Untreated Malocclusions Research Articles

Impact of untreated dental caries and dental pain on sadness related to oral health of Brazilian children.

Children should feel sad when they believe that a negative outcome is permanent. The sadness that an oral problem might bring tends to contribute to children's loneliness and increase the social stress levels. The aim of this study was to evaluate the impact of untreated dental caries, dental pain, malocclusion, and traumatic dental injury on prevalence of sadness related to oral health among Brazilian children. This cross-sectional study was carried out with 397 children aged 8-10years randomly selected from public and private schools in Diamantina, Brazil. The Brazilian version of the CPQ8-10 was applied. Sadness was collected through the question, "In the last month how often did you feel sad because of your teeth or mouth?" and dental pain through the question, "In the last month, how many times have you had pain in your teeth?" One calibrated examiner (Kappa value intra examiner: 0.77-0.91; Kappa value inter examiner: 0.80-1.00) performed the exam for dental caries (DMFT), malocclusion (DAI), and dental trauma (O'Brien). Parents answered questions addressing socioeconomic issues. Descriptive analyses, Chi-square test, and hierarchical Poisson regression models were performed (IC 95%; p < 0.05)." The prevalence of sadness related to oral health was 30.5% (n = 121). Sadness related to oral health was associated with untreated dental caries (PR: 1.46; 95% CI 1.32-2.46; p = 0.001) and dental pain (PR: 2.91; 95% CI 2.00-4.22; p < 0.001). Other clinical variables analyzed (traumatic dental injury and malocclusion) were not significantly associated with sadness related to oral health. Children with untreated dental caries and dental pain presented a higher report of sadness related to oral health.

Untreated malocclusions and oral health status of an urban population in South-South Nigeria

&#x0D; &#x0D; &#x0D; &#x0D; Objective: Lack of awareness and an accompanying lack of knowledge results in a lack of utilization of dental services and a consequent increased burden of oral disease. This study assessed untreated malocclusions and the oral health status of an urban population.&#x0D; Methods: A descriptive cross sectional study design was employed. Data was collected from consenting participants using an interviewer administered questionnaire after which an intraoral examination was carried out on each participant. Data was analysed using the SPSS version 20 and the level of significance set at p&lt;0.05.&#x0D; Results: There were a total of 403 participants in this study. About a tenth of the participants indulged in oral habits 41 (10.2%). Untreated malocclusions in the form of tooth displacements 35 (8.7%), rotations 32 (7.9%), crossbite 9 (2.2%) and scissors bite 1 (0.3%) were seen in the study population. Majority, 383 (95%) used a toothbrush and flouridated toothpaste to clean their teeth and 264 (65.5%) brushed once a day. Most of the participants 281 (69.7%) had good oral hygiene.&#x0D; Conclusion: Several untreated malocclusions comprising tooth rotations, displacements, crossbite, scissors bite and anterior open bite were seen in our study population. Their utilization of dental services was poor but oral health practices were good which translated to good oral hygiene and low DMFT.&#x0D; &#x0D; &#x0D; &#x0D;

Oral Health Impact Profile in Orthodontic Patients with Ectopic Canine: A Prospective Clinical Intervention of Four Treatment Modalities.

This study evaluated the oral health-related quality of life (OHRQoL) in Saudi subjects with ectopic canine, severe crowding, and class I normal occlusion. Moreover, we assessed the differences among orthodontic treatment modalities (OTM) in the ectopic canine group. Study design: Retrospective and prospective evaluation. A total of 96 subjects were assessed for OHRQoL using the Oral Health Impact Profile, English version (OHIP-16). Initial comparison of the baseline data of ectopic canine subjects was made with severe crowding (>8 mm) and class I normal occlusion with the matched number and age of the subjects in later groups. Moreover, a comparison of OHIP-16 scores among four OTM in the ectopic canine group, baseline, 1 day, and 28 days after treatment were performed. OHIP-16 scores of ectopic canine, severe crowding, and class I normal occlusion group were 33.06, 33.09, and 26.43, respectively. Subjects with ectopic canine and severe crowding reported a significantly greater negative impact in terms of embarrassment, avoiding smiling, and lack of self-confidence. OHRQoL had no significant changes among the four OTM groups (p > 0.05). Untreated malocclusion had a significant negative impact on OHRQoL. The negative impact was seen in several domains 1 day after treatment, and gradual improvement was noted 28 days after treatment.

The relationship between malocclusion and oral health-related quality of life among adolescents: a systematic literature review and meta-analysis.

Malocclusion is a deviation from an anatomical norm that occurs in various populations. Evidence shows that it has physical and psychological implications as well as an influence on the patient's oral health-related quality of life (OHRQoL). Self-perception of oral health plays an important role in the understanding of malocclusion's influence on the quality of life. Malocclusion has been reported to impair a patient's function, appearance, interpersonal relationships and psychological well-being. The aim of this study was to investigate whether adolescents aged between 11 and 18 years with malocclusion are at increased risk for having a high level of OHRQoL compared with those without malocclusion. The Ovid Medline, Embase and Scopus databases were used to identify studies measuring the association between malocclusion and HRQoL. Only cross-sectional studies were included, and the following inclusion criteria were used: subjects were systemically healthy; data were available for untreated malocclusion and OHRQoL; malocclusion was measured by Dental Aesthetic Index and Index of Orthodontic Treatment Needs; OHRQoL was assessed by Child Perception Questionnaire, Child Oral Health Impact Profile and Child Oral Health Impact Profile; and the paper was published in English. Data were extracted by two independent reviewers. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to establish the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence quality assessment tool was used to assess the impact of malocclusion on adolescents across studies. The initial search yielded 530 papers. Eleven cross-sectional studies were included in the meta-analyses, and all data describing the relationship between malocclusion and OHRQoL were gathered via a structured questionnaire. Our results showed that malocclusion is linked to decreased OHRQoL in children and adolescents aged between 11 and 18 years in continuously analysed studies. However, in dichotomously analysed studies, it was shown that young people without malocclusion are linked to decreased OHRQoL. Adolescents with severe levels of malocclusion might have among the worst levels of OHRQoL. The effects of malocclusion on OHRQoL were influenced by the age of the adolescents as well as by their culture and environment. PROSPERO (CRD42020178657).

Relationship Between the Severity of Malocclusion and Oral Health Related Quality of Life: A Systematic Review and Meta-analysis.

To investigate the impact of untreated malocclusion on different aspects of oral health-related quality of life (OHRQoL). All relevant literature published up to February 18, 2016 was collected from nine electronic databases. To make studies comparable, studies that used the dental aesthetic index (DAI), index of orthodontic treatment need (IOTN), or index of complexity, outcome and need (ICON) to measure malocclusion and oral health impact profile (OHIP) to measure OHRQoL were selected for systematic review. Meta-analysis, two independent-samples t-test and binary logistic regression were used to test whether different malocclusion severity groups had different OHIP scores. A total of 564 non-duplicate publications were identified first. Of these, 13 studies were included in this review. All studies had a cross-sectional design and most of them used convenience samples. Eleven studies presented a significant result about the association of malocclusion and OHIP scores. Statistical analyses showed that malocclusion had an impact on all subscales scores, and more severe malocclusion indicated higher OHIP scores on the subscales of physical disability, physical pain, psychological discomfort, psychological disability, and social disability. Untreated malocclusion was significantly associated with OHRQoL. The more severe the malocclusion, the worse was the impact on some physical domains and all psychosocial domains of OHRQoL. There was a lack of longitudinal population-based studies to confirm this result.

The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies.

Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life. To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents. Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low. The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL. The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

A 57-year follow-up of occlusal changes, oral health, and attitudes toward teeth

Very few studies have addressed long-term development and risks associated with untreated malocclusion. The purpose of this study was to examine changes in occlusion in a lifelong perspective and to compare oral health and attitudes toward teeth among persons with malocclusion with those having normal occlusion. In 1950 an epidemiologic survey of 2349 8-year-olds was conducted and included 4 intraoral photographs. Three selected samples with different malocclusions (deep bite, crossbite, or irregular teeth) and 1 sample with normal occlusion (a total of 183 subjects) were, 57 years later, invited for examination and an extensive interview about dental experiences and attitudes. Sixty-nine responded (38%) and constitute the subjects studied. Malocclusion remained the same or worsened except in subjects having deep bite in childhood, which in some improved and in others became worse. Crowding generally increased. Sixteen persons reported moderate or severe temporomandular joint (TMJ) problems, and of these 7 belonged to the group with crossbite in childhood. With few exceptions, the subjects in all samples had good oral hygiene, visited the dentist regularly, and had well-preserved dentitions. Mean number of missing teeth was significantly lower among those with normal occlusion compared with the malocclusion groups. Individuals with normal occlusion responded favorably to all questions related to attitudes and experiences about their teeth, while responses in the malocclusion groups varied. Persons with the particular malocclusions examined experienced more problems related to teeth later in life compared with those having normal occlusion in childhood.

Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population

The purpose of this study was to evaluate the effects of malocclusion and orthodontic treatment on adolescent self-esteem. A total of 4509 middle school students were clinically evaluated for dental crowding. Lip protrusion was also measured with a specially designed ruler. Rosenberg's self-esteem scale was used to determine each subject's level of self-esteem. The results showed that sex played a role in the relationship between self-esteem and malocclusion. For the girls, crowding of the anterior teeth had significant effects on their self-esteem; however, there was no significant difference in the boys' self-esteem. After fixed orthodontic treatment, the girls had higher self-esteem than the untreated malocclusion group. Girls with an ideal profile and good tooth alignment also showed higher self-esteem than students with crowding or protrusion. This clinical study proved that malocclusion and fixed orthodontic treatment can affect self-esteem in adolescent girls.

Longitudinal craniofacial changes in Japanese adults with untreated maxillary and mandibular protrusions

This study evaluates the craniofacial change during the third decade of life and compared the changes that occurred in subjects with normal occlusion and untreated malocclusions. 10 cases each of normal occlusion, untreated maxillary protrusion and mandibular protrusion were subjected to cephalometric analysis and model analysis. The mean age at the beginning of the observation (T1) was 24 years, and the observation period (T2) was approximately 13 years in three groups. There was no significant difference in any cephalometric values between T1 and T2 in the normal occlusion group. The SNB angle was slightly decreased, the Y-axis was increased, and upper incisors were lingually inclined in the maxillary protrusion group and increasing of overjet and decreasing of overbite was observed in the mandibular protrusion group. In model analysis, the arch length discrepancy (ALD) and the inter-molar width (IMW) were slightly increased in the lower arch in the normal occlusion group and the upper arch length (AL) had decreased in the mandibular protrusion group. In conclusion, significant differences were found in the changes of several skeletal and dental parameters between normal occlusion and untreated malocclusion subjects in the third decade of life. These changes in the third decade of life should be considered in order to plan the orthodontic treatment and evaluate the long-term stability in the patients with maxillary and mandibular protrusion.

Impacts on Daily Performances Attributed to Malocclusions Using the Condition-Specific Feature of the Oral Impacts on Daily Performances Index

To assess the prevalence, intensity, and extent of sociodental impacts attributed to malocclusions by sex, socioeconomic status, and normative orthodontic treatment need level. One thousand sixty 15- to 16-year-old adolescents without history of previous or current orthodontic treatment were randomly selected from all secondary schools in Bauru, Brazil. Interviews were done to collect information about sociodemographic variables and sociodental impacts on quality of life attributed to malocclusions using the Oral Impacts on Daily Performances Index. Adolescents were also clinically examined using the Index of Orthodontic Treatment Need. Statistical comparison by covariables was performed using chi(2) and Kruskal-Wallis tests. The prevalence of condition-specific impacts (CSIs) was 24.6%. Among adolescents with CSIs, 52.1% reported severe or very severe intensity and 77.4% reported impacts on only one daily performance, commonly, smiling. The prevalence, intensity, and extent of CSIs differed by level of normative orthodontic treatment need but not by sex or socioeconomic status. However, among adolescents with definite normative orthodontic treatment need, 24.5% reported CSIs of severe or very severe intensity, whereas among those with moderate or slight/no need, 13.0% and 7.9%, respectively, experienced CSIs of severe or very severe intensity. Untreated malocclusions have physical, psychological, and social consequences on quality of life of Brazilian adolescents. However, because adolescents with a definite normative orthodontic need are considered by orthodontists as in need of care, these results raise the issue of whether all these adolescents should be considered for orthodontic attention since most had no perceived impacts on performing their daily life activities.

Maxillary and Mandibular Dentoalveolar Heights of French-Canadians 10 to 15 Years of Age

To establish reference data for anterior and posterior dentoalveolar heights of growing French-Canadians with untreated normal occlusions and malocclusions. The mixed longitudinal sample includes 227 French-Canadians, 119 male and 108 female, with cephalograms taken annually between 10-15 years of age. Maxillary and mandibular dentoalveolar heights were measured as the perpendicular distances of the incisor tips and first molar mesial cusp tips to the palatal (ANS-PNS) and mandibular (Go-Me) planes. Male dentoalveolar heights were significantly (P < .05) greater than female heights at all ages. Dentoalveolar heights at 15 years of age were significantly larger (P < .05) than at 10 years of age, with differences ranging from 2.1-4.2 mm in male subjects and from 2.1-3.8 mm in female subjects. The greatest difference in dentoalveolar heights between the 10- and 15-year-old age groups was for the maxillary first molar; the maxillary central incisor height showed the smallest age effects. The coefficients of variation were greater for the maxillary than the mandibular dentoalveolar heights. Correlations of dentoalveolar heights within jaws ranged from 0.53 to 0.82; correlations between jaws ranged from 0.30 to 0.44. The mandibular heights showed the strongest associations. French-Canadian adolescents require age- and sex-specific reference data for dentoalveolar heights.

Dental Trauma Due to Sport in the Pediatric Patient

Dental trauma due to sport is devastating to any athlete but is made worse when the athlete is young and still growing. Orofacial trauma is relatively common in the pediatric population and can have significant management problems. Continued maxillary and alveolar growth, development, and maturation of individual teeth, as well as behavioral considerations create unique challenges in the management of this population. Children and youths have increased risk factors for dental trauma due to sports, including untreated malocclusions, an increase in risk-taking behavior, and undeveloped coordination and skill levels. This review article aims to increase awareness as to the role of sports in dental and orofacial injuries, discuss risk factors for this trauma as well as its prevention, and outline risk minimization for the pediatric athlete.

A study of clinical signs and symptoms of temporomandibular dysfunction in subjects with normal occlusion, untreated, and treated malocclusions

In the light of the universally growing concern over the suggested relationship between orthodontic treatment and temporomandibular (TM) dysfunction, the purpose of the present investigation was to compare the status of signs and symptoms of TM disorders in three groups of adolescents and young adults. The groups consisted of 30 persons with normal occlusions, 41 with untreated malocclusions, and 31 with treated malocclusions. The clinical status and subjective symptoms of TM dysfunction were recorded according to the principles introduced by Helkimo. The results showed that the normal occlusion group had the maximum number of persons free from any dysfunction, but the differences between the groups in the distribution of persons according to the anamnestic and clinical dysfunction indices were not significant. The only statistically significant finding was the difference in the clinical dysfunction index scores of the persons with normal occlusions and untreated malocclusions. According to anamnesis, the most frequently reported symptoms were related to periods of stress. Among the clinical signs and symptoms, the most commonly occurring were crepitations on palpation and sounds on auscultation of the joints in all the three groups. In conclusion, the absence of substantial differences between the three groups indicates that the role of orthodontic treatment in either precipitation or prevention of TM dysfunction remains questionable.

Long-term periodontal status after orthodontic treatment

This study evaluated the clinical periodontal status of persons who had completed orthodontic therapy at least 10 years previously (study) and compared the findings to those of adults with untreated malocclusions (control). Subjects in the study (n = 112; 63 female subjects, 49 male subjects; mean age 29.3 ± 4.2 [SD] years) and control (n = 111; 62 female subjects, 49 male subjects; mean age 32.9 ± 6.5 years) populations underwent a comprehensive periodontal examination that consisted of measurements taken at six points around the circumference of each tooth: (1) plaque, (2) visual inflammation, (3) bleeding after probing, (4) pocket depth, (5) gingival recession, and (6) loss of connective tissue attachment. Data from the individual measuring points were organized into 14 different combinations of either tooth types or surface locations; each was subjected to a four-way ANOVA partitioned on group (study vs. control), sex, socioeconomic status, and malocclusion type. The results showed that differences in age distribution within the groups were affecting the comparisons between the groups. Consequently, the groups were balanced for age and analyses were done to investigate group differences by means of multiple regression techniques. The comparisons showed no significant differences between the groups for any of the periodontal variables. It was concluded that orthodontic treatment during adolescence had no discernible effect upon later periodontal health.

Tooth morphology and lower incisor alignment many years after orthodontic therapy

The dental models of seventy-seven orthodontically treated patients were evaluated to determine the contribution of lower incisor tooth dimensions to their alignment many years after treatment. Tooth dimensions included the maximum mesiodistal (MD) and faciolingual (FL) dimensions and the shape ratio represented by MD/FL. Incisor alignment was assessed by means of Little's irregularity index, and all measurements were recorded to the nearest 0.1 mm with modified dial calipers. Multiple regression analysis revealed that the total contribution of all these lower incisor dimensions accounted for only 7.4% of the variability in their alignment, which was not statistically significant. A similar lack of association between lower incisor tooth dimensions and their alignment was found in a sample of eighty-six adults with untreated malocclusions. It therefore appears that the size and shape of the lower incisors do not significantly contribute to their alignment many years after orthodontic treatment.

Malocclusion at adolescence related to self-reported tooth loss and functional disorders in adulthood

It has been argued that malocclusion may predispose to tooth loss and functional disorders of the masticatory system. It was the purpose of this study to examine relationships between untreated malocclusion, recorded at adolescence, and self-reported tooth loss and functional disorders in adulthood. In 1965–1966, the occurrence of morphologic traits of malocclusion was recorded in 977 Danish adolescents who did not have access to organized orthodontic care. Fifteen years later, 841 (86%) of these subjects responded to a questionnaire screening for tooth loss, symptoms involving the temporomandibular joints and muscles, and some other symptoms of dysfunction. The occurrence of malocclusion was related to the symptoms of the temporomandibular joints and muscles and other functional symptoms. Only a few significant coefficients of correlation were observed. Extreme maxillary overjet (greater than 9 mm) and frontal open bite showed significant correlations with unsatisfactory biting ability. Crossbite was correlated positively with speech defects but negatively with tenderness or fatigue of the cheeks; unilateral crossbite was associated with locking of the mandible. It was concluded that the untreated morphologic traits of malocclusion did not seem to predispose to tooth loss or functional disorders of the masticatory system as reported at the age of 30 years.

Long-term status of temporomandibular joint function and functional occlusion after orthodontic treatment

The status of temporomandibular joint (TMJ) function and functional occlusion was evaluated by means of a questionnaire and a detailed clinical examination in a group of seventy-five subjects between 25 and 55 years of age who had been treated orthodontically with full fixed appliances at least 10 to 35 years previously, during adolescence. The findings were compared to those of a control group of adults with untreated malocclusions. The findings indicate that in patients who underwent orthodontic treatment many years previously the prevalence of TMJ signs/symptoms is similar to that of a control group of adults with untreated malocclusions. However, a trend exists which suggests that subjects who have undergone extensive fixed appliance orthodontic treatment many years previously may possibly have a lower prevalence of TMJ problems than a similar group of adults with untreated malocclusions. A similar high prevalence of nonfunctional occlusal contacts occurred in the orthodontically treated and control groups. Also, a high prevalence of mandibular shift from the retruded contact to the intercuspal position was evident in both groups, with the shift being significantly greater in the control group than in the orthodontic group. When subjects in the orthodontic and control groups were combined, no relationship was evident between subjects exhibiting signs or symptoms of TMJ dysfunction and the presence of nonfunctional occlusal contacts and mandibular shifts.

The Social Importance of Orthodontic Rehabilitation: Report of a Five Year Follow-Up Study

The research tested the assumption that orthodontic treatment might alleviate social discrimination due to malocclusion. Two hundred and fifty-two persons were interviewed approximately five years after finishing orthodontic treatment and compared to sixty-seven persons with untreated malocclusions who were also interviewed to see if there were differences which might be due to orthodontic treatment in social rank variables, courtship, self-concept, and in personality measures. There were small differences, barely statistically significant, in occupational rank but not in social class or educational level, in engagement and marriage but not in other dating patterns, in assessment of personal appearance but not in self-esteem, in anxiety scores but not in extraversion or neuroticism. The relatively small differences do not permit the unequivocal rejection of the possibility that orthodontic treatment makes little or no social difference, perhaps because malocclusion does not often serve as a basis for social discrimination or because the untreated persons compensate in their role performance.

An electromyographical comparison of the temporal and masseter muscles of orthodontically treated and untreated malocclusion of the teeth: By Ralph E. Karau, D.D.S., Northwestern University Dental School, Chicago, Ill.

An electromyographical comparison of the temporal and masseter muscles of orthodontically treated and untreated malocclusion of the teeth: By Ralph E. Karau, D.D.S., Northwestern University Dental School, Chicago, Ill.