Self-harm, dentofacial features, and bullying.

INTRODUCTION: Self-harm is a growing public health problem. The study aimed to investigate the prevalence of self-harm among a representative sample of school children and the contribution of dentofacial appearance and being bullied because of dentofacial appearance to self-harm. METHODS: This was a cross-sectional study in which a representative sample of eighth-grade students (aged 13-14 years) from randomly selected schools was asked to complete anonymous questionnaires distributed in the classroom. The final sample size was 699 children (339 girls, 360 boys) with a mean age of 13.3 years, representing 1.26% of the target population. RESULTS: The prevalence of self-harm was 26.9% (n = 188), with no statistically significant gender differences (P >0.05). Among all the subjects who reported self-harm, 47.9% (n = 90) reported self-harm because of dentofacial features. A total of 41 subjects reported self-harm because of bullying targeted at dentofacial features, representing around one fifth of subjects who reported self-harm. The 3 most common dentofacial features contributing to self-harm and self-harm as a result of bullying were tooth color and shape, spacing between the teeth or missing teeth, and prominent maxillary anterior teeth. CONCLUSIONS: This study demonstrated a relatively high experience of self-harm reported by adolescent school children, with many reporting self-harm as a result of their dentofacial appearance and bullying because of dentofacial features. The present study provides baseline data to better understand the relationship between self-harm and dentofacial features.

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES: To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05. RESULTS: Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year. CONCLUSIONS: Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Do various degrees of tooth decalcification affect orthodontists', general dentists' and laypersons' ratings of smile esthetics?

OBJECTIVES: To compare the effect of various degrees of decalcification after orthodontic treatment (white spot lesions) on orthodontists', general dentists', and laypersons' ratings of smile esthetics. MATERIALS AND METHODS: Eight photographs representing incrementally altered tooth decalcification lesions of maxillary anterior teeth ranging from mild to severe were shown randomly to the study participants. Photographs were rated by a matched sample of orthodontists (N = 42), general dentists (N = 52), and laypeople (N = 58). A visual analogue scale (VAS) was used to assess perceptions of smile esthetics. RESULTS: The three groups of raters could distinguish between different decalcification levels. Raters gave more negative scores as the decalcification level increased. CONCLUSIONS: The three groups of raters were able to distinguish between various degrees of decalcification lesions. General dentists were the most critical of all groups when rating decalcification lesions.

Impact of bullying due to dentofacial features on oral health-related quality of life.

INTRODUCTION: The aim of this study was to investigate whether there is a relationship between self-reported bullying because of dentofacial features and oral health-related quality of life among a representative sample of Jordanian schoolchildren. METHODS: This was a cross-sectional study in which a representative sample of sixth-grade students (age, 11-12 years) from randomly selected schools in Amman, Jordan, were asked to complete questionnaires distributed in the classroom in the presence of the researchers. The questionnaire used for this purpose was the short form of the Child Perceptions Questionnaire for 11- to 14-year-old children. The final sample size was 920 children (470 girls, 450 boys). RESULTS: There were significant differences between the sexes for the total Child Perceptions Questionnaire score and for the oral symptoms and the social well-being subscales, with boys reporting higher scores and thus more negative effects on their oral health-related quality of life. Comparison of the total scores and subscales scores for boys and girls subdivided into those who reported being bullied and not being bullied about their teeth showed that bullied boys had significantly greater effects on overall oral health-related quality of life and on all subscales than did not-bullied boys (P <0.001 for all comparisons). Bullied girls also had significantly greater effects on the overall oral health-related quality of life and all subscales than did not-bullied girls (P <0.001 for all comparisons). However, bullied boys and girls reported similar scores for the different subscales of the Child Perceptions Questionnaire; there were no significant differences. CONCLUSIONS: This study demonstrated a significant relationship between bullying because of dentofacial features and negative effects on oral health-related quality of life. The results highlight the importance of addressing the bullying problem among schoolchildren and provide important data for educational authorities to create antibullying programs to help students receive education in a safe and healthy environment.

Bullying among Jordanian schoolchildren, its effects on school performance, and the contribution of general physical and dentofacial features.

INTRODUCTION: The aims of this study were to investigate the experience of bullying in a representative sample of Jordanian schoolchildren in Amman, to look at its effect on school attendance and perception of academic performance, and to look at the contribution of general physical and dentofacial features to this phenomenon. METHODS: This was a cross-sectional study in which a representative sample of sixth-grade students (11-12 years of age) from randomly selected schools was asked to complete questionnaires distributed in the classroom in the presence of the researchers. The final sample size was 920 children (470 girls, 450 boys). RESULTS: The prevalence of bullying was 47% (n = 433); significantly more boys reported being bullied than girls (P <0.001). The percentage of students subjected to name-calling was 40.9%. A significantly greater proportion of victims of bullying reported playing truant from school and disliking school than those who were not bullied. Teeth were the number 1 feature targeted for bullying, followed by strength and weight. The 3 most commonly reported dentofacial features targeted by bullies were spacing between the teeth or missing teeth, shape or color of the teeth, and prominent maxillary anterior teeth. CONCLUSIONS: This study demonstrated a high prevalence of bullying in Jordanian schools, with many children experiencing bullying because of their dental or facial appearance.

A comparison between a new 2-dimensional digital on-screen tooth measurement method with direct measurements.

OBJECTIVE: To compare the accuracy and reproducibility of tooth measurements using newly developed software that gives 2-dimensional scanned images of dental setups with direct measurements using digital calipers. METHODS: This experimental study was performed at the Dental Laboratories of the Faculty of Dentistry, University of Jordan, Amman, Jordan from September 2010 to December 2010. Ten sets of acrylic teeth (10 upper and 10 lower arches) were used. The mesiodistal width of each individual tooth was measured using a digital caliper (method I), which was considered the gold standard. The teeth were set to create 20 dental setups. The mesiodistal widths of teeth on the created setups were then measured by using a digital caliper (method II). The dental setups were then scanned using a flatbed computer scanner and tooth width measurements were performed using a special computer program (method III). Tooth measurements were divided into 6 groups, and the 3 methods were compared. RESULTS: There was a statistical significant difference between the 3 measurement methods in most of the measured tooth groups. Methods I and II exhibited significant differences for most of tooth groups (ranged from 0.02 to 0.22 mm) while no significant difference was found between methods I and III (ranged from 0.03 to 0.11 mm). CONCLUSION: Tooth width measurement with on-screen 2-dimensional scanned images of dental casts is comparable to measurements obtained using direct digital caliper.

Effect of gender on performance of undergraduate dental students at the University of Jordan, Amman.

The purpose of this study was to see if gender-based differences exist in the performance of dental students at the University of Jordan (UJ), Amman. The retrospective analysis included data from two groups of students: 413 fourth-year dental students (178 males and 275 females) from four consecutive years (2005 through 2008) and 357 fifth-year students (128 males and 229 females) who graduated in the years 2005 to 2008. The influence of gender on the results of the fourth-year students in six theoretical and six clinical courses and the cumulative GPAs of the fifth-year students were studied. In both theoretical and clinical fourth-year courses, multivariate analysis of variance (MANOVA) revealed significant main differences in raw scores between the two gender groups. Female students were significantly better in five theoretical courses. In clinical courses, female students outscored male students in pediatric dentistry and prosthodontics, male students outperformed female students in conservative dentistry and orthodontics, and no significant gender differences were seen in oral surgery and fixed prosthodontics. The cumulative GPAs of the female graduated students were significantly higher than those of the male students. The results showed a significant relationship between gender and academic performance of dental students for these classes. The reasons for these findings should be further investigated.

A comparison of health-related quality of life between Jordanian and British orthognathic patients.

The aim of this study was to assess health-related quality of life (HRQoL) in adult Jordanian patients referred for orthognathic treatment, and to compare this with previously published data from a British cohort. Thirty-eight Jordanians (21 females and 17 males; aged 16-31 years) who were about to commence a course of orthognathic treatment completed a generic HRQoL questionnaire [Short-Form 36 (SF-36)] and a condition-specific orthognathic quality-of-life questionnaire (OQoLQ). The questionnaires were completed prior to commencing any pre-surgical orthodontic treatment. The data were compared using the Mann-Whitney U-test for independent groups with non-normally distributed data. There were no statistically significant differences between the Jordanian males and females for any of the OQoLQ or SF-36 items; hence, the groups were combined for analysis. When comparing the OQoL data with that of the British sample, there was no statistically significant differences for three of the four domains: dentofacial aesthetics (P = 0.726), social aspects (P = 0.096), or the awareness of dentofacial aesthetics (P = 0.066). There was, however, a significant difference for oral function (P = 0.016), with the Jordanian group reporting a poorer quality of life (QoL) (mean value 10.9) than the British cohort (mean value 8.4). However, it is questionable whether this difference would be of clinical relevance. While it was not possible to directly compare the results of the SF-36 questionnaires with the same British cohort, Jordanian patients had generally lower scores, and therefore a poorer QoL, than reported in other studies. These differences may be cultural or may be due to differences in the health care system's criteria for funding, and this needs further investigation.

Condition-specific quality of life in Jordanian patients with dentofacial deformities: a comparison of generic and disease-specific measures.

OBJECTIVES: To determine the impact of dentofacial deformities and related treatment on quality of life (QOL) of Jordanian patients, and to make a comparison between the generic and specific measures used. STUDY DESIGN: A case-control study was performed involving 143 subjects: 36 before surgery, 35 after orthognathic treatment, 35 who declined surgery (Dec-surg), and 37 control subjects. Their QOL was assessed using the 36-item Short-Form Health Survey (SF-36) and Orthognathic Quality of Life Questionnaire (OQLQ). RESULTS: There were significant differences in OQLQ scores among the 4 groups (P < .001). When comparing the presurgery group to other groups: significant differences were found with postsurgery, Dec-surg, and control subjects (P < .001). The Dec-surg group showed no significant differences with postsurgery and control groups. CONCLUSIONS: Orthognathic surgery has a positive impact on patients' QOL. The condition-specific OQLQ showed better discriminator ability than the generic SF-36, although both measures provide an effective combination to evaluate QOL in patients with dentofacial deformities. More emphasis is required to understand emotional and psychosocial status of patients in addition to their esthetic and functional needs.

Tooth size discrepancies among Jordanian schoolchildren.

The aims of this study were to determine the tooth size discrepancies (TSD) in a representative sample of Jordanian schoolchildren and to compare TSD between genders. Dental casts of 367 (174 males and 193 females; mean age 15.5 years) Jordanian schoolchildren were selected. Anterior and overall Bolton ratios were determined using a digital calliper. Differences between genders were analyzed using a t-test. The results showed that there were no significant differences in the TSD between males and females. The percentages of subjects with more than 2 standard deviations for the anterior and overall ratios were 23.7 and 9.5, respectively.

Factors affecting satisfaction of patients after orthognathic surgery at a University Hospital.

OBJECTIVE: To analyze factors that influence patient's satisfaction with orthognathic treatment and evaluate patient's perception of changes in physical and psychosocial aspects. METHODS: In a retrospective clinical study conducted at Jordan University Hospital, Amman, Jordan between December 2006 and December 2007, we examined 38 patients who had orthognathic surgery after an average follow-up of 20 months. Examination included evaluation of nerve function and temporomandibular function with Helkimo index. Patients filled out a questionnaire on treatment satisfaction, and perception of physical and psychosocial changes after treatment. RESULTS: Patients were generally satisfied with the result, 82% agreed they would undergo treatment again. They were divided into very satisfied n=25 and less satisfied n=13 groups according to satisfaction score, with statistically significant differences found between them concerning diagnosis, and follow-up period, with all vertical maxillary excess patients very satisfied and 75% of asymmetrical deformities patients less satisfied, and less satisfaction by patients more than one year postoperatively p=0.006. Patients perceived improvement in oral function, general health, appearance and interpersonal skills. Lower rates of joint and muscular pain, and increased mobility of lower jaw correlated with better patients' perception of health and appearance. CONCLUSION: Although patients' report high satisfaction levels, several factors such as the temporomandibular joint function could affect patients' psychosocial adjustment after treatment. Sufficient information for patients on the treatment course is required to improve satisfaction. Controlling these factors could improve patients' quality of life.

Mixed dentition analysis in a Jordanian population.

OBJECTIVE: To examine the applicability of the Tanaka and Johnston method of prediction in a Jordanian population and to develop a new prediction method for this specific population if necessary. MATERIALS AND METHODS: Three-hundred and sixty-seven Jordanians (193 female, 174 male, mean age 15.5 years) were randomly selected to represent 0.1% of 10th grade schoolchildren from Amman, Jordan. The mesiodistal crown diameters of the permanent teeth were measured and compared with the predicted values derived from the Tanaka and Johnston equations. RESULTS: Significant sexual dimorphism was found in tooth sizes. The correlation coefficients between the total mesiodistal width of the mandibular permanent incisors and that of the maxillary and mandibular canines and premolars were found to be 0.60 and 0.66, respectively. There were significant differences between the actual measurements and measurements derived from the Tanaka and Johnston equations. New linear regression equations were derived for both genders to allow tooth size prediction in Jordanians. CONCLUSIONS: There is a limitation in the application of the Tanaka and Johnston's prediction method to a Jordanian population. It is important to use separate equations for male and female patients.

Application of Pont's Index to a Jordanian population.

The aim of this study was to assess the applicability of Pont's Index to a Jordanian population and to compare the results with those obtained from studies of different ethnic subjects. Dental casts of 144 Jordanians (71 males and 73 females; mean age, 15.5 years) with 'normal' occlusions were selected from the records of a random stratified sample of 383 Jordanian schoolchildren in the 10th grade. The mesiodistal widths of the maxillary permanent incisors, as well as intercanine, interpremolar, and intermolar arch widths, were measured directly on the selected dental casts using a digital calliper. An independent sample t-test was used to determine significant differences in tooth and/or arch width values for males and females. Correlation coefficients determined between the measured arch width values and those calculated according to Pont's Index were low in all cases, with r values ranging from 0.25 to 0.39. It was concluded that Pont's Index should not be used to pre-determine ideal arch width values in Jordanian individuals.

Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents, and dentists.

The aims of the present study were to compare rankings of dental aesthetics and the threshold at which orthodontic treatment would be sought among patients, parents, and dentists. A prospective cross-sectional study was designed to address these aims. The study sample comprised 100 patients and parents and 23 dental specialists. The patients were equally divided between males and females and their mean age was 14.7 years (standard deviation 2.3 years). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) represented impairment of dental aesthetics. The 10 numbered photographs of the AC were cut into equal-sized rectangles and subjects were asked to arrange them from 'the one that looks best' to 'the one that looks worst'. The subjects were then presented with the 10 photographs of AC in sequence and asked to identify the cut-off point between 'teeth that need orthodontic treatment' and 'no treatment'. Statistical analysis was undertaken with a Mann-Whitney test. The results showed that median rankings of dental aesthetics were similar among the three groups (P > 0.05). The median ranking of photographs 1, 2, 3, 4, and 10 were identical to the AC of IOTN. The photographs representing IOTN AC 7 and 8 were allocated the same median rank of 7 and AC 5 and 9 were allocated corresponding median ranks of 6 and 8, respectively. There were no significant differences in median cut-off points for treatment need among the three groups of subjects (P > 0.05), indicating that the mean threshold at which treatment would be sought was AC 4.

Regional odontodysplasia: a review of the literature and report of a case.

We present a rare case of a developmental anomaly called regional odontodysplasia or 'ghost teeth' in an 8.5-year-old Jordanian girl. The anomaly affected both the mandibular primary and permanent incisors, and the canines bilaterally. The maxillary teeth were unaffected. This is the first case of the anomaly to be reported in Jordan. The clinical, radiographic and histological features are reviewed. The management of affected patients is discussed.