Pamela Kenealy

Malocclusion and Temporomandibular Disorder: A Comparison of Adolescents with Moderate to Severe Dysfunction with those without Signs and Symptoms of Temporomandibular Disorder and Their Further Development to 30 Years of Age

A total of 1018 subjects were examined at the age of 11 years, 791 were reexamined at 15 years, 456 at 19 years, and 337 at 30 years. Anamnestic and clinical recordings of temporomandibular disorder (TMD) were made. Morphology, including calculation of peer assessment rating (PAR) scores, was recorded. Previous history of orthodontic treatment was assessed. Muscular endurance was recorded. The subjects completed four psychological measures. The malocclusion prevalence, occlusal contacts, psychological factors, and muscular endurance in subjects with no recorded signs and symptoms of TMD were compared with those with the most severe dysfunction at 19 years of age. The further development of TMD to 30 years of age was followed. PAR scores were significantly higher in the subjects with the most severe dysfunction. Apart from crowding of teeth, no other significant differences were found between the groups with regard to separate malocclusions, tooth contact pattern, orthodontic treatment, or extractions. A greater proportion of subjects with low endurance were found in those with TMD. Significant associations between TMD and general health and psychological well-being as well as the personality dimension of neuroticism and self-esteem were found. During the period from 19 to 30 years, the prevalence of muscular signs and symptoms showed considerable reduction, whereas clicking showed a slight increase. Locking of the joint showed a decrease from 19 to 30 years. One-quarter of the TMD subjects showed complete recovery. Thus, orthodontic treatment seems to be neither a major preventive nor a significant cause of TMD.

An evaluation of the psychological and social effects of malocclusion: Some implications for dental policy making

Initial findings are reported from a longitudinal study investigating the effects of malocclusion on dental health and psychological well-being and the effectiveness of orthodontic treatment. Implicit in the orthodontic intervention decision process is the view that there are discernible social and psychological benefits of good occlusion. This view has not been adequately validated. The primary psychological question addressed by this study concerns the relationship between adolescents orthodontic status and their psychological status and well-being. Empirical evidence allowed an examination of the major hypothesis that children with poor occlusion are likely to be socially and psychologically disadvantaged. Ratings of dental status and physical attractiveness, and measures of psychosocial well-being were obtained for sample of 1018, 11-12-year-old children and the associations between these variables were examined. The results provide little support for the major hypothesis that children suffer psychologically from having poor dentition. Several points of caution are made with regard to this conclusion and some implications for dental policy making are considered.

The Cardiff dental study: A 20-year critical evaluation of the psychological health gain from orthodontic treatment

OBJECTIVESnDespite the widespread belief that orthodontics improves psychological well-being and self-esteem, there is little objective evidence to support this (Kenealy et al., 1989a; Shaw, OBrien, Richmond, & Brook, 1991). A 20 year follow-up study compared the dental and psychosocial status of individuals who received, or did not receive, orthodontics as teenagers.nnnDESIGNnA prospective longitudinal cohort design with four studies of the effect of orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment received in a 2 x 2 factorial design.nnnMETHODSnA multidisciplinary research programme studied a cohort of 1,018, 11-12 year old participants in 1981. Extensive assessment of dental health and psychosocial well-being was conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre-treatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up 337 (30-31 year olds) were re-examined in 2001.nnnRESULTSnParticipants with a prior need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and satisfaction. However when self-esteem at baseline was controlled for, orthodontics had little positive impact on psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self-esteem at outcome explaining 8% of the variance. Self-esteem in adulthood was more strongly predicted (65% of the variance) by psychological variables at outcome: perception of quality of life, life satisfaction, self-efficacy, depression, social anxiety, emotional health, and by self-perception of attractiveness.nnnCONCLUSIONSnLongitudinal analysis revealed that the observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior need for treatment assessed in childhood made a small contribution to the prediction of self-esteem 20 years later in adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model that included other psychological variables. When prior need for treatment was taken into account there was little objective evidence to support the assumption that orthodontics improves long-term psychological health.

Influence of Children's Physical Attractiveness on Teacher Expectations.

Abstract Ratings of the physical attractiveness of 1,006 11- to 12-year-old children were obtained, and the association between physical attractiveness and teachers judgments of these children on a number of measures was examined. There appeared to be reasonable agreement between teachers ratings of childrens physical attractiveness, judges ratings, interviewers ratings, and childrens self-ratings of attractiveness. Teachers ratings of attractiveness were significantly correlated with their judgments of childrens sociability, popularity, academic brightness, confidence, and qualities of leadership. Teachers revealed a systematic tendency to rate girls higher than boys, and significant sex differences were observed in teachers ratings of attractiveness, academic brightness, sociability, and confidence.

Twenty-year cohort study of health gain from orthodontic treatment: Temporomandibular disorders

INTRODUCTIONnTemporomandibular disorder (TMD) is a common condition. Studies of TMD in relation to orthodontic treatment did not show an association, but longitudinal studies from adolescence to adulthood are lacking. The aim of this study was to investigate the relationship between orthodontic treatment and TMD with a longitudinal study design.nnnMETHODSnThis prospective cohort study was conducted in South Wales, United Kingdom. The baseline investigation was carried out in 1981 and involved children aged 11 to 12 years (n = 1018). Follow-up investigations were done in 1984 (n = 792), 1989 (n = 456), and 2000 (n = 337).nnnRESULTSnOverall TMD prevalence increased from the baseline (3.2%) to age 19 to 20 (17.6%) and decreased by age 30 to 31 (9.9%). TMD prevalence was higher in females at all follow-up points, except the baseline. Overall, incidences of TMD were 11.9%, 11.5%, and 6.0% at the first, second, and last follow-ups, respectively. Females were more likely to develop TMD than males (hazard ratio [HR], 2.1; 95% CI, 1.3 and 3.3), and those with high self-esteem were less likely to develop TMD (HR, 0.6; 95% CI, 0.4 and 0.8). There was no association between orthodontic treatment and new TMD onset. The incidences of persistent TMD were 20.0%, 34.9%, and 28.0% at the first, second, and last follow-ups, respectively. Females were more likely to have persistent TMD than males (HR, 2.5; 95% CI, 1.0 and 6.1). There was no association between orthodontic treatment and persistent TMD. The only significant predictors of TMD in adults aged 30 to 31 were female sex (odd ratio, 3.0; 95% CI, 1.1 and 8.2) and TMD in adolescence (odds ratio, 4.5; 95% CI, 2.0 and 10.0).nnnCONCLUSIONSnOrthodontic treatment neither causes nor prevents TMD. Female sex and TMD in adolescence were the only predictors of TMD in young adulthood.

Incidence and prevalence of the vegetative and minimally conscious states

The methodological difficulties of obtaining accurate epidemiological data for vegetative state (VS) and minimally conscious state (MCS) are considered, and prompt the conclusion that published data are of uncertain validity, partly due to variation in the criteria for diagnosis. On the basis of these data, incidence of VS continuing for at least six months arises at a rate of between 5 and 25 per million population (PMP). The prevalence of VS in adults in the US is between 40 and 168 PMP, and may be lower in the UK, but precise figures are not available. The incidence and prevalence of MCS have yet to be established.

Autobiographical Memory, Depression and Quality of Life in Multiple Sclerosis

The relationship between autobiographical memory, depression and quality of life (QoL) was investigated in a study of 30 persons with severe neurodisability resulting from multiple sclerosis. Sixty percent (n = 18) of patients were found to have deficits in autobiographical memory (AMI) for incidents in their earlier life; these deficits were associated with significant impairments in personal semantic memory of facts from their past life. Patients with impaired autobiographical memory who had been diagnosed for longer than 21 years reported significantly better QoL (SF-36: Role Physical) than those diagnosed more recently, or those with normal autobiographical memory; patients who had been diagnosed for longer were also significantly less depressed than patients diagnosed more recently. Patients with normal autobiographical memory reported the highest levels of depression (HADS) and the lowest levels of QoL (Role Physical). It is concluded that impairment of autobiographical memory affects perception of QoL; patients with deficits in autobiographical memory had impaired knowledge about their past QoL and may therefore be unable to make valid comparative judgements about the quality of their present life.

The Effects of Social Class on the Uptake of Orthodontic Treatment

The relationship between social class and uptake of orthodontic treatment was investigated in a longitudinal cohort study of 1018 children living in South Glamorgan, Wales. Previous studies have shown that working class people make less use of dental services and receive inferior dental care than middle class people. The present investigation examined the role of one factor which appears likely to contribute to this effect: namely, the uptake of orthodontic treatment by families from different social classes. If a significant association were shown then findings relating to the effectiveness of orthodontic treatment might be confounded by this social class factor.

Assessing quality of life in persons with severe neurological disability associated with multiple sclerosis : The psychometric evaluation of two quality of life measures

Objectives. To examine the psychometric properties of two conceptually different quality of life (QoL) measures, the SEIQoL-DW (a person-centred measure) and the SF36 (a health-based measure), in a severely disabled population of individuals with multiple sclerosis (MS). Design. A factorial repeated measures design was used. Method. The two QoL measures were administered at baseline to 30 individuals with MS at the Royal Hospital for Neuro-disability, Putney; participants were aged between 20 and 65 years and selected on the basis of their communication ability, years since diagnosis and extent of physical disability (using EDSS ratings). Administration of the SEIQoL-DWand the SF-36 was repeated on five fortnightly occasions on a subset of 22 participants 10 months after baseline. On each of the five re-test occasions, participants also rated their QoL ‘today’ and ‘generally’ on visual analogue scales, and reported significant positive/negative life changes that had affected their QoL. Results. The SF-36 was more reliable by traditional re-test standards than the SEIQoL-DW, but several floor and ceiling effects were observed. Only the SEIQoLDW was significantly related to QoL today (average correlation 0. 52) and QoL generally (average correlation 0. 52) (p < .05) ratings and analyses using ANOVA suggested that the measure was also more sensitive to life changes reported (F (2, 36)= 7. 57, p <. 01). Conclusion. The SEIQoL-DW is recommended as a suitable person-centred measure for use with the current population, because it appears to have good face validity and is capable of reflecting individual reports of life change between assessments. It has potential use in other severely disabled samples who obtain low scores on health-based measures because of their physical status, providing a more holistic view of individual QoL than the SF-36.

Orofacial pain in young adults and associated childhood and adulthood factors: results of the population study, Wales, United Kingdom

OBJECTIVESnThe aim of the study was to investigate the prevalence of orofacial pain (OFP) among young adults (30-31 years old) and to determine the effect of childhood and adulthood risk factors on the occurrence of OFP.nnnMETHODSnProspective cohort study to investigate dental and social effects of malocclusion and effectiveness of orthodontic treatment was conducted in Wales, United Kingdom. At 20-year follow-up 337 subjects aged 30-31 participated (74% from previous follow-up aged 19-20 and 33% from the baseline) and were asked about OFP.nnnRESULTSnThe prevalence of OFP was 23% (95% CI: 19%, 28%). Childhood factors, socio-demographic, lifestyle, health behavior factors, history of orthodontic treatment and tooth wear were not associated with OFP. Participants with OFP were more likely to report that their teeth did not fit together properly [odds ratio (OR) = 12.4, 95% CI: 2.7-56.5) and reported previous trauma to the jaws (2.3; 1.3-4.2). Both diurnal and nocturnal teeth clenching and grinding were significantly associated with OFP (3.1; 1.4-7.1). Participants with frequent headaches had increased risk of having OFP (3.7; 1.6-8.4) while having reported 4-10 types of pain in other parts of the body other than the head, was associated with OR = 9.2 (3.7-23.0). An increased tendency to have OFP was seen in those individuals with higher levels of psychological distress (2.3; 1.4-3.9), high score on Life Event Inventory (2.6; 1.3-5.3), depressive symptoms (2.2; 1.2-4.0) and stress (2.2; 1.2-4.0). High self-esteem associated with lower risk of OFP (0.5; 0.3-0.9).nnnCONCLUSIONSnThis study shows that OFP is frequently reported by young adults aged 30-31 and supports a multifactorial etiology with factors from many domains, including local mechanical factors, psychological and co-morbidities. However, none of the childhood factors considered in this study were associated with OFP in adulthood.