Customized planning of the visible maxillary arch width in harmony with interparopia width and smile width for female facial aesthetics.

BACKGROUND: The visible maxillary arch width (VAW) is an important aesthetic-determining feature. To date, there is no well-established methodology to determine the aesthetically optimal VAW in customized treatment planning. METHODS: In this study, the common traits of the dentofacial configuration were investigated in most attractive Asian and Caucasian female smiles. The smiling photo of a subject was digitally modified based on combined variations of VAW, smile width (SW), transverse facial dimensions (TFD), and vertical facial dimensions. These modified photos were assessed for aesthetics. The aesthetically essential parameters were identified, and their mathematic correlations and reference ranges were determined for different vertical facial patterns. Using the obtained results, a mathematic guidance was constructed for customized smile designing. The applicability of this guidance was tested in Asian females. RESULTS: The most attractive Asian and Caucasian female smiles have intraracial and interracial commonalities in the VAW-to-TFD ratios. The interparopia width (IPD) predominated over facial widths in determining well-matched VAW and SW. For optimal smile aesthetics, the VAW and SW were correlated as simulated by the formula 1.92 IPD ≤ VAW + 2.3 SW ≤ 2.17 IPD, plus the VAW-to-IPD ratio within 0.54 to 0.62 and the SW-to-IPD ratio within 0.61 to 0.71, ranges tailored to vertical facial patterns. This constitutes a mathematic guidance for customized planning of the aesthetically optimal VAW. This guidance was preliminarily validated to be applicable to Asian females. CONCLUSIONS: The VAW-to-TFD ratios were essential for Caucasian and Asian female smile aesthetics. The mathematic guidance could serve as a reference for customized smile designs for Asian females.

Impact of dental caries and Self-perceived oral health on daily lives of children and mothers in rural Egypt: a household survey.

BACKGROUND: The present study assessed the impact of oral health on the daily lives of children and mothers living in a rural area in Northwestern Egypt. METHODS: A cross-sectional household survey including children between 6 and 12 years old and their mothers was conducted in rural Egypt, 2019-2020. Data were collected using clinical examination and interview-based questionnaires of children and mothers. Three binary logistic regression models were used to assess the relationship between the dependent variables (oral health impact (yes, no) on avoiding smiling, chewing problems, and missing school (children) and avoiding social events (mothers)), and the explanatory variables: oral health (clinically-assessed caries experience and self-reported oral health) controlling for sociodemographic profile (child age and sex, mother's education), daily toothbrushing and village of residence. RESULTS: A total of 211 households with 355 children and 211 mothers were included (91.5% response rate). About 54% of the children were girls, mean (SD) age = 8.7 (2.05) years and 82.3% did not brush their teeth daily. Mother's mean (SD) age was 31.70 (5.45) years. Because of dental problems, 31.3% of children reported chewing difficulties, 31% avoided smiling compared to 76.3% and 43.6% of mothers. Also, 30.4% of children missed school and 76.8% of mothers reported reduced participation in social activities. In children, the number of decayed anterior teeth was associated with significantly higher odds of avoiding smiling (AOR = 1.22, 95%CI: 1.03, 1.44). In mothers, a greater number of posterior missing teeth was associated with significantly higher odds of chewing difficulties (AOR = 1.21, 95%CI: 1.01, 1.45), and a greater number of all missing teeth was associated with significantly higher odds of reduced participation in social events (AOR = 1.30, 95%CI: 1.30, 1.57). Good/ very good reported oral health in children and mothers was associated with lower odds of avoiding smiling and chewing problems (p < 0.05). CONCLUSION: Decayed anterior teeth in children have a negative impact on smiling whereas missing teeth in mothers affect the ability to chew food and socialize. The psychological, functional, and social impacts of caries in this rural setting needs to be mitigated by improving oral health literacy and access to care.

Correlation of social smile symmetry with facial symmetry.

BACKGROUND: This study aimed to assess the correlation of social smile symmetry with facial symmetry. METHODS: In this cross-sectional study, frontal view photographs were obtained from 169 eligible patients at rest and smiling with a camera at the level of their nose tip. Several landmarks were selected for facial symmetry and measured at rest and social smiling at the two sides of the face. The respective formula was used to calculate the asymmetry index (AI). The mean values for each AI were calculated, and the correlation between the criteria for a symmetric smile in a social smile with the criteria for facial symmetry, and the correlation between the difference in symmetry criteria at rest and social smiling with facial symmetry criteria were analyzed. RESULTS: Significant correlations were noted between Oc-b AI (smile) and Sn-B (rest) facial AI (P = 0.046), An-a (smile) AI and Gn-a (rest) facial AI (P = 0.002), An-b (smile) AI and Sn-b (rest) facial AI (P < 0.001), Pog-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-a (smile) and Sn-a (rest) facial AI (P < 0.001), Nt-b (smile) and Sn-b (rest) facial AI (P < 0.001), Ph-a (smile) and Sn-a (rest) facial AI (P < 0.001), Ph-b (smile) and Sn-b (smile) facial AI (P = 0.007), Oc-b AI (difference) and Gn-b (rest) facial AI (P = 0.031), Oc-Pog (difference) AI and Gn-b (rest) facial AI (P = 0.041), An-b (difference) AI and Sn-b (rest) facial AI (P < 0.001), Nt-a (difference) and Sn-a (rest) facial AI (P = 0.006), Nt-b (difference) and Sn-b (rest) facial AI (P < 0.001), and Ph-b (difference) and Sn-b (rest) facial AI (P < 0.001). CONCLUSIONS: A significant correlation exists between social smile symmetry and facial symmetry.

The Case for Smiling? Nonverbal Behavior and Oral Corrective Feedback.

Oral Corrective Feedback is a widely used teaching strategy that has been found to help language acquisition. The factors that contribute to its effectiveness, however, remain elusive. In this study, the role of smiling during teachers' OCF provision is investigated in intact language classrooms by modifying the analytical framework developed by Lyster and Ranta (Stud Second Lang Acquis, 19(1):37-66, 1997), which determines OCF effectiveness by the success of the learner uptake. In addition to the feedback strategies used, this study examines teacher smiling during the feedback instances, and whether they were genuine or polite smiles. The Facial Action Coding System (Ekman & Friesen, Environ Psych Nonver, 1(1), 56-75, 1976; Ekman, Friesen, & Hager, Facial Action Coding System: The Manual on CD ROM. Salt Lake City, UT: Research Nexus division of Network Information Research Corporation, 2002) is utilized to operationalize smile genuineness. Significant findings indicate that when teacher smiling is genuine, learners are more likely to correct their errors, while polite smiles do not have the same effect.

The Interference of Age and Gender on Smile Characterization Analyzed on Six Parameters: A Clinical-Photographic Pilot Study.

Background and Objective: This study aimed to evaluate six smile-esthetic parameters (deviation of the upper dental midline from the facial midline, upper lip curvature, smile line, smile arch, smile width, and shape of the maxillary central incisors), correlating them with age and gender. Materials and methods: Caucasian individuals (N = 114) were grouped by gender (male and female) and age (group I-18 to 30 years old; group II-31 to 50 years old; and group III-over 50 years old). Using a digital camera, extra and intraoral pictures were taken to analyze the variables above-mentioned. The data were statistically evaluated, considering a significance level of p < 0.05. Results: Most participants found deviations of the upper dental midline, straight upper lip curvature, and the medium smile line coincided with the facial midline. The parallel smile arch exposing 9 to 11 upper teeth, the absence of exposure of lower teeth when smiling, and oval upper incisors were prevalent parameters. Regarding gender, significant results were found for the curvature of the upper lip (p = 0.049), the smile arch (p = 0.001), and the shape of the upper central incisors (p = 0.004). For age, the association with the curvature of the upper lip (p = 0.032), the smile line (p = 0.001), the smile arch (p = 0.007), the width of the smile exposing lower teeth (p = 0.002), and the shape of the upper central incisors (0.012) were significant. Conclusions: Within this study's limitations, gender and age affect the anterior teeth shape and upper lip curves; gender and age did not influence the coincidence between dental and facial midlines.

Saudi Children's and Their Parents' Perception of a Digitally Modified Photograph Model of Different Smiles with Different Anterior Teeth Alignments and Dental Appearances.

AIM: Since there is a lack of data on dentofacial esthetic perception in Saudi Arabia, the present research was conducted to study children's and their parent's perceptions of smiles with different dental alignments and dental appearances. In addition, we aimed to determine whether facial attractiveness or dental esthetic dominates the overall esthetic perception. Finally, we aimed to investigate the influence of gender on the judgment of a dental smile. MATERIALS AND METHODS: Six digitally altered photographs and two dynamic videos of smiling faces of boys and girls with different dental alignments and appearances were shown to 183 children and their parents in malls in Saudi Arabia's Qassim Province. Following the parent's acceptance of the interview, the child was interviewed first, followed by the parent. Their responses were measured using a smile perception questionnaire (SPQ) for children aged 8-10 years. Data were analyzed using the Kruskal-Wallis one-way analysis of variance (ANOVA) and the Wilcoxon signed-rank test. RESULTS: The results demonstrated that whole-face smiles of both boys and girls with different poor dentofacial esthetics had a significantly lower rating score than lower third-face smiles scores among children and their parents (p ≤ 0.05). Except for a few views, there were no significant differences between children's and their parents' dentofacial esthetic judgments. Moreover, the answers to the smile perception questionnaire 8-10 for the smiling face dynamic videos of boys and girls were not significantly different. CONCLUSION: Children agreed with their parents in judging the smiles of different dentofacial esthetic perceptions. Overall, esthetics was more influenced by facial esthetics than dental esthetics. Background attractiveness and sexual characteristics do not affect smile perception. CLINICAL SIGNIFICANCE: The smile is considered one of the major determinants of how the overall esthetic of children will appear. Thus, the comprehensive diagnosis involving the analysis of malocclusion and poor dental appearance psychological effect can be used for patient care improvement. Consequently, dental treatment to improve the dental smile will enhance the children's quality of life and social interaction.

Automated detection of smiles as discrete episodes.

BACKGROUND: Patients seeking restorative and orthodontic treatment expect an improvement in their smiles and oral health-related quality of life. Nonetheless, the qualitative and quantitative characteristics of dynamic smiles are yet to be understood. OBJECTIVE: To develop, validate, and introduce open-access software for automated analysis of smiles in terms of their frequency, genuineness, duration, and intensity. MATERIALS AND METHODS: A software script was developed using the Facial Action Coding System (FACS) and artificial intelligence to assess activations of (1) cheek raiser, a marker of smile genuineness; (2) lip corner puller, a marker of smile intensity; and (3) perioral lip muscles, a marker of lips apart. Thirty study participants were asked to view a series of amusing videos. A full-face video was recorded using a webcam. The onset and cessation of smile episodes were identified by two examiners trained with FACS coding. A Receiver Operating Characteristic (ROC) curve was then used to assess detection accuracy and optimise thresholding. The videos of participants were then analysed off-line to automatedly assess the features of smiles. RESULTS: The area under the ROC curve for smile detection was 0.94, with a sensitivity of 82.9% and a specificity of 89.7%. The software correctly identified 90.0% of smile episodes. While watching the amusing videos, study participants smiled 1.6 (±0.8) times per minute. CONCLUSIONS: Features of smiles such as frequency, duration, genuineness, and intensity can be automatedly assessed with an acceptable level of accuracy. The software can be used to investigate the impact of oral conditions and their rehabilitation on smiles.

A video polysomnographic study of spontaneous smiling during sleep in newborns.

The objective of the present study was to confirm the link between spontaneous smiling and active sleep in newborns, and to identify the role of the cortex in the generation of spontaneous smiles. A total of 12 healthy newborns born at term and three infants with major congenital abnormalities (two with hydranencephaly and one with a left hemispherectomy) were evaluated by video and polysomnography during a 3-hr sleep period. Smiles were graded and their association with isolated rapid eye movements and grouped rapid eye movements was analysed. In all, 383 smiles were recorded of which 377 occurred during active sleep. Smiles were shown to be significantly associated with active sleep (p < .0001) and with grouped rapid eye movements (p < .0001). Bilateral smiles were more frequent than asymmetrical smiles. Among asymmetrical smiles, left-sided smiles were more frequent than right-sided smiles (p < .0001). Maternal stimulation during active sleep did not increase smiles. Smiling was absent during active sleep only in the infant with total hydranencephaly in whom nearly all cortical tissue was absent. In conclusion, smiling occurs in healthy newborns, almost exclusively in active sleep and is associated with grouped rapid eye movements. In infants with major congenital abnormalities, smiling is abolished only when nearly all of the cerebral cortex is absent. These results support the hypothesis of the role of active sleep in the stimulation of neuronal circuits responsible for spontaneous smiling and emphasise the importance of cortical areas in newborn smiling.

Factors influencing the aesthetics of smile: An observational study on clinical assessment and patient's perception.

AIM: To clinically assess the aesthetics of smile and the possible influencing factors. MATERIALS AND METHODS: In this explorative study, an initial questionnaire on demographic variables and perception of own quality of smile (Visual Analogue Scale) was administered by a first examiner. A second blinded assessor examined all patients and recorded clinical data. In addition, for each patient, the Smile Aesthetic Index (SEI) was calculated. Descriptive statistics and multilevel logistic models were performed. RESULTS: One hundred consecutive subjects were enrolled. The mean SEI was 8.4 ± 1.2, while the mean patient's perception of smile was 7.1 ± 2.0. However, they did not correlate (r = 0.16 from -0.04 to 0.34; p = .12). Gingival recessions were perceived by 21.9% of subjects, tooth alignment by 38.6%, tooth dyschromia by 34.3%, and missing papilla/diastema by 26.7%. In particular, gingival recessions were perceived when they were deeper (p = .0342), located in the upper jaw (p = .0223), and corresponding to incisors (p < .0001) and canines (p = .0159) with respect to molars. CONCLUSIONS: Clinical assessment and patient perception represent two important diagnostic phases. However, there is no correlation between them. Attention should be given to specific variables to provide the most comprehensive aesthetic analysis of smile.

Aesthetic crown lengthening and lip repositioning surgery: Pre- and post-operative assessment of smile attractiveness.

AIM: To assess the effect of aesthetic crown lengthening (ACL) and lip repositioning surgery (LRS) on perception of smile attractiveness. MATERIALS AND METHODS: Preoperative and 6-month postoperative smile photographs of ACL- or LRS-treated patients were evaluated by 100 raters (five gender-balanced groups of ten per procedure) of diverse background (dental students, general dentists, periodontists and laypersons with and without any aesthetic concerns about their own smile). Smile attractiveness was rated by visual analogue scale (VAS). Multivariate mixed-effect models were applied to determine the effect of procedure, rater (age, gender and group) and case (gingival display and GD) on smile attractiveness rating. RESULTS: Average preoperative and postoperative VAS scores for ACL patients were 3.8 ± 2.0 and 6.2 ± 1.9, respectively. Corresponding LRS patient values were 4.8 ± 2.0 and 6.4 ± 1.9. Treatment, baseline GD and rater age were significant determinants (p < .001) of smile attractiveness for both procedures. Rater gender was not significant. Rater group was significant (p < .032) only for ACL. Procedure (p < .001), baseline VAS (p < .001), change in GD (p ≤ .002) and rater age (p ≤ .017) were significant determinants of smile attractiveness change from preoperative to postoperative. CONCLUSIONS: ACL and LRS are two periodontal plastic surgery procedures that deliver significant smile attractiveness improvements, in the eyes of both laypersons and dental professionals.

Smiling faces on food packages can increase adults' purchase likelihood for children.

Manufacturers often include smiling faces on food packages, especially those targeted towards children. Prior research suggests that anthropomorphized images in general, and smiling faces in particular, are an effective marketing tool that encourage food choice and consumption among children. However, it is not clear how adult consumers, who often make food purchases for children, respond to smiling faces on packaging when making decisions for a child recipient. The results of four experiments show that food packages with (vs. without) smiling faces activate child-related thoughts which leads to expectations of making a child happy with the food and ultimately greater purchase likelihood for the child recipient. The serial effects of smiling faces on purchase likelihood through child-related thoughts and the expectations of a child's emotional reaction are robust to an array of products with more and less appealing flavors. Further, a smile line in the absence of eyes does not catalyze the same serial mechanism. Overall, our findings suggest that marketers should exercise caution when utilizing smiling faces on food packages, especially when packages contain unhealthy foods; and, consumers should be aware of the effects that this seemingly innocent packaging feature can have on their product responses.

Lip repositioning surgery for gummy smile: 6-month clinical and radiographic lip dimensional changes.

OBJECTIVES: The present case series aimed to examine lip repositioning surgery (LRS) outcomes related to changes in external and internal upper lip (UL) dimensions, utilizing both conventional clinical and novel radiographic approaches. MATERIALS AND METHODS: Patients (n = 13) diagnosed with hypermobile UL (>8-mm mobility during smile) and excessive gingival display (≥4-mm) were included and assessed at baseline and 6 months postoperatively. Clinical parameters at rest included total lip and internal lip length (vestibular depth). At maximum smile included total lip, philtrum (ergotrid), and vermilion lengths. Cephalometric parameters included anterior maxillary height; lip length; nasolabial angle; anteroposterior lip thickness; internal lip length (vestibular depth); and vestibular fornix position (using novel approach employing radiopaque marker). Linear mixed-effect models, Pearson's correlation, and linear regression were used for statistical analyses. RESULTS: LRS did not affect total UL length at rest (p = 0.418). It resulted in significant internal UL length decrease (-3.8 ± 2.1 mm, p < 0.001) and significant increases of vermilion length (1.9 ± 1.0 mm, p < 0.001) and anteroposterior lip thickness (0.7 ± 0.7 mm, p = 0.002). The clinical and radiographic measurements of total UL length at rest (r ≥ 0.734) and of internal UL length (r ≥ 0.737), and the two radiographic assessments of vestibular depth (r = 0.842), were strongly correlated. CONCLUSIONS: LRS resulted in significant decrease of vestibular depth/internal UL length and in significant increases of UL vertical vermilion length and UL anteroposterior thickness, without affecting total UL length at rest. CLINICAL RELEVANCE: The documented lip dimensional outcomes should help practitioners when treatment-planning LRS and counseling patients seeking treatment for hypermobile UL.

Smile esthetic evaluation of mucogingival reconstructive surgery.

To assess the difference in smile esthetic impact of Coronally Advanced Flap (CAF) with or without the adjunct of a collagen matrix (CMX) used as root coverage procedures. Subjects with esthetic demands showing multiple upper gingival recessions of at least 2 mm, without interproximal attachment loss and cervical abrasion no more than 1 mm were recruited and randomized to CAF plus CMX or CAF alone. The Smile Esthetic Index (SEI) was adopted to quantify the quality of the smile recorded at baseline and 12 months after treatment for each treatment group. In addition, between group difference in the SEI was calculated. 24 Patients were treated and analysed. At baseline, mean gingival recession depths were 2.3 ± 0.7 mm for Test group and 2.6 ± 1.0 mm for Control group. After 1 year, the residual recession depth was 0.3 ± 0.4 mm in the CAF + CMX group and 0.6 ± 0.3 mm in the control group. The SEI at baseline was 8.1 ± 1.0 and 7.9 ± 0.7 for Test and Control group, respectively. The between groups difference at 12 months in SEI was 0.4 (95% C.I. - 0.0 to 0.8, P = 0.0697). Twelve months after treatment, CAF + CMX provided a similar SEI compared to CAF alone and the adjunct of a collagen matrix did not show a different impact on the smile esthetic appearance.

Effectiveness of lip repositioning surgeries in the treatment of excessive gingival display: A systematic review and meta-analysis.

To synthesize the available evidence regarding lip repositioning surgery (LRS) and quantify the short- and long-term reduction in excessive gingival display (EGD) with the procedure. Additionally, evaluate the effect of myotomy on the results. Seven electronic databases were searched up to May 2020 by two independent reviewers. Studies evaluating the exclusive use of LRS to treat EGD were included. After risk of bias assessment, the data were quantitatively evaluated with random-effects meta-analysis. The initial database search yielded 368 studies, of which 16 were selected for full-text review. Finally, eight studies were included. The random effects model exhibited an EGD reduction of 2.87 mm (95% CI: 1.91-3.82) after 3 months of LRS. These results decreased after 6 months (2.71 mm; 95% CI: 1.95-3.47) and 12 months (2.10 mm; 95% CI: 1.48-2.72). Meta-analysis comparing the performance of myotomy showed greater EGD reduction at 6 months than without myotomy (P < 0.02). LRS is an effective approach for treating EGD, and it has satisfactory results up to 6 months. After this period, the effectiveness appears to progressively decrease over time indicating substantial relapse at 12 months. Myotomy seems a suitable alternative to increase the stability of LRS. Lip repositioning surgery is an effective procedure to improve smile esthetics in the short-term (up to 6 months). After this period, the efficacy of LRS seems to decrease progressively, and an approximately 25% relapse may be expected after 12 months. Clinicians should combine the procedure with other approaches, such as plastic periodontal surgeries, restorative procedures, or botulin toxin injections for more predictable and stable outcomes.

Bispectral Index Monitoring and Observer Rating Scale Correlate with Dreaming during Propofol Anesthesia for Gastrointestinal Endoscopies.

Background and objectives: Dreaming is a commonly reported side effect of propofol anesthesia. Materials and Methods: We investigated the inci-dence and character of dreams in patients undergoing intravenous propofol anesthesia and cor-related it with an observer rating scale of facial expression on the seven-point scale from pain to smile. A total of 124 patients undergoing gastrointestinal endoscopy were recruited in the pro-spective observational study. Bispectral index (BIS), blood pressure (BP), and pulse were moni-tored. Upon emergence from anesthesia, the patient's facial expression was rated numerically. Thereafter, patients were asked whether they had dreams and to rate their dreams as pleasant or unpleasant. The mean age of participants was 53; body mass index, 26.17; duration of procedure, 20 min; and average propofol dose, 265 mg. Results: Dreaming was reported by 43% of patients. Dreams were pleasant in all but one patient. There was a significant correlation of the observer's rating of facial expression with dreaming (r = 0.260; p = 0.004). Dreamers had higher scores of observer rating of facial expression (1 (0-2) vs. 0.5 (0-1), p = 0.006). Conclusions: BIS values were lower in the dreamers vs. non-dreamers 2 min after the endoscopy started (48 (43-62) vs. 59 (45-71), p = 0.038). Both BIS and observer ratings correlate with dreaming in patients undergoing gastrointestinal endos-copy. Trial registration number: NCT04235894.

How should we understand the digital economy in Asia? Critical assessment and research agenda.

By Asian digital economy, we refer to high-tech developments, business and social transformations, and information-driven changes in the region's growth. We discuss its background and foundations, significance in Asia and contribution to removal of historical barriers in traditional business. We assess how new value chains are transforming country-level involvement in worldwide manufacturing and note "smiling curve theory" predictions about the global value chain in Asia for high-tech firms and their economies. The takeaway is that the digital economy in Asian nations involves revamping business processes through technology innovation, government policies for growth, and digital entrepreneurship. We analyze the "digital economy and society index", and attributes of nations, societies and economies, as a basis for framing our ideas. We consider research directions prompted by data analytics and AI, the platform economy, digital trade, fintech innovation, and societal and economic sustainability. We further highlight new issues in light of the COVID-19 pandemic.

Adjunctive benefit of a xenogenic collagen matrix associated with coronally advanced flap for the treatment of multiple gingival recessions: A superiority, assessor-blind, randomized clinical trial.

AIM: To evaluate the superiority of coronally advanced flaps (CAFs) when used in combination with a xenogeneic collagen matrix (CMX) for root coverage of multiple adjacent gingival recessions. MATERIALS AND METHODS: Participants with at least 2 upper adjacent teeth exhibiting gingival recession depth ≥2 mm were recruited and randomized to CAF with (test) or without (control) CMX, respectively. Mean and complete root coverage, amount of keratinized tissue (KTw), gingival thickness (GThick) and patient-reported outcomes (PROMs) were recorded at baseline, 3, 6 and 12 months. RESULTS: Twenty-four patients providing 61 gingival recessions were analysed. After 1 year, gingival recession depth decreased from 2.3 ± 0.7 to 0.3 ± 0.4 mm in the CAF + CMX group (2.0 ± 0.8 mm meanRC) and from 2.6 ± 1.0 to 0.6 ± 0.3 mm in the control group (2.0 ± 1.1 mm meanRC). No difference was observed between the two groups (p = 0.2023). Nineteen (63%) of the test and 16 (52%) of control defects showed complete root coverage (p = 0.4919). GThick greatly increased in the test group (0.5 mm; 0.2-0.8 mm, 95% CI; p = 0.0057). No difference between the two groups was observed for KTw (p = 0.5668) and PROMs. CONCLUSION: At 1 year, CAF + CMX provided similar root coverage to CAF alone, but a significant increase in gingival thickness.

Food Composition Tables in Southeast Asia: The Contribution of the SMILING Project.

Objectives Food composition data are key for many nutrition related activities in research, planning and policy. Combatting micronutrient malnutrition among women and young children using sustainable food based approaches, as aimed at in the SMILING project, requires high quality food composition data. Methods In order to develop capacity and to align procedures for establishing, updating and assessing the quality of key nutrient data in the food composition tables in Southeast Asia, a detailed roadmap was developed to identify and propose steps for this. This included a training workshop to build capacity in the field of food composition data, and alignment of procedures for selecting foods and nutrients to be included for quality assessment, and update of country specific food composition tables. The SEA partners in the SMILING project finalised a country specific food composition table (FCT) with updated compositional data on selected foods and nutrients considered key for designing nutrient dense and optimal diets for the target groups. Results Between 140 and 175 foods were selected for inclusion in the country specific FCTs. Key-nutrients were: energy, protein, total fat, carbohydrates, iron, zinc, (pro-)-vitamin A, folate, calcium, vitamin D, vitamin B1, vitamin B2, vitamin B3, vitamin B6, vitamin B12 and vitamin C. A detailed quality assessment on 13 key-foods per nutrient was performed using international guidelines. Nutrient data for specific local food items were often unavailable and data on folate, vitamin B12 and vitamin B6 contents were mostly missing. For many foods, documentation was not available, thereby complicating an in-depth quality assessment. Despite these limitations, the SMILING project offered a unique opportunity to increase awareness of the importance of high quality well documented food composition data. Conclusion for Practise The self-reported data quality demonstrated that there is considerable room for improvement of the nutrient data quality in some countries. In addition, investment in sustainable capacity development and an urgent need to produce and document high quality data on the micronutrient composition of especially local foods is required.

Face-to-Face Versus Video Assessment of Facial Paralysis: Implications for Telemedicine.

BACKGROUND: Patients with facial nerve paralysis (FNP) experience challenges in accessing health care that could potentially be overcome by telemedicine. However, the reliability of telemedicine has yet to be established in this field. OBJECTIVE: This study aimed to investigate the consistency between face-to-face and video assessments of patients with FNP by experienced clinicians. METHODS: A repeated-measures design was used. A total of 7 clinicians assessed the FNP of 28 patients in a face-to-face clinic using standardized grading systems (the House-Brackmann, Sydney, and Sunnybrook facial grading systems). After 3 months, the same grading systems were used to assess facial palsy in video recordings of the same patients. RESULTS: The House-Brackmann system in video assessment had excellent reliability and agreement (intraclass correlation coefficient [ICC]=0.780; principal component analysis [PCA]=87.5%), similar to face-to-face assessment (ICC=0.686; PCA=79.2%). Reliability of the Sydney system was good to excellent, with excellent agreement face-to-face (ICC=0.633 to 0.834; PCA=81.0%-95.2%). However, video assessment of the cervical branch and synkinesis had fair reliability and good agreement (ICC=0.437 to 0.597; PCA=71.4%), whereas that of other branches had good to excellent reliability and excellent agreement (ICC=0.625 to 0.862; PCA=85.7%-100.0%). Reliability of the Sunnybrook system was poor to fair for resting symmetry (ICC=0.195 to 0.498; PCA=91.3%-100.0%) and synkinesis (ICC=-0.037 to 0.637; PCA=69.6%-87.0%) but was good to excellent for voluntary movement (ICC=0.601 to 0.906; PCA=56.5%-91.3%) in face-to-face and video assessments. Bland-Altman plots indicated normal limits of agreement within ±1 between face-to-face and video-assessed scores only for the temporal and buccal branches of the Sydney system and for resting symmetry in the Sunnybrook system. CONCLUSIONS: Video assessment of FNP with the House-Brackmann and Sunnybrook systems was as reliable as face-to-face but with insufficient agreement, especially in the assessment of synkinesis. However, video assessment does not account for the impact of real-time interactions that occur during tele-assessment sessions.

Class II functional appliance treatment and dynamic three-dimensional mimic muscle evaluation.

BACKGROUND: Functional appliances have skeletal and dentoalveolar treatment effects, but knowledge on their effect on facial expressions is limited. OBJECTIVE: To analyse changes in facial expressions, using three-dimensional (3D) mimic muscle evaluation, in growing children with Class II malocclusion and large overjet, undergoing functional appliance treatment. METHODS: Fifteen growing children with Class II division 1 malocclusion, selected prospectively, had dynamic 3D recordings of facial expressions prior to and 12 months after commencing functional appliance treatment. Facial expressions recorded were smile and lip pucker, and the movements of the oral commissures were analysed, as well as mouth width and its symmetry. A control group of fifteen age- and sex-matched growing children without immediate need for orthodontic treatment had similar recordings prior to and after a 12-month observation period. RESULTS: In the treatment group, the Class II malocclusion in all children improved after 12 months of functional appliance wear. With regard to movements of the oral commissures, the initial recordings of the treatment group did not show any significant differences to the control group for neither smile nor lip pucker. Differences were noted however when looking at mouth width asymmetry, where this tended to become more symmetrical in the functional appliance treatment group, during rest and during smiling, while it became more asymmetrical in the untreated control group. CONCLUSION: The use of removable functional appliances in children with Class II division 1 malocclusion may have a positive effect on mouth width symmetry when smiling, making it more symmetrical.