Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a cross-sectional study

Perception of parents and caregivers about the need for dental appointments for adolescents from a Brazilian birth cohort

OBJECTIVE

To investigate the perception of parents or caregivers regarding the need for dental appointments for adolescents aged 12-13 years and associated factors.

METHODS

Data from the Pelotas 2004 Birth Cohort were used. The outcome variable was the need for dental appointments for young adolescents perceived by parents or caregivers. Demographic and economic exposure variables were obtained from the first (2004) and sixth general follow-up (2015), respectively. The exposure variables 'previous history of dental pain', 'self-rated oral health', clinical variables and the outcome variable were obtained from the second oral health follow-up (2017). Unadjusted and adjusted multivariate Poisson regression analyses provided prevalence ratios (PR) and respective 95% confidence intervals (CI).

RESULTS

At the first oral health follow-up (2009), 1303 five-year-old children were recruited, 996 of whom were reassessed and underwent oral health examinations at 12 and 13 years of age (response rate: 76.4%). The findings showed that 72.4% of parents/caregivers perceived that the adolescents needed dental appointments. No associations were found between the outcome and sociodemographic or economic variables. After adjustments, the outcome remained positively associated with previous history of toothache (PR 1.22; 95% CI 1.14-1.32), self-rated oral health as fair or poor (PR 1.26; 95% CI 1.15-1.39), the presence of dental caries (PR 1.27; 95% CI 1.20-1.38) and severe or disabling malocclusion (PR 1.14; 95% CI 1.05-1.25).

CONCLUSIONS

The perception of parents/caregivers regarding the need for dental appointments on the part of their adolescent sons and daughters was associated with oral health problems, and these findings can serve as the basis for creating and improving oral health programmes that seek a better understanding on the part of parents and caregivers regarding the importance of integral care for their adolescent children.

Does malocclusion affect ingestion: a systematic review

OBJECTIVES

The multifactorial aspect of malocclusions and their consequences on ingestion function is rarely described in the literature. The aims of this review are (i) to investigate the relationship between oral ingestion and malocclusion and (ii) to gather malocclusion tools that could help screen subjects at risk of malocclusion-related ingestion disorders.

MATERIAL AND METHODS

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria have been documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42023395840. The bibliographic search involved the PubMed®, Cochrane and PROSPERO databases.

RESULTS

A total of 29 articles published between 2007 and 2023 were retained by the search criteria for the qualitative synthesis. Twenty of the studies found that the severity of malocclusion has a negative impact on oral ingestion. This review highlights that malocclusion and ingestion impairments are associated but it is not possible to determine causality due to the observational approach of many of the studies.

CONCLUSION

Malocclusion has a negative impact on ingestion function. During orthodontic consultations, particular interest should be directed towards chewing, biting, and swallowing disorders, which can affect patients' nutritional status. This review offers arguments for designing further studies assessing the extent to which malocclusions may affect nutritional status.

CLINICAL RELEVANCE

Orthodontic treatment should focus on improving patients' ingestion.

Parental influence in orthodontic treatment: a systematic review

The reasons for searching orthodontic treatment in pediatric/adolescent patients are multifactorial. The aim of this systematic review was to study the parental influence in this process. This study comprises a systematic review of the literature, based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. We analyzed 41 articles related to the study hypothesis, 29 of which followed the general inclusion criteria, and 21 specific studied the parental influence in orthodontic treatment. The results demonstrated that dental aesthetics and facial appearance were the main triggering factors related to the search for orthodontic treatment. Pair influence also plays an important role. The perception of malocclusion and the motivation are factors that emphasize the importance of parents in this process. Parental support was identified as a positive factor in orthodontic success reported in most of the studies. Parental influence has a positive effect on orthodontic treatment and should be understood by clinicians as a central factor in achieving the desired treatment plans.

Saudi Children's and Their Parents' Perception of a Digitally Modified Photograph Model of Different Smiles with Different Anterior Teeth Alignments and Dental Appearances

AIM

Since there is a lack of data on dentofacial esthetic perception in Saudi Arabia, the present research was conducted to study children's and their parent's perceptions of smiles with different dental alignments and dental appearances. In addition, we aimed to determine whether facial attractiveness or dental esthetic dominates the overall esthetic perception. Finally, we aimed to investigate the influence of gender on the judgment of a dental smile.

MATERIALS AND METHODS

Six digitally altered photographs and two dynamic videos of smiling faces of boys and girls with different dental alignments and appearances were shown to 183 children and their parents in malls in Saudi Arabia's Qassim Province. Following the parent's acceptance of the interview, the child was interviewed first, followed by the parent. Their responses were measured using a smile perception questionnaire (SPQ) for children aged 8-10 years. Data were analyzed using the Kruskal-Wallis one-way analysis of variance (ANOVA) and the Wilcoxon signed-rank test.

RESULTS

The results demonstrated that whole-face smiles of both boys and girls with different poor dentofacial esthetics had a significantly lower rating score than lower third-face smiles scores among children and their parents (p ≤ 0.05). Except for a few views, there were no significant differences between children's and their parents' dentofacial esthetic judgments. Moreover, the answers to the smile perception questionnaire 8-10 for the smiling face dynamic videos of boys and girls were not significantly different.

CONCLUSION

Children agreed with their parents in judging the smiles of different dentofacial esthetic perceptions. Overall, esthetics was more influenced by facial esthetics than dental esthetics. Background attractiveness and sexual characteristics do not affect smile perception.

CLINICAL SIGNIFICANCE

The smile is considered one of the major determinants of how the overall esthetic of children will appear. Thus, the comprehensive diagnosis involving the analysis of malocclusion and poor dental appearance psychological effect can be used for patient care improvement. Consequently, dental treatment to improve the dental smile will enhance the children's quality of life and social interaction.

Satisfaction with smile appearance mediates oral health-related quality of life in adolescents regardless of orthodontic treatment need – a cross-sectional study

OBJECTIVES

To explore the relationship between adolescents' oral health-related quality of life (OHRQoL), satisfaction with smile appearance, treatment need and treatment demand through direct and serial mediation models.

MATERIALS AND METHODS

This cross-sectional study included 215 11-14-year-olds and their parents. The instruments included the Child Perceptions Questionnaire and the Index of Orthodontic Treatment Need. Satisfaction with smile appearance, orthodontic treatment demand and parental perception of their child's orthodontic treatment need was recorded on a Likert scale (0 = not at all to 4 = very much). Serial mediation models were used to assess the effects of malocclusion on the OHRQoL.

RESULTS

Objective treatment need explained less than 5% of the adolescents' OHRQoL. Serial mediation models through satisfaction with smile appearance, parental perception of their child's orthodontic treatment need, and patients' orthodontic treatment demand explained 23-25% of the variance.

CONCLUSIONS

Satisfaction with smile appearance mediates the OHRQoL in adolescents. Parents have no direct influence, but their perception of the need to correct their child's teeth might amplify adolescents' orthodontic treatment demand, leading to lower OHRQoL.

A Cross-Sectional Online Survey on Knowledge, Awareness, and Perceptions of Hollywood Smile Among the Saudi Arabia Population

Background:

Hollywood smile has gained popularity in recent times to improve aesthetics among the general population. Since patients’ perceptions of dental aesthetics play a vital role in planning and evaluating cosmetic dental treatment, it is essential to understand their knowledge, awareness, and factors that influence their perceptions of dental aesthetics.

Objectives:

The objective of this study was to assess the knowledge, awareness, and perceptions of Hollywood smile among the general population in Saudi Arabia.

Methods:

A close-ended questionnaire consisting of demographic information and 20 questions related to Hollywood smile was circulated through social media in Saudi Arabia. Statistical analyses of the data obtained were performed using Statistical Package for Social Sciences software (SPSS version 17, USA). Frequencies, percentages, and mean and standard deviation were calculated using descriptive statistics. Pearson chi-squared test was employed to test the association between the demographic variables, such as age, gender, and education levels, with the questionnaire items.

Results:

A total of 4104 participants responded to the study questionnaire. The responses to the questionnaire revealed that nearly half of the participants were not satisfied with their dental appearance (48.6%). The majority of the participants had heard or known about Hollywood smile (98%). About 42% of study participants were aware of the complications involved in the procedure. The results revealed that the younger generation (18 to 30 years) had more awareness and felt more need for dental aesthetics (p=0.001). The proportion of male participants who underwent Hollywood smile correction were more than females (p=0.001). Graduates showed more awareness regarding smile, dental aesthetics, and Hollywood smile than the other categories (p=0.001).

Conclusion:

This study has shown that the younger generation, female participants, and graduates had more awareness regarding smile, dental aesthetics, and Hollywood smile.

Orthodontic Retention-Protocols and Materials-A Questionnaire Pilot Study among Polish Practitioners

The aim of the study was to analyze retention protocols and materials for fixed retainers used by clinicians providing orthodontic treatment in Poland. The survey was carried out from February to April 2021. The questionnaire was designed using the Google Forms tool. After validation, the questionnaire was delivered to verified active orthodontists gathered in a closed social media group of 615 members. Finally, 104 answers were received. Answers to individual questions were provided in percentages and tabularized. A chi-squared test of proportion was used to compare: the proportion of clinicians using retainers of different characteristics and the proportions of clinicians indicating the superiority of a given clinical solution. Rectangular steel braided wire was rated as most reliable. However, doctors who declared to use gold chain were mostly solely using this type of wire. Multistranded round wire was rated the worst. Fiber-reinforced composite was mainly used in periodontal patients. The protocols used by Polish orthodontic practitioners relied on double long-term retention with regular follow-up. The most popular material was stainless steel braided rectangular wire bonded with a flowable composite. Most clinicians believed they could maintain the treatment results, but they declared that patients’ cooperation was a challenge.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition

INTRODUCTION

This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition.

METHODS

The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance.

RESULTS

Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05).

CONCLUSIONS

Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

Open and closed surgical exposure of palatally displaced canines: a cost-minimization analysis of a multicentre, randomized controlled trial

OBJECTIVE

To evaluate the costs of open and closed surgical exposure and subsequent orthodontic treatment for the correction of palatally displaced canines (PDCs).

TRIAL DESIGN

A multicentre, two-arm parallel group randomized controlled trial.

METHODS

One hundred twenty adolescents between 9 and 16 years of age, from three orthodontic specialist centres, were randomized to one of the two surgical exposure interventions. The randomization was conducted according to a two-arm parallel group 1:1 allocation ratio, using computerized lists with block randomization. In both the surgical techniques, whole mucoperiosteal flaps were raised, and bone covering the PDCs was removed. In the open technique, glass ionomer was built up on the PDC crown - reaching above the mucosa through a hole punched in the flap - to allow the canine to erupt autonomously. After eruption, the canine was orthodontically moved above the mucosa. In the closed technique, an eyelet was bonded onto the PDC, the flap was repositioned and the canine was orthodontically moved beyond the mucosa. The trial ended when the PDC was successfully aligned in the dental arch.Cost analysis was performed including costs for surgery, orthodontic treatment, emergency visits, and material, as well as costs for transports and time spent in connection with every appointment.

BLINDING

Patients and caregivers could not be blinded due to obvious limitations of the clinical setting, while outcome assessors and data analysts were blinded.

RESULTS

A cost-minimization analysis was performed since both exposure groups succeeded equally well in terms of treatment effects. The two different surgical exposures and following orthodontic treatments did not differ significantly in terms of costs.

GENERALIZABILITY AND LIMITATIONS

Costs are estimated in the Swedish setting, which needs to be considered if applying the results in other settings. Calculations of total cost do not include finishing, debonding, retention, and follow-up.

CONCLUSION

There is no significant difference in costs between closed and open surgical exposure with following orthodontic treatments in PDCs.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02186548.

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.

How is orthodontic treatment need associated with perceived esthetic impact of malocclusion in adolescents?

INTRODUCTION

The purpose of this research was to evaluate the esthetic impact of orthodontic treatment need in adolescents.

METHODS

This cross-sectional study was performed with 1172 adolescents aged 12 (n = 638) years and 15 (n = 534) years from Salvador, Bahia, Brazil. The esthetic impact was the following outcome variables: Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale. The normative orthodontic treatment need was assessed by the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and by the Dental Aesthetic Index (DAI). Logistic regression models were adjusted, estimating crude odds ratio with the respective 95% confidence intervals. The variables with P ≤0.20 in the individual analyses were tested in multiple logistic regression models, remaining the variables with P ≤0.05.

RESULTS

The results showed a statistically significant association for the esthetic impact (Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale) when assessing the normative orthodontic treatment need by the DAI (P <0.05). However, there was no significant association between subjective esthetic impact and normative needs when using the IOTN-DHC (P >0.05).

CONCLUSIONS

DAI was more associated with the adolescents' esthetic concern than IOTN-DHC and should be the Index of Orthodontic Treatment Need to be selected to complement the patient's self-perception.

Accuracy of computer-aided prediction in soft tissue changes after orthodontic treatment

INTRODUCTION

An accurate prediction in the soft tissue changes is of great importance for orthodontic treatment planning. Previous studies on the accuracy of the Dolphin visual treatment objective (VTO) in predicting treatment results were mainly focused on orthognathic treatment. The accuracy of Dolphin VTO prediction for orthodontic treatment is, however, poorly understood. The aim of this study was to evaluate the accuracy of Dolphin VTO prediction in soft tissue changes after orthodontic treatment by comparing the changes between predicted and actual values.

METHODS

A total of 157 patients were screened for eligibility, and 34 young adult patients (8 males, 26 females; mean age 24.8 ± 3.9 years) were finally included in the study based on the inclusion and exclusion criteria. The landmarks and parameters of the Holdaway soft tissue analysis were used for the cephalometric analyses. The cephalometric tracings of the actual treatment result and the Dolphin predicted treatment outcome were superimposed to calculate the prediction errors. Paired t test was used to compare the statistical differences between the predicted and actual treatment outcomes of the parameters used in the Holdaway soft tissue analysis.

RESULTS

There were significant differences between the predicted and actual values in parameters of the Holdaway soft tissue analysis (P < 0.05). The prediction of the landmarks in the lips region (ie, subnasale, soft tissue A-point, upper lip, lower lip, and soft tissue B-point) was inclined to be overestimated horizontally and underestimated vertically, whereas the prediction of the landmarks belonging to the chin region (ie, soft tissue pogonion, soft tissue gnathion, and soft tissue menton) was inclined to be underestimated horizontally and overestimated vertically. The most accurate prediction was found in the soft tissue A-point, whereas the least accurate one was found in the soft tissue in the chin region. The prediction was relatively more accurate in the vertical direction than in the horizontal direction.

CONCLUSIONS

The Dolphin VTO prediction in soft tissue changes after the orthodontic treatment in patients with bimaxillary protrusion is the most accurate for the soft tissue A-point and the least accurate for the soft tissue chin region.

Analysis of the stomatognathic system of children according orthodontic treatment needs

PURPOSE

The present study evaluated electromyographic activity (EMG), masticatory performance, and tongue strength in children without and with orthodontic treatment needs.

PATIENTS AND METHODS

A total of 90 children were screened and divided into the following groups: Group I (no treatment needed; mean age: 8.00 ± 0.43 years; n = 26), Group II (few malocclusions, treatment needed; mean age: 8.89 ± 0.43 years; n = 28), and Group III (slight-to-borderline treatment needed; mean age: 8.44 ± 0.22 years; n = 36). Orthodontic treatment need was classified on the basis of IOTN-DHC (Index of Orthodontic Treatment Need - Dental Health Component). The electromyographic Trigno EMG Systems was used for muscle analysis and the Iowa Oral Pressure Instrument (IOPI) was used to measure tongue strength. Data were analyzed using normality tests and one-way analysis of variance with a Bonferroni post hoc test (p ≤ 0.05).

RESULTS

EMG in almost all mandibular movements was higher in Group III with statistically significant differences compared to position at rest: right masseter (p = 0.03); protrusion: left temporal (p = 0.02); saliva swallowing: left temporal (p = 0.05) and water swallowing: orbicularis oris mouth, right upper segment (p = 0.05). Lower masticatory performance was found in Group III, but the difference compared to Group I and II was not significant. There were no significant differences between the groups in terms of tongue strength.

CONCLUSIONS

Children with borderline orthodontic treatment needs show functional disorders of the stomatognathic system.