Impacts of anterior-posterior jaw disproportions on speech of dentofacial disharmony patients.

BACKGROUND/OBJECTIVES: Articulation problems impact communication, development, and quality of life, and are diagnosed in 73-87% of patients with Class II Dentofacial Disharmony (DFD). We evaluated whether differences exist in stop (/t/ or/k/), fricative (/s/ or/ʃ/), and affricate (/tʃ/) consonant sounds of Class II DFD subjects, and whether extent of malocclusion correlates with severity of speech distortion. We hypothesized that Class II patients display milder distortions than Class III and anterior open bite (AOB), as Class II patients can posture into a Class I occlusion. MATERIALS/METHODS: Audio and orthodontic records were collected from DFD patients (N = 53-Class II, 102-Class III, 72-Controls) who were pursuing orthodontics and orthognathic surgery. A speech pathologist perceptually scored speech. Acoustic differences in recordings were measured using Spectral Moment Analysis. RESULTS: When Class II subjects were compared to controls, significant differences were found for the centroid frequency (M1) of the /s/ sound and the spectral spread (M2) of /t/, /tʃ/, and /s/ sounds, with pairwise significance for controls relative to Class II AOB and all Class II subjects. Class II AOB subjects had higher M1 and M2 values than patients with Class II closed bites and Class I controls for most sounds. When comparing across anterior-posterior (AP) groups, differences exist between controls, Class II and III DFD subjects for M1 of /t/, /tʃ/, and/ʃ/ and M2 for /t/, /tʃ/, /s/, and /ʃ/ sounds. Using linear regression, correlations between Class II and III severity and spectral measures were found for /t/ and /tʃ/ sounds. CONCLUSIONS/IMPLICATIONS: Class II and III patients have a higher prevalence of qualitative distortions and spectral changes in consonants compared to controls, but Class II spectral shifts are smaller and affect fewer sounds than in Class III and AOB cohorts. Linear correlations between AP discrepancy and spectral change suggest causation and that treatment may improve articulation problems.

Impacts of Skeletal Anterior Open Bite Malocclusion on Speech.

Introduction: Articulation problems are seen in 80-90% of dentofacial deformity (DFD) subjects compared with 5% of the general population, impacting communication and quality of life, but the causal link is unclear. We hypothesize there are both qualitative (perceptual) and quantitative (spectral) differences in properties of stop (/t/ or /k/), fricative (/s/ or /∫/), and affricate (/t∫/) consonant sounds and that severity of anterior open bite (AOB) jaw disharmonies correlates with degree of speech abnormality. Methods: To test our hypotheses, surgical orthodontic records and audio recordings were collected from DFD patients (n=39 AOB, 62 controls). A speech pathologist evaluated subjects and recordings were analyzed using spectral moment analysis (SMA) to measure sound frequency distortions. Results: Perceptually, there is a higher prevalence of auditory and visual speech distortions in AOB DFD patients when compared to controls. Quantitatively, a significant (p<0.01) increase in the centroid frequency (M1) was seen in the /k/, /t/, /t∫/, and /s/ sounds of AOB subjects compared to the controls. Using linear regression, correlations between AOB skeletal severity and spectral distortion were found for /k/ and /t/ sounds. Conclusions: A higher prevalence of qualitative distortion and significant quantitative spectral distortions in consonant sounds were seen in AOB patients compared to controls. Additionally, severity of skeletal AOB is correlated with degree of distortion for consonant sounds. These findings provide insight into how the surgical and/or orthodontic treatment of AOB may impact speech.

Validating Spectral Moment Analysis as a Quantitative Measure of Speech Distortions in Speakers With Class III Malocclusions.

Purpose: This study examined the relationship between judged speech sound distortions and spectral moment metrics in speakers with Class III malocclusion. Methods: A quantitative online survey was distributed to 30 speech specialists (clinicians and/or students) and 100 lay listeners to judge the clarity of the sounds /s/, /ʃ/, /t/ and /k/ using a visual analog scale (VAS) from recordings of 11 Class III (underbite) Dentofacial Disharmony (DFD) patients and eight Class I controls. Patients and controls were grouped according to high, moderate, and low /s/-/ʃ/ first spectral moment differences. A linear mixed model was used to analyze the data. Results: VAS scale ratings increased as a function of decreasing spectral contrast for both groups of listeners. VAS ratings of speech specialists were more homogenous than lay listeners, and speech specialists rated distortions as less severe than lay listeners. Conclusions: Recordings of Class III DFD patients with low /s/-/ʃ/ first spectral moment differences were scored by listeners as having increased VAS scale ratings, indicative of more significant perceived speech-sound distortions. Spectral moment analysis appears to be a promising approach for characterizing speech of DFD patients and other craniofacial disorders.

Patient and Caregiver Perceptions of Animal Assisted Activity in Orthodontics.

Dental anxiety affects up to 21% of children and 80% of adults and is associated with lifelong dental avoidance. Animal assisted activity (AAA) is widely used to reduce anxiety and pain in medical settings and has promise in dentistry. The primary objective of this study was to evaluate caregiver and patient perceptions of canine AAA in orthodontics. A cross-sectional survey consisting of pre-tested and validated questions was conducted (n = 800) including orthodontic patients (n = 352 minors, n = 204 adults) and parents/caregivers (n = 244) attending university orthodontic clinics. In this study, AAA and dog therapy were not used or tested for dental anxiety management. More than a third of orthodontic patients (37%) had moderate or greater anxiety related to care. Participants believed that therapy animals would make dental experiences more enjoyable (75%) and reduce anxiety (82%). There was little to no concern expressed regarding cleanliness (83%), allergies (81%), and safety (89%) with a therapy animal in dental settings. Almost half of the participants would preferentially select an orthodontic office offering AAA. In light of the COVID-19 pandemic, we assessed whether perceptions of AAA changed before and after the shutdown of dental offices, with no significant differences. Across patients and caregivers, the responses support the use of AAA in orthodontic settings with minimal concerns.

Orthodontic loading activates cell-specific autophagy in a force-dependent manner.

INTRODUCTION: Orthodontic tooth movement (OTM) relies on bone remodeling and controlled aseptic inflammation. Autophagy, a conserved homeostatic pathway, has been shown to play a role in bone turnover. We hypothesize that autophagy participates in regulating bone remodeling during OTM in a force-dependent and cell type-specific manner. METHODS: A split-mouth design was used to load molars with 1 of 3 force levels (15, 30, or 45 g of force) in mice carrying a green fluorescent protein-LC3 transgene to detect cellular autophagy. Fluorescent microscopy and quantitative polymerase chain reaction analyses were used to evaluate autophagy activation and its correlation with force level. Cell type-specific antibodies were used to identify cells with green fluorescent protein-positive puncta (autophagosomes) in periodontal tissues. RESULTS: Autophagic activity increased shortly after loading with moderate force and was associated with the expression of bone turnover, inflammatory, and autophagy markers. Different load levels resulted in altered degrees of autophagic activation, gene expression, and osteoclast recruitment. Autophagy was specifically induced by loading in macrophages and osteoclasts found in the periodontal ligament and alveolar bone. Data suggest autophagy participates in regulating bone turnover during OTM. CONCLUSIONS: Autophagy is induced in macrophage lineage cells by orthodontic loading in a force-dependent manner and plays a role during OTM, possibly through modulation of osteoclast bone resorption. Exploring the roles of autophagy in OTM is medically relevant, given that autophagy is associated with oral and systemic inflammatory conditions.

Educational debt and the gender gap: Understanding factors influencing orthodontists' career decisions.

INTRODUCTION: Orthodontic residents face challenges unparalleled to their predecessors, including competitive marketplaces, rising debt burdens, and changing demographics that have contributed to the shift in initial career choice from owner to employee. We aim to understand factors important to orthodontists at different career stages and the impact on job satisfaction through a sequential mixed methodology study. METHODS: Semistructured interviews were conducted with 25 orthodontic residents and practitioners. A survey was developed from qualitative findings that explored career decision-making of orthodontic residents and practicing orthodontists, with descriptive and bivariate statistical analyses (n = 343 orthodontists and 185 residents). RESULTS: Graduating orthodontic residents are choosing employment over ownership as their initial job, prioritizing high income to offset the educational debt. The majority of residents report thinking about their debt very often to all of the time and find it very to extremely stressful. Current residents have long-term goals of ownership, whereas practicing doctors of both genders became owners at equal frequencies. However, on average, women earn $119,000 less per year and report being the primary family caretaker more often than men. CONCLUSIONS: Excellent patient care, work-life balance, and sufficient income are the most important drivers for career choices and job satisfaction for orthodontists of all ages. Despite debt, most residents and working orthodontists report a high level of job satisfaction and would recommend the field of orthodontics to others.

Understanding technology adoption by orthodontists: A quantitative study.

INTRODUCTION: Digital scanning, treatment planning, 3-dimensional imaging, and printing are changing the practice of orthodontics. These tools are adopted with the hope that treatment becomes more predictable, efficient, and effective while reducing adverse outcomes. Digital tools are impacting care, but knowledge of nationwide adoption trends and motivators is incomplete. METHODS: We aimed to identify adoption decision-makers, information sources, incentives, and barriers through the first nationwide survey of American Association of Orthodontics members on their technology adoption habits, needs, and outcomes. Data were assessed using descriptive and bivariate analyses. The survey was developed from a comprehensive qualitative interview phase as part of a mixed methodology study. RESULTS: Responses (n = 343) revealed orthodontists make adoption decisions on the basis of advice from other dentists and company representatives while rarely consulting staff or research literature. Continuing education and meetings are most effective at disseminating information to practicing doctors, whereas journals generate less impact. Key adoption incentives include added capabilities, practice efficiency, ease of implementation, and performance, whereas cost is the main barrier to purchase. Early adopters with larger practices charge higher fees than other adopters to support the costs of technologies. Treatment outcome is not a primary adoption incentive for specific technologies. CONCLUSIONS: Orthodontists positively perceive the influence of intraoral scanning, cone-beam computed tomography imaging, 3-dimensional printing, computer-aided design-computer-aided manufacturing archwires, and clear aligner therapy on their practice and patient care. The orthodontic technological transformation is underway, and knowledge of adoption can guide our transition into modern practice, in which digital tools are effective adjuncts to the specialists' expertise.

Orthognathic speech pathology: impacts of Class III malocclusion on speech.

INTRODUCTION: Patients with dentofacial disharmonies (DFDs) seek orthodontic care and orthognathic surgery to address issues with mastication, esthetics, and speech. Speech distortions are seen 18 times more frequently in Class III DFD patients than the general population, with unclear causality. We hypothesize there are significant differences in spectral properties of stop (/t/ or /k/), fricative (/s/ or /ʃ/), and affricate (/tʃ/) consonants and that severity of Class III disharmony correlates with the degree of speech abnormality. METHODS: To understand how jaw disharmonies influence speech, orthodontic records and audio recordings were collected from Class III surgical candidates and reference subjects (n = 102 Class III, 62 controls). A speech pathologist evaluated subjects and recordings were quantitatively analysed by Spectral Moment Analysis for frequency distortions. RESULTS: A majority of Class III subjects exhibit speech distortions. A significant increase in the centroid frequency (M1) and spectral spread (M2) was seen in several consonants of Class III subjects compared to controls. Using regression analysis, correlations between Class III skeletal severity (assessed by cephalometric measures) and spectral distortion were found for /t/ and /k/ phones. CONCLUSIONS: Class III DFD patients have a higher prevalence of articulation errors and significant spectral distortions in consonants relative to controls. This is the first demonstration that severity of malocclusion is quantitatively correlated with the degree of speech distortion for consonants, suggesting causation. These findings offer insight into the complex relationship between craniofacial structures and speech distortions.

Identifying factors that impact general dentists' referrals to orthodontists.

INTRODUCTION: Referrals from general dentists are a significant source of orthodontic patients, but our knowledge of factors guiding referral decisions predates recent marketplace trends of direct-to-consumer products and broad digitization. To provide orthodontists with current, nationwide data on referral values and communication preferences, a mixed-methods study was conducted. METHODS: Semistructured interviews were conducted with practicing general dentists (n = 23), and interviews were analyzed to identify factors important to communication and referrals. Qualitative data provided the foundation to develop and pretest a survey distributed nationally to American Dental Association general dentists through email (n = 373). Survey results were evaluated using bivariate and descriptive statistics. RESULTS: Although 42% of general dentists provide orthodontics, of those, 68% report insufficient orthodontic training in dental school, and 61% have increased orthodontic care in recent years. General dentists refer to orthodontists for complex cases and growing patients, with the orthodontist's perceived skill and proximity to the patient being important for choosing a specific orthodontic practice. Phone (70%) and email (61%) are the most used interoffice communication methods, with email (40%) and then phone (30%) being the most preferred. The most important aspects of a working relationship were patient satisfaction and final occlusal outcome, whereas the best way to boost referrals was through improving communication. CONCLUSIONS: Excellent care and patient satisfaction remain primary motivators for referrals from generalists to orthodontists. An improved orthodontic curriculum is needed for general dentists. Good communication with dentists is critical for growing referral streams and enhancing patient care.

Influence of BMI percentile on craniofacial morphology and development in children and adolescents.

BACKGROUND: The prevalence of childhood and adolescent obesity is increasing worldwide. Reports suggest that elevated body mass index (BMI) is associated with larger craniofacial dimensions and advanced dental and skeletal development. Such an association is important for timing orthodontic treatment relative to pubertal growth and dental eruption. MATERIALS AND METHODS: To evaluate associations between BMI, craniofacial morphology, dental age, and cervical vertebrae maturation staging (CVMS), 400 participants were consecutively selected (8-15 years, n = 200 overweight and obese BMI >85%, 200 normal weight) from the University of North Carolina database. Records were analysed for cephalometric measures, Demirjian index values, and CVMS. Bivariate statistics and linear regression analysis evaluated whether CVMS, dental age, and cephalometric dimensions varied with BMI. RESULTS: Overweight/obese children and adolescents had a proportionally larger bimaxillary prognathic skeletal pattern compared to those of normal weight. These cephalometric measurements [articulare-gnathion (Ar-Gn), condylion-anterior nasal spine (Co-ANS), sella-gonion (S-Go), nasion-menton (N-Me), anterior nasal spine-menton (ANS-Me), sella-nasion-A point (SNA), sella-nasion-B point (SNB), and sella-nasion-pogonion (SNPg)] were significantly different [statistically (P < 0.05) and clinically (>2 mm or >2 degrees)] between the two study groups, with a linear relationship between BMI percentile and craniofacial dimension. The overweight/obese BMI group had a mean dental age 1.4 years advanced relative to the normal weight group (P < 0.05), with an advancement of nearly one CVM stage between the ages of 12 and 14 (P < 0.05). LIMITATIONS: The study is retrospective. CONCLUSIONS: Obese/overweight children and adolescents have proportionally larger antero-posterior and vertical dimensions and are more likely to experience advanced dental and skeletal maturation. Obese/overweight subjects may enter their growth spurt at a younger age and have earlier eruption of teeth, affecting treatment timing. BMI percentile should be a consideration for orthodontic treatment in growing patients.