Etiologies of excessive gingival display in a Saudi population.

Introduction: Excessive gingival display (EGD) is a mucogingival deformity characterized by overexposure of the maxillary gingiva while smiling. This cross-sectional study aimed to identify EGD etiologies and their prevalence in participants at King Saud University, Saudi Arabia. Methods: Adults with a gummy smile, who resided in Saudi Arabia, were nonsmokers, had good overall health, and had all their maxillary anterior teeth were eligible for inclusion. Participants were first screened by phone, and those who met the eligibility criteria were further screened at the Dental University Hospital (King Saud University, Riyadh, Saudi Arabia). The demographic characteristics of all eligible participants were recorded. Participants were further subjected to extraoral examination, which included gingival display (GD), vertical maxillary excess (VME), hypermobile upper lip (HUL), smile line, altered passive eruption (APE), gingival overgrowth, and short upper lip (SUL). Intraoral examination included periodontal pocket depth and bleeding upon probing. Student's t-test was used to compare the mean GD values across the main etiologies (VME, HUL, APE, and SUL). Results: All 123 participants (mean age: 23.1 ± 0.2 years; 74 females) had EGD (i.e., GD ≥ 4 mm), of whom 55 (44.7 %) had a single etiology, and the remaining 68 (55.3 %) had > 1 etiology. APE was the predominant etiology (n = 90, 73.2 %) in the study population. Of these (n = 90), APE alone was prevalent in 29 (32.2 %) participants, whereas the remaining patients had APE in combination with other EGD etiologies (n = 61; 67.8 %). The presence of more than one EGD etiology in the same participant was associated with greater GD. The VME and HUL were significantly associated with smile line classes (p < 0.05). Conclusions: APE (alone or in combination) was the predominant etiology of EGD in the study population. The presence of multiple EGD etiologies in the same patient emphasizes the need for an etiology-based, sequential, and multiple-treatment strategy to effectively manage EGD.

Lip repositioning surgery for gummy smile: 6-month clinical and radiographic lip dimensional changes.

OBJECTIVES: The present case series aimed to examine lip repositioning surgery (LRS) outcomes related to changes in external and internal upper lip (UL) dimensions, utilizing both conventional clinical and novel radiographic approaches. MATERIALS AND METHODS: Patients (n = 13) diagnosed with hypermobile UL (>8-mm mobility during smile) and excessive gingival display (≥4-mm) were included and assessed at baseline and 6 months postoperatively. Clinical parameters at rest included total lip and internal lip length (vestibular depth). At maximum smile included total lip, philtrum (ergotrid), and vermilion lengths. Cephalometric parameters included anterior maxillary height; lip length; nasolabial angle; anteroposterior lip thickness; internal lip length (vestibular depth); and vestibular fornix position (using novel approach employing radiopaque marker). Linear mixed-effect models, Pearson's correlation, and linear regression were used for statistical analyses. RESULTS: LRS did not affect total UL length at rest (p = 0.418). It resulted in significant internal UL length decrease (-3.8 ± 2.1 mm, p < 0.001) and significant increases of vermilion length (1.9 ± 1.0 mm, p < 0.001) and anteroposterior lip thickness (0.7 ± 0.7 mm, p = 0.002). The clinical and radiographic measurements of total UL length at rest (r ≥ 0.734) and of internal UL length (r ≥ 0.737), and the two radiographic assessments of vestibular depth (r = 0.842), were strongly correlated. CONCLUSIONS: LRS resulted in significant decrease of vestibular depth/internal UL length and in significant increases of UL vertical vermilion length and UL anteroposterior thickness, without affecting total UL length at rest. CLINICAL RELEVANCE: The documented lip dimensional outcomes should help practitioners when treatment-planning LRS and counseling patients seeking treatment for hypermobile UL.

Hypermobile upper lip is highly prevalent among patients seeking treatment for gummy smile.

BACKGROUND: Excessive gingival display (EGD), or a gummy smile (GS), is a mucogingival deformity that can be of concern to patients. The prevalence of GS etiologies, such as altered passive eruption (APE) and hypermobile upper lip (HUL), has not been reported. The aim of this study was to assess the prevalence of APE and HUL in patients seeking to correct their GS, and to determine possible prevalence differences among patients with different gingival display (GD) levels. METHODS: During clinical screening of patients interested in participating in a GS treatment study, GD diagnosis, GD level, and presence of APE and/or HUL were determined. Descriptive statistics were calculated for APE, HUL, and GD group prevalence. Fisher's exact test was used to determine difference in frequency of etiologies between GD groups. RESULTS: Fifty-six patients were clinically screened (27.2 ± 7.2 years old; 85.7% females; 94.6% with GD, 5.4% without GD). Among patients having GD, 75.5% presented with GD≥4 mm and 24.5% with GD<4 mm. Prevalence of etiologies was: 20.8% APE alone, 45.3% HUL alone, and 34% APE and HUL. The prevalence difference between GD≥4 mm and GD<4 mm groups was statistically significant (p<0.0001); for ≥4 mm GD: 5% presented with APE alone, 50% HUL alone, and 45% APE and HUL; for <4 mm GD: 69.2% presented with APE alone and 30.8% HUL alone. CONCLUSION: Among patients seeking GS treatment, HUL is the most predominant etiology and it is often present in combination with APE.

Medical and dental health status of orphan children in central Saudi Arabia.

OBJECTIVE: To evaluate the medical and dental health status of orphan children from 4 to 12-years-old, and compare them with children living with their parents. METHODS: This analytical, cross-sectional study took place in 3 government orphanages and 3 ordinary schools in Riyadh, Saudi Arabia from July 2011 to January 2012. All orphans aged 4-12 year were selected (N=90). Ninety children living with their parents were selected randomly to serve as the controls. Demographic data, medical, and dental history were obtained through a questionnaire answered by the orphans' foster mothers and children's parents. The study groups were examined to evaluate their caries status using the Decayed-Missing and-Filled Teeth/Surface indices (DMFT/DMFS) for permanent teeth and (dmft/dmfs) for primary teeth. Oral hygiene status (OHI), plaque deposition (PI), and gingival health (GI) were also assessed. Pearson Chi-square, Mann-Whitney, and Kruskal-Wallis tests were used for statistical analysis. RESULTS: Approximately 36% of the orphans had medical conditions compared to 14.4% of the control children. The control children visited the dentist more than the orphans (p<0.001). Approximately 96% of the orphans had dental caries compared to 90% of the control children (p<0.001). Decayed-missing and-filled teeth/surface index scores were higher among orphans (p=0.004) compared to the control children (p<0.001). Orphans scored higher in PI (p=0.009), GI (p=0.002), and OHI (p<0.001). CONCLUSION: Medical health conditions were more prevalent among orphans living in government orphanages, but they were provided with good and continuous medical care. However, they had more dental caries and worse oral hygiene, as dental care was provided to them only in case of emergency.