Increased demand for orthodontic treatments during the COVID-19 pandemic: a commentary.

Despite the impact of the COVID-19 pandemic upon healthcare sectors generally, and what this continues to mean in particular for the practice of dentistry, there is evidence of an unanticipated upsurge in the demand for orthodontic treatment. This was observed in the UK and internationally as a manifestation of the so-called 'Zoom boom', in which video conferencing from home on various platforms suddenly exponentiated. As a result, it seems people became more self-conscious when viewing their appearance on-screen. Among the precipitating factors for individuals taking the consequent step of seeking orthodontic treatment are: the unavailability of more invasive smile enhancement treatments due to the pandemic restrictions; a more favourable infection control probability in orthodontic therapy; and the extra disposable funds that would otherwise be spent on holidays and leisure activities. This article explores different possible social and commercial drivers behind this phenomenon and suggests that the circumstances of the pandemic have shifted the pursuit of the desirable smile somewhat towards orthodontics, and as a consequence, is beneficial both to the public and the profession of dentistry as a whole.

Smiling makes you look older, even when you wear a mask: the effect of face masks on age perception.

The widespread use of face masks in the era of the Covid-19 pandemic has promoted research on their effect on the perception and recognition of faces. There is growing evidence that masks hinder the recognition of identity and expression, as well as the interpretation of speech from facial cues. It is less clear whether and in what manner masks affect the perception of age from facial cues. Recent research has emphasized the role of the upper region of the face, a part not covered by a mask, in the evaluation of age. For example, smile-related wrinkles in the region of the eyes make smiling faces appear older than neutral faces of the same individuals (the aging effect of smiling, AES). In two experiments, we tested the effect of face masks on age evaluations of neutral and smiling faces in a range of different age groups from 20 to 80 years. The results showed that smiling faces were perceived as older than neutral faces even when individuals were wearing a face mask-and there was no effect of masks on bias in age evaluations. Additional analyses showed reduced accuracy in age evaluations for smiling compared to neutral faces and for masked compared to unmasked faces. The results converge on previous studies emphasizing the importance of the upper region of the face in evaluations of age.

Accuracy of Dental Photography: Professional vs. Smartphone's Camera.

There is a scant literature on the accuracy of dental photographs captured by Digital Single-Lens Reflex (DSLR) and smartphone cameras. The aim was to compare linear measurements of plaster models photographed with DSLR and smartphone's camera with digital models. Thirty maxillary casts were prepared. Vertical and horizontal reference lines were marked on each tooth, with exception to molars. Then, models were scanned with the TRIOS 3 Basic intraoral dental scanner (control). Six photographs were captured for each model: one using DSLR camera (Canon EOS 700D) and five with smartphone (iPhone X) (distance range 16-32 cm). Teeth heights and widths were measured on scans and photographs. The following conclusions could be drawn: (1) the measurements of teeth by means of DSLR and smartphone cameras (at distances of at least 24 cm) and scan did not differ. (2) The measurements of anterior teeth by means of DSLR and smartphone cameras (at all distances tested) and scan exhibited no difference. For documentational purposes, the distortion is negligeable, and both camera devices can be applied. Dentists can rely on DSLR and smartphone cameras (at distances of at least 24 cm) for smile designs providing comparable and reliable linear measurements.

Mask wearing increases eye involvement during smiling: a facial EMG study.

The use of face masks has become ubiquitous. Although mask wearing is a convenient way to reduce the spread of disease, it is important to know how the mask affects our communication via facial expression. For example, when we are wearing the mask and meet a friend, are our facial expressions different compared to when we are not? We investigated the effect of face mask wearing on facial expression, including the area around the eyes. We measured surface electromyography from zygomaticus major, orbicularis oculi, and depressor anguli oris muscles, when people smiled and talked with or without a mask. Only the actions of the orbicularis oculi were facilitated by wearing the mask. We thus concluded that mask wearing may increase the recruitment of the eyes during smiling. In other words, we can express joy and happiness even when wearing a face mask.

Workhorse Free Functional Muscle Transfer Techniques for Smile Reanimation in Children with Congenital Facial Palsy: Case Report and Systematic Review of the Literature.

BACKGROUND: Pediatric facial palsy represents a rare multifactorial entity. Facial reanimation restores smiling, thus boosting self-confidence and social integration of the affected children. The purpose of this paper is to present a systematic review of microsurgical workhorse free functional muscle transfer procedures with emphasis on the long-term functional, aesthetic, and psychosocial outcomes. MATERIALS AND METHODS: We performed a literature search of the PubMed database from 1995 to 2019 using the following search strategy: "facial paralysis"[Title/Abstract] OR "facial palsy"[Title]. We used as limits: full text, English language, age younger than 18 years, and humans. Two independent reviewers performed the online screening process using Covidence. Forty articles met the inclusion criteria. The protocol was aligned with the PRISMA statement (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and was registered at the International Prospective Register of Systematic Reviews (PROSPERO, CRD42019150112) of the National Institute for Health Research. RESULTS: Free functional muscle transfer procedures include mainly segmental gracilis, latissimus dorsi, and pectoralis minor muscle transfer. Facial reanimation procedures with the use of the cross-face nerve graft (CFNG) or masseteric nerve result in almost symmetric smiles. The transplanted muscle grows harmoniously along with the craniofacial skeleton. Muscle function and aesthetic outcomes improve over time. All children presented improved self-esteem, oral commissure opening, facial animation, and speech. CONCLUSIONS: A two-stage CFNG plus an FFMT may restore a spontaneous emotive smile in pediatric facial palsy patients. Superior results of children FFMT compared to adults FFMT are probably attributed to greater brain plasticity.

"I'm smiling back at you": Exploring the impact of mask wearing on communication in healthcare.

BACKGROUND: Surgical and respirator masks are worn to reduce the risk of droplet and airborne transmission of viral respiratory disease. As a result of the novel coronavirus (COVID-19) pandemic, mask wearing has been designated mandatory for healthcare professionals working in UK hospitals for the foreseeable future. It is thus timely to consider the long-term implications of mask wearing on communication within healthcare settings, from both a patient and a clinician perspective. AIMS: The primary objective is to identify research evidence that corresponds to the mask-wearing experiences of healthcare professionals working on the ground. By drawing together a summary of the literature illustrating the potential challenges associated with mask wearing, it is possible to make an application to various clinical cohorts and to formulate a set of preliminary, evidence-based support strategies. The paper additionally explores the role for the Speech and Language Therapist (SLT) in supporting communication in the context of mask wearing. METHODS & PROCEDURES: Through a scoping review of the relevant literature, this paper reflects holistically on the prospective challenges associated with mask wearing across a variety of healthcare settings and patient populations. The subsequent conclusions have been used to inform the proposed clinical guidelines for safe and effective practice. OUTCOMES & RESULTS: There is a current research gap with regards to mask wearing in non-medical and non-clinical healthcare workers, and the impact this may have on both a professional and a personal basis. In the absence of preliminary data, the development of associated communication support strategies is hindered. This paper draws upon a variety of clinically conceivable issues faced by healthcare professionals, outlines important practical and ethical considerations, and proposes evidence-based solutions to some of the challenges identified. Future research is required to gather evidence with regards to actual clinical experiences of mask wearing to substantiate hypotheses. CONCLUSIONS & IMPLICATIONS: Although undoubtedly essential in protecting the health of staff and patients, there are numerous logistical, physiological, psychological, social and economic complications associated with the wearing of masks. The ability of healthcare staff to successfully communicate with patients and with colleagues is jeopardized, which may adversely affect the efficiency, effectiveness, equitability and, most notably, safety of therapeutic intervention. The SLT has a distinct role in facilitating communication in order to safeguard the provision, accessibility and efficacy of services. What this paper adds What is already known on the subject Existing research explores the impact of mask wearing on medical doctors, surgeons and dentists, and upon the corresponding patient cohorts. Little is known about how mask wearing may affect Allied Health Professionals and their ability to deliver therapeutic interventions safely and effectively. With mandatory face covering potentially a long-term requirement for UK healthcare staff, it is both timely and relevant to consider the consequences of mask wearing on communication across acute and community settings. What this paper adds to existing knowledge This paper identifies a range of prospective key issues associated with mask wearing across a variety of clinical and non-clinical populations, with application specifically to vulnerable patient cohorts. Through evidence synthesis, this paper provides a summary of fundamental issues supported by relevant literature, and draws upon these in order to propose a preliminary set of evidence-based clinical guidelines setting out potential solutions to the challenges faced. This review additionally assists in quantifying the role of the SLT within these extraordinary circumstances, with the aim of prompting unified practice, building upon professional guidance and increasing skill recognition. What are the potential or actual clinical implications of this work? In addition to their role in facilitating the development of individualised communication strategies for patients, SLTs should actively seek to provide widely accessible multidisciplinary education opportunities focusing on supporting communication; with specific reference to mask wearing and the associated communicative challenges. At a commissioning and managerial level, leaders within healthcare should acknowledge mask wearing as just one of the complexities associated with frontline working in the context of the COVID-19 pandemic, and aim to support their workforce by delivering resources and protocols which maximize and promote staff safety, efficiency, resilience and well-being in concurrence with positive patient outcomes.