Orthodontic patients and the information found on the web: a cross-sectional study.

BACKGROUND: In recent years, the Web has become a source of medical information for patients, even though the information available online may be incorrect or qualitatively inadequate. Younger generations, immersed in a digital environment since a very tender age, are more likely to get informed online. This study aims to understand the relevance of online information for prospective orthodontic patients and to investigate the effects of digital research on patients' decision-making process, and it also aims to investigate potential generational differences between digital natives and digital immigrants. MATERIALS AND METHODS: An anonymous questionnaire was developed to investigate patients' orthodontic-themed Web searches as well as the effects digital material had on their decision-making process. Before submitting the newly designed survey to patients, it was validated in a pilot study. Univariate analysis was applied to analyze the relationship between the demographic characteristics of respondents and their answers on the use of digital research for the decision-making process. RESULTS: 64.6% of the study population searched the Web for orthodontic information prior to their visit. Google was the most used platform regardless of patients' age. The perceived reliability of online sources varied significantly with age. Men displayed more trusting behavior towards their doctor than women. Prospective patients' satisfaction with affected patients' decision-making processes, and the perceived reliability of online sources of information had repercussions on the doctor-patient relationship. CONCLUSIONS: Orthodontists should be aware that the majority of patients use the Internet as a source for orthodontic information, and that patients who are digital immigrants are more prone to trust the information found online. Patients who perceive the information found on the Web as either useful or reliable don't easily discard it, even if it is inconsistent with the orthodontist's opinion.

Evaluating video-based lectures on YouTube for dental education.

PURPOSE/OBJECTIVES: Multimedia presentations and online platforms are used in dental education. Though studies indicate the benefits of video-based lectures (VBLs), data regarding user reception and optimal video features in dental education are limited, particularly on Web 2.0 platforms like YouTube. Given increasing technology integration and remote learning, dental educators need evidence to guide implementation of YouTube videos as a freely available resource. The purpose of this study is to determine video metrics, viewership and format efficacy for dental education videos. METHODS: First, a cross-sectional survey was conducted of viewers (N = 683) of the Mental Dental educational videos on YouTube. Analytics were evaluated for 677 200 viewers to assess audience demographics, retention and optimal video length. Second, a randomized crossover study was conducted of dental students (N = 101) who watched VBLs in either slideshow or pencast formats and were tested on content learning to compare format efficacy. RESULTS: Most viewers of Mental Dental videos were dental students (44.2%) and professionals (37.8%) who would likely recommend the platform to a friend or colleague (Net Promoter Score = 82.1). Audience retention declined steadily at 1.34% per minute, independent of video length. Quiz performance did not differ between slideshow and pencast videos, with students having a slight preference for slideshows (P = 0.049). CONCLUSIONS: Dental students and professionals use VBLs and are likely to recommend them to friends and colleagues. There is no optimal video length to maximize audience retention and lecture format (slideshow vs. pencast) does not significantly impact content learning. Results can guide implementation of VBLs in dental curricula.

Impacts of Skeletal Anterior Open Bite Malocclusion on Speech.

Introduction: Articulation problems are seen in 80-90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /∫/), and affricate (/t∫/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality. Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n=39 AOB, 62 controls). A speech pathologist evaluated subjects and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions. Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant (p<0.01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /t∫/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds. Conclusions: A higher prevalence of qualitative distortion and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.

A machine learning approach to determine the prognosis of patients with Class III malocclusion.

INTRODUCTION: The conundrum of determining how to treat a patient with Class III malocclusion is significant, creating a burden on the patient and challenging the orthodontist. The objective of this study was to employ a statistical prediction model derived from our previous cephalometric data on 5 predominant subtypes of skeletal Class III malocclusion to test the hypothesis that Class III subtypes are associated with treatment modalities (eg, surgical vs nonsurgical) and treatment outcome. METHODS: Pretreatment lateral cephalometric records of 148 patients were digitized for 67 cephalometric variables, and measurements were applied to a mathematical equation to assign a Class III subtype. Subjects were assigned to either a surgical or nonsurgical group depending on the treatment received. Treatment outcome was determined by facial profile and clinical photographs. Log binomial models were used for statistical analysis. RESULTS: Subtype 1 (mandibular prognathic) patients were 3.5 × more likely to undergo orthognathic surgery than subtypes 2/3 (maxillary deficient) and 5.3 × more likely than 4/5 (combination). Subtype 1 patients were also 1.5 × more likely to experience treatment failure than subtypes 2/3 (maxillary deficient) and 4/5 (combination). CONCLUSIONS: This assessment of a systematic method to characterize patients with Class III malocclusion into subtypes revealed that subtype 1 (mandibular prognathic) showed a likelihood to undergo orthognathic surgery while subtypes 2/3 experienced significantly lower treatment failure (in response to orthodontics alone). Further refinement of the equation may yield a reliable prediction model for earlier identification of surgical patients and also provide predictive power of Class III treatment outcomes.

Identifying factors that impact general dentists' referrals to orthodontists.

INTRODUCTION: Referrals from general dentists are a significant source of orthodontic patients, but our knowledge of factors guiding referral decisions predates recent marketplace trends of direct-to-consumer products and broad digitization. To provide orthodontists with current, nationwide data on referral values and communication preferences, a mixed-methods study was conducted. METHODS: Semistructured interviews were conducted with practicing general dentists (n = 23), and interviews were analyzed to identify factors important to communication and referrals. Qualitative data provided the foundation to develop and pretest a survey distributed nationally to American Dental Association general dentists through email (n = 373). Survey results were evaluated using bivariate and descriptive statistics. RESULTS: Although 42% of general dentists provide orthodontics, of those, 68% report insufficient orthodontic training in dental school, and 61% have increased orthodontic care in recent years. General dentists refer to orthodontists for complex cases and growing patients, with the orthodontist's perceived skill and proximity to the patient being important for choosing a specific orthodontic practice. Phone (70%) and email (61%) are the most used interoffice communication methods, with email (40%) and then phone (30%) being the most preferred. The most important aspects of a working relationship were patient satisfaction and final occlusal outcome, whereas the best way to boost referrals was through improving communication. CONCLUSIONS: Excellent care and patient satisfaction remain primary motivators for referrals from generalists to orthodontists. An improved orthodontic curriculum is needed for general dentists. Good communication with dentists is critical for growing referral streams and enhancing patient care.

Orthognathic speech pathology: impacts of Class III malocclusion on speech.

INTRODUCTION: Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS: To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS: A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS: Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Educational debt and the gender gap: Understanding factors influencing orthodontists' career decisions.

INTRODUCTION: Orthodontic residents face challenges unparalleled to their predecessors, including competitive marketplaces, rising debt burdens, and changing demographics that have contributed to the shift in initial career choice from owner to employee. We aim to understand factors important to orthodontists at different career stages and the impact on job satisfaction through a sequential mixed methodology study. METHODS: Semistructured interviews were conducted with 25 orthodontic residents and practitioners. A survey was developed from qualitative findings that explored career decision-making of orthodontic residents and practicing orthodontists, with descriptive and bivariate statistical analyses (n = 343 orthodontists and 185 residents). RESULTS: Graduating orthodontic residents are choosing employment over ownership as their initial job, prioritizing high income to offset the educational debt. The majority of residents report thinking about their debt very often to all of the time and find it very to extremely stressful. Current residents have long-term goals of ownership, whereas practicing doctors of both genders became owners at equal frequencies. However, on average, women earn $119,000 less per year and report being the primary family caretaker more often than men. CONCLUSIONS: Excellent patient care, work-life balance, and sufficient income are the most important drivers for career choices and job satisfaction for orthodontists of all ages. Despite debt, most residents and working orthodontists report a high level of job satisfaction and would recommend the field of orthodontics to others.

Validating clinical characteristic of primary failure of eruption (PFE) associated with PTH1R variants.

BACKGROUND: Primary failure of eruption (PFE) is a hereditary condition, and linkage with variants in the PTH1R gene has been demonstrated in many cases. The clinical severity and expression of PFE is variable, and the genotype-phenotype correlation remains elusive. Further, the similarity between some eruption disorders that are not associated with PTH1R alterations is striking. To better understand the genotype-phenotype correlation, we examined the relationship between the eruption phenotype and PTH1R genotype in 44 patients with suspected PFE and 27 unaffected relatives. Sanger sequencing was employed to analyze carefully selected PFE patients. Potential pathogenicity of variants was evaluated against multiple genetic databases for function prediction and frequency information. RESULTS: Mutational analysis of the PTH1R coding sequence revealed 14 different variants in 38 individuals (30 patients and 8 first-degree relatives), 9 exonic and 5 intronic. Their pathogenicity has been reported and compared with the number and severity of clinical signs. In 72.7% of patients with pathogenic variants, five clinical and radiographic criteria have been found: involvement of posterior teeth, involvement of the distal teeth to the most mesial affected, supracrestal presentation, altered vertical growth of the alveolar process and posterior open-bite. In cases with mixed dentition (3), the deciduous molars of the affected quadrant were infraoccluded. DISCUSSION: The probability of an affected patient having a PTH1R variant is greater when five specific clinical characteristics are present. The likelihood of an eruption defect in the absence of specific clinical characteristics is rarely associated with a PTH1R mutation. CONCLUSIONS: We report here that systematic clinical and radiographic observation using a diagnostic rubric is highly valuable in confirming PFE and offers a reliable alternative for accurate diagnosis.

A novel nonsense PTH1R variant shows incomplete penetrance of primary failure of eruption: a case report.

BACKGROUND: Aim of this work was to describe a rare inheritance pattern of Primary Failure of Eruption (PFE) in a small family with incomplete penetrance of PFE and a novel nonsense PTH1R variant. CASE PRESENTATION: The proband, a 26 year-old man with a significant bilateral open-bite, was diagnosed with PFE using clinical and radiographic characteristics. DNA was extracted from the proband and his immediate family using buccal swabs and the entire PTH1R coding sequence was analyzed, revealing a novel heterozygous nonsense variant in exon 7 of PTH1R (c.505G > T). This variant introduces a premature stop codon in position 169, predicted to result in the production of a truncated and non-functional protein. This variant has never been reported in association with PFE and is not present in the Genome Aggregation Database (gnomAD). Interestingly, the c.505G > T variant has also been identified in the unaffected mother of our proband, suggesting incomplete penetrance of PFE. CONCLUSIONS: In this study, we report a new PTH1R variant that segregates in an autosomal dominant pattern and causes PFE with incomplete penetrance. This underlines the diagnostic value of a thorough clinical and genetic analysis of all family members in order to estimate accurate recurrence risks, identify subtle clinical manifestations and provide proper management of PFE patients.

Craniofacial characterization of Marfan Syndrome.

OBJECTIVE: The morbidity and mortality associated with the Marfan Syndrome (MFS) warrant timely diagnosis and intervention that can improve long-term prognosis. The aim of this study was to test the hypothesis that a distinct craniofacial morphology exists for patients with MFS that can be described quantitatively and qualitatively. METHODS: Subjects with a positive diagnosis of MFS were recruited for this study (N = 36). Craniofacial anthropometric measurements were made on each subject and compared to established norms of age- and sex-matched controls using z-scores calculated for measurements of MFS patients. Lateral and frontal photographs were obtained to make qualitative assessments and describe facial features of subjects, and a clinical examination was completed to document occlusal relationships. RESULTS: The subjects were primarily female (58%) ranging in age between 4 and 57 years (mean age 10.7 ± 6.0 years). Comparison of craniofacial measurements revealed that for 10 of the 12 measurements, ≥65% of the study population had a z-score of ± 2 and fell within the normal range for facial dimension. For 2 of the 12 measurements, over half of the subjects fell outside of the normal range (z-score < -2 or > 2) for facial dimension. Specifically, the majority of participants resided in the supernormal category for biocular width and the subnormal category for width of the face. Photographic assessment revealed retrognathia (54%) and down-slanting palpebral fissures (62%) were most prevalent in MFS patients. CONCLUSION: Our data suggest there are quantitative differences in the facial morphology of patients with MFS when compared to a control population.

Preface to COAST 2018 Innovators' Workshop: Bridging the biology and technology gap in orthodontics and craniofacial care.

OBJECTIVE: A third focused workshop explored how to transfer novel findings into clinical orthodontic practice. SETTING AND SAMPLE POPULATION: Participants met at the Scottsdale Plaza Resort, 12-16 September 2018 for the Consortium for Orthodontic Advances in Science and Technology 2018 Innovators' Workshop. Thirty speakers and four lunch-hour focus group leaders shared and exchanged information with approximately 45 registered attendees. MATERIAL AND METHODS: This Innovators' Workshop was organized according to five themed sessions which covered: (a) The relevance of genetics, biology and environment to therapeutic outcomes; (b) Application of bioinformatics in craniofacial research; (c) Regeneration with and for orthodontic treatment; (d) Technology in precision orthodontics; and (e) Muscle, joint, and airway: Growth, function and pain. RESULTS: The papers that comprise this supplemental issue exemplify the important outcomes of the 2018 COAST Workshop. In addition, matters identified as important needs include improved understanding of neural, skeletal and muscle tissue crosstalk in early craniofacial growth; standardized methods for three-dimensional radiographic and surface landmark and reference plane identification, measurements and serial superimpositioning techniques for use in the clinic; sharing and making available existing data sets (eg, cone beam computed tomography images, genotype-phenotype data); evidence of the usefulness and effectiveness of new devices; guidelines of what to measure to characterize the airway; more information about the influences of the soft tissues on craniofacial morphology; and information about effective digital work flows applied to clinical and educational settings. CONCLUSIONS: Progress in bridging the biology-technology gap has identified new needs for improvements in orthodontics and craniofacial care.

Primary failure of eruption: Clinical and genetic findings in the mixed dentition.

OBJECTIVE: To test the hypothesis that mutations in the parathyroid hormone 1 receptor ( PTH1R) include effects in both primary and permanent teeth. MATERIALS AND METHODS: DNA was extracted from saliva samples of 29 patients (8 familial and 21 sporadic) who presented with clinical evidence of infraoccluded teeth, and their unaffected relatives (N = 22). Sequencing followed by mutational analysis of the coding regions of PTH1R gene was completed for all individuals (N = 29). RESULTS: Eight of 29 cases revealed a heterozygous pathogenic variant in the PTH1R gene; five of eight variants represented distinct mutations based on comparison with the dbSNP, HGMD, and ESP databases. One mutation (c.1765 T>C p.Trp89Arg) was found to segregate within a family (n = 3). In silico analyses for all variants revealed a putative pathogenic effect. A genotype-phenotype correlation was reported as defined by a functional mutation in PTH1R and corresponding effects on one or more posterior teeth only; unilateral or bilateral involvement, infraoccluded primary teeth. CONCLUSIONS: Novel mutations were reported in the PTH1R gene that included PFE-affected primary molars, thus providing the basis for using a genetic diagnostic tool for early diagnosis leading to proper management.

Genetic Disorders of Dental Development: Tales from the Bony Crypt.

PURPOSE OF REVIEW: The ebb and flow of genetic influence relative to the understanding of craniofacial and dental disorders has evolved into a tacit acceptance of the current genetic paradigm. This review explores the science behind craniofacial and dental disorders through the lens of recent past and current findings and using tooth agenesis as a model of advances in craniofacial genetics. RECENT FINDINGS: Contemporary studies of craniofacial biology takes advantage of the technological resources stemming from the genomic and post-genomic eras. Emerging data highlights the role of key genes and the epigenetic landscape controlling these genes, in causing dentofacial abnormalities. We also report here a novel Glu78FS MSX1 mutation in one family segregating an autosomal dominant form of severe tooth agenesis as an illustration of an evolving theme, i.e., different mutations in the same gene can result in a spectrum of dentofacial phenotypic severity. The future of clinical therapeutics will benefit from advances in genetics and molecular biology that refine the genotype-phenotype correlation. Indeed, the past century suggests a continued convergence of genetic science in the practice of clinical dentistry.