Nutrition, obesity, and dental development in young adolescents in Chicago.

OBJECTIVES: Childhood obesity is a systemic disease with multiple downstream consequences, including shifts in timing of growth and development. It has been documented that children with high body mass index (BMI) show accelerated timing of dental development, but the mechanism for this acceleration is unknown. Prior work has suggested that inflammation and/or nutrition may play a role. We investigate the potential association between diet (caloric intake, macronutrients), obesity, and accelerated dental development. METHODS: Children and adolescents (age 10-15; n = 112) were recruited from dental clinics at the University of Illinois Chicago. We collected subjects' height, weight, panoramic radiographic records, and each subject filled out a Block Food Frequency Questionnaire. RESULTS: The only macronutrient level associated with BMI was a negative correlation to Total Fat consumption (p = .01), though this relationship was not significant in the path analysis (p > .05). Regression analyses indicated that BMI (p = .003) and total caloric intake (controlling for BMI; rho = 0.19; p = .04) were both significantly correlated with timing of dental development. However, when a path analysis was conducted, it was revealed that only BMI was statistically significant (p = .008). CONCLUSIONS: Body mass index percentile, regardless of caloric intake, is positively associated with accelerated dental development. While it is possible that excess caloric intake itself plays a minor role in timing of dental development, we do not see unambiguous evidence for this in our sample. We posit that another mechanism, such as inflammation, may be the link between obesity status and dental development.

Orthodontics in the era of big data analytics.

The objective of this report was to provide an overview of the current landscape of big data analytics in the healthcare sector, introduce various approaches of machine learning and discuss potential implications in the field of orthodontics. With the increasing availability of data from various sources, the traditional analytical methods may not be conducive anymore for examining clinical outcomes. Machine-learning approaches, which are algorithms trained to identify patterns in large data sets, are ideally suited to facilitate data-driven decision making. The field of orthodontics is particularly ripe for embracing the big data analytics platform to improve decision making in clinical practice. The availability of omics data, state-of-the-art imaging and potential for establishing large clinical data repositories have favourably positioned the specialty of orthodontics to deliver personalized and precision orthodontic care. Specifically, we discuss about next-generation sequencing, radiomics in the context of CBCT imaging, and how centralized data repositories can enable real-time data pooling from multiple sources.

Accuracy of Dental Monitoring 3D digital dental models using photograph and video mode.

INTRODUCTION: This study aimed to test the accuracy of the 3-dimensional (3D) digital dental models generated by the Dental Monitoring (DM) smartphone application in both photograph and video modes over successive DM examinations in comparison with 3D digital dental models generated by the iTero Element intraoral scanner. METHODS: Ten typodonts with setups of class I malocclusion and comparable severity of anterior crowding were used in the study. iTero Element scans along with DM examination in photograph and video modes were performed before tooth movement and after each set of 10 Invisalign aligners for each typodont. Stereolithography (STL) files generated from the DM examinations in photograph and video modes were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of both photograph and video modes of DM technology. RESULTS: No clinically significant differences, according to the American Board of Orthodontics-determined standards, were found. Mean global deviations for the maxillary arch ranged from 0.00149 to 0.02756 mm in photograph mode and from 0.0148 to 0.0256 mm in video mode. Mean global deviations for the mandibular arch ranged from 0.0164 to 0.0275 mm in photograph mode and from 0.0150 to 0.0264 mm in video mode. Statistically significant differences were found between the 3D models generated by the iTero and the DM application in photograph and video modes over successive DM examinations. CONCLUSIONS: 3D digital dental models generated by the DM smartphone application in photograph and video modes are accurate enough to be used for clinical applications.

A longitudinal assessment of sex differences in the growth of the mandibular retromolar space.

OBJECTIVE: To assess longitudinal variation in patterns of retromolar space growth, with regard to sex and cervical vertebrae maturation. DESIGN: We utilized serial lateral cephalograms from three craniofacial growth studies (Denver, Iowa, Oregon), measuring retromolar space and cervical vertebrae maturation in 99 subjects (56% male) from 8 to 18 years of age for each subject. Repeated measures ANOVA and a linear mixed effects model were used to assess retromolar space growth through time. RESULTS: Our analyses revealed an average increase in retromolar space of 8.73 mm from 8 to 18 years. While t-tests failed to find differences in retromolar space growth between males and females at the measured age points, repeated measures ANOVA and linear mixed effects models revealed modest differences in growth trends between sexes, with females having more growth earlier but a younger age of deceleration of growth (between 12 and 14 years of age). CONCLUSIONS: Our results confirm large increases in retromolar space through growth, reaching an average of 1.38 mm/year around puberty. Importantly, we add to the conversation regarding sex differences, showing differences in timing of growth. This highlights the importance of using longitudinal data and analytical approaches to address questions of this nature.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid.

BACKGROUND: The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions. METHODS: The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated. RESULTS: The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318. CONCLUSIONS: MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage. PRACTICAL IMPLICATIONS: MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

Childhood obesity may accelerate timing of human facial growth.

OBJECTIVE: We hypothesize that childhood obesity influences both facial and mandibular size and form in children and adolescents. DESIGN: Pre-treatment records of patients (n = 181; 86 males, 95 females) from the Department of Orthodontics at the University of Illinois at Chicago representing six different ancestry groups (Asian, African-American, Caucasian Non-Hispanic, Hispanic, Multiracial, Unknown) were reviewed retrospectively. Body mass index (BMI) scores and categories were calculated using the Center for Disease Control and Prevention (CDC) guidelines. Twenty-two landmarks were collected on lateral cephalometric radiographs. The landmark dataset was analyzed as a whole (facial shape) and a subset of landmarks was also used to study mandibular shape in isolation. RESULTS: Evidence of allometry (size related shape differences) was detected. Principal Component Analyses (PCA) were performed on the allometric regression residuals. Overall facial shape did not correlate with BMI. A series of one-way ANOVA tests on PC1-6 on a mandible-only subset of the landmarks using BMI category (normal, overweight, obese) showed PC5 and PC6 were significant (p = 0.003; p = 0.027). Centroid size was positively correlated with BMI when controlling for age (facial: p = 0.011, r = 0.196; mandibular: p < 0.001, r = 0.256). CONCLUSIONS: Our results mostly did not support a relationship between high BMI and facial shape. However, we found larger facial skeletal sizes in high BMI children, providing tentative evidence that childhood obesity may lead to accelerated timing of facial growth.

Orthodontic and Surgical Considerations for Treating Impacted Teeth.

Impacted teeth occur in a significant number of patients. Their management requires coordinated efforts of orthodontists and oral and maxillofacial surgeons. Specifically, optimal results require a prompt orthodontic diagnosis and treatment plan with execution of either closed or open exposure of impacted teeth by the oral and maxillofacial surgeon. Failure to consider orthodontic mechanics and proper surgical technique can lead to suboptimal results. Thus, orthodontist/oral and maxillofacial surgeon communication is essential for success and patient education and shared decision-making is mandatory before initiating treatment.

An Overview of Timeline of Interventions in the Continuum of Cleft Lip and Palate Care.

This article provides an overview of timeline of interventions and the critical role different providers have in the continuum of cleft lip and palate care. The earliest intervention is the presurgical infant orthopedic treatment, which is initiated in the first few weeks of life. This is followed by several interventions done in a phased manner. These include: lip repair, palate repair, velopharyngeal surgery, maxillary expansion, maxillary bone grafting, limited phase of orthodontic treatment, comprehensive phase of orthodontic treatment (with/without orthognathic surgery), and restorative dentistry.

Interceptive Dentofacial Orthopedics (Growth Modification).

Although all dentofacial deformities involve deviation of skeletal and dental units that require correction, the timing and method of treatment can vary considerably. Growth is a key consideration when managing dentofacial deformities, because it has a direct impact on the timing and method of management. Some deformities may be intercepted and managed during growth, whereas others can only be definitively managed after cessation of growth. This article focuses on clinical considerations of growth in managing dentofacial deformities, and discusses methods of growth evaluation and interceptive orthodontic management strategies in different types of dentofacial deformities.

The implementation of the Handicapping Labio-Lingual Deviation index on access to orthodontic care.

OBJECTIVES: In 2017, the state of Illinois changed the system by which they define severe malocclusion from the DentaQuest Orthodontic Criteria Index to the Handicapping Labio-Lingual Deviation Index (HLD). The purpose of this study was to compare subjects who were submitted for coverage under either the DentaQuest Orthodontic Criteria Index or the HLD index to see if a difference exists in the number of subjects who received coverage and the type of malocclusions that were covered. METHODS: All subjects evaluated for orthodontic coverage by the Illinois Department of Human Services for treatment at the University of Illinois, College of Dentistry during the years 2016 and 2017 were included in this study. One hundred consecutively approved and 100 consecutively denied subjects from both 2016 and 2017 were selected for further analysis. RESULTS: There was a statistically significant decrease in the overall rate of approval in 2017 compared to 2016. No difference was found in the approval rate of Class I, II, or III subjects, but there was a significant decrease in the approval rate of subjects with impacted teeth. CONCLUSIONS: The implementation of the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois.

The Relationship between Caries and Malocclusion in Chinese Migrant Workers' Children in Shanghai.

OBJECTIVE: To evaluate the relationship between caries and malocclusion in the early and late mixed dentition in a population of children of Chinese migrant workers in Shanghai. METHODS: Dental charts were obtained for 646 children in the mixed dentition, aged between 6 and 13 years old. The decayed, missing, and filled teeth (DMFT) index and interproximal tooth structure lost due to caries (ITSLC) were evaluated. RESULTS: In the early mixed dentition, overbite was more likely to be ideal in subjects with DMFT > 0. In the late mixed dentition, crowding in both arches was greater in subjects with DMFT > 0. In the total sample, crowding in the lower arch only was greater in subjects with DMFT > 0. In the early mixed dentition, upper crowding was lower in subjects with ITSLC in the upper arch and in both arches and the rate of anterior crossbite was higher in subjects with ITSLC in the upper arch. In the late mixed dentition, overjet was more likely to be ideal in subjects with ITSLC in the upper arch and upper crowding was greater in subjects with ITSLC in both arches. In the total sample, overjet was more likely to be ideal in subjects with ITSLC in the upper arch and lower crowding was greater in subjects with ITSLC in both arches. CONCLUSION: A relationship exists between caries and malocclusion, and between ITSLC and malocclusion, and some relationships may change with dental age.