Causal relation between malocclusion and caries

Relationship between dental caries, oral hygiene and malocclusion among Syrian refugee children and adolescents: a cross-sectional study

BACKGROUND

Little is known about the oral disease burden in refugee children and associated risk factors. This cross-sectional study aimed to explore the oral hygiene status and prevalence of caries, and to investigate their association with malocclusion characteristics in a child refugee population.

METHODS

606 Syrian refugee children and adolescents aged 7-19 years, registered as refugees in Jordan and residing in Zaatari camp, were recruited to the study. Oral hygiene and caries status were recorded using DMFT (mean of decayed, missing, and filled permanent teeth) and OHI-S (Simplified Oral Hygiene Index) according to WHO criteria. Oral health results were then cross tabulated with previously reported malocclusion traits for the same study sample (crowding, spacing, contact point deflection and IOTN) to detect any associations. Statistical analysis was conducted using chi-square test, independent sample t-test, one-way ANOVA, Welch test and Post Hoc testing (Gabriel and Games-Howell).

RESULTS

Overall DMFT and OHI-S were 4.32 and 1.33 respectively with no difference between males and females. Around 40% of the sample showed ≥ 5 DMFT score. 96.1% of the sample either do not brush or brush occasionally: females showed better oral hygiene practices (P = 0.002). No significant differences in DMFT scores were noted for gender or age, other than the 7-9.9 year old group having significantly higher mean DMFT scores than all other age groups (P < 0.01);the mean of OHI-S was not significantly different between different age groups (P = 0.927). Subjects with malocclusion, specifically crowding, contact point deflection and IOTN grades 3, 4 and 5 had higher scores in both arches for OHI-S and DMFT than subjects without malocclusion traits, although this was not statistically significant for DMFT scores. Overall, patients with generalized spacing had a significantly lower OHI-S score than those without spacing (P = 0.021). Significant correlations were found between parameters of intra-arch and inter-arch relationships and oral health indices (DMFT and OHI-S).

CONCLUSION

Malocclusion may increase the risk of caries and periodontal disease; the magnitude of this risk is amplified in populations with poor oral health and limited access to oral healthcare services, highlighting the need for preventive and curative oral health programs.

Orthodontic Treatment as a Protective Factor for Dental Caries Experience and Severity: A Population-Based Study

Objective

The aim of this study was to assess the effects of orthodontic treatment on the experience, prevalence, and severity of dental caries later in life in a representative sample of U.S. adults.

Methods

Using a population-based study design, data from 9,486 participants in the third National Health and Nutrition Survey (NHANES), including self-reported information on the history of orthodontic treatment and its timing, were obtained. Caries experience and prevalence was assessed using the decayed (DT) and filled (FT) teeth indices (i.e., DT > 0, FT > 0, and their aggregate DFT > 0). Severe dental caries experience and prevalence was defined as DT > 2, FT > 11, and DFT > 12. Unadjusted and adjusted logistic regression models that accounted for the complex sampling design were used to assess the association between orthodontic treatment and dental caries experience, prevalence, and severity. Statistical significance was set at a P value of less than 0.05.

Results

The history of orthodontic treatment was reported in 19.62% of the adults. Around 94% of participants had at least one decayed or filled tooth (DFT > 0), and 21.09% met the aggregate DFT criterion for severe caries (DFT > 12). After controlling for confounding variables, a reported history of orthodontic treatment was found to significantly decrease the odds of DT > 0, DT > 2, FT > 11, and DFT > 12 (odds ratios (OR) = 0.41, 0.36, 0.74, and 0.60, respectively).

Conclusion

A history of orthodontic treatment was a protective factor for untreated dental caries, in assessments of the severity and prevalence of dental caries experience.

Association between coronal caries and malocclusion in an adult population

Purpose

Only a few but conflicting results have been reported on the association between malocclusions and caries. We investigated this association using data from the population-based cross-sectional Study of Health in Pomerania (SHIP).

Methods

Sagittal, vertical and transversal intermaxillary relationship, space conditions and sociodemographic parameters of 1210 dentate subjects (median age 30 years, interquartile range 25–35 years) were collected. Caries was assessed with the Decayed-Missing-Filled Surfaces index but analyzed as ordered outcome (four levels: sound, enamel caries, caries, tooth loss) in ordinal multilevel models, taking into account subject, jaw, and tooth level simultaneously.

Results

Anterior open bite ≤3 mm (odds ratio [OR] = 2.08, 95% confidence interval [CI]: 1.19–3.61), increased sagittal overjet of 4–6 mm (OR = 1.31, CI: 1.05–1.64), distal occlusion of ½ premolar width (OR = 1.27, CI: 1.05–1.53) and distal 1 premolar width (OR = 1.31, CI: 1.06–1.63) were associated with adjusted increased odds for a higher outcome level (caries). Anterior spacing (OR = 0.24, CI: 0.17–0.33), posterior spacing, (OR = 0.69, CI: 0.5–0.95), posterior crowding (OR = 0.57, CI: 0.49–0.66) and buccal nonocclusion (OR = 0.54, CI: 0.33–0.87) were associated with a lower outcome level (caries).

Conclusion

The results from this population-based study suggest that a connection between caries and malocclusion exists to a limited extent in young adults. The associations with caries are contradictory for several malocclusion variables. Distal occlusion (OR = 1.31, CI: 1.06–1.63) and related skeletal anomalies displayed positive associations with caries whereas crowding did not. Orthodontic treatment of anterior crowding would probably not interfere with caries experience. These aspects should be considered for patient information and in treatment decisions.

Association between incisor irregularity and coronal caries: A population-based study

INTRODUCTION

The objective of this study was to investigate the association between incisor irregularity and anterior coronal caries by means of an arch-specific analysis among the U.S. population in the National Health and Nutritional Examination Survey (NHANES III) 1988-1994.

METHODS

This study analyzed data from 9049 participants who were surveyed from 1988 to 1994 as a part of the NHANES III. Participants with a complete set of fully erupted permanent anterior teeth in the maxillary and mandibular segments (ie, canine to canine), who completed an examination of occlusal characteristics and anterior dental caries, and who reported no previous orthodontic treatment were included in the study. Incisor irregularity per arch was determined with the use of the Little irregularity index. Anterior coronal caries per arch was defined as ≥1 surface with decayed or filled surface (CDFS ≥1). Analyses were conducted with the use of chi-square test and logistic regression modeling taking into account the complex sampling design of the survey.

RESULTS

In the maxillary arch, 25.1% of the study population had maxillary anterior coronal caries experience (CDFS ≥1), whereas only 5.5% of the study population had mandibular anterior coronal caries experience (CDFS ≥1). In both arches, no statistically significant association between incisor irregularity and anterior coronal caries experience was found.

CONCLUSIONS

Maxillary and mandibular incisor irregularity is not associated with anterior dental caries prevalence in a subset of NHANES III data that included mostly highly educated adult participants who were white, of medium socioeconomic status, and with high oral health compliance and oral self-care. Future well designed prospective cohort studies are needed to confirm these results. Clinicians are still encouraged to continue providing oral health education to their patients about the well established effect of incisor irregularity on plaque retention.

Caries prevalence and experience in individuals with osteogenesis imperfecta: A cross-sectional multicenter study

OBJECTIVE

Dentinogenesis Imperfecta (DI) forms a group of dental abnormalities frequently found associated with Osteogenesis Imperfecta (OI), a hereditary disease characterized by bone fragility. The objectives of this study were to quantify the dental caries prevalence and experience among different OI-types in the sample population and quantify how much these values change for the subset with DI.

METHODS

To determine which clinical characteristics were associated with increased Caries Prevalence and Experience (CPE) in patients with OI, the adjusted DFT scores were used to account for frequent hypodontia, impacted teeth and retained teeth in OI population. For each variable measured, frequency distributions, means, proportions and standard deviations were generated. Groups means were analyzed by the unpaired t-test or ANOVA as appropriate. For multivariate analysis, subjects with caries experience of zero were compared with those with caries experience greater than zero using logistic regression.

RESULTS

The stepwise regression analysis while controlling for all other variables demonstrated the presence of DI (OR 2.43; CI 1.37-4.32; P = 0.002) as the significant independent predictor of CPE in the final model.

CONCLUSION

This study found no evidence that CPE of OI subjects differs between the types of OI. The presence of DI when controlled for other factors was found to be the significant predictor of CPE.

Caries risk profiles in orthodontic patients: A 4-year follow-up study using the Cariogram model in governmental vs. private clinics

OBJECTIVES

To (1) analyze caries-related factors and (2) evaluate caries risk using the Cariogram model for governmental and private orthodontic patients at de-bonding and 4 years after de-bonding.

MATERIALS AND METHODS

Forty orthodontic patients with mean age of 26.4 years were recruited from a governmental (G) group (n = 20) and private (P) group (n = 20) and were examined at de-bonding (T1) and 4 years after de-bonding (T2). The examination included a questionnaire, plaque scoring, caries examination, bitewing radiographs, and assessment of salivary secretion rate, buffering capacity and cariogenic microorganisms. The data were entered into the Cariogram program to illustrate the caries risk profiles.

RESULTS

The chance to avoid new cavities was higher in P-group compared to G-group at T1 (58% and 31%, respectively) (P < 0.01) and T2 (77% and 52%, respectively) (P < 0.001). Plaque index was significantly higher in G-group, and fluoride was used significantly more in P-group at T1 and T2 (P < 0.05). The chance to avoid new cavities was higher at T2 compared to T1 (64% and 44%, respectively) (P < 0.001). Saliva secretion rate and buffer capacity were significantly increased, and the plaque index was significantly decreased at T2 compared to T1 (P < 0.01).

CONCLUSION

According to the Cariogram, orthodontic patients were less likely to avoid new cavities at de-bonding and 4 years after de-bonding in government clinics compared to private clinics, and the caries risk significantly decreased 4 years after orthodontic treatment for all patients, regardless of the location of treatment.

Association between malocclusion and dental caries in adolescents: a systematic review and meta-analysis

AIM

To evaluate the scientific evidence regarding the association between malocclusion and dental caries in adolescents.

METHODS

Searches were conducted of six electronic databases, complemented by manual searching of the reference lists of the selected articles and grey literature. Two independent reviewers performed the selection of the articles, data extraction and the evaluation of the risks of bias through an assessment of methodological quality. Meta-analysis was performed considering the mean decayed, missing and filled teeth (DMFT) index for caries and the Dental Aesthetic Index (DAI) for malocclusion. Heterogeneity was tested using the I² statistic and a random effect model was employed. Summary effect measures were calculated as differences in means.

RESULTS

The initial search retrieved 2644 studies, only 15 of which were selected for full-text analysis. Four cross-sectional studies were included in the qualitative systematic review. Only one of these studies found no association between malocclusion and dental caries. The meta-analysis of three studies demonstrated that a lower DAI value was significantly associated with a lower mean DMFT index, except for the comparison of DAI 26-30 vs. 31-35.

CONCLUSIONS

Based on the studies analysed, the scientific evidence indicates an association between malocclusion and dental caries.

Long-term effects of Class II orthodontic treatment on oral health

AIM

To investigate the long-term (≥15 years) benefit of orthodontic Class II treatment (Tx) on oral health (OH).

SUBJECTS AND METHODS

All patients (Department of Orthodontics, University of Giessen, Giessen, Germany) who underwent Class II correction (Herbst-multibracket Tx, end of active Tx ≥ 15 years ago) and agreed to participate in a recall (clinical examination, interview, impressions, and photographs) were included. Records after active Tx were used to assess the long-term OH effects. Data were compared to corresponding population-representative age-cohorts as well as to untreated Class I controls without orthodontic Tx need during adolescence.

RESULTS

Of 152 treated Class II patients, 75 could be located and agreed to participate at 33.7 ± 3.0 years of age (pre-Tx age: 14.0 ± 2.7 years). The majority (70.8%) were fully satisfied with their teeth and with their masticatory system. The Decayed, Missing, Filled Teeth Index (DMFT) was 7.1 ± 4.8 and, thus, almost identical to that of the untreated Class I controls (7.9 ± 3.6). In contrast, the DMFT in the population-representative age-cohort was 56% higher. The determined mean Community Periodontal Index (CPI) maximum score (1.6 ± 0.6) was also comparable to the untreated Class I controls (1.7 ± 0.9) but in the corresponding population-representative age-cohort it was 19-44% higher. The extent of lower incisor gingival recessions did not differ significantly between the treated Class II participants and the untreated Class I controls (0.1 ± 0.2 vs. 0.0 ± 0.1 mm).

CONCLUSION

Patients with orthodontically treated severe Class II malocclusions had a lower risk for oral health impairment than the general population. The risk corresponded to that of untreated Class I controls (without orthodontic Tx need during adolescence).

Impact of malocclusion and dentofacial anomalies on the prevalence and severity of dental caries among adolescents

OBJECTIVES

To investigate the association between malocclusion/dentofacial anomalies and dental caries among adolescents.

MATERIALS AND METHODS

A cross-sectional study was conducted with 509 adolescents aged 11 to 14 years enrolled at public schools in the city of Osório in southern Brazil. Parents/caregivers answered a structured questionnaire on demographic and socioeconomic variables. A trained examiner recorded the presence of malocclusion (Dental Aesthetic Index [DAI]), traumatic dental injury, and dental caries. Data analysis involved the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Poisson regression with robust variance was used for the multivariable analysis.

RESULTS

A total of 44.8% of the adolescents had dental caries (mean DFMT  =  1.33 ± 1.84). The DAI index ranged from 15 to 77 (mean  =  29.0 ± 7.9); 43.6% of the sample had severe malocclusion and 11.6% had traumatic dental injury. The prevalence and severity of dental caries were significantly greater among adolescents with severe malocclusion. The multivariate analysis demonstrated that adolescents with severe or handicapping malocclusion had a 31% greater probability of having dental caries (prevalence ratio: 1.31; 95% CI: 1.02-1.67), independently of demographic, socioeconomic, or clinical aspects. The orthodontic characteristics associated with the occurrence and severity of caries were maxillary irregularity ≥3 mm (P  =  .021) and abnormal molar relationship (P  =  .021).

CONCLUSIONS

Handicapping malocclusion, maxillary irregularity, and abnormal molar relationship were associated with the occurrence and severity of dental caries. The findings suggest that the prevention and treatment of these conditions can contribute to a reduction in dental caries among adolescents.

Orthodontic Treatment Provided by General Dentists with Different Types of Appliances in Chattishgarh, India

OBJECTIVE

The study was done to determine the quantity of orthodontics and the type of appliance used for orthodontic treatment by general dentist.

MATERIALS AND METHODS

A total of 410 dentists completely participated in the study. The study included questions to know the positive effects of orthodontic treatment done by general dentists and their opinions and qualities regarding the provision of treatment.

STATISTICAL ANALYSIS

Statistical analysis was done using SPSS version of 16.0 was used at p ≤ 0.05.

RESULTS

One forty six (35.6%) dentists answered that they practice orthodontic treatment to their patients, of which most were providing removable appliances (39.5%). There was a significant difference between the groups toward the benefits of orthodontic treatment according to experience of service and locality. General dentist were providing this treatment mainly in the mixed dentition period i.e. 96(65.8%). Most of the participants gave positive response regarding expansion of their syllabus related to orthodontics.

CONCLUSION

A significant difference in response to the benefits of the treatment were seen according to experience and are of practice and most of the participants showed positive response increasing their courses in orthodontics at undergraduate level.

Orthodontic treatment and referral patterns: A survey of pediatric dentists, general practitioners, and orthodontists

OBJECTIVE

This study aims to assess the orthodontic diagnostic skills, referral patterns, and the perceptions of orthodontic benefits of pediatric and general dentists in comparison with orthodontists.

MATERIALS AND METHODS

Two online surveys were e-mailed to pediatric dentists, general dentistry practitioners, and orthodontists registered as members of the Saudi Dental Society and the Saudi Orthodontic Society. The surveys included questions about the type of orthodontic treatment provided, referral trends, and timing; presumed benefits associated with successful orthodontic treatment; and diagnosis and treatment plans of seven cases representing different malocclusions.

RESULTS

In total, 25 orthodontists, 18 pediatric dentists, and 14 general practitioners completed the survey. Only 38.8% of pediatric dentists and 7.1% of general practitioners reported that they practiced orthodontics clinically. The perceptions of the three groups toward the benefits of orthodontic treatment were comparable in the psychosocial areas. However, the orthodontists perceived significantly lesser effects of orthodontic treatment on the amelioration of temporomandibular disorder (TMD) symptoms. Pediatric dentists tended to rate the need and urgency of treatment higher, while general practitioners tended to rate the need of treatment lower. The selected treatment plans for three early malocclusion cases showed the greatest discrepancies between the orthodontists and the other two groups.

CONCLUSIONS

The orthodontists consistently and significantly downplayed the perceived benefit of orthodontic treatment to reduce TMD symptoms. Also, while there was a similarity in the diagnosis, there were notable differences in the proposed treatment approaches, perceived treatment need, and timing of intervention between the three groups of practitioners.

Dental crowding as a caries risk factor: a systematic review

INTRODUCTION

The association between dental crowding and dental caries has long been accepted because of increased food accumulation and plaque retention in areas of crowding. The aim of this review was to evaluate this potential causal relationship systematically.

METHODS

Six electronic databases were accessed, supplemented by manual searching of the references of the relevant retrieved articles, peer-reviewed orthodontic journals, and gray literature. Search terms included caries, decay, crowding, and irregularity. Non-English articles were excluded from the review in the study-selection stage. Data extraction and evaluation of primary studies were performed independently by 2 reviewers.

RESULTS

The initial search retrieved 6914 citations. However, only 18 articles met the inclusion criteria. The qualitative systematic review included 8 studies, with articles of low or moderate quality. No association between crowding and caries was reported in 4 studies, a significant negative correlation was found in 2 studies, 1 study showed a direct and significant relationship, and another study showed a positive association in the mandibular anterior region but an inverse correlation in the maxillary posterior region.

CONCLUSIONS

To date, there are no high-quality studies to resolve the possible association between dental crowding and caries; further high-quality longitudinal studies are needed to clarify this relationship.

The relationship of orthodontic treatment need with periodontal status, dental caries, and sociodemographic factors

The aim of this study was to determine the relationship of orthodontic malocclusion with periodontal status, dental caries, and sociodemographic status. Our study population consisted of a sample of 836 school children (384 male and 452 female, aged 11-14 years). Four experienced orthodontists and two experienced periodontists performed the clinical examinations. The Treatment Priority Index (TPI), Community Periodontal Index of Treatment Needs (CPITN), decayed, missing, filled teeth (DMFT) scores, and a questionnaire that surveyed socio-demographic status of students were used. Spearman's rank correlation coefficients were used to measure the association between variables. TPI scores showed that 36.4% of the students had normal occlusion, while 41.2% had slight, 15.7% had definite, 4% had severe, and 2.7% had very severe malocclusion. TPI values did not show any significant differences between pupils in different age, gender, socioeconomic status groups, and CPITN scores, whereas there was a significant relationship between TPI and DMFT scores. The orthodontic treatment need was not significantly correlated with CPITN or socio-demographic status; however, the correlation coefficient showed a significant relationship between TPI and DMFT scores.

A review of the oral health-related evidence that supports the orthodontic treatment need indices

BACKGROUND AND OBJECTIVES

To date, there is no evidence-based method of quantification for malocclusion. Consequently, how deviant occlusal traits should be scored and weighted relative to one another is a matter of serious debate. Orthodontic Treatment Need Indices (OTNI) use the subjective opinion of the experts, as their foundation, to define the pathological boundaries (cut-offs) of occlusal traits. This paper reviews the evidence relating malocclusions or deviated occlusal traits to oral health problems, and investigates if this evidence supports the cut-off points and the rationale used for OTNI.

MATERIALS AND METHODS

The relevant cited studies and reviews from the MEDLINE, Web of Science, Scopus, Cochrane databases, and scientific textbooks were used. The citation rate was confirmed by using the Google Scholar.

RESULTS

So far, the evidence for harmful effects of deviated occlusal traits on oral health is either lacking or exists as cross-sectional (mostly) and longitudinal (a few and primarily short-term) studies. When an association was reported between a deviated occlusal trait and an oral health problem, either the strength of that association was weak, or due to methodological issues, findings were not conclusive. Consequently, establishing a cause and effect relationship is difficult. Further, commonly used OTNI do not record a full spectrum of occlusal traits, and relating their ranking or scoring systems to the available evidence is difficult. Therefore, there is little evidence to suggest that individuals with a high need (high score), as measured by OTNI, will necessarily put at risk their oral health if they turn down orthodontic therapy.

CONCLUSION

OTNI have a role in the epidemiology and can be used for resource planning, but their predictive value to detect the future objective functional deficits or oral health problems is questionable. OTNI will need revalidation over time with emerging research findings.

Impact of social and economic characteristics on orthodontic treatment among children and teenagers in France

OBJECTIVES

This study aimed to estimate the prevalence of orthodontic treatment in France among children and teenagers aged 8-18 years, by sex and by age, and to investigate the specific role of social and economic characteristics on use of orthodontic treatment.

METHODS

We analyzed data from the cross-sectional national health survey conducted in France in 2002-2003, which included a sample of 5988 children aged 8-18 years. All data were collected by interview including the question on orthodontic treatment. Other data used in our study were family social status and income, maternal educational attainment and place of birth, whether the child was covered by a supplementary health insurance and whether the residence was urban or rural. We also calculated the density of orthodontists in the district. Multivariate logistic regression analyses were used to study the relationships between these social and economic factors and orthodontic treatment.

RESULTS

The prevalence of orthodontic treatment was 14% of all children aged 8-18, 15% for girls, and 13% for boys, and 23% in the 12 to 15-year age group. Children were less likely to have orthodontic treatment when parents were service or sales workers compared with children whose parents were managers or professionals (aOR = 0.50; 95%CI: [0.34;0.76]), when family income was in the lowest, compared with highest quartile (aOR = 0,62; 95% CI: [0.45;0.85]), when children had no supplementary insurance compared with children covered by private insurance (aOR = 0.53; 95% CI: [0.34; 0.81]), or when they lived in rural compared with urban areas (aOR = 0.70; 95% CI: [0.54; 0.91]).

CONCLUSION

There are social inequalities in orthodontic treatment in France, associated mainly with social status, annual income, supplementary insurance, and the residence area.

Prevalence of malocclusion and its relationship with socio-demographic factors, dental caries, and oral hygiene in 12- to 14-year-old Tanzanian schoolchildren

The aim of this study was to assess the prevalence of malocclusion and its association with socio-demographic characteristics, caries experience, and level of oral hygiene in 12- to 14-year-old schoolchildren residing in two socio-economically different districts of Tanzania. A total of 1601 children (mean age 13 years, 60.5 per cent girls) attending 16 primary schools in Kinondoni and Temeke districts participated in a clinical examination and were interviewed in school settings. Chi-square and multiple logistic regression models were used to test for statistically significant differences between different groups. The results showed that 63.8 per cent (62.6 per cent in Kinondoni and 66.0 per cent in Temeke) of the subjects had at least one type of anomaly, with a midline shift (22.5 per cent), spacing of at least 2 mm (21.9 per cent), and an open bite (16.1 per cent) being the most frequently recorded. The majority (93.6 per cent) of the children showed a Class I molar relationship. Class II and Class III malocclusions were registered in 4.4 and 2.0 per cent, respectively. Multiple logistic regression analyses, controlling for socio-demographic factors, showed that the odds ratio for having an open bite was 1.8 if residing in a less socio-economically privileged district. Subjects with decayed, missing, and filled teeth (DNFT) (>0) were 1.7, 2.1, 2.4, and 1.7, respectively, more likely to be diagnosed with a malocclusion, a midline shift, Angle Class II and III, and an open bite. Schoolchildren with fair/poor oral hygiene were less likely than their counterparts with good oral hygiene to be diagnosed with a midline shift. Malocclusions were prevalent in the Tanzanian children investigated and were associated with environmental factors in terms of caries experience and residing in a less affluent district. Preventive programmes to combat the prevalence of malocclusion are recommended.

Prevalence of malocclusions in Hungarian adolescents

The aim of this epidemiological study was to assess the prevalence of malocclusion, associated caries experience, and level of oral hygiene in the Hungarian population using the World Health Organisation (WHO) questionnaire designed to assess dentofacial anomalies. A total of 483 adolescents (289 girls, 194 boys), aged 16-18 years, were assessed. Orthodontic anomalies were detected in 70.4 per cent of the sample. Crowding and spacing were observed in 14.3 and 17 per cent, respectively, with the latter being more prevalent in the maxilla than in the mandible (10.4 and 2.9 per cent, respectively). A Class I occlusion was found in 52.8 per cent of the subjects. A half cusp anomaly in the antero-posterior molar relationship was more prevalent than a full cusp anomaly (26.9 and 20.3 per cent, respectively). The decayed, missing, and filled teeth (DMFT), the decayed, missing, and filled surfaces (DMFS), and the visible plaque indices scores (VPI) of the 340 adolescents with malocclusion were significantly higher (P < 0.05) than those of the adolescents who displayed no anomalies. The prevalence of malocclusion in the Hungarian population seems to be comparable with other European communities.

ABO certification in the age of evidence and enhancement

The American Board of Orthodontics (ABO) phase III certification examination was originally constructed and recently modified to "help the Board determine the candidate's knowledge of clinical orthodontics and provide a basis to assess the quality of the candidate's clinical treatment results." For the most part, the ABO phase III examination measures the orthodontic treatment-induced changes in occlusion in a limited and biased patient sample. The process and outcome measures used in the current model-the discrepancy index and the objective grading system-are so narrowly focused that an orthodontist might lack up-to-date clinical knowledge, psychomotor and critical thinking skills, diagnostic acumen, patient management ability, and patient-centered ethics, and still pass the examination largely because of mechanically morphing the patient's teeth into the board's construct of ideal occlusion. The goal of this article is to provide provocative insight into the core concepts that drive the ABO phase III certification process and to recommend an alternative paradigm predicated on a patient-centered, evidence-based clinical practice model.

Perceptions of dental esthetics of Asian orthodontists and laypersons

INTRODUCTION

The aim of the study was to determine the impact of anterior dental crowding, overjet, overbite, dental spacing, and type of malocclusion on dental esthetic perceptions of Asian orthodontists.

METHODS

Twenty-one Asian orthodontists (10 men, 11 women) and 158 adult laypersons (38 men, 120 women) rated the attractiveness of 50 pairs of black-and-white intraoral photographic prints of various types of malocclusions. Each pair included a frontal and a right buccal view of the dentition at maximum intercuspation. Raters used a visual analogue scale (VAS), with "least attractive" (0 mm) and "most attractive" (100 mm) as the 2 extremes, to score the dental esthetics of the photographs. A principal investigator objectively measured the dental traits from study models. Linear regression analysis was performed with VAS scores as the dependent variable and anterior dental crowding, overjet, and overbite measurements as the independent variables. Independent sample t tests were used to determine the effect of dental spacing on the VAS scores. The Kruskal-Wallis test was used to determine the effect of type of malocclusion (Class I, Class II Division 1, Class II Division 2, Class III) on VAS scores.

RESULTS

Increased overjet (>6 mm) and severe maxillary dental crowding (>8 mm) were found to be significantly correlated with laypersons' VAS scores (P <.05). Reverse overjet was found to be significantly correlated with orthodontists' VAS scores (P <.05). No significant correlation was found between overbite, dental spacing, and VAS scores. Class III malocclusions were significantly perceived to be the most unesthetic by orthodontists.

CONCLUSIONS

Overjet was the major occlusal trait that influenced the perceptions of dental esthetics of both laypersons and orthodontists.

Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults

INTRODUCTION

The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health.

METHODS

The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents.

RESULTS

Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment.

CONCLUSIONS

These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Evidence-based orthodontics for the 21st century

BACKGROUND

This article examines some of the data-driven advances in clinical orthodontics and how they might influence the decision-making process in the specialty.

TYPES OF STUDIES REVIEWED

Nearly 100 years of orthodontic study has focused on two issues: one-phase versus two-phase treatment of Class II malocclusion and extraction versus nonextraction treatment of arch perimeter deficiencies. The author addresses these issues by presenting data from the first randomized clinical trial in orthodontics and from a survey of the current literature.

RESULTS

The clinical trial involved subjects who had Class II malocclusion. The researchers who conducted the trial found no difference in the quality of the dental occlusion between the children who had early treatment and those who did not, as judged by both an occlusal index (Peer Assessment Rating scores) and the percentages of the subjects with excellent and less-than-optimal outcomes. Early treatment did not reduce the eventual need for orthognathic surgery. In a separate study, a researcher reported that the maxillary arch perimeter could be increased by 3 to 4 millimeters by using rapid palatal expansion, or RPE, providing space for incisor alignment to resolve crowding. The author concluded that any added benefit of RPE treatment in patients without a crossbite might be "challenging to define."

CLINICAL IMPLICATIONS

The challenge facing orthodontists in the 21st century is the need to integrate the accrued scientific evidence into clinical orthodontic practice.

Malocclusion and caries prevalence: is there a connection in the primary and mixed dentitions?

The purpose of this epidemiological cross-sectional study was to determine the prevalence of malocclusion and caries in children and to investigate whether a relationship exists between prevalence of caries and studied malocclusion. The study consisted of 8,864 preschool and schoolchildren with primary dentitions (mean age 4.5 years) and mixed dentitions (mean age 8.9 years). 1997 WHO dental caries criteria were applied to both groups. The existence of an increased caries risk was deducted from the dmft and DMFT indices related to age. Malocclusion in primary and mixed dentitions was classified into seven types. Fifty-seven percent of all children had some form of malocclusion. Prevalence of malocclusion increased and was significantly greater in the mixed dentition sample (p < 0.001) than in the primary dentition sample. Seventy-four percent of children with primary dentitions and 23% of children with mixed dentitions had zero dmft and DMFT scores. Mean dmft indices in subjects with primary and mixed dentitions were 1.02 and 1.53, respectively. No positive correlation between prevalence of caries and malocclusion could be established in the sub sample with primary teeth only. However, statistically significant parallelism in prevalence of malocclusion and caries were found for posterior cross-bite (p= 0.050) and mandibular overjet (p= 0.013) in children with mixed dentitions.

Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores

Clinical impressions by Indian Health Service (IHS) dentists of a greater frequency of severe dental malrelations among Native Americans than in the general US population have never been objectively confirmed. This study uses the DAI as the standard to determine whether there is a greater prevalence of severe malocclusions among Native Americans. Four hundred eighty-five Native American students in grades 7-12 from two remote sites--Pine Ridge, SD, and Many Farms, AZ--and one nonremote site--Lapwai, ID--were scored for the DAI. The mean scores from each reservation, as well as the mean score from the three reservations combined, were significantly higher, indicating poorer aesthetics, than the mean DAI score from a large sample of the general US population. These data confirm the clinical impressions of IHS dentists that Native Americans residing on reservations have significantly poorer dental aesthetics than the aesthetics found in the general US population; therefore, Native Americans have greater needs for orthodontic treatment.

Causal relation between malocclusion and periodontal health

The purpose of this 20-year follow-up study was to assess whether persistent traits of morphologic malocclusion imply an increased risk of periodontal disease. In 1965-66 malocclusion was recorded in 176 adolescents who were re-examined in 1986-87 at the age of 33-39 years. Markedly healthier periodontal conditions were found in women than men, in the higher social group than the lower one, and in the maxilla than the mandible. Subjects with specified malocclusion traits at both examinations were compared with subjects without malocclusion for the occurrence of calculus, gingivitis (bleeding), and pocketing. Controlling for the effect of sex and social group, periodontal disease was significantly more frequent in the maxilla in connection with crowding, extreme maxillary overjet, and cross-bite (p less than 0.05). No association was found in the mandible. The presence of certain malocclusion traits in adolescence may probably often call for special professional efforts of oral hygiene education rather than orthodontic therapy.