Adolescent Orthodontic Patients Research Articles

Lip and incisor changes in patients with different ethnicities treated with extraction versus nonextraction: A cone-beam computed tomography study

This study used cone-beam computed tomography (CBCT) via voxel-based superimposition to evaluate lip and incisor changes after orthodontic treatment with four premolar extractions (Ext) versus nonextraction (Non-Ext) among African American (AA) and White (W) patients. A total of 240 CBCTs of 120 adolescent orthodontic patients with Class I skeletal/dental relationships were included. Patients were initially divided according to treatment, and then each group was subdivided according to patients' ethnicity (Ext/W = 30, Ext/AA = 30, Non-Ext/W = 30, and Non-Ext/AA = 30). CBCTs were imported into Invivo6 for voxel-based superimposition. Lip and incisor measurements were recorded. Independent t tests and two-way ANOVA were used for statistical assessment. The Non-Ext/W group had a greater increase in all outcome variables compared with the Non-Ext/AA group, with a significant change in volume and position of upper (UL) and lower lips (LL), inclination of upper (U1) and lower incisors (L1), and position of U1. The Ext/AA group had a greater decrease in all measured outcomes compared with the Ext/W group, with significant change in inclination of U1 and L1, and position and volume of LL. W patients had more crowding than AA patients in both treatment approaches. Retraction ratios of 6.5:1 and 2.1:1 were recorded between the U1 and UL positions, and L1 and LL positions, respectively. There were no direct interaction effects between ethnicity and treatment, nor were there any significant effects of ethnicity after controlling for the covariates. Ethnicity alone has no impact on incisor and lip position after treatment. However, ethnicity in the form of initial presentation of malocclusion can have a significant influence.

Cleansing efficacy of an oral irrigator with microburst technology in adolescent orthodontic patients. A randomized-controlled crossover study

ObjectivesSimplifying interdental space cleaning is a constantly discussed topic. The present study aimed to compare the cleansing efficacy of an oral irrigator with that of dental flossing in adolescent patients with fixed braces after four weeks of home-use.Materials and methodsThe study design is a randomized, single-blinded cross-over study. Following a twenty-eight-day period of product utilization in a home setting, a comparative analysis was conducted on hygiene indices, the Rustogi Modified Navy Plaque Index (RMNPI) and the Gingival Bleeding Index (GBI), between the test group (oral irrigator) and the control group (dental floss).ResultsSeventeen adolescent individuals completed the study. After 28 days of cleaning with the oral irrigator, RMNPI was 58.81% (55.31–66.47) compared to 59.46% (52.68–68.67) with dental floss (p = 0.070). Subgroup analyses did not indicate the superiority of either method. GBI after the test phase with the oral irrigator was 28.93% (23.21–33.97) and insignificantly higher compared to 26.40% (21.01–31.41) achieved with dental floss (p = 0.1585).ConclusionsNeither of the two products demonstrated statistically significant superiority in terms of cleaning efficacy. Therefore, no recommendation can be made in favor of one over the other. It was found that the high initial hygiene indices for fixed orthodontic appliances could be improved through increased awareness and precise instruction.Clinical relevanceFor adolescent patients who struggle to use interdental brushes an oral irrigator may be suggested as a simple alternative in hard-to-reach areas, such as those around a fixed dental appliance.

Effect of verbal and written information on the perception of pain and analgesic consumption, in adolescent orthodontic patients: A randomised controlled trial.

To investigate the impact of written instructions, about post-bonding pain, on patients' pain perception and analgesic consumption and to evaluate the correlation of pain with personality types. Two-arm parallel randomised controlled trial. University Hospital Centre Zagreb, Zagreb, Croatia. Participants included adolescents in the permanent dentition with mild or moderate crowding. The participants were randomly allocated, using computer-generated random list, into two groups. After bonding and archwire insertion, all participants received oral instructions on potential pain occurrence and pain control. Participants in the study group also received written information on post-bonding pain. Pain intensity was evaluated using the Numerical Rating Scale immediately after (T0), 2 days (T1) and 7 days (T2) after the placement of the fixed orthodontic appliance. Analgesic consumption was assessed as yes or no, and personality traits were assessed using the Big Five Inventory. Operators who scored pain intensity and recorded analgesic consumption and personality traits were blinded to the group allocation. Statistical analyses included the t-test, Mann-Whitney U-test, Spearman correlations and stepwise regression analysis. The highest rate of pain was recorded at T1 (P < 0.001). No statistically significant difference in pain perception between groups was observed. There was no statistically significant difference in analgesic consumption between the two groups (P = 0.81). The correlations between personality traits and pain perception were not significant. The additional written information had little impact on pain perception, and it had no relationship to personality types. The perception of pain and analgesic consumption were not affected by the provision of additional written information (P = 0.81). Participants' personality types did not affect the impact of the information given.

Patients' and Parents' Concerns over Orthodontic Treatment during the COVID - 19 Pandemic.

We aimed to assess the impact of the COVID-19 pandemic on the concern of adolescents in orthodontic treatment, and to determine whether personality traits and parental perception were predictors of adolescent patients' concerns. The sample consisted of 229 adolescent patients (57.2% female) and 223 parents (65.1% female). Questionnaires included items about the importance of infection control and concern about treatment duration and results. Their latent structure was determined using exploratory factor analysis. The Big Five Inventory was used for assessing personality traits. Predictors of patients' and parental orthodontic concern and awareness of the importance of infection control measures were tested by the hierarchical multiple regression analysis. Two factors were revealed for the patient questionnaire, Treatment concern (TC) and Awareness of the importance of measures (AM), and four factors for the parent questionnaire, Parents' treatment concern (PTC), Parents' awareness of the importance of measures (PAM), Parents' concern about the pandemic (PCP) and Parents' concern about their child with regards to the pandemic (PCC). Adolescents' personality traits were not predictors of either TC or AM. PTC was a predictor of TC (p<0.001), accounting for 28% of the variance. PAM and the patient's following of the news were predictors of AM (p≤0.022), accounting for 24% and 2% of the variance, respectively. Parental concern and awareness of measures had an important role in attitudes of adolescent orthodontic patients during the COVID-19 pandemic, while personality traits did not. The clinician should put additional emphasis on communication with the parent.

Randomized controlled clinical trial on the efficacy of a novel antimicrobial chewing gum in reducing plaque and gingivitis in adolescent orthodontic patients

ObjectivesChewing gums containing antiseptics or other antimicrobial substances may be effective in reducing plaque and gingivitis. Therefore, the aim of this randomized placebo-controlled clinical trial was to investigate the efficacy of a novel antimicrobial chewing gum containing essential oils (cinnamon, lemon, peppermint) and extracts on reduction of dental plaque and gingivitis as well as on oral health-related quality of life (OHRQoL) in adolescent orthodontic patients.Materials52 patients (11-22 years of age) were randomly assigned to use a test chewing gum (COVIDGUM, Clevergum) or a commercially available control chewing gum over a period of 10 days. Approximal plaque index (API), papillary bleeding index (PBI) and an OHRQoL questionnaire for children (COHIP-G19) were assessed at baseline (BL), after 10 days (10d) and 30 days (30d). In addition, oral health and oral hygiene related questions of the COHIP-G19 questionnaire were evaluated separately in subscales at each timepoint. Data were analyzed using non-parametrical statistical procedures (α = 0.05).ResultsAPI and PBI decreased significantly over time from BL to 10d and from BL to 30d in both groups, without significant differences between the groups. In both groups, the COHIP-G19 score, oral health subscale and oral hygiene subscale decreased significantly over time. Regarding the oral hygiene subscale, the test group showed significantly better scores at 30d (p = 0.011).ConclusionBoth chewing gums performed similarly effective in terms of reducing plaque accumulation and gingival inflammation and improving OHRQoL.Clinical relevanceChewing gums without antimicrobial ingredients may be sufficient to decrease plaque accumulation and gingival inflammation.

Longitudinal Microbiome Changes in Supragingival Biofilm Transcriptomes Induced by Orthodontics.

Common oral diseases are known to be associated with dysbiotic shifts in the supragingival microbiome, yet most oral microbiome associations with clinical end points emanate from cross-sectional studies. Orthodontic treatment is an elective procedure that can be exploited to prospectively examine clinically relevant longitudinal changes in the composition and function of the supragingival microbiome. A longitudinal cohort study was conducted among 24 adolescent orthodontic patients who underwent saliva and plaque sampling and clinical examinations at time points: before fixed appliance bonding and at 1, 6, and 12 wk thereafter. Clinical indices included bleeding on probing (BOP), mean gingival index (GI), probing depths (PDs), and plaque index (PI). To study the biologically (i.e., transcriptionally) active microbial communities, RNA was extracted from plaque and saliva for RNA sequencing and microbiome bioinformatics analysis. Longitudinal changes in microbiome beta diversity were examined using PERMANOVA tests, and the relative abundance of microbial taxa was measured using Kruskal-Wallis tests, Wilcoxon rank-sum tests, and negative binomial and zero-inflated mixed models. Clinical measures of oral health deteriorated over time-the proportion of sites with GI and PI ≥1 increased by over 70% between prebonding and 12 wk postbonding while the proportion of sites with PD ≥4 mm increased 2.5-fold. Streptococcus sanguinis, a health-associated species that antagonizes cariogenic pathogens, showed a lasting decrease in relative abundance during orthodontic treatment. Contrarily, caries- and periodontal disease-associated taxa, including Selenomonas sputigena, Leptotrichia wadei, and Lachnoanaerobaculum saburreum, increased in abundance after bonding. Relative abundances of Stomatobaculum longum and Mogibacterium diversum in prebonding saliva predicted elevated BOP 12 wk postbonding, whereas Neisseria subflava was associated with lower BOP. This study offers insights into longitudinal community and species-specific changes in the supragingival microbiome transcriptome during fixed orthodontic treatment, advancing our understanding of microbial dysbioses and identifying targets of future health-promoting clinical investigations. Bonding braces was associated with subsequent changes in the oral microbiome characterized by increases in disease-associated species, decreases in health-associated species, and worsened clinical measures of oral health.

Prevalence and Clinical Significance of Incidental Findings in the Maxillofacial Complex of Adolescent Orthodontic Patients: A Retrospective Cone Beam Computed Tomography Analysis.

The aim of this study was to determine the prevalence and severity of incidental findings in the maxillofacial complex of orthodontic patients imaged with cone beam computed tomography (CBCT) and assign those findings an appropriate clinical significance. Incidental findings (IF) were identified in 250 CBCT scans of adolescent orthodontic patients (aged 13-18 years) with a large field-of-view and categorized based on their anatomic location and placed into one of six subgroups based on anatomic region: i) sino-nasal, ii) dentoalveolar, iii) nasooropharyngeal airway, iv) temporomandibular joint, v) neck, vi) calcifications, and vi) miscellaneous findings. Additionally, findings were assigned a clinical significance score based on severity on a scale of mild, moderate and severe. Mild IF was defined as an IF that does not require any further investigation or referral. Moderate IF was defined as an IF that has the tendency to become clinically significant and should be observed periodically. IFs that warrant further investigation and/or intervention were designated as severe. The percentage of IFs in sino-nasal and dento-alveolar regions were 44.7% and 19.1% respectively. The percentage of IFs with mild, moderate, and severe clinical significance were 27%, 72%, and 1%, respectively. Out of the IFs involving calcifications, 80.8% were stylohyoid calcifications and <1% were cranial cavity IFs such as petroclinoid calcifications and falx cerebri calcifications. Among the sino-nasal findings, 1.2% were identified as severe. The sino-nasal region had the highest frequency of IFs. Understanding the prevalence of incidental findings and its clinical relevance is important for clinicians to allow for appropriate monitoring and timely treatment of patients.

Effect of high-fluoride toothpaste and mouth rinse on the prevention of demineralized lesions during orthodontic treatment: a randomized controlled trial.

To evaluate the effect of high-fluoride mouth rinse and high-fluoride toothpaste on the development of demineralized lesions (DLs) during orthodontic treatment. Three-armed parallel-group randomized controlled trial. The trial was performed with 270 adolescent orthodontic patients. Randomization was performed in blocks of 30, enrolling the patients into one of the following groups: the fluoride mouth rinse (FMR) group receiving 0.2% sodium fluoride (NaF) mouth rinse plus 1450 ppm fluoride (F) toothpaste; high-fluoride toothpaste (HFT) group receiving 5000 ppm F toothpaste; and the Control (CTR) group receiving 1450 ppm F toothpaste. Inclusion criteria were patients scheduled for treatment in both arches with fixed appliances and age between 12 and 20 years. The primary outcome variable was the proportion of participants with at least one new demineralized lesion as assessed on digital photos taken before and after treatment, analysed by a blinded clinician. The analysis included all teeth or teeth in the aesthetic zone, i.e. all central incisors, lateral incisors, and canines. A random sample of 30 participants was assessed to check intra- and inter-reliability. For pairwise comparison between groups, Fisher's non-parametric permutation test was used for continuous variables. Blinding was employed during the caries registration and data analysis. October 2010 to December 2012. In total, 270 patients were randomized, of which 22 were excluded during treatment. Therefore, 248 participants were included in the study. The number of patients with an increase of ≥1 DL, including only central- and lateral incisors and canines, during orthodontic treatment, was significantly lower in the HFT group, 51/85 60%, compared to the CTR group, 64/82 78%, RR 0.77 (CI 0.62; 0.95), P = .01 and in the FMR group, 47/81 58%, compared to the CTR group, RR 0.74 (CI 0.60; 0.92), P < .01. To prevent demineralized lesions in the aesthetic zone, high-fluoride mouth rinse and high-fluoride toothpaste may be recommended. The protocol was not registered, and the present study did not use a double-blinded design.

Effect of Premolar Extraction on the Upper Airway in Adult and Adolescent Orthodontic Patients: a Meta-analysis.

To analyse the effects of premolar extraction on the upper airway in adult and adolescent orthodontic patients using CBCT. The Embase, Web of Science, Cochrane Library and Medline (via PubMed) databases were searched with no language restrictions. Longitudinal studies in which CBCT was applied to assess the effects of tooth extraction on the upper airway were included in the analysis. Two authors performed the study selection, methodological quality assessment, data extraction and data synthesis independently. A total of 12 studies were included, six of which were eligible for quantitative synthesis. In the adult group, the nasopharynx and oropharynx volume showed no significant change, and the minimum cross-sectional area of the upper airway demonstrated a non-significant decrease compared to the non-extraction group. In the adolescent group, the nasopharynx volume, oropharynx volume and minimum cross-sectional area of the upper airway increased in a non-significant manner. The currently available evidence indicates that tooth extraction does not increase the risk of airway collapse in adult and adolescent patients. The present findings should be interpreted with caution and evaluated in further high-quality studies.

Digital evaluation of Bolton's tooth size discrepancies among different malocclusions categories of Egyptian adolescent orthodontic population: A retrospective study

This retrospective investigation aimed to compare Bolton's ratios among different malocclusion groups of Egyptian adolescent orthodontic patients with original Bolton's standards. Pre-treatment dental casts of 588 Egyptian subjects, 290 males and 298 females with mean age 16.7±2.2 years, were randomly selected and classified into 220 class I (108 males and 112 females), 230 class II (112 males and 118 females), and 138 class III (68 males and 70 females) groups. Mesiodistal widths from first molar to first molar were measured on 3-dimensionally scanned models via software and ratios were calculated. Two-way analysis of variance compared ratios as a function of skeletal classification and gender. Additionally, percentages of significant discrepancy outside 2 standard deviations (SDs) were calculated. The anterior mean ratio for the total sample were higher (79.4±4.7) and overall mean ratio was lower (90.1±5) than Bolton's standards. The differences between the obtained and standard values were statistically significant (P<0.001). However, there were no significant differences in either anterior ratio (P=0.637) or overall ratio (P=295) regarding gender. Class I cases showed the highest mean anterior ratio of 80±5.7 whereas class II and class III cases had the lowest ratio of 78.5±4.6 and 78.7±3.5, respectively. Concerning overall ratio, class III subjects had the highest ratio of 91.8±2.6 with no substantial distinction from class II cases (90.2±4.7) but was significantly different from class I cases that demonstrated the lowest ratio (89.7±5, P=0.020). High percentages of patients displayed clinically significant tooth size discrepancies (TSD), exceeding either above or below 2SD of Bolton's values, which were more marked in the anterior ratio. These were 25.2% and 7.4% for anterior ratio and 3.4% and 15.4% for overall ratio. Tooth size ratios of Egyptian orthodontic patients are generally different than the original Bolton's standards. Patients with class I and class III malocclusions had greater anterior and overall ratios than those with class II malocclusions with no considerable gender differences in either ratio.

Effectiveness of the Lorodent Probiotic Lozenge in Reducing Plaque and Streptococcus mutans Levels in Orthodontic Patients: A Double-Blind Randomized Control Trial

Orthodontic patients are at a significant risk for oral diseases due to increased plaque accumulation and oral bacterial dysbiosis. We aimed to determine the efficacy of the commercially available Lorodent Probiotic Complex at reducing plaque accumulation and Streptococcus mutans bacterial levels in adolescent orthodontic patients. Sixty adolescents undergoing fixed orthodontic treatment for a minimum of 6 months were recruited in a randomized, double-blind, parallel-group, placebo-controlled trial. They received either Lorodent probiotic lozenge (intervention, n = 30) or placebo lozenge (control, n = 30) orally every day for a 28-day administration period. Participants were assessed at four appointments (T1–T4) over a total of 56 days. Compliance and lozenge satisfaction were monitored. Saliva samples and supragingival plaques were collected for evaluation of S. mutans levels. Clinical assessment using a Plaque Index (PI) was used. Compliance with lozenge intake of all participants was over 90%. There was no significant change in the PI and composite PI scores in both placebo and probiotic groups at each time frame (all p > 0.05) or the relative S. mutans DNA levels in the saliva and plaque between the probiotic and placebo groups. The findings of high compliance and satisfaction with the probiotic lozenges combined with the study's rigorous design offer a baseline for subsequent testing of further potential probiotics (of varying formulations, concentrations), especially in adolescents.

Adolescents’ perception of malocclusion, their motivations, and expectations concerning the orthodontic treatment. Is it all about attractiveness? A qualitative study

In addition to essential clinical parameters, orthodontic treatment outcomes should also consider patients' opinions and perceptions, which could be comprehensively clarified with a qualitative scientific approach. Considering that the information on younger patients' views is scarce, the objective of this study was to investigate how adolescent orthodontic patients perceive malocclusion, and their motivations and expectations concerning orthodontic corrective treatment. In this descriptive qualitative study, 12 adolescents aged 12 to 14 years and of both genders, covering a heterogeneous collection of malocclusions, were recruited from the waiting list of an Orthodontics Graduate Course. They were individually interviewed before the appliance insertion by an experienced researcher using an interview guide and photographic records to stimulate patients' self-perception of their oral condition. The interviews proceeded simultaneously with transcription analyses until saturation. After the transcription evaluation, the framework analysis technique was performed. Data derived from the transcription analyses were grouped into 3 major themes: perceptions concerning the concepts of normality and abnormality regarding oral health; self-perceptions regarding malocclusion and other discrepancies; and motivations for seeking orthodontic treatment and expectations related to the results. Attractiveness was exceptionally relevant among adolescent patients. Most interviewees seemed to focus their attention on esthetically upsetting dentofacial traits, which they expected to be corrected by orthodontic treatment. In addition to self-oriented appearance-driven motivations, parents, other health professionals, friends, and peers also influenced adolescents' perception of their need for treatment. The achievement of a normal dentofacial status seems to be closely attached to social and individual aspirations.

Quality of life in an adolescent orthodontic population.

To investigate adolescent orthodontic patient experiences and quality of life with fixed appliances compared to Invisalign. Adolescent patients in active treatment with Invisalign or fixed appliances for a minimum of 6 months were provided with the Child Oral Health Impact Profile-Short Form 19 questionnaire, along with additional items of interest that were assessed separately. Pearson's χ2 test was used to compare responses (P < .05), and unpaired t-tests (P < .05) were used to test for differences in mean satisfaction, quality of life, and domain scores. In total, 74 patients (37 in each treatment group) participated. Overall, no significant differences were noted in the mean quality of life, satisfaction, or domain scores between the two groups. A significant difference was noted in the time taken to adjust to appliances, with the Invisalign group demonstrating faster adaptation. Additionally, the fixed appliance group was 3.8 times more likely to report missing school because of their appliance (95% confidence interval [CI]: 1.2, 12.5) and 2.7 times more likely to report having difficulty eating certain foods (95% CI: 1.1, 7.1). When the sample of females between the ages of 14 and 18 was analyzed, the Invisalign group reported feeling attractive more often than the fixed appliance group. Both treatment groups were generally very satisfied with their treatment modality. The overall quality of life of adolescent orthodontic patients undergoing treatment with fixed appliances and Invisalign for a minimum of 6 months was similar.

Screening of obstructive sleep apnea (OSA) risk in adolescent population and study of association with craniofacial and upper airway morphology

BackgroundObstructive sleep apnea (OSA) is a common form of sleep-disordered breathing with high prevalence and associated co-morbidities. It still goes largely under-reported due to events occurring in sleep and difficulty in identifying predisposing factors. AimsTo perform questionnaire-based screening of OSA-risk in adolescents and study association of OSA-risk with craniofacial and upper airway morphology. Material and methodsModified STOP-BANG questionnaire was used for screening OSA-risk in adolescent orthodontic patients (10–19 years) in a government dental hospital in India. Patients were categorised into two groups: OSA-risk and non-risk, based on the questionnaire scores, and were subsequently evaluated for craniofacial and upper airway morphology, both on examination and on lateral cephalometric radiographs. ResultsDocumented a high prevalence of 14% for OSA-risk in adolescent orthodontic patients. The extra-oral and intra-oral parameters found significantly associated with OSA-risk were convex profile [Odd's ratio (OR) - 3.824], steep mandibular plane angle [MPA] (OR- 79.75), Type 3/4 faucial pillars (OR- 11.227), Class II molar relationship (OR - 4.518), ovoid upper arch form (OR - 13.750). In addition, the cephalometric parameters: ANB (p– 0.025), SN-MP (p– 0.007), BA-SN (p– 0.020), PNS-AD1 (p < 0.001), PNS-AD2 (p – 0.001) also showed highly significant association to OSA-risk. The ROC curves demonstrated high sensitivity and specificity for PNS-AD1 (60%,83.3%), PNS-AD2 (73.3%, 70%) and SN-MP (60%,70%), respectively for OSA-risk. ConclusionsThe study supported applicability of modified STOP-BANG questionnaire for OSA-risk in Indian adolescents. The parameters [extra-oral, intra-oral, cephalometric and upper airway (PNS-AD1, PNS-AD2, SN-MP)] significantly associated with OSA-risk, were identified.

A biopsychosocial-cultural model for understanding oral-health-related quality of life among adolescent orthodontic patients

BackgroundBased on previous theoretical oral-health-related quality of life (OHRQoL) models and most recently framework, as well as sociocultural model of body image dissatisfaction, the current study aimed to investigate the effect of individual (dental aesthetics and dental appearance social comparison) and sociocultural factors (social reinforcement from parents, peers and mass media on dental aesthetics) as well as their interaction on psychosocial dimension of OHRQoL among adolescent orthodontic patients.MethodsIn this cross-sectional study comprising 427 adolescent orthodontic patients (151 boys and 276 girls) aged between 11 and 16 years old, the psychosocial dimension of OHRQoL was measured by Psychosocial Impact of Dental Aesthetics Questionnaire. Individual predictor of dental aesthetics was defined by the Aesthetic Component of the Index of Orthodontic Treatment Need, and dental appearance social comparison was assessed by four items adapted from Physical Appearance Comparison Scale. Sociocultural predictor of social reinforcement was measured by six items adapted from Perceived Sociocultural Pressure Scale. Spearman correlations, path analyses, and structural equation modeling were used to build up several predictive models.ResultsAs hypothesized, two direct pathways were observed that patients’ dental aesthetics and all three sources of social reinforcement directly predicted the psychosocial dimension of OHRQoL. Meanwhile, we observed one indirect pathway, that three sources of social reinforcement predicted the psychosocial dimension of OHRQoL, in part, through dental appearance social comparison.ConclusionsThis study provides preliminary evidence indicating that dental aesthetics, social reinforcement and dental appearance comparison are reliable predictors of psychosocial dimension of OHRQoL among adolescent orthodontic patients.

Smartphone application-assisted oral hygiene of orthodontic patients: a multicentre randomized controlled trial in adolescents.

The aim of this trial was to test whether the use of a smartphone application (app) connected to a toothbrush improves the oral hygiene compliance of adolescent orthodontic patients. The study was designed as a multicentre, randomized, controlled clinical trial. Two academic hospitals. The study was approved by the ethics committee. This multicentre randomized controlled trial was conducted on 38 adolescents aged 12-18 years with full-fixed orthodontic appliances. Participants were randomly assigned either to a test group that used an interactive oscillating/rotating electric toothbrush connected to a brushing aid app or to a control group that used an oscillating/rotating electric toothbrush alone. At baseline, all patients received verbal and written oral hygiene instructions. Data collection was performed at T1 (baseline), T2 (6 weeks), T3 (12 weeks) and T4 (18 weeks-end of the study). At each time point, the plaque index (PI), gingival index (GI) and white spot lesion (WSL) score were recorded. Several app-related parameters were evaluated. Patient-related outcome measures were investigated in the test group. Test and control groups were similar at baseline except for WSL score. Between T1 and T4, PI and GI decreased significantly in both groups but evolutions were globally similar in both groups. Interestingly, at T3 (12 weeks), the PI was significantly lower in the app group than in the control group (P = 0.014). Data showed a marked decline in the use of the app over time in the test group. This trial, conducted over 18 weeks in two academic hospitals, showed no significant effect of the use of the app in promoting oral hygiene. Not registered.

Treatment compliance of adolescent orthodontic patients with headgear activator and twin-block appliance assessed prospectively using microelectronic wear-time documentation.

Success of orthodontic removable appliance treatment relies on patient compliance. The aim of this quantitative and qualitative study was to explore the compliance and self-reported experience of adolescents in orthodontic treatment with headgear activator (HGA) or twin-block (TB) appliance. The study group comprised 52 adolescents with a mean age of 12.6 (±1.3) years at the start of the treatment. The patients were treated at a free-of-charge public dental clinic. Participants were randomly allocated to two equal groups to be treated with either HGA or TB. Patient compliance was evaluated as appliance wear time and subjective experience. Appliance wear time was recorded with Theramon® microchip, and the self-reported subjective experience using a questionnaire. In total, 30 patients completed the treatment during the follow-up period. HGA was worn on average 7 hours per day and TB 9 hours per day by those patients, who successfully completed the treatment. During a mean observation period of 13 months (range 7-23 months), the mean actual wear time was 43 per cent less than the advised 12 or 18 hours per day in the whole patient group, and 55 per cent in those patients, who completed the treatment. Compliance level was unrelated to the appliance type. Study assessed a relatively small number of patients. Adolescent patients wear HGA and TB less than advised. Individual variation in treatment adherence is considerable. Thereby, microelectronic wear-time documentation can be a cost-effective mean of identifying non-compliance.

Evaluation of temporomandibular disorder symptoms and oral health-related quality of life in adolescent orthodontic patients with different dental malocclusions

ABSTRACT Objective: To estimate the prevalence of temporomandibular disorders in adolescent orthodontic patients with different dental malocclusions and to assess the relationship between oral health-related quality of life. Methods: This study was carried out on 648 randomly selected individuals 14–19 years of age. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD), Fonseca Questionnaire, and Oral Health Impact Profile-14 (OHIP-14) forms were used. Results: The GCPS, TMD Pain, Fonseca, OHIP-14, PHQ-9, GAD-7, OBC, and PHQ-15 mean scores of female participants were statistically significantly higher than males (p < 0.05).There was a significant difference among the malocclusion groups in terms of their mean scores in GCPS, Fonseca, and OHIP-14 (p < 0.05).The age values and JFLS, TMD Pain, Fonseca, OHIP-14, PHQ-9, GAD-7, and PHQ-15 were statistically significant correlations in the positive direction. Conclusion: The DC/TMD form allows both a physical assessment of Axis I and II that examines psychosocial status and pain-related disorders and a more comprehensive assessment. The mean OHIP-14 and Fonseca questionnaire scores of Class III groups were found to be significantly higher.

The effect of using a mobile application (“WhiteTeeth”) on improving oral hygiene: A randomized controlled trial

ObjectiveTo evaluate the effectiveness of the WhiteTeeth mobile app, a theory‐based mobile health (mHealth) program for promoting oral hygiene in adolescent orthodontic patients.MethodsIn this parallel randomized controlled trial, the data of 132 adolescents were collected during three orthodontic check‐ups: at baseline (T0), at 6‐week follow‐up (T1) and at 12‐week follow‐up (T2). The intervention group was given access to the WhiteTeeth app in addition to usual care (n = 67). The control group received usual care only (n = 65). The oral hygiene outcomes were the presence and the amount of dental plaque (Al‐Anezi and Harradine plaque index), and the total number of sites with gingival bleeding (Bleeding on Marginal Probing Index). Oral health behaviour and its psychosocial factors were measured through a digital questionnaire. We performed linear mixed‐model analyses to determine the intervention effects.ResultsAt 6‐week follow‐up, the intervention led to a significant decrease in gingival bleeding (B = −3.74; 95% CI −6.84 to −0.65) and an increase in the use of fluoride mouth rinse (B = 1.93; 95% CI 0.36 to 3.50). At 12‐week follow‐up, dental plaque accumulation (B = −11.32; 95% CI −20.57 to −2.07) and the number of sites covered with plaque (B = −6.77; 95% CI −11.67 to −1.87) had been reduced significantly more in the intervention group than in the control group.ConclusionsThe results show that adolescents with fixed orthodontic appliances can be helped to improve their oral hygiene when usual care is combined with a mobile app that provides oral health education and automatic coaching. Netherlands Trial Registry Identifier: NTR6206: 20 February 2017.

Role of taste perception in white spot lesion formation during orthodontic treatment.

To investigate the role of individual's taste sensitivity using 6-n-propylthiouracil (PROP) in the development of white spot lesions (WSLs) in adolescent orthodontic patients. 44 healthy adolescents, aged 12 to 16 years old, who were in fixed-appliance orthodontic treatment for at least 6 months, consented to participate in this cross-sectional study. Data regarding participants' demographic information, oral hygiene practices, and dietary habits were obtained by a questionnaire. An oral clinical examination was performed to determine the oral hygiene status, the presence of WSLs and dental caries experience. The taste phenotype of the participants was evaluated through PROP test and they were accordingly divided into PROP nontasters and PROP tasters. The sample consisted of 24 subjects in the WSL group and 20 subjects in the WSL-free group. The WSL group demonstrated higher mean plaque score (48.2), mean decayed, missing, and filled surfaces (2.38), and mean decayed, missing, and filled teeth (1.96) scores compared to the WSL-free group (38.7, 0.85, and 0.55, respectively), but no significant differences were found. Most subjects in the WSL group were PROP nontasters (66.6%) whereas most subjects in the WSL-free group were PROP tasters (75%); a significant difference was observed between the groups (P = .006). The prevalence of white spot lesions was significantly higher in adolescent orthodontic patients who were PROP nontasters compared to PROP tasters. A PROP taste perception could be a potential risk factor for the formation of WSLs during fixed orthodontic treatment that warrants further attention.