Changes in the oral health-related quality of life 24 h following insertion of fixed orthodontic appliances

The Impact of Non-Extraction Orthodontic Treatment on the Oral-Health-Related Quality of Life between a Modified Aligner Appliance with Ni-Ti Springs and the Traditional Fixed Appliances: A Randomized Controlled Clinical Trial

Background and Objectives: To compare the oral-health-related quality of life (OHRQoL) outcomes between patients treated with modified Ni-Ti spring-based alignment appliances or conventional fixed appliances using the Oral Health Impact Profile 14 (OHIP-14), as well as the levels of satisfaction with the appliance appearance, treatment progress, and outcomes. Materials and Methods: Thirty-six patients (11 males, 25 females) were randomly divided into two groups: either the modified aligner appliance with Ni-Ti springs group (MAA) or the traditional fixed appliances group (FA). The allocation ratio was 1:1, and the randomization process was carried out by an independent investigator not involved in this study. Mild crowding cases were included in this study. The OHRQoL of patients was evaluated using the short-form Oral Health Impact Profile (OHIP-14) at five time points: before the treatment commencement (T0); 2 weeks (T1), 1 month (T2), and 2 months (T3) after the treatment initiation; and post-treatment (T4). The visual analog scale (VAS) was used to evaluate the patient satisfaction. Blinding was performed only during the outcomes assessment. Results: This randomized controlled trial had no dropouts, and the demographic characteristics of the groups were comparable. The MAA group experienced significantly greater functional limitations compared with the FA group at all three evaluation time points (T1, T2, and T3), as evidenced by the statistically significant p-values (p = 0.004, p = 0.001, and p < 0.001, respectively). The psychological disability in the MAA group was significantly lower than in the FA group at both T2 (p = 0.005) and T3 (p = 0.003). The patient satisfaction with the appliance appearance was significantly higher in the MAA group than in the FA group (p = 0.002). Conclusions: The OHRQoL improved in both the modified aligner appliance with Ni-Ti springs and fixed appliance groups after the treatment. Moreover, the functional limitations during the treatment were less severe in the FA group, while the psychological disability was lower, and the patient satisfaction with the appliance appearance was higher in the MAA group.

Duration of orthodontic treatment with clear aligners versus fixed appliances in crowding cases: a systematic review

OBJECTIVE

To critically appraise and assess the currently observed evidence about the difference in orthodontic treatment duration between clear aligners and fixed appliances in crowding cases.

MATERIALS AND METHODS

An electronic search without limitations was conducted from inception to June 2023 covering nine databases: The Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Scopus, Web of Science, Google Scholar, Trip, CINAHL via EBSCO, EMBASE via OVID and ProQuest. Randomized controlled trials (RCTs) and matched non-randomized studies were included in this systematic review. Risk of Bias was assessed via Cochrane's tool (RoB 2) for RCTs and ROBINS-I tool for non-randomized studies. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was employed to evaluate the overall quality of evidence.

RESULTS

Out of the 3537 articles initially identified, ten eligible studies were included in this systematic review; six were RCTs. Only one study offered extraction-based treatment, while the other nine adopted non-extraction treatments. According to the GRADE, there is low evidence that treatment duration in mild to moderate crowding cases with clear aligners is similar to that in fixed orthodontic appliances. Meta-analysis was not administered due to high inconsistency.

CONCLUSIONS

Based on currently available information, there was no significant difference in the treatment duration between the CA and FA groups in mild to moderate crowding cases. Further well-performed RCTs, especially in severe cases, are required.

CLINICAL RELEVANCE

Time efficiency is an essential outcome measure for clinical orthodontic practice. While the type of appliance used is a critical determinant of treatment duration, orthodontists should be aware of other factors that can significantly impact treatment time, such as patient and treatment-related factors.

Enhancing Orthodontic Renewal and Retention Techniques: A Systematic Review

Orthodontists have a variety of options available for retainers. Research in Orthodontics focuses on assessing outcomes important to clinicians; however, there is inconsistency in how these outcomes are selected and evaluated. This review sought to assess the effects of different orthodontic retainers on patients' quality of life (QoL). Various approaches were employed in this systematic review, and a thorough search was conducted across six databases. The review involved a comprehensive evaluation of six included studies, highlighting changes in dental structure post-treatment, emphasizing the role of extraction procedures and the quality of debonding in improving retention. The study identified key outcomes for orthodontic clinical trials, highlighting orthodontists' preferences for specific retainer types. Moreover, it discussed the impact of sociocultural influences on retention care. Involving patients actively in discussions about whether to end or extend the retention phase was deemed essential. Noteworthy improvements in occlusal outcomes were linked to extraction treatments. Gender and malocclusion severity influenced QoL before and after orthodontic treatment. The degree of improvement observed in the Class III malocclusion group was comparatively lower than that in the Class I and Class II groups. Orthodontic treatment was found to yield favorable psychological outcomes, as evidenced by notable enhancements in self-esteem and social engagement among individuals. Fixed appliances were shown to negatively affect oral health-related quality of life (OHRQoL), particularly for those with aesthetic and functional concerns. A consensus has been reached on the essential themes and outcomes that should be incorporated in clinical trials related to orthodontic retention for non-cleft and non-surgical cases.

Comparison of pain intensity and impacts on oral health-related quality of life between orthodontic patients treated with clear aligners and fixed appliances: a systematic review and meta-analysis

OBJECTIVE

This study aimed to compare the pain intensity and impacts on oral health-related quality of life (OHRQoL) between orthodontic patients treated with clear aligners (CAs) and fixed appliances (FAs).

METHODS

A systematic search was conducted up to December 2022 using PubMed, Web of Science, Cochrane Central Register of Controlled Trials, and Embase. Randomized controlled trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) comparing pain intensity or OHRQoL between patients treated with CAs and FAs were included. The risk of bias (RoB) of individual studies was evaluated using the Cochrane RoB tool 2.0 and ROBINS-I tool for RCTs and non-RCTs, respectively. Further, meta-analyses were separately conducted for each included study using the total oral health impact profile (OHIP)-14 and visual analog scale (VAS) scores to evaluate OHRQoL and pain intensity, respectively.

RESULTS

Overall, 12 studies (5 RCTs and 7 non-RCTs) were included in the study. Subgroup analyses conducted according to the total OHIP-14 scores revealed that patients treated with CAs had higher OHRQoL at 1 week, 1 month, and 6 months of the treatment. Meanwhile, subgroup analyses conducted according to the VAS scores revealed that pain levels were lower in the CA group only at 3 and 4 days of the treatment.

CONCLUSIONS

Patients treated with clear aligners had higher OHRQoL than those treated with fixed appliances during orthodontic treatment. However, OHRQoL appeared to be similar between the two groups at the end of the treatment. Moreover, patients treated with clear aligners experienced lesser pain than those treated with fixed appliances on the third and fourth day after the initial treatment. The difference in pain intensity between the two treatment modalities was not noted at other time points.

Comparative analysis of periodontal pain and quality of life in patients with fixed multibracket appliances and aligners (Invisalign®): longitudinal clinical study

BACKGROUNDS

The aim of this longitudinal clinical study is to analyse and compare according to location, degree and type, the pain presented by patients during their first year of treatment, as well as the quality of oral life after the placement of two types of orthodontic appliances: conventional brackets and removable Invisalign ® aligners.

METHODS

The sample consisted of 140 patients grouped into 2 study groups of 70 patients each. The first group (brackets group- BG), with fixed multibracket appliances, using the MBT technique and a 0.022" slot. The second group (invisaling group- IG), in treatment with removable aligners (IG), using the Invisalign ® system. They were providen with a questionnare where they had to record the degree (mild, moderate or intense), the type and location of the pain monthly during the first year of treatment. The second form was the Spanish version of the OHIP-14, oral quality of life questionnaire, which was provided the twelfth month after the start of treatment.

RESULTS

In both groups, we found that the most frequent location of pain occurred during the first phase: mandibular for the IG group and maxillary in the BG group. Throughout the whole analysis, the intensity was mild-moderate with lower values in the conventional brackets' group. The BG group reported acute pain while the IG group reported sensitive pain during the first month; later both reported sensitive pain.

CONCLUSIONS

There are differences in terms of periodontal pain in its degree, location, and type according to the different orthodontic techniques used.

TRIAL REGISTRATION

The study was approved by the bioethics committee of the University of Salamanca (USAL_20/516).

Validity and reliability of the orthodontic experience questionnaire in Malayalam, an Indian language

AIM

To translate the orthodontic experience questionnaire into Malayalam, an Indian language, and assess its validity and reliability in the Kerala population.

MATERIALS AND METHODS

The original questionnaire, which was developed in English, was translated into Malayalam. Face validity was assessed, and minor changes were made, followed by a content validity assessment by an expert panel. The final version was given to 324 patients who marked their responses on a Likert scale. Internal consistency reliability was tested using Cronbach's alpha, and test-retest reliability was tested using the intraclass correlation coefficient. Principal component factor analysis was performed to regroup the valid items.

RESULTS

The principal component factor analysis revealed three domains. Reliability assessed by Cronbach's alpha of the whole questionnaire was 0.799, and that of the three domains was 0.73, 0.71, and 0.71, respectively. The test-retest reliability was found to be good (0.798).

CONCLUSION

The Malayalam version of the orthodontic experience questionnaire was found to be content valid with good reliability. To obtain a successful treatment result, an orthodontist must be aware of these and this questionnaire, with adequate validity and reliability, has been designed to achieve this in the Malayalam-speaking population.

Reflection on patients' experience with orthodontic appliances wear and its impact on oral health related quality of life: observational comparative study

BACKGROUND

The objective of this study was to explore and compare patient's experience with the use of a removable functional appliance or fixed orthodontic appliance and its influence on oral health-related quality of life.

MATERIAL AND METHODS

This clinical trial included 81 participants having Class II Division 1 and age ranging between 10 and 16 years. The participants were included in any of a three equal groups according to the set inclusion and exclusion criteria; Group 1: patients treated with a Twin-Block functional appliance; Group 2: patients treated with a fixed orthodontic appliance only; and Group 3 (control group): patients not in orthodontic treatment yet. The COHIP SF-19 was used. Patients were given the questionnaire as follows: Group 1: (1) after at least 8 months from starting treatment; (2) after completing phase 1 by 2-3 months without wearing the appliance; Group 2: (1) just before debonding; (2) after finishing the treatment by 2-3 months without any appliances; and Group 3: (1) at the patient's first visit to the orthodontic clinic; (2) after 2-3 months from the first visit to the orthodontic clinic and before starting any treatment.

RESULTS

The 81 participants were 31 males and 50 females with median age of 13 years. The total COHIP SF-19 scores at baseline were 57 (49-64), 67 (63-72), and 47 (42-53) for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively. Two-month mean scores adjusted to the baseline scores were 64.82 ± 1.15, 65.65 ± 1.47, and 54.45 ± 1.44 for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively.

CONCLUSIONS

Both at baseline and two-months (adjusted to the baseline scores), participants in the malocclusion group showed compromised socio-emotional quality of life and reported the poorest total OHRQoL. At the baseline, better socio-emotional and total OHRQoL was reported by the fixed appliance group compared to the Twin-Block group but, after two months both groups gave similar sores. Therefore; patients' perceptions about their experience with the orthodontic appliance might change.

Cervical headgear therapy and sleep-related attributes

INTRODUCTION

The study aimed to assess (1) the effect of the treatment with cervical headgear on patients' sleep-related attributes and well-being and (2) whether these sleep-related parameters (ie, sleep quality and quantity) were associated with patients' compliance during the orthodontic treatment.

METHODS

The study protocol was based on a prospective longitudinal quasi-experimental design. Participants (n = 26; 9 males; mean age, 12.4 ± 1.68 years) were patients in the Postgraduate Orthodontic Clinic, National and Kapodistrian University of Athens. All patients received treatment with a cervical headgear having an embedded TheraMon microsensor. Sleep was assessed by wrist-worn actigraphy for 59 ± 19 days. The Epworth Sleepiness Scale was used to assess average daytime sleepiness, whereas we used the Athens Insomnia Scale for insomnia symptoms. Oral health-related quality of life (OHRQOL) was assessed by the Oral Health Impact Profile (OHIP-14).

RESULTS

Patients slept on average 7.35 ± 0.42 h/d. Compared with the lowest sleep duration recommended for their age group, patients had an average chronic sleep deficit of 1.40 ± 0.49 h/d. Patients wore the headgear 90.9% of the days for 10.40 ± 4.17 h/d. However, only 7 (28%) patients reached or exceeded the wear-time recommendation of 12 h/d. In contrast, 2 (8%) patients wore headgear <5 h/d, 11 (44%) 5-10 h/d, and 12 (48%) patients wore headgear >10 h/d. Aggregated by participants, the median Epworth Sleepiness Scale score during the study was 3.40 (interquartile range [IQR], 4.85; range, 0.2-13.6), the median Athens Insomnia Scale score was 3.00 (IQR, 4.25; range, 0-7), and the median Oral Health Impact Profile score was 1.40 (IQR, 4.17; range, 0.0-20.8). Compared with patients who wore the orthodontic appliance >7.8 h/d, patients who wore it <7.8 h/d had worse average daytime sleepiness (P = 0.050) and worse OHRQOL (P = 0.019).

CONCLUSIONS

Orthodontic treatment with cervical headgear has no substantive negative effect on sleep attributes (quantity and quality), average daytime sleepiness and OHRQOL. However, poor compliance with orthodontic treatment seems to be associated with higher levels of daytime sleepiness.

A Detailed Correlation of Oral-Health-Related Quality of Life of Patients Undergoing Fixed Orthodontic Therapy

Malocclusion is a dental condition that can affect both children's and adolescents' oral-health-related quality of life (OHRQoL), and the seriousness of the condition is indicated by the patient's requirement for orthodontic therapy. The patient or his or her caretaker may personally report the necessity for orthodontic therapy, or the doctor or orthodontist may quantify it objectively. However, discrepancies in the requirement for either objective orthodontic therapy or subjective orthodontic therapy have been noted. The OHRQoL measurements should be used in conjunction with the indicator of orthodontic therapy requirement to represent the patient's anticipated treatment requirement. Some systematic reviews have revealed evidence that malocclusion has a detrimental effect on OHRQoL. In addition to the effects of malocclusion, the impact of orthodontic therapy on OHRQoL has also been documented. There is a dearth of related follow-up studies, particularly those documenting OHRQoL improvements in adolescents both before the beginning of treatment and termination of orthodontics treatment. Additionally, it has been hypothesized that self-esteem affects OHRQoL, albeit there is insufficient data to support either its specific function or its connection to perceptions of oral health. As a result, the purpose of this literature review is to determine whether patients receiving fixed orthodontic therapy report any changes in their reported OHRQoL. There was an extensive review of available original research, case reports, systematic reviews, literature reviews, etc., available in reliable sources of information like PubMed, Scopus, Web of Science, etc. The review found that the process of receiving orthodontic therapy might be unpleasant, affecting OHRQoL. The discomfort caused by orthodontic equipment, which are foreign things put into a delicate portion of the body, is both psychological and physical. Such discomfort may have a detrimental effect on the patient's willingness to receive therapy, their participation, and the treatment's effectiveness. The main sources of discomfort that patients undergoing fixed orthodontic treatment report are the appliance's design, amount of force used in the early stages of their therapy, prior painful memories, emotional variables, cognitive variables, and environmental factors such as age, sex, and culture. As a result, orthodontic treatment may have negative effects on a person's QoL that, in most situations, are temporary.

Einfluss der Dauer kieferorthopädischer Behandlung auf das subjektive Empfinden der mundgesundheitsbezogenen Lebensqualität

Hintergrund Aufgrund der aktuell noch geringen Datenlage war es Ziel dieser Studie, den Einfluss der Dauer einer kieferorthopädischen Behandlung auf die mundgesundheitsbezogene Lebensqualität (MLQ) zu untersuchen.

Methode Die beobachtende, prospektive Längsschnittstudie erfolgte mit der deutschen Basisversion des Oral Health Impact Profile (OHIP-G14) im Zeitraum von 2008–2018. Die MLQ wurde zu drei Zeitpunkten (T1, T2, T3) bei 598 Patient*innen innerhalb ihrer kieferorthopädischen Behandlung erhoben und die Ergebnisse statistisch analysiert. Ein durchschnittlicher Anstieg (∆OHIP-G14) von>2,00 Punkten wurde als klinisch relevant (Minimal Important Difference, MID) und Zeichen einer herabgesetzten mundgesundheitsbezogenen Lebensqualität definiert.

Ergebnisse Von initial 598 eingeschlossenen Patient*innen füllten 79 ProbandInnen die Fragebögen zu allen drei Zeitpunkten vollständig aus und konnten in die Studie aufgenommen werden. Das Durchschnittsalter lag zu Beginn der Behandlung bei 11,5 Jahren (SD=3,3), am Ende der Behandlung bei 16,3 Jahren (SD=3,1). Die durchschnittliche Behandlungsdauer betrug 4,7 Jahre (SD=2,3). Ein Vergleich der erreichten Summenwerte zu den Zeitpunkten T1, T2, T3 der ernannten Subgruppen (Geschlechter, Altersgruppen, Behandlungsapparatur und -zeitraum) untereinander zeigte in keiner der Gruppen signifikante Unterschiede (Mann-Whitney-U-Test, Kruskal-Wallis-Test, Chi-Quadrat-Test p<0,05). Ein Vergleich der Gesamtwerte der jeweiligen Zeitpunkte zeigte eine klinisch (∆OHIP-G14>2,00) und statistisch signifikante Abnahme der MLQ während der initialen Behandlungsphase (T1 vs. T2, p<0,001). Die Verbesserung der MLQ am Ende der Behandlung (T2 vs. T3) war statistisch nicht signifikant (p=0,128) und hatte keine klinische Auswirkung (MID ∆OHIP-G14<2,00). Weitere Analysen der Behandlungsdauer und der OHIP-Summenwerte ergaben zu keinem Zeitpunkt signifikante Abhängigkeit oder Korrelation zwischen Behandlungsdauer und MLQ (β2=− 0,078, β3=0,191, multiple lineare Regression, p=0,05; r2=0,073, r3=0,103, Spearman Korrelation, p=0,05).

Schlussfolgerung Im Vergleich zu T1 war die MLQ während der Behandlung sowohl zu T2 als auch T3 leicht herabgesetzt. Es kann jedoch festgestellt werden, dass der Durchschnitt der erhobenen Summenwerte zu allen drei Zeitpunkten der Befragung (T1, T2 und T3) im Normbereich der gesunden Allgemeinbevölkerung lag. Hinsichtlich der Kernfrage dieser Studie konnte kein Zusammenhang zwischen Behandlungsdauer und MLQ gezeigt werden. Das Anstreben eines guten Behandlungsergebnisses im Rahmen einer differenzierten kieferorthopädischen Therapie sollte daher nach Möglichkeit einem raschen Abschluss der Behandlung vorangestellt werden.

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.

The Effect of Treatment With Clear Aligners Versus Fixed Appliances on Oral Health-Related Quality of Life in Patients With Severe Crowding: A One-Year Follow-Up Randomized Controlled Clinical Trial

Objective

To compare the level of oral health-related quality of life (OHRQoL) between patients receiving clear aligners or fixed appliances within one year of follow-up using Oral Health Impact Profile 14 (OHIP-14), a validated self-administered questionnaire.

Materials and methods

A single-centered, two-arm parallel-group randomized controlled clinical trial was conducted on 36 adult patients (19 females, 17 males; age range: 18 to 25 years) who had severe crowding and require orthodontic treatment with first premolars extraction. The patients were equally and randomly divided into two groups: The clear aligners (CA) group and the fixed appliances (FA) group. OHRQoL was assessed using the OHIP-14 tool at various times during comprehensive orthodontic therapy: baseline (T0), one week (T1), two weeks (T2), one month (T3), 6 months (T4), and 12 months (T5) after starting the active orthodontic treatment. Mann-Whitney U test or Friedman test were used to detect significant differences. The level of significance was set at 5%. 

Results

All of the selected patients entered the statistical analysis stage. There were no significant differences between the CA and FA groups for the psychological discomfort, psychological disability, social disability, and handicap (P˃0.05) at almost all assessment times. For the functional limitation, physical pain, physical disability, and the overall score, there were significant differences between the studied groups (P˂0.05), with the FA group having higher mean scores than the CA group in all of the assessment times.

Conclusion

Patients' treatment with clear aligners has less impact on OHRQoL than those treated using conventional fixed appliances during the first year of treatment.

Activation and installation of orthodontic appliances temporarily impairs mastication

OBJECTIVES

To investigate the masticatory (masticatory performance, bite force, swallowing threshold, muscle activity, and questionnaires) and nutritional (nutrient intake) impacts of the activation and/or installation of different orthodontic appliances (fixed labial, lingual appliances, and clear aligners).

MATERIALS AND METHODS

Six electronic databases and gray literature were searched (up to May 2021) for relevant studies evaluating mastication and nutrition after activation/installation of orthodontic appliances. This review followed PRISMA guidelines and was registered at PROSPERO (CRD42020199510). The risk of bias (RoB 2 and ROBINS-I) and evidence quality Grading of Recommendations Assessment, Development, and Evaluation were analyzed.

RESULTS

Of 4226 recorded and screened, 15 studies were finally included. Masticatory performance (standardized mean difference [SMD]: 1.069; 95% coefficient interval [CI]: 0.619 to 1.518) and bite force (SMD: -2.542; 95% CI: -4.867 to -0.217) reduced in the first 24 to 48 hours of fixed labial appliance installation/activation, but they were both normalized after 30 days (P > .05). The swallowing threshold remained constant (P > .05). Nutritional intake was rarely reported but showed copper (P = .002) and manganese (P = .016) reductions, with higher calorie and fat intake (P < .05). Lingual appliances impacted chewing more than labial, and clear aligner wearers reported fewer chewing problems (P < .001). Low to very low levels of evidence were found.

CONCLUSIONS

Based on low to very low levels of evidence, mastication was reduced during the first 24 to 48 hours of fixed labial appliance activation/installation, but it was transitory (up to 30 days). Due to insufficient data, the nutritional impact of orthodontic appliances was not conclusive.

Looking good but tweeting bad? The social perception of orthodontic-related posts on Twitter and Instagram

BACKGROUND

Social media plays a major role in the daily life of adolescents and has become highly interesting for healthcare research as well. The aim of this study was to explore the social perception of orthodontic-related posts on Twitter and Instagram by young adults.

METHODS

401 orthodontic-related posts were collected during a 30-day period and categorized with regard to specific characteristics - their content and the social networking site (SNS) being used as well as the presence or absence of a selfie. In order to investigate the social perception of these posts, 42 young adults rated the emotional states of the SNS users using the Self-Assessment Manikin (SAM)-Tool. A total of 4211 poster-rater observations pertaining to the three SAMs dimensions pleasure, arousal and dominance were analyzed by using linear and multinomial logistic regression analyses.

RESULTS

The investigated characteristics of the collected posts had significant effects on the perceived emotional state of the SNS users. Besides significant SNS-associated differences, there were also effects that were independent of the SNS being used: Receiving orthodontic appliances was more often associated with rather negative emotions (p < 0.001), while users who posted about the removal of such braces were more often perceived as joyful (p < 0.001). Interestingly, users whose posts contained selfies with visible braces were perceived as significantly more positive and stronger in comparison to users who did not post a picture of themselves (p < 0.05).

CONCLUSION

This research gives insights into the social perception of orthodontic-related posts on SNS. While users' emotional states were perceived highly differential on both SNS, orthodontic-related content also revealed significant effects on social perception. Because selfies with visible braces were associated with positive feelings by young adults, a modern and SNS-related way of coping with a temporary supposed impairment like fixed orthodontic appliances might have been revealed through this research.

Oral-Health-Related Quality of Life (OHRQoL) and Anterior Open Bite in Adult Patients: A Case-Control Study

Oral-health-related quality of life (OHRQoL) is defined as the impact of oral health on activities of daily living. Malocclusions are a public health problem with a high prevalence. Different studies have concluded that malocclusions negatively affect OHRQoL in patients of all ages. The aim of this study was to analyze the influence of having an anterior open bite on the OHRQoL of adult patients. Materials and Methods: A case-control study (1:1) was carried out with a sample size of 80 adults at the University of Salamanca in 2021. The case group (n = 40) was made up of patients with an anterior open bite, and the control group (n = 40) contained patients without an anterior open bite. OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The influences of gender and age on the OHRQoL of the patients were also analyzed. Results: There were no significant differences in gender or age between the case and control groups. An anterior open bite was not found to influence the OHRQoL of adult patients. Age was not shown to significantly influence OHRQoL. Female patients with an anterior open bite had higher scores in the handicap domain of the OHIP-14 questionnaire compared with male patients (p < 0.05). Conclusions: Anterior open bite can influence the OHRQoL of orthodontic patients. Gender can be considered an influencing factor.

Oral Health Impact Profile in Orthodontic Patients with Ectopic Canine: A Prospective Clinical Intervention of Four Treatment Modalities

This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective evaluation. A total of 96 subjects were assessed for OHRQoL using the Oral Health Impact Profile, English version (OHIP-16). Initial comparison of the baseline data of ectopic canine subjects was made with severe crowding (>8 mm) and class I normal occlusion with the matched number and age of the subjects in later groups. Moreover, a comparison of OHIP-16 scores among four OTM in the ectopic canine group, baseline, 1 day, and 28 days after treatment were performed. OHIP-16 scores of ectopic canine, severe crowding, and class I normal occlusion group were 33.06, 33.09, and 26.43, respectively. Subjects with ectopic canine and severe crowding reported a significantly greater negative impact in terms of embarrassment, avoiding smiling, and lack of self-confidence. OHRQoL had no significant changes among the four OTM groups (p > 0.05). Untreated malocclusion had a significant negative impact on OHRQoL. The negative impact was seen in several domains 1 day after treatment, and gradual improvement was noted 28 days after treatment.

Oral Impacts Experienced by Orthodontic Patients Undergoing Fixed or Removable Appliances Therapy in Saudi Arabia: A Cross-Sectional Study

PURPOSE

The objective of this study is to compare the orthodontic patient's experiences with removable and fixed orthodontic appliances on daily activities, food consumption, and oral symptoms in Riyadh city, Saudi Arabia.

METHODS

This was a cross-sectional observational study carried out among orthodontic patients. A total of 150 adult patients, including 118 in the fixed orthodontic appliance group and 32 in the removable (Invisalign) orthodontic group, who met the inclusion criteria completed a validated and self-administered questionnaire. In addition, the study participants reported their experience in terms of daily routine, food consumption, and oral symptoms one week after appliance activation. Data were analyzed using the chi-square test and Fisher's exact tests for the categorical variables. In addition, Mann-Whitney U, Kruskal-Wallis, and Spearman's tests were also applied to the data.

RESULTS

The fixed orthodontic patients compared to the removable orthodontic cases showed significantly higher difficulty in sleeping (1.28±1.10 vs 0.94±0.88, p=0.024), sores on the tongue (0.97±1.00 vs 0.56±0.76, p=0.042) and cheeks (1.20±1.11 vs 0.72±0.81, p=0.027), and the presence of food debris under the appliance (1.53±1.16 vs.1.00±0.95, p=0.021). Moreover, the oral health impact score showed a significant positive correlation with the duration of the orthodontic treatment (r=0.339, p<0.001) and pain intensity (r=0.309, p<0.001).

CONCLUSION

The fixed orthodontic treatment compared to removable orthodontic treatment resulted in more severe pain, sleeping difficulty, sores on the tongue and cheeks, and food impaction after one week of appliance activation.

Pain and Oral-Health-Related Quality of Life in Orthodontic Patients During Initial Therapy with Conventional, Low-Friction, and Lingual Brackets and Aligners (Invisalign): A Prospective Clinical Study

The aim of this study was to compare pain and its relationship with the oral quality of life of patients with different types of orthodontic appliances: conventional and conventional low-friction brackets, lingual brackets, and aligners. A prospective clinical study was carried out with a sample size of 120 patients (54 men, 66 women) divided into 4 groups of 30 patients each. The modified McGill questionnaire was used to measure pain at 4, 8, and 24 h and 2, 3, 4, 5, 6, and 7 days after the start of treatment, and the Oral Health Impact Profile-14 (OHIP-14) questionnaire was used to measure the oral-health-related quality of life (OHRQoL) in the first month of treatment. The maximum peak of pain was obtained between 24 and 48 h of treatment. It was found that patients in the lingual orthodontic group described lower levels of pain at all times analyzed, and their scores in the total OHIP-14 indicated less impact on their oral quality of life (1.3 ± 1.2, p < 0.01) compared with the other groups analyzed. There was little difference with the aligners group (Invisalign) (1.7 ± 1.9, p < 0.01). The technique used influences the pain and quality of life of patients at the start of orthodontic treatment.

Influence of a Lubricating Gel (Orthospeed®) on Pain and Oral Health-Related Quality of Life in Orthodontic Patients during Initial Therapy with Conventional and Low-Friction Brackets: A Prospective Randomized Clinical Trial

The aim of this study was to investigate whether statistically significant differences exist regarding pain and the impact on oral quality of life of orthodontic treatment. A conventional brackets system was compared with low-friction brackets. A total of 90 patients (male = 35, female = 55) were chosen for this randomized clinical trial. Pain was assessed at 4, 8, and 24 hours and 2, 3, 4, 5, 6, and 7 days after the start of treatment using the McGill Pain Questionnaire. Oral health-related quality of life (OHRQoL) was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. Oral quality of life was assessed at one month, with patients with low-friction brackets describing lower levels of pain. The patients with conventional brackets indicated a worse impact on their quality of life compared to the group with low-friction brackets. Statistically significant differences were found between the groups, with maximum pain observed between the first 24 and 48 hours, and the values of minimum pain are reached after 7 days. The pain and impact on oral quality of life was statistically worse in patients with conventional brackets compared to patients with low-friction brackets. The type of bracket system used was therefore shown to influence patients' perceptions of pain and impact on their OHRQoL.

Pain perception of orthodontic treatment - A cross-sectional study

Objectives:

The objectives were to evaluate the intensity of pain perceived 24 hours following insertion of fixed orthodontic appliance components i-e separators, bands and brackets.

Methods:

This cross-sectional study conducted at a Dental College in Karachi (July 2017-March 2018) investigated the amount of pain perceived during different stages of fixed orthodontic treatment. The inclusion criteria were healthy individuals without systemic disease, age 13-26 years, fixed orthodontic treatment candidates having healthy permanent first molars. The exclusion criteria were missing permanent first molars, patients requiring brass wire separators instead of elastomeric separators and molar tubes instead of bands, ongoing or previous periodontal disease and syndromic patients. Pain intensity was assessed in ninety eight patients using a Numeric Rating scale (NRS) at baseline (T0) before insertion, and 24 hours after insertion (T1) of a component. This procedure was repeated six times, twice each for separators, bands and brackets. Scoring was done on the NRS from 0 to 10 where 0 indicated no pain and 10 indicated worst pain possible.

Results:

A significant difference in perceived pain was found between baseline and after 24 hours of placement of all components (P-value 0.000). Odds ratio indicated that males were at a greater risk to feel pain than females at baseline and after 24 hours of insertion of all components. Mann-Whitney U test showed that the most painful components at baseline were bands (Mean value=0.56) and after 24 hours were brackets (Mean value 6.25).

Conclusions:

Significant increase in pain was noted 24 hours after insertion of separators, bands and brackets. The most painful components were bands at baseline and brackets after 24 hours of insertion. There were no significant variations in pain perception based on age. However, males perceived higher pain than females both at baseline and after 24 hours.

Oral health-related quality of life in orthodontics: a cross-sectional multicentre study on patients in orthodontic treatment

Objective

This study aimed to assess oral health-related quality of life (OHRQoL) in relation to associated covariates in orthodontic patients of different age groups (children, adolescents, and adults) in a cross-sectional study.

Methods

A total of 898 subjects (50.6% females, 49.4% males; mean age 16.89 years) undergoing orthodontic treatment anonymously completed the German version of the Oral Health Impact Profile (OHIP-G14) to assess OHRQoL in addition to completing 23 other items. Descriptive, exploratory statistical analysis and multiple linear regression modelling were performed.

Results

The mean score of the OHIP-G14 was 8.3 for the 6- to 11-year olds, 8.9 for the 12- to 17-year olds, and 12.6 for adults. Physical pain (Subscale 2) was the highest factor in all groups. Additionally, a relevant factor was Subscale 3 (psychological discomfort). A linear regression model showed that, in the adolescent group, aesthetics in combination with pain had a significant negative influence on OHRQoL, whereas, in the adult group, function in combination with pain showed the same significant negative influence. Second, except for the children, fixed appliances had a significant negative effect on OHRQoL compared to removable appliances.

Conclusions

Our study showed that the majority of the 6- to 11-year olds and 12- to 17-year olds reported a good OHRQoL. Nevertheless, adolescents and adults who reported aesthetic/pain and function/pain problems, respectively, as reasons for orthodontic treatment showed a significant occurrence for reduced OHRQoL. Fixed appliances, in comparison with removable appliances, also resulted in a significant reduction in OHRQoL for both groups.

Prostanoid-dependent spontaneous pain and PAR2-dependent mechanical allodynia following oral mucosal trauma: involvement of TRPV1, TRPA1 and TRPV4

Abstract

During dental treatments, intraoral appliances frequently induce traumatic ulcers in the oral mucosa. Such mucosal injury-induced mucositis leads to severe pain, resulting in poor quality of life and decreased cooperation in the therapy. To elucidate mucosal pain mechanisms, we developed a new rat model of intraoral wire-induced mucositis and investigated pain mechanisms using our proprietary assay system for conscious rats. A thick metal wire was installed in the rats between the inferior incisors for one day. In the mucosa of the mandibular labial fornix region, which was touched with a free end of the wire, traumatic ulcer and submucosal abscess were induced on day 1. The ulcer was quickly cured until next day and abscess formation was gradually disappeared until five days. Spontaneous nociceptive behavior was induced on day 1 only, and mechanical allodynia persisted over day 3. Antibiotic pretreatment did not affect pain induction. Spontaneous nociceptive behavior was sensitive to indomethacin (cyclooxygenase inhibitor), ONO-8711 (prostanoid receptor EP1 antagonist), SB-366791, and HC-030031 (TRPV1 and TRPA1 antagonists, respectively). Prostaglandin E2 and 15-deoxyΔ12,14-prostaglandin J2 were upregulated only on day 1. In contrast, mechanical allodynia was sensitive to FSLLRY-NH2 (protease-activated receptor PAR2 antagonist) and RN-1734 (TRPV4 antagonist). Neutrophil elastase, which is known as a biased agonist for PAR2, was upregulated on days 1 to 2. These results suggest that prostanoids and PAR2 activation elicit TRPV1- and TRPA1-mediated spontaneous pain and TRPV4-mediated mechanical allodynia, respectively, independently of bacterial infection, following oral mucosal trauma. The pathophysiological pain mechanism suggests effective analgesic approaches for dental patients suffering from mucosal trauma-induced pain.

Study of Associated Factors With Probable Sleep Bruxism Among Adolescents

STUDY OBJECTIVES

To evaluate the prevalence of probable sleep bruxism (SB) and its association with sleep features, orthodontic fixed appliance wearing, and extraoral and intraoral clinical signs and symptoms in a population of adolescents.

METHODS

Two hundred thirty-nine 12-year-old adolescents enrolled in private and public schools in Brumadinho, southeast Brazil, and their parents were invited to participate. They answered a questionnaire containing information regarding adolescents' sleep features and history of SB. Extraoral and intraoral examination was performed to identify some clinical signs (ie, absence of lip competence, presence of mouth breathing, clicks in the temporomandibular joint [TMJ], tooth wear) and symptoms (ie, pain in the masseter muscle upon palpation), and ongoing orthodontic treatment with fixed appliances. Parental report and clinical examination were used to determine probable SB. Descriptive statistics and logistic regression were performed to identify association of probable SB with independent variables.

RESULTS

Of 239 adolescents initially selected, 231 (96.6%) participated in the study. Prevalence of probable SB was 16.9%. Adolescents who snored during sleep (odds ratio [OR] = 3.14; 95% confidence interval [CI] = 1.47-6.70), adolescents who did not have clicks in the TMJ (OR = 3.37; 95% CI = 1.11-10.15), and those who wore orthodontic appliances (OR = 2.72; 95% CI = 1.04-7.14) were more likely to be in the group with probable SB.

CONCLUSIONS

Snoring, absence of clicks in the TMJ, and fixed appliance wearing were associated with probable SB among adolescents. This study adds to the ongoing research on SB in adolescents and its associated factors.

COMMENTARY

A commentary on this article appears in this issue on page 1281.

Cross-cultural adaptation and validation of the Impact of Fixed Appliances Measure questionnaire in Brazil

The aim of this study was to translate and cross-culturally adapt the condition-specific instrument Impact of Fixed Appliances Measure (IFAM), assessing its validity and reliability for use among Brazilian children/adolescents. The IFAM was translated, back-translated, cross-culturally adapted, and pilot-tested. The Brazilian version of the IFAM (B-IFAM) was tested on 161 10-to-18-year-old children/adolescents. Internal consistency was assessed using Cronbach's alpha (α) and test-retest reliability by intraclass correlation coefficients (ICC). Construct validity was conducted using Pearson correlation among the overall and subscales of the B-IFAM. Discriminant validity was evaluated by comparisons of B-IFAM's means and SD with children's/adolescents' sex (Student t-test). Internal consistency was 0.89 for overall score and 0.55-0.86 for subscales. ICC for test-retest reliability was 0.81 for overall score and 0.55-0.78 for subscales. The overall score of the B-IFAM presented large correlation coefficients with most subscales (r = 0.52-0.74), supporting construct validity. Discriminant validity demonstrated statistically significant difference in the overall score, aesthetics, and physical impact subscales among female and male children's/adolescents' (p < 0.05). In the conclusion, the B-IFAM overall score and some subscales demonstrated adequate psychometric properties regarding reliability and validity. The study achieved a specific-condition instrument feasible for use on Brazilian children/adolescents who wear fixed orthodontic appliances.

An evaluation of oral health-related quality of life in orthodontic patients treated with fixed and twin blocks appliances

OBJECTIVE

To study the impact of orthodontic treatment on the quality of life in two patient groups, one treated with the twin block appliance and the other with fixed appliances.

MATERIALS AND METHODS

Ninety-eight patients, aged between 10 and 16 years, were recruited in the fixed (20 males and 29 females) or functional (29 males and 20 females) treatment groups. The oral health-related quality of life (OHRQoL) was measured before treatment and followed up at the end of the treatment. The instrument used to measure OHRQoL was a modified self-administered short version of the English Oral Health Impact profile (OHIP-16[E]) questionnaire.

RESULTS

OHRQoL worsened at the initial stages of the treatment. The overall score of OHRQoL reduced significantly at the end of the treatment in both groups. Both groups showed comparable improvements in OHRQoL as the treatment progressed (analysis of variance test P = 0.05).

CONCLUSIONS

The OHRQoL patterns, during the treatment with fixed and twin block appliances, were very similar. This suggests that the functional appliance's impact on the QoL may be overestimates by clinicians. OHRQoL improved significantly with both fixed and functional appliances by the end of the treatment. The OHRQoL trends observed during the study can be communicated to patients and used to increase patients' compliance since they are made aware of the whole treatment process.

Comparison of oral health-related quality of life of patients treated by palatal expanders with patients treated by fixed orthodontic appliances

INTRODUCTION AND PURPOSE

Wearing orthodontic appliances may negatively affect a patient's oral health-related quality of life (OHRQoL) physiologically, psychologically, and socially. Few studies have assessed the effect of palatal expanders on OHRQoL. The aim of this study was to evaluate the impact of palatal expanders on OHRQoL and to compare it with that of fixed orthodontic appliances.

MATERIALS AND METHODS

All adolescent and adult orthodontic patients who were undergoing treatment with fixed appliances or palatal expanders between July 2015 and January 2016 in King Abdulaziz University Orthodontc Dental Clinics, were recruited (n=399). The OHRQoL of each participant was assessed using the shortened Arabic version of the Oral Health Impact Profile-14 questionnaire. OHRQoL was compared between users of fixed appliances and users of palatal expanders; it was also compared after stratifying the patients by gender. Chi-squared and Fisher's exact tests were used, as indicated.

RESULTS

Palatal expanders had significantly greater negative effects on chewing ability (P≤0.01) and pronunciation (P=0.048). However, fixed orthodontic appliances had significantly greater negative impacts on mouth aching (P=0.003), difficulty in relaxing (P=0.01), irritability (P=0.001), and embarrassment (P≤0.01).

CONCLUSION

Palatal expanders had a significantly greater negative impact on some aspects of OHRQoL when compared with fixed orthodontic appliances in adolescents and young adults.

Can shielded brackets reduce mucosa alteration and increase comfort perception in orthodontic patients in the first 3 days of treatment? A single-blind randomized controlled trial

INTRODUCTION

Orthodontic patients can experience pain and discomfort on the oral mucosa from trauma caused by friction with the brackets and the wires. In this split-mouth design, single-blind randomized controlled trial, we aimed to investigate whether brackets with a self-snapping customized plastic shield would induce less mucosa alteration and discomfort than those without the shield.

METHODS

The overall sample comprised 42 patients (22 female, 20 male) from a government-funded orthodontic practice, with a mean age of 16.7 years. Eligibility criteria included, among others, no history of mouth ulcers or systemic diseases. Customized shields for the maxillary and mandibular brackets were fabricated and inserted on one side of the mouth. The null hypothesis was that bracket shielding would have no advantage. The primary outcomes were mucosal and discomfort assessments. As the secondary outcome, the numbers of spontaneous detachments of the shields were reported. Treatment allocation was mainly implemented using a random number table for selection of the intervention side. Only the raters in charge of assessing the oral mucosa were blinded to the side of the mouth where the shields had been placed. The mucosa was assessed by 3 calibrated raters at the following time points: immediately before bracket placement (baseline assessment, T0), 3 days after delivering the shields (direct assessment of intervention, T1), and 4 days after removal of the shields (indirect assessment of intervention, T2). The raters used a newly devised yardstick in which the higher the score, the more severe the alteration. Discomfort was assessed at T1 and T2 using a visual analog scale. The Mann-Whitney U test was performed at the 5% level of significance.

RESULTS

Of 60 patients, 42 were eligible, and 35 were randomly selected to have one side of the mouth receive the intervention. Two patients discontinued the intervention at T1, and 5 stopped at T2. Seven additional patients were recruited and completed all time points. Thus, 42 patients participated at T0, 40 at T1, and 35 at T2. Thirty-five patients participated at all time points. At T1, no statistically significant difference in terms of mucosa alteration was observed between the 2 sides (median of all differences [MD], 0.0; 95% CI, 0.0-1.0; P = 0.11). The same occurred at T2 (MD, 0.0; 95% CI, 0.0-0.0; P = 1.00). The comfort level was statistically higher at T1 on the shielded side (MD, 14.0; 95% CI, 1.0-36.0; P = 0.04), whereas no difference was observed at T2 (MD, 0.0; 95% CI, 0.0-1.0, P = 0.81). No serious harm was observed.

CONCLUSIONS

The customized bracket shields were effective in reducing discomfort during the first 3 days of orthodontic treatment despite no significant difference in terms of visible mucosa alteration.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

Expenses for the fabrication of the shields were covered by the main author (L.P.B.P.). Orthodontic materials were from the Center for Dental Specialties in Cajazeiras, Brazil.