Prevalence of white spot lesions and gingival index during orthodontic treatment in an academic setting.

INTRODUCTION: The objective of this study was to determine the prevalence of white spot lesions (WSL) in orthodontic patients in an academic setting. Specific aims include using a novel combination to measure plaque accumulation (PA) and detect the association between WSL and PA and the associations between multiple independent variables. METHODS: Cross-sectional data were collected on 111 patients. To enhance standardization, a combination of plaque-disclosing agents and standardized intraoral photographs was used to analyze plaque index (PI) and WSL for all teeth except molars. Factors including time in fixed appliances (FA), number of teeth, location of the lesions, and demographic information were reported. A multiple linear regression model was used to detect associations between the PI and WSL and the independent variables (P <0.05). RESULTS: Approximately 79.3% of participants had at least one WSL, with a mean of 4 affected teeth per patient. A significant association was found between time in FA and the more severe PI reporting (P <0.001). There was no significant association between WSL and PI or the other variables. WSL was greater in the maxilla than in the mandible. PI was greater on the left than on the right side. Interexaminer reliability was assessed for PI and WSL (κ = 0.93 and 0.92). CONCLUSIONS: The prevalence of WSL for orthodontic patients treated at this institution was greater than previously reported in the literature. In addition, the severity of PI was associated with increased time in FAs. Combining the proposed method of reporting PA facilitates standardization, calibration, and documentation in an academic environment.

Comparison of BMI, AHI, and apolipoprotein E ε4 (APOE-ε4) alleles among sleep apnea patients with different skeletal classifications.

STUDY OBJECTIVES: This case-control study investigated whether variations within the APOE-ε gene were associated with having a convex facial profile (skeletal Class II) compared to exhibiting a straight or concave facial profile (Class I or Class III) among patients with obstructive sleep apnea (OSA). Associations between the apnea-hypopnea index (AHI) and body mass index (BMI) scores for these OSA patients were also examined in the context of facial profile. METHOD: OSA patients with an AHI ≥ 15 were recruited from a sleep clinic and classified by facial and dental occlusal relationships based on a profile facial analysis, lateral photographs, and dental examination. Saliva was collected as a source of DNA. The APOE-ε1-4 allele-defining single nucleotide polymorphisms (SNPs) rs429358 and rs7412 were genotyped. A χ(2) analysis was used to assess Hardy-Weinberg equilibrium and for association analysis (significance at p < 0.05). ANOVA and Fisher exact test were also used. RESULT: Seventy-six Caucasian OSA patients participated in the study-25 Class II cases and 51 non-Class II cases. There was no association of the APOE-ε4 allele with facial profile among these OSA patients. Class II OSA patients had significantly lower BMIs (30.7 ± 5.78) than Class I (37.3 ± 6.14) or Class III (37.8 ± 6.17) patients (p < 0.001), although there was no statistical difference in AHI for Class II patients compared with other groups. CONCLUSION: OSA patients with Class II convex profile were more likely to have a lower BMI than those in other skeletal groups. In fact 20% of them were not obese, suggesting that a Class II convex profile may influence or be associated with OSA development independent of BMI.

Dens evaginatus: the hornet's nest of adolescent orthodontics.

Dens evaginatus is a rare dental anomaly that occurs during tooth development and results in an abnormal protrusion from the occlusal surface of the affected tooth, often in the area of the central groove between the buccal and lingual cusps. Of clinical importance to the orthodontist is that these occlusal tubercles fracture easily or can be worn away, resulting in direct pulp exposure in a noncarious tooth. This can cause severe complications, including loss of tooth vitality, facial infection in the form of an abscess or cellulitis, or osteomyelitis of the jaw. If extraction of premolars is indicated for orthodontic treatment after careful diagnosis and treatment planning, it is paramount to establish the health of the premolars that will remain in the dentition before extracting the teeth.

Patient compliance with orthodontic retainers in the postretention phase.

INTRODUCTION: Retention is an important, even critical, component of orthodontic treatment. There is little research on practice protocols and patient compliance with long-term or short-term retention. This lack of information leaves our specialty with many opinions and practice protocols. The purposes of this study were to evaluate and quantify orthodontic retainer wear according to several variables, including patient age, sex, time in retention, and retainer type, and to identify predictors of compliance and reasons for noncompliance with removable orthodontic retainers. METHODS: Questionnaires were mailed to patients who finished full fixed appliance therapy in either the orthodontic graduate clinic or the orthodontic faculty practice at the University of Kentucky within the past 6 years. Of the 1085 questionnaires mailed, 280 were returned (25.8%). A logistic regression model that described the probabilities of retainer wear was created (P <0.0001). RESULTS: Patient compliance was greater with vacuum-formed retainers (VFRs) for the first 2 years after debonding. However, compliance with VFRs decreased at a much faster rate than with Hawley retainers. Because of this, patient compliance was greater with Hawley retainers at any time longer than 2 years after debonding, and patient compliance overall was greater with Hawley retainers. CONCLUSIONS: This evidence disagrees with the current anecdotal trend of orthodontists who favor switching from Hawley retainers to VFRs. An unexpected finding was that patients reported few esthetic concerns about retainers, and the few that were reported were equally distributed between Hawley retainers and VFRs.

Heuristic reasoning and cognitive biases: Are they hindrances to judgments and decision making in orthodontics?

Studies show that our brains use 2 modes of reasoning: heuristic (intuitive, automatic, implicit processing) and analytic (deliberate, rule-based, explicit processing). The use of intuition often dominates problem solving when innovative, creative thinking is required. Under conditions of uncertainty, we default to an even greater reliance on the heuristic processing. In health care settings and other such environments of increased importance, this mode becomes problematic. Since choice heuristics are quickly constructed from fragments of memory, they are often biased by prior evaluations of and preferences for the alternatives being considered. Therefore, a rigorous and systematic decision process notwithstanding, clinical judgments under uncertainty are often flawed by a number of unwitting biases. Clinical orthodontics is as vulnerable to this fundamental failing in the decision-making process as any other health care discipline. Several of the more common cognitive biases relevant to clinical orthodontics are discussed in this article. By raising awareness of these sources of cognitive errors in our clinical decision making, our intent was to equip the clinician to take corrective action to avoid them. Our secondary goal was to expose this important area of empirical research and encourage those with expertise in the cognitive sciences to explore, through further research, the possible relevance and impact of cognitive heuristics and biases on the accuracy of orthodontic judgments and decision making.

Temporary anchorage device insertion variables: effects on retention.

OBJECTIVE: To quantify the influence of temporary anchorage device (TAD) insertion variables on implant retention. MATERIALS AND METHODS: Three hundred thirty TADs from three companies were placed in synthetic bone replicas at variable depths and angulations and compared. Clinically relevant forces were applied to the TADs until failure of retention occurred. RESULTS: In all three implants, increased insertion depth increased implant retention. As the distance from the abutment head to the cortical plate increased, the retention of all three implants decreased. A significantly greater force to fail was required for a 90 degrees insertion angle than for 45 degrees or 135 degrees insertion angles. No significant difference was found between the 45 degrees and 135 degrees insertion angles. A significant reduction in force to fail occurred when comparing 90 degrees and 45 degrees oblique insertion angles. CONCLUSIONS: Increasing penetration depth of TADs results in greater retention. Increased abutment head distance from cortical plate leads to decreased retention. Placement of TADs at 90 degrees to the cortical plate is the most retentive insertion angle. Insertion at an oblique angle from the line of force reduces retention of TADs.

Implant rehabilitation for a patient with Hallerman-Streiff syndrome: a case report.

Hallermann-Streiff syndrome is a rare genetic disorder characterized by craniofacial malformations, sparse hair, eye abnormalities, dental defects, degenerative skin changes, and short stature. The syndrome has many implications for dental treatment. Patients typically present with multiple missing and poorly formed teeth. The purpose of this case report is to discuss the overall management of a patient with Hallermann-Streiff syndrome by oral maxillofacial surgery, orthodontic treatment, and prosthodontic reconstruction.

Evaluation of orthodontic mini-implant anchorage in premolar extraction therapy in adolescents.

INTRODUCTION: The purpose of this study was to determine the success rate, positional stability, and patient evaluation of orthodontic mini-implants (OMIs). METHODS: Thirteen patients (8 girls, 5 boys; average age, 14 years 10 months) were treated with 82 OMIs measuring 1.6 mm in diameter and 6 mm in length placed in the buccal alveoli (1 unloaded OMI and 1 loaded OMI per quadrant). The right or left side of each arch was randomly selected for immediate loading with up to 250 g of direct force; the contralateral side was loaded 3 to 5 weeks later. Serial impressions, clinical observations, and orthodontic maintenance were performed until adequate space closure was achieved. RESULTS: The overall OMI success rate was 70.73%. As calculated with a mixed-model analysis, there was no statistically significant difference between the success rates of immediately loaded OMIs (80.0%) and delayed loaded OMIs (80.95%). The combined success rate for loaded OMIs (80.49%) was significantly higher than that of unloaded OMIs (60.98%). Patients' motivation for OMI treatment was primarily the desire to avoid headgear. Using a 100-mm visual analog scale, the patients indicated average scores of 54.77 for the amount of pain during OMI placement and 27.10 for the amount of pain during OMI removal. CONCLUSIONS: OMIs are a predictable, effective, and well-tolerated anchorage source for adolescents. Neither the timing of force application nor the force itself precipitated failure of the OMIs. Orthodontic forces can be applied immediately to OMIs. Various anatomic and behavioral conditions unique to adolescents and a clinical learning curve can affect the success rate of OMIs.

Hypodontia as a risk marker for epithelial ovarian cancer: a case-controlled study.

BACKGROUND: Genetic mutations that result in hypodontia also may be associated with abnormalities in other parts of the body. The authors conducted a study to establish the prevalence rates of hypodontia among subjects with epithelial ovarian cancer (EOC) and control subjects to explore possible genetic associations between these two phenotypes. METHODS: The authors recruited 50 subjects with EOC and 100 control subjects who did not have EOC. The authors performed a dental examination on each subject to detect hypodontia, and they reviewed pertinent radiographs and dental histories. They also recorded any family history of cancer and hypodontia. RESULTS: The prevalence of hypodontia was 20 percent for EOC subjects and 3 percent for control subjects. The difference between these two hypodontia rates was significant. This difference implied that women with EOC are 8.1 times more likely to have hypodontia than are women without EOC. The severity of hypodontia was similar between the two groups, with one to two teeth being affected. Maxillary lateral incisors followed by second premolars were the most frequently affected teeth. CONCLUSION: The preliminary data suggest a statistical association between hypodontia of the permanent dentition and EOC. CLINICAL IMPLICATIONS: Genetic analysis of the genes of interest is necessary to explore similarities between hypodontia and EOC further. An association could allow hypodontia to serve as a potential risk marker for EOC.

Realigning biomedical science instruction in predoctoral curricula: a proposal for change.

Currently in North America, there is an active dialogue going on about the state of predoctoral dental education and the need for curriculum change, innovation, and the adoption of contemporary, competency-based educational models. At the institutional level, curriculum committees struggle with requests from faculty to add new content to an overburdened didactic and clinic schedule. This article will describe potential solutions centering on the role and scope of the biomedical sciences in predoctoral dental education. The authors propose that dental educators and institutions reconsider the current admission prerequisites and curriculum content of the biomedical sciences in predoctoral programs. The proposed changes are intended to eliminate content redundancy between undergraduate and predoctoral dental education by integration of the biomedical sciences--in particular, biochemistry, microbiology, and physiology--into other clinically oriented coursework and learning experiences in the curriculum based on a pathophysiology model that fosters students' comprehension of the etiology of oral and systemic diseases encountered by the general dental practitioner. The authors explore how changes in the biomedical science prerequisites for dental school matriculation and associated modifications in curriculum focus and content would impact admissions testing, composition of national board exams, and strategies for teaching and learning within dental schools.

Racial variations in cephalometric analysis between Whites and Kuwaitis.

The objective of this study is to determine whether (1) Kuwaiti adolescents differ from Caucasian adolescents with respect to their cephalometric values; (2) sex plays a role in the differences between the two groups; and (3) a need exists to develop cephalometric standards for the Kuwaiti population. Standardized cephalometric films were obtained from 36 Kuwaiti females and 32 Kuwaiti males between the ages 11 and 14 years. Only subjects with Class I molar occlusion and a positive overjet of no more than 4 mm were selected. Each subject was age matched with White cephalometric values. Intraexaminer error, paired, and two-sample t-tests were made. The results show that there were significant differences between the Kuwaiti population and the Caucasian population for the majority of the variables tested (P < .01). Sex produced no significant effect on any of the variables studied. The Kuwaiti population has fuller lips, more facial convexity, greater dental protrusion, a more retruded and smaller mandible, and shorter posterior face height than the Caucasian population.

Psychiatry in orthodontics. Part 1: Typical adolescent psychiatric disorders and their relevance to orthodontic practice.

Adolescence is a time of rapid physical and mental development. It is also a time when many diagnosable psychiatric diseases are first noticed. A prior study showed that a high rate of suicidal behavior is seen in orthodontic practices. The orthodontist is in a unique position among medical practitioners because treatment occurs over several years with frequent appointments. This article is a current review of the etiology, diagnosis, and therapy for several pertinent mental disorders that occur in adolescents, including mood disorders, schizophrenia, attention-deficit hyperactivity disorder, personality disorders, and eating disorders. All have been associated with high rates of suicidal behavior and completed suicides. With a keen eye for the development of psychiatric issues, the orthodontist is in a position to make appropriate referrals, if needed.

Psychiatry in orthodontics. Part 2: Substance abuse among adolescents and its relevance to orthodontic practice.

Substance abuse by adolescents is a serious problem that will touch every orthodontic practice. Recent data show that 40% of tenth graders in the United States will use an illicit drug at some time, and 18% will do so in a 30-day period. These are significant figures that should impact orthodontic diagnosis and treatment planning. The nature of orthodontic treatment is unique in that the orthodontist will see relatively healthy adolescent patients on a monthly basis over a period of years. The orthodontist is in a prime position to recognize potential substance abuse problems and make referrals. This article discusses various types of substance abuse, diagnosis, options for referral, and orthodontic implications.

Efficacy of a wax containing benzocaine in the relief of oral mucosal pain caused by orthodontic appliances.

During orthodontic treatment, pain and discomfort of the oral mucosa can be experienced as a result of trauma from the appliances caused by increased friction between mucosal tissue and the surface of the brackets. Currently, orthodontists have few remedies to prevent or relieve this mucosal irritation. The orthodontist can give the patient wax to cover the brackets as a prophylactic measure or to use as needed on specific irritating appliances. Orthodontic wax contains no analgesic components. The purpose of this study was to determine the efficacy of an orthodontic wax containing benzocaine that is released over time in a controlled manner. This randomized, prospective, double-blind, clinical trial compared patients' responses to the wax with benzocaine and the currently used unmedicated orthodontic wax. Seventy patients, 35 in each treatment group, were instructed to apply the wax in a specific manner, and their pain levels were recorded at 6 different time points. The pain levels were analyzed with a repeated-measure analysis of variance (ANOVA) model with factors of treatment (medicated wax vs unmedicated wax) and times (6 levels). Post-hoc pair-wise comparisons were made on the basis of the Fisher least significant difference procedure. The results of this study clearly indicated that the pain profile over time of the group that received the wax containing benzocaine was significantly different from that of the subjects who received the unmedicated wax. The medicated group had significantly lower pain levels at every time point after the first hour (P <.0003 in each case) compared with the unmedicated group. The medicated wax was effective immediately and continued to reduce pain in greater magnitude than did the unmedicated wax. A wax applied to orthodontic brackets that slowly and continuously releases benzocaine is significantly more effective at reducing the pain associated with mucosal irritation than is the current option used by most orthodontists.