Impact of Habitual Snoring on Subjective Dental Esthetics in University Population.

OBJECTIVE: The aims of this study were to assess the prevalence of snoring in the University population and to test the null hypothesis that there is no impact of habitual snoring on the self-perceived of dental esthetics. MATERIALS AND METHODS: Berlin Questionnaire and esthetic component of the index of orthodontic treatment need was given to 700 students and employees aged 17-59 years (22 ± 4.5). Both snorers and nonsnorers were assessed for orthodontic treatment need. Chi-square and Student t-test were used to compare the difference between both groups using SPSS Statistics for Windows, Version 23.0. (IBM Corp, Armonk, NY). RESULTS: The prevalence of snoring was 19.2% (male 11.8% and female 7.4%). Nodded off or fall asleep during driving a car or while waiting at least twice a month were reported in 46%. The prevalence of tiredness and fatigue after sleep from 3 to 4 times a week was 36.9% and during the working time was 33.6%. Based on the Berlin Questionnaire stratification for risk of obstructive sleep apnea (OSA), 8.2% were considered as a high-risk patient for OSA, (males: 3.8% and females: 4.4%). About 38.3% of the participants with habitual snoring have gone through orthodontic treatment, while only 28.5% of nonsnoring participant have done that. About 12.3% of snoring participant consider themselves in need of orthodontic treatment compared to 6.6% of a nonsnoring participant (P < 0.04). CONCLUSION: The null hypothesis is rejected; snoring has an impact on the self-perceived of dental esthetics. Snoring participant seeks orthodontic treatment more than the nonsnoring participant in our University population.

Orthodontic view in the diagnoses of obstructive sleep apnea.

Obstructive sleep apnea is an exciting area for orthodontists to be involved. The level of awareness of sleep apnea and related health issues is growing rapidly. The demand of integrating sleep into the orthodontic practice shortly will be driven by the need of the societies as some of our patients will be shortly coming into our offices aware of sleep apnea. However, with our busy clinical orthodontic practice, the need of condense short review become more demanding. Therefore, this review will try to summarize the clinical and orthodontic observation in the diagnoses of adult obstructive sleep apnea with clinical application in orthodontic practice.

Problem-based learning: Dental student's perception of their education environments at Qassim University.

AIMS: The objectives of this study were to assess perceptions of the Saudi dental students of the problem-based learning (PBL) curriculum and to compare their perceptions among different sex and academic years. SUBJECTS AND METHODS: Data was collected through a questionnaire-based survey at Qassim College of dentistry. The questionnaire consisted of 19 questions regarding the perception of PBL curriculum and was distributed to 240 students. The chi-square test was used for statistical analysis of the data. RESULTS: Out of the 240 students recruited for this study, 146 returned a complete questionnaire (the response rate was 60.8%). The majority of the students perceived that PBL enhances the ability to speak in front of people (91.1%); improved the ability to find the information using the internet/library (81.5%); enhances the problem-solving skills (71.3%); increases the practice of cooperative and collaborative learning (69.2%); improves the decision-making skills (66.4%). Sixty-five percent (n = 96) noted that some students dominate whereas others are passive during PBL discussion session. Statistically, significant differences were found in the following variables according to the academic year students assuming before responsibility for their own learning (P < 0.037) and the role of facilitator in the process (P < 0.034). Moreover, according to gender; there were statistically significant differences in the following variables, assuming responsibility for own learning (P < 0.003); activating prior knowledge and learning to elaborate and organize their knowledge (P < 0.009); enhancing the ability to find the information using the Internet/library (P < 0.014); PBL is effective without having lecture of the same topic (P < 0.025); helping in identifying the areas of weakness for improvement (P < 0.031); student understanding the objectives of the PBL session better than the conventional way (P < 0.040); and enhancing the ability to speak in front of people (P < 0.040). CONCLUSIONS: Perceptions of Saudi dental students regarding their education environments at Qassim College of dentistry using PBL hybrid curriculum were more positive than negative. However, improvements are still required to provide students with stimulating favorable learning environment and to take the students recommendations into consideration.

Prevalence of snoring and facial profile type, malocclusion class and dental arch morphology among snorer and nonsnorer university population.

OBJECTIVES: The objectives of this study were to determine the prevalence of snoring in an adult male university population, and to test the null hypothesis that there is no difference in facial profile shape, malocclusion type, or palatal morphology among snorer and nonsnorer. MATERIALS AND METHODS: Berlin questionnaire was given to 840 students and employees aged 18-45 years (24 ± 40). Both snorers and nonsnorers were assessed for the facial profile type, malocclusion type, and palatal morphology. Chi-square and Student's t-test were used to compare the difference between the two groups. RESULTS: The prevalence of snoring was 16.28%. The most frequent findings among snorer were straight profiles (52.0%), Class I malocclusion (74.7%), and V palatal shape (16.0%), respectively. The Chi-square test revealed a significant difference in terms of V-shaped palatal morphology (P < 0.05); higher neck circumference (NC) (P < 0.007); upper arch length was significantly shorter (P < 0.038); and the inter- first upper premolar distance was significantly narrower (P < 0.013). CONCLUSION: The null hypothesis is rejected. Snoring in our university population is associated with V-shape palatal morphology, increased NC and decrease in the upper arch length, and inter- first upper premolar distance.

Career decisions of undergraduate dental students at the University of Science and Technology, Yemen.

Students' reasons for choosing dentistry as a profession have not been well documented, especially in the developing countries. Therefore, the aim of this study was to determine the reasons why undergraduate Yemeni dental students who attended the University of Science and Technology (UST) chose dentistry as a career. A total of 300 out of 500 responses were recorded for this study, a response rate of 60 percent. An anonymous questionnaire was administered to dental students at UST, and a chi-square test was used for statistical analysis of the data. The results showed that students chose dentistry as a career for the following reasons: economic (easy to find jobs, 44.7 percent); vocational (I like to treat people to improve their health, 39.0 percent); personal (my family dentist's encouragement, 37.3 percent); and professional (I can work in many fields, 33.0 percent). When group and item scores were compared between genders, statistically significant differences were only found for vocational reasons (p<0.05). In conclusion, the reasons Yemeni dental students chose dentistry as a profession were primarily economic, then vocational. However, vocational reasons were found to be the significant factors for choosing dentistry as a career by both genders in this group of UST Yemeni dental students.

Craniofacial changes in patients with Class III malocclusion treated with the RAMPA system.

OBJECTIVE: The underlying etiology of Class III malocclusion may be associated with cranial base morphology. The aim of this study is to test the efficacy of a Right-Angled Maxillary Protraction Appliance (RAMPA) System in Asian subjects with Class III malocclusions. MATERIALS AND METHODS: 27 homologous landmarks were digitized from lateral cephalographs for 10 pre-pubertal Japanese children (mean age 95 months) with skeletal Class III malocclusion prior to and after RAMPA treatment. The mean, pre- and post-treatment craniofacial configurations were computed using Procrustes superimposition, and subjected to principal components analysis (PCA), and finite-element analysis (FEA). RESULTS: The mean treatment time was 22.5 months. All patients showed significant craniofacial change with correction of anterior and/or posterior crossbite. The mean, pre- and post-treatment craniofacial configurations were statistically different when tested using PCA (p < 0.001), with the first two principal components accounting for 97% of the total shape change. Using FEA, the anterior cranial base showed a relative 12-32% increase in size. The midfacial and mandibular regions, as well as the oropharyngeal airway showed large relative size-changes. CONCLUSION: This study suggests that the anterior cranial base may be targeted in the correction Class III malocclusions.

Assessment of 3-D nasal airway morphology in Southeast Asian adults with obstructive sleep apnea using acoustic rhinometry.

The aim of the present study is to investigate nasal airway morphology in Asian adults with and without obstructive sleep apnea (OSA) using acoustic rhinometry (AR), principal components analysis (PCA), and 3-D finite-element analysis (FEA). One hundred eight adult Malays aged 18-65 years (mean ± SD, 33.2 ± 13.31) underwent clinical examination and limited channel polysomnography, providing 54 patients with OSA and 54 non-OSA controls. The mean minimal cross section area 1 (MCA1) and the mean minimal cross sectional area 2 (MCA2) were obtained from AR for all subjects and subjected to t tests. The OSA and control nasal airways were reconstructed in 3-D and subjected to PCA and FEA. The mean MCA1 and MCA2 using AR were found to be significantly smaller in the OSA group than in the control group (p < 0.001). Comparing the 3-D OSA and control nasal airways using PCA, the first two eigenvalues accounted for 94% of the total shape change, and statistical differences were found (p < 0.05). Similarly, comparing the nasal airways using FEA, the 3-D mean OSA nasal airway was significantly narrower in the OSA group compared to the control group. Specifically, decreases in size of approx. 10-22% were found in the nasal valve/head of inferior turbinate area. In conclusion, differences in nasal airway morphology are present when comparing patients with OSA to controls. These differences need to be recognized as they can improve our understanding of the etiological basis of obstructive sleep apnea and facilitate its subsequent management.

Craniofacial obesity in patients with obstructive sleep apnea.

INTRODUCTION: Obstructive sleep apnea (OSA) and obesity are serious, widespread public health issues. OBJECTIVE: To localize and quantify geometric morphometric differences in facial soft tissue morphology in adults with and without OSA. MATERIALS AND METHODS: Eighty adult Malays, consisting of 40 patients with OSA and 40 non-OSA controls, were studied. Both groups were evaluated by the attending physician and through ambulatory sleep studies. 3-D stereophotogrammetry was used to capture facial soft tissues of both groups. The 3-D mean OSA and control facial configurations were computed and subjected to principal components analysis (PCA) and finite-element morphometry (FEM). RESULTS: The body mass index was significantly greater for the OSA group (32.3 kg/m(2) compared to 24.8 kg/m(2), p < 0.001). The neck circumference was greater for the OSA group (42.7 cm compared to 37.1 cm, p < 0.001). Using PCA, significant differences were found in facial shape between the two groups using the first two principal components, which accounted for 50% of the total shape change (p < 0.05). Using FEM, these differences were localized in the bucco-submandibular regions of the face predominantly, indicating an increase in volume of 7-22% (p < 0.05) for the OSA group. CONCLUSION: Craniofacial obesity in the bucco-submandibular regions is associated with OSA and may provide valuable screening information for the identification of patients with undiagnosed OSA.

Prevalence of snoring and craniofacial features in Malaysian children from hospital-based medical clinic population.

Snoring is considered as the most common clinical symptom of obstructive sleep apnea-hypopnea syndrome. However, many snoring studies were done in western population, and data from around Asia is scarce. Therefore, the purposes of this study were to determine the prevalence of snoring among Malaysian children from hospital-based medical clinic population setting and to compare the craniofacial features of children with and without snoring using cephalometric analysis. A cross-sectional study among children aged 7-15 years were carried out in Hospital Kuala Terengganu. Sleep behavior questionnaire (Berlin questionnaire) was given to 500 children. The respondents were divided into snoring and non-snoring groups. Thirty children from each group were randomly selected to undergo a cephalometric X-ray. For each lateral cephalometric radiograph, 17 parameters consisting bony, soft tissue, and angular measurements were recorded using computer software VixWin2000. Independent t test was used to analyze the data. The results indicated that the whole questionnaire respondents were 317 (46 snoring and 271 non-snoring), hence, the prevalence of snoring in our survey population was 14.51%. The cephalometric X-ray showed that the snoring children manifested a significant different craniofacial features, such as narrow airway at the level of the soft palate and oropharynx (p < 0.05), more inferiorly positioned hyoid bone (p < 0.05), longer vertical airway length from posterior nasal spine to the base of epiglottis (p < 0.05), more protruding maxilla, and anterior-posterior discrepancy of maxilla and mandible (p < 0.05). In conclusion, our snorer children exhibit significant craniofacial differences compared to non-snorer groups.

Cranial base and airway morphology in adult malays with obstructive sleep apnoea.

BACKGROUND: Obstructive sleep apnoea (OSA) has been described as a public health problem comparable to smoking in its impacts upon society. OBJECTIVE: To compare the differences in cranial base and airway morphology in Malay adults with and without OSA using finite element analysis (FEM). METHOD: Lateral skull radiographs of 38 adult Malays aged 18-60 years were divided into two groups of 19 (13 male, 6 female). The first group consisted of 19 patients with OSA, defined as an apnoea-hypopnea index > 5/hr of sleep, diagnosed with overnight polysomnography. The second group consisted of 19 healthy, non-OSA control subjects. For each lateral skull radiograph 27 homologous landmarks, which encompassed the naso-oropharyngeal airway, were digitised using MorphoStudio software. The mean OSA and control 2D airway configurations were computed and subjected to t-tests and FEM. RESULTS: The mean 2D OSA airway was statistically different from the mean control airway (p < 0.01). Inter-landmark analysis revealed that the cranial base saddle angle was more acute in the OSA group (153.9 degrees +/- 3.4) compared to the control group (158.3 degrees +/- 2.5; p < 0.01). In addition, using pseudo-coloured FEM a relative 58 per cent decrease in nasopharyngeal airway area was found above and behind the soft palate. As well, a 32 per cent decrease in oropharyngeal airway area was located behind the base of the tongue, with a 23 per cent decrease in hypopharyngeal area near the level of the hyoid bone. In contrast, a 96 per cent increase in area associated with downward displacement of the hyoid bone was detected. CONCLUSION: Functional airway impairments associated with OSA can be quantified and localised in Malay patients, and are predominantly associated with the morphology of the posterior regions of the cranial base.

Dental arch shape and size in Malay schoolchildren with Class II malocclusion.

AIM: To quantify and localise differences in Class I and Class II dental arches in Malay schoolchildren. METHODS: The subjects were 50 Malay schoolchildren (Mean age: 15 + 0.7 years) with either Class I (N = 25) or Class II (N = 25) malocclusions. Fourteen homologous landmarks on the upper and lower study models of the subjects were digitised using MorphoStudio software, and the Procrustes means were computed. The mean Class I and Class II configurations were subjected to ftests and finite element analysis. RESULTS: Normalised upper arch Class I and Class II configurations were statistically different (p < 0.05), but the lower arches were not. However, normalised Class II linear parameters were statistically smaller in the upper arch and larger in the lower arch. The upper Class II dental arch was narrower by 15 per cent and asymmetric changes in size (11-20 per cent) were localised in the labial and buccal regions of the lower Class II arch. CONCLUSIONS: Size and shape differences between Class I and Class II dental arches can be identified with finite element analysis.

Facial soft tissue features assessed with finite element analysis.

Facial soft tissues are a major determinant of treatment choice. When Class I and Class II malocclusions were compared using finite-element analysis, morphologic differences were localized and quantified. This study highlights the importance of determining the timing, magnitude and direction offacial growth prior to treatment to achieve stable results.