Satisfaction with smile appearance mediates oral health-related quality of life in adolescents regardless of orthodontic treatment need - a cross-sectional study.

OBJECTIVES: To explore the relationship between adolescents' oral health-related quality of life (OHRQoL), satisfaction with smile appearance, treatment need and treatment demand through direct and serial mediation models. MATERIALS AND METHODS: This cross-sectional study included 215 11-14-year-olds and their parents. The instruments included the Child Perceptions Questionnaire and the Index of Orthodontic Treatment Need. Satisfaction with smile appearance, orthodontic treatment demand and parental perception of their child's orthodontic treatment need was recorded on a Likert scale (0 = not at all to 4 = very much). Serial mediation models were used to assess the effects of malocclusion on the OHRQoL. RESULTS: Objective treatment need explained less than 5% of the adolescents' OHRQoL. Serial mediation models through satisfaction with smile appearance, parental perception of their child's orthodontic treatment need, and patients' orthodontic treatment demand explained 23-25% of the variance. CONCLUSIONS: Satisfaction with smile appearance mediates the OHRQoL in adolescents. Parents have no direct influence, but their perception of the need to correct their child's teeth might amplify adolescents' orthodontic treatment demand, leading to lower OHRQoL.

Parental influence is the most important predictor of child's orthodontic treatment demand in a preadolescent age.

The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11-14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test-retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (ß = 0.335, p = 0.002), parental influence (ß = 0.221, p = 0.002), and malocclusion severity (ß = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4-25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5-12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1-1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0-1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents' cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

Impact of the Tobacco Heating System and Cigarette Smoking on the Oral Cavity: A Pilot Study.

Cigarette smoking and the harmful chemicals released during smoking have negative effects on oral health. As a measure of harm reduction, a new alternative tobacco heating system (THS) has been developed. The aim of the study was to analyze and compare the effects of conventional cigarettes and THS on the oral mucosa, the salivary flow rate (SFR), halitosis, and the load of Candida spp. The study included 20 tobacco heating smokers, 20 conventional cigarette smokers, and 20 nonsmokers. The subjects completed questionnaires on medical information, smoking habits, oral lesions, and symptoms. A clinical examination and SFR test were performed on each subject, followed by an organoleptic assessment of halitosis. Mucosal swabs were collected and cult ured to identify Candida spp. Significant differences were found between the smoking groups in relation to halitosis (p < 0.001; ε2 = 0.624), intraoral findings (p < 0.001; ε2 = 0.507), SFR (p < 0.001; ε2 = 0.0331) and dry mouth for subjective complaints (p = 0.021; ε2 = 0.363). The SFR was significantly lower; however, halitosis, the prevalence of intraoral findings, and dry mouth were significantly higher among smokers, but there were no significant differences between THS and conventional smokers. The present study suggests that THS smoking has similar effects on oral tissues, especially the SFR and halitosis, as conventional cigarette smoking.

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment.

OBJECTIVES: To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment. MATERIALS AND METHODS: The sample consisted of 77 subjects (aged 11-13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed. RESULTS: There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2-9.4; P = .017). Patients were 3.2 times (95% CI, 1.1-9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0-9.4; P = .044). CONCLUSIONS: Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.

Effects of Visual Stimuli from Media on the Perception of Dentofacial Esthetics.

OBJECTIVES: The study explored whether television commercials change the perception of one's own dentofacial attractiveness and to identify if it is influenced by personality traits. MATERIALS AND METHODS: The sample included 83 participants, aged 19-27 years. The experimental group (N=42) watched commercials portraying famous young individuals with high smile esthetics, bright teeth and no visible malocclusions, while the control group (N=41) watched neutral commercials (without people or visible teeth). The perception of subjects` own orofacial esthetics and its psychosocial effects were assessed a month before the exposure and immediately after it. The subjects` malocclusion severity and personality characteristics (extraversion, conscientiousness, agreeableness, neuroticism, intellect, self-esteem and perfectionism) were assessed. RESULTS: In their second report, respondents were inclined to report less psychosocial impacts with small differences (ranging from 0-3 scalar points on average) and less significant in the active group compared to neutral group (2 out of 7 vs. 5 out of 7 aspects). Types of visual stimuli were a significant predictor only of changes pertaining to psychological impact of dental esthetics (p=0.045; r=0.221). The intellect moderated perception of smile esthetics, after having been exposed to commercials, accentuated beautiful smiles as a suppressor (ΔR2=0.076; p=0.005; total model R2=0.347; p=0.033). In subjects with higher cognitive abilities, an increase in the self-perceived malocclusion level induced a smaller decrease in psychological impact of dental esthetics as compared to those with lower intellect. CONCLUSION: Psychosocial influences of malocclusion are not stable and tend to decrease during time. However, the exposure to a high smile esthetic of other individuals can inhibit that process in persons with more severe malocclusion and higher cognitive abilities.

Child Perceptions Questionnaire in Croatia: Two Domains for Measuring Oral Health.

OBJECTIVE: To perform cross-cultural adaptation and to test psychometric properties of the 8-item CPQ in 11-14 year-olds: stepwise-regression (RSF:8) and item-impact (ISF:8) short-forms. MATERIALS AND METHODS: The sample included 237 orthodontic patients aged 11-14 at two University Dental Clinics in Croatia. Structural and construct validity, reliability and responsiveness were assessed. Intraoral examination included an assessment of dental caries and malocclusion severity. RESULTS: Two domains instead of originally suggested four are more appropriate for the assessment of oral health-related quality of life (OHRQoL) in both ISF:8 and RSF:8 (60.05% and 52.24% variance; α=0.56-0.85). Oral symptoms and functional limitations from the original instrument were grouped in one dimension that defines oral function, while emotional and social well-being was grouped in a dimension of psychosocial well-being. Instruments are able to detect differences between subjects with low and high caries and malocclusion severity. They were stable when there were no changes in oral conditions, while it was possible to detect differences induced by correction of malocclusion following orthodontic treatment (p<0.05). CONCLUSION: A 8-item CPQ demonstrated good psychometric properties but points to the fact that two domains instead of four are more appropriate for the assessment of OHRQoL in 11-14 year-olds.

Changes in Quality of Life Induced by Tooth Whitening are Moderated by Perfectionism: A Randomized, Double-Blind, Placebo-Controlled Trial.

PURPOSE: To explore the influence of perfectionism on the short-term changes in satisfaction with smile esthetics and quality of life (QoL) induced by tooth whitening. MATERIALS AND METHODS: A total of 60 subjects were analyzed: 30 in the active group, in which the subject's anterior teeth were whitened with a photoactivated gel, and 30 in the placebo group. The Smile Esthetics-Related Quality of Life and Multidimensional Perfectionism Scale questionnaires were administered to all participants. RESULTS: The active group demonstrated an increase in dental self-confidence and a decrease in dissatisfaction with color (P < .05). The amount of color change did not correlate linearly with change in dissatisfaction or with QoL. In subjects with higher perfectionism, increasing the color change led to more decrease in dental self-consciousness. CONCLUSION: Perfectionism moderates perception of smile esthetics.