Attitudes and satisfaction with dental appearance in young adults with and without malocclusion

The aim of the study was to assess the quality of a Public Dental Service (PDS) system in Sweden with regard to the orthodontic care and to investigate the selection made for the consultation by the general practitioners (GPs) and by orthodontists of those patients with malocclusion. In the individuals leaving the PDS system, the residual need and demand for treatment due to malocclusions and satisfaction with and opinion of their teeth was assessed in orthodontically treated and untreated 19-year-olds. Altogether 121 19-year-olds were clinically investigated with respect to six defined malocclusion traits and given a questionnaire. The following results were found: Ten per cent of the 19-year-olds that had not had an orthodontic consultation showed a residual treatment need. One third of the individuals judged by the orthodontist not to need treatment and one third that had been treated by the GP showed a marked orthodontic treatment need at the age of 19 years. Twenty-two per cent of all 19-year-olds left the PDS with an orthodontic treatment need. Ninety-four per cent were satisfied with their teeth irrespective of malocclusion or not. Every second individual considered their teeth important for their self-esteem. It was concluded that 19-year-olds in general were satisfied with their dental appearance. Half of the registered residual need and demand for orthodontic treatment was not related to measurable malocclusions.

Comparison of the Opinions of Adolescents With Different Orthodontic Treatment Needs

BACKGROUND

The aim of this study was to compare oral health-related quality of life (OHRQoL) among adolescents granted (G) versus not granted (NG) publicly funded orthodontic treatment.

MATERIALS AND METHODS

Adolescents aged 15-20 years who were granted versus not granted publicly funded orthodontic treatment responded to a web-based survey, assessing OHRQoL in relation to functional impact, psychological impact, and motivators for orthodontic treatment. Before the survey, pretesting of the questionnaire was conducted to ensure its reliability. Differences between the groups were tested using the chi-squared and Mann-Whitney U-tests. Reliability was assessed using Cohen's κ and Pearson's correlation coefficient during the pretest phase.

RESULTS

One hundred and forty patients, equally distributed between a G and an NG group, responded to the survey. Gender, age, and demographic distribution were comparable in both groups. All respondents expressed a high subjective treatment need and similar answers regarding functional aspects. Orthodontic treatment motivators (G: 86.2% and NG: 94.7%, p = 0.443) were primarily related to improved self-esteem, overall well-being, facial appearance, and being able to laugh without embarrassment. The NG group expressed a more negative OHRQoL impact due to the appearance of their teeth compared with the G group (p < 0.001) and a negative impact caused by the position of their teeth (p < 0.001).

CONCLUSIONS

Orthodontic treatment need indices should aim to reinforce subjective measures as adolescents express similar motivators for orthodontic treatment, regardless of the clinician's objectively based decision about treatment need.

Assessment of patient knowledge and perceptions towards orthodontic treatment in the Aljouf Region, Saudi Arabia: a cross-sectional study

Background

In orthodontic treatment, it is most important to assess the patient's perspective of malocclusion because these perceptions are fundamental to determining the patient's demands and level of treatment satisfaction. This study was done to assess the knowledge and perception of residents of the Aljouf Region of Saudi Arabia seeking orthodontic treatment. Furthermore, we determined the factors associated with the patients' knowledge and perception of orthodontic treatment.

Methods

This cross-sectional study was conducted using a pre-tested and validated questionnaire among patients seeking orthodontic treatment who were registered at King Abdulaziz Hospital, Sakaka, and primary health centers. We identified the associated factors using binomial logistic regression analysis. Finally, we applied Spearman's correlation test to identify the correlation between knowledge and perception.

Results

A total of 282 individuals participated in the current study, of which 53.3% were female and 46.1% were male. About one-third (36.9%) of patients had a low level of knowledge, 35.5% had a medium level of knowledge, and 27.7% had a high level of knowledge regarding orthodontic treatment. A total of 20.6% had low perceptions, 42.9% had medium perceptions, and 36.5% had high perceptions of orthodontic care. A significant correlation was found between age and gender, knowledge (p = 0.001), and perception (p = 0.040). Moreover, we observed a positive correlation between knowledge and perception (Spearman's rho = 0.297, p = 0.001).

Conclusion

People in Aljouf have poor knowledge and medium perception regarding orthodontic treatment. We recommend that the concerned authorities make a health educational plan for the patients seeking orthodontic treatment.

Oral Health-Related Quality of Life among Adolescents in the First 6 Months of Fixed Orthodontic Therapy

Clarification on disabilities that may arise during orthodontic treatment allows patients to have more realistic expectations. This prospective study assessed the impact of fixed orthodontic therapy on adolescents' quality of life over 6 months. A total of 78 adolescents aged 11-17 years were included. Quality of life was measured using the Child Perceptions Questionnaire (CPQ11-14, short form) at five moments: before treatment (T0), one week (T1), one month (T2), three months (T3), and six months (T4) after treatment initiation. Multiple and pairwise comparisons were conducted for CPQ11-14 scores (Friedman and Wilcoxon test; effect size). Changes in the quality of life were assessed as mean differences (T0-T1 and T0-T4) in total and domain scores (Kruskal-Wallis and Mann-Whitney test) (α = 5%). Significant differences were observed between T0 and T4 in the oral symptoms' domain (p < 0.001), and between T0 and T1, T2, T3, and T4 for emotional well-being (p < 0.001 for all). Significant differences in impact were also found between T0 and T2, T3, and T4 with regard to social well-being (p = 0.004, =0.049, and <0.001, respectively). Orthodontic therapy positively impacted the emotional and social aspects of adolescents' quality of life. Negative effects were primarily related to pain, mouth sores, and difficulty biting or chewing. Understanding the symptoms and feelings of orthodontic patients aids professionals in decision-making.

Predictors of orthodontic treatment preferences in a large representative UK adult cohort

Introduction The number of adults seeking orthodontic treatment globally continues to rise. This study aimed to clarify how demographic characteristics, treatment-related factors (perceived quality, cost, convenience), psychological factors (dental aesthetics, body image, mental health) and oral health influence adults' interest in pursuing orthodontic treatment.Methods A representative sample of 604 adults with the same proportion of participants as the national United Kingdom population across three core demographics (age, sex, ethnicity) completed an online survey. Data were analysed using chi-squared tests, multinomial logistic regressions, mixed analyses of variance and hierarchical multiple regression.Results A high proportion of respondents had at least some interest in pursuing orthodontic treatment and those with the greatest interest were also more likely to prefer that an orthodontist deliver this treatment. Individuals who reported a preference for an orthodontist (53% of respondents) identified treatment quality as the primary advantage and cost as the most common concern. For those who preferred direct-to-consumer aligners (25% of respondents), quality was the most common concern and convenience the primary advantage. Hierarchical multiple regression revealed that, while demographic control variables explained 10.96% of variance in respondents' interest in pursuing any type of orthodontic treatment, a model that included psychological variables and oral health explained substantial additional unique variance (20.61%; both ps <0.05). Greater negative psychosocial impact of dental aesthetics, better body image and good oral health each made significant unique contributions to predicting orthodontic interest.Conclusions These data provide a more nuanced and comprehensive understanding of the many distinct factors that influence interest in undertaking orthodontic treatment in the adult general population, with implications for ethical and consumer-centred marketing, as well as patient satisfaction and treatment adherence.

Awareness of malocclusion and desire for orthodontic treatment in 11 to 14 year-old Nigerian schoolchildren and their parents

OBJECTIVES

To investigate Nigerian children's and their parents' satisfaction with the children's facial and dental appearances and their desire for orthodontic treatment, and to compare their assessments of treatment need with those determined by an orthodontist.

METHODS

The subjects were 242 11-14 year-old schoolchildren randomly selected from private and public schools in the Ife Central Local Government area, Nigeria. A questionnaire was used to obtain information from the children and their parents of their liking of the facial and dental appearances of the children and the need and desire for orthodontic treatment. The children, the parents and an orthodontist used the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to assess the need for treatment.

RESULTS

More parents liked their child's facial and dental appearances than the children liked themselves. Almost twice as many schoolchildren thought they needed (27 per cent) and desired (29 per cent) orthodontic treatment than their parents (115 per cent). Low, but statistically significant correlations, were found between the children's, their parents' and an orthodontist's assessments of treatment need using the AC scale. Only 8 per cent of the children and 3 per cent of the parents considered that there was a 'moderate-definite' need of treatment. The orthodontist considered 38 per cent of the children had a 'moderate-definite' need of treatment.

CONCLUSIONS

The children's responses suggest greater concern about their facial and dental appearances, a greater perception of the need for orthodontic treatment and greater desire for treatment than their parents. These findings require further investigation as previous studies have reported that parents are usually more motivated for orthodontic treatment than their children.

Orthodontic evolution: an update for the general dental practitioner. Part 2: psychosocial aspects of orthodontic treatment, stability of treatment, and the TMJ-orthodontic relationship

As a result of recent innovations and improvements, orthodontic treatment has become easier and more efficient to carry out, allowing greater numbers of patients to receive treatment. The main result of orthodontic treatment is improved dental alignment and aesthetics. Treatment has no effect on caries or periodontal disease, and the dental health gain is modest, apart from a very small percentage of destructive malocclusions. Psychological improvements using different psychological parameters show differing results and it is not clear that any psychological gains are long lasting. Social gain (greater willingness to smile, feeling good about oneself, satisfaction with dental appearance, etc.), and reported improved quality of life (QoL measures), are now becoming more important as consumer-related outcomes and may, ultimately, contribute to psychosocial and psychological status. Stability of orthodontic treatment results cannot be guaranteed and all patients need to be informed of this, and of the need for long-term retention. Malocclusion has little or no relationship to temporo-mandibular joint dysfunction and orthodontic treatment neither causes nor cures such problems. Extractions as part of orthodontic treatment do not cause TMD, nor do they cause collapse of the vertical dimension. The major improvements in dental health in the last 40 years have been accompanied by a great increase in demand for treatment. In any public health service that is free at the point of use, demand for treatment invariably exceeds the ability of resources to supply this. Indices of treatment need are widely used to determine treatment need and eligibility for treatment in public health systems. Demand for orthodontic treatment among adolescents can be as high as 60% in the general population, while the professionally-assessed need for treatment is approximately half this figure. Age, sex, socio-economic status, perceived unattractiveness of dental appearance, and availability of orthodontic services all influence receipt of treatment.

Management of a congenitally missing maxillary central incisor. A case study

When a maxillary lateral incisor is missing, often the treatment options can be clearly defined, that is, substitute an adjacent tooth for the missing one; open the space for an implant, a bonded bridge or fixed bridge. When a maxillary central incisor is missing and the space for the tooth is absent, the treatment choices become complicated, especially in a growing child. There must be multi-disciplinary coordination among the restorative dentist, the oral surgeon or periodontist, and the orthodontist to obtain the optimum result. At the initiation of treatment, this information must be relayed and the treatment plan agreed upon by the patient or the parents of the patient.

The provision of orthodontic treatment: some ethical considerations

The majority of orthodontic procedures are elective, aimed at reorganising structures placed by nature in an area of stability. Although these structures are expressions of normal biological diversity, the costs and long-term benefits of treatment are generally accepted by society. In light of this, it is vital to provide orthodontic treatment that is done to the highest possible standard, using techniques based on a sound scientific basis, recognising that the main reason for the treatment is to improve a patient's self-esteem. This is valid reason for treatment, which can benefit a patient enormously. On this basis the patient can make an informed, autonomous decision on whether or not to undergo this treatment, knowing that the treatment benefits will outweigh the risks of having the treatment performed. Only then can the provision of orthodontic treatment be ethically justified.

Assessment of psychosocial parameters in adolescents seeking orthodontic treatment

AIM

The aim of this study was to investigate the psychosocial impact of malocclusion and the motivation for seeking orthodontic treatment among adolescents.

METHODS

A cross-sectional study included 102 adolescents (ages 11-18) whose malocclusion was rated using 3 occlusal indices: IOTN, DAI, and PAR. The participants answered three structured questionnaires selected to measure Oral Health Related Quality of Life (OHRQoL) through the short form of the Child Oral Health Impact Profile (COHIP), the patient's perceived impact related to orthodontics through the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and self-esteem through the Rosenberg Self-Esteem Scale (RSES). Independent two-tailed t-tests, one-way mixed analysis of variance (ANOVA), and Spearman's correlations were used to test various associations.

RESULTS

Patients with higher malocclusion scores displayed increased psychosocial impact with weak to moderate correlations (0.2 < r < 0.3; p < 0.05), but 98% wished their teeth looked better, and 70% were unhappy about their smile esthetics. The IOTN esthetic component AC was better associated with psychosocial implications of malocclusion (p < 0.01). Self-motivated patients (over 80%) had higher impactful psychosocial scores than patients whose parents were motivated for treatment. Sex did not influence the findings. Older adolescents and bullied individuals were more affected by the psychological burden of malocclusion.

CONCLUSION

The results indicate the prevalence of psychosocial and esthetic impacts of malocclusion over oral and functional problems. PIDAQ discriminated better than COHIP between varying degrees of dental aesthetics. The results suggest that the orthodontist should explore patients' expectations of treatment outcomes, not only the chief complaint.

Immigrant background and orthodontic treatment need. Quantitative and qualitative studies in Swedish adolescents

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

[Psychological aspects of orthodontic treatment]

Psychical factors are often contributory determinants of success or failure of treatment. The orthodontist should therefore dispose of basic psychological knowledge to give his patients help in an entire sense. The psychosocial impact of malocclosion should represent a major factor in the decision to obtain treatment, because what is most important in terms of psychosocial response to malocclusion is not the absolute degree of disfigurement that results from malocclusion, but rather how the individual perceives and evaluates the esthetic effects of these dentofacial problems and their orthodontic correction.

Time course of the discomfort in young patients undergoing orthodontic treatment

Discomfort may accompany orthodontic movement of teeth. The purpose of this study was to determine the time envelope of discomfort induced in young patients (10-16 years) following placement of orthodontic separators and arch wires. Secondly, psychosocial factors concerning feelings of "self" were investigated. Forty-five experimental and 14 control patients seeking orthodontic treatment were included. A data sheet consisting of several visual analogue scales measuring patient perceptions of dental discomfort and psychosocial factors was used. The results indicated that the experimental group experienced significant discomfort with both separators and arch wires at 4 and 24 hr compared to controls; however, the discomfort dissipated by 7 days. The appearance of the teeth and face were significant factors predicting the patient's perspective of "self." The results have significant clinical implications and these are discussed.

Subjective orthodontic treatment need and perceived dental appearance among young Finnish adults with and without previous orthodontic treatment

Subjective orthodontic treatment need and perceived oral condition were studied in a sample of 226 young adult Finns with and without previous orthodontic treatment. The subjects, applicants to enter the University of Helsinki, were interviewed immediately after their entrance examination. Altogether 38.5 per cent of the subjects had received some form of orthodontic treatment. A higher percentage of subjects who had been orthodontically treated reported a current subjective need for treatment than did the untreated ones but this only reached statistical significance in men (P < 0.05). Appearance was the reason for the treatment need among 64.7 per cent of treated and among 80.0 per cent of untreated subjects. The differences in proportions were non-significant. Men were more often satisfied with their dentition than women. Most, 56.3 per cent of treated and 66.2 per cent of untreated subjects, considered their anterior teeth regularly positioned. The most prevalent type of malocclusion noted in the anterior segments was crowding (27.0 per cent), followed by malpositioned (18.6 per cent) and protruding (9.3 per cent) teeth. It is likely that those who had received orthodontic treatment, had initially had more, and more severe malocclusions than those who were untreated. Thus, it may be that orthodontic treatment had raised the perceptions of the dentition of the treated individuals to the same level as the untreated individuals.

The community and orthodontic care. Part II: Community-perceived importance of correcting various dentofacial anomalies. Part III: Community perception of the importance of orthodontic treatment

Part II. A professionally-managed telephone survey was undertaken to assess the community-perceived importance of correcting various dentofacial anomalies. The sample included 505 respondents, aged eighteen and over, from metropolitan and non-metropolitan households across the state of Victoria. The sample distribution had a 95 per cent confidence limit with a 5 per cent margin of error and closely matched the known population distributions for age, sex and geographical location. This article forms part two of a series. It was found that the correction of functional problems such as "difficulty chewing or speaking" was considered to be very important, regardless of age, sex or geographical area. The correction of other factors such as "top teeth which stick out in front", "bottom teeth which stick out in front" or "crooked or crowded front teeth" was also considered to be important. "Spaced front teeth" was the factor considered least important for correction within all groups. It is interesting to note that, for all factors, correction seemed to be considered more important by females and non-metropolitan respondents than by males and metropolitan respondents, In contrast to previous studies in which it has been suggested that patients seek treatment mainly for reasons of aesthetics, the results of this study have shown a definite community recognition of the importance of functional problems as well. Part III. A professionally-managed telephone survey was undertaken to assess the community's perceptions of the importance of having "straight teeth and a nice smile", to assess if a Medicare (the Australian government health benefit scheme) rebate should be provided for orthodontic treatment and to assess whether respondents had any private health insurance that would help cover the cost of orthodontic treatment. The sample included 505 respondents, aged eighteen and over,, from metropolitan and non-metropolitan households across the state of Victoria. The sample distribution had a 95 per cent confidence limit with a 5 per cent margin of error and closely matched the known population distributions for age, sex and geographical location. It was found that a very large percentage of respondents considered the need for "straight teeth and a nice smile" to be very important. This finding is supported by the many studies showing the importance of facial attractiveness to the lives of all people, young and old. Only a small percentage of respondents indicated that they had any private dental health insurance that would help cover the cost of orthodontic treatment. Efforts should be made to inform those responsible for the planning of orthodontic services in both the public and private sectors of the importance of the community's perceptions of aesthetics, and the large amount of published work that reinforces the impact of facial attractiveness on people's lives.