Incisor display during speech and smile: Age and gender correlations.

OBJECTIVES: To evaluate age- and gender-related changes in the soft tissues, incisors, and gingival display during rest, speech, and posed smile. MATERIALS AND METHODS: A total of 265 participants (122 men, 143 women) ranging in age from 19 years to 60 years were recruited for this study. Participants were divided into one of the following four age groups: 19 to 24 years, 25 to 34 years, 35 to 44 years, and 45 to 60 years. Image capture was performed using standardized videographic methods. Each video produced pictures where measurements were performed: rest, speech, and smile positions. RESULTS: A statistically significant gender dimorphism was apparent in most of the variables. There was a significant increase in the upper lip length and lip commissures height with aging and more markedly in men. A greater exposure of mandibular incisor with increasing age was a feature in both genders. With increasing age there was a significant decrease in maxillary incisor display, especially for men. CONCLUSIONS: After 25 years of age there is significant difference in the aging process between men and women. Gingival and maxillary incisor display during speech and smile is a youthful and feminine characteristic.

Capture, analysis and measurement of images of speech and smile dynamics

INTRODUCTION: Dynamic analysis of smile and speech makes it easier to identify the features that define facial esthetics while allowing researchers to study different variables and observe the effects of aging. OBJECTIVE: The aim of this study is to present a method for capturing, analyzing and measuring video images to support the study of speech and smile dynamics. METHODS: Natural head positioning was standardized with the aid of a head holder (cephalostat). Image acquisition is performed with a video camera attached to a tripod, positioned at a fixed distance of 0.90 m. The subjects are trained to say out loud: "Tia Ema torcia pelo antigo time da Tchecoslováquia" and then to smile. The resulting images are fragmented and yielded four pictures that best represent a resting position, the least exposure of maxillary incisors, the greatest exposure of upper and lower incisors, and a posed smile. A freeware computer program called VIDEOMED was used to carry out measurements. CONCLUSION: The method presented in this study is an effective resource to record images captured during rest, speech and smile, thereby enabling a better understanding of changes in perioral soft tissues.

INTRODUÇÃO: a análise dinâmica do sorriso e da fala facilita a identificação de características da estética facial, possibilita o estudo de diferentes variáveis e viabiliza a observação dos efeitos do envelhecimento. OBJETIVO: o objetivo desse trabalho é apresentar um método de captura, análise e medição de imagens por meio de vídeos, para o estudo da dinâmica da fala e do sorriso. MÉTODOS: foi padronizado o posicionamento da cabeça em posição natural com o auxílio de um cefalostato. A captura de imagens foi realizada por uma câmera de vídeo, acoplada a um tripé, posicionada a uma distância fixa de 0,90m. Os indivíduos foram treinados a pronunciar a frase "Tia Ema torcia pelo antigo time da Tchecoslováquia" e depois sorrir. As imagens geradas foram fragmentadas de forma a gerar quatro quadros que melhor representassem o repouso, a menor exposição de incisivo superior, a maior exposição de incisivos superior e inferior, e o sorriso posado. Para realização das medidas, utilizou-se um programa específico, chamado VideoMed. CONCLUSÃO: o método apresentado torna possível um registro eficaz para captura de imagens durante o repouso, a fala e o sorriso, possibilitando um maior entendimento sobre as alterações dos tecidos moles peribucais.

Critérios para o diagnóstico e tratamento estável da mordida aberta anterior / Criteria for diagnosing and treating anterior open bite with stability

INTRODUÇÃO: dentre as más oclusões, a mordida aberta anterior é considerada uma das anomalias de mais difícil correção, sobretudo no que se refere à sua estabilidade. A literatura possui inúmeros trabalhos sobre o tema, porém com informações controversas e conflitantes. As discordâncias ocorrem desde a definição do que é a mordida aberta, passando por seus fatores etiológicos, até os possíveis tipos de tratamentos. Provavelmente, a falta de consenso sobre a etiologia da mordida aberta anterior originou tratamentos diversificados, o que pode explicar o alto índice de instabilidade pós-tratamento dessa má oclusão. OBJETIVO: rever os conceitos de etiologia, tratamento e estabilidade da mordida aberta anterior e apresentar critérios para o diagnóstico e tratamento dessa má oclusão, baseados em sua etiologia, e exemplificados por casos tratados e estáveis em longo prazo.

INTRODUCTION: Anterior open bite is considered a malocclusion that still defies correction, especially in terms of stability. The literature reports numerous studies on the subject but with controversial and conflicting information. Disagreement revolves around the definition of open bite, its etiological factors and available treatments. It is probably due to a lack of consensus over the etiology of anterior open bite that a wide range of treatments has emerged, which may explain the high rate of instability following the treatment of this malocclusion. OBJECTIVE: Review the concepts of etiology, treatment and stability of anterior open bite and present criteria for diagnosing and treating this malocclusion based on its etiology, and provide examples of treated cases that have remained stable in the long term.

Multidisciplinary solution for an avulsed upper central incisor: case report.

This case report refers to an 18-year-old female who suffered from dental trauma when she was 7 years old caused by a bicycle accident. Her maxillary right central incisor was avulsed, and the left one was extrusively luxated. The left central incisor was correctly repositioned and immobilized with a semi-rigid splint. The right one could not be found. She presented with class II malocclusion and severe negative arch-length discrepancies in both arches. The treatment objectives were the following: recover smile esthetics by replacing the maxillary right central incisor, correct the class II relationship, and optimally reduce mandibular and maxillary crowding. Extractions of the maxillary left lateral incisor and the lower right first bicuspid were performed; thus, the maxillary right lateral incisor would function as a maxillary right central incisor, the canines would function as lateral incisors, and the first bicuspids would function as canines. This allowed for the malocclusion to be corrected while simultaneously reestablishing the smile esthetics, without the use of an osseointegrated implant. A good occlusion with coincident upper and lower midlines was achieved. After orthodontic therapy, the patient underwent periodontal surgery to improve her gingival margins. Subsequent teeth bleaching was performed, and the patient received six porcelain veneers. A combination of orthodontic space closure and prosthetic rehabilitation may be the best treatment option after severe traumatic tooth loss.

Exposição dos incisivos durante a fala e o sorriso: correlação com a idade e o gênero / Incisors display during speech and smile: age and gender correlations

O objetivo deste estudo foi avaliar dinamicamente o comportamento dos tecidos moles peribucais, a exposição de incisivos superiores e inferiores e a exposição gengival de indivíduos do gênero feminino e masculino de diferentes faixas etárias durante o repouso, a fala e o sorriso posado. A amostra foi composta por 265 indivíduos com idades variando de 19 a 60 anos, distribuídos em quatro grupos etários: 19-24 anos; 25-34 anos; 35-44 anos e 45- 60 anos. A captura das imagens foi realizada por uma câmera de vídeo digital, acoplada a um tripé, posicionada a uma distância fixa em linha reta de 90cm entre a face do participante e a lente da câmera. O posicionamento da cabeça foi padronizado na posição natural com o auxílio de um cefalostato. Os indivíduos foram treinados a pronunciar a frase "Tia Ema torcia pelo antigo time da Tchecoslováquia" e depois a sorrirem. Os vídeos foram transferidos para o computador e fragmentados de forma a gerar quatro quadros estáticos que melhor representasse o repouso, a menor exposição de incisivo central superior na fala, a maior exposição de incisivo central superior e inferior na fala e o sorriso posado. Para realização das medidas utilizou-se o programa VIDEOMED. Ocorreu um aumento significativo no comprimento do lábio superior e na altura das comissuras labiais direita e esquerda nos indivíduos do gênero masculino. Houve uma redução significativa da menor e da maior exposição do incisivo central superior durante a fala em ambos os gêneros, porém de forma mais acentuada nos indivíduos do gênero masculino. O aumento significativo da exposição do incisivo central inferior durante a fala, conforme o aumento da idade foi uma característica comum para ambos os gêneros. Ocorreu uma redução significativa da exposição máxima do incisivo central superior no sorriso posado nos indivíduos do gênero masculino. Houve uma redução significativa da exposição da margem gengival superior no sorriso posado em todos os grupos etários avaliados, porém de forma mais acentuada nos indivíduos do gênero masculino. Os resultados revelam que a partir dos 25 anos de idade é possível identificar diferenças estatisticamente significativas quanto ao gênero.

The aim of this study was to dynamically evaluate the behavior of the perioral soft tissues, the exposure of maxillary and mandibular incisors and gingival exposure from males and females individuals of different ages during rest, speech and posed smile. The sample consisted of 265 subjects with ages ranging from 19 to 60 years, divided into four age groups: 19-24 years; 25-34 years; 35-44 years and 45-60 years. Image capture was performed with a digital video camera, attached to a tripod, positioned at a fixed distance in a straight line of 90cm between the participant's face and the camera lens. The head position was standardized in the natural position with the aid of a cephalostat. The subjects were trained to pronounce the phrase "Tia Ema torcia pelo antigo time da Tchecoslováquia" and then to smile. The videos were transferred to the computer and fragmented in order to produce four static frames that best represented the rest, the least exposure of maxillary central incisor during speech, the greatest exposure of maxillary and mandibular central incisor during speech and the posed smile. VIDEOMED program was used to perform measurements. There was a significant increase in the upper lip length and in the height of the right and left labial commissures in males. There was a significant decrease in the least and in the greatest exposure of maxillary central incisor during speech in both genders, more markedly in males. The significant increased of mandibular central incisor exposure during speech with increasing age was a common feature for both genders. There was a significant decrease in the maximum exposure of the maxillary central incisor in the posed smile in males. There was a significant decrease in the maxillary gingival margin exposure during the posed smile in all age groups, more pronounced in males. Results show that after 25 years of age it is possible to identify statistically significant differences according to gender.

Mental health and psychiatric pharmacy instruction in US colleges and schools of pharmacy.

OBJECTIVES: To describe the extent of psychiatric pharmacy instruction in US pharmacy curricula, including course and faculty characteristics and mental health topics taught in clinical therapeutics-based courses. METHODS: An 11-item survey instrument (54% response) was developed and mailed to 91 colleges and schools of pharmacy. RESULTS: Over 75% of colleges and schools employed a psychiatric pharmacist; however, less than 50% of faculty teaching psychiatric pharmacy content were psychiatric pharmacy specialists as defined in the study. All colleges and schools included psychiatric topics as part of a therapeutics-based course with an average of 9.5% of course content devoted to these topics. About 25% of colleges and schools offered elective didactic courses in psychiatric pharmacy. Only 2 schools required a psychiatric pharmacy advanced pharmacy practice experience (APPE), but about 92% offered elective APPEs. The mean number of hours spent on lecture- and case-based instruction across all colleges and schools was highest for depression and lowest for personality disorders. CONCLUSIONS: There is a need for colleges and schools of pharmacy to better identify and standardize the minimal acceptable level of didactic instruction in psychiatric pharmacy as well as the minimal level of specialty qualifications for faculty members who teach this subject.

The impact of fear of HIPAA violation on patient care.

The deadline for compliance with the privacy rule of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) was April 14, 2003. Understandably, many psychiatrists and other mental health providers have been focusing on compliance. This brief report discusses the negative impact of efforts to implement HIPAA on patient care in a community-based mental health system. Three cases highlight several issues: fear of violating HIPAA, failure to understand HIPAA's privacy regulations, and ethical concerns. The authors discuss the key issues and address implications for practice. Several recommendations are offered for maintaining excellent patient care while complying with HIPAA.