Faculty Bibliography

INTRODUCTION: The purpose of this study was to identify variables of dental malocclusion with the greatest effect on sound production that can be easily identified during an orthodontic assessment. METHODS: One hundred fifteen patients (8.2-36 years of age) seeking orthodontic evaluation were assessed for speech sound production abnormalities. An orthodontic clinical examination assessed Angle classification, overjet, overbite, crowding, spacing, and crossbites. A standard speech sample was elicited from each subject. RESULTS: The results indicated that 71 (62%) of the subjects made a production error, particularly with the /s/ and /t/ sounds. However, auditory distortions occurred in 12 subjects (20%), and 56 (80%) subjects had visual distortions of the sound. An open bite (>2 mm) was the key malocclusal factor underlying speech sound errors. There was statistical significance between the Orthodontic Treatment Priority Index and the sound errors of /s / and /t/ (mean score of 9.54 vs 6.29 for subjects without sound errors). CONCLUSIONS: Predictive malocclusal traits are associated with speech sound production errors. The more severe or handicapping the malocclusion, the more likely that a speech sound error will occur. Open bites of 2 mm are associated with sound production errors. Visual inaccuracy of the sound occurs with more frequency than auditory inaccuracy and is the most common articulation error noted with occlusal irregularities.

OBJECTIVE: To explore the impact of fixed labial orthodontic appliances on speech sound production. MATERIALS AND METHODS: Speech evaluations were performed on 23 patients with fixed labial appliances. Evaluations were performed immediately prior to appliance insertion, immediately following insertion, and 1 and 2 months post insertion. Baseline dental/skeletal variables were correlated with the ability to accommodate the presence of the appliances. RESULTS: Appliance effects were variable: 44% of the subjects were unaffected, 39% were temporarily affected but adapted within 2 months, and 17% of patients showed persistent sound errors at 2 months. Resolution of acquired sound errors was noted by 8 months post-appliance removal. Maladaptation to appliances was correlated to severity of malocclusion as determined by the Grainger's Treatment Priority Index. Sibilant sounds, most notably /s/, were affected most often. CONCLUSIONS: (1) Insertion of fixed labial appliances has an effect on speech sound production. (2) Sibilant and stopped sounds are affected, with /s/ being affected most often. (3) Accommodation to fixed appliances depends on the severity of malocclusion.

Our College recently convened a series of retreats bringing together faculty, administrators and employees to identify common concerns. Stakeholders working independently in small groups separately and collectively agreed that our major organizational concern was communication. This theme played out in various ways. From not knowing what was going on beyond an individual's immediate work area to broader interpersonal challenges. Some felt a lack of caring or appreciation. Often the word, "respect," was used. Perceived deficiencies extended to students, faculty, administrators, staff, and most troubling, to patients. Communication skills are recognized as essential to professional competence by the Commission on Dental Accreditation, the American Dental Education Association, and the Inter professional Educational Collaborative. It is a theme that crosses disciplines and is foundational to patient-centered care. As scientifically driven evidence based healthcare and technologies progress, the emotional, psychological, social and cultural needs of patients may be neglected. Communication skills centered on empathy and showing you care, yield benefits to both the doctor and patient in terms of satisfaction, compliance, and treatment outcomes. (C) 2016 Elsevier Inc. All rights reserved.

White spot lesions (WSLs) are an all too common negative outcome of orthodontic treatment: a disheartening truth in an esthetically driven profession. WSLs are areas of enamel demineralization 100-150-mu m deep, with an intact porous surface layer, which can progress until a complete inward collapse of the surface occurs. Their un-esthetic opaque appearance is potentially reversible, but irreversible once cavitated. Clinically detectable WSLs can occur as early as 1 month after fixed appliance placement. It is estimated that 50% of patients develop WSLs in at least one tooth by the end of orthodontic treatment. Although orthodontists have recognized this issue, the problem still persists. An immediate application of fluoride to a white spot lesion will cause a rapid surface remineralization, leaving deeper layers demineralized, so prevention of lesion progression is necessary for an ideal esthetic outcome. Aside from excellent oral hygiene, fluoride varnish, MI Paste, and smooth surface sealants are currently the primary methods of WSL prevention. There is an existing body of research related to the use of topical fluoride and calcium-phosphate pastes to prevent demineralization during orthodontic treatment, including at-home topical treatments. However, the self-reported compliance rate is approximately 50%. Professional fluoride varnish is thought to have the advantages of reducing demineralization without being technique sensitive. Other methods of WSL prevention are available, such as placement of sealants on facial surfaces of teeth, but preliminary research has shown conflicting results on their effectiveness. Regression of WSLs after treatment is attributed to gradual surface abrasion of tooth structure. Research has shown no improvement in WSLs when comparing non-invasive treatment methods such as MI Paste to routine oral hygiene practice. Success has been shown in treating arrested WSLs with a resin infiltration technique, but this is most useful on a small scale. (C) 2016 Elsevier Inc. All rights reserved

Optimal communication between practitioners, their patients and staff requires a clear and focused understanding of what the mutual treatment goals are. Education is the key to making such communication successful and at all levels it needs to be clear and consistent. It begins with the initial phone call and reinforced by all members of your practice team using coherent language to build trust. The use of visual aids helps to educate and explain treatment plans supporting the parental/patient confidence in their decision to proceed with care. Social media can help us stay connected with our patients/parents as well as referrers creating a de facto "dental family or home base." Generating a close relationship with our referrers and their team through contact and "learning opportunities" is a substantial tool to create the consistency and focus on our shared goal of optimal patient care. Through clinical scenarios the above concepts will be discussed along with potential strategies offered on how to implement them into practice. (C) 2016 Published by Elsevier Inc

Pre-eruptive intracoronal radiolucencies (PIR) and post-eruptive hidden caries (PHC) are non-cavitated intracoronal dental lesions that are usually detected only through radiographic observation. As a result, these lesions present numerous challenges for the dental healthcare provider that markedly differs from that of other non-cavitated dental lesions (early/incipient/demineralized white spots). Best practice principles should be employed, for example, timely recognition and radiographic surveillance/observation, logical treatment management, along with judicious communication amongst all parties involved (parent/guardian, pediatric dentist and orthodontist). This article attempts to review and discuss the literature of these conditions and present a case report of a patient with PIR. (C) 2016 Elsevier Inc. All rights reserved

INTRODUCTION: Esthetic considerations play an increasingly important role in patient care, and clinicians need a methodology that includes imaging techniques to capture the dynamic nature of the smile. Photographs of the posed smile are routinely used to guide diagnosis and treatment, but there is no standardized and validated method for recording the dynamic smile. The purposes of this study were to (1) determine whether a posed smile is reproducible, (2) compare visual and verbal cues in eliciting a smile, and (3) compare the diagnostic value of videography and photography in evaluating a patient's smile. METHODS: The smiles of 22 subjects were simultaneously photographed and videotaped on 2 separate occasions. For objective comparisons, measurements of the smile were obtained from 8 x 10 color still photographs and selected digitized video images. A panel consisting of a layperson, an oral surgeon, an orthodontist, and a prosthodontist subjectively assessed the reproducibility of the smile, posed vs spontaneous smiles, and the diagnostic value of video vs still images. RESULTS: Objective measurements showed that the posed smile can be reliably reproduced, whether captured by videography or still photography. However, subjectively, the panel members detected differences between the posed smiles taken on different days 80% of the time. The clinician panel members expressed a strong preference for videography over photography and for the spontaneous over the posed smiles. CONCLUSIONS: This study emphasizes the need to continue to investigate and standardize the methods of eliciting and recording a smile of diagnostic quality.