Retrospective CBCT analysis of airway volume changes after bone-borne vs tooth-borne rapid maxillary expansion.

OBJECTIVES: To compare changes in upper airway volume after maxillary expansion with bone- and tooth-borne appliances in adolescents and to evaluate the dentoskeletal effects of each expansion modality. MATERIALS AND METHODS: This retrospective study included 36 adolescents who had bilateral maxillary crossbite and received bone-borne maxillary expansion (average age: 14.7 years) or tooth-borne maxillary expansion (average age: 14.4 years). Subjects had two cone beam computed tomography images acquired, one before expansion (T1) and a second after a 3-month retention period (T2). Images were oriented, and three-dimensional airway volume and dentoskeletal expansion were measured. Analysis of variance was used to test for differences between the two expansion methods for pretreatment, posttreatment, and prepost changes. Paired t-tests were used to test for significance of prepost changes within each method. RESULTS: Both groups showed significant increase only in nasal cavity and nasopharynx volume (P < .05), but not oropharynx and maxillary sinus volumes. Intermolar and maxillary width increased significantly in both groups (P < .05); however, the buccal inclination of maxillary molars increased significantly only in the tooth-borne group (P < .05). There was no significant difference between tooth- and bone-borne expansion groups, except for the significantly larger increase in buccal inclination of the maxillary right first molar after tooth-borne expansion. CONCLUSIONS: In adolescents, both tooth- and bone-borne RME resulted in an increase in nasal cavity and nasopharynx volume, as well as expansion in maxillary intermolar and skeletal widths. However, only tooth-borne expanders caused significant buccal tipping of maxillary molars.

Associations of fluoride intake with children's cortical bone mineral and strength measures at age 11.

OBJECTIVES: There is strong affinity between fluoride and calcium, and mineralized tissues. Investigations of fluoride and bone health during childhood and adolescence show inconsistent results. This analysis assessed associations between period-specific and cumulative fluoride intakes from birth to age 11, and age 11 cortical bone measures obtained using peripheral quantitative computed tomography (pQCT) of the radius and tibia (n = 424). METHODS: Participants were a cohort recruited from eight Iowa hospitals at birth. Fluoride intakes from water, other beverages, selected foods, dietary supplements, and dentifrice were recorded every 1.5-6 months using detailed questionnaires. Correlations between bone measures (cortical bone mineral content, density, area, and strength) and fluoride intake were determined in bivariate and multivariable analyses adjusting for Tanner stage, weight and height. RESULTS: The majority of associations were weak. For boys, only the positive associations between daily fluoride intakes for 0-3 years and radius and tibia bone mineral content were statistically significant. For girls, the negative correlations of recent daily fluoride intake per kg of body weight from 8.5 to 11 years with radius bone mineral content, area, and strength and tibia strength were statistically significant. No associations between cumulative daily fluoride intakes from birth to 11 years and bone measures were statistically significant. CONCLUSIONS: In this cohort of 11-year-old children, mostly living in optimally fluoridated areas, life-long fluoride intakes from combined sources were weakly associated with tibia and radius cortical pQCT measures.

MALOCCLUSION, PAST ORTHODONTIC TREATMENT, AND SATISFACTION WITH DENTAL APPEARANCE AMONG CANADIAN ADULTS.

OBJECTIVE: To examine whether malocclusion and past orthodontic treatment are associated with satisfaction with dental appearance among Canadian adults. METHODS: Using data from the 2007-09 Canadian Health Measures Survey, this cross-sectional study analyzed information from 2184 respondents (1005 men and 1179 women) aged 20-59 years. The outcome variable was satisfaction with dental appearance. Ordinal logistic regression was used to investigate the relation between satisfaction with dental appearance and 2 independent variables: malocclusion and past orthodontic treatment. RESULTS: Of the participants, 70% were "very satisfied" or "satisfied" with the appearance of their teeth. The prevalence of malocclusion and past orthodontic treatment was 25% and 20%, respectively. Controlling for the effect of covariates, malocclusion had a significant negative effect on satisfaction with dental appearance (p = 0.02), but past orthodontic treatment did not (p = 0.36). Satisfaction with dental appearance was greater among those in the higher-income group, never smokers, those with better self-rated health, those with no anterior decayed teeth, and those with no anterior filled teeth. CONCLUSION: Past orthodontic treatment was not linked to satisfaction with dental appearance in this sample of Canadian adults. Public health programs and clinicians should focus on addressing esthetic problems by restoring inadequate anterior teeth fillings, restoring anterior tooth decay, and implementing smoking cessation programs before considering orthodontic treatment.

Time until first dental caries for young children first seen in Federally Qualified Health Centers: a retrospective cohort study.

OBJECTIVES: The study assessed the time until first dental caries for young children seen at five Federally Qualified Health Centers (FQHC) in Iowa and the relationship with the frequency and gaps (in months) of dental episodes, the number of topical fluoride treatments, and the number of dentists caring for the subject. METHODS: Forty children were randomly selected at each FQHC (n = 200). All children were continuously enrolled in the Medicaid program and had their first dental visit prior to age 6. Dental chart findings, claims data for the child and family, and birth certificate information were merged into one dataset. Dental visits were followed for a minimum of 36 months, including dental visits external to the FQHCs. Using time until first caries as the dependent variable, the data were subject to left, interval, and right censoring and were analyzed via Weibull regression. RESULTS: Slightly more than half of the 200 children experienced caries. Regression analysis indicated that the hazard of first dental caries increased by approximately 2% with each additional month that transpired between preventive recall examinations. In addition, children with older siblings who had a dental visit at the same center during the previous year prior to the subject's first visit were more likely to have a longer time until first dental caries. CONCLUSIONS: Timing of dental care episodes was associated with caries experience in young children from low income families. Dental professionals should focus on regularity of dental care to prevent or delay caries experience in young children.

General dentist characteristics associated with rural practice location.

PURPOSE: To examine whether there is a difference in the likelihood that a general dentist practices in a rural location based on individual characteristics, including dental school attended, birth state, practice arrangement, sex, and age. METHODS: All private practice, general dentists in Iowa were included in this study. Data were extracted from the year 2010 version of the Iowa Dentist Tracking System, which monitors practice patterns of active dentists. Rurality of primary office location, categorized using Rural-Urban Commuting Area codes, served as the outcome variable. Chi-square tests and multivariable logistic regression were used to explain associations between rural practice location and dentist characteristics. FINDINGS: Fifteen percent of the state's population resided in isolated small rural towns, but only 8% of general dentists practiced here. Approximately 17% of dentists in isolated small rural towns were age 40 or younger, compared to 32% of dentists in urban areas. Among male dentists, those who were born in Iowa (P = .002) were older (P = .020), and graduated from dental schools other than the University of Iowa (P = .009) were more likely to practice in rural areas than were their counterparts. Conversely, among female dentists, solo practice (P = .016) was the only variable significantly associated with rural practice location. CONCLUSIONS: The dentist workforce in rural areas of Iowa is dominated by older males who were born in Iowa. As this generation retires and increasing numbers of women enter the profession, state policy makers and planners will need to monitor changing trends in the rural workforce.

Periodicity of dental recall visits for young children first seen in community health centers.

OBJECTIVES: To study the factors associated with young children who had their first dental visit (FDV) at a Federally Qualified Health Center (FQHC) and returned within 12 months for a second dental episode. METHODS: Two hundred Medicaid-enrolled children who were less than 6 years old were randomly selected from five Iowa FQHCs. Dental utilization was followed for 36 months using dental charts and Medicaid medical and dental claims data, regardless of provider. Child's birth certificate data were also used as covariates. Multivariable logistic regression, using backward elimination, was used to identify variables that were associated with whether a child returned for a dental recall visit within 1 year of the initial dental episode. RESULTS: About 56% of the children returned for dental care within 1 year of their initial episode. The number of children in the household had a positive impact on children returning for a second dental episode. However, an increase in the frequency of medical well-child visits at the FQHC prior to the FDV had a negative influence. Unadjusted analysis demonstrated that children with dental caries at the FDV were less likely to return within 12 months; however, this variable failed to make the final regression model. Moreover, age at FDV did not make a difference in regard to returning for a second episode within 12 months. CONCLUSIONS: The experience gained from having other Medicaid-enrolled children in the household appears to be important for younger children entering into continuous and comprehensive dental care.

Comparison of dental esthetic perceptions of young adolescents and their parents.

OBJECTIVES: To compare dental esthetic perceptions of adolescents at age 13 with those of parents and to assess associations with dental fluorosis. METHODS: Adolescents aged 13 underwent dental examinations for fluorosis on maxillary anterior teeth using the Fluorosis Risk Index. Adolescents and parents completed questionnaires concerning satisfaction with adolescents' dental appearance. McNemar and Bowker tests of symmetry were used for comparisons of esthetics ratings between parents and adolescents. Comparison of satisfaction between subjects with fluorosis and subjects with no fluorosis was made using Cochran-Armitage Trend and Fisher's Exact tests. RESULTS: From 376 adolescents included in the study, 26 percent had definitive fluorosis, mostly at a mild level. Fifteen percent of adolescents were dissatisfied with dental appearance, and concerns were mainly about color (45 percent) and alignment (35 percent). Adolescents were less satisfied with overall dental appearance (P < 0.001) and color (P = 0.048) and more concerned about tooth shape (P = 0.002) than were their parents. Fluorosis status (yes/no) was not significantly associated with adolescents' perceptions (P > 0.05). Parents of subjects with fluorosis were more dissatisfied with dental appearance (P = 0.014) and color (P < 0.001) than other parents. The number of maxillary anterior zones exhibiting fluorosis was negatively associated with adolescent (P = 0.03) and parent (P = 0.002) satisfaction. CONCLUSION: Adolescents generally had less satisfaction with dental appearance and color, and were more concerned with tooth shape than were parents. For both parents and adolescents, decreased satisfaction was associated with the number of zones with definitive fluorosis.