Socioeconomic status in life course is associated with dental appearance dissatisfaction.

The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

Are changes in malocclusion associated with adulthood psychosocial well-being?

INTRODUCTION: The purpose of this study was to investigate the longitudinal psychosocial effects of changes in malocclusion from adolescence to adulthood on oral health-related quality of life (OHRQOL), self-rated dental appearance, and overall life satisfaction. METHODS: The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study of 1037 children born at Queen Mary Hospital, Dunedin, New Zealand, between April 1, 1972 and March 31, 1973. Data on their health and development, including dental examinations, has since been collected periodically. Malocclusion severity was measured using the Dental Aesthetic Index in participants aged 15 and 45 years (data collected at age 18 years was supplemented for data missing at age 15 years). Other data collected included clinically assessed oral health (dental caries and periodontal disease experience) and self-rated dental appearance, OHRQOL, life satisfaction, and personality traits. RESULTS: Malocclusion data were available for 868 participants in adolescence and 834 aged 45 years. For those with a severe handicapping malocclusion at 15 years old, 46.6% who received orthodontic treatment transitioned to a resolved (ie, mild-moderate) malocclusion when aged 45 years, whereas only 16.2% of those who did not receive orthodontic treatment made that transition. A transition to a worse malocclusion was associated with impacts on OHRQOL when aged 45 years in the subdomains of functional limitation, psychological discomfort, and physical disability as well as worse self-ratings of dental appearance, and these findings were held after adjusting for potential confounders. Malocclusion was not associated with overall life satisfaction. CONCLUSIONS: Maintenance of acceptable occlusion after orthodontic treatment requires a strong emphasis on achieving and maintaining excellent dental health and avoiding chronic oral conditions such as dental caries and tooth loss. The long-term benefits of orthodontic treatment may diminish by midlife unless good dental health is maintained. Orthodontists have the responsibility to raise awareness among their patients on how to maintain good oral health after orthodontic treatment.

Male-to-female transgenders demonstrated unique perspectives on perceived facial attractiveness and orthognathic surgery need.

PURPOSE: The esthetic preference and decision concerning undergoing orthognathic surgery in the transgender population have not been reported. The aims of this study were to examine the influence of the sagittal mandibular position on the esthetic perception and perceived surgery need in male-to-female transgenders (MTFTs) compared with male and female laypeople. MATERIALS AND METHODS: A questionnaire study was performed by male-to-female transgender, male and female laypeople. Three-dimensional black & white male and female facial images with facial contour angle (FCA) of 3°, 1°, 5°, 9°,13°, 17°, and 21° were shown to the participants. The participants scored the images' perceived facial attractiveness using visual analog scales (VAS) and indicated whether orthognathic surgery was needed. RESULTS: The participants included 85 MTFTs, 85 males, and 85 females. The results revealed that there were significant differences in the VAS scores between the MTFT and male participants. The MTFTs rated the male images with prognathism of 1° and -3°FCA in significantly lower scores compared with the males (P = 0.033, P = 0.010). Female images with prognathism 1°FCA was rated by the MTFTs in significantly lower scores compared with the males (P = 0.041). A significantly higher number of surgery needs was found in the MTFTs compared with the other groups. CONCLUSIONS: Gender influences esthetic perception and the decision to undergo orthognathic surgery. MTFTs have a unique perspective on facial esthetics, being more desirous of surgery than males and females. Clinicians should be aware of the ideal expectation in facial esthetics in MTFTs.

Effect of the ethnic, profession, gender, and social background on the perception of upper dental midline deviations in smile esthetics by Chinese and Black raters.

BACKGROUND: The purpose of this study was to compare the perception of upper dental midline deviation on the attractiveness of a smile among raters from different ethnicities, professions, genders, and ages and measure to what extent the presence or absence of the associated smiling structures influence the raters' evaluations. METHODS: A male subject (26 years of age) with adequate smile characteristics was selected by 3 experienced orthodontists, and 561 raters from 2 different ethnic groups (281 Chinese raters and 280 Black raters) rated the subject's smile after the subject's upper dental midline was digitally altered from 0 to 5 mm using a 5-point Likert scale on 12 smile photographs divided into two groups: group 1, in the presence of smile related structures, two-thirds of the nose, lips, and chin (NLC), and group 2, in the absence of smile related structures, the lips only (L). RESULTS: There were statistically significant differences (p < 0.05) between the two ethnicities, in 2 mm and 4 mm in-group NLC and 5 mm in-group L, as well as the raters' profession to each midline shift of both groups (NLC) and (L) for both ethnicities except for 0 mm. Regarding the role of associated smile structures, the smile photos were observed in the presence of smile-associated structures, and in its absence (NLC × L), statistically significant differences (p < 0.05) were found when the deviation was 5 mm among the Chinese raters; in 1 mm, and 4 mm among the Black raters. Among different genders, statistical differences were only reported (p < 0.05) for Chinese raters for 5 mm in NLC, while statistical differences were observed for 2 mm and 3 mm in NLC for Black raters. For age categories, differences were observed (p < 0.05) for 4 mm, 5 mm in NLC and 4 mm, and 5 mm in L for Chinese raters, while 5 mm in NLC and 1 mm in L for Black raters. CONCLUSION: Perception of the upper dental midline deviations was influenced by the factors of ethnicity, profession, presence or absence of smile-associated structures, as well as the gender and age of the raters.

The Psychosocial Impact of Dental Esthetics in Undergraduates with Borderline Malocclusion.

Background: The study investigates the existing correlation between self-perceived malocclusion, the psychosocial impact of dental esthetics, and whether this link involves personality traits. Methods: The 179 questionnaires from 615 undergraduates in Wenzhou were used for analysis after applying the exclusion criteria. The Psychosocial Impact of the Dental Aesthetics Questionnaire (PIDAQ) was administered to evaluate participants' perceptions of the psychosocial impacts of malocclusion. The need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN). The Chinese version of the Eysenck Personality Questionnaire-Short Scale (EPQ-RSC) evaluated participants' personality characteristics. The Kruskal-Wallis test was used to assess differences between the IOTN-Dental Health Component (DHC) and expectations of orthodontic treatment. Linear regression was applied with PADAQ and its subscale scores against possible variables. Results: The total and subscale PIDAQ scores were positively correlated with neuroticism. Total PIDAQ scores, the DHC, and the Aesthetic Component (AC) were significantly positively correlated with the subjective AC. The DHC was significantly negatively correlated with extroversion. Conclusions: We confirmed a modest link between the need for orthodontic treatment and the psychosocial impact of dental esthetics.

Deformidades dentoesqueléticas influenciam no julgamento social das pessoas? / Do dentoskeletal deformities influence people's social judgment?

Os padrões estéticos desempenham um importante papel na aceitação social, por conta disso há uma preocupação acerca dos impactos psicossociais que deformidades dentoesqueléticas podem causar a um indivíduo. Partindo desse pressuposto, esta pesquisa tem por objetivo desenvolver, validar e aplicar um instrumento/questionário que avalie as repercussões estéticas e sociais que a correção ortocirúrgica de classe II causa em indivíduos leigos. Fotografias em vista frontal e lateral de um indivíduo do sexo masculino e outro do sexo feminino, portadores de deformidade dentoesquelética de classe II por retrusão de mandíbula, foram manipuladas (Adobe Photoshop v.23.0.1, Adobe Systems Inc., San Jose, CA) de modo a simular a correção da deformidade dentoesquelética ântero-posterior. Para isso, foi criado, validado e aplicado um questionário contendo 10 perguntas que avaliavam questões estéticas e psicossociais. As respostas às questões foram: certamente sim" = 4 pontos, "talvez sim" = 3 pontos, "neutro" = 2 pontos, "talvez não" = 1 ponto e "certamente não" = 0 pontos. O conjunto de fotografias/questionário foi aplicado a 159 indivíduos leigos, com idades entre 18 e 76 anos. Estatística descritiva (média ± desvio padrão; mediana e intervalo interquartil) e teste de Wilcoxon foram utilizados para comparar os escores de julgamento social. Como resultado, o questionário desenvolvido apresentou aceitabilidade, confirmou a confiabilidade e validade do construto e consistência interna adequada (ICC: 0,5 - 0,7). Independentemente do sexo do indivíduo na imagem, as pontuações de julgamento social, em geral, foram maiores nas fotografias manipuladas que simulam a correção da classe II esquelética por meio de cirurgia ortognática (P < 0,001). Ao comparar as fotografias originais (controle) de acordo com o sexo, o indivíduo do sexo feminino apresentou escores maiores que do sexo masculino (P < 0,001). Portanto, conclui-se que o questionário desenvolvido se mostrou válido para avaliar as repercussões estéticas e sociais que a correção ortocirúrgica classe II causa em indivíduos leigos, além de ter demonstrado que essa maloclusão impacta negativamente na percepção e julgamento social dos leigos. (AU)

Aesthetic standards play an important role in social acceptance. Consequently, there is a concern about the psychosocial impacts that dentoskeletal deformities can cause to an individual. Based on this assumption, this research aims to develop, validate and apply an instrument that assesses the aesthetic and social repercussions class II orthosurgical correction causes in lay people. Front and side photographs of a male and a female subject with dentoskeletal class II deformity due to mandibular retrusion were manipulated (Adobe Photoshop v.23.0.1, Adobe Systems Inc., San Jose, CA) to simulate the correction of anteroposterior dentoskeletal deformity. For this, a questionnaire was created, validated and applied, containing 10 questions that evaluated aesthetic and psychosocial issues. The answers to the questions were: certainly yes" = 4 points, "maybe yes" = 3 points, "neutral" = 2 points, "maybe no" = 1 point and "certainly not" = 0 points. The set of photographs/questionnaire was applied to 159 lay individuals, aged between 18 and 76 years. Descriptive statistics (mean ± standard deviation; median and interquartile range) and Wilcoxon test were used to compare social judgment scores. As a result, the questionnaire developed showed acceptability, confirmed the reliability and validity of the construct and appropriate internal consistency (ICC: 0.5 - 0.7). Independently of the sex of the individual in the image, social judgment scores were generally higher in manipulated photographs that simulate skeletal class II correction of skeletal class II through orthognathic surgery (P < 0.001). When comparing the original photographs (control) according to sex, the female individual had higher scores than the male (P < 0.001). Therefore, it is concluded that the developed questionnaire proved to be valid to evaluate the aesthetic and social repercussions that the class II orthosurgical correction causes in laypersons, in addition to having demonstrated that this malocclusion negatively impacts the laypersons' perception and social judgment. (AU)

Relationship of Anxiety and Depression with Perfectionism in Patients with Aesthetic All-Ceramic Repair of Anterior Teeth.

BACKGROUND Many psychological problems arising from patients undergoing aesthetic repair of teeth should be considered. However, there are no published studies on the relationship between anxiety/depression and perfectionism in patients with aesthetic repair of anterior teeth. MATERIAL AND METHODS A total of 640 patients receiving aesthetic repair of anterior teeth were assessed using the Corah dental anxiety scale (CDAS), a self-rating anxiety scale (SAS), a self-rating depression scale (SDS), and the Chinese version of the Frost Multidimensional Perfectionism Psychological Scale (CFMPS). Statistical analyses included use of the independent-samples t test, correlation analysis, and multiple stepwise regression analysis. RESULTS We found that 156 patients with a high dental anxiety disorder had significantly greater SAS and SDS scores than those without a high dental anxiety disorder. There were significant differences between these patients and the non-high dental anxiety group, based on 3 dimensions of the CFMPS: concern over mistakes (CM), doubt about action (DA), and organization (OR). Patients with dental anxiety had a significant positive correlation with SAS in the categories CM and DA, with SDS in the categories CM and DA, and with personal standard (PS); OR was negatively correlated with SAS and SDS scores. Regression analysis showed that the CM and OR dimension scores of CFMPS and age had strong predictive effects on SAS scores, while CM, DA, PS dimension scores, and age were strong predictors of SDS scores. CONCLUSIONS The incidence of dental anxiety prior to anterior tooth repair treatment is high, and patients with dental anxiety have a significant tendency toward pursuing perfectionism.

Comparison of clinical esthetic outcomes of immediately placed implants with and without immediate provisionalization in single-tooth implants of the esthetic area: A protocol for systematic review and meta-analysis.

BACKGROUND: Immediately placed implants with immediate provisionalization have become attractive options for patients and clinicians. However, there is no agreement on the esthetic advantages of immediately placed implants with immediate provisionalization. The aim of this systematic review and meta-analysis will be to assess the effect of immediate provisionalization on the clinical esthetic outcomes of immediately placed implants in a single-tooth implant of the esthetic area. METHODS: An electronic search of MEDLINE/PubMed, EMBASE, Web of Science, Clinicaltrials.org., Cochrane Library, China Biology Medicine (CBM), Wan Fang Database, China National Knowledge Infrastructure Database (CNKI), and VIP Science Technology Periodical Database will be performed. The search will be carried out in the databases for articles published until May 2021. Two researchers will independently perform the literature selection, data extraction and quality assessment. Only randomized controlled trials (RCTs) reporting on the impact of immediate provisionalization on the clinical esthetic outcomes of implants immediately placed in a single-tooth implant of the aesthetic area will be included. The primary outcome of this study will be the esthetic outcome assessed by the objective index and patient satisfaction. The survival rate of implants and restorations and the changes in mucosa and bone around implants will also be analyzed. The included studies will be analyzed by Review Manager 5.3, and a meta-analysis will be performed. RESULTS: The study will evaluate the clinical esthetic outcomes of immediately placed implants with and without immediate provisionalization in single-tooth implants of the esthetic area. The results will provide clinicians with a better treatment approach in their application. CONCLUSION: This systematic review and meta-analysis will provide more reliable, evidence-based data for the impact of immediate provisionalization on the clinical esthetic outcomes of immediately placed implants, which may or may not be beneficial. REGISTRATION NUMBER: PROSPERO registration number: CRD42021221669.

Experiência ortodôntica no Youtube: avaliação de conteúdo e de possíveis impactos / Orthodontic experience on YouTube: evaluation of content and possible impacts

Objetivou-se neste estudo, avaliar o conteúdo de vídeos do YouTube publicados por brasileiros que abordam a experiência do uso de aparelho fixo, sinalizando a percepção de aspectos estéticos, psicoemocionais e sociais relacionados ao tratamento ortodôntico, avaliando o perfil dos autores e veracidade das informações apresentadas. Foi gerada uma lista de vídeos a partir do termo "tirei meu aparelho", e selecionados 100 canais do YouTube que abordassem a experiência ortodôntica vivenciada pelos youtubers. Foram excluídos vídeos que não apresentassem uso de aparelho fixo e casos em que o aparelho foi removido antes do tempo preconizado. As variáveis avaliadas incluíam a percepção estética dentária antes, durante e após o uso do aparelho, dor, dificuldade de alimentação e higienização bem como relação com o profissional e informações dadas pelo youtuber. Os 10 vídeos mais vistos, ultrapassaram 7,5 milhões de visualizações. Observou-se maior prevalência de vídeos postados por mulheres (85%), adolescentes entre 11 e 18 anos (55%), utilizando aparelho fixo metálico (92%). Quanto à percepção estética prévia, 72% relataram estar insatisfeitos, após o tratamento, 86% ficaram satisfeitos. Quanto a alimentação e higienização 51% e 35% respectivamente tiveram percepção negativa. Presença de dor por ulceração foi relatada em 57% dos casos e por movimentação em 35% dos casos. Apenas 3 casos mencionaram insatisfação com o profissional. Informações quanto à aparelhos autoligados e extrações dentárias divergiam da ciência baseada em evidência. Com base nos resultados obtidos observou-se relatos de dor, dificuldade de alimentação e higienização foram temas recorrentes, bem como bom relacionamento com profissional, insatisfação estética anterior ao tratamento e satisfação estética após tratamento. Houve predomínio de vídeos postados por mulheres, adolescentes. Informações sem base científica referente à aparelhos autoligados e extrações dentárias foram encontradas. (AU)

The objective of this study was to investigate the content of YouTube videos published by Brazilians that address the experience of using a fixed appliance, signaling the perception of aesthetic, psychoemotional and social aspects related to orthodontic treatment, evaluating the profile of the authors and the veracity of the information presented. The analyzed sample was obtained through the search results of the phrase "tirei meu aparelho" ("I took off my appliance"), from which 100 YouTube channels were selected that addressed the orthodontic experience experienced by youtubers. Videos that did not show the use of a fixed appliance and cases in which the appliance was removed before the recommended time were excluded. The analyzed variables were the dental aesthetic perception before, during and after the use of the appliance, pain, difficulty of feeding and cleaning, as well as the relationship with the professional and accuracy of the technical information provided by the youtuber. The most 10 viewed videos surpassed 7.5 million views. There was a higher prevalence of videos posted by women (85%), adolescents between 11 and 18 years old (55%) using fixed metallic braces (92%). As for aesthetic perception, 72% reported being dissatisfied before the treatment and 86% were satisfied after the treatment. As for feed and sanitation, 51% and 35% had a negative perception, respectively. Presence of pain due to ulceration was reported in 57% of cases, whereas pain due to movement in 35% of cases. Only 3 cases mentioned dissatisfaction with the professional. Technical information on self-ligating and tooth extractions diverged from evidence-based Science. Based on the results obtained, there is a greater tendency of reports by female adolescents using metallic braces, expressing pain, feeding and hygiene difficulties, with good relationship with the professional, esthetic dissatisfaction before treatment and esthetic satisfaction after treatment were observed. Unscientific information regarding self-ligating appliances and tooth extractions was found. (AU)

Aesthetic perceptions and social judgments about different enamel opacities.

This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

A biopsychosocial-cultural model for understanding oral-health-related quality of life among adolescent orthodontic patients.

BACKGROUND: Based on previous theoretical oral-health-related quality of life (OHRQoL) models and most recently framework, as well as sociocultural model of body image dissatisfaction, the current study aimed to investigate the effect of individual (dental aesthetics and dental appearance social comparison) and sociocultural factors (social reinforcement from parents, peers and mass media on dental aesthetics) as well as their interaction on psychosocial dimension of OHRQoL among adolescent orthodontic patients. METHODS: In this cross-sectional study comprising 427 adolescent orthodontic patients (151 boys and 276 girls) aged between 11 and 16 years old, the psychosocial dimension of OHRQoL was measured by Psychosocial Impact of Dental Aesthetics Questionnaire. Individual predictor of dental aesthetics was defined by the Aesthetic Component of the Index of Orthodontic Treatment Need, and dental appearance social comparison was assessed by four items adapted from Physical Appearance Comparison Scale. Sociocultural predictor of social reinforcement was measured by six items adapted from Perceived Sociocultural Pressure Scale. Spearman correlations, path analyses, and structural equation modeling were used to build up several predictive models. RESULTS: As hypothesized, two direct pathways were observed that patients' dental aesthetics and all three sources of social reinforcement directly predicted the psychosocial dimension of OHRQoL. Meanwhile, we observed one indirect pathway, that three sources of social reinforcement predicted the psychosocial dimension of OHRQoL, in part, through dental appearance social comparison. CONCLUSIONS: This study provides preliminary evidence indicating that dental aesthetics, social reinforcement and dental appearance comparison are reliable predictors of psychosocial dimension of OHRQoL among adolescent orthodontic patients.

Aesthetic perceptions and social judgments about different enamel opacities

Abstract This study aimed to evaluate adolescents' aesthetic perceptions and their social judgments regarding different enamel opacities. Sample size was calculated and resulted in the inclusion of 100 adolescents (aged 10 to 15 years) from a public school in Jequié, Bahia, Brazil. Images of enamel opacities were manipulated to create aesthetic enamel defects, such as enamel color changes (unilateral and bilateral white opacity, unilateral and bilateral yellowish opacity, and unilateral and bilateral yellowish opacity with loss of structure). The images of the opacities were based on Fédération Dentaire Internationale's Developmental Defects of Enamel (DDE) Index. Aesthetic perception and social judgments were evaluated using a validated questionnaire with 12 questions (six positive and six negative points) on social aspects, considering the six manipulated images and the control. The photographic analyses were projected one-by-one by computer to adolescents individually in a classroom. Participants had one minute to observe each image and answer the questionnaire. The data were analyzed by descriptions, and the Friedman Wilcoxon test (p < 0.05). The results indicate that all opacities negatively impacted social judgment (p < 0.001). The enamel aesthetic defects most affecting an individual's perception were bilateral yellow opacity with or without loss of structure (p < 0.001). Regarding social judgment, all participants showed a negative perception of all the tested opacity types (p < 0.001). In conclusion, even opacities presenting only a color change caused aesthetic dissatisfaction to the individuals and changes in their social judgment toward others. Color changes in dental enamel have several aesthetic consequences.

The effect of dental and background facial attractiveness on facial attractiveness and perceived integrity and social and intellectual qualities.

INTRODUCTION: The purposes of this study were to assess the role of dental attractiveness in background facial attractiveness and to evaluate how facial and dental attractiveness influenced raters' opinions of the integrity, social attractiveness, and intellectual attractiveness of the models. METHODS: Photographs of male and female individuals rated by peers as unattractive, average, and attractive were combined with oral images of 4 different levels of dental attractiveness (Index of Orthodontic Treatment Need [IOTN] 1, 5, 7, and 10). Sixty-seven participants meeting the inclusion criteria were recruited as raters. Raters viewed closed-lip smile and open-lip, posed smile of 24 models and rated them for facial attractiveness and integrity and multiple social/intellectual attractiveness dimensions using a Visual Analog Scale. RESULTS: Intrarater reliability was fair to excellent. Analysis of variance showed significant 3-way interactions (P < 0.0001=aim 1; P < 0.005=aim 2) for model sex, facial attractiveness, and dental attractiveness. The contribution of dental attractiveness to facial attractiveness was not fixed or linear, but dependent on dental attractiveness level, background facial attractiveness, and model sex. For both sexes, dental impact on facial attractiveness was neutral or negative when teeth were less than ideal, beginning at IOTN 5 for all background facial attractiveness levels. The impact of dental attractiveness on integrity and social and intellectual attractiveness was also dependent on dental attractiveness level, background facial attractiveness, and model sex. Dental attractiveness can make dramatic differences in Average and Attractive male individuals. CONCLUSIONS: The impact of dental attractiveness on facial attractiveness and integrity and social and intellectual attractiveness was dependent on dental attractiveness level, background facial attractiveness, and model sex. The effect of dental esthetics on facial attractiveness was neutral or negative for both male and female individuals when there was a need for treatment (IOTN 5 or higher) for all levels of facial attractiveness. For both male and female models, lower dental esthetics had a greater effect on more attractive faces. Judgments about integrity and social and intellectual attractiveness were strongly affected by dental esthetics, and these effects were more dramatic and consistent for male faces.

Does the vertical position of maxillary central incisors in men influence smile esthetics perception?

INTRODUCTION: The aim of this study was to investigate whether there is any influence on the perception of smile esthetics among orthodontists and laypersons, with regard to different vertical positions of the maxillary central incisors. METHODS: Frontal smile photographs digitally altered at full-face view and close-up view of 2 adult men aged between 20 and 30 years were used. Six vertical positions of the central incisors were created, with changes of 0.5 mm. The images were randomly assembled in an album that was presented to 53 orthodontists and 53 laypersons, who evaluated the attractiveness of the images by using visual analog scales. Comparison among the images was performed using 1-way analysis of variance, with Tukey post-hoc test. To compare the distribution of the mean scores between the full-face and close-up smile views, and between orthodontists and laypersons, the Student t test was used. The level of significance was established at 5%. RESULTS: The best evaluations presented the following: (a) the gingival margins of the central incisors corresponded to, or were up to, 1 mm below the line of the canine gingival margins, and (b) the incisal step between the central and lateral incisors was from 1.0 to 2.0 mm. The smiles considered least attractive showed (a) the central incisor gingival margins were 1.0 mm above or 1.5 mm below the canine gingival margins, and (b) no step, or a step of 2.5 mm, between the central and lateral incisors. CONCLUSIONS: The results of this study suggested that, in men, slightly extruded central incisors were esthetically more attractive than intruded incisors.

Validity and reliability of the Persian version of the psychosocial impact of dental aesthetics questionnaire.

BACKGROUND: The psychosocial impact of dental aesthetics questionnaire (PIDAQ) is an efficient tool for assessment of oral health-related quality of life (OHRQoL). It evaluates the effect of dental esthetics on the psychosocial status of young adults. This questionnaire has been translated to many languages so far. However, it has not yet been translated to Persian. This study aimed to assess the validity and reliability of the Persian version of PIDAQ for use among the young adults. MATERIAL AND METHOD: The questionnaire was translated to Persian, back-translated to English and underwent cultural adaptation and pretesting. It was then filled out by 398 young adults (215 females and 183 males) between 18 to 30 years in Shiraz, Iran. The Persian version of PIDAQ along with the index of orthodontic treatment need-aesthetic component (IOTN-AC) and the perception of occlusion (POS) index were administered among participants to assess its discriminant validity. RESULTS: Factor analysis extracted four domains and the factor loading of domains ranged from 0.479 to 0.837. The Cronbach's alpha for the Persian version of PIDAQ ranged from 0.809 to 0.886. The mean score for each of the domains and the total score for PIDAQ, classified according to IOTN-AC and POS, showed a significant difference. The mean score acquired by subjects requiring orthodontic treatment was significantly higher than the score acquired by those not requiring orthodontic treatment (P = 0.00). CONCLUSION: The Persian version of PIDAQ has optimal validity, reliability and responsiveness for assessment of the psychosocial impact of malocclusion on the Iranian young adults.

Psychosocial dental impact in adult orthodontic patients: what about health competence?

BACKGROUND: Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown. AIMS: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level. METHODS: A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed. RESULTS: A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group. CONCLUSIONS: The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.

Parental Expressed Concerns about Silver Diamine Fluoride (SDF) Treatment.

Background: The staining associated with its caries arrest may be a deterrent for the use of Silver Diamine Fluoride (SDF). This study aims to elucidate the concerns that inform parents' perceptions and acceptance of SDF as a treatment option for their child. Study Design: We analyzed qualitative data obtained through an investigation in which parents attending a pediatric dental appointment participated in a survey, which included an open-ended question to evaluate their opinions about SDF staining. Thematic analysis of the comments, offered by the subsample of participants who replied to this question (n=43), yielded insights about perception of SDF therapy. Results: Most parents who provided comments were mothers (83.7%), college graduates (72.1%), primarily white (48.8%) or Hispanic (27.9%). Six themes emerged from the thematic analysis of the parents' responses: Esthetic Concerns, Psychosocial Concerns, SDF Treatment Process, Risks and Side Effects, Situational Benefits, and Dental Treatment Process. While many of the parents' comments are related to appearance, other topics that merit consideration when discussing SDF treatment were mentioned. Conclusions: Although parents are concerned about the esthetic impact of SDF, they understand the risks of alternative treatments and welcome information that will allow them to make an informed decision. Location of the cavities and visibility of the staining appear to heavily influence the decision to accept or reject this therapy.

Malocclusion and dental appearance in underprivileged Brazilian adolescents.

Satisfaction with dental aesthetics is a subjective indicator used in epidemiological studies and is related to health behaviours. Little is known about the factors that influence this indicator, particularly among adolescents who live in a situation of social vulnerability. The aim of this study was to investigate the relationship between malocclusion and dental appearance in underprivileged Brazilian adolescents. This analytical cross-sectional study was conducted in Piracicaba, Brazil, and evaluated 884 adolescents from 13 to 19 years of age. The dependent variable was satisfaction with dental appearance, and the independent variables were classified as individual (components of the Dental Aesthetic Index - DAI, sex and age) and contextual (social exclusion index). For statistical analysis, multilevel regression models were estimated. The individual variables were considered Level 1, and the contextual variable was considered Level 2, with a level of significance of 5%. The mean age of the adolescents was 15.3 years. Female adolescents more frequently affirmed that they were satisfied with their dental appearance than did male individuals. There was an increase in dissatisfaction with oral health with the increase in anterior maxillary overjet, midline diastema, larger anterior irregularity in the maxilla, larger anterior irregularity in the mandible, anterior open bite and antero-posterior molar relation. Satisfaction with dental appearance was associated with individual factors such as sex and DAI components.

Association between malocclusion severity and psychosocial issues among adolescents / Asociación entre gravedad de maloclusión y problemas psicosociales en adolescentes

Aim: To evaluate the association between malocclusion severity and psychosocial issues among Brazilian adolescents. Methods: The study sample consisted of 120 adolescents between 11 and 12 years, patients at the Dental School of the Federal University of Minas Gerais. Psychosocial issues were assessed by means of two questions, through which the adolescents were asked about whether a classmate had teased or called them names due to the condition of their teeth, or whether the adolescents had felt upset due to their teeth. The higher the response scores the greater the psychosocial impact. Malocclusion was evaluated with the Dental Aest-hetic. Index, with assignment of individuals to the following sub-groups: mild malocclusion (DAI≤25), moderate malocclusion (DAI=26­30), definite malocclusion (DAI=31­35) and severe malocclusion (DAI≥36). Results: Adolescents' mean age was 11.50 years. The more severe the malocclusion the greater the frequency of episodes of teasing or name-calling because of the condition of the teeth (p=0.010), and the greater the frequency of episodes when the adolescents had felt upset due to their teeth (p=0.001). Individuals with severe malocclusion had a higher frequency of episodes during which they were teased or called names due to the condition of their teeth when compared to individuals with mild malocclusion (p=0.013). Individuals with severe malocclusion had a higher frequency of episodes in which they felt upset due to their teeth when compared to individuals with mild malocclusion (p<0.001), individuals with moderate malocclusion (p=0.002), and those with defined malocclusion (p=0.001). Conclusion: Severe malocclusion was associated with psychosocial issues among adolescents.

Objetivo: Evaluar la asociación entre la gravedad de la maloclusión y los problemas psicosociales en adolescentes brasileños. Métodos: La muestra de estudio consistió en 120 adolescentes entre 11 y 12 años, pacientes de la Escuela de Odontología de la Universidad Federal de Minas Gerais. Los problemas psicosociales se evaluaron mediante dos preguntas, a través de las cuales se preguntó a los adolescentes si un compañero de clase se había burlado de ellos o les habían insultado debido a la condición de sus dientes, o si los adolescentes se habían sentido molestos debido a sus dientes. Cuanto mayor la puntuación de la respuesta, mayor el impacto psicosocial. La maloclusión se evaluó con el Índice de Estética Dental y se asignó los siguientes subgrupos: maloclusión leve (DAI≤25), maloclusión moderada (DAI=26-30), maloclusión definida (DAI=31-35) y maloclusión grave (DAI≥36). Resultados: la edad media de los adolescentes fue de 11,50 años. Cuanto más grave la maloclusión, mayor la frecuencia de episodios de burlas o insultos debido a la condición de los dientes (p=0.010) y mayor la frecuencia de episodios cuando el adolescente se ha sentido molesto debido a sus dientes (p=0.001). Las personas con maloclusión severa tuvieron una mayor frecuencia de episodios durante los cuales fueron objeto de burlas o se les insultó y les dio nombres debido a la condición de sus dientes en comparación con las personas con maloclusión leve (p=0.013). Los individuos con maloclusión severa tuvieron una mayor frecuencia de episodios en los que se sintieron molestos debido a sus dientes en comparación con individuos con maloclusión leve (p<0,001), individuos con maloclusión moderada (p=0,002) y aquellos con maloclusión definida (p=0.001). Conclusión: la maloclusión grave se asoció con problemas psicosociales en adolescentes.