A longitudinal study of the probability of developing malocclusion in children using a Bayesian analysis.

INTRODUCTION: This study evaluated the probability of developing malocclusions in mixed dentition. METHODS: A longitudinal study was conducted with 598 children (aged 5 years) in deciduous dentition. The children were followed for 3 years until mixed dentition (aged 8 years). Overjet, overbite, and transversal relations were evaluated. Bayesian models were used to analyze the data and estimate the parameters. RESULTS: The parameter θ was used for the distributions, indicating the probability of presenting a given condition with a credibility index (ICr) of 95%. After 3 years of follow-up, 121 children were reevaluated. The results showed that children have a high probability of malocclusion in mixed dentition. There was a higher probability of developing an increased overjet in the mixed dentition of 20.5% (ICr 95%, 13.6-28.4) to 48.3% (ICr 95%, 39.1-57.7) and a higher probability of having a normal overbite in the deciduous dentition and a lower probability in the mixed dentition (ICr 95%, 9.2-21.3). CONCLUSIONS: Considering the probabilistic model of Bayesian analysis, children with normal overjet in the deciduous dentition may show an increased overjet in the mixed dentition. Concerning overbite, children may present an anterior open bite during the transition between deciduous and mixed dentition, as well as self-correction of deep overbite in mixed dentition. Furthermore, they may present a posterior crossbite during the mixed dentition when there is a normal transverse relationship in the deciduous dentition.

Relationship between aesthetic concern and self-esteem in adolescents with severe malocclusion.

OBJECTIVE: This study aimed to evaluate the relationship between aesthetic concern and self-esteem in adolescents with severe malocclusion. METHODS: A cross-sectional study developed with 543 adolescents from 11 to 13 years of age and severe malocclusion was selected. Dental aesthetic index (DAI) diagnosed the malocclusion and selected the groups with greater severity (DAI 3 and 4). Aesthetic concern was assessed using the oral aesthetic subjective impact scale (OASIS) and considered an outcome variable. The global negative self-evaluation (GSE) evaluated self-esteem. The variables were analysed using Poisson multiple regression and the model adjustment determined by the Akaike information criterion (AICC). The effect of each variable on OASIS was expressed as a prevalence ratio (PR) with 95% confidence intervals. The analyses were performed using the R program with a significance level of 5%. RESULTS: A significant association was observed between aesthetic concern scores and self-esteem (p<.05). Individuals with low self-esteem had OASIS scores 14% higher (PR: 1.14; 95% CI: 1.08-1.21). There was no significant association between OASIS and gender and age (p>.05). CONCLUSIONS: Self-esteem modulates how the individual perceives malocclusion. Adolescents with severe and very malocclusion and low self-esteem have greater aesthetic concerns.

Impact of Dental Aesthetic Index characteristics on the severity levels of malocclusion in a non-White population.

INTRODUCTION: This study evaluated the impact of the esthetic and occlusal characteristics of the Dental Aesthetic Index (DAI) on the need for orthodontic treatment in a non-White population. METHODS: A cross-sectional study was conducted with 1296 non-White adolescents aged 12 years. DAI was the outcome variable (DAI 1 and 2 and DAI 3 and 4). The independent variables were categorized on the basis of the occlusal esthetic characteristics evaluated by DAI (tooth absence, crowding, spacing, midline diastema, maxillary misalignment, mandibular misalignment, maxillary anterior overjet, mandibular overjet, anterior open bite, and anteroposterior molar relationship). Simple logistic regression models were adjusted for the outcome, and the raw odds ratios were estimated. Variables with a P value of <0.20 for individual analyses were tested in a multiple logistic regression model, with P ≤0.05 remaining. RESULTS: A total of 1296 adolescents (764 girls and 532 boys) were evaluated; 1067 (82.3%) had DAI 1 or 2 (minor to a moderate need for orthodontic treatment), and 229 (17.7%) had DAI 3 or 4 (defined need for orthodontic treatment). The results showed that adolescents with diastema, maxillary irregularity, mandibular irregularity, mandibular overjet, anterior open bite, and the altered molar relationship had 5.34, 2.36, 2.63, 3.56, 8.73, and 5.16 times more likelihood to have DAI 3 or 4 (P ≤0.05), respectively. CONCLUSIONS: Diastema, maxillary and mandibular misalignment, mandibular overjet, anterior open bite, and anteroposterior molar relationship were the characteristics that influenced the determination of the need for orthodontic treatment in a non-White population using the DAI index.

Correlation between malocclusion and history of bullying in vulnerable adolescents.

OBJECTIVES: To assess the correlation between malocclusion and a history of bullying. MATERIALS AND METHODS: A cross-sectional study of 494 adolescents aged 12 to 15 years was conducted. The National School Health Survey questionnaire (PeNSE 1 and 2) was used to determine history of bullying by identifying the victim and the abuser. Variables were evaluated based on the individual (age), environment (income, father's and mother's education, housing, government assistance, and parents' occupation), social and emotional well-being (CPQ11-14 domains), self-perceived need for orthodontic treatment, and clinical conditions (crowding, diastema, maxillary and mandibular overjet, and anterior open bite). Data were analyzed by Spearman correlation and by multivariate analysis, which allowed graphical representation of the eight variables studied in only two dimensions. RESULTS: There was no correlation between bullying and variables related to the individual and the environment. Maxillary overjet and self-perception related to the need for orthodontic treatment were important to explain the data variability. CONCLUSIONS: Malocclusion did not correlate with bullying history. However, increased maxillary overjet influences adolescent self-perception, suggesting a potential condition for bullying events.

The impact of erosive tooth wear related to masticatory quality in an indigenous Brazilian population: A cross-sectional study.

OBJECTIVE: The study aimed to associate the impact of tooth wear with the perception of masticatory quality and eating habits in a Brazilian indigenous population. METHODS: A cross-sectional observational study was carried out with 197 indigenous from the Macuxi tribe (Roraima, Brazil) divided into age groups (adolescents and adults). Tooth wear was determined by the Basic Erosive Wear Examination (BEWE). The masticatory quality was evaluated using the Quality of Masticatory Function Questionnaire (QMFQ). Study participants also answered questions regarding eating habits and frequency of food consumption. Logistic regression models and crude Odds Ratios were estimated with 95% confidence intervals. Variables with P<0.20 in simple analyses were tested in a multiple logistic regression model; those with P ≤ 0.05 remained in the model. RESULTS: Tooth wear was observed in 38.1% of the indigenous, and 48.2% of them reported having their masticatory function affected; banana was the most frequently consumed item (54.3%); there was a significant association between adulthood and the presence of tooth wear (P<0.0001). CONCLUSIONS: Tooth wear related to eating habits and poor masticatory quality did not impact the oral health condition of the studied indigenous population. However, adulthood was associated with tooth wear in this sample.

Parental perception of malocclusion, its severity and aesthetic concerns in children with mixed dentition: A cross-sectional study.

OBJECTIVE: This study aimed to associate the parents' perception of the need for treatment and the children's aesthetic concern, considering the influence of malocclusion severity levels. METHODS: A population-based cross-sectional study was conducted with 770 children aged 8 to 10 years in the mixed dentition stage. A closed question sent to parents assessed the subjective orthodontic treatment need (outcome). Orthodontic Aesthetic Subjective Impact Score (OASIS) evaluated children's aesthetic concerns, and the Dental Aesthetic Index (DAI) diagnosed the anterior characteristics and malocclusion severity levels. Individual analyses were performed relating the outcome as independent variables. The variables with P<0.20 in the individual analyses were tested in multiple logistic regression models, and those with P<0.10 remained in the model. The adjusted odds ratio was estimated with a 95% confidence interval. RESULTS: Parents of children with higher aesthetic concerns are 1.82 times more likely to believe that their child needs orthodontic treatment (P<0.05). Parents of children with very severe malocclusion are 1.91 times more likely to perceive their child's need for orthodontic treatment (P<0.05). CONCLUSION: Parents of children with greater aesthetic concerns are more likely to perceive the need for orthodontic treatment, and very severe malocclusion also influences parents' perception of the need for orthodontic treatment.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition.

INTRODUCTION: This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition. METHODS: The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance. RESULTS: Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05). CONCLUSIONS: Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

Upper airways after mandibular advancement orthognathic surgery: A 4-year follow-up.

INTRODUCTION: The purpose of this study was to assess the stability of changes in the upper airways 4 years after orthognathic surgery in patients with skeletal Class II malocclusion. METHODS: A retrospective clinical study was conducted including 33 cone-beam computed tomography images from 11 patients (average age of 35.91 years) followed up longitudinally for 4 years. The airways were measured with the help of the Dolphin Imaging software (Dolphin Imaging and Management Systems, Chatsworth, Calif) at 3 points: T1 (preoperative), T2 (6 months after surgery), and T3 (4 years after surgery). The parameters assessed were surface area (SA), minimum axial area, and volume (VOL) of the pharyngeal airway space. The times were compared using analysis of variance and Tukey's test. Pearson's analysis was performed to assess the correlation with surgical changes and age (P <0.05). RESULTS: Four years after operating on the airway spaces, the means of SA and VOL were significantly higher than those observed before the surgery (P <0.05). The means at 6 months were intermediate, with no significant difference before the surgery and 4 years after it (P >0.05). There was no significant correlation of the changes in SA, VOL, and minimum axial area with the amount of mandibular advancement, counterclockwise rotation of the occlusal plane, and age of the patient (P >0.05). CONCLUSIONS: Four years after mandibular advancement surgery in patients with skeletal Class II malocclusion, the increases in the airways remained stable.

Is the adolescent's esthetic concern associated with anterior occlusal conditions or the malocclusion severity level?

OBJECTIVES: To assess the esthetic impact of anterior occlusal conditions and malocclusion severity levels. MATERIALS AND METHODS: A population-based cross-sectional study of 700 adolescents aged 15 to 19 years was conducted. The Oral Aesthetic Subjective Impact Scale (OASIS) was used to evaluate the subjective esthetic impact of malocclusion. The Dental Aesthetic Index (DAI) criteria were used to diagnose the anterior occlusal characteristics in isolation and the severity levels of malocclusion. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI). RESULTS: Of the adolescents, 42% showed negative self-perception of malocclusion. In addition, 15.4% of adolescents had severe malocclusion (DAI 3) and 18.9% very severe malocclusion (DAI 4). Crowding and spacing were shown to be 2.90 (CI: 2.06-4.09) and 2.53 (CI: 1.65-3.86) times, respectively, more likely to cause a negative esthetic impact in adolescents (P < .05). In addition, adolescents with orthodontic treatment need (DAI 2, 3, and 4) were more likely to report a negative esthetic impact (P < .05). CONCLUSIONS: Anterior crowding and spacing are the conditions that most influence the esthetic concern of adolescents. Adolescents with very severe malocclusion and higher orthodontic treatment need are more likely to report a negative esthetic impact.

Oral and maxillofacial outcomes in children with microcephaly associated with the congenital Zika syndrome.

INTRODUCTION: The objective of this study is to assess the oral and maxillofacial characteristics of microcephalic children associated with congenital Zika syndrome (CZS). METHODS: A cross-sectional, observational study was carried out with 61 patients with microcephaly/CZS born between June 2015 and September 2017 (29 boys and 32 girls, average age of 22.8 months) and a control group with 58 non-CZS children born in the same period (25 boys and 33 girls, average age of 23.8 months). The functional clinical analysis considered the labial and lingual frena, tongue anterior projection, oral escape, palate form, and first tooth eruption. For the craniofacial analysis, facial anthropometric points and the cephalic perimeter at the time were measured. Demographic data were collected from medical records, and a clinical exam was performed in order to register the intrabuccal characteristics and craniofacial measures. The chi-square test and Student's t-test were used with a significance level of 0.05. RESULTS: The narrow palate form, tongue anterior projection, oral escape, and late first tooth eruption were significantly more present in the group with microcephaly/CZS. As for the craniofacial analysis, face width (Bi-Zi), mandible width (Go-Go), height of face upper third (Tr-G), and monthly growth of cephalic perimeter were significantly smaller, whereas height of face lower third (Sn-Gn) was significantly bigger in the group with microcephaly/CZS (P < 0.05). CONCLUSION: Children with microcephaly resulting from a congenital Zika infection showed functional, oral, and maxillofacial changes and smaller facial development in comparison with non-CZS children in the same age group.