Thalassemias and their dental implications.
(73/688)
Thalassemias constitute a form of anemia that pose clear problems in relation to dental treatment. Dental professionals must be aware of the treatment adaptations required in patients with severe forms of beta-thalassemia. Until medical research is able to afford a definitive solution to these diseases (thereby greatly simplifying the dental management of such patients), effort will continue to center on the improvement of available therapeutic modalities, with the aim of obtaining effective and inexpensive oral chelators and drugs that either individually or in combination allow increases in fetal hemoglobin levels. Undoubtedly, the use of such measures together with serial blood transfusions has made it possible for an ever increasing number of patients with beta-thalassemia to reach adult age, where the provision of integral rather than merely palliative dental treatment must be seriously considered. At present, the clinical orofacial manifestations caused by the erythroid mass expanding the facial bones - resulting in dental malocclusions and protrusions tend to be less intense as a result of early medical treatment. In the future, gene therapy may be expected to allow a normal facial appearance thanks to complete healing of the patient. (+info)
The Aesthetic Component of the Index of Orthodontic Treatment Need validated against lay opinion.
(74/688)
This study aimed to determine the threshold of aesthetic impairment where orthodontic treatment would be sought by a sample of lay people. Using the 10-grade Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN), 215 university students selected the level of aesthetic impairment that represented the point at which they would seek orthodontic treatment. Only nine (4.3 per cent) of the respondents recorded a threshold grade beyond grade 5 in the AC. The AC photograph grade 4 was found to be the most commonly selected threshold photograph. Subjects who visited the dentist every 6 months were more likely to choose a threshold photograph closer to the attractive end of the scale than those who visited their dentist less frequently (P < 0.01). This study, using lay people rather than dental health professionals, suggests that as currently used the AC does not reflect society's aesthetic expectations. The results indicate that when using the AC of the IOTN the 'no need for treatment' category should be grades 1-3 of the AC, rather than grades 1-4. (+info)
Orthodontic aspects of the use of oral implants in adolescents: a 10-year follow-up study.
(75/688)
The aim of the present study was to evaluate the long-term effect of implants installed in different dental areas in adolescents. The sample consisted of 18 subjects with missing teeth (congenital absence or trauma). The patients were of different chronological ages (between 13 and 17 years) and of different skeletal maturation. In all subjects, the existing permanent teeth were fully erupted. In 15 patients, 29 single implants (using the Branemark technique) were installed to replace premolars, canines, and upper incisors. In three patients with extensive aplasia, 18 implants were placed in various regions. The patients were followed during a 10-year period, the first four years annually and then every second year. Photographs, study casts, peri-apical radiographs, lateral cephalograms, and body height measurements were recorded at each control. The results show that dental implants are a good treatment option for replacing missing teeth in adolescents, provided that the subject's dental and skeletal development is complete. However, different problems are related to the premolar and the incisor regions, which have to be considered in the total treatment planning. Disadvantages may be related to the upper incisor region, especially for lateral incisors, due to slight continuous eruption of adjacent teeth and craniofacial changes post-adolescence. Periodontal problems may arise, with marginal bone loss around the adjacent teeth and bone loss buccally to the implants. The shorter the distance between the implant and the adjacent teeth, the larger the reduction of marginal bone level. Before placement of the implant sufficient space must be gained in the implant area, and the adjacent teeth uprighted and paralleled, even in the apical area, using non-intrusive movements. In the premolar area, excess space is needed, not only in the mesio-distal, but above all in the bucco-lingual direction. Thus, an infraoccluded lower deciduous molar should be extracted shortly before placement of the implant to avoid reduction of the bucco-lingual bone volume. Oral rehabilitation with implant-supported prosthetic constructions seems to be a good alternative in adolescents with extensive aplasia, provided that craniofacial growth has ceased or is almost complete. (+info)
Bite force in pre-orthodontic children with unilateral crossbite.
(76/688)
In the present study bite force was examined in pre-orthodontic children with unilateral posterior crossbite and compared with an age- and sex-matched control group. The sample comprised 52 children aged 7-13 years, 26 pre-orthodontic children with unilateral posterior crossbite (crossbite group), and 26 children with neutral occlusion (control group). Unilateral bite force was measured at the first molar by means of a pressure transducer. Furthermore, symptoms and signs of temporomandibular disorders (TMD) and number of teeth in contact in the intercuspal position (ICP) were recorded. In both groups, the maximum bite force increased significantly with age and with increasing stages of dental eruption, but the bite force in both sexes did not differ significantly. There were no significant differences in bite force between sides, but this was significantly smaller in the crossbite group than in the controls (P < 0.001). Regression analysis showed that stage of dental eruption (P < 0.001), number of teeth in occlusal contact (P < 0.01), and unilateral crossbite (P < 0.001) were the only variables significantly correlated with bite force. The number of teeth in contact was significantly smaller in the crossbite group than in the controls (P < 0.05) and the frequency of muscle tenderness was significantly higher in the crossbite group than in the controls (P < 0.05). These results suggest that differences in the muscle function associated with unilateral crossbite lead to a significantly smaller bite force in the crossbite group compared with controls and this difference did not diminish with age and development. These findings indicate that early treatment of unilateral posterior crossbite is advisable to optimize conditions for function. (+info)
Are pre-treatment psychological characteristics influenced by pre-surgical orthodontics?
(77/688)
A number of investigations have looked at psychological changes occurring in association with orthognathic treatment. However, most of these studies have used a pre-surgery questionnaire as the baseline measurement. There is little data relating to the true baseline, i.e. that prior to any active treatment. Until this aspect is investigated, it is not possible to assume that pre-surgery is an acceptable baseline. This questionnaire based study aimed to assess changes in six psychological outcome measures between T1 (prior to any active treatment) and T2 (following pre-surgical orthodontics/prior to surgery). The outcome variables were: state anxiety, trait anxiety, depression, self-esteem, body image, and facial body image. Sixty-two patients (39 females and 23 males) completed both questionnaires. The results showed that intervention, in the form of orthodontic treatment, had a minimal effect on the chosen psychometric outcome variables. There was a significant reduction in satisfaction with body image amongst patients who initially reported mild to moderate dental/facial problems, whilst a moderate increase in satisfaction occurred in those patients reporting severe conditions initially. Also of note were significant increases in state anxiety amongst older patients whilst trait anxiety showed greater increases in females than males. (+info)
Malocclusions in guinea pigs, chinchillas and rabbits.
(78/688)
The types of malocclusions encountered in rodents and lagomorphs are classified. Diagnosis, treatment, and prognosis are reviewed. Some malocclusions are curable, whereas others can only be controlled. The need to perform a complete oral examination and to find a cause for the condition is stressed, as it will seriously affect the prognosis. (+info)
Effectiveness of community-based salaried orthodontic services provided in England and Wales.
(79/688)
OBJECTIVES: To assess the effectiveness of the salaried Community Orthodontic Services in England and Wales, using occlusal indices, and to determine the predictors of treatment outcome. DESIGN: A retrospective investigation. A random stratified sample of districts where Community Orthodontic Services are provided was selected and visited during 1997. METHOD: All community orthodontists in England and Wales, and CDS managers who could be identified were asked to take part in this study. A stratified random sample of 15 per cent of the districts where community orthodontic services were provided was selected and a sample of the records of treated patients was examined. RESULTS: The orthodontists in the sample were providing treatment for patients clearly in need of treatment. There were, however, some variations between districts. Similarly, when the effectiveness of treatment in terms of dento-alveolar change was evaluated, the mean change in PAR and percentage PAR reduction was high. Again, there were variations between the districts. CONCLUSIONS: The Community Orthodontic Service provides effective orthodontic treatment to many individuals clearly in need of that treatment. The most significant predictor of treatment outcome was the use of two-arch fixed appliances, which produced the best treatment outcome (+info)
Are photographic records reliable for orthodontic screening?
(80/688)
AIM: The aim of the study was to evaluate the reliability of a panel of orthodontists for accepting new patient referrals based on clinical photographs. SAMPLE: Eight orthodontists from Greater Manchester, Lancashire, Chester, and Derbyshire observed clinical photographs of 40 consecutive new patients attending the orthodontic department, Hope Hospital, Salford. METHOD: They recorded whether or not they would accept the patient, as a new patient referral, in their department. Each consultant was asked to take into account factors, such as oral hygiene, dental development, and severity of the malocclusion. STATISTICS: Kappa statistic for multiple-rater agreement and kappa statistic for intra-observer reliability were calculated. RESULTS: Inter-observer panel agreement for accepting new patient referrals based on photographic information was low (multiple rater kappa score 0.37). Intra-examiner agreement was better (kappa range 0.34-0.90). CONCLUSION: Clinician agreement for screening and accepting orthodontic referrals based on clinical photographs is comparable to that previously reported for other clinical decision making. (+info)