Orthodontic management of traumatized teeth: a survey among orthodontists.

BACKGROUND: Information on previous traumatic dental injuries is important as they can lead to increased complications during orthodontic treatment and impact the treatment planning and outcomes. The aim of this study was to assess the knowledge of Jordanian orthodontists in orthodontic management of traumatized permanent teeth. METHODS: Cross-sectional survey among active registered orthodontists using a questionnaire distributed by hand. RESULTS: The study included 139 orthodontists. Nearly half of orthodontists treated between one to three patients with a history of traumatic dental injuries in the past 3 months. Only 43.2% of the participant asked routinely about history of trauma. A vast discrepancy in times waited before orthodontic movement and in the orthodontic management approach of traumatized teeth was noted. A statistically significant negative relationship between age and knowledge level was found (p = 0.002). A significantly higher level of knowledge was found among participants who had fellowship or board certification than those having the high diploma degree (P-0.032) and also who had treated patients with history of dental trauma in the last 3 months than those who did not (p = 0.001). CONCLUSIONS: The knowledge of the surveyed orthodontists in both the recommended observation period before orthodontic treatment and management approaches of traumatized teeth during orthodontic treatment was insufficient. Years of clinical experience significantly affected knowledge, with older participants having lower levels of knowledge. Orthodontists who treated patients with history of dental trauma in the last 3 months had significantly higher knowledge in orthodontic management of traumatized teeth. Orthodontists needs to be aware of the proper timing and strategies on orthodontic management of traumatized permanent teeth to improve the long term prognosis and to reduce further complications during orthodontic treatment through proper management.

Self-harm, dentofacial features, and bullying.

INTRODUCTION: Self-harm is a growing public health problem. The study aimed to investigate the prevalence of self-harm among a representative sample of school children and the contribution of dentofacial appearance and being bullied because of dentofacial appearance to self-harm. METHODS: This was a cross-sectional study in which a representative sample of eighth-grade students (aged 13-14 years) from randomly selected schools was asked to complete anonymous questionnaires distributed in the classroom. The final sample size was 699 children (339 girls, 360 boys) with a mean age of 13.3 years, representing 1.26% of the target population. RESULTS: The prevalence of self-harm was 26.9% (n = 188), with no statistically significant gender differences (P >0.05). Among all the subjects who reported self-harm, 47.9% (n = 90) reported self-harm because of dentofacial features. A total of 41 subjects reported self-harm because of bullying targeted at dentofacial features, representing around one fifth of subjects who reported self-harm. The 3 most common dentofacial features contributing to self-harm and self-harm as a result of bullying were tooth color and shape, spacing between the teeth or missing teeth, and prominent maxillary anterior teeth. CONCLUSIONS: This study demonstrated a relatively high experience of self-harm reported by adolescent school children, with many reporting self-harm as a result of their dentofacial appearance and bullying because of dentofacial features. The present study provides baseline data to better understand the relationship between self-harm and dentofacial features.

Anxiety and post-traumatic stress symptoms in orthognathic surgery patients.

OBJECTIVE: To assess the impact of orthognathic surgery in terms of anxiety and stress levels in pre-treatment and post-treatment groups compared with controls and the role of previous trauma exposure on anxiety and stress levels following treatment. MATERIALS AND METHODS: A case-control study was performed involving three age-gender matched groups: 38 'pre-surgery', 39 'post-surgery' and 39 'control' subjects. All subjects had assessment of dental anxiety, post-traumatic stress responses and frequency of previous distressing events. Seventeen subjects were followed up prospectively for 1 year after surgery. RESULTS: 'Post-surgery' group reported lower dental trait anxiety (S-DAI) scores than other groups (P = 0.001). S-DAI was significantly associated with frequency of previous traumatic events in 'pre-surgery' and 'post-surgery' groups (P < 0.01), and was significantly associated with post-traumatic stress disorder (PTSD) symptoms in 'pre-surgery' subjects (P < 0.01) who had the highest PTSD symptoms among the three groups (P = 0.005). Symptom severity (IES-R) levels were significantly associated with frequency of previous distressing dental events in 'pre-surgery' (P < 0.05) and 'post-surgery' groups (P < 0.01). Post-operative S-DAI and IES were significantly associated with pre-operative PTSD symptoms (P < 0.01). CONCLUSIONS: The two orthognathic groups were associated with low levels of anxiety and PTSD symptoms in comparison with the control group of the study. Trauma exposure prior to orthognathic treatment can be considered as a risk factor for the development of dental anxiety and PTSD symptoms. The need to improve communication between patients and team is emphasized, especially during the assessment of patients' emotional state pre-operatively, in addition to discussing psychological issues and psychosocial treatment implications.

Impact of bullying due to dentofacial features on oral health-related quality of life.

INTRODUCTION: The aim of this study was to investigate whether there is a relationship between self-reported bullying because of dentofacial features and oral health-related quality of life among a representative sample of Jordanian schoolchildren. METHODS: This was a cross-sectional study in which a representative sample of sixth-grade students (age, 11-12 years) from randomly selected schools in Amman, Jordan, were asked to complete questionnaires distributed in the classroom in the presence of the researchers. The questionnaire used for this purpose was the short form of the Child Perceptions Questionnaire for 11- to 14-year-old children. The final sample size was 920 children (470 girls, 450 boys). RESULTS: There were significant differences between the sexes for the total Child Perceptions Questionnaire score and for the oral symptoms and the social well-being subscales, with boys reporting higher scores and thus more negative effects on their oral health-related quality of life. Comparison of the total scores and subscales scores for boys and girls subdivided into those who reported being bullied and not being bullied about their teeth showed that bullied boys had significantly greater effects on overall oral health-related quality of life and on all subscales than did not-bullied boys (P <0.001 for all comparisons). Bullied girls also had significantly greater effects on the overall oral health-related quality of life and all subscales than did not-bullied girls (P <0.001 for all comparisons). However, bullied boys and girls reported similar scores for the different subscales of the Child Perceptions Questionnaire; there were no significant differences. CONCLUSIONS: This study demonstrated a significant relationship between bullying because of dentofacial features and negative effects on oral health-related quality of life. The results highlight the importance of addressing the bullying problem among schoolchildren and provide important data for educational authorities to create antibullying programs to help students receive education in a safe and healthy environment.

Bullying among Jordanian schoolchildren, its effects on school performance, and the contribution of general physical and dentofacial features.

INTRODUCTION: The aims of this study were to investigate the experience of bullying in a representative sample of Jordanian schoolchildren in Amman, to look at its effect on school attendance and perception of academic performance, and to look at the contribution of general physical and dentofacial features to this phenomenon. METHODS: This was a cross-sectional study in which a representative sample of sixth-grade students (11-12 years of age) from randomly selected schools was asked to complete questionnaires distributed in the classroom in the presence of the researchers. The final sample size was 920 children (470 girls, 450 boys). RESULTS: The prevalence of bullying was 47% (n = 433); significantly more boys reported being bullied than girls (P <0.001). The percentage of students subjected to name-calling was 40.9%. A significantly greater proportion of victims of bullying reported playing truant from school and disliking school than those who were not bullied. Teeth were the number 1 feature targeted for bullying, followed by strength and weight. The 3 most commonly reported dentofacial features targeted by bullies were spacing between the teeth or missing teeth, shape or color of the teeth, and prominent maxillary anterior teeth. CONCLUSIONS: This study demonstrated a high prevalence of bullying in Jordanian schools, with many children experiencing bullying because of their dental or facial appearance.

Perception of frontal facial images compared with their mirror images: chirality, enantiomorphic discrimination, and relevance to clinical practice.

BACKGROUND: What we think we see consists of models constructed in our brains, which may be constrained, limited and perhaps modified at a cerebral level. Patients may view their mirror image differently to how others and the clinical team view them. Understanding potential variations in perception between real and mirror images is important in clinical practice. The aims were to assess differences in self-perception between frontal facial and mirrored photographs, comparing the results with selfie photographs. METHODS: Facial photographs were taken by one investigator under standardized conditions for preclinical and clinical students. Each student took a selfie photograph at rest and smiling using his/her smartphone. A mirror image was generated for each image. Each student was shown his/her original and mirror image, without being informed which was which. For each pair of images, students were asked to choose which photograph they perceived as more attractive. A set of photographs of a male volunteer was shown to all participants, to choose either the original or mirror image as the more attractive. RESULTS: Most observers preferred the true image of the volunteer (P < 0.05), which may be evidence that most people prefer the true image of others, which is how they normally view them. Most observers preferred their own original photograph in frontal view at rest and smiling (P < 0.05), but preferred the mirror image of their selfie photograph at rest and smiling (P < 0.05). CONCLUSIONS: Significant differences in perceptions of attractiveness between true and mirror-reversed frontal and selfie images were found. Observers preferred their image the way they view themselves in a mirror. The selfie is how other people view an individual. If a selfie is flipped horizontally, that is how an individual sees themselves in a mirror. Most observers preferred the mirror image of their selfie, which is how they would view themselves in a mirror.

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES: To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05. RESULTS: Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year. CONCLUSIONS: Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Hypocone reduction and Carabelli's traits in contemporary Jordanians and the association between Carabelli's trait and the dimensions of the maxillary first permanent molar.

The objective of this study is to determine the prevalence of expression and bilateralism of two dental morphological traits in contemporary Jordanians: The hypocone reduction trait on the maxillary second permanent molar and Carabelli's trait on maxillary permanent first and second molars. Furthermore, inter-trait correlation and the relationship of Carabelli's traits with upper first molar dimensions were investigated. Three hundred subjects of school children at their 10th grade and of an average age of 15.5 +/- 0.4 years were involved. Alginate impressions for the maxillary arch were taken, dental casts were reproduced. The selected accurate casts were of 132 male- and 155 female-students. The frequencies of hypocone reduction trait on the maxillary second molar and Carabelli's trait on the maxillary molars were examined. Buccolingual and mesiodistal diameters of the maxillary first molar were measured and recorded. Paired Sample t test and Nonparametric Correlation analysis were used for data analysis. Hypocone reduction trait on the maxillary second molar was found in 29.8% of the examined students. Positive forms of Carabelli's trait on first and second molars were observed in 65.0% and 3.8%, respectively. Nonparametric correlation analysis revealed positive association between Carabelli's trait on first molar and hypocone reduction trait on the maxillary second molar. The presence of Carabelli's trait on first molar was strongly associated with the increase of buccolingual, but not the mesiodistal, diameter. Bilateralism was found highly significant in the tested traits and both genders (p < 0.001). This finding might be a sign of relatively low environmental stresses in the living Jordanian population and/or great ability of its individuals to buffer the adverse effects of such stresses.

A comparison of health-related quality of life between Jordanian and British orthognathic patients.

The aim of this study was to assess health-related quality of life (HRQoL) in adult Jordanian patients referred for orthognathic treatment, and to compare this with previously published data from a British cohort. Thirty-eight Jordanians (21 females and 17 males; aged 16-31 years) who were about to commence a course of orthognathic treatment completed a generic HRQoL questionnaire [Short-Form 36 (SF-36)] and a condition-specific orthognathic quality-of-life questionnaire (OQoLQ). The questionnaires were completed prior to commencing any pre-surgical orthodontic treatment. The data were compared using the Mann-Whitney U-test for independent groups with non-normally distributed data. There were no statistically significant differences between the Jordanian males and females for any of the OQoLQ or SF-36 items; hence, the groups were combined for analysis. When comparing the OQoL data with that of the British sample, there was no statistically significant differences for three of the four domains: dentofacial aesthetics (P = 0.726), social aspects (P = 0.096), or the awareness of dentofacial aesthetics (P = 0.066). There was, however, a significant difference for oral function (P = 0.016), with the Jordanian group reporting a poorer quality of life (QoL) (mean value 10.9) than the British cohort (mean value 8.4). However, it is questionable whether this difference would be of clinical relevance. While it was not possible to directly compare the results of the SF-36 questionnaires with the same British cohort, Jordanian patients had generally lower scores, and therefore a poorer QoL, than reported in other studies. These differences may be cultural or may be due to differences in the health care system's criteria for funding, and this needs further investigation.

The maxillary incisor labial face tangent: clinical evaluation of maxillary incisor inclination in profile smiling view and idealized aesthetics.

BACKGROUND: To test the hypothesis that in profile smiling view, for ideal aesthetics, a tangent to the labial face of the maxillary central incisor crowns should be approximately parallel to the true vertical line and thereby perpendicular to the true horizontal line. METHODS: An idealized female image was created with computer software and manipulated using the same software to construct an "ideal" female profile image with proportions, and linear and angular soft tissue measurements, based on currently accepted criteria for idealized Caucasian profiles. The maxillary incisor labial face tangent was altered in 5° increments from 70 to 120°, creating a range of images, shown in random order to 70 observers (56 lay people and 14 clinicians), who ranked the images from the most to the least attractive. The main outcome was the preference ranks of image attractiveness given by the observers. RESULTS: The most attractive inclination of a tangent to the labial face of the maxillary incisor crowns in profile view in relation to the true horizontal line was 85°, i.e. 5° retroclined from a perpendicular 90° inclination. The most attractive range appears to be between 80 and 90°. Excessive proclination appeared to be less desirable than retroclination. Beyond 105° most observers recommend treatment. CONCLUSION: In natural head position, the ideal inclination of the maxillary incisor crown labial face tangent in profile view will be approximately parallel to the true vertical line and thereby approximately perpendicular to the true horizontal line.

Tooth size discrepancies among Jordanian schoolchildren.

The aims of this study were to determine the tooth size discrepancies (TSD) in a representative sample of Jordanian schoolchildren and to compare TSD between genders. Dental casts of 367 (174 males and 193 females; mean age 15.5 years) Jordanian schoolchildren were selected. Anterior and overall Bolton ratios were determined using a digital calliper. Differences between genders were analyzed using a t-test. The results showed that there were no significant differences in the TSD between males and females. The percentages of subjects with more than 2 standard deviations for the anterior and overall ratios were 23.7 and 9.5, respectively.

Proportions of the aesthetic African-Caribbean face: idealized ratios, comparison with the golden proportion and perceptions of attractiveness.

BACKGROUND: In the absence of clear guidelines for facial aesthetic surgery, most surgeons rely on expert intuitive judgement when planning aesthetic and reconstructive surgery. One of the most famous theories regarding "ideal" facial proportions is that of the golden proportion. However, there are conflicting opinions as to whether it can be used to assess facial attractiveness. The aim of this investigation was to assess facial ratios of professional black models and to compare the ratios with the golden proportion. METHODS: Forty photographs of male and female professional black models were collected. Observers were asked to assign a score from 1 to 10 (1 = not very attractive, 10 = very attractive). A total of 287 responses were analysed for grading behaviour according to various demographic factors by two groups of observers. The best graded photographs were compared with the least well-graded photographs to identify any differences in their facial ratios. The models' facial ratios were calculated and compared with the golden proportion. RESULTS: Differences in grading behaviour were observed amongst the two assessment groups. Only one out of the 12 facial ratios was not significantly different from the golden proportion. CONCLUSIONS: Only one facial ratio was observed to be similar to the golden proportion in professional model facial photographs. No correlation was found between facial ratios in professional black models with the golden proportion. It is proposed that an individualistic treatment for each ratio is a rather better method to guide future practice.

The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities.

OBJECTIVE: This study investigated the effect of temporomandibular disorders on quality of life (QOL) of patients with dentofacial deformities. STUDY DESIGN: A case-control study was performed involving 3 age- and gender-matched groups: 38 preoperative participants, 38 postoperative participants, and 39 control participants. Temporomandibular joints were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I), and QOL was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Short-Form Health Survey (SF-36). RESULTS: Significantly lower OQLQ scores were found in postoperative patients with one or more RDC/TMD findings; the domains in which these occurred were mental health, dentofacial esthetics, and awareness of dentofacial esthetics for patients with myofascial pain; social aspects and awareness of dentofacial esthetics for patients with disk displacement with reduction; and all domains for patients with arthritis (all P < .05). CONCLUSIONS: Despite the variable effect of orthognathic treatment on TMDs, the presence of TMDs in patients after treatment can have a negative effect on their QOL.

A comparison between a new 2-dimensional digital on-screen tooth measurement method with direct measurements.

OBJECTIVE: To compare the accuracy and reproducibility of tooth measurements using newly developed software that gives 2-dimensional scanned images of dental setups with direct measurements using digital calipers. METHODS: This experimental study was performed at the Dental Laboratories of the Faculty of Dentistry, University of Jordan, Amman, Jordan from September 2010 to December 2010. Ten sets of acrylic teeth (10 upper and 10 lower arches) were used. The mesiodistal width of each individual tooth was measured using a digital caliper (method I), which was considered the gold standard. The teeth were set to create 20 dental setups. The mesiodistal widths of teeth on the created setups were then measured by using a digital caliper (method II). The dental setups were then scanned using a flatbed computer scanner and tooth width measurements were performed using a special computer program (method III). Tooth measurements were divided into 6 groups, and the 3 methods were compared. RESULTS: There was a statistical significant difference between the 3 measurement methods in most of the measured tooth groups. Methods I and II exhibited significant differences for most of tooth groups (ranged from 0.02 to 0.22 mm) while no significant difference was found between methods I and III (ranged from 0.03 to 0.11 mm). CONCLUSION: Tooth width measurement with on-screen 2-dimensional scanned images of dental casts is comparable to measurements obtained using direct digital caliper.

Condition-specific quality of life in Jordanian patients with dentofacial deformities: a comparison of generic and disease-specific measures.

OBJECTIVES: To determine the impact of dentofacial deformities and related treatment on quality of life (QOL) of Jordanian patients, and to make a comparison between the generic and specific measures used. STUDY DESIGN: A case-control study was performed involving 143 subjects: 36 before surgery, 35 after orthognathic treatment, 35 who declined surgery (Dec-surg), and 37 control subjects. Their QOL was assessed using the 36-item Short-Form Health Survey (SF-36) and Orthognathic Quality of Life Questionnaire (OQLQ). RESULTS: There were significant differences in OQLQ scores among the 4 groups (P < .001). When comparing the presurgery group to other groups: significant differences were found with postsurgery, Dec-surg, and control subjects (P < .001). The Dec-surg group showed no significant differences with postsurgery and control groups. CONCLUSIONS: Orthognathic surgery has a positive impact on patients' QOL. The condition-specific OQLQ showed better discriminator ability than the generic SF-36, although both measures provide an effective combination to evaluate QOL in patients with dentofacial deformities. More emphasis is required to understand emotional and psychosocial status of patients in addition to their esthetic and functional needs.

Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents, and dentists.

The aims of the present study were to compare rankings of dental aesthetics and the threshold at which orthodontic treatment would be sought among patients, parents, and dentists. A prospective cross-sectional study was designed to address these aims. The study sample comprised 100 patients and parents and 23 dental specialists. The patients were equally divided between males and females and their mean age was 14.7 years (standard deviation 2.3 years). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) represented impairment of dental aesthetics. The 10 numbered photographs of the AC were cut into equal-sized rectangles and subjects were asked to arrange them from 'the one that looks best' to 'the one that looks worst'. The subjects were then presented with the 10 photographs of AC in sequence and asked to identify the cut-off point between 'teeth that need orthodontic treatment' and 'no treatment'. Statistical analysis was undertaken with a Mann-Whitney test. The results showed that median rankings of dental aesthetics were similar among the three groups (P > 0.05). The median ranking of photographs 1, 2, 3, 4, and 10 were identical to the AC of IOTN. The photographs representing IOTN AC 7 and 8 were allocated the same median rank of 7 and AC 5 and 9 were allocated corresponding median ranks of 6 and 8, respectively. There were no significant differences in median cut-off points for treatment need among the three groups of subjects (P > 0.05), indicating that the mean threshold at which treatment would be sought was AC 4.

Application of Pont's Index to a Jordanian population.

The aim of this study was to assess the applicability of Pont's Index to a Jordanian population and to compare the results with those obtained from studies of different ethnic subjects. Dental casts of 144 Jordanians (71 males and 73 females; mean age, 15.5 years) with 'normal' occlusions were selected from the records of a random stratified sample of 383 Jordanian schoolchildren in the 10th grade. The mesiodistal widths of the maxillary permanent incisors, as well as intercanine, interpremolar, and intermolar arch widths, were measured directly on the selected dental casts using a digital calliper. An independent sample t-test was used to determine significant differences in tooth and/or arch width values for males and females. Correlation coefficients determined between the measured arch width values and those calculated according to Pont's Index were low in all cases, with r values ranging from 0.25 to 0.39. It was concluded that Pont's Index should not be used to pre-determine ideal arch width values in Jordanian individuals.