Daniel J. Rinchuse

Relationship of skeletal pattern and nasal form

This article investigates the relationship of skeletal facial pattern and soft-tissue nasal form. The case sample comprises 123 white female subjects, aged 11.0 to 20.6 years, with no histories of pathology, trauma, surgical intervention, or orthodontic treatment. Measurements were made from cephalometric radiographs, posteroanterior radiographs, and the physioprint photographs. Skeletal classifications were based on the relationship of the maxilla to the mandible; the three classifications were straight profile, retrusive chin profile, and prognathic profile. Pearson product--moment correlation coefficients were used to test intercorrelations of all quantitative variables (including age) with each other. Correlations were highly significant for age, the three profile measurements, and two of the frontal measurements. Hence, noses and skeletal structures showed, as expected, increases with age. Also, profile measurements were highly significantly correlated; larger noses were larger in all profile dimensions. A stepwise discriminant analysis was used to study nonquantitative categories of nasal shape (straight, convex, and concave). This analysis indicated that more than 86% of patients in the sample of 123 demonstrated a correlation of nasal shapes with specific skeletal groupings. Patients with straight profiles tended to have straight noses; convex profiles accompanied convex nasal shapes; and concave profiles were found with concave nasal shapes. The clinical significance of this research is to emphasize the importance of total facial harmony (especially nasal shape) during orthodontic diagnosis and treatment planning.

Reliability of three methods of occlusion classification.

Four orthodontic faculty at one dental school classified 25 dental casts according to the classification systems of Angle, Katz, and the British Incisor Classification. The dental casts were selected from a pool of 350 pretreatment graduate orthodontic cases and were those deemed the most atypical. The results demonstrated that Katzs classification was more reliable than both Angle and the British. Angles classification was the least reliable of the three methods.

Effect of text message follow-up on patient's self-reported level of pain and anxiety

OBJECTIVES To determine whether a text message reduces the severity of patient self-reported levels of pain and anxiety following initial placement of orthodontic appliances. MATERIALS AND METHODS Thirty-nine orthodontic patients were randomly assigned to one of two groups and matched for age, gender, and bracket type (self-ligating vs conventional). The subjects completed baseline questionnaires to ascertain their levels of pain and anxiety before initiating orthodontic treatment. Following the initial appointment, subjects completed the pain questionnaire and anxiety inventory at the same time daily for 1 week. One group received a structured text message showing concern and reassurance, while the second group served as a control and received no postprocedural communication. RESULTS There was a statistically significant difference in pain in relation to time between the text message group and the control group as it was demonstrated that demonstrated that compared with the text message group, mean pain intensity increased and selfreported discomfort was longer in the control group. Anxiety was determined to be at its peak the day following initial orthodontic appliance placement and gradually tapered off from that time point. No intergroup difference was noted when analyzing anxiety. CONCLUSIONS This study demonstrated that a text message sent from an orthodontic office following initial appliance placement resulted in a lower level of patients self-reported pain. Additionally, patient anxiety is at its peak the day following the initial appointment and decreases from that point forward.

The impact of the American Dental Association's guidelines for the examination, diagnosis, and management of temporomandibular disorders on orthodontic practice

Abstract There appears to be no simple diagnosis and treatment plan for the management of TM disorder patients. A differential diagnosis of TM disorders should be based upon a logical classification that incorporates a number of variables, such as masticatory disorders, problems involving derangement of the TMJ, problems that result from extrinsic trauma, degenerative joint diseases, inflammatory joint disorders, chronic mandibular hypomobility, and growth disorders of the joint. In the absence of definitive scientific research pertaining to TM disorders, the ADA has established guidelines for the examination, diagnosis, and management of TM disorders. Most often, treatment of TM disorders has been anecdotal and directed at allaying the symptoms and not particularly directed at the cause. The general recommendation of the ADA guidelines regarding TM disorder treatment is that it be conservative, reversible, and based upon scientific data whenever possible. These general recommendations, although nebulous, point to the fact that we simply have not progressed far enough to develop a consensus plan concerning the most appropriate treatment for each and every patient with TM disorders. The problems in the patient population are too complex and varied for an outline or “cookbook” type of treatment plan. Since orthodontists have become more involved in the treatment of TM disorders, some may re-evaluate their thinking in light of the ADA TM disorder guidelines. The orthodontist may also have to resolve conflicts that arise over differing opinions regarding the major issues involved in TM disorder examination, diagnosis, and treatment. Too often simplistic models of natural phenomena may be misleading and inaccurate, as is true of some existing models which explain TM disorders. It is time that we, as members of the great profession of dentistry, critically evaluate current literature in order that we may responsibly justify our diagnoses and treatment modalities. In light of the fact that the more knowledge we accumulate, the more we should realize how much we do not know, it might be wise for us to reflect upon the following quotation from Shakespeare: The fool doth think he is wise, but the wise man knows himself to be a fool.

The influence of text messaging on oral hygiene effectiveness

OBJECTIVE To investigate whether text message reminders regarding oral hygiene have an effect on plaque removal in orthodontic patients. MATERIALS AND METHODS In this randomized, controlled clinical trial, 50 orthodontic patients were assigned to either a text message or control group. Patients in the text message group received 12 text messages over the course of 4 weeks and one text message for 8 weeks thereafter. Photos were taken at baseline (T0), at 4 weeks after baseline (T1), and at 12 weeks after baseline (T2). For each subject, photos of eight teeth were taken and then the area of the tooth and amount of plaque were measured using planimetry. RESULTS There was a statistically significant difference in plaque coverage between baseline and both T1 and T2 in the text message group as measured using planimetry. This was demonstrated by comparing the average measurements of the control group and the treatment group. CONCLUSION This study demonstrated that the use of automated text message reminders sent from an orthodontic office was effective in improving oral hygiene compliance in orthodontic patients.

Practitioner and Patient Perceptions of Orthodontic Treatment: Is the Patient Always Right?

PURPOSE As dentists embrace evidence-based clinical practice, we place increased emphasis on patient values. Standards like Angle Classification are not related to patient perceptions of the tangible benefits of treatment. This study quantifies the differences dentists and patients perceive in orthodontic treatment outcome. MATERIALS AND METHODS A survey is used to quantify a patients perception of orthodontic treatment. It was completed by 30 patients who completed treatment at the University of Pittsburgh School of Dental Medicine. Their responses were compared with the perceptions of five orthodontists, three general dentists, and two prosthodontists. RESULTS Multivariate analysis of variance found the differences between and within the subjects to be significant at p < 0.004. Univariate analysis of variance of the initial scores showed the data to be significant at p < 0.002 and pairwise comparisons showed significant mean differences. Final score analysis of variance was significant at p < 0.001 and pairwise comparison showed significant mean differences. CONCLUSIONS Patients and general dentists have a significantly less favorable initial perception of their dental esthetics and function when compared with orthodontists. Final scores of esthetic and functional perceptions between the patients and all three dentist groups showed significant differences, with patients perceiving the results of their treatment more favorably than practitioners. CLINICAL SIGNIFICANCE The data herein elucidates differences in the value systems of professionals and patients. It is meant to encourage dentists to consider whether these differences justify the persistence of traditional orthodontic treatment goals or if treatment planning should incorporate consideration of each individual patients preferences to maximize utility.

Clinical pharmacology for the orthodontist

The practice of orthodontics encompasses all other aspects of dentistry, but at the same time it also is very different. Therefore, the pharmacologic agents that would be practical for orthodontic practice are much more limited than those used in other disciplines of dentistry. This, however, does not imply that a full understanding of pharmacologic drug action, side effects, and contraindications is unnecessary. Some common drugs, such as the antibiotics, anticholinergics, fluoride, antianxiety agents, and drugs for myofacial pain, are reviewed according to their application to orthodontic practice.

Consecutive treatments and the “random walk”

The nature of rationality and truth has played an important role in western culture since the time of the ancient Greeks. There is still ambivalence and debate as to whether reality is beyond experience; how knowledge, reality, and truth are defined; and whether science is an account of experience or reality. As a result of our neural “hardware,” the mind has a proclivity toward illusion, distortion, and error. These tendencies are called “cognitive biases and blind spots.” Often, people are stubborn in their beliefs and have a tendency to make evidence subservient to belief, a phenomenon known as “belief preservation.” Even evidence, or what we interpret as reality, often conflicts with experience or our senses. For instance, from a perspective on earth, it appears that the sun is moving, but the earth is actually revolving around the sun. Experience is particular, uncertain, and contingent compared with reality, which must be universal, necessary, and certain. The age of Dr Edward H. Angle was termed the “era of the expert.” After that era was the “era of science,” and it lasted for more than 50 years. Presently, we are in the “era of evidence.” Today, evidence-based medicine and dentistry are accepted as the gold standard. Evidence-based dentistry (EBD) is “the conscientious, explicit and judicious use of current best evidence about care of individual patients integrated with clinical expertise and patient values to optimize outcomes and quality of life.” The primary goal of EBD is “to encourage the ordinary practitioner to look for and make sense of the evidence available in order to apply it to everyday clinical problems.” Huang provided further clarification of the evidence-based view:

Effects of Short-Term and Long-Term Administration of Procaine Hydrochloride and Mepivacaine Hydrochloride on Hexobarbital-Induced Sleeping Times in Mice

Investigations were performed to determine the effects of short-and long-term pretreatment with procaine and mepivacaine on hexobarbital-induced sleeping times in mice. It was found that short-term preadministration with procaine (40 mg/kg) and mepivacine (40 and 60 mg/kg) significantly increased hexobarbital-induced sleeping time, but long-term pretreatment had no effect.