口腔综合防治措施对正畸儿童龋病和牙龈炎的影响

目的 :本实验通过对年龄 13～ 15岁 ,均为矫治仅 1周的患者进行口腔防治措施及口腔健康教育。方法 :防治措施包括氟制剂和绿茶多酚制剂的应用。对对照组儿童不采取任何防治措施。结果用团体T检验的方法进行统计。结果 :实验组无新龋发生 ,对照组龋均比实验前有所上升 ,但两组之间无统计学上的显著性差异。而实验组儿童口腔内GI、SBI、PLI指数明显降低 ,与对照组相比有显著性差异。结论 :对正畸儿童在矫治期间进行龋病和牙龈炎的防治非常必要 ,它可以防止龋病和牙龈炎的发生。     

洁治对正畸儿童牙周健康状况的影响

目的观察洁治和口腔卫生宣教对正畸患者口腔健康状况的影响。方法选择固定矫治6个月以上的正畸儿童60例,随机分为3组,每组20例,3组均使用同种牙膏、牙刷。实验Ⅰ组行口腔卫生宣教 全口洁治1次;实验Ⅱ组行口腔卫生宣教 全口洁治2次;对照组不采取任何措施。分别于治疗前和治疗后1个月、3个月检查牙龈指数和龈沟出血指数,对所得结果进行统计分析。结果经统计学分析发现,实验Ⅰ、Ⅱ组与对照组间牙龈指数和龈沟出血指数差异有显著性,治疗后1个月和3个月与治疗前相比差异有显著性,而治疗后1个月和3个月间差异无显著性。结论洁治和口腔卫生宣教是维护正畸儿童口腔健康的良好方法。     

Reliability and Validity of the Digigraph? 100 in Orthodontic Diagnosis

Cephalometric analyses of lateral cephalograms allow important statements to be made on diagnosis and treatment planning. Such radiographs should, however, be taken with a considerable reduction in radiation exposure. With the Digigraph^® 100 (Dolphin Imaging Systems Inc., USA) a cephalometric technique based on distance measurements of emitted sonic signals is now available. This study was aimed at determining the degree to which this procedure can cope with the requirements of reliability and validity in the field of orthodontics. For this purpose 50 volunteers were examined by conventional cephalometry with manual tracing of lateral cephalograms as well as by sonic cephalometry, with Jarabak analysis in both cases. In addition an option was available for reading lateral cephalograms into the Digigraph^® by means of a radiography evaluation program. The 31 evaluated parameters were subjected to modified statistical analysis. Good reliability was recorded in the range between 0.96 and 0.99 for eleven sonic cephalometric measurements, whereas 26 values were between 0.69 and 0.95. The validity was significantly lower in comparison to radiocephalometry. In particular, measurements related to landmarks which were difficult to access or could be only indirectly determined, such as the sella point, the articulare point or the apices of the incisors, proved to be weak points of sonic cephalometry. The device is thus indicated rather in the field of communication with the patient or for intermediate examination without radiation exposure. Cephalometry without radiation exposure would represent decisive progress in orthodontic diagnostics. However, some developmental work on the processing software or even the development of a specific sonic cephalometry which deliberately dispenses with parameters that are difficult to record with this procedure is still needed. Zusammenfassung Die kephalometrische Analyse eines Fernröntgenseitenbildes erlaubt es, für die Diagnostik und Planung einer Behandlung wichtige Aussagen zu machen. Die Anfertigung einer solchen Röntgenaufnahme sollte jedoch unter weitestgehender Reduktion der Strahlenexposition geschehen. Mit dem Digigraph^® 100 (Dolphin Imgaing Systems, USA) steht nun eine auf der Distanzmessung emittierter Schallsignale basierende Kephalometrietechnik zur Verfügung. Ziel dieser Studie war es herauszufinden, inwieweit das Verfahren den Anforderungen an Reliabilität und Validität auf dem Gebiet der Kieferorthopädie zu genügen vermag. Hierzu wurden 50 Probanden konventionell kephalometrisch unter manueller Durchzeichnung der Fernröntgenseitenbilder sowie schallkephalometrisch jeweils nach der Analyse von Jarabak untersucht. Zusätzlich bestand die Option, die Fernröntgenseitenbildaufnahmen mit Hilfe eines Röntgenauswerteprogramms in den Digigraph^® einlesen zu lassen. Die 31 ermittelten Parameter wurden einer modifizierten statistischen Analyse zugeführt. Es ergab sich eine gute Reliabilität im Bereich 0,96 bis 0,99 für elf schallkephalometrische Messungen, während 26 Werte zwischen 0,69 und 0,95 lagen. Die Validität im Vergleich zur Röntgenkephalometrie lag deutlich niedriger. Insbesondere erwiesen sich Maße, die sich auf nur indirekt zu bestimmende oder schwer zugängliche Messpunkte wie den Sellapunkt, den Artikularepunkt oder auch die Zahnwurzelspitzen der Inzisivi beziehen, als Schwachstellen der Schallkephalometrie. Die Indikation des Gerätes ist daher eher im Bereich der Kommunikation mit dem Patienten oder für Zwischenuntersuchungen ohne Strahlenexposition zu sehen. Eine Kephalometrie ohne Strahlenexposition wäre ein entscheidender Fortschritt für die kieferorthopädische Diagnostik. Allerdings bedarf es hierzu noch einiger Entwicklungsarbeit bei der Verarbeitungssoftware oder gar der Entwicklung einer eigenen Schallkephalometrie, die bewusst auf die Einbeziehung mit diesem Verfahren schwierig zu erfassender Parameter verzichtet.     

Orthodontic Procedures in the Treatment of Obstructive Sleep Apnea in Children

INTRODUCTION: Even minor dimensional changes in the child's upper airway can already affect the resistance therein. Craniofacial anomalies may constrict the upper airway and are suspected to be a direct cause of obstructive sleep apnea syndrome (OSAS) in children. CASE REPORTS: In the present two cases we report on the successful orthodontic treatment of an 8-year-old girl and a 6 1/2-year-old boy with craniofacial anomalies and severe OSAS diagnosed during a sleep study. The primary treatment aim was to improve the cardio-respiratory situation during sleep by enlarging the upper airway and preventing its collapse. Prior to the onset of treatment we had ruled out the presence in both children of any adenotonsillar hypertrophy requiring surgical treatment. Patient 1 (the girl) presented mouth breathing predominantly while sleeping and a narrow skeletal maxilla that was treated via rapid maxillary expansion followed by a Fr?nkel-II appliance. A function regulator type-II was applied in the second patient, a boy suffering from OSAS, and spinal muscular dystrophy with a narrow skeletal upper jaw and mandibular retrognathism. We were able to successfully treat both cases of obstructive sleep apnea with these orthodontic procedures. CONCLUSION: Orthodontic therapeutic measures should be considered as a causal treatment option in children with OSAS and craniofacial anomalies restricting the upper airway. Parents and patient cooperation, as well as good interdisciplinary care within the field of sleep medicine are mandatory for this kind of treatment.     

Elastics—Their Properties and Clinical Applications in Orthodontic Fixed Appliance Therapy

Abstract

A variety of orthodontic elastics were investigated: firstly to determine any change in length and consequent loss of force of selected orthodontic elastics when subjected to intra and intermaxillary forces under a simulated intra-oral environment (creep test); and secondly, to produce and interpret average stiffness graphs for each type of elastic tested.

Some types of elastic showed a considerable amount of creep and the force produced would fall off even after 1 hour of use, especially when they were employed for intermaxillary traction.

An Instron testing machine was used to produce stiffness graphs. The thinner elastics gave lower stiffness figures but the forces these elastics produced in the mouth were more predictable.     

Prevalence of TMD among Children Provided with Fixed Orthodontic Treatment

BackgroundAccording to available scientific references and textbooks, there are contradictory views concerning the etiology of signs and symptoms of TMD.ObjectivesThe aim of this study was to determine a correlation between the incidence of signs and symptoms of TMD in children aged 12-18 who do not wear a fixed orthodontic appliance and the incidence of signs and symptoms of TMD in children who wear a fixed orthodontic appliance.Material and MethodsThe total number of 120 subjects were included in this survey and divided into two groups. There were 60 respondents in the experimental group that consisted of 30 boys and 30 girls with different types of malocclusion, who were treated with a fixed orthodontic straight wire technique. The remaining 60 respondents, which was a group that also consisted of 30 boys and 30 girls, were patients with neutroclusion.ResultsThe results of the study have shown that the TMJ clicking sound symptom, the most common symptom of TMD, occurs with almost equal prevalence in both groups of respondents; specifically, 56.4% in orthodontic patients, and 46.6% in the control group respondents. A statistically significantly higher percentage of female respondents in both groups have experienced headache problems (p <0.03).ConclusionOn the basis of the statistics obtained as a result of this research, we can come to the conclusion that there is no correlation between the fixed orthodontic treatment and the development of signs and symptoms of TMD.     

One Year in Pittsburgh: Some Experiences of a British Orthodontist Working in an American Orthodontic Department

Abstract

Orthodontic therapy is best carried out in a normal skeletal and soft tissue environment. In patients requiring orthognathic surgery, it is suggested that there are advantages in correcting the skeletal and soft tissue elements as early as possible, and to orthodontically control the occlusion post-operatively. This results in a shorter overall treatment time due to more biologically favourable tooth movement, more predictable occlusal results and better management by the orthodontist. The clinical benefits of post-operative orthodontics are outlined.     

TM Dysfunction in Children: The Development of a Screening Instrument and Parent Questionnaire

This paper outlines preliminary procedures used for developing a reliable, valid, observational screening instrument and parent questionnaire for school-based research on temporomandibular joint (TMJ) dysfunction in children. Potential items for the instrument were developed after a review of the literature and submitted to members of the American Academy of Craniomandibular Disorders for professional validation. The results of the validation effort presented here, complete phase one of a larger study. It is projected that the instruments, once refined, could be used by school health nurses and lay persons for early screening of children exhibiting symptoms associated with TM dysfunction.     

Perceptions of Dutch Orthodontic Patients and Their Parents on Oral Health-Related Quality of Life

Objective:To test the hypotheses that 1) there is no difference between orthodontic patients'' and their parents'' reports of patients'' oral health-related quality of life, and 2) there are no gender differences.Materials and Methods:The sample consisted of 182 orthodontic patients (age range, 8–15) and their parents. Respondents were required to complete the Child Oral Health Impact Profile (COHIP). Items were divided into five different subscales, and scores on all subscales were compared between and within groups. Also, scores on six additional items regarding treatment expectations and global health perception were compared. Two hypotheses were tested: first, that no differences between parents and patients would be detected, and second, that no differences between boys and girls would be found.Results:The first hypothesis could not be rejected. Only a few minor differences between parents and patients were found. The second hypothesis was rejected. Differences between boys and girls were found on the subscales Emotional Well-Being and Peer Interaction, indicating that girls experience more effects of oral health on their quality of life than do boys.Conclusions:Parents'' reports on their children''s oral health-related qualities of life were in agreement with reports of the orthodontic patients. This suggests that parents are suitable alternatives to their children in surveys measuring oral health-related quality of life.     

Validity of Self-reported Tooth Counts During a Telephone Screening Interview

Objectives : Telephone screening has become a common method used in health services research to identify efficiently persons in specific populations of interest. In this research, we used a large-scale telephone screening survey to assess: (1) the effectiveness of the telephone method in gathering tooth count information by measuring response rate (cooperation) to specific questions and (2) the validity of subjects' reports of the number of remaining natural teeth. Methods : We used a telephone screening methodology to identify dentate persons (at least one natural tooth remaining) who were 45 years old or older and resided in one of four counties of north Florida. At a second stage, a sample of the telephone screening participants was selected for further study, which consisted of a baseline in-person interview and a clinical examination. We compared the number of remaining teeth reported during the telephone interview with the number determined at baseline examination. Results : The telephone method was effective at gathering tooth count information, although response rates varied with the level of specificity required. Almost all subjects reported the number of teeth at least at the nominal and ordinal levels, but fewer than three-fourths reported the number at the interval level. When the unit of analysis was the overall sample, self-reported number of teeth was a valid measure of the true number. When the unit of analysis was the individual subject, validity was associated with certain clinical and sociodemographic factors. Conclusion : When the unit of analysis is the overall sample, these results suggest that self-reported tooth counts during a telephone interview are sufficiently valid to meet all but the most stringent data requirements. When the unit of analysis is the individual subject, these tooth counts may not be valid, depending upon the degree of specificity required and subject characteristics.     

The Use of Microimplants in Lingual Orthodontic Treatment

Currently excellent clinical results can and are being achieved with lingual orthodontics. For many patients, due to esthetic considerations, this is their only choice. Certain orthodontists may still feel reluctant or hesitant to attempt this form of therapy; however, several articles^{7, 8, 9, 10 and 11} have shown that with the indirect bonding techniques available, by using straight wire principles and making use of microimplants for anchorage, the technique has been greatly simplified and has introduced significant treatment alternatives in 21st century orthodontics.     

Dentists' Attitudes and Practices Toward Provision of Orthodontic Treatment for Children with Visual and Hearing Impairments

The objective of this study was to determine differences in behavior and attitudes of dentists in Riyadh, Saudi Arabia, in providing orthodontic care for children who are sensory impaired. A self‐administered questionnaire was sent to all dentists working in Riyadh to assess the following domains: personal characteristics of the dentists and their practices, provision of dental care for children who are visually‐impaired (VI) and/or hearing‐impaired (HI), and their attitude toward providing orthodontic care for these children. Attitudes were measured on two scales and the overall score of these two scales represented each respondent's attitude. Thirty percent of the dentists provided dental care for children with VI and 45.3 percent did for children with HI. The provision of orthodontic care was significantly affected by the country in which the dentists had received their dental training, both for children with VI and HI (p<0.01), and by number of years they had been in practice for children with VI (p<0.05). Regression analysis showed that only the country of dental training significantly affected the dentist's attitude score. There were also significant variations in attitudes toward the provision of orthodontic treatment for children with sensory impairment (SI), influenced by dental training and experience. In practical terms, this means that improvement in attitudes needs to be initiated at the dental undergraduate level. Establishing global guidelines for the provision of orthodontic treatment for patients with sensory impairment is likely to assist both professionals and patients.     

Modelling the Validity of Periodontal Disease Screening Questions in a Nondental Clinical Setting

ObjectivePeriodontal examinations are time-consuming and potentially uncomfortable for recipients. We modelled if self-reported questions alone, or combined with objective evidence of periodontal bone loss observable from radiographs, are accurate predictors of periodontitis.MethodsSelf-reported data from the Australian National Survey of Adult Oral Heath 2004-06 were compared with clinical periodontal examinations to assess the validity of 8 periodontitis screening questions in predicting moderate/severe periodontitis. To model alveolar bone loss, a proxy variable simulating radiographic clinical attachment level (rCAL) was created. Three multivariable binary logistic regression models were constructed: responses to 8 screening questions alone (Model 1), screening questions combined with 5 classic periodontitis risk indicators (age, sex, smoking status, country of birth, and diabetes status) (Model 2), and the addition of rCAL (Model 3). Predictive validity was determined via sensitivity (Se) and specificity (Sp) scores and graphically represented using area under the receiver operator characteristic curves (AUROC).ResultsData from 3630 participants periodontally examined determined that 32.4% exhibited periodontitis. Periodontitis risk indicators were all significantly associated with periodontitis case status. Six of 8 screening questions (Model 1) were weak periodontitis predictors (Se = 0.28; Sp = 0.89; AUROC = 0.61). Combining 13 variables for (Model 2) improved prediction (Se = 0.55; Sp = 0.81; AUROC = 0.77). The addition of rCAL (Model 3) improved diagnostic capacity considerably (AUROC = 0.86).ConclusionsSelf-reported questions combined with classic risk indicators are “useful” for periodontitis screening. Addition of radiographs markedly improved diagnostic validity. Based on modelling, nondental health care professionals may provisionally screen for periodontitis with minimal training.