Functional needs in orthognathic patients with different sagittal skeletal discrepancies.

OBJECTIVES: This retrospective study aimed to evaluate the relationship between the Index of Orthognathic Functional Treatment Need (IOFTN) and sagittal skeletal discrepancy (ANB angle) among orthognathic patients. STUDY DESIGN: Records of 403 orthognathic patients (229 females/174 males, aged 16-50 years) were reviewed. Malocclusion type (incisor-based), sagittal skeletal relationship (ANB angle), and IOFTN scores were documented. Spearman correlation coefficient (r) and scatter plots were utilized to examine the relationship between functional need (IOFTN scores) and sagittal skeletal discrepancy (ANB angle). Regression analyses were conducted to determine the extent to which variations in IOFTN scores could be attributed to variations in ANB angles. RESULTS: Class III malocclusion/sagittal skeletal pattern were most prevalent (62.3%). The Spearman correlation coefficient (r) for the entire sample was -0.297 (P < .001), indicating a weak negative correlation. Linear regression analysis demonstrated a coefficient of determination of 0.069, indicating that approximately 6.9% of the variance in IOFTN data could be accounted for by variations in ANB angles. Upon stratifying data by different malocclusions, coefficients of determination were 0.065, 0.034, and 0.089 for class I, II, and class III malocclusions, respectively. CONCLUSION: The observed linear relationships between sagittal skeletal discrepancy (ANB angle) and IOFTN score were weak and lacked clinical significance.

General dentists' awareness of orthodontic treatment needs of patients and their referral practices.

Background: Since general dentists (GDs) usually act as the primary referral source for the patients in need of orthodontic treatments, having the proper knowledge and understanding of the accurate diagnosis of clinical situations is very important. The aim of this study was to assess GDs about the identification of orthodontic treatment needs and their referral practices. Materials and Methods: This descriptive and analytical cross-sectional study was carried out in Iran 2020. A questionnaire consisting of three main parts was designed and distributed electronically among GDs. The first section included 11 image and scenario-based questions meant to assess the ability of GDs to correctly diagnose the orthodontic treatment needs of the patients. The next two parts were to assess the dentists' knowledge of the necessity of referral to an orthodontist with 11 questions, and the proper timing of orthodontic treatments with 8 questions. Data were analyzed using SPSS 26, by conducting Mann-Whitney, Kruskal-Wallis, and correlation tests α = 0.05. Results: Among 384 participated dentists, 50.3% (193) were female. The mean score of knowledge was 17.3 ± 3.5 out of 30. The highest percentage of good knowledge (70% of range) was related to the diagnosis of orthodontic problems, while the lowest one belonged to the referring pattern. There was a weak positive correlation between the working experience and the proper timing of referral (R = 0.15, P = 0.004 (. Kruskal-Wallis test also showed a significant difference between the total knowledge scores (P = 0.04) and the knowledge of the proper timing of treatment (P = 0.04) based on the age groups of participants. Eighty-seven percentage (n = 334) reported that they would refer the patients in need of orthodontic treatment. Conclusion: The knowledge level of orthodontic treatment needs among GDs was moderate, thus emphasizing the importance of planning more educational courses for them to improve their knowledge, thus reducing the possible detriments of postponed or inaccurate treatments.

Utilization of dental care among adult populations: a scoping review of applied models.

BACKGROUND: The timely and appropriate utilization of dental health care is essential to the prevention and accurate treatment of oral diseases. Therefore, it is crucial that managers, health professionals and healthcare providers be fully aware of the predictors encouraging the utilization of dental services and reduce social inequalities. In this scoping review, we aimed to analyze the published articles and reports to find out the factors associated with dental services utilization and the comprehensiveness of the applied models among general adult populations. MATERIALS AND METHODS: This scoping study was based on the 5-steps of Arksey and O'Malley framework. Keywords were selected under two main concepts: determinants of dental care utilization and the concept of the applied models. Searches were conducted in some electronic databses including PubMed, Google Scholar and Scopus with variations, and a combination of the keywords under the two main afore-mentioned concepts. All the relevant articles reporting the utilization of dental care and its potential predictors among adult populations were chosen. No restrictions involving terms of study time, location or methodological aspects of oral health utilization were considered. Using tables and charts mapping, we tried to group the studies based on the year of their publication, geographic distribution, the range of included indices and the type of their measurement. Also, a directed content analysis method was used to investigate the comprehensiveness of the studies in regard to considering the determinant factors at different levels suggested by the Andesen model. RESULTS: Fifty-two articles were included in the analysis. Thirty-six (69%) had been published between 2016 and 2020. The United States had conducted the most research in this scope. About 30% of studies had mentioned all three domains of demographics, social structure and beliefs, simultaneously. To evaluate the enabling factors, in 84.61% and 59.61% of studies, the income levels and insurance feature were assessed, respectively. 57.69% of the retrieved studies considered the perceived need features and 38.46% referred to the evaluated ones. The dental services utilization, in terms of the last visit during the "past 12 months", was assessed more commonly. Only 11.54% of studies did evaluate the contextual characteristics and about 71.15% of articles were relatively comprehensive. CONCLUSION: Overall, it seems that in most of the studies, not all of the determinant factors at different levels of the Andersen model have been considered. In order to discover the conceptual linkages and feedback loops of the model, it is essential to conduct more comprehensive research in the future.

Access to dental care among 15-64 year old people.

INTRODUCTION: The current study aims to study people's access to oral and dental health-care services and their satisfaction with the services provided to them. MATERIALS AND METHODS: A descriptive study with multi-stage sampling was conducted on 1360 people aged 16-64 years residing in Isfahan city, Iran. The required data were collected by a questionnaire which comprised of three main parts: demographic characteristics, patients' access to oral and dental health-care services and its barriers and participants' satisfaction with access to services. Data were analyzed by SPSS statistical software. RESULTS: The results showed 40% of participants reported an average level for oral health, and 82% of them did not have any problems regarding access to dental care facilities. The main causes of their dissatisfaction were high cost of services (60%) and insufficient health insurance coverage (40%). About 73% reported that they had to spend 30 min or less to access to a dental health-care facility. In addition, 50% of participants were satisfied with the provided services. The main reported reasons for referring to dentists were oral and dental problems (69%) and regular check-ups (15%). There was no significant relationship between participants' gender, education level, insurance coverage, and access to dental health-care centers (P > 0.05). CONCLUSION: Most participants were satisfied with access to dental healthcare, but they were dissatisfied with the costs and inadequate insurance coverage. About half of the participants were satisfied with the services provided to them, and the highest level of satisfaction was reported for easy access to health-care centers.

Prevalence of orthodontic treatment need in permanent dentition of Iranian population: A systematic review and meta-analysis of observational studies.

BACKGROUND: Malocclusion is a common oral health problem and can affect the psychosocial well-being in the long term. Therefore, in the recent decades, demand for orthodontic treatment to correct malocclusion has greatly increased worldwide. This systematic review and meta-analysis was undertaken to assess existing evidence on the prevalence of orthodontic treatment need in Iran. MATERIALS AND METHODS: National and international databases were searched for articles on the prevalence of orthodontic treatment need using index of orthodontic treatment need (IOTN) and dental aesthetic index (DAI). The required data were completed by hand-searching. After applying the inclusion and exclusion criteria, the quality of articles was checked by a professional checklist. Data extraction and meta-analysis were performed. A random effects model was employed, and publication bias was checked. RESULTS: From a total of 443 articles that reported orthodontic treatment need in Iran, 24 articles were included in the meta-analysis process. Meta-analysis was performed on components of IOTN and DAI. The pooled prevalence of orthodontic treatment need based on Dental Health Component and Aesthetic Component of IOTN and DAI was 23.8% (19.5%-28.7%), 4.8% (3.3%-7%), and 16.1% (12.3%-20.8%). The results were found to be heterogeneous (P < 0.05). CONCLUSION: The results of this study revealed that orthodontic treatment need was not high in the Iranian population. Considering the differing prevalence of orthodontic treatment need based on normative index and self-perceived index, it is essential to improve the people's awareness of malocclusion and its side effects on their oral and general health.

Prevalence of Malocclusion in Permanent Dentition of Iranian Population: A Review Article.

BACKGROUND: The aim of this study was systematic review and meta-analysis of prevalence in current and relevant literature about this developmental disorder to present the profile of malocclusion in Iran. METHODS: This review study was carried out with systematically identified and critically assessed studies reporting malocclusion prevalence among Iranian population in permanent dentition. National and international databases were searched for articles about prevalence of malocclusion by Angle classification in different regions of Iran from 1994 to 2015. After applying inclusion and exclusion criteria, the quality of articles was checked by professional checklist. Data extraction and meta-analysis was performed. A random-effect model was employed. Publication bias was checked. RESULTS: Of 2768 articles, 21 cases were included. The pooled prevalence of malocclusion was about 87% (95% CI: 78.3-92.2) in Iranian population; however, the prevalence of malocclusion across individual studies varied considerably (ranging from 23.7% to 99.7%). Prevalence of normal occlusion, class I, II and III malocclusion were reported as 13.3% (CI 95%: 7.8-21.7), 50.7% (CI 95%: 42.9-58.4), 21% (CI 95%: 17.5-25.1), 5.5% (CI 95%: 3-10); respectively. Maximum prevalence of malocclusion was in the East of Iran. CONCLUSION: The results showed a high prevalence of malocclusion in Iranian population. The baseline information could be appropriately utilized for the future planning to meet the orthodontic treatment need among the Iranian population.

Impact of Orthognathic Surgery on Quality of Life in Patients with Dentofacial Deformities.

The aim of this investigation was to determine the impact of orthognathic surgery on quality of life in patients with dentofacial deformities at immediate presurgery and at 3-week, 3-month, and 6-month intervals following the surgery. Subjects included forty-three 18-40-year-old Iranian orthognathic patients who were referred to private offices in Isfahan. Data collection was performed using the 22-item Orthognathic Quality of Life Questionnaire (OQLQ). Participants completed the questionnaire prior to surgery and 3 weeks, 3 months, and 6 months after it. Differences and correlations were calculated by the two-tailed t-test, ANOVA with Repeated Measure test, and the Pearson correlation coefficient. The results showed significant reduction returned to baseline in OQLQ mean scores and aesthetic, awareness, and social subdomains in all 3 intervals after surgery. However oral function domain showed an increase at T2 and then a decrease at next intervals. Maximum and minimum effect size were observed in aesthetic (ES = 0.7) and oral function (ES = 0.3) domain, respectively. Based on the finding of this study, in 6-month interval after surgery, orthognathic surgery causes significant improvements in quality of life in patients with dentofacial deformities as assessed in emotional, psychological, oral function, and social domains and maximum changes occurred in emotional domain.

A Retrospective Analysis of Dentofacial Deformities and Orthognathic Surgeries.

BACKGROUND: Information regarding the prevalence of surgical osteotomies used for the correction of dentofacial deformities in Iran is lacking. MATERIALS AND METHODS: This retrospective cross-sectional study assessed the distribution of orthognathic surgeries performed (2011-2015) at major University hospital in Iran. Records of 103 orthognathic surgery patients were assessed (58 female, 45 males, aged = 23.47 [6.44] years). RESULTS: Class III malocclusion (incisor classification, 45.6%) and Class II skeletal pattern (based on ANB angle, 51.5%) were the most prevalent type. Overall, 4.8%, 51.5%, and 43.7% of subjects had Class I, II, and III sagittal skeletal patterns, respectively. The most prevalent (66%) osteotomy was the bimaxillary osteotomy. The frequencies of reported and corrected asymmetries in the lower third of the face (35%) were similar among patients with different malocclusions (χ2 = 4.134, P = 0.127) or sagittal skeletal patterns (χ2 = 2.133, P = 0.344), as well as between Class II and III malocclusions (P = 0.125) or sagittal skeletal patterns (P = 0.149). CONCLUSION: Compared to Class II subjects, Class III (malocclusions or sagittal skeletal patterns) subjects had more bimaxillary osteotomies, indicating the higher prevalence of skeletal discrepancies affecting both jaws in Class III subjects.

Assessment of Iranian orthodontists' practice with regard to the prevention and treatment of white spot lesions.

INTRODUCTION: White spot lesions (WSLs) are common adverse effect of orthodontic treatment, which can be prevented and treated by orthodontists. This study was conducted to assess Iranian orthodontists' practice regarding the prevention and treatment of WSLs in their patients. METHODS: In this cross-sectional study, 109 Iranian orthodontists were selected from the Iranian Association of Orthodontists' directory by cluster sampling. For data collection, a questionnaire was designed and its validity and reliability was confirmed (Cronbach's α =0.85). The questionnaire included eight general questions and eight questions about practice with regard to the prevention and treatment of WSL. Data were analyzed by descriptive tests, ANOVA test, and t-test in SPSS 20 software. P < 0.05 was considered statistically significant. RESULTS: The mean score of orthodontists' practice was 7.62 (range: 0-8), and 94.4% of the participants were rated as good, while 3.7% and 1.9% were rated as moderate and weak, respectively. Women's score was significantly higher than that of men (P = 0.001). With increasing participants' age, their practice has been improved (P = 0.001), but there was no significant relation between years of experience and their practice (P = 0.230). Nearly 94.4% of the orthodontists prescribed fluoride products. Toothpastes and fluoride mouth rinses were the most common prescribed products (34%). CONCLUSIONS: With regard to Iranian orthodontists' practice, it was fortunate to note that majority of the respondents were taking care of their patients with regarding to the prevention and treatment of WSLs. For enhancing their competencies, it is recommended to plan educational courses which are useful for promoting their knowledge and practice about new products and procedures used for the prevention and treatment of WSLs.

Ibuprofen and Low-level Laser Therapy for Pain Control during Fixed Orthodontic Therapy: A Systematic Review of Randomized Controlled Trials and Meta-analysis.

INTRODUCTION: To systematically review high-quality randomized controlled trials (RCTs) and meta-analysis on the effectiveness of use of ibuprofen and low-level laser therapy (LLLT) for pain control during fixed orthodontic appliance therapy. MATERIALS AND METHODS: A web-based systematic search of PubMed and Medline database using relevant keywords was performed in August 2016 limited to the English language studies. Based on inclusion and exclusion criteria, RCTs utilizing blind approach were selected. The quality of studies was analyzed and only high-quality studies were included. Following data extraction, meta-analysis was performed by standardized mean difference Hedges' (adjusted) g with 95% confidence interval. RESULTS: A total number of six studies (four ibuprofen and two LLLT) comprising 315 patients were included. Heterogeneity among ibuprofen studies was small, while large heterogeneity was found among LLLT studies. The results showed that both ibuprofen and LLLT could reduce pain intensity during fixed orthodontic therapy and during 17 days follow-up period. However, this reduction was statistically significant only at 6 to 24 hours postoperatively for ibuprofen and 2 hours and 3 to 7 days for LLLT (p < 0.05). CONCLUSION: Considering the limitations of the current meta-analysis, ibuprofen could alleviate orthodontic archwire activation pain during the 1st day with relatively high level of evidence. Low-level laser therapy could reduce this pain in the long term with limited evidence. Further well-designed RCTs are required to provide more evidence.

Correlation coefficients of three self-perceived orthodontic treatment need indices.

BACKGROUND: To determine patient orthodontic treatment need, appropriate self-perceived indices are required. The aim of this study was to assess the sensitivity and specificity of esthetic component (AC) of the index of orthodontic treatment need (IOTN), oral esthetic subjective index scale (OASIS), and visual analog scale (VAS) through dental health component (DHC) IOTN as a normative index to determine the more appropriate self-perceived index among young adults. MATERIALS AND METHODS: In this cross-sectional study, a sample of 993 was randomly selected from freshman students of Isfahan University. Those with a history of orthodontic treatment or current treatment were excluded. DHC was evaluated by two inter- and intra-calibrated examiners. Data for AC, OASIS, and VAS were collected through a questionnaire completed by students. Descriptive statistics, Mann-Whitney U-test, and Spearman correlation test, were used for data analyses. Sensitivity, specificity, positive and negative predictive values of self-perceived indices were calculated through DHC. RESULTS: Sensitivity of AC, OASIS, and VAS for evaluating definite orthodontic treatment need was calculated at 15.4%, 22.3%, and 44.6%, respectively. Specificity of these indices for evaluating definite orthodontic treatment need was calculated at 92.7%, 90.5%, and 76.2% percent, respectively. All self-perceived indices had a significant correlation with together and with DHC (P < 0.01). Among demographic factors, there was weak but significant correlation only between mother's educational level and VAS (P < 0.01). CONCLUSION: Due to the sensitivity and specificity of the three self-perceived indices, these indices are not recommended for population screening and should be used as adjuncts to a normative index for decision-making in orthodontic treatment planning.

Cross-sectional Study of Dental Trauma and Associated Factors Among 9- to 14-year-old Schoolchildren in Isfahan, Iran.

PURPOSE: To assess the prevalence of dental trauma (DT) and its associated factors in 9- to 14-year-olds. SUBJECTS AND METHODS: A cross-sectional survey was carried out through clinical examination of the permanent incisors and canines of 907 schoolchildren (9 to 14 years old, average age = 11 ± 0.5 [SD] years, 55% female and 45% male) enrolled in 20 public schools in Isfahan, Iran. The demographic data, history and cause of trauma were recorded during patient interviews and with a structured questionnaire filled in by their parents. The overjet, lip coverage, and visible signs of DT (permanent incisors only, similar to the classification used by the US National Health and Nutrition Examination Survey 1988-1994, NHANES III) were recorded. DT in permanent canines were also recorded. RESULTS: Approximately 36% (n = 325) recalled the occurrence of dental trauma, but only 23.8% (n = 216) of children had visible signs of dental trauma to the permanent incisors (girls [18.8%], boys [29.9%], OR = 0.54; 95% CI 0.40- 0.74; p = 0.000). The maxillary central incisors were commonly injured (69.5%). The most frequent types of injuries were the enamel fracture (59.0%), craze lines (16.3%), and enamel and dentin fracture (13.4%). Tooth avulsion was seen in 0.7%. No significant association was found between dental trauma and increased overjet of > 3 mm (p = 0.328), but a tendency was identified for overjet > 5 mm (OR = 1.51; 95% CI 0.89-2.58; p = 0.060). The relationship between DT and lip coverage was statistically significant (OR = 1.63; 95% CI 1.18-2.25; p = 0.003). Violence (30%) and fall (22.7%) were the main causes of DT. CONCLUSION: The prevalence of DT in permanent incisors was high (23.8%) and significantly lower in girls. The association between DT and lip coverage was significant. There was no association between DT and increased overjet of > 3 mm.

Assessment of knowledge, attitude, and practice with regard to evidence-based dentistry among dental students in Isfahan University of Medical Sciences.

AIM: Evidence-based dentistry (EBD) is an approach to oral health that requires the application and examination of relevant scientific data related to the patient's oral health and his priorities. The aim of this study was to assess knowledge, attitude, and practice of dental students of Isfahan about EBD. MATERIALS AND METHODS: In this descriptive study, 168 dental students in 3 final years of their education who engaged in clinical practice by consensus sampling were recruited. For data collection, a validated questionnaire was used. The questionnaire was consisted of demographic questions and some questions about four issues: Knowledge of self-assess (KSA), evidence-based practice, actual knowledge and attitude about EBD. Data were analyzed with t-test, one-way ANOVA, Chi-square, and linear regression with SPSS 16. RESULTS: One hundred and thirty-six students from 168 students were filled the questionnaire. The mean of KSA was 13 ± 4.3, mean of usage of useful references in EBD was 16.9 ± 7.6. One-third of students were studied their last article in last 6 months before. The mean of actual knowledge and attitude was 7.4 ± 2.3 and 24 ± 3.8, respectively. The relation between 4 main issues was significant (P < 0.05). CONCLUSION: By considering overall interest and positive attitude toward learning EBD in dental students, it is highly recommended that practical educational courses about EBD be planned by dental faculties.

Functional needs of subjects with dentofacial deformities: A study using the index of orthognathic functional treatment need (IOFTN).

OBJECTIVES: To assess the functional needs of orthognathic patients treated in Isfahan University of Medical Sciences affiliated hospitals using the index of orthognathic functional treatment need (IOFTN). MATERIALS AND METHODS: A retrospective study was conducted using 2011-2015 records of 103 patients [58 female, 45 males, 16-45 years, mean (SD) age = 23.47 (6.44) years] who had orthognathic surgery. Malocclusion type (incisor classification), sagittal skeletal pattern (ANB angle), IOFTN score, and Dental Health Component of the IOTN [IOTN (DHC)] were recorded. RESULT: Overall, 92.2% and 82.5% of subjects scored 4 or 5 for IOFTN and IOTN (DHC), respectively, and no gender differences detected for both indices (P > 0.05). Gender differences detected for malocclusions/skeletal patterns (P < 0.05). Class III malocclusions (45.6%) and Class II skeletal patterns (51.5%) were the most prevalent type. Subjects with Class I, Class II, and Class III sagittal skeletal bases formed 4.8%, 51.5%, and 43.7% of the sample, respectively. IOFTN score of 5.3 (reverse OJ ≥ 3 mm, 27.2%) was the most prevalent, followed by 4.2(19.4%), 4.3(13.6%), 4.10 (12.6%), and 5.2 (8.7%). Subjects with Class III sagittal skeletal patterns or malocclusions had higher percentages of grade 5 IOFTN scores (62.2% and 59.6%), compared to Class II sagittal skeletal patterns or malocclusions (18.9% and 21.2%) and the distribution of functional needs between malocclusions or sagittal skeletal patterns were different (p < 0.01). CONCLUSION: IOFTN identified 92.2% of orthognathic surgery patients as having great and very great functional needs and appeared to be reliable tool to identify patients in need of orthognathic surgery. Higher percentages of Class III subjects scored grade 5 of IOFTN, indicating higher functional need for orthognathic surgery in this group.

Assessment of dental student satisfaction with regard to process of thesis educational courses.

INTRODUCTION: Ensuring achievement of research experience by students is one of the most important goals of the thesis-conduction process and evaluation of student satisfaction with this process is one of the most imperative challenges herein. AIMS: The aim of this study is to investigate the satisfaction of dental students passing the thesis educational course from the Isfahan Dental School. SETTINGS AND DESIGN: Sixty-two dental students who had graduated in2011, from the Isfahan Dental School, participated in this descriptive cross-sectional study. MATERIALS AND METHODS: The postgraduate Research Experience Questionnaire (PREQ) was used for data collection. The questionnaire evaluated student satisfaction in seven domains: Thesis supervision, skill development, intellectual climate, infrastructure, thesis examination, goals and expectations, and overall satisfaction. STATISTICAL ANALYSIS USED: The data were analyzed on an SPSS software using descriptive and inferential statistics. RESULTS: The mean score of satisfaction of the participants was 75 ± 12. On the basis of their scores, satisfaction in 3.2% of them was slow, in 33.9%was medium, in 61.3% was good and in 1.6% was high. The highest satisfaction was found to be in thesis supervision and the least was in the intellectual climate domain. There was no significant statistical difference between satisfaction and gender (P = 0.46). CONCLUSIONS: Considering the results, to increase student satisfaction for passing the thesis courses, it is necessary to improve the intellectual climate in dental schools and also increase the research budget for more financial support of students to carry out their projects.

Evaluation of orthodontic treatment need by patient-based methods compared with normative method.

BACKGROUND: A comprehensive system of assessing orthodontic need requires the integration of normative clinical measures with patient-based indicators. This study sought to discover weather an oral health-related quality of life measure or Aesthetic Component of Index of Orthodontic Treatment Need (AC-IOTN) could be used as a predictor of orthodontic treatment need. Factors affecting the judgment of patient and dentist about this need are discussed. MATERIALS AND METHODS: Oral examination on 597 Iranian students between 13 years and 18 years was done to reach the grade of Dental Health Component (DHC). The Child Oral Health Impact Profile (COHIP) and AC-IOTN were recorded. The diagnostic values of subjective tests were assessed. Multiple logistic regressions were applied to investigate the role of variables in the persons' perceptions. RESULTS: Half of the 570 eligible students did not need orthodontic treatment either on professional or self-assessment; 60% of patients with definite need had a distinct impact on their quality of life. The specificity of AC to detect the healthy persons was excellent (0.99) but its sensitivity was low (0.08). COHIP score gave a better sensitivity but its specificity was 50%. Caries experience, quality of life, father's education, and brushing habits were the factors relating to the same judgment of persons and dentists (P > 0.02). CONCLUSION: Regarding the discrepancies between two assessment methods, present instruments did not meet the predictor's competencies. The patient-based methods could not substitute the professional assessment, but by identification, the persons with higher impacts would benefit the prioritization process.

Assessing the oral health-related quality of life in Iranian adolescents: validity of the Persian version of the Child Oral Health Impact Profile (COHIP).

PURPOSE: To evaluate the psychometric properties of an oral-health related quality of life (OHRQoL) instrument for application in the population of Iranian adolescents and to assess the discriminate and convergent validity and reliability of the Persian version of the Child Oral Health Impact Profile (COHIP) in a representative sample of this population. MATERIALS AND METHODS: Using multistage stratified sampling, 597 schoolchildren aged from 13 to 18 years living in the city of Isfahan were recruited to complete the Persian COHIP questionnaire. They were also examined for dental caries and malocclusion by two trained, calibrated examiners. RESULTS: Overall COHIP scores ranged from 15 to 135 (mean ± SD: 103.6 ± 18). Sixty-six percent of the students experienced at least one frequent oral health-related impact over the past three months. The Cronbach alpha coefficient was 0.89 for the overall score. Discriminate validity was supported by the significant difference between COHIP scores in the caries-free group and the others (P = 0.01). In addition, the questionnaire was able to differentiate among the groups by various degrees of need for orthodontic treatment (P < 0.01). Convergent validity was confirmed by significant association between the quality of life scores, the self-perceived health and oral health ratings and the self-perceived treatment need (r = 0.36, 0.57, -0.40). CONCLUSION: The Persian COHIP demonstrated acceptable psychometric properties for the descriptive purposes. Some discrepancies observed between the clinical data and quality of life status were confirmed by the perceptual identity of such indices influenced by several overt and covert variables.

A comparison of two orthodontic aesthetic indices.

OBJECTIVES: A cross-sectional study was conducted to determine the level of agreement between the Dental Aesthetic Index (DAI) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). METHODS: DAI and AC scores were recorded in 728 subjects (340 females and 388 males, aged 11-20 years). The percentage of subjects needing treatment and the different treatment categories for the DAI and AC were gender compared. Spearman's rank correlation coefficient (rho) was used to explore the relationship between the DAI and AC scores. Observer determined and Kappa statistics were used to analyse the diagnostic level of agreement between the DAI and AC, sorted into 'yes' or 'no' categories of orthodontic treatment need. RESULTS: According to the DAI and AC, 21.8 and 10.9% of subjects were in need of treatment, respectively. Significant positive correlations existed between the DAI and AC scores (rho = 0.795). The DAI had a lower treatment need threshold compared with the AC. The Kappa statistics and percentage agreement between the DAI and AC was 0.55 (95% CI: 0.46-0.63) and 87.6%, respectively. CONCLUSION: The DAI and AC showed strong association. However, only a moderate level of diagnostic agreement was identified (12.4% difference in observed percentage agreement) which highlights the need for a unified and universal orthodontic index for consideration when interpreting, comparing, or quantifying treatment needs.

Association between orthodontic treatment need and caries experience.

OBJECTIVE: To investigate the association between orthodontic treatment need (OTN) and caries experience (CE). SUBJECTS AND METHODS: Using a stratified sampling method, 748 subjects (355 females, 393 males; mean ± standard deviation age 15.11 ± 2.23 years) were examined. The Dental Aesthetic Index (DAI), DMFT, simple (DMFT > 0) and severe CE (DMFT > 8) were recorded. Socio-economic status (SES) was assessed by recording parental education, mother's employment status, and household size. RESULTS: Higher (but not statistically significant) CE was observed in subjects with OTN (DAI > 30). The association between DAI and DMFT scores was not significant (rho = 0.05). Mean DMFT score did not vary significantly between the SES and OTN subgroups. In children with a household size >6 persons (n = 85), OTN was associated with higher CE and a higher prevalence of severe CE compared with those without OTN. In this group, when DAI treatment need grade increased, severe CE prevalence also increased from 10.8% to 50%. Similarly, in those with OTN and household size >6 persons, the odds of observing subjects with severe CE was 4.6 times higher (95% confidence interval 1.45-14.55) compared to those without OTN. CONCLUSIONS: Associations were observed between OTN and CE and also between the prevalence of severe CE and the severity of malocclusion in children with a household size >6 persons. The current findings suggest that the relationship between caries experience and malocclusion should be assessed in a wider context of SES and background factors.

An investigation into the association between facial profile and maxillary incisor trauma, a clinical non-radiographic study.

OBJECTIVES: To explore the association between maxillary incisor trauma (MIT) and facial skeletal forms (sagittal and vertical), overjet (OJ), lip coverage, and gender. SUBJECTS AND METHODS: Five hundred and two subjects (253 females and 249 males, aged 11-14 years) were examined. Sagittal (Class I, II or III) and vertical skeletal pattern (average, increased or decreased Frankfort-Mandibular Plane Angle (FMPA)) were recorded. Samples were categorized into four groups according to OJ severity: OJ ≤ 3.5 mm, 3.5 mm < OJ ≤ 6.0 mm with competent lips, 3.5 mm < OJ ≤ 6.0 mm with incompetent lips and OJ > 6 mm. Samples were also subdivided into two groups: OJ ≤ 3.5 mm and OJ > 3.5 mm. Chi-square test was performed to determine any gender differences in trauma experience. Logistic regression was performed to test for any differences in risk of MIT in different groups, and to estimate the predictive value of facial skeletal pattern (sagittal), FMPA, gender, OJ, and lip competence for MIT. RESULTS: Nine percent had incisor trauma (8.4% MIT). Boys had greater odds of receiving MIT than girls (OR = 2.16; 95% CI, 1.11-4.21). Subjects with Class II skeletal patterns had greater odds of MIT than those with Class I skeletal patterns (OR = 3.98; 95% CI, 1.98-8.00). Subjects with decreased FMPA had greater odds of MIT than subjects with average FMPA (OR = 4.55; 95% CI, 2.28-9.06). Lip competence was not associated with MIT (P > 0.05). Subjects with OJ > 3.5 mm had greater odds of MIT than subjects with OJ ≤ 3.5 mm (OR = 2.83; 95% CI, 1.49-5.37). CONCLUSION: Compared with children with normal OJ (≤3.5 mm), Class I skeletal pattern (Straight profile) and average FMPA, the odds of MIT increased significantly in children with OJ > 3.5 mm (OR = 2.83), Class II skeletal pattern (OR = 3.98) and decreased FMPA (short face profile) (OR = 4.55), respectively.