Anxiety and post-traumatic stress symptoms in orthognathic surgery patients.

OBJECTIVE: To assess the impact of orthognathic surgery in terms of anxiety and stress levels in pre-treatment and post-treatment groups compared with controls and the role of previous trauma exposure on anxiety and stress levels following treatment. MATERIALS AND METHODS: A case-control study was performed involving three age-gender matched groups: 38 'pre-surgery', 39 'post-surgery' and 39 'control' subjects. All subjects had assessment of dental anxiety, post-traumatic stress responses and frequency of previous distressing events. Seventeen subjects were followed up prospectively for 1 year after surgery. RESULTS: 'Post-surgery' group reported lower dental trait anxiety (S-DAI) scores than other groups (P = 0.001). S-DAI was significantly associated with frequency of previous traumatic events in 'pre-surgery' and 'post-surgery' groups (P < 0.01), and was significantly associated with post-traumatic stress disorder (PTSD) symptoms in 'pre-surgery' subjects (P < 0.01) who had the highest PTSD symptoms among the three groups (P = 0.005). Symptom severity (IES-R) levels were significantly associated with frequency of previous distressing dental events in 'pre-surgery' (P < 0.05) and 'post-surgery' groups (P < 0.01). Post-operative S-DAI and IES were significantly associated with pre-operative PTSD symptoms (P < 0.01). CONCLUSIONS: The two orthognathic groups were associated with low levels of anxiety and PTSD symptoms in comparison with the control group of the study. Trauma exposure prior to orthognathic treatment can be considered as a risk factor for the development of dental anxiety and PTSD symptoms. The need to improve communication between patients and team is emphasized, especially during the assessment of patients' emotional state pre-operatively, in addition to discussing psychological issues and psychosocial treatment implications.

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.

The effect of temporomandibular disorders on condition-specific quality of life in patients with dentofacial deformities.

OBJECTIVE: This study investigated the effect of temporomandibular disorders on quality of life (QOL) of patients with dentofacial deformities. STUDY DESIGN: A case-control study was performed involving 3 age- and gender-matched groups: 38 preoperative participants, 38 postoperative participants, and 39 control participants. Temporomandibular joints were assessed using the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD axis I), and QOL was assessed using the Orthognathic Quality of Life Questionnaire (OQLQ) and the Short-Form Health Survey (SF-36). RESULTS: Significantly lower OQLQ scores were found in postoperative patients with one or more RDC/TMD findings; the domains in which these occurred were mental health, dentofacial esthetics, and awareness of dentofacial esthetics for patients with myofascial pain; social aspects and awareness of dentofacial esthetics for patients with disk displacement with reduction; and all domains for patients with arthritis (all P < .05). CONCLUSIONS: Despite the variable effect of orthognathic treatment on TMDs, the presence of TMDs in patients after treatment can have a negative effect on their QOL.

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.

Evaluation of an innovative computer-assisted sagittal split ramus osteotomy to reduce neurosensory alterations following orthognathic surgery: a pilot study.

BACKGROUND: Sagittal split ramus osteotomy (SSRO) can be associated with postoperative neurosensory disturbances. This study aimed to evaluate the effectiveness of computer-assisted SSRO in reducing the incidence and severity of neurosensory alterations, using a surgical guide fabricated by computer-aided design and rapid prototyping (to guide bone cutting lateral to the inferior alveolar nerve). METHODS: A prospective double-blind, randomized controlled, clinical trial of computer-assisted SSRO vs conventional SSRO (assigned in a split-mouth design) in eight patients, mean age 23 (range 18-30) years, who participated in one session preoperatively and three sessions at 1 week and 1, 3 and 6 months postoperatively. At each session, subjective oral sensation was scored and quantitative sensory tests were performed. Neurosensory changes were compared between the two sides. RESULTS: The results showed that on the computer-assisted SSRO sides, patients had lower postoperative abnormal thresholds for the Semmes-Weinstein monofilaments on lower lip and chin (p < 0.05 at 3 months) and for the two-point discrimination on lower lip (p < 0.05 at 1 week) and chin (p < 0.05 at 6 months), with fewer abnormal self-reported changes in lower lip sensation (p < 0.05 at 1 week) after surgery. CONCLUSIONS: These findings imply that computer-assisted SSRO is associated with better levels of neurosensory function after surgery.

Dental students' perception of theater-based learning as an interactive educational tool in teaching oral surgery in Jordan.

OBJECTIVE: To evaluate dental students' perception of theater-based learning, and explore its association with their clinical knowledge and future career decisions. METHODS: This cross-sectional study was carried out in the Oral Surgery Department, Jordan University Hospital, Amman, Jordan between September 2007 and March 2008 on dental students of batch 2005-2007 comprising 157 students and graduates. Seventy-two subjects were exposed to theater-based learning (group 1), and 85 subjects had conventional oral surgery teaching (group 2). All subjects completed a questionnaire consisting of 23 skills and competencies with 2 career-related items. RESULTS: Students with theater experience perceived better ability to describe surgical procedures (71% of students in group 1 reported "adequate" or higher levels compared to 38% as reported by group 2 students, more understanding of theater and cross infection control protocols and teamwork value (96% in group 1 responded "adequate" or higher, 81% by group 2 students), higher competence to deal with complications (94% in group 1 responded "adequate" and 82% by group 2 students), more awareness of resident's duties and more familiarity with hospital environment (88% in group 1 and 71% by group 2 students) (p=0.000). They showed more interest in oral surgery as a career (53% of group 1 responded "certain", 33% by group 2 students) (p=0.007). Alpha reliability scores of 0.50-0.90 were obtained for the questionnaire subscales. CONCLUSION: Dental students perceived theater-based learning as a valid interactive educational tool. Active integration of dental students can lead to a superior educational experience, and promotes postgraduate surgical programs.

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.

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.

The treatment of masseter hypertrophy with botulinum toxin type A.

Masseter hypertrophy is a benign condition with variable causative factors, such as bruxism, temporomandibular disorders, malocclusion and others, but has an unclear etiology in the majority of cases. Surgical masseteric resection was the conventional method of treatment for the asymmetric swellings over the ramus and angle of the mandible on one or both sides, in addition to the generally unsuccessful treatments of occlusal adjustment, splint therapy, tranquilizers or others. An effective alternative was the local injection of very small doses of botulinum toxin type A into the masseter. The toxin binds permanently to the motor end plate preventing acetylcholine release causing pre-synaptic neuromuscular blockade, the muscle can be selectively weakened and local paralysis is followed by atrophy of the muscle. Four cases with their follow-up are reported. This technique provided a predictable and conservative method of treatment for this type of facial asymmetry.