Effects of the COVID-19 pandemic on orthodontic care in Finland

OBJECTIVES

To investigate the measures that were taken to limit the risk of COVID-19 contagion, how the risk of adverse effects on patient treatment outcomes was mitigated in orthodontic practices in Finland during the COVID-19 pandemic, and how these measures affected the course of orthodontic treatment.

MATERIALS AND METHODS

In January 2021, an online questionnaire was sent by email to the members of the Orthodontic Division of the Finnish Dental Association Apollonia (n = 361). An additional inquiry was sent to the chief dental officers of 15 health centers.

RESULTS

A total of 99 clinically active members (39.8%) responded to the questionnaire. Of them, 97.0% had made changes in their practices, e.g. using additional protective gear such as visors (82.8%), incorporating preoperative mouthwashes (70.7%), and limiting the use of turbines (68.7%) and ultrasonics (47.5%). Two in three respondents reported temporary lockdowns (mean 1.9 months, range 0.3-5.0 months), during which some occlusions slightly regressed (30.2%) and some relapsed to a previous stage of treatment (9.5%). During this study, 59.6% of respondents reported that some treatments were still behind schedule. One in three respondents had used teleorthodontics because of the pandemic.

CONCLUSIONS

Preventive measures and changes in treatment procedures were implemented according to the local COVID-19 situation. Some treatments were prolonged, e.g. because of lockdowns or patient's fear of contracting COVID-19 whilst receiving treatment. New methods like teleorthodontics were introduced for coping with the increased workload.

Craniofacial microsomia - more than a structural malformation

OBJECTIVES

To analyse the prevalence and distribution of craniofacial microsomia (CFM) cases in Finland and their most frequent comorbidities. The second aim was to analyse the patients' need for specialized healthcare services.

MATERIALS AND METHODS

Data were gathered from two complementary registers: The Register of Congenital Malformations and the Care Register for Social Welfare and Health Care (Hilmo) of the Finnish Institute for Health and Welfare (THL).

RESULTS

The prevalence of CFM patients in Finland was 1:10 057. They were evenly distributed across the five university hospital districts. Their most frequently used ICD-10 diagnosis codes were F40-48 (Neurotic, stress-related and somatoform disorders), 60% of patients in adolescent and adult psychiatry; Q67.0 (Facial asymmetry), 43% in plastic surgery; Z00.4 (General psychiatric examination, not elsewhere classified), 31% in child psychiatry; Z31.5 (Genetic counselling), 28% in clinical genetics and Q67.40 (Other congenital deformities of the skull, face and jaw, Hemifacial atrophy), 18% in dental, oral and maxillofacial diseases. Of the patients, 70% had had visits in clinical genetics, 60% in plastic surgery, 41% in dental, oral and maxillofacial diseases, 28% in adolescent/adult psychiatry and 21% in child psychiatry. The majority of the patients' plastic surgery visits were concentrated in one university hospital. Other services were mainly provided by patients' own hospital districts.

CONCLUSIONS

Even though the majority of CFM patients' visits in specialized healthcare services are related to correction of facial asymmetry and ear malformations, the obvious need for psychiatric care was apparent in all age groups.

Adverse effects of orthodontic forces on dental pulp. Appearance and character. A systematic review

OBJECTIVE

To comprehensively assess recent data on the effects of orthodontic forces on the dental pulp and to critically evaluate, whether any of the changes are permanent.

MATERIALS AND METHODS

Articles published between 2/2009 and 2/2022 were searched electronically on the PubMed, EMBASE and SCOPUS databases. The initial search retrieved 780 publications and, applying the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, 33 relevant articles were identified. Twenty articles fulfilled the requirements for high (n = 1) or moderate (n = 19) methodological quality and were included. All assessments were made independently by three researchers.

RESULTS

Orthodontic forces appeared to cause a reduction in pulpal blood flow and a reduction in tooth sensibility, as indicated by increased response thresholds and increased amounts of negative responses to tooth sensibility tests. In addition, there were increases in the expression or activity levels of enzymes and neuropeptides associated with hypoxia and inflammation. Fibrotic tissue formation in the pulp was also reported.

CONCLUSIONS

Except for some histological and morphological alterations, the observed pulpal changes were in most cases only temporary, appearing within days of initiating the treatment and usually lasting for weeks. There were no clear signs of permanent damage.

Does orthognathic treatment improve patients' psychosocial well-being?

OBJECTIVE

To analyse changes in patients' psychosocial well-being from before treatment until post-surgical orthodontic treatment (including retention) is completed.

MATERIALS AND METHODS

Data was collected six times: before treatment (T0), 6-8 weeks after the placement of orthodontic appliances (T2), 3-4 weeks before surgery (T3), six weeks after surgery (T4), one year after surgery (T5) and after completing orthodontic treatment (T6; 20-57 months after surgery). At T0, 60 patients participated while at T6, data was available for 15 patients. All patients completed the Orthognathic Quality of Life Questionnaire (OQLQ), Rosenberg Self-Esteem Questionnaire (RSES), Acceptance and Action Questionnaire II (AAQ-II) and the Symptom Checklist 90 (SCL-90). All pairwise comparisons between variables were conducted with the Wilcoxon signed-rank test.

RESULTS

OQLQ function, RSES, AAQ-II and SCL GSI worsened from T0 to T2. At T5, improvements compared to T0 were found in all aspects of OQLQ and SCL GSI. When comparing results at T6 to T0, improvements where only found in OQLQ sum, OQLQ facial aesthetics and OQLQ function.

CONCLUSIONS

Although well-being of orthognathic patients seems to improve during treatment, many improvements cannot be verified anymore at the completion of the retention period. Most stable changes are found in the oral function component and in the facial aesthetics component of the OQLQ.

Longitudinal analysis of the quality of orthodontic treatment outcome and stability of occlusal traits

OBJECTIVES

To assess the quality and stability of orthodontic treatment outcome relative to the initial malocclusion.

MATERIAL AND METHODS

The study was performed in one public health care clinic in Finland. Study subjects comprised 51 orthodontic patients (age range 12.7-18.7 years). Pre-treatment medical records and lateral skull radiographs were analysed for malocclusion type. The main reasons for orthodontic treatment were mandibular retrognathia, Class II distal bite, deep bite and crowding. At the end of a retention phase (Examination 1), the quality of treatment outcome was assessed using the occlusal morphology and function index (OMFI) and patients were asked about treatment satisfaction. Stability of occlusal traits and patient satisfaction were re-evaluated after a two-year follow-up (Examination 2). Occlusal characteristics descriptive statistics were performed.

RESULTS

At Examination 1, all six morphological criteria for acceptability were fulfilled by 76% and all functional criteria by 82% of the patients. All OMFI criteria were met by 67% of the patients. At Examination 2, 68% of the patients fulfilled all morphological and 82% all functional criteria of acceptability. At Examination 2, all the OMFI criteria were still met by 64% of the patients and 92% expressed satisfaction with own occlusion. The main reasons for unacceptability were deficiencies in canine relationship and overbite, in addition to functional protrusion interferences.

CONCLUSIONS

In the evaluated health care clinic, patient satisfaction and the quality of treatment outcome were high. However, deep bite showed a tendency for relapse.

Quality of life several years after orthodontic-surgical treatment with bilateral sagittal split osteotomy

Objective: To analyse oral health related quality of life (OHRQoL) several years after orthognathic treatment in patients who had Class II malocclusion with retrognathic mandible.Material and methods: The initial study cohort comprised 151 patients with orthognathic treatment in 2007-2011. Of them, 77 patients (Group 1, mean age 41 years, range 19-71 years, 71% women) were clinically examined 6 years (range 4-8 years) after bilateral sagittal split osteotomy (BSSO). Group 2 included 24 former patients (mean 48 years, range 25-79 years, 50% women) who were willing to participate in a structured telephone interview. Group 3 consisted of 22 prospective patients (mean 35 years, range 18-56 years, 86% women) with a recent orthognathic treatment plan and awaiting treatment. QoL was assessed using two questionnaires, OHIP-14 and OQLQ.Results: Based on responses, patients who had received orthognathic treatment (Groups 1 and 2) had better QoL than those awaiting treatment (Group 3).Conclusion: Conventional orthognathic treatment, including mandibular advancement with BSSO, seems to have a positive long-term effect on patients' QoL. More long-term follow-up studies are needed to assess the real impact of treatment on patients' lives in the long run.

Malocclusions in primary and early mixed dentition in very preterm children

Objective: To compare the prevalence of malocclusions in the primary and early mixed dentition of very preterm and full-term children.Material and methods: Study subjects consisted of 205 very preterm (90 girls and 115 boys), and 205 age- and gender-matched full-term children. Data were collected from the register of Turku University Hospital (children born before the 37th week of pregnancy with a birth weight of less than 1500 g, and all infants born before the 32nd week of pregnancy) and from public health centre dental registers.Results: In primary dentition, case children had a higher odds of dental crowding (OR = 2.94, 95% CI 1.17-7.35, p = .021), a tendency toward increased overbite (OR = 1.55, 95% CI 0.93-2.59, p = .096), and a lower odds of increased overjet (OR = 0.19, 95% CI 0.07-0.57, p = .003) compared to control children. In early mixed dentition, there were no statistically significant differences in occlusal traits; however, case children were significantly more likely to have received orthodontic treatment (OR = 2.80, 95% CI 1.50-5.23, p = .001) compared to controls.Conclusions: The results indicate that in primary dentition, the prevalence of malocclusion varies between very preterm and full-term children. In early mixed dentition, the distribution of occlusal traits is more similar.

Association between quality of life and severity of profile deviation in prospective orthognathic patients

Aim

to evaluate whether severity of skeletal facial profile deviation assessed by professionals associates with quality of life and psychosocial factors in patients with dentofacial deformities and prospective orthognathic treatment.

Materials and method

The study consisted of 55 patients admitted to orthognathic treatment. Skeletal profile was assessed from lateral head films using cephalometric analysis. The following angles were used to assess the sagittal position of upper and lower jaw and profile: Sella-Nasion-A-point-angle, Sella-Nasion-B-point-angle, and A-point-Nasion-B-point-angle (ANB). For vertical assessment, gonial angle and the angle between Sella-Nasion and mandibular plane were used. Merrifield’s Z-angle was used to assess soft-tissue profile. Severity of skeletal facial profile deviation was assessed with deviation in ANB angle. Orthognathic quality of life (OQoL) and psychosocial factors were defined with four questionnaires: Orthognathic Quality of Life Questionnaire, Symptom Checklist-90, Rosenberg Self-Esteem Scale, and a body image questionnaire.

Results

Increase in ANB deviation was associated with increased awareness of dentofacial deformity [Orthognathic Quality of Life Questionnaire subscale awareness of dentofacial deformity (OQLQ-AoDD), r = 0.319, P = 0.017). OQOL-AoDD was not found to be equal when ANB angle was divided into three different categories (χ 2 = 6.78, P = 0.034): G1. ANB = 0–4 degrees; G2. ANB <0 degrees; and G3. ANB >4 degrees. Furthermore, categories G1 and G2 differed significantly (U = 50.5, P = 0.017). Increase in ANB angle was also associated with a more positive body image (r = 0.342, P = .023). There were no significant correlations between other cephalometric variables, quality of life, and psychosocial factors.

Conclusion

Skeletal facial profile seems to associate with some aspects of orthognathic quality of life. Professional cephalometric analysis of the severity of facial profile deviation correlates with patients’ awareness of their own facial and dental appearance. Patients with more deviating skeletal profile are more aware of their dentofacial deformities compared to patients with normal values.

Occlusal traits, orthodontic treatment need and treatment complexity among untreated 17-21-year-olds in Estonia

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17-21-year-old Estonians.Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17-21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants' opinions regarding their teeth were determined with a questionnaire.Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5 mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5 mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants' main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants' desire for orthodontic treatment.

Symptoms in the masticatory system and related quality of life in prospective orthognathic patients

OBJECTIVE

The aim of this study was to investigate the relation between orthognathic patients' self-reported symptoms in the head and neck region and their quality of life (QoL).

MATERIAL AND METHODS

Participants included were consecutive patients (n = 50) referred to the assessment of orthognathic treatment need and voluntary first-year university students (n = 29). All participants filled in the Orthognathic Quality of Life Questionnaire (OQLQ) and a structured diary created by the authors. The median values of Orthognathic Quality of Life (OQOL) sum and subscores, satisfaction with oral function and number of awakenings were compared between patients and controls. Further, correlations between the OQOL sum and subscores, satisfaction with oral function and number of awakenings were analyzed.

RESULTS

Patients reported significantly more symptoms (p = .013) and woke up significantly more often than the controls (p = .032). Their OQOL sum scores were significantly higher (indicating a lower OQOL) (p = .001), and they were significantly less satisfied with their oral function than the controls (p < .001). Among the awakened and not-rested patients, the most commonly reported symptoms were pain in the head and/or neck region and fatigue and/or stiffness in the jaws.

CONCLUSIONS

Experiences of pain and discomfort have a significant impact on patients' OQOL and well-being.

Occlusal traits and orthodontic treatment need in 7- to 10-year-olds in Estonia

The aim of this study was to evaluate the distribution of occlusal traits and orthodontic treatment need and complexity in Estonian 7- to 10-year-old children. This data provides solid information for planning of orthodontic care. Data of 392 Estonian children (198 girls and 194 boys, mean age 9.0 years, range 7.1-10.4 years) was analysed in this cross-sectional study. Assessed traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Orthodontic treatment need and complexity were assessed using the Index of Complexity, Outcome, and Need. Parents' opinion regarding their child's teeth was determined using a questionnaire. The most prevalent occlusal traits were canine class I sagittal relationship (73.7%), midline diastema (73.0%), molar class I sagittal relationship (57.4%), and overbite ≥3.5 mm (51.8%). According to the Index of Complexity, Outcome, and Need, 64.3% of Estonian elementary school children were in need of orthodontic treatment. Treatment complexity was simple in 12.5%, mild in 38.8%, moderate in 22.7%, difficult in 14.0%, and very difficult in 12.0% of the children. Approximately 66.4% of the parents felt that their child needed orthodontic treatment. This study confirms earlier findings indicating that the most frequent sagittal relationship is class I in the first molars and class I in the canines. However, the sagittal relationship was asymmetric in more than half of the children. Correlation between objectively defined treatment need and parents' desire for treatment was high in Estonia.

Self-reported temporomandibular disorder symptoms and severity of malocclusion in prospective orthognathic-surgical patients

OBJECTIVE

The objective of this study is to analyze the association between self-reported symptoms of temporomandibular joint disorder (TMD) and the severity of malocclusion in prospective orthognathic-surgical patients.

MATERIAL AND METHODS

The subjects consisted of 50 consecutive patients (13 males and 37 females) referred to two university clinics for assessment of orthodontic-surgical treatment need. Data considering self-reported TMD symptoms were gathered using a semi-structured diary. At the first appointment, all patients rated the importance of treatment (on a scale of 1-10) and assessed self-perceived dental appearance using a VAS scale. The scale was anchored with photographs 1 and 10 from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Study models were assessed by an experienced orthodontic specialist using the Peer Assessment Rating (PAR) index and the Index of Complexity, Outcome and Need (ICON). Association between the PAR and ICON scores and the number of reported symptoms was analyzed statistically.

RESULTS

Seventy-one percent of patients reported experiencing TMD symptoms. The most prevalent symptoms were pain in the head and/or neck region and fatigue in the TMJ region. The number of symptoms was highest in the morning. Ninety percent of males and 86% of females rated the importance of treatment as high; males experiencing TMD symptoms tended to rate surgery as more important compared with males with no symptoms (p = 0.056).

CONCLUSIONS

In this sample, the results cannot unambiguously confirm an association between self-reported symptoms of TMD and objectively defined severity of malocclusion.

Inhalation or ingestion of orthodontic objects in Finland

OBJECTIVES

Although inhalation or ingestion of orthodontic appliances can lead to serious medical problems, the real incidence of these complications is anecdotal. This study had two aims: (1) to define the frequency of accidental inhalation/ingestion of orthodontic objects in Finland and (2) to analyze their further management.

MATERIALS AND METHODS

An electronic, semi-structured questionnaire was sent to all members of the Orthodontic Section of Apollonia, the Finnish Dental Society (n=251) and the Finnish Federation of Dental Hygienists (n=437). After one reminder, 55.8% of dentists and 34.8% of dental hygienists responded.

RESULTS

In total, 20.0% of the dentists and 6.9% of the dental hygienists reported having one patient who had ingested or inhaled an orthodontic object. The percentages for two or more cases were 18.6% and 6.9%, respectively. According to dentists' answers, the procedures following these complications were (1) observation for 2-14 days (n=27), (2) radiologic evaluation (n=14), (3) medical emergency (n=6) and (4) dietary instruction (n=4). Dental hygienists reported (1) observation (n=9), (2) dietary instruction (n=3) and (3) medical emergency (n=1). None of the cases had been life-threatening.

CONCLUSIONS

Although the risk of inhalation or ingestion of orthodontic objects is small and the consequences rarely serious, it should be taken into consideration. Prospective patients should be informed of this possibility.

An analysis of residual orthodontic treatment need in municipal health centres

OBJECTIVE

The aim of this study was to analyse residual orthodontic treatment need in Finnish municipal health centres.

SUBJECTS AND METHODS

A random sample of two age groups, 16- and 18-year-olds (n = 2212), from seven municipalities was invited for a clinical examination, and 1041 adolescents participated. Two calibrated orthodontists blindly examined the participants for residual treatment need, applying the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Self-perceived treatment need, satisfaction with occlusal function, and dental appearance were evaluated with a questionnaire. Differences between objective and self-perceived treatment need and between treated and untreated adolescents were analysed using the chi-square test.

RESULTS

A total of 18.8 per cent of all adolescents had DHC grade 4 or 5 and/or AC category 8-10, indicating a definite need for treatment. In the analysis between treated and untreated adolescents, orthodontic treatment history or gender had no statistically significant association with the objectively defined need (P > 0.05). Self-perceived treatment need was reported by 9.6 per cent of adolescents. This need was more common among treated (13.9 per cent) than untreated (4.6 per cent) adolescents (P < 0.001). Among all adolescents, satisfaction with occlusal function was high, 91.3 per cent; 78.9 per cent of adolescents were satisfied with their dental appearance. The main reasons for dissatisfaction and self-perceived need were visible contact point displacements.

CONCLUSIONS

The observed proportion of residual orthodontic treatment need is in line with earlier findings. The high satisfaction with occlusal function reflects the applied selection criteria; orthodontic treatment of displacements causing only aesthetic concern is not prioritized.

Psychosocial well-being of prospective orthognathic-surgical patients

OBJECTIVE

To compare the psychosocial well-being of prospective orthognathic-surgical patients and controls.

MATERIALS AND METHODS

Sixty patients referred for assessment of orthognathic-surgical treatment need and 29 controls participated. All participants filled in the modified version of Secord and Jourard's Body Image Questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem scale, the Acceptance and Action Questionnaire II and a structured diary developed by the authors. Patients also filled in the Symptom Checklist 90. Patients assessed their dental appearance on a visual analogue scale modified from the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Professional assessment was made from study models with the AC.

RESULTS

Patients rating their dental appearance as AC grades 5-10 suffered from lower orthognathic quality-of-life and poorer body image than the controls, while those with AC grades of 1-4 only had poorer oral function. Self-perceived dental appearance was more important to orthognathic quality-of-life and body image than an orthodontist's assessment. Patients and controls had equal psychological flexibility and self-esteem. In all, 23-57% of patients had significant psychiatric symptoms, which explained the adverse emotions patients felt during the day. Fifteen per cent of the patients had been bullied.

CONCLUSIONS

Many orthognathic-surgical patients cope well with their dentofacial deformities, despite functional masticatory problems. It seems that a subjective view of dental appearance may be a key factor in finding patients with psychosocial problems. It should be a major issue when considering psychosocial support and other treatment options.

The objective and subjective outcome of orthodontic care in one municipal health center

OBJECTIVE

The aim of this study was to assess the outcome of orthodontic care in one municipal health center.

MATERIALS AND METHODS

The material consisted of one age-cohort of 15-16 year-old adolescents (n = 67). Of them, 97% participated in a clinical examination. The final group included in the study consisted of 61 adolescents (91% of the whole age cohort). The occlusions were evaluated applying the Occlusal Morphology and Function Index (OMFI), the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Moreover, all adolescents filled in a semi-structured questionnaire enquiring about their satisfaction with the function and appearance of their own dentition and self-perceived orthodontic treatment need. They also scored their own dental appearance on a Visual Analog Scale (VAS).

RESULTS

Of the adolescents, 42% had received orthodontic treatment, while 58% were untreated. All morphological criteria of the OMFI were met by 58% of orthodontically treated and 49% of untreated adolescents and all functional criteria by 67% and 57%, respectively. Treatment need was registered in two of the treated adolescents (7%) and five of the untreated adolescents (14%). Treated adolescents were more often satisfied with their dental appearance than untreated adolescents (p = 0.034). In both groups, satisfaction with the function was high (93%).

CONCLUSIONS

Orthodontic treatment seems to improve both occlusal morphology and function. The high satisfaction with one's own dental appearance among the treated adolescents is worth noting.

Patients' perceptions of orthognathic treatment, well-being, and psychological or psychiatric status: a systematic review

OBJECTIVE

To conduct a systematic review of studies concerning the psychosocial well-being of surgical-orthodontic patients.

MATERIAL AND METHODS

Articles published between 2001 and 2009 were searched using PubMed, Web of Science, and PsycInfo. Only articles written in English were included. Articles on methodological issues or on patients with clefts or syndromes or studies in which treatment had included surgically assisted maxillary expansion or intermaxillary fixation were excluded. The exclusion of articles was carried out in collaboration with two reviewers. To find new relevant articles, references from all the obtained review articles were hand-searched. Thirty-five articles fulfilled the selection criteria and were included in this review.

RESULTS

The main motives for seeking treatment were improvements in self-confidence, appearance, and oral function. Patients were not found to suffer from psychiatric problems. Treatment resulted in self-reported improvements in well-being, even though these improvements were not found with current assessment methods. Changes in well-being were most often registered using measures designed for evaluation of the impact of oral health on quality of life (e.g. the Orthognathic Quality of Life Questionnaire and the Oral Health Impact Profile).

CONCLUSIONS

Surgical-orthodontic patients do not experience psychiatric problems related to their dentofacial disharmony in general. However, subgroups of patients may still experience problems, such as anxiety or depression, as many studies only report patients' mean problem scores and compare them to controls' scores or population norms. New assessment methods focusing on day-to-day changes in mood and well-being, as well as prospective studies with controls, are needed.

Acceptability of adolescents' occlusion in Finnish municipal health centres with differing timing of orthodontic treatment

The objective of the study was to compare the acceptability of occlusion among orthodontically treated and untreated adolescents in eight Finnish municipal health centres applying different timing of treatment. A random sample of 16- and 18-year olds (n = 2325) living in these municipalities was invited for a clinical examination, and 1109 adolescents participated. Two calibrated orthodontists blindly examined the participants for the acceptability of occlusion with the Occlusal Morphology and Function Index. The history of orthodontic treatment was elicited by questionnaire. The impact of the history and timing of treatment on the acceptability of occlusion was analysed with logistic regression analysis. The history of orthodontic treatment decreased the odds for acceptability of morphology [odds ratio (OR) = 0.719, 95 per cent confidence limit (CL), P = 0.016] and acceptability of function (OR = 0.724, 95 per cent CL, P = 0.018). The early timing of treatment increased the odds for acceptability of morphology (OR = 1.370, 95 per cent CL, P = 0.042) and of function (OR = 1.420, 95 per cent CL, P = 0.023). No substantial differences were observed in the acceptability of occlusion between the early and late timing health centres. However, the proportion of subjects with acceptable occlusion was slightly higher in the early than in the late timing group. These findings suggest that when examining the effect of timing on treatment outcome, factors other than acceptability of occlusion should be concomitantly evaluated. Consequently, in this context, the duration and cost of treatment need to be investigated.

Acceptability of dental appearance in a group of Finnish 16- to 25-year-olds

OBJECTIVE

To define a grade in the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) that would differentiate between esthetically acceptable and unacceptable occlusions and that would also be both subjectively and objectively meaningful.

MATERIALS AND METHODS

Dental appearance and self-perceived orthodontic treatment need were analyzed in a group of Finnish young adults (171 males, 263 females, age range 16-25 years). Subjective data were gathered using a questionnaire, and the respondents were requested to score their dental appearance on a visual analog type 10-grade scale. Professional assessment of dental appearance was performed by two orthodontists using the AC of the IOTN. The cutoff value between esthetically acceptable and unacceptable occlusions was defined using receiver operating characteristic curves.

RESULTS

Sixty-six percent of orthodontically treated and 74% of the untreated respondents were satisfied with their own dental appearance. Every third respondent reported one or more disturbing traits in their dentition. The most frequently expressed reason for dissatisfaction was crowding; girls expressed dissatisfaction more often than boys did (P = .005). A self-perceived treatment need was reported infrequently by 8% of orthodontically treated and 6% of untreated respondents. In the logistic regression analysis, self-perceived need for orthodontic treatment was the only significant factor explaining dissatisfaction with own dental esthetics. On the applied scales, grades 1 and 2 fulfilled the criteria for satisfactory dental esthetics.

CONCLUSION

The results suggest that the AC grade 3 could serve as a cutoff value between esthetically acceptable and unacceptable occlusions.

Occlusal status in orthodontically treated and untreated adolescents

In order to evaluate the outcome of orthodontic care, all available 16-year-old adolescents (n = 138) living within the catchment area of one Finnish health center were invited for a clinical examination. A total of 126 adolescents participated, corresponding to 79% of the whole age cohort. Of these, 47% had been treated orthodontically, 2% were still wearing appliances, and 51% were untreated. In 80% of cases, a non-extraction treatment was carried out. All occlusions were evaluated using a recently developed occlusal morphology and functional index (OMFI) based on assessment of 6 morphological and 4 functional traits which are classified applying an acceptable-non-acceptable dichotomy. The occlusal status in untreated individuals was used as a second reference in comparisons between the treated and untreated occlusions. The morphological criteria for an acceptable occlusion were met by 42% of the participants and the functional criteria by 64%. Although the treated occlusions failed to meet the criteria of morphological acceptability more often than the untreated ones (73% vs 40%), the proportions of non-acceptable occlusions were fairly high among untreated occlusions. The main reasons for non-acceptability were the failure of the canine relationship, overbite, and protrusion movement to fulfill the criteria of acceptability. Only 19% of the adolescents had occlusions classified as acceptable, both morphologically and functionally. In the evaluated health center, the allocation of resources resulted in a high coverage of orthodontic care. However, our results indicate that the general occlusal status in the examined age cohort did not reach an optimal level.

Selection of criteria for assessment of occlusal acceptability

There is no general agreement on criteria that could be applied to distinguish between orthodontically acceptable and non-acceptable occlusions after the completion of dental development. The aim of the present study was to analyse morphological and functional features that could be used as an index to define an acceptable occlusion in young adults. Three expert panels representing specialists in orthodontics and stomatognathic physiology participated in a modified Delphi method. Each panel responded to a questionnaire concerning the usefulness of various occlusal features, and a set of characteristics was selected on the basis of the responses; thereafter, applicability of the chosen characteristics and their cut-offs for an acceptable non-acceptable dichotomy was tested clinically. To obtain a consensus level of 100%, the last panel session was completed with a group discussion. Assessments made using the morphological criteria were compared with those made with the dental health component of the Index of Orthodontic Treatment Need. The selected morphological characteristics consisted of overjet, overbite, canine relationship, crossbite, scissors bite and midline deviation. The functional evaluation comprised assessments of discrepancy between the centric relation and the intercuspal position, working- and non-working-side contacts and protrusion contacts. The dental health component and our morphological criteria showed different sensitivity to contact point displacements, interdigitation in buccal segments and increased overbite. This study provides a set of morphological and functional indicators reflecting the current consensus opinion of Finnish professionals. Further studies are needed to analyse the reproducibility of assessment of the characteristics included.

Morphological, functional and aesthetic criteria of acceptable mature occlusion

At present, there are no generally accepted criteria that could easily be applied to the evaluation of occlusal acceptability in clinical examinations at population level. The present study analyses the opinions of Finnish orthodontists and general practitioners on the characteristics required for acceptable occlusion in the full permanent dentition. A questionnaire was sent to all 37 health centres where at least one orthodontist was employed, 31 regionally comparable health centres without an orthodontist, 12 private orthodontists, and 13 orthodontists working at university dental clinics. Seventy-four orthodontists returned the questionnaire giving a response rate of 80 per cent. They were asked to give their views on the importance of morphology, function, long-term stability, and dental appearance as elements of acceptable occlusion. They were also encouraged to indicate other significant characteristics and requested to assess the relative significance of these features. In general, the respondents expressed the need to assess morphological, functional and aesthetic aspects of occlusion as a whole. Good function, rather than morphology, was considered to be the most important feature of an acceptable occlusion, with a relative significance of 40 per cent (range 20-90 per cent). According to the respondents, the acceptability of occlusion is determined not only by morphological features, but also by the functional status and long-term stability, as well as by the patient's opinion of the dental appearance.

Outlining the morphological characteristics of acceptable occlusion

OBJECTIVES

The aim of this study was to outline the definitions of a morphologically acceptable occlusion in young adults that could be applied to assess the outcome and effectiveness of orthodontic treatment. The opinions of Finnish orthodontists and general practitioners were investigated for this purpose.

METHODS

A semi-structured questionnaire was sent to all health centres where at least one orthodontist was employed (n=37), to health centres without any orthodontist (n=31), to private orthodontists working as consultants (n=12) and to orthodontists working at university dental clinics (n = 13). The criteria for moderate and little orthodontic treatment need in the Need of Orthodontic Treatment Index (NOTI) and the Index of Orthodontic Treatment Need (IOTN) were chosen to describe the basic characteristics of occlusal acceptability.

RESULTS

The questionnaire was returned by 76 subjects (82%). The respondents' views on an acceptable occlusion in young adults were not totally in line with the chosen definitions. Only 16% of the respondents accepted the definitions of both indices as such; the criteria in NOTI were accepted by 25% and those in IOTN by 21% of the respondents. Functional considerations of the occlusion were the main reasons for the desire for further details in the description of an acceptable occlusion. Crossbites with a discrepancy between retruded contact position and intercuspal position were the least accepted anomalies. The opinions were statistically significantly associated with the level of the respondents' orthodontic education and their type of employment.

CONCLUSIONS

We conclude that the selected definitions of NOTI and IOTN can serve as a basis for the characteristics of a morphologically acceptable occlusion in young Finnish adults, but measures of the functional aspects of occlusion must be added for studies on the outcome of orthodontic services.