their perceptions of what influences their own co-operation.

DESIGN

Qualitative, cross-sectional study.

SETTING

An orthodontic department in a UK dental hospital.

PARTICIPANTS

Purposive sampling was used to recruit young people, aged 11-17 years, wearing a range of different types of retainers.

METHODS

Semi-structured interviews were conducted and transcribed. The resultant data were analysed using codebook thematic analysis.

RESULTS

Ten patients were recruited before thematic saturation was achieved. Four themes were identified: impact and experiences of wearing retainers; facilitators and barriers to retainer adherence; finding out about retainers; and, finally, involvement in decisions about retainers. Although some initial negative impacts were described, participants generally adapted quickly to retainers. Several factors were perceived to influence co-operation with removable retainers, including concerns about relapse and the associated waste of personal effort and wider resources. There were perceived deficiencies in the information provided by clinicians, which led participants to seek advice from other sources, including social media. Some young people wanted to be more involved in decisions about their retainers.

CONCLUSION

While patients perceived retainers to be easier to wear than active appliances, some transient negative impacts occurred, largely related to initial periods of full-time wear. There were a range of factors which patients perceived to influence their adherence with removable retainers.

Toxicological Assessment of an Acrylic Removable Orthodontic Appliance Using 2D and 3D In Vitro Methods

Malocclusion is a global health problem, mainly affecting children and adolescents. For this reason, orthodontic treatment must be, on the one hand, safe, non-toxic, and effective and, on the other hand, it must have the best possible esthetic profile. Thus, the use of orthodontic appliances is addressed to all age groups, including young children, for a long period of time, which is why their safety profile is a matter of real interest. For this reason, the purpose of the present study was to evaluate the safety and biocompatibility of an acrylic removable orthodontic appliance made of polymethylmethacrylate and stainless steel alloy made by our team of researchers. To verify the biocompatibility of the medical device, it was immersed in artificial saliva with three different pHs (3, 7, and 10) for a period of ten days. Subsequently, the three types of saliva were tested on human keratinocytes (HaCaT cell line) in terms of viability and modification of cell morphology. Finally, the use of 3D reconstructed human epidermis verified the cytotoxic and irritating potential of the medical device, thus providing relevant information regarding its biocompatibility. The results revealed that by maintaining the orthodontic device in the saliva there is no release of substances with a toxic effect on the human keratinocytes and on the 3D reconstructed human epidermis. There were also no significant changes in cell morphology. In conclusion, it is suggested that the acrylic removable appliance has a safety profile recommended for in vivo use.

Concerns of orthodontic patients during the COVID-19 quarantine period

Introduction:

Quarantine protocols for coronavirus disease 2019 (COVID-19) pandemic has modified orthodontic appointments.

Objective:

to evaluate self-reported experience and needs of orthodontic patients during the quarantine period without in-person appointments.

Methods:

Thirty patients, aged 8 to 21 years, under active orthodontic treatment were randomly selected. A phone call questionnaire including questions on physical and emotional impacts of the quarantine of COVID-19 was applied during the second month of Brazilian quarantine.

Results:

Sixteen percent of the patients reported pain related to the orthodontic appliance. Appliance breakage was observed in 23.33%. Twenty percent felt the need of an emergency orthodontic appointment and 3.33% visited a private practice. Moreover, 23% reported that even in an emergency need, they would not search for an appointment, preferring to communicate with the orthodontist by WhatsApp. Oral hygiene self-perception status showed improvement in 36.67% and worsening in 6.67% of the patients, while 56.66% reported maintenance of the same hygiene status. Sixty percent were concerned about the orthodontic treatment. General concerns were primary related to health and a possible extension of the quarantine time.

Conclusions:

During COVID-19 quarantine, orthodontic patients demonstrated a low frequency of orthodontic appliance interference in daily life, and most of them reported a maintenance of oral hygiene habits. The frequency of appliance related pain and breakage was 16.67% and 23.33%, respectively. Patients’ main concern during the quarantine period was the fear of getting sick and the uncertainness about the extension of the quarantine period.

Space Maintainers Used in Pediatric Dentistry: An Insight of Their Biosecurity Profile by Applying In Vitro Methods

Space maintainers have presented an increased interest due to their chemical composition which influences the electrochemical and electrolytic processes of the oral cavity, leading to important biological activity. The present study was purported to evaluate the biological in vitro activity of three types of space maintainers (S1, S2, and S3, differing from each other in terms of metal composition) used in pediatric dentistry, in terms of their antimicrobial effect and biosecurity profile using two types of keratinocytes (PGK: primary gingival keratinocytes, and HaCaT: human immortalized keratinocytes) by assessing the morphology, viability, cytotoxicity, and gene expression of the cells. Statistical differences were calculated by the one-way ANOVA test, followed by Tukey’s post-test. Antimicrobial screening highlighted a dilution-dependent influence that, in the case of all strains tested, did not show inhibition or stimulation of bacterial growth. The in vitro evaluations revealed that the test samples did not induce important cytotoxic potential on both keratinocyte cell lines (HaCaT and PGK), with the cells manifesting no morphological alteration, a good viability rate (above 90%: PGK–S1, * p < 0.05), and a low cytotoxic activity (less than 11%: PGK, S1 *** p < 0.001 and S3 * p < 0.05; HaCaT, S1 ** p < 0.01). The data obtained in this study highlight the fact that the samples analyzed are biocompatible and do not develop the growth of the studied bacteria or encode the gene expression of primary and immortalized keratinocytes.

What has changed in orthodontic patient care between the two surges of the COVID-19 pandemic? A thematic analysis

BACKGROUND AND AIM

The coronavirus disease 2019 (COVID-19) has brought new challenges to every specialty and orthodontics is no exception. Currently, there seems no way other than to mitigate the risk and proceed with routine orthodontic treatment. The aim of the present study was to conduct a qualitative inquiry into the coping strategies, perceptions and anticipations of orthodontic patients and the challenges faced by orthodontists.

METHODS

An in-depth telephone interview of 30 patients and/or their parents and orthodontists belonging to an Academic-based Residency Program and Private Practice was conducted regarding the challenges, opportunities and futuristic ways of coping with COVID-19. Inputs were recorded, transcripts were prepared and anonymised, and a thematic analysis was performed.

RESULTS

Six themes and several sub-themes emerged from the detailed interviews and their transcripts. The initial fearful situation due to COVID-19 has gradually transformed into a certain 'new normal' in the lives of patients and caregivers, explaining why patients started seeking orthodontic treatment as usual or even preferring to begin treatment during this period. Orthodontists in the midst of uncertainty are delivering quality care and expecting future innovations and changes to combat such pandemics.

CONCLUSION

Humans can adapt to any crisis that runs over a period of time. The new insights obtained will help to plan treatment and set up practice to cope with pandemics and crises that can affect orthodontic treatment in the future.

Is wearing orthodontic appliances associated with eating difficulties and sugar intake among British adolescents? A cross-sectional study

AIM

To determine whether wearing orthodontic appliances was associated with eating difficulty and lower sugars intake among British adolescents.

METHODS

This study analysed data from 4116 12- and 15-year-olds who participated in the 2013 Children's Dental Health Survey in the UK. Information on eating difficulties in the past 3 months and usual intake of six sugary items was collected through self-administered questionnaires. The presence and type of orthodontic appliances (fixed or removable) were assessed during clinical examinations. Logistic regression was used to evaluate the association between wearing orthodontic appliances and eating difficulty whereas linear regression was used to evaluate the association between wearing orthodontic appliances and sugars intake. Regression models were adjusted for socio-demographic, behavioural, and clinical characteristics of adolescents.

RESULTS

12.9 per cent of the 4116 adolescents wore orthodontic appliances (10.1 per cent fixed and 2.8 per cent removable), 21.0 per cent reported eating difficulties and the mean daily intake of sugars was 5.3 times/day (SD: 3.7, range: 0-20). Adolescents with fixed appliances had 4.02 (95% CI: 3.03, 5.33) greater odds of reporting eating difficulty than those with no appliances, but no differences were found between adolescents wearing removable and no appliances. No association was found between wearing orthodontic appliances and daily sugars intake either [coefficients of 0.20 (95% CI: -0.27, 0.66) and -0.30 (95% CI: -0.96 to 0.36) for adolescents wearing fixed and removable appliances, respectively].

CONCLUSION

Wearing fixed orthodontic appliances were associated with greater odds of reporting eating difficulty, but not with lower sugars intake among British adolescents.

Early Treatment of Anterior Crossbite with Eruption Guidance Appliance: A Case Report

The purpose of this investigation was to show how to manage an anterior crossbite in early mixed dentition with an eruption guidance appliance (EGA). The analyzed clinical case reported an anterior crossbite, a bimaxillary retrusion tendency, and a horizontal growth pattern. The anterior crossbite was an unfavorable occlusal condition that could lead to a class III malocclusion growth pattern. An early treatment approach was suggested to reach a correct sagittal jaw relationship. Hence, the selected approach acted on the dentoalveolar sector, aiming to have effects on the posterior vertical dimension and to improve the sagittal jaw's relation. An EGA was selected to treat the patient in early mixed dentition. After 7 months of therapy with night-time use, the dental malocclusion was completely resolved. The patient continued to be treated with the same device, used as active retention. With the EGA treatment, the erupting forces, rather than the active forces, were used to resolve the dental malocclusion. This approach allowed a low compliance requirement and had a minimum psychosocial and psychological impact on the patient. The early treatment was essential to give a functional occlusion and a good balance of the soft perioral tissues and muscles.