Prevalence and Patterns of Positional Dental Anomalies in First Permanent Molars: Insights from a Study in Oradea, Romania.

Tooth position anomalies, influenced by both genetic and environmental factors, can significantly impact oral health and play a critical role in establishing proper occlusion. The aim of this study was to identify the most prevalent tooth position anomalies in first permanent molars among Romanian patients and to evaluate additional variables as well. This retrospective study utilized digital study models to identify all existing tooth position anomalies. The study included patients aged 12 to 40 years with complete permanent dentition. Axial changes (buccal tilting, oral tilting, mesial tilting, and distal tilting) as well as rotational changes (mesio-buccal rotation and disto-buccal rotation) were investigated. After applying the exclusion criteria, 103 patients remained in the study. Our findings revealed a notable prevalence of positional anomalies, with disto-buccal rotations being most common in upper molars (tooth 1.6-22.3%, tooth 2.6-31.1%) and oral tilting predominating in lower molars (tooth 3.6-6.8%, tooth 4.6-14.6%). Interestingly, neither gender nor malocclusion type significantly influenced the occurrence of tooth position anomalies. Symmetrical patterns in positional changes were observed, with patients having tooth position anomalies at 1.6 significantly more frequently associated with anomalies at 2.6. Similarly, anomalies at 3.6 were significantly more frequently associated with anomalies at 4.6. Additionally, for molars 2.6 and 3.6 on the left side, the differences were statistically significant, with patients having anomalies at 2.6 significantly more frequently associated with anomalies at 3.6. This pattern was not observed for the molars situated on the right side of the dental arches. While this study provides insights into positional anomalies in first permanent molars among the Romanian population, its retrospective design and focus on a specific demographic may limit generalizability. In conclusion, the study underscores the significant prevalence of positional anomalies in first permanent molars among adolescents and adults in Oradea, Romania. Early detection and targeted interventions are crucial to address these anomalies and improve orthodontic outcomes. Comprehensive assessment and treatment planning are essential to achieve optimal dental harmony and function. Further research is needed to elucidate the underlying factors contributing to these positional changes and their long-term impact on oral health and occlusal stability.

Orthodontic Pain and Dietary Impact Considering Age Groups: A Comparative Study.

(1) Background: orthodontic treatment can frequently be associated with discomfort and pain, a significant factor contributing to treatment discontinuation. (2) Methods: This study, conducted on 160 orthodontic patients across different age groups, aimed to explore the influence of age on patients' responses to treatment, particularly regarding changes in dietary patterns and weight loss. The patients were categorized into three age groups and assessed through a questionnaire about pain perception, pain latency, dietary changes, and weight loss associated with orthodontic appliances. (3) Results: Younger patients (6-12 years) reported lower pain levels, shorter pain latency and fewer alterations in dietary habits compared to adults (over 18 years). Females over 18 represented a significant portion of the sample, suggesting a self-driven inclination towards orthodontic treatment for aesthetic reasons. Fixed orthodontic appliances induced more significant pain than removable ones. Adults experienced more changes in dietary habits and weight loss than younger individuals. (4) Conclusions: the results provide valuable insights for orthodontic practitioners aiming to mitigate adverse effects and improve overall patient experience during treatment.

The Relationship between Dietary Habits and Periodontal Pathogens in a Sample of Romanian Children and Adolescents: A Cross-Sectional Study.

The role of diet in shaping oral microbiota and its potential contribution to the development of periodontal pathogens cannot be understated. This study aimed to explore the correlation between dietary habits and the prevalence of 11 periodontal pathogens among children and adolescents in Oradea, Romania. The identification of these pathogens was performed using the micro-IDent test kit, capable of detecting 11 specific periodontal pathogens. Bacterial sampling was conducted from the crevicular fluid in the morning, prior to brushing, followed by the completion of a brief questionnaire by parents. The questionnaire captured various aspects of the children's eating habits, including meal frequency, consumption of sweets, and hydration levels. The collected samples were dispatched to the laboratory for analysis, which provided insights into the abundance of microorganisms. The study encompassed 60 participants aged between 2 and 18 years, with the majority reported by their parents to have regulated meal timings, frequent sugar intake, and adequate hydration. The findings revealed significant associations between certain dietary factors and the presence of specific periodontal pathogens. Notably, the absence of breastfeeding was linked with the detection of Tannerella forsythia and Campylobacter rectus. Furthermore, frequent consumption of sweets corresponded with the presence of Capnocytophaga spp., which was particularly observed in individuals consuming sweets 2-3 times a day. Insufficient age-appropriate hydration showed an association with the prevalence of T. forsythia, Peptostreptococcus micros, and Capnocytophaga spp. In this sample, it became evident that eating habits and diet influenced the presence of several periodontal pathogens. The lack of breastfeeding was predominantly associated with positive results for T. forsythia and C. rectus, while inadequate hydration correlated more frequently with the presence of T. forsythia and P. micros. Moreover, frequent consumption of sweets was linked to the presence of Capnocytophaga spp.

The Relationship between Age, Gender, BMI, Diet, Salivary pH and Periodontal Pathogenic Bacteria in Children and Adolescents: A Cross-Sectional Study.

The oral microbiome can be influenced by many factors and its dysbiosis can have negative effects on oral and general health. The purpose of this study was to analyze the intensity of 11 periodontal pathogenic microorganisms identified in the oral cavity of a sample of children and adolescents from Oradea, Romania and to investigate the association of some variables (age, gender, body mass index, diet, and salivary pH) with the identified microorganisms. The cross-sectional study was conducted on a group of clinically healthy patients under the age of 18 years from Oradea, Romania. For the analysis of the periodontal pathogens, the micro-IDent kit was used, which determines 11 bacterial markers for periodontitis and peri-implantitis. The kit is based on the polymerase chain reaction (PCR). Bacterial sampling was carried out according to the manufacturer's instructions. A total of 60 children (23 male, 37 female) were included in this study, and were divided into three different age categories. No statistically significant results were identified for gender. However statistically significant results were obtained for other variables. Positive results for Prevotella intermedia and Bacteroides forsythus were associated with ages between 13 and 18 years, while positive results for Capnocytophaga spp. were associated with ages between 2 and 5 years. Positive results for Prevotella intermedia, Bacteroides forsythus, Peptostreptococcus micros, Campylobacter rectus and Eikenella corodens were associated with an overweight BMI. Negative results for Prevotella intermedia and Eikenella corodens were associated with a natural diet in the first 6 months of life. Positive results for Fusobacterium nucleatum and Campylobacter rectus were associated with an acidic salivary pH. In this study, the identified periodontal pathogens were associated with age, body mass index, diet in the first 6 months of life, and salivary pH.

Ectopic Eruption of First Permanent Molars in Children from North-Western Romania.

Ectopic eruption of first permanent molars can lead to complications if left untreated. The aim of this study was to determine the prevalence of the ectopic eruption of first permanent molars in a sample of children from North-Western Romania, and to identify the characteristic of this anomaly in the studied population. We included patients aged between 5 and 9 years, and patients who needed a radiological examination for the diagnosis and treatment of dental or dento-maxillary diseases. The following exclusion criteria were applied: unclear or poor-quality radiographs; radiographs that belonged to patients who benefited from an orthodontic treatment before the panoramic radiograph was taken; patients who were undergoing orthodontic treatment when the radiograph was taken; and patients with local or general diseases that could influence dento-facial growth and development. Three degrees of severity were selected (moderate, severe, and very severe). The sample consisted of 438 patients, and 61 patients were diagnosed with ectopic eruption of first permanent molars (13.92%). Out of the 1752 analyzed molars, 103 were affected (5.87%). Patients with a moderate degree of ectopy were more frequently boys (56%, n = 14), while patients with a severe degree of ectopy were more frequently girls (52.8%, n = 19). Patients with a moderate degree of ectopy had significantly more frequently a unilateral position (57.1%, n = 16), while patients with a very severe degree of ectopy had significantly more frequently a bilateral position (36.4%, n = 12). The ectopic eruption was diagnosed at the level of the upper-right first permanent molar in a percentage of 18.4% (n = 19), at the level of the upper-left first permanent molar in a percentage of 17.5% (n = 18), at the level of the lower-right first permanent molar in a percentage of 32% (n = 33), and at the level of the lower-left first permanent molar in a percentage of 32% (n = 33). Although not very frequent, the ectopic eruption of first permanent molars is an important anomaly that should be early diagnosed, monitored and treated.

The Influence of Gingival Exposure on Smile Attractiveness as Perceived by Dentists and Laypersons.

Background and Objectives: Smile is an important mark of beauty, and smile attractiveness can be influenced by various factors, one of these being the amount of gingival exposure. The aim of this research was to evaluate the perception of an ideal gingival exposure in smile in a sample of Romanian dentists and laypersons, and to find out what is the most important aspect that influences the smile perception for the respondents included in the study sample. Materials and Methods: An online survey was conducted between 3 February 2020 and 31 October 2020. The authors developed a short questionnaire consisting of 7 items. The first four items investigated the respondents' age, gender, profession and whether or not they underwent an orthodontic treatment in the past. For items 5 and 6, participants had to choose the most and the least attractive amount of gingival exposure, and for the last item they had to choose the factor that mostly influences the smile attractiveness in their opinion. Results: 235 questionnaires remained in the study. The sample consisted of 194 women and 41 men, 162 laypersons and 73 dentists. The average value for the most attractive amount of gingival exposure was −0.57 ± 2.407 mm, with a median value of 0 mm while the average value for the least attractive amount of gingival exposure was 1.43 ± 3.785 mm, with a median value of 4 mm. The differences between the most or least attractive gingival exposure perceived by the participants were not significant according to gender or professional category (p > 0.05), but, when compared between having or not having an orthodontic treatment in the past the differences were statistically significant (p < 0.05). As such, participants who had an orthodontic treatment in the past perceived a significantly higher value for the most attractive gingival exposure, and a significantly higher value for the least attractive gingival exposure (p = 0.026) than the participants who didn't have an orthodontic treatment in the past. As for the factor that mainly influences smile attractiveness, laypersons chose significantly more frequent white teeth or aligned teeth (96%, 71.7%) while dentists chose significantly more frequent a gingival exposure between 0−3 mm (70.4%) as smile factors for an aesthetic smile (p < 0.001). Conclusions: In this study sample, the respondents considered that the most attractive smile involved a covering of 0.57 mm (in average) of the upper incisors by the upper lip. Although smile attractiveness did not appear to be influenced by gender or profession in this study population, it was influenced by previous orthodontic treatment. The participants' roles of dentist or layperson influenced the factors chosen for an aesthetic smile.

Mini-Implant Rejection Rate in Teenage Patients Depending on Insertion Site: A Retrospective Study.

Mini-implants have undeniable advantages in Orthodontics. However, the use of mini-implants shows some limitations and disadvantages related to patient age, the quality of the bone tissue, the characteristics of the oral mucosa, implant site, the state of health of the organism and the quality of oral hygiene. The aim of this paper was to analyze the rejection rate of mini-implants in teenage patients, depending on their insertion site, and examine their stability up to three months after insertion. This retrospective study was conducted on dental charts belonging to patients aged between 12 and 17 years, from Oradea, Romania. The mini-implants were placed for various therapeutic reasons and were inserted in the following sites: buccal maxillary area, the infrazygomatic region, palatal area, buccal mandibular area and lingual area; they had a diameter of 1.6 mm (inter-radicular spaces) and of 2 mm (nonbearing tooth areas), and a length of 6-8 mm (mandible) or 8-10 mm (maxilla). The rejection rate was checked in the first month, second month, third month and after the third month from insertion. A total of 432 patients were included in the study, and they had a total of 573 mini-implants. Most implants were placed in the buccal region of the maxilla (27.7%), and most patients had one mini-implant placed (65.7%). The highest rejection rate was obtained in the first month (15.2%). The rejection rate between genders was similar. The mini-implants from the buccal mandibular region had a significantly higher rate of rejection in the first month (M1) in comparison to the mini-implants from the palatal region (24.4% vs. 8.3%). The mini-implants from the lingual region of the mandible had a significantly higher rate of rejection in the second month (M2) in comparison to the mini-implants from the infrazygomatic or the palatal region (10.5% vs. 0%/0%). Mini-implants are very useful for carrying out various orthodontic treatments, but their stability should be enhanced.

Substantial Improvements in Facial Morphology through Surgical-Orthodontic Treatment: A Case Report and Literature Review.

Background and Objectives: The long face type is associated with excessive vertical facial growth and most often with anterior open bite. In many cases of anterior open bite of high severity associated with bimaxillary dento-alveolar protrusion, lips are unable to form an adequate seal at rest. This leads to many issues, including facial dysmorphism. The aim of this study was to describe the case of a 15 year old girl who addressed the orthodontist in November 2015, having complaints related to the skeletal and dental open bite. Case Description: A 15.7 year old patient required a consultation with the orthodontic service for impaired dento-facial aesthetics at rest, smile and speech due to an exaggerated superior protrusion of the upper frontal teeth, labial incompetence with excessive gingival exposure at rest and smile associated with upper and lower anterior teeth crowding. The orthodontic diagnostic consisted of skeletal open bite with a hyperleptoprosop morphological facial type, high degree of hyperdivergence, bimaxillary dento-alveolar protrusion, 7 mm skeletal open-bite, 3 mm vertical inocclusion of the anterior teeth, skeletal class II relationships, bilateral half cusp class II molar and canine relationships, labial incompetence, highly increased interlabial gap, facial asymmetry, excessive gingival exposure of 7 mm at smiling and bimaxillary anterior crowding. Because the patient initially refused orthognathic surgery, prior to starting the orthodontic treatment, the patient was recommended to receive a bilateral extraction of the first upper premolars. Key objectives of pre-surgical orthodontic treatment were to achieve a retroclined position of the upper incisors under their normal inclination for the planned upward maxillary rotation, to maintain slightly lower incisor proclination. The orthognathic surgery consisted of Le Fort I impaction osteotomy with 8 mm anterior impactation, bilateral sagittal split osteotomy, and mandibular repositioning using occlusal splint. Conclusions: At the end of the orthodontic-surgical treatment, the patient presented significant improvement in dento-facial aesthetics, and optimal skeletal, muscular and dental balance.

The Attitudes of Children Undergoing Orthodontic Treatment toward Face Mask Wearing during the COVID-19 Pandemic: A Cross Sectional Study.

During the COVID-19 pandemic, the protective face mask has proven to be essential. The protective face masks cover the lower part of the face, including teeth and, for orthodontic patients, the orthodontic appliances. The aim of this study was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic and, especially, wearing a protective face mask had on a sample of Romanian children, and to compare the results previously obtained on a sample of Romanian teenagers with the results obtained after investigating children under the age of 12 years. The cross-sectional survey was conducted in two orthodontic offices from the city of Oradea, Romania. The study sample included children with ages between 8 and 11.9 years that were undergoing an orthodontic treatment with removable or fixed orthodontic appliances. After obtaining the results, comparisons were made with the answers provided by a group of adolescents previously investigated. The questionnaires consisted of 9 items that investigated children' attitudes toward protective face mask wearing and other aspects related to the COVID-19 pandemic. Two hundred fifty-six children were included in the study (53.1% female patients, 46.9% male patients). Most of the children were not worried that face masks would hide their orthodontic appliances (Item 1-Never, 40.2%; Rarely, 28.9%) and did not consider that the necessity of face mask wearing negatively impacted their desire to undergo an orthodontic treatment, despite the fact that it covered the appliances (Item 2-Never, 37.1%; Rarely, 31.6%). However, 44.5% of children were not happy because they had to wear a face mask during the orthodontic treatment, considering the fact that it covered the orthodontic appliance (Item 6), and most patients (49.2%) did not want the face mask to continue to be mandatory (Item 7). Although children were not happy that they had to wear a face mask that covered the orthodontic appliances, protective face masks were generally well tolerated by Romanian children.

Validity of the Demirjian Method for Dental Age Estimation in Romanian Children.

Dental age assessment is useful in various medical fields. The Demirjian method for dental age estimation is one of the most widely used in the field of pediatric dentistry. The aim of this study was to verify the accuracy of the Demirjian method in determining age in a sample of girls and boys from Oradea, Romania. This retrospective and radiographic study was based on the evaluation of 1006 panoramic radiographs, belonging to 1006 patients (431 boys and 575 girls) with ages between 3 and 13.9 years from the city of Oradea, Romania. They were collected from three private dental practices from Oradea and were analyzed between 1 September 2021, and 10 November 2021. The patients were distributed into 11 age groups, each group spanning over one year (e.g., 3−3.9, 4−4.9). For the assessment of dental age, the Demirjian method was used, which is based on the evaluation of the developmental stages of the lower left permanent teeth. The mean chronological age of the patients was 9.496 ± 2.218 years, and the mean dental age was 10.934 ± 2.585 years. The overestimation of dental age was obtained in all age groups for the entire sample. As such, dental age was higher than chronological age, with values varying from 0.34 years in the 3−3.9 years age group to 1.7 years in the 10−10.9 years age group. In girls, dental age was higher than chronological age, with values varying from 0.46 years in the 3−3.9 years age group to 1.73 years in the 11−11.9 years age group, while in boys, the values varied from 0.15 years in the first age group to 2.02 years in the 10−10.9 years age group. The comparison of the differences between chronological age and dental age according to the gender of the patients revealed that the distribution of the differences was nonparametric in both groups according to the Shapiro−Wilk test (p < 0.05). The differences between the groups were not significant according to the Mann−Whitney U test. However, larger differences were identified for boys (1.46 years) than girls (1.417 years), with an overestimation of the dental age. The Demirjian method overestimated the age of the children included in the investigated sample, with different values for the different age groups investigated, and requires adaptations.

Orthodontic Adolescent Patients' Attitudes toward Protective Face Mask Wearing during the COVID-19 Pandemic.

Background and Objectives: The COVID-19 pandemic led to restrictive measures, which aimed to limit the spread of the SARS-CoV-2 virus. These restrictions impacted all areas of life, including the activity of dental offices. For patients with orthodontic appliances, closing the dental offices was a major issue, as most orthodontic treatments last for more than a year and require regular checkups. The aim of this research was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic, and, especially, wearing a face mask had on a sample of Romanian teenagers undergoing fixed orthodontic treatment. Material and Methods: The study group consisted of 277 orthodontic patients, with ages between 12 and 17.9 years, from North-Western Romania. They completed a 9-item questionnaire. The control group consisted of 231 participants, with ages between 12 and 17.9 years. They completed an 8-item questionnaire. Results: Most patients from the study group were not worried that wearing a protective face mask would hide their braces (never-49.5%; rarely-26.7%), and their desire to undergo an orthodontic treatment was not affected by the compulsoriness of face mask wearing (never-51.6%; rarely-26%). In contrast to that, in the control group, more than 50% of the participants were worried to some degree that wearing a protective face mask would hide their smile (occasionally-29.9%; frequently-18.2%; very frequently-2.2%). The majority of the participants from the study group did not consider interrupting the orthodontic treatment due to the COVID-19 pandemic (62.5%), and the majority of the participants from the control group did not consider not going to the dentist due to the COVID-19 pandemic (70.6%). Most of the participants from the study group were not happy that they had to wear a face mask, which covered their orthodontic appliances, during the orthodontic treatment (68.6%). The attitude was similar to that of the participants from the control group, who were not happy that they had to wear a face mask, that covered their smile (51.1%). In the study group, most patients did not want face mask wearing to continue to be compulsory, given the fact that their orthodontic appliances were no longer visible (52%). In the control group, the attitude was similar, with 48.1% of the participants not wanting face mask compulsoriness to be maintained. Conclusions: In conclusion, although, most patients would not like to continue wearing a face mask as a mandatory regulation, they were not concerned or negatively affected by wearing a protective face mask, even though face masks hid their braces.

Psychometric Properties of Scared-C Scale in a Romanian Community Sample and Its Future Utility for Dental Practice.

The psychological management of children and adolescents in need of pedodontics or orthodontic treatments continues to be an essential objective in dental activity because along with the accuracy of the techniques that are used, anxiety reduction, and knowledge of how to approach the patient are necessary for the treatment to be successful. Therefore, our study aimed to validate the Screen for Child Anxiety Related Emotional Disorders questionnaire, the child version of 41 items (SCARED-C) in the Romanian population for later use in pediatric dentistry. The instrument showed moderate to good internal consistency (α Cronbach from 0.63 to 0.91 for the total scale) and good test-retest reliability (0.70) on a subset of a sample comprising 85 children. A confirmatory factorial analysis (CFA) was conducted to test the factor structure of the Romanian version of the SCARED-C; the results showed that SCARED-C has good psychometric properties that can be used for screening anxiety in Romanian children and adolescents. The implications of using the SCARED-C in dental practice are discussed. Future studies need to be conducted to explore the convergent and discriminative validity of the instrument and its sensitivity to current DSM-V criteria. Application on a pediatric dental sample is also required.

Research on demographic, clinical and paraclinical aspects in pregnant women infected with Toxoplasma gondii.

Toxoplasmosis is a zoonotic disease caused by the Toxoplasma gondii protozoan parasite. The aim of this study was to determine the frequency of acute toxoplasmosis or its presence in the medical history of 240 pregnant women, depending on age and geographical background. The second purpose was to analyze several medical aspects (clinical and paraclinical) in pregnant women with acute toxoplasmosis. The study identified several serological changes including positive toxoplasma IgM, IgG, and IgA antibodies. The chemiluminescence immunoassay (CLIA) method was used to detect T. gondii-specific IgM and IgG antibodies and the enzyme immunoassay (EIA) method to detect T. gondii-specific IgA antibodies. Of the 96 pregnant women (40%) infected with T. gondii, approximately 1/3 had acquired acute infection and 2/3 had a history of prior acute infection (P<0.0001). No statistically significant differences according to age groups (P=0.9384) were found in terms of serological profile. The number of patients with negative serology was significantly higher in urban areas than in rural areas (P<0.0001). The highest incidence among the pregnant women with acute toxoplasmosis with a single chain of ganglia affected was represented by those with the involvement of cervical lymph nodes (75%), the difference compared to the involvement of other chains of ganglia being statistically significant (P=0.0087). All 35 pregnant women with acute toxoplasmosis tested positive for T. gondii-specific IgM antibodies. Most pregnant women with acute T. gondii infection (57.1%) tested negative for T. gondii-specific IgM antibody serum titres within 3-6 months of presentation. The difference compared to other intervals from the moment pregnant women sought care was statistically significant (P=00002). Only 80% of all pregnant women with acute toxoplasmosis tested positive for T. gondii-specific IgA antibodies. Pregnant women with acute toxoplasmosis have a 3.3 times higher risk of pregnancy loss.

The Influence of Age on the Development of Dental Caries in Children. A Radiographic Study.

Dental caries is a chronic disease that can be influenced by a multitude of factors. Poor oral hygiene and unhealthy eating habits are the most incriminating factors in the onset of dental caries, but age has been proven to impact the disease. The aim of this study was to find correlations between age and the evolution of dental caries in the first permanent molars in children. The retrospective study was conducted based on 400 panoramic radiographs, belonging to Romanian children between the ages of 6 and 14 years. All first permanent molars were investigated, and the carious lesions were classified according to their depth. The chronological age was calculated by subtracting the patient's date of birth from the date when the radiograph was performed, while for the assessment of dental age, the Demirjian method was used. The gender of the patients did not significantly influence the number of superficial, medium, and deep carious lesions. Most of the identified carious lesions were superficial. Regarding correlations between age and dental caries, there was an association between the decrease in the chronological age and the increase in the number of superficial carious lesions on the first permanent molars and also an association between the increase in the chronological age or dental age and the increase in the number of medium and deep carious lesions on the first permanent molars. Age can impact the development of dental caries in first permanent molars.

Chronological Age in Different Bone Development Stages: A Retrospective Comparative Study.

The assessment of an individual's development by investigating the skeletal maturity is of much use in various medical fields. Skeletal maturity can be estimated by evaluating the morphology of the cervical vertebrae. The aim of this study was to conduct comparisons of the chronological age in different bone development stages. The retrospective study was conducted based on lateral cephalometric radiographs belonging to patients with ages between 6 and 15.9 years, from Romania. For the assessment of skeletal maturity, the Cervical Vertebral Maturation (CVM) method was used. In total, 356 radiographs were selected, but after applying the exclusion criteria, 252 radiographs remained in the study (178 girls and 74 boys). Different mean chronological age values were obtained for the general sample, as well as for the two genders. The chronological age started to be significantly different at the CS4 stage. Patients with CS4, CS5, and CS6 stages had a significantly higher chronological age compared to patients with CS1, CS2, and CS3 stages. It was noted that patients with CS1 and CS2 stages were more frequently boys, while patients with the CS5 stage were more frequently girls.