Orthodontics - A Quarterly Newsletter on Dental SpecialtiesJADA Specialty Scan

Bullying and oral health-related quality of life

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Kids who are bullied or teased about their teeth feel worse about their oral health-related quality of life (OHRQoL) than kids that aren’t.

The 2000 Report of the US Surgeon General defines OHRQoL as a “a multidimensional construct that reflects, among other things, people's comfort when eating, sleeping and engaging in social interaction; their self-esteem; and their satisfaction with respect to their oral health.” Oral symptoms, functional limitations, emotional well-being and social well-being scores are all affected when children are teased or bullied.

Although previous research found a relationship between the influences bullying has on quality of life in an orthodontic population, scientists publishing in the December 2014 issue of the American Journal of Oral and Dentofacial Orthopedics found little information in the literature about its impact on the general population. A previous study in Jordan showed the prevalence of bullying among 11- to 12-year-old schoolchildren to be 47 percent; significantly more boys reported being bullied than girls. Teeth were the feature most targeted for bullying, followed by strength and weight. That study also reported the features most targeted by bullies were spacing of the teeth, shape or tooth color and prominence of maxillary anterior teeth.

To investigate whether there is a relationship between self-reported bullying because of the teeth and OHRQoL, scientists studied 920 sixth-graders, 11 to 12 years of age (470 girls, 450 boys), who were not wearing orthodontic appliances. The students, attending school in Amman, Jordan, completed the short form of the Child Perceptions Questionnaire for 11- to 14-year-olds, which measures responses in four health domains: oral symptoms, functional limitations, emotional well-being and social well-being.

Boys in general demonstrated more negative oral health impacts on their quality of life. The authors postulated that this may be due to families preferentially seeking treatment for girls over boys and girls having more comfort with discussing problems with family and friends. Comparing responses between the sexes and between the victims of bullying and those who were not bullied, scientists learned that there were significant scoring differences between bullied and non-bullied subjects for both genders. The take home point as measured in this study was that both boys and girls were similarly negatively affected by bullying.    

Authors said their study was the first to investigate the relationship between self-reported bullying related to teeth and OHRQoL among a representative sample from a general population. They deduced that although the sociocultural context of one country does not necessarily extend to the rest of the world, the results highlight the relationship between bullying and OHRQoL in schoolchildren. They said the main limitation of their study was that the findings were based only on self-reported questionnaires and no clinical exams were performed, making it impossible to draw any conclusions regarding the severity or type of malocclusion and the effects on bullying and OHRQoL.

Nevertheless, the research showed that being bullied about the teeth was significantly associated with negative effects on OHRQoL, authors concluded.

“The results of this study highlight the importance of addressing the problem of bullying among schoolchildren, and it provides important data for educational authorities to create antibullying programs to allow students to receive education in a safe and healthy environment.”



Consulting Editor: Lee W. Graber, DDS, MS, MS, PhD
Diplomate, American Board of Orthodontics

Choosing a retainer

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Retainer design and appearance influences social perceptions in young adults appraising their peers, according to research published in the December 2014 issue of the European Journal of Orthodontics.

Authors said that although it’s well known that personality traits are inferred from dental appearance, particularly among young adults, previous research showed that little information exists on whether adults make social judgments about their peers in relation to the orthodontic appliances they wear. And, although recent studies found that lingual and clear aligners were judged more attractive among adults, the assessment wasn’t made in the context of overall attractiveness because images of only lips and teeth were evaluated.

Because many dentists prescribe full-time wear of removable retainers, possible negative social perceptions associated with retainer wear is an important factor in retainer choice. That’s why scientists at University College Cork, Cork, Ireland, conducted a study to determine whether social perceptions of a young adult are influenced by orthodontic retainer design and appearance.

They recruited one adult female and one adult male with harmonious facial proportions, 18 to 25 years old. They fabricated four maxillary retainers for each subject: Essix clear overlay retainer; Hawley retainer with conventional stainless steel labial bow; Hawley retainer with anterior acrylic supported labial bow; and a Begg retainer with a circumferential wrap-around stainless steel labial bow. Researchers took photographs of each of the subjects with each retainer type. A fifth photo of each of the two subjects wearing no retainer was taken to simulate the appearance of a maxillary-bonded retainer (BR).

Students (420) in the same age group as the photographed subjects were randomly assigned an envelope containing a single photograph and questionnaire (a prize ticket was included as incentive to participate). The questionnaire contained 10 statements addressing social competence, as follows.

This person:

Students submitted their responses on a five-point Likert scale for statements 1-8 and used yes/no/don’t know for statements 9 and 10. The research team transferred their responses to an Excel spread sheet for statistical analyses.  

Among key results, students perceived no significant differences between subjects depicted in the photographs in the areas of social competence or psychological adjustment. The appearance of the male subject with the lingual bonded retainer (BR) was perceived as having greater intellectual ability when compared to assessments when wearing the conventional or acrylic labial bow Hawley. The BR appearance had a higher mean score for attractiveness than all the other retainer types. The difference, however, was only significant when compared with the Begg wrap-around labial bow-type retainer.

Those who self-rated their oral health as ‘excellent/very good/good’ gave lower scores for attractiveness. “This may have indicated a view of a subgroup, which may be more sensitive to dental appearance,” authors said.
Scientists drew two conclusions:

Editor’s note: While clinicians select a specific retainer for the functional aspects, considerations regarding the social implications will be important for some patients as wear compliance may be affected.


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CS Solutions for Orthodontics
With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software. The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system.



Internet discussion forums and patient information

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What information are orthognathic patients seeking on the Internet?

The validity of information available on the Internet is a concern for many clinicians. For example, a study in the United Kingdom assessing the quality of available information to orthognathic patients showed that only six of 25 websites would’ve been recommended by clinicians.

Clinicians are interested in the nature of patient queries and the chosen forum patients use to find answers. A study of blogs and virtual communities revealed that patients typically posted information they considered to be essential but that professionals considered more basic. The results highlighted that there was a difference between what information patients feel they require and what health care professionals think patients should know.

Researchers publishing in the January 2015 issue of the American Journal of Orthodontics and Dentofacial Orthopedics found few studies investigating patients’ perceptions of their information needs concerning orthodontic and surgical phases of orthognathic treatment. They aimed to gain insight into the topics patients discuss regarding the whole treatment process on an internationally used orthognathic discussion forum.

Scientists selected an orthognathic discussion forum based in the United States identified as one of the most active. Used by an international audience, the forum contained nearly 19,000 posted comments.

Researchers analyzed posts with thematic analysis (a process previously used to analyze medical issues), grouped together into topics and then reviewed and refined them until meaningful and distinct main themes and subthemes emerged. 

Results showed that the main themes patients discussed were:

Researchers deduced that Internet forums are used as a means not only for patients to obtain or share information but also to acquire additional support and emotional encouragement from other patients undergoing similar treatment.

“Unexpectedly, there were limited discussions regarding the actual surgical procedure and the general anesthetic,” authors said. “Health care providers are often focused on providing information that enables patients to consent to treatment in an informed manner, but they can occasionally fail to give the practical advice that patients in treatment require to improve their experience.”

Scientists said the research supports the idea that health care teams should evaluate the way they provide information to patients and consider establishing formalized mechanisms to allow patients to talk to other patients who had similar treatment.

“The advantage of health care providers’ establishing such support for their patients instead of their using nonclinically supported Internet discussion forums is that health care providers can tailor information given to patients that is relevant to the service in which they are being treated and ensure the accuracy of the information.”

The published article includes excerpts from patient forum discussions posted in the topic areas of this study; their comments represent examples of areas of common interest for orthodontic/orthognathic surgery patients.



The influence of tonsil size

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Is there a correlation between malocclusion and the space taken up by the palatine tonsils? If yes, is there reason to believe that an evaluation of upper airway obstruction should be part of a prevention program for orthodontic abnormalities during dental arch development?

Finding no study to answer objectively, a team of scientists in Dakar, Senegal, conducted a study implementing a tonsillar hypertrophy grading scale based on the space the palatine tonsils occupy in the pharynx. Their study was reported in the February, 2015, American Journal of Orthodontics and Dentofacial Orthopedics.

The patient sample consisted of 80 Senegalese children (37 boys, 43 girls), between 6 and 12 years of age. They were divided into the five grades, as defined by the scale, according to the size of their tonsils. The grading scale—0 to 4—is based on the space occupied by the tonsils between the anterior pillars of the oropharynx, with grade four meaning that the tonsils occupy 75 to 100 percent of the space. Interarch and intra-arch parameters measurements were made on plaster casts using an electronic caliper. Values were read directly in millimeters on the mini screen of the caliper. Scientists evaluated the strength of the association between the tonsillar grade as assessed and quantitative and qualitative measures of intra-arch and inter-arch deviations, i.e., malocclusion.

Results showed that the maxillary dental arch depth was significantly and positively correlated to tonsil size. Grade four was strongly associated with molar Class II malocclusions and posterior crossbite with functional lateral deviation of the mandible.

After summarizing key results in conclusions, authors added, “Early assessment of tonsillar grade during the preadolescence years should therefore be considered.”


Capture high-resolution images with the CS 3500 intraoral scanner

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With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software.

The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system. The scanner features high-angulation scanning of up to 45 degrees and to a depth from -2 to +13 millimeters. It also includes an autoclavable tip available in two sizes, a smaller tip for children or adults with small mouths and a larger tip for adults, to ensure users adhere to the best practices for infection control.      
With the scanner, practitioners can capture high-resolution images digitally rather than using the putty associated with traditional impressions—eliminating the need for using impression material, pouring molds or waiting for stone models to set.

Once digital impressions are created, CS Model software takes basic distance measurements—including overjet, overbite, pressure map, arch length, tooth size, crowding measurement and more—to further improve clinicians’ diagnostic capabilities. CS Model enables orthodontists to quickly create digital models; review and store them electronically; and produce orthodontic appliances through preferred labs.

Creating digital models is an environmentally friendly solution that ensures that patients’ models are not damaged, lost or mixed-up over time. Plus, CS Model gives practices access to all cases 24/7, without the need to access third-party storage via the Internet.

Digital models not only save time and money, but also serve as a powerful tool to engage patients in treatment planning and increase case acceptance.


Consumer alert eyes use of elastics as gap bands

The September 2014 issue of The American Journal of Orthodontics and Dentofacial Orthopedics features an editorial and consumer alert addressing the proliferation of Internet videos and websites which encourage people to attempt to straighten their teeth on their own. Its purpose is to make both practitioners and consumers aware of the risks of “do-it-yourself” orthodontic treatment.

It’s available at http://www.ajodo.org/article/S0889-5406(14)00626-X/fulltext


Reach teens on their level with ADA’s Braces Journal

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For teens embarking on the journey to a better smile, the ADA offers The Braces Journal. Focusing on the benefits of braces, the booklet coaches young patients on how to get the most from the orthodontic experience. Space for notes, sketches and photos are included, as well as lists of websites, books and magazines geared to teens. The book reminds kids that wearing braces is “a partnership between you, your family and your doctor to create a new smile—your new smile!”

The Braces Journal is sold in boxes of 36 booklets. Sample pages can be viewed here. Call 1-800-947-4746 or go to adacatalog.org. Readers who use the code 15405E before March 13 can save 15 percent on all ADA Catalog products.

The template calls for the image at 160 by 160 but adjustments can be made

CS Solutions for Orthodontics
With CS Solutions for Orthodontics, users have the option to create digital impressions with the CS 3500 intraoral scanner for use with new CS Model software. The CS 3500 intraoral scanner acquires true color, 2D and 3D images without the need for a heater, powder or trolley system.



What is Specialty Scan?

This is one in a series of quarterly newsletters updating dentists on selected specialties in dentistry. Information presented is aggregated and summarized from previously published materials, each item attributed to its publication of origin. This issue of JADA Specialty Scan focuses on orthodontics, the first in the series on this topic for 2015. Other Specialty Scan issues are devoted to endodontics, oral and maxillofacial radiology, pediatric dentistry, periodontics and prosthodontics. The ADA has engaged the specialty organizations in these areas as well as its own divisions of Science and Legal to assist with these newsletters. We welcome feedback on this and all Specialty Scan issues.

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