Perception of smile esthetics varies between patients and dental professionals when recession defects are present.

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

Perception of Smile Esthetics Varies Between Patients and Dental Professionals When Recession Defects are Present

The aim of this study was to compare the smile esthetic perception of patients, dental students and dentists faced to different situations concerning gingival margin position. A total of 123 individuals (41 patients, 41 dental students and 41 dentists) completed a structured questionnaire and evaluated 6 pictures of the same smile modified in Adobe Photoshop® image-editing software representing: no gingival recession, 2 mm recession in one maxillary lateral incisor, 2 mm recession in both maxillary lateral incisors, 2 mm recession in one maxillary canine, 2 mm recession in both maxillary canines and generalized 2 mm recession. The visual analogue scale (VAS) was used to rate the esthetic perception. Mean VAS values were calculated and compared among gingival situations as well as group of respondents by one-way ANOVA, with an alpha level of 0.05. VAS analysis revealed that mean values ranged from 4.2 (±1.8) to 6.8 (±1.7). Images with no gingival recession received the highest score by all groups, with statistically significant differences among dentists and dental students. However, patients scored images with no recession with significantly lower ranks as compared with dentists and dental students. No significant differences were observed among patients for any of the situations. When dentists and dental students were compared, the worst situation was observed for generalized gingival recession, with scores 4.2 (±1.8) and 4.9 (±1.8), respectively. Patients and dental professionals had different perceptions about esthetics related to gingival margin position.

O objetivo do estudo foi comparar a percepção estética do sorriso de pacientes, estudantes de odontologia e dentistas, em relação a diferentes situações de posição da margem gengival. Cento e vinte e três indivíduos (41 pacientes, 41 estudantes de odontologia e 41 dentistas) responderam um questionário estruturado e avaliaram 6 fotografias de um mesmo sorriso modificadas no Photoshop representando: periodonto inalterado (sem recessão gengival), recessão de 2 mm em um incisivo lateral superior, recessão de 2 mm em ambos incisivos laterais superiores, recessão de 2 mm em um canino superior, recessão de 2 mm em ambos caninos superiores e recessão generalizada de 2 mm. Uma escala visual analógica (EVA) foi usada para graduar a percepção estética. Médias da EVA foram calculadas e comparadas entre as situações gengivais, bem como entre os grupos de respondentes pela ANOVA de um critério com nível de significância de 0,05. A análise da EVA revelou que os valores médios variaram entre de 4,2 (±1,8) a 6,8 (±1,7). Periodonto inalterado foi avaliado com o maior escore por todos os grupos (com diferença estatisticamente significativa entre dentistas e estudantes de odontologia). Entretanto, pacientes avaliaram periodonto inalterado com valores menores quando comparados a dentistas e estudantes de odontologia. Entre pacientes nenhuma diferença significativa foi observada para nenhuma das situações apresentadas. Quando dentistas e estudantes de odontologia foram considerados, a pior situação foi observada para recessão gengival generalizada (4,2±1,8 e 4,9±1,8, respectivamente). Pacientes e profissionais da odontologia demonstraram diferentes percepções sobre as situações de estética relacionadas à posição da margem gengival.

Patient perceptions of buccal gingival recessions and requests for treatment.

AIMS: The aims of this study were to verify patients' perception of buccal recessions and their requests for treatment. METHODS: The patients filled out a questionnaire dealing with demographic variables and perception of buccal gingival recessions. A calibrated examiner checked for recessions and recorded the clinical variables. Then, the patients were asked to explain what they believed to be the causes of the recessions and whether they were interested in obtaining treatment of their lesions. Descriptive statistics and multilevel logistic models were used. RESULTS: Of 120 enrolled patients, 96 presented 783 gingival recessions, of which 565 were unperceived. Of 218 perceived recessions, 160 were asymptomatic, 36 showed dental hypersensitivity, 13 aesthetics, 9 aesthetic + hypersensitivity issues. Only 11 patients requested treatment for their 57 recessions. Younger individuals (p = 0.0077), deeper recessions (p < 0.0001), incisors and canines (p < 0.0001) and non-carious cervical lesions (p = 0.0441) were significantly associated with patient perception of own recessions. Younger subjects (p = 0.0118), deeper recessions (p = 0.0387) and incisors (p = 0.0232) were significantly associated with patient request of treatment. Four hundred and sixty-eight recessions (60%) were not ascribed to exact causes by the patients. CONCLUSION: This study shows that perception of gingival recessions and the patients' requests for treatment should be evaluated carefully before proceeding with decision making.

Effect of surgical defect coverage on cervical dentin hypersensitivity and quality of life.

BACKGROUND: Root exposure due to gingival recession (GR) can cause cervical dentin hypersensitivity (CDH), which is characterized by tooth pain. The aim of this study is to evaluate the effect of surgical defect coverage on CDH and quality of life in patients with GR. METHODS: Twenty-five GRs in maxillary canines and premolars were treated with coronally positioned flap plus connective tissue graft. GR dimensions, amount of keratinized gingiva, and clinical attachment level were evaluated. CDH was assessed by thermal and evaporative stimuli. Quality of life was assessed by use of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. All parameters were evaluated at baseline and after 3 months. RESULTS: Statistically significant reduction in CDH (P <0.001), significant reduction in impact of oral health on quality of life (P <0.001), and significant changes in periodontal parameters were observed after 3 months. Mean defect coverage of 67.90% was achieved, with full coverage in 11 cases. Percentage defect coverage showed no correlation with air blast-stimulated CDH (P = 0.256) or cold stimulus (P = 0.563). The OHIP-14 physical disability dimension was correlated with the amount of keratinized tissue (P = 0.010) and also with defect coverage (P = 0.035). CONCLUSIONS: Surgical defect coverage may reduce CDH and improve patient quality of life, by keratinized gingiva augmentation and impact on physical disability, irrespective of amount of defect coverage.

Effect of initial periodontal therapy on oral health-related quality of life in patients with periodontitis in Japan.

BACKGROUND: It is becoming increasingly important for periodontists and dental hygienists to take a biopsychosocial approach to care when considering periodontal interventions. However, information on how patients perceive periodontitis and its treatment is limited. The purpose of the present study is to gain insight into the patient perception of oral health and the impact that periodontitis and treatment have on self-assessed quality of life (QoL). METHODS: This was a prospective, two-center, clinical study in Japan. Patients with periodontitis were assessed for their perceptions of oral health by using an instrument for oral health-related QoL (OHRQL) before and after initial periodontal therapy. RESULTS: A total of 58 patients (mean age: 53.6 years; 23 male and 35 female) participated in the study and completed initial periodontal therapy. At baseline, 97% of the patients perceived that their oral health status impacted on their QoL in one or more ways. Pain, eating and chewing, and psychologic function were identified as compromised OHRQL domains. More than one-half of the patients rated their overall oral health as poor. Initial periodontal therapy, consisting mainly of oral hygiene instructions and scaling and root planing, significantly improved OHRQL scores (P = 0.0027). The effect size was calculated to be 0.51, indicating a moderate improvement. Compared with baseline, a significantly higher proportion of patients reported rarely or never having a problem regarding OHRQL domains such as pain (P = 0.0049) and eating and chewing (P = 0.0145) after treatment. No significant difference in the OHRQL improvement was found with respect to disease severity. CONCLUSIONS: Periodontitis negatively affected QoL in this population of Japanese patients with periodontitis. Conventional non-surgical periodontal therapy has a potential to ameliorate patient perceptions of oral health.

Patients' ranking of interdental "black triangles" against other common aesthetic problems.

The purpose of this study is to assess patients' aesthetic perceptions of interdental "black triangles", both in terms of the number of triangles visible and their severity; and to ascertain how patients rank the presence of "black triangles" against other aesthetic problems. It is based on a questionnaire of 80 randomly selected individuals who were asked to rate the aesthetics of digitally-manipulated images. Patients'perceptions of interdental "black triangles" were compared with their perceptions of other 'non-aesthetic' features. Interdental "black triangles" were rated as the third most disliked aesthetic problem below caries and crown margins. This study demonstrates the importance of interdental "black triangles" to patients, and therefore, as they can occur during prosthetic treatment, must be discussed with patients prior to commencing therapy.

Self-assessed and clinically diagnosed periodontal health status among patients visiting the outpatient department of a dental school in Bangalore, India.

BACKGROUND: The purpose of the present cross-sectional study was to assess the extent of agreement between clinical and self-assessed periodontal health status among patients visiting the outpatient department of M.S. Ramaiah Dental College, Bangalore, India. MATERIALS AND METHODS: The study population included 216 patients aged between 20 and 44 years who attended the outpatient department of the M.S. Ramaiah Dental College, Bangalore. The study population was subjected to a self-administered questionnaire (questions regarding bleeding gums, deposits on teeth, receding gums, swelling of gums, loose teeth), which was followed by periodontal examination. The clinical examination included an assessment of the periodontal condition, using the criteria of Loe and Silness Gingival Index, the Community Periodontal Index, and Mobility, respectively. CONCLUSION: The present study showed that the perceived periodontal health status was low and the discrepancy between the subjectively and objectively assessed needs was very distinct. The awareness of the periodontal problems has been reported to increase with increasing severity of the disease due to the destructive changes that set in.

Aesthetic perception after root coverage procedure.

AIM: To investigate the aesthetic perception of the clinical outcomes of a simulated root coverage procedure in three different groups: patients, dentists, and periodontists. MATERIAL AND METHODS: 100 patients, 107 general dentists affiliated with the Dental Association of Prato, Italy, and 81 active members of the Italian Society of Periodontology were recruited for this study. The following variables: age, gender, level of education, place of residence, and years of practice (only for dentists and periodontists) were recorded by means of a questionnaire administered to each subject within the three different groups. In addition, the participants in the study were requested to assign scores to images of eight simulated clinical cases of gingival recessions: a pre- and post-treatment image for each case. RESULTS: Statistically significant differences between groups were not detected in most of the scores. Gender and residence were not significantly associated with the scores, while age was correlated for two clinical cases (p=0.0014 and 0.0017). All the cases of complete root coverage showed the highest scores among all the participants. CONCLUSIONS: These results showed that complete root coverage following root coverage procedure is perceived as the most successful outcome by patients, dentists, and periodontists.

Common implant esthetic complications.

Today, osseointegration of implants is readily attainable with high long-term survival rates. Consequently, clinicians are now focusing on improving implant esthetics and are starting to incorporate this parameter into their definition of implant success. However, studies measuring factors that affect implant esthetics and implant esthetic outcomes are lacking in the literature. A satisfactory esthetic outcome requires the clinician to be aware of the different factors affecting esthetics during the preplanning, surgical, and prosthetic phases of implant placement. This article addresses the etiologies of esthetic complications during each of these 3 phases and provides preventive and corrective treatment suggestions for these situations.

Self-injurious behavior in a patient with mental retardation: review of the literature and a case report.

Self-injurious behavior is deliberate harm to the body that may lead to factitious oral injuries. Management of patients with self-inflicted injury continues to be a challenge for the dental profession. The purpose of this article is to review clinical findings in a patient who presented with severe, painful gingival recession in the primary dentition. A case report of an 8-year-old girl with mental retardation is presented. The periodontal examination showed bilateral gingival recession of the mandibular canines and the mandibular first and second molars so severe that it was possible to clinically observe the exposed roots. The diagnosis of self-inflicted gingival lesions and self-injurious behavior was established. Although the lesions are no longer present, the self-injurious behavior persists. Psychologic support was suggested, and an oral removable appliance was fitted.

Oral health-related quality of life and periodontal status.

BACKGROUND: As patient-centered approaches become more popular, increasing attention is being given to assess the effects of various human health situations on an individual's overall quality of life (QoL). Measures have been used in dentistry to study the effects of orthodontic treatment and oral surgery, but so far little has been reported about the effects of periodontal disease. OBJECTIVE: This study assessed the impact of periodontal health status on QoL. METHODS: A subsample of 767 subjects were selected from a community study (n=1000) which investigated the association between psychological factors and clinical periodontal attachment level (CAL). The sample included subjects with full-mouth mean CAL3 mm (high/severe periodontal attachment loss group). The subjects were requested to complete the Chinese short-form version of Oral Health Impact Profile (OHIP-14S) and a checklist of self-reported periodontal symptoms during the previous 12 months. RESULTS: A total of 727 subjects (95%) completed the questionnaire. The OHIP-14S and subscale scores were significantly associated with six of seven of the self-reported periodontal symptoms. A comparison of the mean OHIP-14S scores of the healthy/low and the high/severe periodontal attachment loss groups revealed significant differences in respect of the subscales of functional limitation, physical pain, psychological discomfort, physical and psychological disabilities. CONCLUSION: This study demonstrates a significant association between oral health-related QoL and periodontal disease.

Impact of oral health on the life quality of periodontal patients.

OBJECTIVES: To assess the impact of oral health on the life quality of a periodontal patient group. MATERIALS AND METHODS: Two hundred and five patients attending a private periodontal clinic completed a questionnaire incorporating the 16-item UK oral health-related quality-of-life measure (OHQoL-UK), a check list of questions about their periodontal health over the past year and a comprehensive periodontal examination. RESULTS: The effect of oral health on quality of life was considerable, with many individuals experiencing negative impacts across a broad range of physical, social and psychological aspects of life quality. OHQoL-UK(Copyright ) scores was associated with patient's self-reported periodontal health in the past year: experiences of "swollen gums" (p<0.01), "sore gums" (p<0.01), "receding gums" (p<0.01), "loose teeth" (p<0.01), "drifting teeth" (p<0.01), "bad breath" (p<0.01) and "toothache" (p<0.01). In addition, OHQoL-UK scores were correlated with the number of teeth with pocket depths of 5 mm or more (r(s)-0.42, p<0.01). New patients had poorer oral health-related quality of life compared with the treated maintenance group (p<0.01). CONCLUSIONS: Periodontal status impacts on life quality. This has implications in understanding the consequences of periodontal health and in the use of patient-centred outcomes in periodontal research.

Factitial (self-induced) gingival disease: four case reports.

Bizarre-appearing gingival recessions that do not correspond to any known gingival disease or oral manifestation of any known systemic disease are called factitial (self-induced) gingival disease. Psychological factors are very important in their etiology. Generally, the lesions occur during the time the child is experiencing stress associated with the frustration of his or her dependency needs. Four cases of self-induced gingival recessions involving children aged 4 to 6 years are presented and investigated from the pedodontic, periodontologic, and psychiatric viewpoints.

[Psychosomatic diseases and dentistry (report of two psychoneurotic cases)]. / Psikosomatik hastaliklar ve dis hekimligi (2 psikonörotik vaka nedeniyle).

Harmful effects that result from psychic influences on the organic control of tissues are known as psychosomatic disorders. Psychologically, the oral cavity is related directly or symbolically to the major human instincts and passions. In this article, before treating two patients, who have gingival recession and itching, the importance and necessity of their treatment of psychiatric disorders were mentioned and the relationship between psychiatry and dentistry is explained.