Potential Impact of Long COVID-19 on Orthodontic Treatment.

Pooled estimates indicate about 226 million individuals are currently experiencing or have experienced persistent symptoms from COVID-19. Long COVID-19 (LC) has been associated with a prolonged inflammatory and stress responses in affected individuals. Due to common pathways, LC could impact the biological mechanisms of orthodontic tooth movement, orthodontically-induced inflammatory root resorption and periodontal tissue response of patients undergoing orthodontic treatment. The authors of the present report discussed potential biological mechanisms through which LC may influence orthodontic treatment highlighting the need for further research in this area.

Learning Games: A New Tool for Orthodontic Education.

Learning games that are based on current scientific concepts are underutilized in dental education. This paper explores the relevant science of learning and discusses several principles that are conducive to learning and teaching in an educational setting, namely retrieval practice, feedback, motivation, and engagement. A discussion of learning games in health professional education ensues, followed by a description of relevant best practices in game design for learning. This paper concludes by presenting Dealodontics©, a card game developed at New York University College of Dentistry with the goal of helping second-year dental students review, practice, and apply basic skills relevant to their orthodontics competency requirements.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists.

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

Stress and anxiety in orthodontic residents during the coronavirus disease 2019 pandemic.

INTRODUCTION: The coronavirus disease 2019 pandemic has had far-reaching effects on health care providers and health professional students; however, little is known about the factors related to stress and anxiety levels, specifically among orthodontic residents during this time. METHODS: A 2-part questionnaire, which included modified stress and anxiety inventories, was disseminated electronically to U.S. orthodontic residents between June and July 2020. Descriptive and comparative statistics were used to analyze the data. RESULTS: Overall, 261 participants responded (56% female), representing a response rate of 26.8%. Significant gender differences were found in 18 stress items, with female respondents expressing more stress than their male counterparts. Only 1 stress item (ie, fear of being unable to catch up if behind) varied as a function of the difference on the basis of respondents' stage in the program. First-year residents reported more stress in relation to this than more senior residents. Responses to all anxiety items but 1 item varied by gender, with females reporting higher scores. Residents in the middle stages of their program responded with higher anxiety scores with significant differences on 3 anxiety items. CONCLUSIONS: Although financial responsibilities and travel plans were the most stressful and anxiety-inducing items for orthodontic residents during the early aspect of the coronavirus disease 2019 pandemic, multiple items contributed to their stress and anxiety. In addition, both gender and stage of progress in a residency program impacted the level of stress and anxiety reported by respondents.

Should attendance for preclinical simulation and clinical education be mandatory?

Mandatory attendance, particularly in didactic settings, is a highly debated topic in higher education, including dental education. Within dental education, a large portion of education occurs in preclinical laboratories and clinical environments. There is little to no research on attendance in these settings in dental schools. This point/counterpoint paper examines the pros and cons of mandatory attendance in these highly specialized educational settings. With the backdrop of the COVID-19 pandemic that began in March 2020 and continues to impact dental education at the time of publication, this topic has become even more relevant. Viewpoint 1 claims that attendance should be mandatory because a greater exposure to preclinical and clinical environments helps foster better clinical hand skills, critical thinking, decision-making, problem-solving skills, and an overall sense of professional identity. It goes on further to suggest that there may be a link between attendance and performance in exams and that attendance is part of the dental school's responsibility. Viewpoint 2 argues that the rationale for attendance is complex, and that creating learning environments that are psychologically safe will incentivize students to attend, even without mandatory attendance policies. Furthermore, it explains that technological advances have allowed dental schools to think creatively about asynchronous learning, which by its very nature does not require attendance at a given time. The authors of both viewpoints conclude that the preclinical and clinical education and experience are critical dental education and that dental school leaders should focus on improving the quality of these experiences.

Non-thermal plasma treatment to enhance the adhesion between enamel surface and orthodontic bracket.

BACKGROUND: Adhesion strength of orthodontic attachments to enamel should be within optimal range to resist occlusal forces and to allow debonding without enamel damage. OBJECTIVE: The present study compared the effect of non-thermal plasma (NTP) and conventional surface treatment on the adhesion strength of orthodontic bracket to enamel. METHODS: A total of 100 premolar teeth were allocated into 5 groups according to the bonding procedure followed: Group 1 (Etch, prime and composite adhesive); Group 2 (Prime and composite adhesive); Group 3 (Glass ionomer cement); Group 4 (NTP, prime and composite adhesive) and Group 5 (NTP and glass ionomer cement). Ten specimens in each group were subjected to artificial aging and the remaining ten specimens served as baseline specimens. Adhesion strength values were recorded after debonding and bond failure types were scored. Water contact angles of the NTP treated and untreated enamel surface were measured. RESULTS: Group 1 specimen demonstrated highest bond strength at baseline (21.5 ± 3.01) and thermocycling (15.8 ± 2.87) and the least values were in Group 2 specimens at baseline (3.9 ± 1.01) and thermocycling (1.6 ± 0.7). Among the experimental (NTP) groups, Group 4 specimens exhibited high adhesion strength at baseline (10.2 ± 1.76) and after thermocycling (9.8 ± 2.15) compared to Group 5 specimens at baseline (10.1 ± 1.05) and thermocycling (6.5 ± 2.19). The water contact angle on untreated enamel surface was 53.1° ± 2.1° as compared to 1.4° ± 0.7° in treated surface. CONCLUSION: Non-thermal plasma (NTP) treatment in conjunction with composite adhesives demonstrated clinically acceptable adhesion strength and was well within the optimal range (7-14 MPa) for enamel bonding.

Therapeutic effect of localized vibration on alveolar bone of osteoporotic rats.

OBJECTIVES: Vibration, in the form of high frequency acceleration (HFA), stimulates alveolar bone formation under physiologic conditions and during healing after dental extractions. It is not known if HFA has an anabolic effect on osteoporotic alveolar bone. Our objective is to determine if HFA has a regenerative effect on osteoporotic alveolar bone. METHODS AND MATERIALS: Adult female Sprague-Dawley rats were divided into five groups: 1) Ovariectomized Group (OVX), 2) Sham-OVX Group that received surgery without ovariectomy, 3) OVX-HFA Group that was ovariectomized and treated daily with HFA, 4) OVX+Static Force Group that was ovariectomized and received the same force as HFA, but without vibration, and 5) Control Group that did not receive any treatment. All animals were fed a low mineral diet for 3 months. Osteoporosis was confirmed by micro-CT of the fifth lumbar vertebra and femoral head. HFA was applied to the maxillary first molar for 5 minutes/day for 28 and 56 days. Maxillae were collected for micro-CT, histology, fluorescent microscopy, protein and RNA analysis, and three-point bending mechanical testing. RESULTS: Micro-CT analysis revealed significant alveolar bone osteoporosis in the OVX group. Vibration restored the quality and quantity of alveolar bone to levels similar to the Sham-OVX group. Animals exposed to HFA demonstrated higher osteoblast activity and lower osteoclast activity. Osteogenic transcription factors (RUNX2, Foxo1, Osterix and Wnt signaling factors) were upregulated following vibration, while RANKL/RANK and Sclerostin were downregulated. HFA did not affect serum TRAcP-5b or CTx-1 levels. The osteogenic effect was highest at the point of HFA application and extended along the hemimaxillae this effect did not cross to the contra-lateral side. CONCLUSIONS: Local application of vibration generated gradients of increased anabolic metabolism and decreased catabolic metabolism in alveolar bone of osteoporotic rats. Our findings suggest that HFA could be a predictable treatment for diminished alveolar bone levels in osteoporosis patients.

Age-dependent biologic response to orthodontic forces.

INTRODUCTION: Orthodontic tooth movement results from increased inflammation and osteoclast activation. Since patients of all ages now routinely seek orthodontics treatment, we investigated whether age-dependent biologic responses to orthodontic force correlate with the rate of tooth movement. METHODS: We studied 18 healthy subjects, adolescents (11-14 years) and adults (21-45 years), with Class II Division 1 malocclusion requiring 4 first premolar extractions. Canines were retracted with a constant force of 50 cN. Gingival crevicular fluid was collected before orthodontic treatment and at days 1, 7, 14, and 28 after the canine retraction. Cytokine (IL-1ß, CCL2, TNF-α) and osteoclast markers (RANKL and MMP-9) were measured using antibody-based protein assays. Pain and discomfort were monitored with a numeric rating scale. The canine retraction rate was measured from study models taken at days 28 and 56. RESULTS: Although the cytokine and osteoclast markers increased significantly in both age groups at days 1, 7, and 14, the increases were greater in adults than in adolescents. Interestingly, the rate of tooth movement in adults was significantly slower than in adolescents over the 56-day study period. Adults also reported significantly more discomfort and pain. CONCLUSIONS: Age is a significant variable contributing to the biologic response to orthodontic tooth movement. Adults exhibited a significantly higher level of cytokine and osteoclasts activity but, counterintuitively, had a significantly slower rate of tooth movement.

Effect of micro-osteoperforations on the rate of tooth movement.

INTRODUCTION: Our objectives were to study the effect of micro-osteoperforations on the rate of tooth movement and the expression of inflammatory markers. METHODS: Twenty adults with Class II Division 1 malocclusion were divided into control and experimental groups. The control group did not receive micro-osteoperforations, and the experimental group received micro-osteoperforations on 1 side of the maxilla. Both maxillary canines were retracted, and movement was measured after 28 days. The activity of inflammatory markers was measured in gingival crevicular fluid using an antibody-based protein assay. Pain and discomfort were monitored with a numeric rating scale. RESULTS: Micro-osteoperforations significantly increased the rate of tooth movement by 2.3-fold; this was accompanied by a significant increase in the levels of inflammatory markers. The patients did not report significant pain or discomfort during or after the procedure, or any other complications. CONCLUSIONS: Micro-osteoperforation is an effective, comfortable, and safe procedure to accelerate tooth movement and significantly reduce the duration of orthodontic treatment.