Nonpharmacological Behavior Guidance for the Pediatric Dental Patient.

Purpose: To present evidence-based recommendations on nonpharmacological behavior guidance for the pediatric dental patient. Methods: The work group assessed eight systematic reviews for effectiveness of nonpharmacological behavior guidance techniques in children undergoing preventive care or a dental treatment visit. The key outcomes assessed included cooperative behavior, anxiety, and procedural pain. To formulate the recommendations, the work group used the GRADE framework to obtain consensus on domains such as priority of the problem, certainty of the evidence, balance between desirable and undesirable consequences, patients' values and preferences, acceptability, and feasibility. Results: Overall, the use of basic nonpharmacological behavior guidance techniques resulted in trivial-to-small effect on improvement in behavior or reduction in anxiety. However, for children and adolescents undergoing preventive care, mobile applications and modeling showed large effects in reduction of anxiety. For those undergoing dental treatment, strategies such as modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal-assisted therapy, combined tell-show-do, audiovisual distraction, and cognitive behavior therapy showed large reduction in anxiety. For children and adolescents with special health care needs, audiovisual distraction and sensory-adapted dental environment showed large reduction of anxiety. Conclusions: All the formulated recommendations were conditional and were mostly based on very low certainty of evidence. Conditional recommendations imply that different choices or combinations of behavior guidance techniques may be most appropriate for different patients. Clinicians should use techniques consistent with the parent/patient values and preferences. These recommendations are based on the best available evidence to-date and are intended to aid clinical decision making.

Oral Health in the Down Syndrome Population: Parental Perceptions on Dental Care in the United States.

Purpose: To assess the oral health status of children with Down syndrome (DS) in the United States and evaluate the oral health needs of families with DS. Methods: Among 320 parents who consented to participate, 260 (81.2 percent) surveys were completed. A survey was distributed through the National Down Syndrome Society to parents of children with DS up to age 21 years, which asked questions about children's general and oral health. Results: Parents who reported that their children had difficulty rinsing and spitting were more likely to report their child's overall general health as poor (P<0.05). Parents' frequency of daily toothbrushing was similar to their children's toothbrushing habits (P<0.05). Conclusions: Dysphagia for children with Down syndrome may negatively impact oral health in addition to general health. Encouraging parental involvement in oral care for children with DS may lower their risk for oral disease. Continued support is needed to ensure dental school education includes training for the treatment and management of patients with DS.

Nonpharmacological Behavior Guidance For Children During Dental Treatment Visits: A Systematic Review and Meta-Analysis-Part 2.

'Purpose: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children undergoing dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a dental treatment visit including sealants, restorative care, dental local anesthesia, and simple surgical procedures. The primary outcome measures were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommenda- tions Assessment, Development and Evaluation approach were done. RESULTS: Forty articles qualified for analysis from 219 screened articles. Included studies evaluated the effectiveness of pre-visit preparation and in office strategies rendered pre-/post- or during treatment such as positive imagery, direct observation/modeling, desensitization, tell-show-do and its modifications, voice control, positive reinforcement, memory restructuring, bio- feedback and breathing relaxation, animal assisted therapy, combined therapies, and cognitive behavior therapy. The certainty of evidence ranged from Very low to high and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most of the basic non- pharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with modeling, positive reinforcement, biofeedback relaxation, breathing relaxation, animal assisted therapy, combined tell-show-do and audiovisual distraction, and cognitive behavior therapy showing large effects in reduction of anxiety based on some scales.

Nonpharmacological Behavior Guidance for Children with Special Health Care Needs During Preventive and Treatment Dental Visits: A Systematic Review-Part 3.

PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for children and youth with special health care needs (CYSHCN) during preventive and dental treatment visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a preventive visit (exam, fluoride application, radiographs, and prophylaxis) or a treat- ment visit (simple surgical treatment, sealants, restorative care with or with local anesthesia) with control or other interventions. The primary outcome measures for the studied interventions were reduction in anxiety, fear, pain, and improvement in cooperative behavior. Eight authors determined the included Randomized Controlled Trials (RCTs), performed data extraction, and assessed the risk of bias (ROB). Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Eleven articles qualified for analysis from 219 screened articles. Included studies evaluate the effectiveness of in office strategies such as modeling, audio-visual distraction, sensory adapted dental environment, and picture exchange communication system. The certainty of evidence ranged from Very low to Low and the magnitude of effect varied from trivial to large change in the desired outcomes. CONCLUSIONS: Most basic non-pharmacological behavior guidance techniques showed some trivial to small reduction in self-reported anxiety and/ or improvement in behavior, with audiovisual distraction, Sensory Adapted Dental Environment, and Picture Exchange Communication System showing large reduction in anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

Nonpharmacological Behavior Guidance for Children During Preventive Dental Visits: A Systematic Review-Part 1.

PURPOSE: To assess the effectiveness of nonpharmacological behavior guidance interventions used for a child undergoing preventive dental visits. METHODS: Databases: Ovid MEDLINE, PsycINFO (EBSCOhost), Embase, and Cochrane Library, were searched from 1946 to February 2022, for randomized clinical trials (RCTs) comparing effectiveness of basic and advanced nonpharmacological techniques rendered during a pre- ventive visit including examination, prophylaxis, fluoride application and radiographs. Workgroup (WG) identified moderate-to-high quality system- atic reviews (SRs) published on hypnosis, audiovisual distraction, and parental presence/ absence; and decided to exclude these interventions from current SR to avoid duplication. The primary outcome measures for the studied interventions included reduction in anxiety, fear, pain, and improve- ment in cooperative behavior. Eight authors determined the included RCTs, performed data extraction, and assessed the risk of bias. Standardized Mean Difference calculation and assignment of quality of evidence by Grading of Recommendations Assessment, Development and Evaluation approach were done. RESULTS: Fifteen articles qualified for analysis from 219 screened articles. WG found studies evaluating effectiveness of pre- visit preparation and in-office strategies rendered pre- or during treatment such as positive imagery, communication, modeling, tell-show-do, magic tricks, mobile applications, positive reinforcement, and sensory adapted dental environment. The certainty of evidence ranged from Very low to Moderate and the magnitude of effect varied from trivial to a large change in the desired outcomes. CONCLUSIONS: Most basic nonpharmacological behavior guidance techniques showed trivial to small reduction in self-reported anxiety and/or improvement in behavior, with mobile application and modeling showing large effects in reduction of anxiety based on some rating scales. Systematic Review Registration Number: PROSPERO: CRD42022314723.

Application of Inositol Hexaphosphate and Inositol in Dental Medicine: An Overview.

Phosphorylated inositol hexaphosphate (IP6) is a naturally occurring carbohydrate, and its parent compound, myoinositol (Ins), is abundantly present in plants, particularly in certain high-fiber diets, but also in mammalian cells, where they regulate essential cellular functions. IP6 has profound modulation effects on macrophages, which warrants further research on the therapeutic benefits of IP6 for inflammatory diseases. Here, we review IP6 as a promising compound that has the potential to be used in various areas of dentistry, including endodontics, restorative dentistry, implantology, and oral hygiene products, due to its unique structure and characteristic properties. Available as a dietary supplement, IP6 + Ins has been shown to enhance the anti-inflammatory effect associated with preventing and suppressing the progression of chronic dental inflammatory diseases. IP6 in dentistry is now substantial, and this narrative review presents and discusses the different applications proposed in the literature and gives insights into future use of IP6 in the fields of orthodontics, periodontics, implants, and pediatric dentistry.

Clinicopathologic correlation of oral lichen planus and oral lichenoid lesions: a preliminary study.

Oral lichen planus (OLP) and oral lichenoid lesions (OLL) are clinically and histologically similar lesions but their treatment planning and prognosis are different. The review of the literature indicates numerous criteria to distinguish these two lesions; however there is a lot of inconsistency. Thus, the aim of this study was to determine the correlation of histopathology and clinical OLP and OLL diagnosis and to clarify which histopathologic criteria could best distinguish these two diagnoses. A retrospective study showed that clinically diagnosed 92 OLPs and 14 OLLs have been confirmed histopathologically in 52.2% and 42.9% of cases, respectively. In addition, histopathology showed statistically significant more eosinophils (P<0.0005), plasma cells (P<0.0005), and granulocytes (P<0.05) in OLL than OLP. To establish histopathological diagnosis of OLP and OLL it should be mandatory to define the type of cells in mononuclear infiltrate, which can be associated more accurately with clinical feature and patient history. Therefore, currently accepted diagnostic criteria for OLP and OLL should be modified and validated on a larger number of patients taking into account particular distinguishing histopathological features.

Use of recombinant human bone morphogenetic protein (rhBMP2) in bilateral alveolar ridge augmentation: case report.

In recent years, the delivery of osteoinductive factors such as bone morphogenic proteins (BMPs) has become an alternative approach to traditional bone grafting due to their capacity to produce bone healing and new bone formation. BMP-2 has proved to possess the highest osteoinductive potential among BMPs. The case reported the clinical use of recombinant human BMP-2 for bilateral vertical alveolar ridge augmentation. In a case of 61 year-old patient with a significant bilateral vertical bony deficiency of the mandible, rhBMP-2 administered via an absorbable collagen sponge carrier (ACS) was used for bilateral alveolar ridge bone induction. Augmented sites were covered and fixed with titanium mesh. Augmented sites were reopened 6 months after surgery. Titanium membrane and retaining screws were removed and three dental implants were placed. The tissue samples for the histologic analysis were harvested. Following 3 months healing period, the submerged implants were uncovered and restored with zirconium-ceramic crowns. Cone beam computed tomography (CBCT), panoramix and 3D radiographic evaluation were obtained prior to and after the surgical procedure. Vertical gain of the bone was 5.5 mm on the left and 5 mm on the right side, with 6 mm width of the bone. Histologic analysis revealed formation of mature trabecular bone with signs of osteoblastic proliferation. Implant stability quotient (ISQ) values were in the range between 69 and 75 for all three implants. No suppuration, gingival recession or pain were present 24 months after surgery. Vertical bone augmentation using rhBMP-2 is optional treatment modality to consider when planning dental implant placement in sites where severe vertical insufficiency exists.

Dental caries experience in Croatian school children in Primorsko-Goranska county.

BACKGROUND: Dental caries as an infectious disease is still a major oral public health issue. As documented in some recent studies, it has been recognized as the most common chronic childhood disease. AIM: The aim of this study was to evaluate caries prevalence, DMFT and dmft scores, as opposed to caries free children at the age of 6 years from a well developed western region of Primorsko-Goranska county. The purpose was also to evaluate a Significant Caries Index (SiC) and a Restoration Index (RI) in the same study sample of 6 year olds. METHODS: Data for a sample of 1,825 (868 girls and 957 boys) children was collected and analyzed by using Chi-square and Mann-Whitney U Tests. RESULTS: Results showed that the mean dmft was 4.68 +/- 4.19, and the mean DMFT was 0.22 +/- 0.69. D/d component constituted a major part of caries score (DMFT/dmft) in both primary and permanent dentitions in the population of 6 years old children. Caries prevalence was 74.5 in primary dentition and 11.9 in permanent dentition. Significant Caries Index value (SiC) was 0.66 for permanent and 9.6 for primary teeth, respectively. The Restoration Index (RI) was 20.1 for primary and 39.5 for permanent dentition. CONCLUSION: The results obtained in this study revealed that dental caries still appears to be quite a significant problem among 6 year olds. However, collected data, particularly considering the SiC Index, can be used for further planning of preventive and restorative dental treatments as well as setting up future goals for the prevention of dental caries in Croatian school children of Primorsko-Goranska county.

Recent achievements in preventive dentistry by introducing a new probiotic toothpaste.

Artificially synthesized probiotic from Lactobacillus strain, contained in the tested toothpaste, led to an innovative approach in preventive dentistry. A new concept resulting from this research can be explained due to possible mechanisms of action of probiotic bacteria, according to which equilibrium of hostile bacterial flora is achieved by mechanical elimination of cariogenic bacteria from the mouth. This research was conducted during a 4-week period on a randomly selected Croatian sample of 50 participants, with the aim to investigate the efficacy of the first probiotic toothpaste ever produced in Croatia. CRT tests (Ivoclar Vivadent AG, FL-9494 Schaan/Liechtenstein) were used and individually administrated to each participant to assess the number of Streptococci and Lactobacilli. Saliva samples were tested before, as well as 2 and 4 weeks after using the tested toothpaste. After having had obtained detailed information on the research protocol, participants signed informed consent, and strictly following the instructions, brushed their teeth exclusively using the tested toothpaste and toothbrush of the same manufacturer over the 4 week period. Statistical results obtained after 4 weeks of using the probiotic toothpaste showed significant reduction in the number of participants who, prior to commencing the study, were diagnosed a high number of cariogenic bacteria. The number of participants with the high number of streptococci was significantly reduced from 78.4 to 26.5%, as well as the number of participants with the high number of Lactobacilli, which significantly dropped down from 52.9 to 26.5%. The results indicate a significant efficacy of the tested toothpaste, which can be attributed to the effect of the contained synthetized probiotic substance. Therefore, this research reveals a new achievement in innovative technologies, based on which probiotics can be used with purpose of maintaining balance of bacterial flora within the oral cavity, particularly in high risk groups who are more prone to developing caries.

Oral mucosal lesions during orthodontic treatment.

BACKGROUND: Oral mucosal lesions can result from irritation caused by orthodontic appliances or malocclusion, but their frequency is not known. AIM: To examine the frequency of oral mucosal lesions in wearers of orthodontic appliances in comparison to children with malocclusion. DESIGN: This study comprised 111 subjects: 60 wearers of orthodontic appliances and 51 controls (aged between 6 and 18 years). Type and severity of mucosal lesions, their topography, gingival inflammation, and oral hygiene status were determined by using clinical indices. RESULTS: Mucosal lesions were more present in wearers of orthodontic appliances than in children with malocclusion. Gingival inflammation, erosion, ulceration, and contusion were the most common findings in orthodontic patients. The severity of gingival inflammation was in correlation with oral hygiene status; the poorer oral hygiene, the more severe gingival inflammation was. Better oral hygiene status was found in children during orthodontic treatment than in children with malocclusion. CONCLUSIONS: Orthodontic treatment carries a higher risk of mucosal lesions and implies greater awareness of better oral hygiene as shown by the results of this study. Oral hygiene instructions and early treatment of oral lesions are important considerations in better patient's motivation, treatment planning, and successful outcome.

Dental trauma in children and young adults visiting a University Dental Clinic.

The aim of the study was to present the distribution of traumatic dental injuries in the permanent anterior teeth in 447 consecutively selected patients in the age interval of 6 to 25 years treated at the Department of Paediatric Dentistry at the University Dental Clinic in Rijeka, Croatia, in the period from 2001 to 2006. Data on age, gender, number of injured teeth and type of injury were taken from the dental records. Of all 447 consecutively selected patients with traumatic dental injury 56.2% were boys and 43.8% were girls with a male/female ratio 1.28:1 (P < 0.01). The highest frequency of tooth injuries occurred among 10- to 13-years-old children. Among 30.6% of the cases, two or more teeth were injured (38.6% in boys and 21.4% in girls). Traumatic injuries affecting teeth in the upper jaw were more frequent (P < 0.001). The most commonly affected teeth were the maxillary central incisors (42.4% of right central incisors and 38% of left central incisors). The most frequent injury was enamel and dentin fracture without pulpal involvement (38.7%). In conclusion, more attention should be paid to preventive measures.

Structural analysis of dental fear in children with and without dental trauma experience.

The aim of the study was to evaluate dental fear in children with and without dental injuries in a randomly selected children in Croatia (59 girls and 88 boys). Children were divided into three groups depending on dental trauma experience. They were also divided into two age groups: 5-8 and 9-12 years. Only dental trauma to the permanent teeth was included in the study. The CFSS-DS, CDAS and CMFQ were used for evaluation of dental anxiety and the ISP Hollingshead Index of Social Position was calculated for evaluation of social status. The mean values of CDAS, CFSS-DS and CMFQ tests revealed that the anxiety level decreases with increasing experience of dental injury. The analysis of variance performed for CDAS showed a significant difference between children with and without dental trauma (p = 0,010). Regarding the groups, the analysis of variance for CMFQ (p = 0,021) and CFSS-DS (p = 0,001) showed a significant difference, as well as regarding age (CMFQ; p = 0,001 and CFSS-DS; p = 0,016). Cronbach's alpha coefficients revealed the highest reliability for CFSS-DS (alpha = 0,910). Pearson's correlation coefficients revealed significant correlations between the anxiety scores, age and ISP values for children without dental trauma, and between the anxiety scores and age for children with repeated dental trauma. The results of the ISP Hollingshead Index exhibited the highest frequency in children with dental injuries who belonged to the families with poor social background (ISP = 44-60). No significant difference was obtained between children with and without dental injuries depending on either gender or the ISP value.

Dental anxiety in relation to emotional and behavioral problems in Croatian adolescents.

The investigation was performed on 113 adolescents in the age between 15 and 18 years (63 boys, 50 girls). Corah Dental Anxiety Scale (CDAS) and Children's Fear Survey Schedule - Dental Subscale (CFSS-DS) were used for evaluation of dental fear and Child Medical Fear Questionnaire (CMFQ) for evaluation of the fear of medical treatment. Achenbach Youth Self Report questionnaire (YSR) was used for evaluation of emotional and behavioral problems. The tests were filled in by children. The aim of the study was to evaluate the level of dental anxiety in adolescents and to assess a cause--consequence relationship between dental anxiety and emotional and behavioral problems in adolescents. The results of CDAS, CFSS-DS and CMFQ tests showed that dental anxiety scores and the total internalizing problems were higher in girls. Girls displayed more physical problems (p < 0.001) and were more prone to anxiety/depression disorders (p < 0.05). Both boys and girls were more aggressive, more prone to delinquent behaviour and had more externalizing problems in comparison with the average values obtained for the Croatian population. Significant correlation coefficients for boys were calculated for age and anxiety/depression, and delinquent behaviour and aggression (p < 0.05). Significant correlations were observed between physical problems and dental anxiety measured by the CFSS-DS test (p < 0.01), and between physical problems and the total internalizing problems (p < 0.05). In girls, the CMFQ scores showed significant correlations between dental anxiety and physical problems (p < 0.05), and anxiety/ depression (p < 0.01) and the total internalizing and externalizing problems (p < 0.05). Significant correlations were calculated for age and the total internalizing and externalizing problems for boys (p < 0.05). According to the results of both CDAS and CMFQ tests, anxiety in girls showed significant correlations with delinquent behaviour (p < 0.01). CDAS scores for girls showed significant correlations with aggression (p < 0.05) and the total externalizing problems (p < 0.01).

Dental caries in disabled children.

The aim of the study was to evaluate oral health conditions and dental caries status in disabled and healthy children. Two groups of randomly selected children 3-17 years old were examined. The first group comprised 80 children with disabilities (cerebral palsy, mental retardation, Down syndrome, autism and hearing-speaking disorders) and the second (control) group included 80 healthy children. Examined children were selected from several institutions which take care of disabled persons, kindergardens and four elementary schools. Clinical examination was performed by using a mirror and a probe and revealed the presence of dental caries, missing (extracted) and filled teeth. All clinically detected cavitations were registered as dental caries. The degree of oral hygiene was evaluated according to the OHI-S index values, which was determined by marking the plaque with 1% eozine solution. The values of OHI-S index ranged from 3.8-4.53 in disabled children and 2.73-2.84 in healthy children. In disabled children, the average dft values were 3.42 in deciduous teeth and 5.24 in mixed dentition. In healthy children, the average dft values were 1.43 in deciduous teeth and 5.1 in mixed dentition. The average DMFT index in disabled children was 1.41 for mixed and 6.39 for permanent dentitions. In healthy children, the average DMFT values were 1.23 in mixed and 4.76 in permanent dentitions. In general, the results revealed significantly poor level of oral hygiene and quite high level of caries prevalence in both disabled and healthy children, accentuating the need to reorganize preventive care measurements and improve dental care, particularly in disabled children in Croatia.

Soft-start polymerization of fissure sealant: retention after three years.

The aim of this study was to investigate retention of composite fissure sealant polymerized with standard and soft-start technique after a three year clinical trial. One hundred teeth were divided into two groups (A&B) of teeth and sealed with composite material (Visioseal, 3M Espe) using split mouth design. Sealants were polymerized using standard (Group A) and soft-start (Group B) techniques with commercial polymerization unit (Elipar Highlight, 3M Espe). Retention rate in Group A was 72%. In 14 teeth sealant was partially or completely missing. Group B showed retention rate of 80%. Sealant was partially or completely missing in 10 teeth. Six new caries lesions in Group A (3) and B (3) were detected. Mann-Whitney test did not reveal significant differences between the polymerization techniques. After three years complete retention of sealants, regardless of the group, was 76% (76 teeth) with six new caries lesions. Soft-start polymerization showed a comparable retention rate as the standard polymerization technique.

Relationship between needle phobia and dental anxiety.

PURPOSE: This cross-sectional study aimed to explain the nature of needle phobia and its relationship in dental phobic children with evidence on age-related differences. METHODS: The study used 2,865 patients (52% boys, 48% girls), 4 to 11 years old (mean=7.18 years). The patient sample included randomly selected patients (N=2,153) and an anxious group of children (N=712). Children were divided into 3 age groups (4-6, 7-9, and 10-11 years). The Children Fear Survey Schedule--Dental Subscale (CFSS-DS) was used to assess age-related needle phobia (CFSS-DS question 3) and dental anxiety. Children were arranged into 3 anxiety groups (cutoffs=scores of 25 and 37). Children who scored >37 were considered needle-phobic. Statistical analysis was performed using Statistics for Windows 10. RESULTS: Needle phobia progressively decreases with increasing age (19% of 4- to 6-year-old vs 11% of 10- to 11-year-old needle phobics; P< or =05). Stepwise regression analysis revealed needle phobia does not primarily seem to be related to dental anxiety. Other aspects, like having had someone examine the mouth and the dentist drilling, contribute the most to dental anxiety in both low- and high-anxiety children. Fear of doctors is more specific for high-anxiety children (P < or =05). A significant age-related difference regarding needle phobia is found between children ages 4 to 6 and 7 to 9 and between children ages 4 to 6 and 10 to 11 (P < or =001). CONCLUSIONS: Needle phobia is age related, but should be considered a separate phenomenon. It is not specific for dental anxiety and is related to other painful treatment.

Craniofacial anthropometric pattern profile in hypohidrotic ectodermal dysplasia--application in detection of gene carriers.

Hypohidrotic ectodermal dysplasia (HED) is characterized by clinical manifestations of severe hypodontia or anodontia, hypotrichosis, hypohidrosis, and specific facial appearance. Affected males show complete expression of clinical features of this condition. Their mothers, who are gene carriers, express only some signs, which are usually very mild. Currently available clinical methods are not sufficient for routine identification of the HED heterozygous gene carriers. The purpose of this study was to identify and describe the facial characteristics of HED patients and their mothers and to evaluate the usefulness of craniofacial pattern profile analysis (CFPP) in the diagnosis of this syndrome and the detection of gene carriers. In this study six affected males and their mothers were evaluated. Z-scores for each variable were calculated and compared with age- and sex-matched controls. Anthropometric analysis showed a specific dysmorphic pattern in CST patients that includes decreased skull base width (t-t: -1.67 Z); decreased forehead width (ft-ft: -1.8 Z), decreased midface depth (sn-t: -2.02 Z), markedly decreased total facial height (n-gn: -3.4 Z), and markedly decreased maxillary arc (t-sn-t: -2.5 Z). Gene carriers showed a similar tendency in their pattern profiles. They showed the same tendency towards lower Z-values for forehead width, facial height, and mouth width. The values for these measurements were between those of the affected and healthy controls. The most pronounced findings were increased head width (eu-eu: +2.83 Z), increased lower face width (go-go: +2.06 Z), and reduction of total facial height (n-gn: -0.95 Z). They also displayed increased nose width (al-al: +2.41 Z) and increased biocular distance (ex-ex: +2.01 Z). When used in conjunction with other methods the anthropometrics pattern profile analysis can considerably enhance detection of gene carriers for HED and increase objective assessment of the craniofacial region in HED patients.