Anna-Liisa Svedström-Oristo

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 cutoffs 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.

Orthodontic treatment practices in Finnish municipal health centres with differing timing of treatment

The aim of this study was to compare orthodontic practices in eight Finnish municipal health centres selected on the basis of an earlier survey to represent early and late timing of treatment. The health centres were grouped according to the mean age of starting treatment; earlier versus later than 9 years of age. A random sample of 16 and 18 year olds (n = 2325) living in these municipalities were invited for a clinical examination, and 1109 adolescents participated. The participants reported on their previous or ongoing orthodontic treatment by means of a questionnaire. Data on orthodontic treatment received were collected from the dental files of the adolescents who reported a treatment history and for those who did not recall exactly whether or not they had received orthodontic treatment. Analysis of the non-respondents was made on the basis of their dental files. Differences between the features of orthodontic treatment in the early and late starting health centres were analysed using a two-tailed t-test. In the early group, 70 per cent, and in the late group 42 per cent, of adolescents had a history of orthodontic treatment. General dentists carried out 90 per cent of the treatment in the early group and specialists every third treatment in the late group. An early start resulted in more frequent visits (P = 0.004) and a longer treatment duration (P < 0.001), while later timing resulted in an increase in the number of appliances (P < 0.001).

Reproducibility of Characteristics Assessing the Occlusion of Young Adults

The aim of the present investigation was to analyze the reproducibility in the assessment of six morphological and three functional characteristics included in a new method evaluating the occlusion in young adults. These characteristics comprised coincidence of midlines, overjet, overbite, canine relationship, crossbite, scissors bite, recurrent deviation on opening, guided lateral excursions, and discrepancy between the centric relation and the intercuspal position. The study was conducted in three stages: (1) five observers assessed the occlusions of five volunteers, (2) seven observers assessed nine volunteers, and (3) five observers assessed nine volunteers. Two calibrated orthodontists were used as references. For numerical variables, the nonparametric method for repeated measurements (Friedmans test) was used to test the significance of differences, while the proportion of agreement was calculated for categorical assessments. The results were analyzed using two precision levels: within a measurement unit/the same category and an acceptable/nonacceptable dichotomy. The magnitude of systematic differences was small and of minor clinical importance except in measurements of recurrent deviation on opening. The proportional agreement for acceptance was good in the assessment of overjet, coincidence of midlines, crossbite, scissors bite, open bite, and discrepancy between the centric relation and the intercuspal position. Moderate agreement was achieved in the assessment of overbite, canine relationship, recurrent deviation on opening, and guided lateral excursions. Among the nonacceptable cases, the agreement ranged from poor to good. The results indicated that noncalibrated observers assess categorical characteristics inconsistently.

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

Abstract 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.

Psychosocial well-being of prospective orthognathic-surgical patients

Abstract 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.

A longitudinal study of changes in psychosocial well-being during orthognathic treatment

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n=22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n=22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2-T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.

Inhalation or ingestion of orthodontic objects in Finland

Abstract 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.

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

Abstract 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 ones own dental appearance among the treated adolescents is worth noting.