Perception of frontal facial images compared with their mirror images: chirality, enantiomorphic discrimination, and relevance to clinical practice.

BACKGROUND: What we think we see consists of models constructed in our brains, which may be constrained, limited and perhaps modified at a cerebral level. Patients may view their mirror image differently to how others and the clinical team view them. Understanding potential variations in perception between real and mirror images is important in clinical practice. The aims were to assess differences in self-perception between frontal facial and mirrored photographs, comparing the results with selfie photographs. METHODS: Facial photographs were taken by one investigator under standardized conditions for preclinical and clinical students. Each student took a selfie photograph at rest and smiling using his/her smartphone. A mirror image was generated for each image. Each student was shown his/her original and mirror image, without being informed which was which. For each pair of images, students were asked to choose which photograph they perceived as more attractive. A set of photographs of a male volunteer was shown to all participants, to choose either the original or mirror image as the more attractive. RESULTS: Most observers preferred the true image of the volunteer (P < 0.05), which may be evidence that most people prefer the true image of others, which is how they normally view them. Most observers preferred their own original photograph in frontal view at rest and smiling (P < 0.05), but preferred the mirror image of their selfie photograph at rest and smiling (P < 0.05). CONCLUSIONS: Significant differences in perceptions of attractiveness between true and mirror-reversed frontal and selfie images were found. Observers preferred their image the way they view themselves in a mirror. The selfie is how other people view an individual. If a selfie is flipped horizontally, that is how an individual sees themselves in a mirror. Most observers preferred the mirror image of their selfie, which is how they would view themselves in a mirror.

Fashioned Mucoperichondrial Flap Technique Versus Fishing Line Technique in the Repair of Septal Dislocation: A Prospective Comparative Study.

BACKGROUND: A nasal septal dislocation is a common form of septal deviation with many challenges and different surgical techniques for correction. OBJECTIVE: To assess the efficacy of fashioned mucoperichondrial flap technique versus fishing line technique in the repair of septal dislocation. METHODS: The study was a prospective comparative cohort study conducted on 88 patients aged above 18 years who have symptomatic mild to moderate caudal septal dislocation spanning the period from June 2021 to June 2022. Preoperatively, all patients were evaluated by the Nasal Obstruction and Septoplasty Effectiveness (NOSE) scale to assess the degree of nasal obstruction. Anterior rhinoscopy and endoscopic examination of the nose were done for every patient to assess the degree of obstruction, whether mild, moderate, or severe. Outcomes included an assessment of both techniques' efficacy in managing nasal obstruction as expressed by the NOSE scale and comparing both techniques regarding the operative and postoperative details. RESULTS: The current study showed a highly significant improvement in the NOSE scale postoperatively in both groups (P < .00001 for both groups). The mean operative duration for group I was significantly less than that for group II (P < .00001). There was a nonsignificant difference between both groups regarding the postoperative NOSE scale, and postoperative degree of obstruction (P = .066 and .56, respectively). Regarding postoperative complications, there was a nonsignificant difference between both groups except for patient discomfort as assessed 1 week postoperatively. Group II showed significantly more patient discomfort (P = .02), which improved 4 weeks postoperatively. CONCLUSION: Both techniques presented in this study effectively corrected mild and moderate caudal septal dislocation with significant improvement of nasal obstruction postoperatively. Both techniques produced good esthetic outcomes and were associated with few comparable complications in both groups.

Self-harm, dentofacial features, and bullying.

INTRODUCTION: Self-harm is a growing public health problem. The study aimed to investigate the prevalence of self-harm among a representative sample of school children and the contribution of dentofacial appearance and being bullied because of dentofacial appearance to self-harm. METHODS: This was a cross-sectional study in which a representative sample of eighth-grade students (aged 13-14 years) from randomly selected schools was asked to complete anonymous questionnaires distributed in the classroom. The final sample size was 699 children (339 girls, 360 boys) with a mean age of 13.3 years, representing 1.26% of the target population. RESULTS: The prevalence of self-harm was 26.9% (n = 188), with no statistically significant gender differences (P >0.05). Among all the subjects who reported self-harm, 47.9% (n = 90) reported self-harm because of dentofacial features. A total of 41 subjects reported self-harm because of bullying targeted at dentofacial features, representing around one fifth of subjects who reported self-harm. The 3 most common dentofacial features contributing to self-harm and self-harm as a result of bullying were tooth color and shape, spacing between the teeth or missing teeth, and prominent maxillary anterior teeth. CONCLUSIONS: This study demonstrated a relatively high experience of self-harm reported by adolescent school children, with many reporting self-harm as a result of their dentofacial appearance and bullying because of dentofacial features. The present study provides baseline data to better understand the relationship between self-harm and dentofacial features.

Is self-harm among orthodontic patients related to dislike of dentofacial features and oral health-related quality of life?

OBJECTIVES: To investigate the relationship between self-reported self-harm and dislike of dentofacial features and oral health-related quality of life (OHRQoL). MATERIALS AND METHODS: Anonymous, self-reporting questionnaires were completed by 699 school children (aged 13-14 years), representing over 1% of the age group in Amman, Jordan. Participants were invited from 23 randomly selected schools in 10 educational directorates. OHRQoL was assessed using the Child Perception Questionnaire (CPQ 11-14). Self-harm was assessed using a constructed self-reporting questionnaire. The relationship between OHRQoL and self-harm was assessed and significant findings were identified at probability of α = 0.05. RESULTS: Over one-quarter of schoolchildren (26.9%, n = 88) admitted self-harming behavior. Self-harm was reported to be due to dislike of dentofacial appearance among 12.9% of participants (n = 90). Higher CPQ 11-14 total scores and individual dimension scores were associated with the presence of self-harm (P < .001). High self-harm incidence was reported among participants who had dentofacial features that affected appearance (P < .001). Among subjects admitting self-harm, the frequency of self-harming behavior ranged from once to over 10 times per year. CONCLUSIONS: Significant relationships were found between self-harm and dislike of dentofacial features and OHRQoL.

Academic performance of dental students: A randomised trial comparing live, audio recorded and video recorded lectures.

OBJECTIVES: To compare the academic performance of 4th-year dental students randomly divided into three learning groups: live lecture, video recorded lecture and audio recorded lecture. To assess students' attitudes towards the three learning methods. MATERIALS AND METHODS: 4th-year undergraduate students, enrolled in the Orthodontics Theory-1 course, were randomised into three groups receiving different teaching methods; video recorded lecture, audio recorded lecture and live lecture. Subjects were asked to answer two open-ended questions. The first was a simple basic knowledge question in which the answer involved transcribing information from the question, while the second required analytical thinking. Students were also asked to complete a questionnaire assessing their attitudes towards the three learning methods. RESULTS: 94 students participated in the study and were randomly allocated to each learning method. There were no significant differences in scores between the 3 study groups when answering the basic knowledge question (P > .05). The mean score for the analytic question was significantly higher for the live lecture and video recorded lecture groups compared to the audio recorded lecture group (P < .05). The majority of students agreed that lectures were an essential part of their learning experience and that lectures allowed interaction between students and lecturer. Two-thirds of students reported that watching a video recorded lecture provided a similar learning experience to attending a live lecture. CONCLUSION: Video recorded, audio recorded and live lectures were found to be equally effective for providing basic knowledge. Video recorded and live lectures were more effective than audio recorded lecture at assessing higher levels of analytical thinking. Students attending video recorded lecture performed as well as those attending the live lecture.

Evaluation of Serum Total Immunoglobulin E, Interleukin-17 and Pentraxin-3 as Biomarkers for Chronic Rhinosinusitis With Nasal Polyposis.

BACKGROUND: Different biomarkers are detectable in cases of chronic rhinosinusitis with nasal polyposis (CRSwNP) with need for evaluation of their diagnostic and prognostic roles. OBJECTIVE: To assess the serum levels of total IgE, interleukin-17 and Pentraxin-3 in patients with CRSwNP and correlate them with the clinical evaluation using Sino-Nasal Outcome Test (SNOT-22), radiological evaluation using Lund - Mackay (LM) computed tomography scan score, and polyposis recurrence. METHODS: This cross-sectional comparative study was carried out on fifty patients with CRSwNP and twenty-five age and gender matched healthy volunteers as control group. Patients were assessed clinically by SNOT-22 and radiologically by LM score. Blood samples of patients and controls were analyzed for serum levels of total immunoglobulin E (IgE), Interleukin-17 (IL-17) and Pentraxin-3 (PTX-3). The correlation between the serum levels of every two markers of the study markers was assessed. The levels of the three biomarkers were correlated with SNOT-22 and LM scores and polyp recurrence with assessment of their sensitivity and specificity to diagnose CRSwNP. RESULTS: This study showed significantly higher values of the three biomarkers in patients group compared with control group (p < 0.001 for all). There were significant positive correlations between the levels of the three markers and SNOT 22 and LM scores (p < 0.001 for all) and with recurrence of polyposis (p < 0.001, p = 0.005 and p = 0.032 respectively). Agreement (sensitivity and specificity) for these markers to diagnose patient group was statistically significant (p < 0.001 for all). There was a significant positive correlation between every two markers of the study markers. CONCLUSION: Serum levels of total IgE, IL-17 and PTX-3 are important biological markers for diagnosis and follow up of cases of CRSwNP with high sensitivity and specificity in detection of such cases. They should be included in the routine laboratory workup for cases of CRSwNP.

Dentists' knowledge, attitudes, and professional behavior toward the COVID-19 pandemic: A multisite survey of dentists' perspectives.

BACKGROUND: COVID-19 continues to affect the dental community worldwide. The authors conducted a cross-sectional electronic study using a multisite survey to examine dentists' knowledge, attitudes, and professional behavior toward COVID-19 and the affect on their livelihood. METHODS: A questionnaire was circulated via e-mail and social media platforms to dentists in North America, Europe, Eastern Mediterranean, and Western Pacific regions. It covered demographic characteristics and questions about the COVID-19 outbreak related to dentists' levels of comfort for preventive and safety measures, provision of treatment, affect on work, and financial implications. Responses were tabulated and analyzed by means of χ2 or Fisher exact test. Mann-Whitney and Kruskal-Wallis tests were used to compare means. P < .05 was considered significant. RESULTS: A total of 1,251 dentists responded. General dentists represented 63.9% of the respondents and 62.5% worked in private practice. The global score for level of comfort with the preventive measures and provisions of treatment during the COVID-19 pandemic was low (14 of 30), and differences between regions were significant (P < .01); dentists working in private practice and general dental practitioners were less comfortable (P < .01). CONCLUSIONS AND PRACTICAL IMPLICATIONS: The respondents reported a lack of preparedness to confront a highly infectious respiratory disease. A new level of protective armamentarium in the dental operatory and updated operational guidance and policies are required, necessitating educators and regulators to ensure the delivery of knowledge and skills to oral health care providers. Dentists need to address the sustainability of their practices and have a robust business plan.

Do various degrees of tooth decalcification affect orthodontists', general dentists' and laypersons' ratings of smile esthetics?

OBJECTIVES: To compare the effect of various degrees of decalcification after orthodontic treatment (white spot lesions) on orthodontists', general dentists', and laypersons' ratings of smile esthetics. MATERIALS AND METHODS: Eight photographs representing incrementally altered tooth decalcification lesions of maxillary anterior teeth ranging from mild to severe were shown randomly to the study participants. Photographs were rated by a matched sample of orthodontists (N = 42), general dentists (N = 52), and laypeople (N = 58). A visual analogue scale (VAS) was used to assess perceptions of smile esthetics. RESULTS: The three groups of raters could distinguish between different decalcification levels. Raters gave more negative scores as the decalcification level increased. CONCLUSIONS: The three groups of raters were able to distinguish between various degrees of decalcification lesions. General dentists were the most critical of all groups when rating decalcification lesions.

Does overbite reduction affect smile esthetics?

OBJECTIVES: To compare the effects of two common methods of overbite reduction on smile esthetics. MATERIALS AND METHODS: A prospective clinical trial was conducted with 32 patients in whom overbite reduction was achieved using a maxillary incisor intrusion arch (18 patients) or flat anterior bite plate (14 patients). Clinical and cephalometric records were compared pretreatment (T1), after overbite reduction (T2), and posttreatment (T3). RESULTS: Both treatment groups experienced a reduction in overbite and maxillary and mandibular incisor proclination during treatment (T1-T3). The center of resistance of the maxillary incisor and the incisal edge was significantly intruded in the intrusion arch group during overbite reduction (T1-T2). However, most of the intrusion of the center of resistance was lost by the end of treatment (T2-T3). Both treatment groups experienced a reduction in maxillary incisor display and flattening of the smile arc during overbite reduction. CONCLUSIONS: Both overbite reduction methods caused a decrease in incisor display and flattening of the smile arc. Smiles were improved in some patients by the end of treatment. However, reduction in incisor display persisted. Clinicians should take precautions to prevent negative effects of overbite reduction.

Skeletal malocclusion: a developmental disorder with a life-long morbidity.

The likelihood of birth defects in orofacial tissues is high due to the structural and developmental complexity of the face and the susceptibility to intrinsic and extrinsic perturbations. Skeletal malocclusion is caused by the distortion of the proper mandibular and/or maxillary growth during fetal development. Patients with skeletal malocclusion may suffer from dental deformities, bruxism, teeth crowding, trismus, mastication difficulties, breathing obstruction and digestion disturbance if the problem is left untreated. In this review, we focused on skeletal malocclusion that affects 27.9% of the US population with different severity levels. We summarized the prevalence of class I, II and III of malocclusion in different ethnic groups and discussed the most frequent medical disorders associated with skeletal malocclusion. Dental anomalies that lead to malocclusion such as tooth agenesis, crowding, missing teeth and abnormal tooth size are not addressed in this review. We propose a modified version of malocclusion classification for research purposes to exhibit a clear distinction between skeletal vs. dental malocclusion in comparison to Angle's classification. In addition, we performed a cross-sectional analysis on orthodontic (malocclusion) data through the BigMouth Dental Data Repository to calculate potential association between malocclusion with other medical conditions. In conclusion, this review emphasizes the need to identify genetic and environmental factors that cause or contribute risk to skeletal malocclusion and the possible association with other medical conditions to improve assessment, prognosis and therapeutic approaches.

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists.

BACKGROUND: The authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists. METHODS: The authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina. RESULTS: Sixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist. CONCLUSIONS: WSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist. Clinical implications. General dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.

Development of white spot lesions during orthodontic treatment: perceptions of patients, parents, orthodontists, and general dentists.

INTRODUCTION: Despite the many advances to improve the practice of orthodontics, white spot lesions, or decalcifications, remain a common complication in patients with poor oral hygiene. The purpose of this study was to assess the perceptions and level of awareness of patients, parents, orthodontists, and general dentists toward the development of white spot lesions during orthodontic treatment. METHODS: This was a prospective epidemiologic survey of the perceptions of orthodontic patients (n = 315), parents (n = 279), orthodontists (n = 305), and general dentists (n = 191) regarding the significance, prevention, and treatment of white spot lesions. RESULTS: All surveyed groups indicated that white spot lesions detracted from the overall appearance of straight teeth, attributed primary responsibility for the prevention of white spot lesions to the patients themselves, and thought that the general dentist should be responsible for treating white spot lesions. Patients regarded themselves as ultimately responsible for the prevention of white spot lesions (P <0.05). CONCLUSIONS: The patients, parents, orthodontists, and general dentists had similar perceptions regarding the significance, prevention, and treatment of white spot lesions. All groups indicated that patients were the most responsible for the prevention of white spot lesions. Communication among patients, parents, orthodontists, and general dentists needs to improve to decrease the incidence of white spot lesions in the orthodontic population.

Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents, and dentists.

The aims of the present study were to compare rankings of dental aesthetics and the threshold at which orthodontic treatment would be sought among patients, parents, and dentists. A prospective cross-sectional study was designed to address these aims. The study sample comprised 100 patients and parents and 23 dental specialists. The patients were equally divided between males and females and their mean age was 14.7 years (standard deviation 2.3 years). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) represented impairment of dental aesthetics. The 10 numbered photographs of the AC were cut into equal-sized rectangles and subjects were asked to arrange them from 'the one that looks best' to 'the one that looks worst'. The subjects were then presented with the 10 photographs of AC in sequence and asked to identify the cut-off point between 'teeth that need orthodontic treatment' and 'no treatment'. Statistical analysis was undertaken with a Mann-Whitney test. The results showed that median rankings of dental aesthetics were similar among the three groups (P > 0.05). The median ranking of photographs 1, 2, 3, 4, and 10 were identical to the AC of IOTN. The photographs representing IOTN AC 7 and 8 were allocated the same median rank of 7 and AC 5 and 9 were allocated corresponding median ranks of 6 and 8, respectively. There were no significant differences in median cut-off points for treatment need among the three groups of subjects (P > 0.05), indicating that the mean threshold at which treatment would be sought was AC 4.

An index of orthodontic treatment complexity.

The aim of the present study was to develop an index specifically for the measurement of treatment complexity. Input factors were directly related to complexity, and the output was a score measuring the degree of treatment complexity. The sample comprised 120 sets of dental casts, 30 for each of the four main malocclusion classes. Sixteen orthodontists graded the study casts for perceived treatment complexity on a six-point scale and then listed, in order of importance, up to three occlusal features which they felt contributed to complexity from a pre-determined list. Multiple regression analysis was used to derive weightings for each occlusal feature, which would reflect the relevant treatment complexity. In order to obtain an overall treatment complexity score for each case, weightings were then multiplied by the corresponding occlusal feature scores and summed. The relationship between treatment complexity scores and perceived complexity was examined using Spearman's ranked correlation coefficient. The regression equation explained 49.5 per cent of the variance in treatment complexity of the whole sample. Regression analysis on the basis of malocclusion produced R (2) values of 90.7 per cent for Class I, 42.6 per cent for Class II division 1, 62.3 per cent for Class II division 2, and 79.5 per cent for Class III malocclusions. The index of orthodontic treatment complexity (IOTC) scores showed a moderate but highly significant association with the orthodontists' perceived complexity assessments (rho = 0.42, P = 0.000). The proposed IOTC shows sufficient promise to warrant further development.

Regional odontodysplasia: a review of the literature and report of a case.

We present a rare case of a developmental anomaly called regional odontodysplasia or 'ghost teeth' in an 8.5-year-old Jordanian girl. The anomaly affected both the mandibular primary and permanent incisors, and the canines bilaterally. The maxillary teeth were unaffected. This is the first case of the anomaly to be reported in Jordan. The clinical, radiographic and histological features are reviewed. The management of affected patients is discussed.

The relationship between patient, parent and clinician perceived need and normative orthodontic treatment need.

The aim of the present study was to compare patient, parent and clinician perceived need for orthodontic treatment in relation to normative orthodontic treatment need as measured by the Index of Orthodontic Treatment Need (IOTN). A prospective cross-sectional study was designed to address this aim. The sample comprised 103 patients attending the 'new' patient clinic at the Jordan University Hospital. The patients' mean age was 15.3 years (standard deviation 3.8 years); 33 per cent were males and 67 per cent females. One clinician scored the patients' normative orthodontic treatment need using the IOTN, then determined perceived need using a 10 cm visual analogue scale (VAS). The subjects then assessed their own perceived need and aesthetic component (AC) score and the parents carried out similar assessments for their children. All scoring was carried out blind. The parents had the highest average perceived need scores, followed by patient and clinician scores (6.6, 6.1 and 5.4 cm, respectively). A significant difference was found between the parents and the clinician (P < 0.05). When the relationship between perceived need and clinician-measured normative orthodontic treatment need was investigated, significant differences were found with the dental health component (DHC) for all three groups (P < 0.05). Differences between AC and perceived need scores were also significant for the patients and parents, but not for the clinician (P > 0.05). The present study has shown that perceptions of orthodontic treatment need are multifactorial and influenced by elements other than health measures of normative orthodontic treatment need and perceptions of aesthetics.