Biomechanical properties of the lips in a pre-orthodontic sample of adolescents and young adults.

OBJECTIVES: To assess biomechanical properties of the lip muscles and to investigate their relationship with sex, age, body mass index (BMI), and cephalometric variables. MATERIALS AND METHODS: Demographic information and BMI were collected from 83 study participants seeking orthodontic treatment at the University of Otago. Tone, stiffness, and elasticity of the lip muscles were measured thrice at four different anatomical sites using a digital palpation device. To estimate method error, a duplicate set of measurements in a subsample of 20 participants was taken a week later. Sagittal and vertical cephalometric classifications were based on ANB and FMPA angles, respectively. Data were analysed using mixed models. RESULTS: Biomechanical properties of lip muscles were remarkably consistent both within and between different recording sessions. The lower lip had higher tone and stiffness than the upper lip. Both the upper and lower lip stiffness and tone were higher in females than in males, whereas upper lip elasticity was higher in males. Thinner upper lips had higher tone and were stiffer than thicker upper lips, whereas thinner lower lips were less elastic than thicker lower lips. Muscle tone and stiffness of both the upper and lower lips were lower in Class III than in Class I and Class II individuals. The upper lip of hyperdivergent individuals was less elastic than that of normodivergent and hypodivergent individuals, and stiffer than that of hypodivergent individuals. CONCLUSIONS: The biomechanical properties of perioral soft tissues can be reliably measured and vary with anatomical site, sex, and cephalometric measurements.

Factors associated with orthodontic pain.

BACKGROUND: Pain experienced at teeth during orthodontic treatment varies largely over time, with the reasons for its interindividual variability being largely unknown: age, sex, clinical activations, psychosocial factors and genetic polymorphisms of candidate genes are putative factors that may account to explain this variability. We aimed to investigate the effect of clinical, demographic, psychological and genetic factors on pain levels experienced during fixed orthodontic treatment. METHODS: A convenience sample of 183 patients undergoing full-fixed orthodontic treatment were recruited. Participant's pain levels were assessed seven times over a three-day period via a smartphone app. Clinical, demographic and psychological data were collected via questionnaires. This included the Pain Catastrophising Scale (Child version), the Corah Dental Anxiety Scale and the State and Trait Anxiety Inventory. Participants provided a DNA sample either in the form of blood or saliva, which were used for genotyping COMT gene rs6269, rs4680, rs4646310, NR3C1 gene rs2963155 and the HTR2A gene rs9316233. RESULTS: Bond ups had the greatest influence on perceived levels of pain experienced on teeth during orthodontic treatment, accounting for over 20% of total variance in pain response. High-pain responders had higher scores on pain catastrophising (magnification subscale). Self-reported pain during fixed orthodontic treatment was not influenced by sex, age, time into treatment, anxiety, nor by polymorphisms of COMT, HTR2A or NR3C1 genes. CONCLUSIONS: Pain on teeth resulting from orthodontic fixed appliances is stronger during bonds-up and in patients with high catastrophising scores. Demographics, type of clinical activations and the genetic polymorphisms investigated in this research had little or no impact on perceived pain levels.

Common variants of EDA are associated with non-syndromic hypodontia.

OBJECTIVE: The aim of this case-control study was to investigate the association between non-syndromic hypodontia and nineteen common variants of candidate genes ectodysplasin A (EDA), paired box 9 (PAX9), msh homeobox 1 (MSX1) and axis inhibition protein 2 (AXIN2). SETTINGS AND SAMPLE POPULATION: Sixty-one hypodontia cases were frequency-matched to 253 controls with no missing teeth (excluding the third molars). MATERIAL AND METHODS: Self-report data and DNA samples were collected from each participant. RESULTS: The sample had a mean age of 16.6 years (SD = 7.3), with most participants being female (59.6%), and of New Zealand European origin (75.4%). Using multiple logistic regression analysis, it was found that the T-allele of rs12853659 (EDA) and the G-allele of rs2428151 (EDA) were both associated with a higher risk of hypodontia (odds ratio, OR = 2.79, 95% CI = 1.11-7.01; and OR = 2.87, 95% CI = 1.04-7.94, respectively). The G-allele of rs2520378 (EDA) showed a protective effect with an OR of 0.61 (95% CI = 0.38-0.99). The EDA SNP findings were consistent with previous reports included in a meta-analysis. No associations were found with the PAX9, AXIN2 and MSX1 genes, after adjusting for sex and ethnicity. CONCLUSIONS: Common variants of the EDA genes are associated with specific phenotypes of non-syndromic hypodontia, thus confirming their role in the regulatory pathways of normal tooth development. However, larger samples are needed to investigate the association further.

Evaluation of objective and subjective treatment outcomes in orthodontic cases treated with extraction of a mandibular incisor.

OBJECTIVES: To analyze changes in occlusal characteristics following mandibular incisor extractions (MIE), to determine the usefulness of wax setups in treatment planning MIE cases and to compare the pre- and posttreatment dental attractiveness between MIE cases and nonextraction (NE) controls. MATERIALS AND METHODS: The Peer Assessment Rating (PAR) Index was used to score pre- and posttreatment dental casts of MIE cases (n = 14) and matched NE controls (n = 14). Occlusal characteristics were evaluated on diagnostic wax setups and posttreatment casts. Attractiveness of pre- and posttreatment cases judged on intraoral photographs of cases (n = 6) and controls (n = 6) were rated by 76 dental students and 10 laypeople using visual analogue scales (VAS). RESULTS: The difference in PAR score reduction (%) between the MIE and NE groups was not significant. Between the wax setup and posttreatment casts, there were moderate correlations in overjet, overbite, and right canine classification. There was no significant difference in pre- and posttreatment change in VAS scores (%) for attractiveness between the MIE (49.8 ± 4.3 [S.E.]) and control groups (40.8 ± 4.3 [S.E.]). However, there was a significant difference (P = .000) between the observer groups. CONCLUSIONS: There were no significant differences in the treatment outcomes of orthodontic cases treated with MIE or NE, indicating that MIE is a valid treatment option. A wax setup is moderately correlated with posttreatment results. Both laypeople and dental students rated posttreatment dental attractiveness higher than pretreatment in MIE and NE groups. Dental students tended to be more critical than laypeople in their ratings.

Long-term changes in oral health-related quality of life of standard, cleft, and surgery patients after orthodontic treatment: A longitudinal study.

INTRODUCTION: The aim of this study was to assess long-term changes and describe the trajectories of oral health-related quality of life (OHRQoL) in a cohort of cleft, surgery, and standard patients who received orthodontic treatment. METHODS: Standard (n = 16), cleft (n = 19), and orthognathic surgery (n = 22) patients completed the short-form of the Oral Health Impact Profile (OHIP-14) before treatment, immediately posttreatment, and approximately 5 years posttreatment. RESULTS: An overall reduction in OHIP-14 scores (improvement in OHRQoL) occurred after orthodontic treatment; however, this was only significant for the surgery and standard groups (P <0.05). The total OHIP-14 score increased significantly from posttreatment to 5 years follow-up for all 3 study groups (P <0.05). Relative to pretreatment, however, there were significant reductions in total OHIP-14 scores at 5 years posttreatment in the surgery group (-57.4%; P <0.05), but not in the standard sample (-24.2%; P >0.05). By contrast, the OHIP-14 score in the cleft group increased but not significantly (40.2%; P >0.05). Using a mixed model analysis, a significant interaction was detected between patient group and time (ie, study time point) (F = 6.0; P <0.0001), after adjusting for age and sex. CONCLUSIONS: Distinct patient groups showed different OHRQoL trajectories after orthodontic treatment. Treatment-related improvements in OHRQoL are maintained over time for surgery patients, but not for those with standard malocclusions and orofacial clefts.

Effect of orthodontic treatment on the periodontal tissues.

Reduced periodontal support is a challenge that clinicians often face during rehabilitation of compromised dentition. The close and intricate relationship between the periodontal tissues and the processes of tooth movement suggest that adjunct orthodontic therapy may play an important role in overcoming these problems. On the other hand, excessive movement of teeth beyond the anatomic boundaries of the alveolar process is commonly believed to contribute to further destruction of the periodontal tissues. This review evaluates the clinical effects of various orthodontic tooth movements on the surrounding periodontal soft tissues and alveolar bone. Another objective was to identify possible patient and treatment-related factors that may influence the response of periodontal tissue to specific orthodontic treatments. Particular emphasis is placed on specific tooth movements, such as extrusion, intrusion, space closure and arch expansion. Limitations of current research are also highlighted and discussed.

Management of missing mandibular second premolars: a review.

Tooth agenesis is the most common developmental dental anomaly and it is frequently associated with other dento-skeletal disturbances, such as structural variations of other teeth, late dental eruption, transpositions and crowding. Except for the third molars, the mandibular second premolars are the most commonly missing teeth. Oral rehabilitation of patients with missing mandibular premolars often requires a multi-disciplinary approach, and usually results in prolonged treatment time and a greater burden of care. An understanding of the aetiology and clinical features of hypodlontia is essential for the planning phase and the outcome of treatment. The purpose of the present review is, therefore, to discuss the aetiology of hypodlontia as well as to evaluate the clinical options available for the treatment of missing mandibular second premolars. An insight into future research directions and their clinical applications will also be discussed.

Morphometric growth changes of the nasopharyngeal space in subjects with different vertical craniofacial features.

INTRODUCTION: The purpose of this study was to morphometrically investigate the growth pattern of the adenoids in growing subjects with hyperdivergent and hypodivergent vertical craniofacial features. METHODS: In this retrospective study, we used a longitudinal sample of lateral cephalometric radiographs of 28 hyperdivergent and 30 hypodivergent subjects from 4 to 13 years of age. The radiographs were obtained from the American Association of Orthodontists Foundation Craniofacial Growth Legacy Collection. Measurements were made using digital tracings of the lateral cephalograms and point distribution models. Mixed-model analyses were used for statistical analysis. RESULTS: The mean distance between the sphenoid bone and the posterior nasal spine increased up to 5.3 mm over a 9-year span (95% CI, 4.1-6.5 mm; P <0.001). Furthermore, the mean distance between the sphenoid bone and the posterior nasal spine differed significantly (P = 0.029) between facial types; it was consistently greater (1.8 mm; 95% CI, 0.2-3.3 mm) in the hyperdivergent group. The nasopharyngeal airway area showed a trend to increase with age up to 12-fold (P <0.001). A significant interaction (P = 0.004) was found between age and facial type. Assessment of the adenoid shapes showed greater convexities in the hyperdivergent group, which were observable from an earlier age and for a longer duration. CONCLUSIONS: Clear differences in the morphometric growth pattern of the adenoids were found between facial types. Evaluation of adenoid shapes showed more prominent convexities that lasted longer in the long facial types than in the short facial types.

Oral health-related quality of life changes in standard, cleft, and surgery patients after orthodontic treatment.

INTRODUCTION: The purpose of this study was to investigate the effect of orthodontic treatment on oral health-related quality of life (OHRQoL) in groups of standard patients with severe malocclusions; cleft lip, cleft palate, or cleft lip and palate patients; and orthognathic surgery patients. METHODS: The study sample consisted of 83 consecutive patients undergoing treatment at the orthodontic unit of Christchurch Hospital, Christchurch, New Zealand, divided into 3 groups: 30 adolescents with severe malocclusions; 24 adolescents with cleft lip, cleft palate, or cleft lip and palate; and 29 adults with severe skeletal discrepancies requiring both orthognathic surgery and orthodontic treatment. Each patient completed the Short Form of the Oral Health Impact Profile (OHIP-14) questionnaire before and after orthodontic treatment. RESULTS: The baseline OHIP-14 subscale scores among the 3 study groups were significantly different, with the surgery patients having nearly twice the OHIP-14 scores of the other 2 groups for nearly half of the items (P <0.05). The surgery patients experienced the greatest reduction in OHIP-14 scores (ie, improvement in OHRQoL), with the largest effect sizes reported for the psychological discomfort (+2.73) and disability (+2.65) domains. The group with clefts experienced the smallest changes in OHIP-14 scores across all 7 domains (-0.03 to +0.63). After adjusting for age and sex, the surgical patients had a significantly greater reduction in pretreatment OHIP-14 scores than did the standard and the cleft patients (P <0.01). CONCLUSIONS: The effect of orthodontic treatment on OHRQoL varies for different patient groups even after adjusting for age and sex. The greatest improvement in OHRQoL occurred in adults with a need for orthognathic surgery, whereas the least improvement seemed to occur in adolescents with cleft lip, cleft palate, or cleft lip and palate.

Evidence of secular trends in a collection of historical craniofacial growth studies.

BACKGROUND/OBJECTIVES: Although secular trends have been well documented in the craniofacial region, there is no evidence to suggest that these temporal changes exist in samples used for orthodontic research. The aim of this study is to determine the effect of secular trends on craniofacial growth in a series of longitudinal birth cohorts that are frequently used in orthodontic research. MATERIALS/METHODS: Cephalometric data from serial lateral headfilms of 138 adolescents (total of 1252 cephalograms) were collected from the Craniofacial Growth Legacy Collection, which includes nine historical growth studies that were mostly conducted throughout the past century. Mixed-effects linear models were used to test the effect of 'year of birth (yob)', 'age', and their interaction on six sagittal (SNA, SNB, ANB, S-N, Co-A, Co-Po) and two vertical (N-Me, ANS-Me) cephalometric measurements. RESULTS: Five of the eight cephalometric variables showed a significant (P ≤ 0.017) 'yob' effect, with four of these indicating an increase over time (SNA, ANB, S-N, Co-A) and one indicating a decrease (SNB). Highly significant (P < 0.001) interactions between 'age' and 'yob' were found for the measurements SNA, ANB, Co-A, and S-N. LIMITATIONS: Some of the limitations of the present study include the use of a small, non-random sample of the original large-scale growth studies. CONCLUSIONS/IMPLICATIONS: Secular trends were found in the craniofacial growth records of the 138 participants derived from the longitudinal growth studies. These secular trends are likely to have important clinical implications for the findings of controlled clinical trials in orthodontics. More research is needed to establish the presence of secular trends in other historical collections.

Long-term remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo: a systematic review.

OBJECTIVE: To assess the long-term (>3 months) remineralizing effect of casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) on early caries lesions in vivo. DATA SOURCES: PubMed, Web of Science, Embase, Cochrane-Central, Science Direct, CBM, and CNKI were searched up to April 2013. Only articles in English and Chinese were included. Grey literature was also searched. Randomized or quasi-randomized clinical trials in which CPP-ACP was delivered by any method were considered. All relevant studies underwent two independent reviews. STUDY SELECTION: Of the 738 studies screened, 83 studies were reviewed and eight selected for inclusion in the final sample. The follow-up period of the studies included varied from 3 to 24 months. The long-term remineralizing effect of CPP-ACP in vivo was demonstrated in comparison with placebo in randomized controlled trial. However, there is conflicting evidence regarding the clinical efficacy of CPP-ACP when used in conjunction with fluoride toothpastes. No specific side effect related to CPP-ACP usage was found. CONCLUSIONS: CPP-ACP has a long-term remineralizing effect on early caries lesions in comparison with placebo, although this does not appear to be significantly different from that of fluorides. The advantage of using CPP-ACP as a supplement to fluoride-containing products is still unclear. High-quality, well-designed clinical studies in this area are still required before definitive recommendations can be made. CLINICAL SIGNIFICANCE: CPP-ACP is a promising remineralizing agent with a significant remineralizing effect that has been demonstrated in both in vivo and in vitro studies. The evidence to support its synergistic effect with fluoride is insufficient based on the current existing long-term human randomized controlled trials.

The effect of incremental lower lip advancement on oral pressure and EMG activity of the lower lip.

OBJECTIVES: During orthodontic arch expansion, the teeth are displaced against the perioral soft tissues. This can affect the equilibrium of forces that are thought to act on teeth, with consequent implications for long-term stability. The aim of this study was to investigate the effect of incremental lower lip advancement on intraoral pressure and electromyographic (EMG) activity of the lower lip. MATERIALS AND METHODS: Intraoral pressure and EMG activity was measured in 10 participants (2 males, 8 females; 22 years ± 7 months) as the lower lip was incrementally advanced using three custom-made vacuum-formed stents of differing labial thicknesses (0.5, 2.5, and 4.5 mm). A task paradigm including at rest recordings and maximal voluntary contraction was completed for each tray. RESULTS: Resting lip pressure generated increased as the lower lip was advanced (P < 0.001). The EMG activity of the lower lip increased significantly (P < 0.001) only once the lip was advanced from 2.5 to 4.5 mm. For the pressure recordings, the response to incremental lip advancement showed considerable individual variation. CONCLUSIONS: These findings suggest that the initial pressure increase on the lower incisors was mostly likely due to the inherent viscoelastic properties of the lower lip, while the pressure increase between the 2.5 and 4.5 mm advancement was due to increased muscle activity. Each individual also responded to lower lip advancement in a different yet subject-specific manner.

A three-dimensional evaluation of Maori and New Zealand European faces.

OBJECTIVE: Maori patients are often inappropriately treated using Caucasian norms, despite obvious differences in facial morphology. There is currently very little data concerning the nature and/or magnitude of these differences in facial features. The objective of the present study was therefore to evaluate the facial features of Maori and New Zealand (NZ) Europeans. METHODS: Two convenience samples of 30 Maori and 30 NZ Europeans, evenly matched for age and gender, were recruited from amongst students of the University of Otago, New Zealand. Using a 3D white-light scanner, 12 facial scans were taken of each participant, which were then merged to form a single 3D image of the face. Prior to scanning, round markers were fixed to the skin in order to facilitate the localisation of facial anthropometric points and from which vertical, sagittal, and transverse measurements were assessed from the 3D facial image. Univariate and multivariate analyses of variance were used to test for differences between the two groups before and after adjusting for body mass index (BMI). RESULTS: Significant differences were found in vertical, sagittal, and transverse facial dimensions, before and after adjusting for BMI. The overall face of Maori was significantly larger than that of NZ Europeans, although the facial proportions were generally similar. However, Maori had a broader face, more anterior position of the chin and reduced facial convexity in comparison with NZ Europeans (p < 0.01). CONCLUSION: Maori have markedly different sagittal facial features compared with NZ Europeans. These distinctive features may reflect important differences in environmental and genetic influences between the two populations. The findings from the present study may assist the clinician in the treatment planning and assessment of facial dysmorphology in these ethnic groups.

Evaluation of primary surgical outcomes in New Zealand patients with unilateral clefts of the lip and palate.

OBJECTIVE: To evaluate and compare the primary surgical outcomes of complete unilateral cleft lip and palate (UCLP) patients in two New Zealand cleft care centres. METHODS: This is a retrospective study of two providers of cleft care in New Zealand: Centre A in the North Island and Centre B in the South Island of New Zealand. Preorthodontic study models were evaluated from 28 UCLP patients from Centre A with primary surgical repairs performed between 1987-1999 and 31 UCLP patients from Centre B with primary surgical repairs performed between 1984-2000. Dental arch relationships were measured using the Goslon Yardstick. A Goslon score of 1 is considered to be an excellent outcome, whereas a score of 5 is a very poor treatment outcome. RESULTS: Intra- (Kappa: 0.84 - 0.93) and inter-examiner (Kappa: 0.63 - 0.69) reliabilities revealed good to very good agreement between examiners using the Goslon Yardstick. The mean Goslon score for Centre A was 3.5, with no cases in Group 1, five cases in Group 2 (17.9 per cent), nine cases in Group 3 (32.1 per cent), 11 cases in Group 4 (39.3 per cent) and three cases in Group 5 (10.7 per cent). The mean score for Centre B was 3.1, with one case in Group 1 (3.2 per cent), nine cases in Group 2 (29.0 per cent), eight cases in Group 3 (25.8 per cent), 11 cases in Group 4 (35.5 per cent) and two cases in Group 5 (6.5 per cent). There were no statistically significant differences between the two centres (p > 0.05). CONCLUSIONS: The outcome scores from the two cleft centres, based on historic records, were disappointing and higher than expected. It is recommended that a review of primary surgical protocols be implemented to ensure outcomes comparable with international standards. The results provide useful benchmarks for future comparisons of treatment.

Maxillofacial fractures sustained by unmounted equestrians.

Facial injuries caused by horses are relatively common among riding enthusiasts, but little is known about the nature of maxillofacial fractures sustained by those not mounted. We collected data on patients' characteristics, fractures sites, mechanisms of injury, and treatment of these fractures from the departmental records of the oral and maxillofacial unit at Christchurch Hospital, New Zealand between 1996 and 2008. Of 49 patients with equine-related facial fractures, 35 (mean (SD) age 35.8 (16.7) years) had sustained their injuries while unmounted (71%). Most of the fractures occurred in women (66%), of whom 39% were aged between 16 and 30 years. There was an increasing trend in the incidence of these fractures over much of the 13-year period. Most injuries were caused by kicks (69%), followed by head-butts (26%), and trampling (6%). The zygoma was the most common fracture site (63%), followed by the mandible (34%), and orbital floor (31%). Surgical intervention was required in 60% of cases.

Horse-related facial injuries: the perceptions and experiences of riding schools.

This study aimed to investigate the perceptions and experiences of New Zealand horse riding schools with regard to horse-related facial injuries. All the riding schools listed in the New Zealand electronic phonebook directory were surveyed by post. The survey questions covered riding schools' perceptions of rider profile, general and facial injury patterns and safety equipment used. The face was perceived to be the most common injury site by only 4% of respondents. Helmets were enforced in only 35% of the schools during unmounted activities. Nearly half the schools did not enforce any safety equipment for unmounted equestrians. Falls were perceived to be the most common cause of facial injury (41%), ahead of horse kicks (9%). Poor handling was cited as the most likely cause for horse kick-related injuries (67%). In summary, riding schools did not perceive the face to be among the most common horse-related injury sites. Safety protocols were generally directed towards mounted equestrians.

Features of odontogenic infections in hospitalised and non-hospitalised settings.

OBJECTIVE: To compare the sociodemographic and clinical features of odontogenic infections between hospitalised and non-hospitalised adult patients. METHODS: The two study groups consisted of inpatients (IP) and outpatients (OP) with odontogenic infections who were treated at Christchurch Hospital, New Zealand. Clinical and sociodemographic data were collected retrospectively from patients' hospital records. RESULTS: The study sample consisted of 28 IP (13.9%) and 174 OP (86.1%). There were no significant differences in age, gender or ethnicity between the two groups. A higher proportion of IP had trismus (75.0% IP; 6.9% OP), floor of the mouth oedema (10.7% IP; 0.6% OP) and decreased tongue mobility (10.7% IP; 1.7% OP). The IP group also had a greater proportion of multiple-space infections (39.3%) than the OP group (18.9%). The most commonly involved anatomical space in the OP group was the buccal space (49.4%), while that in the IP group was the submandibular space (57.1%). The submandibular, submental and submasseteric spaces were more likely to be involved in the IP group (p<0.05). The most common source of odontogenic infections in the IP group was the mandibular third molars (20.8%) and first/second molars (20.8%), while that in the OP group was the mandibular first/second molars (30.9%). CONCLUSIONS: There are important differences in the features of odontogenic infections between hospitalised and non-hospitalised patients. Some of these clinical signs may assist in recognising severe courses of odontogenic infections that may potentially require hospitalisation.

Work experiences, professional development and career prospects of New Zealand dental house surgeons.

OBJECTIVE: New dental graduates compete for house surgeon positions every year, despite little being known about the work experience gained from such posts. The main objectives of this study were to identify the nature of house surgeons' work experiences, their continued professional development (CPD) opportunities and the impact of hospital experience on their future career pathways. METHOD: A questionnaire was mailed to all 31 New Zealand dental house surgeons (response rate 100%). RESULTS: The majority of house surgeons (77.4%) found hospital work enjoyable, with nearly all (93.5%) perceiving themselves as better clinicians from their experience. Oral surgery, restorative dentistry, special needs dentistry and removable prosthodontics were the most commonly practised areas. The average weekly number of working hours was 42.3 hours for a normal week and 61.8 hours for an on-call week. Stress levels during on-call work were significantly higher than during day-to-day hospital work (p < 0.05). Departmental seminars were reported to be the most common form of CPD available at hospitals (74.2%), followed by hands-on clinical training (61.3%). More than half of the house surgeons (58.1%) planned to pursue a specialist career, with nearly 13% wishing to return to a New Zealand hospital in the future. CONCLUSIONS: A dental house surgeon position remains an attractive choice and offers an enjoyable experience for young graduates. Hospitals provide ample CPD opportunities and appear to play an influential role in a house surgeon's career pathway.

The oral health of older people: general dental practitioners' beliefs and treatment experience.

The purpose of this study was to examine New Zealand general dentists' beliefs about older people's oral health and to identify the important barriers that prevent dentists from treating institutionalized older adults. A postal survey was distributed nationwide to a representative sample of 700 dentists (response rate 64.5%). Dentists' beliefs were mostly consistent with current epidemiological knowledge, although most (81.5%) mistakenly believed that the root surface caries increment was greater than that for coronal caries. One in four had visited a long-term care (LTC) facility during the previous 2 years. Over three-quarters cited the inconvenience of leaving their practices as a barrier, and the lack of a financial incentive was cited by almost half. The results suggested that the areas most in need of attention were the LTC staff's oral health knowledge and attitudes, as well as government policies. Although dentists' beliefs, practices, and attitudes occasion some optimism, the increase in the dentate older population means that policymakers will need to examine efficient, dentist-acceptable ways of delivering care. The profession will need to develop and sustain an appropriate workforce.

Sports-related maxillofacial fractures over an 11-year period.

PURPOSE: To investigate the prevalence, anatomic sites, and management of sports-related maxillofacial fractures in New Zealand. PATIENTS AND METHODS: A retrospective analysis of 561 patients presenting with sports-related maxillofacial fractures between 1996 and 2006 was conducted. Variables analyzed included sociodemographic data, cause of injury, site of fracture, and method of treatment. RESULTS: The mean patient age was 26.2 years, with a male:female ratio of 9:1. Sports-related facial fractures accounted for 21.7% of all fractures, with most of these secondary to rugby (52.0%), cycling (15.3%), cricket (7.1%), and soccer (4.8%). Mandibular fractures were the most frequent presentation (41.4), followed by zygomatic (29.4%) and orbital floor fractures (16.9%). Almost 50% of the patients from each sport required active treatment, with the majority requiring open reduction and internal fixation of the fracture (60.3%). The prevalence of sports-related facial fractures increased between the first 6 years (17.6%) and the next 5 years (25.8%) of the 11-year study period. The March-to-August period had a considerably higher number of fractures compared with the rest of the year. CONCLUSIONS: Nearly 20% of all maxillofacial fractures were sports-related, with most occurring in males. The prevalence of sports-related facial fractures increased over the study period. Most of the fractures involved the mandible and zygoma. Active intervention was required for almost 50% of the injuries.