Long-term profile attractiveness of patients with Class I and II malocclusion treated with and without extractions: A 35-year follow-up

INTRODUCTION

The objective of this study was to compare the profile attractiveness in subjects treated with and without extractions after the long-term 35-year follow-up, according to laypeople, dentists, and orthodontists.

METHODS

A total of 40 patients with Class I and II malocclusion were divided into 2 groups, according to the treatment protocol: extraction (E) group, extractions of 4 premolars (n = 24), with mean pretreatment (T1), posttreatment (T2), and long-term posttreatment (T3) ages of 13.13, 15.50 and 49.56 years, respectively. The mean treatment time (T2 - T1) was 2.37 years, and the long-term follow-up (T3 - T2) was 34.19. Nonextraction (NE) group (n = 16), with mean ages at T1, T2, and T3 of 13.21, 15.07, and 50.32 years, respectively. The mean (T2 - T1) was 1.86 years, and the (T3 - T2) was 35.25 years. Lateral cephalograms were used to perform profile facial silhouettes, and an online evaluation was performed by 72 laypeople, 63 dentists, and 65 orthodontists, rating the attractiveness from 1 (least attractive) to 10 (most attractive). The intragroup comparison was performed with the repeated measures analysis of variance and Tukey tests. Intergroup comparison was performed with t tests, 1-way analysis of variance, and Tukey tests.

RESULTS

The E group had a longer treatment time than that of the NE group. In the pretreatment, posttreatment, and long-term posttreatment stages, the E and NE groups showed similar profile attractiveness. Laypersons and dentists were more critical than orthodontists.

CONCLUSIONS

At long-term posttreatment follow-up, profile attractiveness was similar in patients treated with and without extractions.

Oral Health-Related Quality of Life among Adolescents in the First 6 Months of Fixed Orthodontic Therapy

Clarification on disabilities that may arise during orthodontic treatment allows patients to have more realistic expectations. This prospective study assessed the impact of fixed orthodontic therapy on adolescents' quality of life over 6 months. A total of 78 adolescents aged 11-17 years were included. Quality of life was measured using the Child Perceptions Questionnaire (CPQ11-14, short form) at five moments: before treatment (T0), one week (T1), one month (T2), three months (T3), and six months (T4) after treatment initiation. Multiple and pairwise comparisons were conducted for CPQ11-14 scores (Friedman and Wilcoxon test; effect size). Changes in the quality of life were assessed as mean differences (T0-T1 and T0-T4) in total and domain scores (Kruskal-Wallis and Mann-Whitney test) (α = 5%). Significant differences were observed between T0 and T4 in the oral symptoms' domain (p < 0.001), and between T0 and T1, T2, T3, and T4 for emotional well-being (p < 0.001 for all). Significant differences in impact were also found between T0 and T2, T3, and T4 with regard to social well-being (p = 0.004, =0.049, and <0.001, respectively). Orthodontic therapy positively impacted the emotional and social aspects of adolescents' quality of life. Negative effects were primarily related to pain, mouth sores, and difficulty biting or chewing. Understanding the symptoms and feelings of orthodontic patients aids professionals in decision-making.

Difference and relation between adolescents' and their parents or caregivers' reported oral health-related quality of life related to orthodontic treatment: a prospective cohort study

BACKGROUND

Parents/caregivers play an important role in deciding whether their children will undergo orthodontic treatment or not. Their perceptions also have an influence on other choices involving orthodontic treatment. The purpose of this study was to investigate the difference and correlation between the ratings given by children and their parents or caregivers on their oral health-related quality of life (OHRQoL) before, during and after orthodontic treatment.

METHODS

In this ongoing observational prospective cohort study, 498 children aged 11 to 16 years-old and one of their parents/caregivers completed questionnaires before (T0), 1 year after start (T1) and 1 month after the end of orthodontic treatment (T2). OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14) and the Parental-Caregiver Perception questionnaire (P-CPQ). The self-perception of oral aesthetics was evaluated with the Oral Aesthetic Subjective Impact Scale (OASIS) in addition to the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). Spearman correlations, Mann-Whitney U-tests and linear models were used to analyze the longitudinal data.

RESULTS

At T0, the ratings of parents/caregivers were significantly lower for the total CPQ as well as for the subdomains of oral symptoms, functional limitations and emotional well-being. Parents/caregivers also scored significantly lower at T2 for the total CPQ and the subdomain of oral symptoms. The relations between the scores of children and their parents/caregivers were significant at all three time points, as were the changes in scores, but all of them were at most moderate in size. Parents/caregivers scored significantly lower for OASIS than their children at all time points and only at baseline a significant, weak correlation was found.

CONCLUSION

The reports of parents/caregivers should be seen as important complementary information in OHRQoL research.

TRIAL REGISTRATION

This study was approved by the Medical Ethical Commitee of the University Hospitals Leuven and the Katholieke Universiteit Leuven (ML5739), Leuven, Belgium, on the 12th of May of 2009, with the registration number S51642. All procedures performed are in accordance with the ethical standards of the institutional and/or national research committees and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

A New Approach to Maxillary Protrusion with an Unstable Mandibular Position Accompanied with Unidentified Complaints: Case Report

This case report describes the importance of combining morphological and functional examination with psychological examination in the establishment ofstable mandibular position in the treatment of maxillary protrusion with unstable mandibular position accompanied by unidentified complaints, which ensures safe orthodontic treatment.

Assessment of the Attitude and Knowledge of the Principles and Practices of Orthodontic Treatment Among the Non-orthodontic Specialists and General Practitioner Dentists

Introduction

General practitioner dentists and non-orthodontic specialties ought to have the knowledge of the basic principles and practices of orthodontics in order to educate the patients, diagnose their problems correctly and for proper referral. The objective of the present study is to assess the attitude and knowledge of the general practitioner dentists and non-orthodontic specialists towards the basic principles and practices of orthodontics.

Methods

This study was performed by presenting a closed questionnaire to a total of 78 participants out of which 46 were general practitioners and 32 were non-orthodontic specialists. A questionnaire consisting of a total of 21 questions was distributed and each question was allocated 0.5 marks for correct response whereas no deduction for wrong answer.

Results

In this present study, the total mean score of the evaluation of the questionnaire came out for general practitioner dentist and the non-orthodontic dental specialists was 13.92 and 16.69 respectively. The present study showed a statistically highly significant knowledge and attitude difference between Group A and Group B ( P<0.001).

Conclusions

This study shows a need for a increased clinically oriented education in the undergraduate courses and a multi-disciplinary inter department seminar presentations and forums set up for the post graduation courses for them to understand the scope of each other's specialties.

Experiences Of Individuals Concerning Combined Orthodontic and Orthognathic Surgical Treatment: A Qualitative Twitter Analysis

OBJECTIVE

The aim of this qualitative study was to analyze the content of posts on Twitter in order to gain an in-depth understanding of patients' thoughts and experiences surrounding orthognathic surgical treatment.

MATERIALS AND METHODS

Using the Twitter search function, with the keywords "jaw surgery," the 1,000 most recent posts on Twitter with relevance to a combined orthodontic and orthognathic surgical treatment were extracted. After applying relevant inclusion and exclusion criteria, the selected posts were analyzed using thematic analysis by 2 independent investigators. Distinct themes and subthemes were developed.

RESULTS

A total of 689 posts were analyzed; the 3 main themes identified in relation to orthognathic surgery were preoperative engagement, postoperative difficulties, and posttreatment satisfaction. Twelve subthemes were also identified, expressing issues such as anticipation or apprehension of the surgical procedure, postoperative pain and edema, dietary restrictions and weight loss, paresthesia, depression, and satisfaction with improvements in appearance and self-confidence. The 6 terms most frequently used in tweets were "recovery," "braces," "swollen," "eat," "liquid diet," and "pain."

CONCLUSIONS

The findings from the present study can increase the awareness of clinicians involved in the combined orthodontic and orthognathic surgical treatment of patients with dentofacial deformities, allowing them to better educate and counsel their patients throughout the entire treatment process.

Esthetic perception of changes in facial profile resulting from orthodontic treatment with extraction of premolars: A systematic review

BACKGROUND

The authors conducted a systematic review to assess changes in patients' facial profiles resulting from orthodontic treatment with and without extraction of 4 premolars and to identify cephalometric parameters that can assist decision making in borderline cases.

TYPES OF STUDIES REVIEWED

The authors conducted a systematic review of randomized clinical trials and observational studies comparing the 2 types of treatment (with and without premolar extraction) in terms of the changes in facial profile. The authors conducted an electronic search of the databases the Cochrane Library, PubMed MEDLINE, Embase, and Latin-American and Caribbean Health Sciences Literature.

RESULTS

The authors identified 1 clinical trial with 26 participants and 5 observational cohort studies, collectively involving 362 participants. The authors assessed cephalometric parameters and esthetic outcomes. Four studies used linear regression analysis to investigate esthetic interaction between treatment strategy and initial lower lip protrusion. The 4 studies determined that if the initial lip protrusion was beyond a determined point, esthetic preferences favored extraction, and if the initial lip protrusion was not to that point, esthetic preferences favored conservative treatment.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

The results of the authors' systematic review found no significant differences between the groups in terms of the esthetic outcomes. The cephalometric parameter of initial lip protrusion can help with decision making in borderline cases.

Dental aesthetics perception and eating behavior in adolescence

BACKGROUND

This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment.

METHODS

Sixty-one adolescents, aged between 12 and 22 years (mean=15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire.

RESULTS

Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student's t-test and using Pearson's correlation analysis.

CONCLUSION

Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

[How to evaluate psychological risks: an ethics of aesthetic demand in orthodontics]

Evaluating risks is part of the day-to-day practice of all orthodontists. Most of the time we forget that healing a patient also requires an evaluation of what is called the psychological risk. Indeed, focusing on harmonisation matters, we tend to omit that patient's requests, especially aesthetic requests, may conceal psychological problems. Such a risk is even higher when it comes to orthodontic-surgical protocols, as the physical changes are more radical. We will discuss the specificities of aesthetical demand, its links with the social discourse and the way self-esteem and reflection in the mirror are closely intermingled. Should we forget to take into account the psychological dimension of any patient, this could be a breach of professional ethics. We will furthermore consider the means we have to recognize patients with a high psychological risk. It is not in our hands to help these patients psychologically. It is in the hands of a mental health specialist, whose adress and phone number we should know in order to refer our patients to him/her.

Evaluation of health related quality of life changes after initial orthodontic treatment

PURPOSE

To evaluate the changes of Oral Health Related Quality of Life (OHRQoL) in patients after the placement of a fixed orthodontic appliance.

MATERIALS AND METHODS

This prospective study consisted of 148 adolescents (97 girls and 51 boys) between the ages of 14 and 17 who were patients of an orthodontic clinic. OHRQoL was assessed by a modified questionnaire that evaluated four domains: oral symptoms, functional limitations as well as emotional and social well-being in three time frames: before bonding and banding (T(0)), two months after initiating orthodontic treatment (T(1)) and six months after initiating orthodontic treatment (T(2)). The repeated measures test was used to compare the relative changes of OHRQoL among the different time frames.

RESULTS

There were no significant differences between the levels of OHRQoL and its domains for boys or girls at any time point. The overall level of OHRQoL decreased significantly at T(1) relative to T(0); however, the emotional well-being domain improved at T(1) in comparison to T(0). At T(2), the OHRQoL level increased significantly relative to T(0) in all domains.

CONCLUSION

The patients' quality-of-life level decreased by initiating orthodontic treatment; however, during that period, emotional well-being increased. As orthodontic treatment progressed, the quality of life level increased.

Comparison of personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment

OBJECTIVE

To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.

MATERIALS AND METHODS

One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences.

RESULTS

Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11).

CONCLUSIONS

Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.

How patient and carer expectations of orthodontic treatment vary with ethnicity

OBJECTIVE

To investigate if the orthodontic treatment expectations of Black British children and their primary carers vary compared with White British children and their primary carers.

SETTING

A hospital orthodontic department (Queen Mary's Hospital, Sidcup, London, UK).

PARTICIPANTS

Patients and their accompanying primary carers who had not received fixed orthodontic appliance treatment and were aged between 12 and 14 years old.

METHOD

Informed consent was obtained from 100 patients and their primary carers, who completed a psychometrically validated questionnaire, to measure their expectations before a new patient orthodontic consultation. This cohort consisted of 50 Black British patients and their primary carers and 50 White British patients and their primary carers.

RESULTS

Mean responses from patients and their primary carers for each ethnic group were compared using the independent groups t-test. Significant statistical differences were found between the two ethnic groups. The greatest statistical differences occurred between Black British patients and their primary carer and Black British primary carers and White British primary carers. Patients tended to have similar orthodontic expectations. There were no statistical significant differences in expectations between White British children and their primary carers.

CONCLUSION

Differences in expectations of orthodontic treatment were more common between Black British and White British primary carers, than their children. White British primary carers had higher expectations at their child's initial appointment and expected dental extractions to be part of the orthodontic treatment plan. These differences have some implications for the provision of orthodontic care. A clinicians understanding of patients and their primary carer's expectations at the start of treatment can help in the quality and delivery of orthodontic care provided.

Perception of the relationship between TMD and orthodontic treatment among orthodontists

INTRODUCTION

The consensus about the relationship between TMD and orthodontic treatment has gone from a cause and effect association between TMD and orthodontic treatment to the idea that there is no reliable evidence supporting this statement.

OBJECTIVE

To assess the beliefs, despite scientific evidence, of Brazilian orthodontists about the relationship between TMD and orthodontic treatment with regards to treatment, prevention and etiology of TMD.

METHODS

A survey about the relationship between TMD and orthodontic treatment was prepared and sent to Brazilian orthodontists by e-mail and social networks. Answers were treated by means of descriptive statistics and strong associations between variables were assessed by qui-square test.

RESULTS

The majority of orthodontists believe that orthodontic treatment not only is not the best treatment option for TMD, but also is not able to prevent TMD. Nevertheless, the majority of orthodontists believe that orthodontic treatment can cause TMD symptoms.

CONCLUSION

This study suggests that orthodontists' beliefs about the relationship between orthodontic treatment and TMD are in accordance with scientific evidence only when referring to treatment and prevention of TMD. The majority of orthodontists believe that, despite scientific evidence, orthodontic treatment can cause TMD.

A qualitative study to develop a tool to examine patients’ perceptions of NHS orthodontic treatment

OBJECTIVE

To identify issues of importance to adolescent patients surrounding the delivery of orthodontic treatment under the National Health Service (NHS), which can form the basis of a tool to examine patients' perceptions of NHS orthodontic treatment.

DESIGN

Study using qualitative research methods.

SETTING

Patients were recruited from the orthodontic departments at Derriford Hospital and Bristol Dental Hospital, and from Specialist Orthodontic Practices in Plymouth and Solihull.

SUBJECTS

A rolling sample of patients from a list of orthodontic patients under treatment at each site was selected. Twenty-six patients took part in five focus group meetings. Three patients took part in semi-structured telephone interviews.

METHODS

Participants were invited to participate in either a focus group meeting or a telephone interview. The transcripts of these meetings were analysed by two researchers working independently. Issues of importance to patients regarding the delivery of orthodontic treatment under the NHS were identified.

RESULTS

The issues identified included being treated with respect by the clinician and being included in discussions about treatment. Participants tended to rely on their peers for advice about what to expect from treatment. The patients also discussed the benefits to them of undergoing orthodontic treatment. These included an improved appearance and increased self-confidence.

CONCLUSION

This qualitative research has identified issues that are important to adolescent orthodontic patients. These issues will be used to form the basis of a patient-centred measure for auditing patients' perceptions of orthodontic treatment under the NHS.

Patients’ expectations of orthodontic treatment: Part 2—findings from a questionnaire survey

OBJECTIVE

To describe patients' and their parents' expectations of orthodontic treatment.

DESIGN

A questionnaire survey of 100 patients and their primary care-givers attending a new patient orthodontic consultant clinic, at a teaching hospital.

SETTING

GKT Orthodontic Department, King's College Dental Hospital, London, UK.

SUBJECTS

The sample consisted of 100 participants who completed the questionnaire, including 50 patients aged 12-14 years who had been referred to the orthodontic department for treatment. One parent of each patient was also invited to participate.

MATERIALS AND METHODS

Participants completed a valid questionnaire measure of orthodontic expectations that was tested for reliability and validity. Descriptive analysis of the responses was undertaken, and comparisons of children's and parents' expectations, in addition to ethnicity, were made.

RESULTS

Patients and parents have similar expectations of treatment, with the exception of expectations of duration of orthodontic treatment (P<0.01), having a brace fitted at the initial visit (P<0.05), and restrictions with regard to what one can eat and drink as a result of orthodontic treatment (P<0.05). Among the patient participants, different ethnic groups displayed different expectations of the initial orthodontic assessment visit, the likelihood of wearing headgear, the impact of orthodontic treatment on diet, and the reaction of peers to treatment (P<0.05). For patients, ethnic group differences were reported for expectations regarding the initial visit, headgear and dietary restrictions (P<0.05).

CONCLUSIONS

Patients and their parents share similar expectations of orthodontic treatment for most aspects of care, although parents are more realistic in their estimation of the duration of treatment and the initial visit. The expectations of patients differ from those of their parents with regard to dietary and drink restrictions in relation to orthodontic treatment. Ethnicity significantly influences expectations of orthodontic treatment, and this may relate to differences in the patients' and their parents' assessed outcome of care.

Comparing a quality of life measure and the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN) in assessing orthodontic treatment need and concern

OBJECTIVE

To compare the use of the Aesthetic Component (AC) of IOTN and the Child Perceptions Questionnaire (CPQ) in assessing orthodontic treatment need and concern.

DESIGN

Cross-sectional observational study.

SUBJECTS AND METHODS

The subjects were 204 children aged 10-12 years studying in 10 schools in Bristol, UK. They completed a questionnaire comprising the CPQ and questions regarding orthodontic concern. AC scores as rated by the child and by the calibrated examiner were recorded.

MAIN OUTCOME MEASURES

CPQ scores were calculated from the responses in the questionnaire. AC scores and responses to questions regarding orthodontic concern were recorded.

RESULTS

The children gave themselves lower AC scores compared to the examiner (p<0.001). The only section of the CPQ that correlated significantly with Examiner AC was the emotional impacts section (rho=0.151). CPQ scores had a slightly higher correlation with self-perceived AC than Examiner AC. However, the correlations were still very low. The emotional impacts section of CPQ (rho=0.332) and overall CPQ score (rho=0.282) were better than the examiner AC (rho=0.209) at reflecting how bothered the children were by the alignment of their teeth, and how upset they would be if they couldn't receive orthodontic treatment (rho=0.464, 0.428 and 0.214, respectively). Children with a normative need for orthodontic treatment, based on examiner AC did not have a worse oral health-related quality of life.

CONCLUSION(S)

The CPQ and IOTN AC measure different attributes. There should be a shift towards using quality of life measures to supplement the IOTN in assessing the perceived need for orthodontic treatment.

A qualitative analysis of orthodontic-related posts on Twitter

OBJECTIVE

To investigate the content of orthodontic-related Twitter posts in order to improve our understanding of orthodontic patients' perceptions and treatment experiences.

MATERIALS AND METHODS

Some 131 consecutive posts were collected from Twitter over a 5-day period. Twitter's advanced-search function was used to limit the sampling frame to New Zealand. The posts were qualitatively analyzed for themes using discourse analysis.

RESULTS

Four main themes were identified: (1) excitement about getting braces off, (2) problems with braces, (3) positive comments about braces, and (4) negative comments about braces. Various language tools and symbols were often used to convey different degrees of emotion. The present study explores these themes and discusses how they relate to modern-age orthodontics.

CONCLUSION

This is the first study to qualitatively analyze orthodontic-related posts in the social media era. Our findings suggest that orthodontic patients use social media sites such as Twitter to convey positive and negative feelings about braces.

[Improvement of orthodontic treatment outcomes in 6-9 years old children]

The collaboration between an orthodontist and parents is essential to improve the effectiveness of orthodontic treatment of 6-9 years old children. The author suggests method for increasing motivation of parents and thus of children by using a diary of orthodontic patient as well as modified orthodontic appliance with vestibular basis to decrease treatment time.

Social media use by orthodontic patients

Internet-based social media sites have recently surged in popularity and are often used to share thoughts and seek support about health issues.

OBJECTIVES

The aim of this study was to investigate how orthodontic patients use Internet-based social media sites to share their treatment-related experiences and attitudes towards braces. A secondary objective was to investigate whether an online or mobile application would be considered helpful in improving co-operation with the use of orthodontic appliances.

METHOD

Patients visiting the orthodontic clinic at the University of Otago were asked to participate in a cross-sectional survey that sought details of their Internet-based social media use and their thoughts about the development of a reminder application.

RESULTS

The sample comprised 130 orthodontic patients, with a mean age of 17.2 (SD 6.9) and a nearly equal sex distribution (52.3% were female). Internet-based social media sites were used by 80.8%, with Facebook being the most popular. Some 13.3% of the sample had posted comments about braces on these social media sites. Only 6.7% had considered obtaining information about orthodontic treatment from Internet-based social media sites, with the majority (81%) preferring to seek this information directly from their orthodontist. Nearly two-thirds of those who had difficulty remembering to wear their orthodontic appliances reported that a reminder application on their phone would be beneficial.

CONCLUSIONS

A large proportion of orthodontic patients use Internet-based social media sites, although only a few currently use them to post about treatment-related topics. Social media sites may provide a useful channel of communication for patients seeking support. Further research is needed to evaluate the use of phone reminder applications in orthodontics.

Effects of buccal corridors on smile esthetics in Japanese and Korean orthodontists and orthodontic patients

INTRODUCTION

The purpose of this study was to evaluate the influence of the size of buccal corridors on the assessment of attractive smile esthetics by Japanese and Korean orthodontists and orthodontic patients.

METHODS

Buccal corridors were modified digitally from 0% to 25% compared with the inner intercommissural width. Using a visual analog scale, 41 Japanese and 25 Korean orthodontists, and 96 Japanese and 72 Korean orthodontic patients (15-29 years old) rated the attractiveness of 6 smiles with altered buccal corridors. The influence of the size of the buccal corridor on smile esthetics was assessed.

RESULTS

Although there was no significant sex difference in judging the effects of buccal corridors for the Korean and Japanese orthodontists, significant sex differences were shown for the Japanese orthodontic patients. There were significant differences in the 6 levels of median esthetic scores for all groups: 0%, 5%, and 10% buccal corridors in the smiles tended to be preferred to the other smiles, to become clinically significant for all groups. The median esthetic score decreased to become clinically significant from 10% to 15% buccal corridors for all groups.

CONCLUSIONS

Japanese and Korean orthodontists and orthodontic patients prefer narrow or medium buccal corridors to broad buccal corridors.

Acceptance and discomfort in growing patients during treatment with two functional appliances: a randomised controlled trial

AIM

To evaluate the levels of acceptance and discomfort between two types of functional appliances.

STUDY DESIGN

Randomised controlled trial.

MATERIALS AND METHODS

A sample of patients who met the inclusion criteria were distributed randomly and equally into two groups: the Trainer for Kids™ made up of 26 patients with an average age of 10.3 years (Group A), and the modified Activator with 28 patients, with an average age of 10.6 years (Group B), as control. A special questionnaire including eight questions about tension, pressure, sensitive teeth, pain, impaired speech, impaired swallowing, oral constraint and lack of confidence in public caused by the appliance was administered at T1 (7 days), T2 (14 days), T3 (3 months), and T4 (6 months).

RESULTS

The sensation of pressure, teeth sensitivity, pain and impaired speech declined significantly in Group A. All complaints decreased significantly in Group B, but the changes in 'lack of confidence in public' were not significant. Moreover the sensation of pressure, teeth sensitivity, oral constraint and impaired speech were significantly higher in Group A than in Group B.

CONCLUSION

The modified Activator caused less discomfort than the Trainer for Kids™ and was more acceptable.

Dental anxiety, dental visits and oral hygiene practices

PURPOSE

The present study investigated the effects of dental anxiety and dental visits on oral hygiene practices, which included brushing, flossing and amount of time brushing.

MATERIALS AND METHODS

The study included a dental questionnaire developed to measure aspects of dental visits, oral hygiene and dental anxiety. A demographic questionnaire included questions pertaining to age, ethnicity and citizenship. Participants included 77 undergraduate students attending a diverse southern United States university enrolled in psychology courses.

RESULTS

Linear regression was conducted to explore the association between dental anxiety and oral hygiene practices. Results revealed the model explained a significant proportion of variance in oral hygiene practices, R2 = 0.141, F(1,76) = 12.441, P < 0.001. Specifically, higher dental anxiety was associated with poorer oral hygiene practices. A correlation was conducted to investigate the association between dental visits and oral hygiene practices. Results revealed a correlation between dental visits and brushing r(75) = 0.342, P = 0.002, and flossing frequency r(75) = 0.294, P = 0.009. There was no association between visits to the dentist and time spent brushing teeth.

CONCLUSION

Results indicate that dental anxiety is associated with oral hygiene practices. Additionally, those who visit the dentist more often have somewhat better oral hygiene practices. The present study indicates that there may be a learned association between dental anxiety and oral hygiene practices. Methods of education can be developed to disassociate anxieties that may inhibit optimum oral hygiene practices. It may also be beneficial for dental professionals to emphasise the value of the amount of time patients spend brushing their teeth.

Orthodontic treatment need, outcome and residual treatment need in 15- and 20-year-olds

The aim of the study was to investigate orthodontic treatment need and the outcome of orthodontic treatment in 15-, and 20-year-olds in Jönköping, Sweden, with special reference to residual treatment need. An offer to participate in a clinical investigation was extended to random samples of 130 15-year-olds and 130 20-year-olds. Ninety-six of the 15-year-olds (73.3%; 45 boys and 51 girls) and 82 of the 20-year-olds (62.6%; 47 males and 35 females) accepted and presented for examination The participants filled in a questionnaire and impressions were taken for study models, which were graded according to the ICON index. In all, 39 (40.6%) of the 15-year-olds and 38 (46.3%) of the 20-year-olds had undergone or were currently undergoing orthodontic treatment. Ninety-one per cent of the 15-year-olds and 84% of the 20-year-olds considered that the orthodontic treatment goals had been fully or almost fully attained. Two of the 15-year-olds and two of the 20-year-olds currently wanted orthodontic treatment. This indicates a residual treatment demand of about 2%.

Dental aesthetic self-perception and desire for orthodontic treatment among school children in Benin City, Nigeria

BACKGROUND

The availability of information on the individual perception of own's dental appearance and desire to uptake orthodontic treatment is of importance in the planning of orthodontic care within a population.

OBJECTIVE

The subjective assessment of personal dental appearance and desire for orthodontic treatment was appraised among Nigerian children.

METHODS

The study was conducted among 91 school children (33 boys, 58 girls) aged 12 years old in Benin City, south-southern region of Nigeria. The satisfaction of the subjects with the arrangement of their anterior teeth and desire to straighten their teeth was determined using a questionnaire. The subjects were further asked to rank their dental attractiveness in relation to the photographs in the Aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN). The need for orthodontic treatment among the subjects was also assessed by the examiner with the Aesthetic component of IOTN. Chi-square tests were used for data analysis.

RESULTS

The result revealed that more than three-quarters (76.9%) of the subjects were satisfied with their dental aesthetics while 23.1% desired to have orthodontic treatment. The boys expressed significantly higher level of dissatisfaction with their dental aesthetics and a greater desire to have orthodontic treatment (P < 0.05). Most subjects (92.3%) rated their dental attractiveness in the "little to no need" orthodontic treatment grade on the AC scale. The normative borderline treatment need was higher than subjective borderline need but there was consistency in distribution of 4.4% in definite need treatment grade by the subjects and examiner.

CONCLUSION

The majority of the children rated their teeth as aesthetically satisfactory but there were gender differences in perception of dental aesthetics and desire for orthodontic treatment among this sample of Nigerian children.

Parents' perceptions of oral health conditions depicted in photographs of anterior permanent teeth

AIM

The aim of this study was to evaluate parents' perceptions of dental fluorosis and other oral health conditions depicted in photographs of anterior teeth.

MATERIALS AND METHODS

The sample comprised 120 parents (average age 39.3 years) whose children were undergoing dental treatment at the School of Dentistry of the Federal University of Minas Gerais. Seven photographs were selected: P1, open bite; P2, dental fluorosis TF 1 associated with open bite; P3, dental fluorosis TF 1; P4, midline deviation and crowding; P5, dental hypoplasia; P6, teeth without oral problems; P7, dental fluorosis TF 3. All photographs were randomly shown to all the parents, who classified the conditions observed based on a numeric scale: 0-19 (very unsatisfactory), 20-39 (unsatisfactory), 40-59 (neutral), 60-79 satisfactory and 80-100 (very satisfactory). The reasons for dissatisfaction and the possible treatment choice were examined.

RESULTS

P6 (normal teeth) was the most satisfactory photograph according to the parents (mean 61.2), and all photographs were statistically significantly different from one another (Mann-Whitney test, p ≤ 0.05), except the following pairs: P1 (mean 52.9) and P7 (mean 50.2) (p 0.537); P2 (mean 32.6) and P3 (mean 39.0) (p 0.073); and P5 (mean 18.9) and P4 (mean 18.4) (p 0.923). Alignment and crowding were considered the most prevalent problem in all cases (27.5 to 90.8% of parents) and orthodontic treatment was the most frequently cited option for treating all conditions (34.2 to 89.2% of parents).

CONCLUSION

In general, parents were dissatisfied with the oral conditions depicted in all photographs. Midline deviation associated to crowding (P4) and dental hypoplasia (P5) were considered the most unsatisfactory conditions. The most frequently cited oral problems by the parents were alignment and crowding. Orthodontic treatment was considered the best option by the majority of parents.

Influence of lower facial height changes on frontal facial attractiveness and perception of treatment need by lay people

OBJECTIVE

To test the hypothesis that lower facial height has no influence on frontal facial attractiveness and treatment need perception of lay people.

MATERIALS AND METHODS

Frontal facial silhouettes of a man and a woman with normal lower facial height values (male: 81.5 mm; female: 70.5 mm) were modified by increasing and decreasing their lower facial heights in steps of 1 mm to obtain frontal images with different lower facial height alterations ranging from +6 mm to -6 mm for each sex. A panel of 100 lay people scored each silhouette's attractiveness on a 100-mm visual analogue scale (VAS) and also indicated whether they would seek treatment if the image represented their own. The Wilcoxon signed rank test was used to compare the VAS scores.

RESULTS

Unaltered +/-1-mm and +/-2-mm silhouettes got the highest VAS scores. Scores were significantly lower (P < or = .001) as the divergence from the normal value exceeded 2 mm. Beyond +3 mm and -4 mm in females and +4 mm and -3 mm in males the difference between the scores became statistically insignificant. At +/-4 mm, more than 75% of the raters elected to have treatment.

CONCLUSION

The hypothesis was rejected.

Is orthodontics an option in the management of bimaxillary protrusion?

Successful orthodontic treatment is based on a clear perception by the clinician of a patient's facial preference and treatment needs. Bimaxillary protrusion is a normal facial trait seen in the Black population and the most acceptable bimaxillary facial profile in a sample of Black subjects was determined by Beukes et al in 2007. Variations from this ideal profile may require extractions as part of orthodontic treatment in order to attain the ideal. The objective of this study was to determine whether Black subjects with bimaxillary protrusion would want to change their facial profile to the ideal and at what financial cost. A sample of 586 school learners and 321 university students were presented with four silhouetted profiles of varying degrees of bimaxillary protrusion. One of the silhouette profiles represented the ideal and treatment procedures required to achieve this ideal were explained to the sample. They were then requested to answer a questionnaire that would assist in identifying their perception of their own profile and their desire to change their appearance. The ideal silhouette was confirmed to be the most attractive (91.51%) and the sample felt that any severe deviations from this ideal profile should be treated. The financial cost of treatment was found to be a concern, as more subjects (62.84%) would undergo the required treatment if it were free. Many subjects (43.55%) would be prepared to pay for the necessary treatment to achieve the ideal profile. Females were found to be more definite in their decision making, reflecting a greater awareness about their aesthetic appearance than their male counterparts. Findings from this study can serve as an essential tool to assist both orthodontists and maxillofacial surgeons in the treatment planning and management of Black patients with bimaxillary protrusion.

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.

Influence of supplemental written information on adolescent anxiety, motivation and compliance in early orthodontic treatment

OBJECTIVES

To test the null hypotheses that supplementation of verbal information with written information when obtaining consent to orthodontic treatment has no effect on (1) anxiety, motivation and apprehension related to treatment and (2) compliance in the early stages of fixed appliance therapy.

MATERIALS AND METHODS

Seventy-six adolescents who were due to start fixed appliance therapy were randomly allocated to receive verbal information only or verbal and written information before orthodontic treatment. Participants' anxiety, motivation, and apprehension were assessed using a questionnaire that was completed prior to meeting the orthodontic clinician (T1), following consent to treatment (T2), and after 12 weeks of treatment (T3). Appointment attendance, appliance breakages, and periodontal scores were used as measures of patient compliance.

RESULTS

Sixty participants completed the study. At T2 there was no change in anxiety scores for either group (P = .412); however, increased motivation was detected in the group that had been given both written and verbal information (P = .049). At T3 both groups demonstrated similar reductions in anxiety (P = .311) and apprehension (P = .790) and similar levels of motivation (P = .756). A reduction in periodontal scores (P = .065), better appointment attendance (P = .732), and fewer breakages (P = .525) were reported in the group that was given additional information, although these changes were not statistically significant.

CONCLUSIONS

Supplementation of verbal information with written information resulted in improved motivation for orthodontic treatment but had no statistically significant effect on anxiety, apprehension, or patient compliance.

Immigrant background and orthodontic treatment need. Quantitative and qualitative studies in Swedish adolescents

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

Self-perceived orthodontic treatment need and prevalence of malocclusion in 18- and 19-year-olds in Sweden with different geographic origin

Orthodontic treatment need and demand in 19-year-olds in Sweden has not previously been analysed in relation to geographic origin. The aim of this follow-up study was to examine the prevalence of self-perceived treatment need, malocclusion, earlier orthodontic treatment, self-perceived dental aesthetics and prevalence of symptoms indicative oftemporomandibular disorders in 18-19 year-olds and to analyze any differences between native born and immigrants. Body esteem and psychological wellbeing were also evaluated. The subjects, n=316, were grouped according to family origin: Group A: both parents born in Sweden (98 girls, 80 boys); Group B:the subject or at least one parent born in Eastern /South Eastern Europe (24 girls, 26 boys) and Group C: Asia (44 girls, 44 boys). Two hundered and sixty-eight participants presented for clinical examination and answered the full questionnaire, and 48 who rejected clinical examination,were interviewed by telephone using selected questions from a questionnaire. The results show that adolescents of Asian origin had a higher self-perceived treatment need than adolescents of Swedish origin. There were negligible inter-group differences with respect to frequency of malocclusion. Forty-four per cent of all participants had previously undergone orthodontic treatment, significantly more Swedish than Asian subjects. Dissatisfaction with dental aesthetics was attributed primarily to tooth colour (38 per cent) and irregular anterior teeth (34 per cent). Adolescents of Asian origin had a higher frequency of headache than those of Eastern/South Eastern European origin. Compared to boys, girls had a higher self-perceived treatment need, a higher frequency of headache and TMD and were more concerned about body appearance. Psychological wellbeing was reduced in nearly one quarter of the participants, predominantly girls: girls of Asian origin had the highest frequency. No association was found between self-perceived orthodontic treatment need and psychological wellbeing.

Self-perception regarding the need for orthodontic treatment among impoverished schoolchildren in Brazil

AIM

The objectives of the present study were to assess predictive factors associated to self-perception regarding the need for orthodontic treatment among 170 impoverished schoolchildren.

MATERIALS AND METHODS

A cross- sectional study was conducted in public schools in the city of Belo Horizonte-MG (Brazil). Children's self-perception regarding the need for treatment was assessed using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a questionnaire addressing biopsychosocial factors. The chi-square test and multiple logistic regression were used in the data analysis.

RESULTS

The predictive factors for the self-perception of orthodontic treatment need on the part of the impoverished schoolchildren included ridicule from persons close to the children regarding the appearance of the teeth (OR 2.81; 95%CI 1.2 to 6.4), dissatisfaction with oral aesthetics due to the alignment of the teeth (OR 2.45; 95%CI 1.1 to 5.4) and missing teeth (OR 3.02; 95%CI 1.0 to 9.23).

CONCLUSION

The alignment of the teeth, missing teeth and ridicule from others regarding the appearance of the teeth are the factors that most strongly influence self- perception regarding the need for orthodontic treatment among impoverished schoolchildren.

I want braces: factors motivating patients and their parents to seek orthodontic treatment

OBJECTIVE

To determine patients' and parents'/guardians' motivation for orthodontic treatment.

BASIC RESEARCH DESIGN

A self-completion postal questionnaire survey of new patients referred for orthodontic assessment.

CLINICAL SETTING

Kent and Canterbury Hospital (January 2003-January 2004).

PARTICIPANTS

Five hundred patients referred from general dental practice and community dental service within East Kent.

RESULTS

Response rate was 66%. Fifty percent of the patients were between 11 and 13-years-old. In 81% of cases referral was initiated by the dentist. Most of the patients (87%) were concerned with the appearance of their teeth, 38% reported teasing related to their dental appearance. Only 20% of patients thought there was nothing wrong with their teeth.

CONCLUSIONS

The patients' general dental practitioner initiated referral for orthodontic treatment in the majority of the cases. Most patients and parents appeared to be highly motivated and accepting of appliances for orthodontic treatment. Teasing was a commonly reported consequence of malocclusion with negative psychosocial impact.

Does orthodontic treatment affect patients' quality of life?

The oral-facial region is usually an area of significant concern for the individual because it draws the most attention from other people in interpersonal interactions and is the primary source of vocal, physical, and emotional communication. As a result, patients who seek orthodontic treatment are concerned with improving their appearance and social acceptance, often more than they are with improving their oral function or health. Enhancing these aspects of quality of life is an important motive for undergoing orthodontic treatment. Regardless of age, patients' and their parents' or caregivers' expectations about improvements in oral function, esthetics, social acceptance, and body image are important for both general dentists and orthodontists to consider when advising patients about these procedures and during the treatment process. This review of research on the impact of conventional and surgical orthodontics on quality of life examines the association between oral health-related quality of life and severity and type of malocclusion, as well as the impact of treatment and patient characteristics on quality of life. The article will emphasize the importance of clinicians' having a clear understanding, before initiating treatment, of their patients' quality of life and their expectations about improvements in specific domains of quality of life.

Combining normative and psychosocial perceptions for assessing orthodontic treatment needs

Whereas perceptions of malocclusion by the public are mainly subjective, currently orthodontic treatment needs are predominantly determined using normative need. There are considerable differences between normative and subjective perceptions of orthodontic need. Yet clinical measures determine current provision of orthodontic services, whereas subjective oral health-related quality of life (OHRQoL) measures are seldom used and play a small part in need assessment despite predicting perceived need. The sociodental approach to assessing orthodontic treatment needs overcomes deficiencies of the sole use of normative need. It is a gradual integration process, estimating orthodontic needs by combining normative and psychosocial perspectives, as well as considering behavioral factors affecting outcomes of orthodontic treatment and scientific evidence about the effectiveness of interventions. To be appropriately used in needs assessment, an OHRQoL measure should provide condition-specific estimates of the impact of malocclusion on daily life. The sociodental approach attempts to replicate the characteristics of good clinical practice using a structured, rational, and coherent system for assessing orthodontic needs and, therefore, is a useful tool in planning oral health services.

Orthodontic evolution: an update for the general dental practitioner. Part 2: psychosocial aspects of orthodontic treatment, stability of treatment, and the TMJ-orthodontic relationship

As a result of recent innovations and improvements, orthodontic treatment has become easier and more efficient to carry out, allowing greater numbers of patients to receive treatment. The main result of orthodontic treatment is improved dental alignment and aesthetics. Treatment has no effect on caries or periodontal disease, and the dental health gain is modest, apart from a very small percentage of destructive malocclusions. Psychological improvements using different psychological parameters show differing results and it is not clear that any psychological gains are long lasting. Social gain (greater willingness to smile, feeling good about oneself, satisfaction with dental appearance, etc.), and reported improved quality of life (QoL measures), are now becoming more important as consumer-related outcomes and may, ultimately, contribute to psychosocial and psychological status. Stability of orthodontic treatment results cannot be guaranteed and all patients need to be informed of this, and of the need for long-term retention. Malocclusion has little or no relationship to temporo-mandibular joint dysfunction and orthodontic treatment neither causes nor cures such problems. Extractions as part of orthodontic treatment do not cause TMD, nor do they cause collapse of the vertical dimension. The major improvements in dental health in the last 40 years have been accompanied by a great increase in demand for treatment. In any public health service that is free at the point of use, demand for treatment invariably exceeds the ability of resources to supply this. Indices of treatment need are widely used to determine treatment need and eligibility for treatment in public health systems. Demand for orthodontic treatment among adolescents can be as high as 60% in the general population, while the professionally-assessed need for treatment is approximately half this figure. Age, sex, socio-economic status, perceived unattractiveness of dental appearance, and availability of orthodontic services all influence receipt of treatment.

Awareness of malocclusion and desire for orthodontic treatment in 11 to 14 year-old Nigerian schoolchildren and their parents

OBJECTIVES

To investigate Nigerian children's and their parents' satisfaction with the children's facial and dental appearances and their desire for orthodontic treatment, and to compare their assessments of treatment need with those determined by an orthodontist.

METHODS

The subjects were 242 11-14 year-old schoolchildren randomly selected from private and public schools in the Ife Central Local Government area, Nigeria. A questionnaire was used to obtain information from the children and their parents of their liking of the facial and dental appearances of the children and the need and desire for orthodontic treatment. The children, the parents and an orthodontist used the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to assess the need for treatment.

RESULTS

More parents liked their child's facial and dental appearances than the children liked themselves. Almost twice as many schoolchildren thought they needed (27 per cent) and desired (29 per cent) orthodontic treatment than their parents (115 per cent). Low, but statistically significant correlations, were found between the children's, their parents' and an orthodontist's assessments of treatment need using the AC scale. Only 8 per cent of the children and 3 per cent of the parents considered that there was a 'moderate-definite' need of treatment. The orthodontist considered 38 per cent of the children had a 'moderate-definite' need of treatment.

CONCLUSIONS

The children's responses suggest greater concern about their facial and dental appearances, a greater perception of the need for orthodontic treatment and greater desire for treatment than their parents. These findings require further investigation as previous studies have reported that parents are usually more motivated for orthodontic treatment than their children.

Satisfaction with dental appearance in 8-9 years-old children. Validation of COAS questionnaire for Italian-speaking children and evaluation of social and geographical context

AIM

This study was designed to adapt the original English-language COAS (Children's Orthodontic Attitude Survey) for third- grade schoolchildren to the Italian cultural environment and to investigate its properties in typical populations, as well as to evaluate children self-perception of their dental appearance.

STUDY DESIGN

The COAS questionnaire for third-grade schoolchildren was translated and culturally adapted for Italian-speaking children. The Italian version of the questionnaire was tested on 169 (73 females, 96 males) children. Test-retest reliability was assessed on 34 children one week after the first administration. We also analysed correlations between social status and questionnaire findings.

METHODS

All children filled in the questionnaire and then they were clinically examined by three residents. The clinical parameters were correlated with the questionnaire findings to evaluate children's satisfaction with their dental appearance.

RESULTS

Ninety-five per cent of children thought it was important to have straight teeth and 87 per cent considered that crooked teeth were ugly. Comparison with clinical parameters showed a statistically significant correlation between crowding and overjet and some answers. Urban children have a better opinion on braces: they would like to have braces and they think they need braces statistically more than rural subjects.

CONCLUSION

The Italian version of the modified-COAS questionnaire had a very good reliability. Social status and geographical context play a very important role in children's satisfaction with dental appearance. Children with different social context demonstrate they have very different approaches towards their dental aspect and braces.

Self-esteem and depression in patients presenting angle class III malocclusion submitted for orthognathic surgery

OBJECTIVE

To assess self-esteem and depression in patients submitted for orthognathic surgery.

METHODS

Assessment was realized on 29 patients, male and female, aged 17 to 46, presenting Angle Class III malocclusion and referred for surgical treatment, during the preoperative (orthodontic preparation) and postoperative (six-month postoperative) periods. Either maxillomandibular or isolated procedures were performed. Two previously validated standardized measurement instruments for this area were used: the UNIFESP-EPM Rosenberg Self-Esteem Scale and the Self-Report Questionnaire-20 (SRQ-20). Descriptive and inferential statistical analysis (Repeated Measures Analysis of Variance and the Bonferroni test) verified possible interactions between the pre and postoperative periods, genders and types of surgery. Significance was determined at 5%.

RESULTS

Females showed improved self-esteem, presenting lower mean values after surgery (8.9 to 6.3). Regarding depression, a significant reduction in the number of depressive symptoms (p=0.002) occurred for female patients.

CONCLUSIONS

Female patients presented improved self-esteem and diminished depressive symptoms due to surgical intervention; whereas male patients showed no alteration in self-esteem and depression with surgical intervention.

Adverse effects of orthodontics: a report of 2 cases

Adverse effects are results beyond the expected good outcomes of treatment. Like any other field in dentistry and medicine, orthodontics is not immune to such effects. The probability of adverse results in orthodontics increases when important rules and facts are ignored. To illustrate this, treatment and its adverse effects in 2 patients are discussed. In 1 young adult female, a palatally impacted maxillary canine was being moved into its place in the arch when it became ankylosed. Despite the cessation of movement, the orthodontist continued to apply mechanical forces to the canine for an additional 16.5 years. The effect of this extremely prolonged treatment period on the rest of the dentition was devastating. In another case, a 12-year 10-month-old boy with a mild Class II, Division 1 malocclusion, developed alopecia areata 4 months after the onset of orthodontic treatment. Four months later, he had lost all of his hair (alopecia totalis). The etiology of this condition was determined to be psychological stress and anxiety evoked by the orthodontic treatment. In both cases, the orthodontists failed to recognize existing problems or chose to ignore them. It was concluded that these adverse effects of orthodontic treatment could have been avoided if the orthodontists would have paid closer attention to the tissue response to mechanotherapy, as well as to the patient's attitude toward treatment. The latter conclusion is particularly noticeable when treating children and teenagers, who can reject being forced by their parents to undergo orthodontic treatment.