Daniela Feu

Oral health-related quality of life and orthodontic treatment seeking

INTRODUCTION The aim of this study was to assess oral health-related quality of life (OHQOL) in adolescents who sought orthodontic treatment. A comparison between these adolescents and their age-matched peers who were not seeking orthodontic treatment provided an assessment of the role of OHQOL in treatment seeking. METHODS The sample consisted of 225 subjects, 12 to 15 years of age; 101 had sought orthodontic treatment at a university clinic (orthodontic group), and 124, from a nearby public school, had never undergone or sought orthodontic treatment (comparison group). OHQOL was assessed with the Brazilian version of the short form of the oral health impact profile, and malocclusion severity was assessed with the index of orthodontic treatment need. RESULTS Simple and multiple logistic regression analysis showed that those who sought orthodontic treatment reported worse OHQOL than did the subjects in the comparison group (P <0.001). They also had more severe malocclusions as shown by the index of orthodontic treatment need (P = 0.003) and greater esthetic impairment, both when analyzed professionally (P = 0.008) and by self-perception (P <0.0001). No sex differences were observed in quality of life impacts (P = 0.22). However, when the orthodontic group was separately evaluated, the girls reported significantly worse impacts (P = 0.05). After controlling for confounding (dental caries status, esthetic impairment, and malocclusion severity), those who sought orthodontic treatment were 3.1 times more likely to have worse OHQOL than those in the comparison group. CONCLUSIONS Adolescents who sought orthodontic treatment had more severe malocclusions and esthetic impairments, and had worse OHQOL than those who did not seek orthodontic treatment, even though severely compromised esthetics was a better predictor of worse OHQOL than seeking orthodontic treatment.

Effect of orthodontic treatment on oral health-related quality of life

OBJECTIVE To assess changes in oral health-related quality of life (OHQoL) in children undergoing fixed orthodontic treatment and compare it to that of two groups not receiving treatment. MATERIALS AND METHODS Two hundred eighty-four subjects aged 12-15 years were followed for 2 years; 87 were undergoing treatment at a university clinic (TG), 101 were waiting for treatment at this clinic (WG), and 96 were attending a public school and had never sought treatment (SG). OHQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T1), 1 year later (T2), and 2 years later (T3). OHIP-14 scores were analyzed using negative binomial regression in generalized estimating equations for correlated data. RESULTS During the follow-up period, the WG and TG OHIP-14 scores showed a statistically significant increase and decrease, respectively (P < .001). At T1, the TG had an OHIP-14 score that was 1.9 times higher than that of the SG; however at T3, the TG score was 60% lower than the initial score of the SG. Adjusting for age, gender, dental health status (DMFT), socioeconomic position, malocclusion severity, and self-perceived esthetics did not change the effect of orthodontic treatment on OHQoL. CONCLUSION Fixed orthodontic treatment in Brazilian children resulted in significantly improved OHQoL after 2 years.

A systematic review of etiological and risk factors associated with bruxism

Objective The aim of the present work was to systematically review the literature and identify all peer-reviewed papers dealing with etiological and risk factors associated with bruxism. Data sources Data extraction was carried out according to the standard Cochrane systematic review methodology. The following databases were searched for randomized clinical trials (RCT), controlled clinical trials (CCT) or cohort studies: Cochrane Library, Medline, and Embase from 1980 to 2011. Unpublished literature was searched electronically using ClinicalTrials.gov. Data selection The primary outcome was bruxism etiology. Studies should have a standardized method to assess bruxism. Data extraction Screening of eligible studies, assessment of the methodological quality and data extraction were conducted independently and in duplicate. Two reviewers inspected the references using the same search strategy and then applied the same inclusion criteria to the selected studies. They used criteria for methodological quality that was previously described in the Cochrane Handbook. Among the 1247 related articles that were critically assessed, one randomized clinical trial, one controlled clinical trial and seven longitudinal studies were included in the critical appraisal. Of these studies, five were selected, but reported different outcomes. Data synthesis There is convincing evidence that (sleep-related) bruxism can be induced by esophageal acidification and also that it has an important relationship with smoking in a dose-dependent manner. Disturbances in the central dopaminergic system are also implicated in the etiology of bruxism.

Factors associated with orthodontic treatment seeking by 12-15-year-old children at a state university-funded clinic.

Objectives To investigate the interrelationships between factors involved in orthodontic treatment seeking by children aged 12–15 years. Setting State funded orthodontic clinic at the Faculty of Dentistry of the Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil, and a nearby public school. Subjects and methods One hundred and ninety‐four adolescents aged 12–15 years took part in the study; 92 had sought orthodontic treatment at UERJ (orthodontic group) and 102 were from a nearby public school and had never undergone or sought orthodontic treatment (comparison group). Each participant underwent a comprehensive oral examination, and both parent and child were questioned about who had initiated the orthodontic referral. Outcomes Normative need assessed with IOTN DHC; clinician and self‐perceived aesthetic perception assessed with IOTN AC, previous caries experience was determined using the decayed, missing and filled teeth index (DMFT) and WHO diagnostic criteria. The ‘Brazil Economic Classification Criteria’ was used to classify the socioeconomic status. Intra‐examiner repeatability and inter‐examiner agreement were assessed with kappa statistics. Univariate and multiple logistic regression analyses were used to investigate the association between orthodontic treatment seeking (dependent variable) and the independent variables (i.e. aesthetic impairment, malocclusion severity, socioeconomic status, gender, age and DMFT). Results Univariate analyses showed that self‐perceived aesthetics (P<0·001), examiner‐assessed aesthetics (P = 0·01) and treatment need (P<0·001), socioeconomic status (P<0·001) were significantly associated with orthodontic treatment seeking, but gender (P = 0·22) and DMFT (P = 0·41) were not. Multiple logistic regression analyses showed that poor self‐perceived aesthetics (OR = 16·7; 95% CI: 4·17–61·9), more severe malocclusion (OR = 3·4; 95% CI 1·64–7·14) and better socioeconomic position (OR = 39·1; 95% CI: 5·47–280·54) significantly influenced the decision to seek orthodontic treatment. Conclusions Concern about dental appearance and the desire for treatment, together with normative orthodontic need, should be carefully assessed by dentists before referring patients to specialized orthodontic care in publicly‐funded clinics. In a publicly‐funded oral health care system, self‐perceived orthodontic treatment need is the key to establishing treatment priority.

Percepção das alterações no plano gengival na estética do sorriso

OBJECTIVE: This study investigated how 80 dental professionals and 80 lay persons, patients from private practice offices and from the School of Dentistry, Federal University of Espirito Santo (UFES), perceived the presence of changes in the gingival plane. METHODS: A photograph of a smiling young woman was digitally modified to produce symmetrical changes in the gingival height of the central incisors and lateral incisors, thereby causing the gingival plane to ascend progressively. Individuals were asked to choose the most pleasant looking picture and thereafter the interviewer questioned each individual to find out if they knew what was being changed in the sequence of pictures, i.e., whether or not they were able to identify changes in the gingival plane. RESULTS: The results showed a significant prevalence in the selection of a harmonious gingival plane in the group of dentists and patients (p<0.001, p<0.05, respectively). Furthermore, there were no significant differences between the specialties comprised in the group of dentists (p = 0.538), which was the case in the lay group (p = 0.05), showing a greater perception on the part of the group of dental office patients. Identification of changes in the gingival plane was significant in the group of dentists (p<0.001) without significant differences between group specialties. Neither was it significant in the lay group (p = 0.100). The results also highlight a significantly higher ability to identify problems in the group of dentists compared to the lay group (p<0.001). CONCLUSION: It was therefore concluded that symmetrical changes greater than 2 mm can be perceived by both dentists and lay people. Moreover, no differences were found in this perception among the dental specialties. Finally, the group of dental office patients was significantly more perceptive than UFES patients.

Indicadores de qualidade de vida e sua importância na Ortodontia

OBJETIVOS: o objetivo desse estudo foi buscar na literatura informacoes consistentes sobre a qualidade de vida relacionada a saude bucal, permitindo aos clinicos acessar e compreender sua influencia no processo de busca e tratamento de seus pacientes. METODOS: foram pesquisadas as bases de dados eletronicas MEDLINE, LILACS, BBO e Cochrane Controlled Trials, entre 1980 e 2010. Foram encontrados 158 estudos que discutiam a qualidade de vida relacionada a saude bucal. RESULTADOS: foram selecionados 30 estudos, sendo dois prospectivos longitudinais, duas revisoes sistematicas, cinco casos-controle, doze estudos epidemiologicos, cinco estudos transversais e tres revisoes de literatura, alem da declaracao da Organizacao Mundial da Saude. A selecao baseou-se no objetivo de descrever os indicadores de qualidade de vida, e na metodologia utilizada nos estudos. CONCLUSOES: o uso de indicadores de qualidade de vida na pesquisa odontologica e na clinica ortodontica e de grande importância e auxilio no diagnostico e planejamento; todavia, esses nao substituem os indices normativos, devendo ser usados em carater complementar

Por que o ortodontista deve conhecer a qualidade de vida de seu paciente

Given the elective nature of orthodon-tic treatment the decision to start treatment hinges on the opinions of patients and their parents, which means that patients’ motivation is often derived from the negative impact of their malocclusion, be it aesthetic, functional or social. Therefore, this patient autonomy plays an important role in predicting the final results since theoretically satisfaction is relat-ed to a reduction or utter elimination of the factors that led them to seek treatment in the first place. So how can orthodontists perform treatments capable of benefitting patients psy-chosocially and be successful in this endeavor without gaining insight into the impact caused by malocclusion?Faced with this new paradigm, Evidence-Based Dentistry has posed a major challenge to orthodontic practice, namely: To be aware of how orthodontic treatment impacts on pa-tients’ daily lives. The reason for this lies in the fact that, to be considered viable, any treatment, including orthodontic treatment, should be ca-pable of bringing significant benefits above and beyond the biological and financial costs to each individual patient.

Is traditional treatment a good option for an adult with a Class II deepbite malocclusion

The Tweed-Merrifield directional force technique is a useful treatment approach for a patient with a Class II malocclusion with dentoalveolar protrusion. The purpose of this case report was to present the diagnosis and treatment descriptions of a patient with an Angle Class II malocclusion complicated by tooth losses, severe dentoalveolar protrusion, and skeletal discrepancy. Treatment involved extraction of the maxillary first premolars, high-pull headgear to enhance anchorage, and high-pull J-hook headgear to retract and intrude the maxillary anterior segments. A successful outcome was achieved with traditional orthodontic treatment in this borderline surgical case.

Orthodontic treatment in the severely compromised periodontal patient

We describe the diagnosis and treatment of a class II division 1 malocclusion complicated by severe periodontal disease, tooth loss, dentoalveolar protrusion associated with tipping and extrusion of the maxillary incisors, and a traumatic occlusion. Treatment involved the use of a modified palatal arch to intrude and retract the maxillary incisors and high-pull headgear to enhance anchorage and correct the Class II relationship. After active treatment for 19 months, a good anterior occlusion was achieved, with 17° of lingual retroclination and 3 mm of intrusion at the apex of the maxillary incisors. An acceptable occlusion and periodontal status was maintained over a retention period of 2 years. With the patients cooperation, a successful outcome was achieved with this approach.