Orthodontic Consultation Research Articles

Virtual-First: A virtual workflow for new patient consultation, engagement and education in orthodontics

Virtual-First is a new patient enquiry system and workflow to provide a screening virtual orthodontic consultation to a potential orthodontic patient. The workflows and systems presented in this paper are an example of how virtual technologies can be integrated by an orthodontic practice, as an additional supplement, to provide a more engaged, educational and screening model for new patients potentially reducing time and costs that are associated with existing traditional orthodontic consultation models. Using Artificial Intelligence (AI) driven technologies, automated or semi-automated responses can be created to increase practice efficiency and reduce administrative time and errors by the orthodontic teams and professionals. This paper also highlights the challenges to technologies and provides advise on improvements in such systems in the future.

Associations between body dysmorphic disorder (BDD) with the dental health component of the index of orthodontic treatment need (IOTN-DHC) and other BDD risk factors in orthodontic patients: A preliminary study.

Body dysmorphic disorder (BDD) is a form of obsessive-compulsive disorder that may be negatively associated with the self-image. It might be associated with orthodontic treatment demand and outcome, and therefore is important. Thus, this study was conducted. The Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS) questionnaire was used in 699 orthodontic patients above 12 years of age (222 males, 477 females), at seven clinics in two cities (2020-2021). BDD diagnosis and severity were calculated based on the first 3 items and all 12 items of the questionnaire. The dental health component of the index of orthodontic treatment need (IOTN-DHC) was assessed by orthodontists. Multivariable and bivariable statistical analyses were performed on ordinal and dichotomized BDD diagnoses to assess potentially associated factors (IOTN-DHC, age, sex, marital status, education level, and previous orthodontic consultation) (α = 0.05). IOTN-DHC scores 1-5 were seen in 13.0%, 39.9%, 29.8%, 12.4%, and 4.9% of patients. Age/sex/marital status/education were not associated with IOTN-DHC (p > 0.05). Based on 3-item questionnaire, 17.02% of patients had BDD (14.02% mild). Based on 12-item questionnaire, 2.86% had BDD. BDD was more prevalent or severer in females, married patients, patients with a previous history of orthodontic consultation, and patients with milder IOTN-DHCs (p < 0.05). IOTN-DHC was negatively/slightly associated with BDD in orthodontic patients. Being female and married may increase BDD risk.

Parents' Awareness of Malocclusion and Orthodontic Consultation for Their Children: A Cross-Sectional Study.

Parents' awareness of malocclusion and the appropriate timing to seek orthodontic consultation for their children has a substantial impact on children's orthodontic treatment. This cross-sectional study aims to investigate parents' awareness of malocclusion and orthodontic consultation of their children and the influence of parents' demographics on their awareness level. An electronic survey collected information about participants' demographics and awareness about malocclusion and orthodontic consultation of children. A total of 473 parents living in Jeddah, Saudi Arabia, participated in the study. The average awareness level among parents was moderate (3.09 ± 1.4). Male gender and unemployment were associated with low orthodontic awareness levels relative to moderate awareness (OR = 3.3, 95% CI = 1.8-5.8 and OR = 2.1, 95% CI = 1.1-3.8, respectively). Former or current orthodontic treatment was associated with high awareness levels (OR = 3.9, 95% CI = 2.4-6.5). There is still a need to raise the awareness of Saudi parents about malocclusion and orthodontic consultations for their children. Orthodontic awareness-raising campaigns should be designed to include fathers and parents with low socioeconomic status. The findings of this study also suggest that orthodontists can enhance their patient's awareness of malocclusion and orthodontic consultation for their children.

Pre-Eruptive Intracoronal Resorption (PEIR): A Case Report

Pre-Eruptive Intracoronal Resorption (PEIR) is a rare yet significant phenomenon in which an abnormal, well-circumscribed, radiolucent area develops in the tooth prior to eruption. This case report outlines the treatment of a 12 year old Hispanic female who was referred for endodontic evaluation of tooth #31 and subsequently diagnosed with PEIR.The patient’s chief complaint was recorded as “spontaneous pain” in the lower right quadrant of her jaw. Clinical examination revealed a partially erupted tooth #31 with no visible decay. Radiographic examination, including a cone beam computed tomography scan, led to the detection of a radiolucent area surrounding the pulp chamber on the mesial aspect of tooth #31. Radiographically, the enamel appeared intact with no signs of perforation. Based on the clinical and radiographic evaluation, tooth #31 was determined to have PEIR, with the pulpal and periapical diagnosis of “Symptomatic Irreversible Pulpitis” and “Normal Apical Tissue,” respectively.The Orthodontic consultation obtained for this patient recommended that tooth #31 be maintained at least until tooth #32 appeared in the oral cavity and could be used as a replacement. Therefore, a treatment plan involving vital pulp therapy and gingivectomy was selected. During the procedure, granulation tissue was excavated and sent for histological evaluation, which concluded the presence of “granulation tissue with acute and chronic inflammation”. No caries were detected.Following the procedure, the tooth was found to be asymptomatic with continued root development. A positive response to Electric Pulp Test was achieved after 3.5 years of follow up.

The Influence of Orthodontic Treatment Need on Oral Health-Related Quality of Life among 12-18-Year-Old Adolescents in Riyadh.

This study assessed the prevalence of orthodontic treatment needs and oral health-related quality of life (OHRQoL) in 12-18-year-old adolescents and explored the association between OHRQoL and treatment needs, gender, education level and family income. A total of 243 participants with no prior history of orthodontic treatment were included in this cross-sectional study utilizing a standardized self-explanatory questionnaire and clinical examination. The questionnaire consisted of two parts. The first part included the participants' demographics (age, gender, education level, economic status) and the second part contained the Arabic version of the oral health impact profile (OHIP)-14, which consists of 14 questions to assess the impact of the severity of malocclusion on routine activities. The clinical examination involved the dental health component (DHC) index of orthodontic treatment needs (IOTN). The outcome of the study showed that 46% of participants had little or no treatment needs, followed by 23.5% with borderline needs, and 30.5% with severe needs. Female participants had higher mean OHIP-14 scores (10.94 ± 8.17) compared to their male counterparts (8.44 ± 7.15), and the difference in the mean scores was significant (p = 0.015). The educational level did not significantly influence the mean OHIP-14 scores (p = 0.723), whereas the family income correlated negatively with the mean OHIP-14 scores. Participants with less family income had higher mean OHIP-14 scores (11.53 ± 8.67) compared to participants with high (8.22 ± 6.71) and average family income (10.68 ± 8.30). The mean OHIP-14 scores between the family income groups were statistically significant (p = 0.036). The overall OHIP-14 score of the participants was 9.67 ± 7.75. The need for orthodontic treatment is crucial among adolescents. It is recommended to have regular orthodontic consultations for adolescents and prompt referral for treatment to improve the OHRQoL.

Sleep-related breathing disorders in young orthodontic patients

This study aimed to find out the frequency of sleep-related breathing disorders (SRBD) in young orthodontic patients in Israel. SRBD is characterized by prolonged upper airway obstruction during sleep. The study group consisted of 309 children aged 6-17 years who attended the Orthodontic Clinic at Hadassah Medical Center. Parents were asked to complete a translated validated Pediatric Sleep Questionnaire. Of the examined children, 10% were at high risk for SRBD. Boys were at higher risk for SRBD and were at high risk at a younger age than girls. Girls had a low risk of SRBD after adenotonsillectomy, whereas 50% of the boys that underwent adenotonsillectomy were at high risk for SRBD. Our findings propose that 10% of the children aged 6-17 years, who were seeking orthodontic consultation at our medical center, were at high risk for SRBD. Boys were significantly at a higher risk for SRBD than girls and were at high risk at a younger age. It is important to screen young orthodontic patients for SRBD and to refer high-risk patients to their physicians for further evaluation and treatment.

Impact of second wave of COVID-19 related lockdown on patients undergoing fixed orthodontic treatment in a dental teaching hospital

Background: Lockdown due to second wave of COVID-19 was implemented, in Kathmandu from April 29, 2021. In most of the dental hospitals, patients’ regular appointments were temporarily suspended and only emergency treatments were considered. Objectives: To assess the impact of the COVID-19 related lockdown on the treatment among patients undergoing fixed orthodontic treatment. Methods: A descriptive cross-sectional study was conducted among 170 individuals undergoing fixed orthodontic treatment at Kathmandu Medical College Teaching Hospital from 1st July to 30th September 2021 after obtaining ethical approval. A standard pretested self-administered online questionnaire having questions regarding impact of COVID-19 on orthodontic treatment was sent to all the study participants. Data were entered in Microsoft Excel Sheet and analysed in Statistical Package for Social Sciences version 20. Descriptive statistics like mean, standard deviation, frequency, and percentage were calculated depending upon the nature of data. Results: Majority of the study participants (113, 66.5%) did not visit orthodontist for more than one month due to second wave of COVID-19 and were very worried (84, 49.4%) for not getting to go for regular follow-ups for their treatment. Most of them were worried thinking that their treatment time will be extended (134, 78.8%), and some (97, 57.1%) participants faced problems like broken brackets and elastics. Conclusion: This study concluded that second wave of COVID-19 had some impact on orthodontic patients. This study highlighted the importance of teledentistry for orthodontic consultation and also the need for preparing the patients to deal with orthodontic appliances if required to prevent trauma.

PREVALENCE OF TEMPOROMANDIBULAR DISORDERS AMONG ORTHODONTIC PATIENTS (CROSS-SECTIONAL CLINICAL SURVEY)

Orthodontic treatment as a risk factor for the development of temporomandibular disorders (TMD) has been a controversy in literature. The aim of this study was to evaluate the prevalence of TMD, as defined in the Diagnostic Criteria (DC)/TMD Axis II, among orthodontic patients. A cross-sectional study (N=180) consisted of 3 groups: 60 control patients seeking orthodontic consultation, 60 patients undergoing orthodontic treatment for 3-5 months, 60 patients undergoing orthodontic treatment for 10-14 months. Patients answered a structured questionnaire that rated their oral parafunctions according to the Oral Behavior Checklist (OBC), pain intensity levels according to the Graded Chronic Pain Scale (GCPS), jaw functional limitations according to the Jaw Functional Limitation Scale 20 (JFLS-20), psychosocial factors (PHQ-9) and somatization levels (PHQ-15). The Chi Square test showed a statistically significant difference p-value=0.001 among both active orthodontic groups (3-5 months/10-14 months) regarding masticatory limitation (53.3%), vertical mobility limitation (41.7% for 3-5 months and 55.0% 10-14 months) and verbal &amp; emotional expression limitation (53.3% 3-5 months and 66.7% 10-14 months). The findings revealed that as orthodontic treatment progresses, the limitation increases. Moreover, no statistical significance was observed between the three groups regarding oral parafunctional habits, chronic pain levels, psychosocial status and somatization. Orthodontic treatment is not a major factor associated with the symptoms of the TMD. Further prospective studies are needed to evaluate the true role of orthodontic treatment in the development of TMD.

Evaluation of Knowledge, Awareness, and Perception toward the Application of Teledentistry on Managing Early Childhood Caries during COVID-19 among Dental Professionals in Kolkata, West Bengal

Background: Teledentistry concerns with the utilization of telecommunication technology to provide clinical information, dental consultation, and treatment planning while avoiding direct personal contact with the patients. Its application is already established within the disciplines of oral medicine, orthodontic consultations, and early detection of caries.[1] Objective: The present study aims to evaluate the relevancy of teledentistry on managing early childhood caries (ECC) during the COVID-19 pandemic among dentists residing in Kolkata, West Bengal. Materials and Methods: This descriptive cross-sectional study using a 22-item prestructured, closed-ended questionnaire was conducted among dental professionals in Kolkata, West Bengal, to evaluate their knowledge on their thought that whether teledentistry can be implemented in the effective management of ECC. Results: A total of 108 participants responded to the survey. Knowledge and awareness regarding teledentistry and its use toward managing ECC is found to be high among postgraduates followed by Post Graduate Trainees (PGTs). The majority of the participants think teledentistry can increase the availability of specialists to rural and undeserving communities, where ECC is more prevalent (88%) and 73% of dentists are willing to practice teledentistry to bridge the gap of lack of health-care facilities to rural and undeserving communities for their dental needs. Conclusion: The majority of the BDS graduates and dentists doing private practice surveyed have less knowledge about teledentistry and awareness of ECC is less among dentists doing private practice. Education about teledentistry and ECC should be considered so that dentists can provide better oral health care.

Relationship between craniofacial morphology and congenitally missing mandibular incisors

Background/purposeTreatment of incisors‘ agenesis is challenging that arouses orthodontists’ interests. The purpose of this study was to compare the craniofacial pattern of individuals with or without congenitally missing mandibular incisors. Materials and methodsThis retrospective study included patients receiving orthodontic consultation between 1999 and 2019 at the Orthodontic Division of the Dental Department of Taipei Medical University Hospital. Cephalometric measurements were obtained through manual tracing and by using computer software. A total of 31 measurements were obtained to evaluate skeletal, dental and soft tissues, and chin morphology. A multivariate analysis of covariance, analysis of covariance, and Scheffé’s post hoc tests were used to analyze the differences among a group of patients with one congenitally missing mandibular incisor (M1), a group of patients with two congenitally missing mandibular incisors (M2), and the control group. Student's t-test was used to analyze the differences between the M1 or M2 group and the control group. Significance was set at P < 0.05. ResultsSignificant differences were observed between the M and control groups in terms of lower incisor angulation and facial balance. Regarding chin morphology, significant differences were noted between the M and control groups and also among the M1, M2, and control groups. ConclusionThe lower incisors of the M group are more retroclined than those of the control group, resulting in retrusive lower lips. Facial balance varies between the M and control groups. Congenitally missing mandibular incisors affect chin morphology, making the chin button prominent.

The impact of malocclusion on the oral health related quality of life of 11\u201314-year-old children

BackgroundThe relationship between malocclusion and the oral health related quality of life (OHRQoL) of children needs to be explored further as existing literature presents conflicting evidence. This study aims to determine the association between malocclusion and OHRQoL of 11–14-year-old children.MethodsThis cross-sectional study was conducted among 250 caregiver/child dyads seeking orthodontic consultation at a tertiary care hospital. The OHRQoL was assessed using child perception questionnaire for 11–14-year-old children (CPQ11–14) and the severity of malocclusion was assessed using the Dental Aesthetic Index (DAI). CPQ11–14 scores ranged from 0 to 64, with lower scores representing better quality of life. Analysis of variance (ANOVA) was used to assess differences between domain and total CPQ11–14 scores.ResultsThe mean CPQ11–14 score was 19.89 ± 9.8. Mean scores for the oral symptoms, functional limitations, emotional well-being, and social well-being domains were 5.26 ± 3.22, 3.67 ± 3.58, 3.98 ± 3.89 and 2.08 ± 2.98, respectively. Normal or slight malocclusion was seen in 37.6%, definite malocclusion was seen in 22.4%, severe malocclusion in 15.2% and handicapping malocclusion in 24.8% of the subjects. In comparisons by pairs, it was found that children with handicapping malocclusion had significantly (p < 0.05) higher scores for the social well-being domain as compared with children having normal/minor malocclusion, indicating a poorer quality of life.ConclusionHandicapping malocclusion had a significant negative impact on the social well-being domain of OHRQoL among 11–14-year-old children in this population.

Parents' Awareness of Early Orthodontic Consultation: A Cross-Sectional Study.

Objective: The aim of this paper is to assess parents’ knowledge about early orthodontic consultation and treatment, and to determine the association of this knowledge with number of children, monthly income, children’s age and perceived dental problems. Methods: A questionnaire was distributed to 3000 school children aged 6–11 years. The children were asked to take the questionnaire to their parents and bring it back the next day. It consisted of 13 questions. Some of these questions were related to the gender of the child, number of children, and parents’ monthly income. The remaining questions assessed the parents’ awareness of their children’s need for orthodontic treatment. Results: In total, 2538 parents completed the questionnaire. Of these, 2014 (79%) of the parents thought that their children’s teeth would have a significant impact on their personality. Moreover, 1637 (64.5%) parents thought that their children had a problem with their teeth; 1080 (66%) of these parents consulted a dentist. Of these 1080 parents, 821 (76%) consulted an orthodontist, and of these 821 parents, 449 (55%) initiated the required orthodontic treatment. The number of children who visited an orthodontist was found to increase with an increase in age (p = 0.0057). Moreover, a perceived overjet was associated with a higher number of orthodontic consultations (p = 0.0326). Conclusion: Although parents’ awareness regarding their children’s orthodontic treatment is important, other factors, such as the age of the child, the severity of the malocclusion and the consulted dentist, play a role in initiating orthodontic treatment.

Oral Health Status of Children Living with Type 1 Diabetes Mellitus.

Background: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. Objective: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. Methods: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson’s chi-square test for statistical analysis and compared the data of the study and control groups. Results: The oral health values of DM children were significantly better (DMF-T 0.83–1.3) than the national average (3.8–4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1–3.5%) in the study (15%) and in the control sibling group (13%). Conclusions: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.

Association between Crowding and the Effective Maxillary and Mandibular Length among Orthodontic Patients of Kathmandu, Nepal.

Background: During orthodontic consultation, the most frequent major complaint of the patients is dental crowding, which is caused by a disparity between the arch length and tooth size. Objective: The purpose of this study was to evaluate the association between crowding and the effective maxillary and mandibular length in Nepalese orthodontic patients.Methods: The orthodontic records of 390 people (from January 2018 to December 2020) were randomly selected and classified into three skeletal malocclusions based on the ANB angle (Angle formed by point A and point B at the nasion). Subjects with skeletal malocclusions were subdivided into two groups depending on the degree of crowding in the mandibular arch: Group 1 had crowding of &lt; 3mm, and Group 2 had crowding of &gt;3mm. On pretreatment casts, digital vernier calipers (Digimatic, Precise, India) were used to assess dental arch crowding, whereas, on a pretreatment lateral cephalogram, digital cephalometric analysis (Vistadent OC 1.1, USA) was done to quantify effective maxillary and mandibular length. Inter-group comparisons were assessed using a one-way analysis of variance. The correlation was assessed by Pearson’s correlation coefficient (p≤0.05).Results: There was a statistically significant difference in effective maxillary and mandibular length among skeletal malocclusions (p&lt;0.05). Skeletal Class II malocclusion had the greatest mandibular crowding, while skeletal Class III malocclusion had the least. The effective maxillary and mandibular lengths and dental crowding had a significant but weak inverse correlation, whereas a strong but moderate positive correlation existed between the maxillary and mandibular effective lengths (r=0.674) and also between maxillary and mandibular crowding (r=0.631).Conclusion: Effective maxillary length was highest in skeletal class II malocclusion whereas effective mandibular length was highest in skeletal class III malocclusion. The shorter effective maxillary and mandibular lengths showed a weak association with dental crowding.

Decision Making Capacity or How to Accept Patient’s Refusal for Orthodontic Treatment

Introduction: Communication in dentistry is bilateral process which usually is based on response (understanding) by the person. That’s why the Oral Healthcare Providers (OHP) should be convinced the consent given by the patient is valid. It means that at the beginning of the treatment the orthodontist will ask a lot of questions and have expectations to receive appropriate answers. There is a specific lack of awareness about the first orthodontic consultation at 7y of age, occurrence and prevention of most of the common tooth jaw discrepancies which affect the oral health, self-confidence and overall development of the child. A variety of socio-demographic, educational, personal and other factors mostly divided into objective and subjective factors influences the perception of facial attractiveness. The orthodontic treatment lays down on the personal desire and attitudes, depends from the motivation but is not without a risk for the patient. The aim of the current research is to present the most objective and subjective factors identifying the patient’s refusal. Material and methods: It’s a case report based on preliminary discussion and orthodontic consultation over the cephalometric analysis and cast models. Orthodontic treatment protocol was followed and given informed consent by the individual was received. Results and discussions: An electronic search was conducted using the Medline database (PubMed), Science Direct, and Scopus. In this case report were described the treatment options for Class III malocclusion with an emphasis on maxillary protraction and existing impacted canine 13. The decision making capacity was evaluated and also what are the objective and subjective factors and how to proceed with patient refusal. Conclusions: Despite the orthodontist’s efforts to improve the management of the dental practice and to attract new patients, these challenges should never been from the first importance. Contemporary dentistry requires that the patient’s right to refuse should be respected and this refusal must be accepted. Because orthodontic treatment is expensive, the process of returning money or sharing responsibility for the treatment depend on the socio-cultural characteristics of both the patient and the doctor. The whole situation requires a very delicate approach, as it affects the image of the dental community in society at whole.

The diagnostic value of orthopantomograms in detecting resorption of lateral incisors associated with ectopic canines: a CBCT study.

To examine the diagnostic value of orthopantomograms (OPG) in the identification of root resorption of lateral incisors, secondary to an impacted canine, as confirmed by a cone-beam computed tomography (CBCT) scan. Retrospective observational cohort study. South Wales secondary care setting: Royal Gwent Hospital, Newport and Nevill Hall Hospital, Abergavenny. A total of 40 consecutive patients with impacted canines between January 2018 and December 2019 were selected. For each patient, one consultant orthodontist examined the OPG in isolation to detect the presence and extent of resorption of lateral incisors. The CBCT report was then studied to confirm the presence and extent of pathology. Sensitivity, specificity, accuracy, positive predictive values and negative predictive values were calculated. In total, 19 maxillary right canines, 18 maxillary left canines, one mandibular right canine and two mandibular left canines were examined. Impactions were more prevalent in the maxilla (92.5%) with higher predilection towards female patients (65%). There was higher prevalence of root resorption in the maxillary right quadrant (57.1%), in concordance with other studies. OPGs were found to have a sensitivity of 81.0% and a specificity of 10.5%, with an accuracy value of 47.5%. Positive and negative predictive values were found to be 50.0% and 33.3%, respectively. The extent of root resorption was incorrectly estimated from the OPG in 84% of cases. Correct estimation occurred in 16% of cases, with overestimation and underestimation occurring in equal proportion (42%). This study demonstrates the limitations of plain film radiographs and the merits of using CBCT in the accurate diagnosis of resorption of lateral incisors with an associated impacted canine. It also gives an indication into the location prevalence of resorption in a small cohort of patients. This preliminary study establishes the basis for future, larger-scale studies where outcomes can be generalisable at a population level.

Pattern of Malocclusion Among Orthodontic Patients in East Coast of Sabah

This study reviewed the pattern of malocclusion among orthodontic patients in East Coast of Sabah and the type of treatment indicated for the patients. A total of 138 pre-treatment orthodontic records of patients who attended the orthodontic consultation clinic in year 2018 were included in this cross-sectional retrospective study. Data taken were demographic data, source of referral, BSI (British Standards Institutes) incisor classification, skeletal pattern, and type of treatment. All data were analysed descriptively using Stata 15. Based on the results, mean age of the patients was 16.89 ± 0.37 years. More females sought orthodontic treatment (n=101, 73.19%) than males. Majority of the patients were Chinese (n=68, 49.28%) and Bumiputera Sabah (n=55, 39.86%). Main source of referral was from dental officers (n=128, 92.75%). The distribution of malocclusion showed high percentage of Class II division 1 (n=56, 40.58%), followed by Class III (n=45, 32.61%), Class I (n=34, 24.64%) and Class II division 2 (n=3, 2.17%). For skeletal pattern, more patients presented with Class II (n=54, 39.13%), while the number of patients presented with Class I and Class III were equal (n=42, 30.43%). Class III malocclusion (n=29, 42.65%) and Class III skeletal pattern (n=29, 42.65%) were more common in Chinese patients. Treatment indicated was mostly fixed orthodontic appliance (n=120, 86.96%). In conclusion, Class II Division 1 malocclusion and Class II skeletal pattern were most common among the patients. Class III malocclusion and Class III skeletal pattern were typical features among the Chinese patients. Fixed orthodontic appliance was the most common treatment method. DOI : http://dx.doi.org/10.17576/JSKM-2021-1902-06

CLINICAL CASE OF DENTINE DYSPLASIA TYPE I

Developmental dental hard tissues disorders are rarely diagnosed both in children and adults, and their treatment is a problem for dentist. Despite the fact that molecular genetics studies allow to discriminate some dentine disorders, pathogenesis of radicular dentin dysplasia is still obscure. Type I dentin dysplasia is characterized by normal or slightly coloured crowns with no roots or only rudimentary roots, reduced pulp space in permanent teeth and incomplete or total obliteration of the pulp chambers, and periapical radiolucent areas or cysts which might result in premature loss of tooth. Fortunately, teeth demonstrate higher resistance to caries than normal teeth do.&#x0D; Dentin dysplasia type II is characterized by yellow, brown, grey, translucent primary teeth with complete pulpal obliteration. Permanent teeth are normal or might be slightly coloured. Roots are normal in size, but pulp chamber has pulp stones. A third type of dentine dysplasia or focal odontoblastic dysplasia has radiographic aspects of the other two types of disease.&#x0D; Also dentine dysplasia type I has subtypes Ia, Ib, Ic and Id. Dentine dysplasia Ia is characterized by complete obliteration of the pulp, disorder of root development, and many periapical radiolucent areas. A single small horizontally oriented and half-moon shaped pulp is presented in case of dentine dysplasia Ib, roots have a few millimetres length and frequent periapical radiolucencies. Dentine dysplasia Ic is characterized by the presence of two horizontal or vertical semicircle-shaped pulpal remnants which surround dentine in pulp chamber. Also teeth have shortened roots and variable periapical radiolucencies. Dentine dysplasia Id is characterized by the distinct pulp chambers with pulp stones in the coronal third of the root canal; periapical radiolucencies are possible as well. Aim of this study was to analyse clinical case of dentine dysplasia in 8,5-year-old boy.&#x0D; A 8,5-year old boy patient with parents came to a dental office due to caries cavity in tooth 62. Shape of tooth crowns was not changed and teeth with no signs of mobility; white lines and spots on teeth are were detected. Based on age, the decision of orthopantomogram was made to evaluate status of primary and permanent teeth. The image showed almost obliterated pulp chamber in both erupted and developing teeth and considerably shortened, blunted and malformed roots without a visible lumen of root canals in primary teeth. Periapical lesions were found about roots of primary molars and follicles of teeth 12 and 14 without caries lesions.&#x0D; Patient's medical history revealed no disturbance in general health. Clinical examination of the patient's mother did not show dental hard tissues disorders, but radiograph examination revealed such disorder in the orthopantomogram. Thus, history, clinical and radiographic findings revealed this case as dentine dysplasia type I subtype 1c inherited from mother.&#x0D; Oral rehabilitation of patients with dentine dysplasia type I require effective prevention and a complex approach. Thus, meticulous oral hygiene measures and dietary instructions, regular check-ups twice a year were established for this patient; orthodontic consultation was recommended. Varnish «Ftoplen-LC» was applied on the permanent teeth 3 times. To prevent early exfoliation, plan of preventive measures was developed included application of fluoride varnish twice a year and fissure sealing in the premolars in 9-10 years and in the second premolars in 12-13 years.&#x0D; Treatment of dentine dysplasia I type that depends on patient age and severity of disease may include also filling of carious teeth, orthodontic, surgical and orthodontic treatment. In this regard, dentist has to know developmental dental hard tissues disorders and select measures to prolong the retention of affected teeth maintaining them as long as possible.

Are the Reasons Why Patients Are Referred for an Orthodontic Visit Correct?

Who does refer patients for an orthodontic consultation? Which are the main reasons for the referral? Does the visit of the orthodontic specialist confirm these reasons or reveal undiagnosed problems? Is there the risk that only evident dental problems are addressed, while craniofacial malformations remain underdiagnosed? This cross-sectional epidemiologic study aims to answer these questions, analysing the clinical data collected during the orthodontic visits of 500 Caucasian young patients referred to a public health structure of northern Italy. All patients were visited by the same expert specialist in orthodontics. Clinical data were collected, analysing both dental and skeletal features. The reasons for the referral of the visit were analysed and compared with the specialistic diagnoses. In our sample, dentists, relatives/friends and paediatricians were the major source of the referrals, followed by family doctors and other facial specialists. In most cases, the reasons for the referral were dental irregularities, but approximately 80% of dental irregularities were associated with undiagnosed facial dysmorphism. Skeletal facial anomalies need an early diagnosis to prevent the development of severe facial malformations that would require invasive and expensive treatments. These findings reveal poor diagnostic skills regarding skeletal anomalies in dentists and paediatricians and the need for better specific training.

Patient, clinician and independent observer perspectives of shared decision making in adult orthodontics.

To investigate and compare the extent of shared decision making (SDM) in orthodontics from the perspective of patients, clinicians and independent observers. A cross-sectional, observational study. NHS teaching hospital. A total of 31 adult patients and their treating clinicians were included in the study. The extent of SDM in new patient orthodontic consultations was measured using three versions of a validated instrument: the self-administered patient dyadic-OPTION scale; the self-administered clinician dyadic-OPTION scale; and an independent observer-rated OPTION12 scale. Patients and clinicians completed the 12-item dyadic-OPTION questionnaire independently at the end of the consultation to rate their perceived levels of SDM. The consultations were also audio-recorded and two calibrated raters independently rated the extent of SDM in these consultations using the OPTION12 scale. There was excellent inter-rater reliability between the two independent raters using the OPTION12 scale (intraclass correlation coefficient (ICC) = 0.909). The mean patient, clinician and independent observer OPTION scores for SDM were 90.4% (SD 9.1%, range 70.8% to 100%), 76.2% (SD 8.95%, range 62.5% to 95.8%) and 42.6% (SD 17.4%, range 13.5% to 68.8%), respectively. There was no significant correlation between the OPTION scores for the three groups (ICC = -0.323). The results showed that generally high levels of SDM were perceived by patients and clinicians but lower levels of SDM were scored by the independent observers. However, it could be argued that the patient's perception of SDM is the most important measure as it is their care that is affected by their involvement.