We aimed to compare the pain discomfort levels between clear aligners and fixed appliances at multiple time points. Four electronic databases (Pubmed, Medline, CENTRAL and Scholar) were searched up to May 2020. There were no year or language restrictions. Randomized clinical trials and case–control studies comparing pain perception through pain visual analog scale (VAS) in patients treated with clear aligners and with fixed appliances were included. Risk of bias within and across studies was assessed using Cochrane tool and Newcastle–Ottawa Scale (NOS) approach. Random-effects meta-analysis were conducted. VAS score and analgesic consumption were collected. Random-effects meta-analyses were used to synthesize available data. Following the review protocol, five articles met the inclusion criteria and were included, with a total of 273 participants (177 females, 96 males). Overall, clear aligners were associated with significantly less pain than fixed appliances during the first seven days of orthodontic treatment. Patients treated with clear aligners experience less pain discomfort than those treated with fixed appliances and consume less analgesics, with SORT A recommendation.

We aimed to investigate the association between blood pressure (BP) and tooth loss and the mediation effect of age. A cross-sectional study from a reference dental hospital was conducted from September 2017 to July 2020. Single measures of BP were taken via an automated sphygmomanometer device. Tooth loss was assessed through oral examination and confirmed radiographically. Severe tooth loss was defined as 10 or more teeth lost. Additional study covariates were collected via sociodemographic and medical questionnaires. A total of 10,576 patients were included. Hypertension was more prevalent in severe tooth loss patients than nonsevere tooth lost (56.1% vs. 39.3%, p < 0.001). The frequency of likely undiagnosed hypertension was 43.4%. The adjusted logistic model for sex, smoking habits and body mass index confirmed the association between continuous measures of high BP and continuous measures of tooth loss (odds ratio (OR) = 1.05, 95% CI: 1.03–1.06, p < 0.001). Age mediated 80.0% and 87.5% of the association between periodontitis with both systolic BP (p < 0.001) and diastolic BP (p < 0.001), respectively. Therefore, hypertension and tooth loss are associated, with a consistent mediation effect of age. Frequency of undiagnosed hypertension was elevated. Age, gender, active smoking, and BMI were independently associated with raised BP.

Several methods have been described to estimate inter-arch tooth size relationship, such as Bolton's ratios. The aims of this study were to verify the validity of Bolton indexes in a sample of untreated Portuguese subjects based on Angle classification and to evaluate the gender difference. 168 pre-treatment dental casts of orthodontics Portuguese subjects (59 males and 109 females) with different occlusions were used, which were selected randomly from 541 consecutively treated orthodontic patients. The mesiodistal widths from first molar to first molar were measured on each pre-treatment cast to the nearest 0.01 mm using digital caliper, and Bolton's anterior and overall ratios were calculated. Descriptive statistics as mean, standard deviation and range were calculated. Moreover, the results were compared to Bolton's ratios and differences based on gender and occlusion groups were evaluated by statistical inference methods. The results reveal that the mean values, standard deviation and range were larger than Bolton's in normal occlusion group (78.3±3.5% in anterior ratio and 92.1±2.2% in overall ratio) and there were no differences between genders (p >0.05). Class I (anterior and overall ratios, p=0.001 and p<0.001, respectively), Class II/2 (anterior ratio, p=0.032) and Class III (overall ratio, p=0.041) were significantly different from Bolton's reference data. The results showed no differences between gender and no difference between normal occlusion and malocclusion groups. Moreover, in normal occlusion group, the anterior and overall tooth size ratios was equivalent to the original Bolton's ratios, although the mean and standard deviation were large. Key words:Bolton anterior and overall ratios, normal occlusion, malocclusion, portuguese population.

We aimed to assess the impact of malocclusion on oral health-related quality of life (OHRQoL) in a sample composed of adolescents, younger adults and adults seeking orthodontic treatment. Participants were consecutively enrolled from January 2019 to March 2020. The oral health impact profile (OHIP-14) was used to measure the OHRQoL. The index of complexity, outcome and need (ICON) was used to assess malocclusion. Sociodemographic, medical, and clinical questionnaires were recorded. Statistical analyses were performed according as a function of sex and age range (15–30 or >30 years old). Linear and logistic regression models were applied to assess the association between OHIP-14 total score, malocclusion, and other relevant confounding variables. In a final sample of 93 participants (60 females and 33 males, aged 15 to 60 years), men reported significantly better OHRQoL (p = 0.005). Participants aged 30 years or older reported significantly worse OHRQoL (p = 0.042). OHIP-14 was significantly correlated with age (ρ = 0.259, p < 0.05) and the number of missing teeth (ρ = 0.369, p < 0.001). Multivariable regression showed OHIP-14 being associated with the number of missing teeth (B = 1.48, SE = 0.57, p < 0.05) and the presence of missing teeth (B = 1.38, SE = 0.65, p < 0.05). Malocclusion showed no association with OHRQoL. Age and the number of missing teeth may be key factors on self-perceived OHRQoL in adult patients seeking orthodontic treatment.

The aim of this study is to assess how vertical skeletal malocclusion affects oral health-related quality of life (OHRQoL) among a sample of individuals comprising adolescents, young adults, and adults seeking orthodontic treatment. From January 2019 to March 2020, participants were consecutively enrolled. The assessment of OHRQoL involved measurement using the oral health impact profile (OHIP-14). Lateral cephalograms were performed to measure the vertical skeletal divergency with four cephalometric measurements. Descriptive and inferential statistical analyses were performed. The Mann–Whitney test was applied to compare OHRQoL scores according to the vertical dimension category. The mean age of the participants ranged between 30.3 ± 14.9 and 29.9 ± 14.4 and there was a majority of female participants, between 64.1% and 65.9%. There were no statistically significant differences observed between hyperdivergent and normodivergent groups in either the total score or any domain of the OHIP-14 questionnaire. Individuals with hyperdivergent facial morphology did not show a reduced OHRQoL compared with a normodivergent facial type.

The assessment of the oral health-related quality of life (OHRQoL) and dental malocclusion are described in the literature and the results indicate a decrease in OHRQoL when clinically determined dental malocclusion severity increase [ 1 Chen M , Feng ZC , Liu X , et al. Impact of malocclusion on oral health-related quality of life in young adults. Angle Orthodontist. 2015;85(6):986–991. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] , 2 Choi SH , Kim BI , Cha JY , et al. Impact of malocclusion and common oral diseases on oral health-related quality of life in young adults. Am J Orthod Dentofacial Orthop. 2015;147(5):587–595. [Crossref], [PubMed], [Web of Science ®] , [Google Scholar] ]. However, there is still a lack of information for the Portuguese population for this issue. This exploratory study aimed to evaluate the relationship between patient perception of OHRQoL and the severity of dental malocclusion in a Portuguese sample. This work was approved by the Egas Moniz Ethics Committee. This cross-sectional observational study involved patients that sought orthodontic treatment between January and April 2019, at the Orthodontic Care Consultation of Egas Moniz Dental Clinic (Monte de Caparica – Almada, Portugal). Exclusion criteria were patients with severe diseases, craniofacial abnormalities, cognitive deficits, caries, periodontal diseases, and previous orthodontic treatment history. A total of 19 patients were enrolled in the study. OHRQoL was assessed by application of the Oral Health Impact Profile – Portuguese validated version (OHIP-14) [ 3 Afonso A , Silva I , Meneses R , et al. Oral health-related quality of life: Portuguese linguistic and cultural adaptation of OHIP-14. Psic Saúde Doenças. 2017;18(2):374–388. [Crossref] , [Google Scholar] ] and dental malocclusion through the Index of Complexity, Outcome and Need (ICON) [ 4 Daniels C , Richmond S. The development of the index of complexity, outcome, and need (ICON). J Orthod. 2000;27(2):149–162. [Taylor & Francis Online] , [Google Scholar] ]. Based on the ICON score, patients were categorised as: in need of treatment (ICON > 43) or not (ICON ≤ 43). Resulting data were submitted to descriptive and inferential statistical analysis. The sample included 7 (37%) males and 12 (63%) females, with a mean age of 27.9 years. Overall OHIP-14 score ranged from 0 to 49 and ICON score from 13 to 75 (9 (47.4%) subjects with ICON > 43 and 10 (52.6%) with ICON ≤ 43). Total OHIP-14 score and all seven median domain scores were not found to be significantly different (p = .113 to p = .968), when comparing both groups. OHRQoL was not found to be significantly different when considering the severity of dental malocclusion. Overall, results highlight a difference between patients’ self-perception of clinical condition impact in OHRQoL when compared to a clinical expertise judgement.