Adverse effects of orthodontics: a report of 2 cases

Adverse effects are results beyond the expected good outcomes of treatment. Like any other field in dentistry and medicine, orthodontics is not immune to such effects. The probability of adverse results in orthodontics increases when important rules and facts are ignored. To illustrate this, treatment and its adverse effects in 2 patients are discussed. In 1 young adult female, a palatally impacted maxillary canine was being moved into its place in the arch when it became ankylosed. Despite the cessation of movement, the orthodontist continued to apply mechanical forces to the canine for an additional 16.5 years. The effect of this extremely prolonged treatment period on the rest of the dentition was devastating. In another case, a 12-year 10-month-old boy with a mild Class II, Division 1 malocclusion, developed alopecia areata 4 months after the onset of orthodontic treatment. Four months later, he had lost all of his hair (alopecia totalis). The etiology of this condition was determined to be psychological stress and anxiety evoked by the orthodontic treatment. In both cases, the orthodontists failed to recognize existing problems or chose to ignore them. It was concluded that these adverse effects of orthodontic treatment could have been avoided if the orthodontists would have paid closer attention to the tissue response to mechanotherapy, as well as to the patient's attitude toward treatment. The latter conclusion is particularly noticeable when treating children and teenagers, who can reject being forced by their parents to undergo orthodontic treatment.

Perception of occlusion, psychological impact of dental esthetics, history of orthodontic treatment and their relation to oral health in naval recruits

OBJECTIVE

To investigate whether the oral health of young male adults was related to (1) the degree of self-perceived malocclusion, (2) the degree of experienced negative psychosocial impact of dental esthetics, and (3) the history of orthodontic treatment and its duration.

MATERIALS AND METHODS

The study subjects were 470 male naval recruits undergoing a routine dental health checkup. They answered the Perception of Occlusion Scale (POS) and Negative Impact of Dental Aesthetics Scale (NIDAS). The Approximal Plaque Index (API), the Sulcus Bleeding Index (SBI), and the number of decayed teeth (DT) and missing teeth (MT) were examined by a staff dentist. Statistical procedures were one-way analyses of variance in the API and SBI and nonparametric Kruskal-Wallis, Mann-Whitney, and chi(2) tests in DT and MT as dependent variables.

RESULTS

(1) The subjects ranging within the upper POS quartile scored higher on the SBI (contrast: P = .003) and DT (P = .002) than did those in the lower POS quartiles. (2) In contrast to the subjects reporting minor negative impacts in the NIDAS, those with strong impacts had higher scores on the API and MT (each P < .001). (3) In the subjects with a history of orthodontic treatment lasting 30 months and longer, lower API (P < .05), SBI and DT (each P = .002), and MT (P = .007) scores were found than in the subjects without previous orthodontic treatment.

CONCLUSION

The results suggest that self-perceived dental irregularity and negative impact of dental esthetics might affect oral health, whereas previous extensive orthodontic treatment may have favorable effects by improving dental health compliance.

Surgical-orthodontic treatment and patients’ functional and psychosocial well-being

INTRODUCTION

Surgical-orthodontic treatment is a common treatment approach for adult patients with skeletal maxillomandibular discrepancy. Some patients report improvement in signs and symptoms of temporomandibular disorder (TMD) after surgery. Whether the correction of malocclusion is responsible for the improvement of TMD symptoms after orthognathic surgery is still controversial. The objectives of this prospective study were to evaluate subjective treatment outcomes in patients with bilateral sagittal split osteotomy (BSSO) and to find out whether signs and symptoms of TMD and changes in occlusion are related to patient satisfaction.

METHODS

Eighty-two patients (53 female, 29 male) with a mean age of 32 years (range, 16-53 years) treated with BSSO in the Oral and Maxillofacial Department at Kuopio University Hospital in Finland were examined; 64 had mandibular advancement, and 18 had mandibular setback. Occlusion and signs and symptoms of TMD were registered pre- and postoperatively. At the postoperative examination (mean, 1.8 years after BSSO), the patients were asked to fill out a questionnaire about the influence of treatment on their masticatory function and symptoms of TMD, as well as their satisfaction with the treatment outcome.

RESULTS

TMD symptoms were significantly reduced after treatment. Improvements were also reported in facial appearance (82%) and chewing ability (61%); also, facial (56%) and temporomandibular joint (40%) pain disappeared. However, in 12% of the patients, temporomandibular joint problems were worse after treatment. Most patients (73%) were very satisfied with the outcomes; no one expressed dissatisfaction. Multiple logistic regression analysis showed that subjects with improved mastication and self-confidence, and those without long-term neurosensory deficits, expressed high satisfaction with the treatment outcome. Patients with mandibular setback were more pleased with the outcome than those with mandibular advancement.

CONCLUSIONS

Orthognathic patients generally experience functional and psychosocial benefits after surgical-orthodontic treatment. In addition to functional and morphological reasons, the psychosocial factors should be more emphasized when making the treatment decision and comparing the alternative treatment approaches.

A 20-year cohort study of health gain from orthodontic treatment: Psychological outcome

INTRODUCTION

Despite the widespread expectation that orthodontic treatment improves psychological well-being and self-esteem, there is little objective evidence to support this. The aim of this study was to compare the dental and psychosocial status of people who received, or did not receive, orthodontic treatment as teenagers.

METHODS

A prospective longitudinal cohort design was adopted. A multidisciplinary research team evaluated 1018 participants, aged 11 to 12 years, in 1981. Extensive assessments of dental health and psychosocial well-being were conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pretreatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up, 337 subjects (30-31 years old) were reexamined in 2001. One-way ANOVA was used to explore differences between the 4 groups (need/no need; treatment/no treatment).

RESULTS

The percentage changes in index of complexity, outcome and need scores for the 4 groups were need/no treatment (12.7%), no need/no treatment (-17.1%), need/treatment (31%), and no need/treatment (-11.4%). Participants with a prior need for orthodontic treatment as children who obtained treatment had better tooth alignment and satisfaction. However, when self-esteem at baseline was controlled for, orthodontic treatment had little positive impact on psychological health and quality of life in adulthood.

CONCLUSIONS

Lack of orthodontic treatment when there was need did not lead to psychological difficulties in later life.

Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents, and dentists

The aims of the present study were to compare rankings of dental aesthetics and the threshold at which orthodontic treatment would be sought among patients, parents, and dentists. A prospective cross-sectional study was designed to address these aims. The study sample comprised 100 patients and parents and 23 dental specialists. The patients were equally divided between males and females and their mean age was 14.7 years (standard deviation 2.3 years). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) represented impairment of dental aesthetics. The 10 numbered photographs of the AC were cut into equal-sized rectangles and subjects were asked to arrange them from 'the one that looks best' to 'the one that looks worst'. The subjects were then presented with the 10 photographs of AC in sequence and asked to identify the cut-off point between 'teeth that need orthodontic treatment' and 'no treatment'. Statistical analysis was undertaken with a Mann-Whitney test. The results showed that median rankings of dental aesthetics were similar among the three groups (P > 0.05). The median ranking of photographs 1, 2, 3, 4, and 10 were identical to the AC of IOTN. The photographs representing IOTN AC 7 and 8 were allocated the same median rank of 7 and AC 5 and 9 were allocated corresponding median ranks of 6 and 8, respectively. There were no significant differences in median cut-off points for treatment need among the three groups of subjects (P > 0.05), indicating that the mean threshold at which treatment would be sought was AC 4.

Patients' expectations and experiences of fixed orthodontic appliance therapy. Impact on quality of life

OBJECTIVE

To compare patients' expectations of the impact of wearing fixed orthodontic appliances on life quality with realities experienced over a 6-month period.

MATERIALS AND METHODS

Two-hundred and seventeen consecutive orthodontic patients (mean age 13.1 +/- 1.5 years) self-completed a 37-item Child Perception Questionnaire (CPQ) in relation to how they expected wearing fixed orthodontic appliances would affect their QoL during orthodontic treatment. The CPQ assessed the attributes of oral symptoms, functional limitations (FL), emotional well-being (EWB), and social well-being (SWB). Expectations were compared with the patients' pretreatment values and reported experiences at 1 week, 1 month, 3 months, and 6 months after insertion of the fixed appliances.

RESULTS

The response rate was 91% (197/217). Patients expected that wearing fixed appliances would considerably compromise their overall oral health-related QoL (OHQoL) compared with pretreatment (P < .001). At 1 week they reported that EWB (P < .001) and SWB (P < .05) were less compromised than expected. At 1, 3, and 6 months, FL (P < .001), EWB (P < .001), SWB (P < .001), and overall OHQoL (P < .001) were less compromised than expected.

CONCLUSIONS

This study indicated the impact on QoL after insertion of fixed orthodontic appliances was considerately less than what child patients expected.

A comparison of treatment impacts between Invisalign aligner and fixed appliance therapy during the first week of treatment

INTRODUCTION

The aim of this study was to evaluate the differences in quality of life impacts between subjects treated with Invisalign aligners (Align Technology, Santa Clara, Calif) and those with fixed appliances during the first week of orthodontic treatment.

METHODS

A prospective, longitudinal cohort study involving 60 adult orthodontic patients (33 with Invisalign aligners, 27 with fixed appliances) was completed by using a daily diary to measure treatment impacts including functional, psychosocial, and pain-related outcomes. A baseline survey was completed before the start of treatment; diary entries were made for 7 consecutive days to measure various impacts of the subjects' orthodontic treatment over time. The data were then analyzed for differences between treatment modalities in terms of the subjects' reported impacts from their orthodontic treatment.

RESULTS

The baseline mean values did not differ between groups for pain reports (P = .22) or overall quality of life impact (P = .51). During the first week of treatment, the subjects in the Invisalign group reported fewer negative impacts on overall quality of life (P <.0001). The Invisalign group also recorded less impact in each quality of life subscale evaluated (functional, psychosocial, and pain-related, all P <.003). The visual analog scale pain reports showed that subjects in the Invisalign group experienced less pain during the first week of treatment (P <.0001). The subjects in the fixed appliance group took more pain medications than those in the Invisalign group at days 2 and 3 (both P <.007).

CONCLUSIONS

Adults treated with Invisalign aligners experienced less pain and fewer negative impacts on their lives during the first week of orthodontic treatment than did those treated with fixed appliances.

The Cardiff dental study: a 20-year critical evaluation of the psychological health gain from orthodontic treatment

OBJECTIVES

Despite the widespread belief that orthodontics improves psychological well-being and self-esteem, there is little objective evidence to support this (Kenealy et al., 1989a; Shaw, O'Brien, Richmond, & Brook, 1991). A 20 year follow-up study compared the dental and psychosocial status of individuals who received, or did not receive, orthodontics as teenagers.

DESIGN

A prospective longitudinal cohort design with four studies of the effect of orthodontic treatment. Secondary analysis of outcome data incorporated orthodontic need at baseline and treatment received in a 2 x 2 factorial design.

METHODS

A multidisciplinary research programme studied a cohort of 1,018, 11-12 year old participants in 1981. Extensive assessment of dental health and psychosocial well-being was conducted; facial and dental photographs and plaster casts of dentition were obtained and rated for attractiveness and pre-treatment need. No recommendations about orthodontic treatment were made, and an observational approach was adopted. At the third follow-up 337 (30-31 year olds) were re-examined in 2001.

RESULTS

Participants with a prior need for orthodontic treatment as children who obtained treatment demonstrated better tooth alignment and satisfaction. However when self-esteem at baseline was controlled for, orthodontics had little positive impact on psychological health and quality of life in adulthood. Lack of orthodontic treatment where there was a prior need did not lead to psychological difficulties in later life. Dental status alone was a weak predictor of self-esteem at outcome explaining 8% of the variance. Self-esteem in adulthood was more strongly predicted (65% of the variance) by psychological variables at outcome: perception of quality of life, life satisfaction, self-efficacy, depression, social anxiety, emotional health, and by self-perception of attractiveness.

CONCLUSIONS

Longitudinal analysis revealed that the observed effect of orthodontic treatment on self esteem at outcome was accounted for by self esteem at baseline. Prior need for treatment assessed in childhood made a small contribution to the prediction of self-esteem 20 years later in adulthood. Dental status in adulthood, whilst statistically significant, appeared to be of minor importance in a model that included other psychological variables. When prior need for treatment was taken into account there was little objective evidence to support the assumption that orthodontics improves long-term psychological health.

Reliability of a Questionnaire Assessing Experiences of Adolescents in Orthodontic Treatment

OBJECTIVE

To evaluate the reliability of a questionnaire that assessed the expectations and experiences of adolescent patients about orthodontic treatment.

MATERIALS AND METHODS

The study included two groups of patients: 30 consecutive patients (19 girls and 11 boys, mean age 14.6 years, SD 2.3 years) naïve to orthodontic treatment, and 30 consecutive adolescent patients (17 girls and 13 boys, mean age 15.1 years, SD 2.0 years) in active orthodontic treatment with fixed appliances in both jaws. A questionnaire comprising 46 items was developed, based upon focus group interviews and previous established questionnaires. The questionnaire covered the following domains: Treatment motivation; treatment expectations; pain and discomfort from teeth, jaws, and face; functional jaw impairment; and questionnaire validity. Internal consistency as well as temporal stability with the test-retest method was investigated.

RESULTS

A majority of the questions exhibited acceptable test-retest reliability, and composite scores yielded excellent reliability for all domains. Internal consistency was acceptable and good face validity was found for all domains.

CONCLUSION

The questionnaire can be recommended for use in the assessment of expectations and experiences of orthodontic 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.

Patients' perceptions of recovery after routine extraction of healthy premolars

INTRODUCTION

In this prospective study, we evaluated patients' perceptions of recovery after orthodontic premolar extractions.

METHODS

Thirty patients (18 girls, 12 boys, mean age 14.6 +/- 3.8 years) were given a health-related quality of life questionnaire to be completed each postoperative day (POD) for 7 days. The questionnaire was designed to assess each patient's perception of recovery: pain, oral function, general activity measures, and other variables. The impact of possible predictor variables, such as age, sex, length of surgical procedure, number of simultaneous extractions, and time during the day, was assessed.

RESULTS

Severe pain (16.7%, 3.3%) and consumption of analgesics (70%, 13.2%) declined dramatically from POD 1 to POD 2. Improvements in oral function and other symptoms were evident by POD 2. Absence from school resembled interference in daily activities (POD 2). Age was the most significant predictor variable, with results showing delayed recoveries for patients older than 15 years. The most striking differences were reported for enjoying food (P <.05), taste (P <.05), and food stagnation (P <.05). The number of extractions performed at the same appointment had no affect on posttreatment recovery.

CONCLUSIONS

This study was designed to provide baseline health-related quality of life information with which to compare other surgical procedures frequently needed in orthodontic treatment, such as removal of third molars and exposure of impacted teeth. Additionally, it provides information for patients and clinicians on postoperative recovery after premolar orthodontic extractions.

Patients' expectations of orthodontic treatment: part 1 - development of a questionnaire

OBJECTIVE

The development of a questionnaire to measure patients' and their parents' expectations before orthodontic treatment, and to test the reliability and validity of this measure.

DESIGN

A two-stage methodology, with open-ended interviews to identify themes and concepts followed by development and testing of the questionnaire.

SETTING

GKT Orthodontic Department, King's College Dental Hospital.

SUBJECTS

The sample consisted of 140 participants, 70 patients aged 12-14 years, who had been referred to the orthodontic department for treatment. One parent of each patient was also recruited.

MATERIALS AND METHODS

The study was in two phases. In the first phase 30 participants (15 new patients and their 15 parents) participated in open-ended interviews, which were analysed qualitatively. Information from these interviews was used to construct a questionnaire. During the second phase, the questionnaire was piloted on 10 participants, five new consecutive patients and their parents. The questionnaire was then distributed to 174 subjects (87 new patients and their 87 parents). Seventy-eight subjects (39 new patients and their 39 parents) completed the questionnaire before their orthodontic consultation. Another 96 subjects (48 new patients and their 48 parents) were invited to complete the questionnaire prior to and at their orthodontic consultation. Test-retest analysis was conducted on 22 participants (11 patients and their 11 parents), who completed the questionnaire previous to and at their orthodontic consultation, and contributed to the psychometric validation of this questionnaire.

MAIN OUTCOME MEASURES

A questionnaire was devized using the key themes and concepts identified in the open-ended interviews. As a result, 10 questions, some with sub-questions were constructed using a visual analogue scale as the response format.

RESULTS

The questionnaire developed had good face validity. Internal consistency of the questionnaire using Cronbach's alpha, produced an overall inter-item reliability > 0.7 along with item-total correlations > 0.3 in over 50% of questions. Test-retest reliability was statistically significant using Spearman's correlation.

CONCLUSION

This study provides a valid and reliable measure of orthodontic expectations in participants aged 12-14 years and their parents.

Does self-weighting of items enhance the performance of an oral health-related quality of life questionnaire?

OBJECTIVES

To determine if self-weighting of the items in an oral health-related quality of life questionnaire improves its psychometric properties.

METHODS

The Surgical Orthodontic Outcome Questionnaire (SOOQ) was designed to assess the oral health-related quality of life of individuals before and after corrective surgery. Each of its 33 'items' consists of two questions: a question concerning the frequency with which a given functional or psychosocial problem had been experienced and a 'weighting' question which asked about how much the individual was bothered by that problem. The questionnaire was completed by three groups of individuals: (i) pretreatment; (ii) immediate (i.e. 2-6 months) postsurgery and (iii) postsurgery (i.e. more than 2 years after surgery). Unweighted scale scores were obtained by summing the response codes to the frequency question and weighted scores by summing the products of the frequency and bother questions. These scores were calculated for the full questionnaire and a short form consisting of 15 items. The discriminative and correlational construct validity of these scores was compared along with internal consistency reliability. The sensitivity to change and longitudinal construct validity of unweighted and weighted scores was assessed in a simulated evaluative study in which pretreatment and postsurgery subjects were paired.

RESULTS

For both the long and short forms of the questionnaire, unweighted and weighted scores discriminated between the groups enrolled in the study. Correlations with a general health rating were similar, as were Cronbach's alpha values and test-retest reliabilities. The simulated evaluative study suggested no differences in sensitivity to change or longitudinal construct validity. When subscale scores were examined, there was a suggestion that weighting improved their reliability.

CONCLUSIONS

Self-weighting of items did not substantially improve the performance of the SOOQ. Domain weights should be developed and tested to determine if they have an effect on its properties.

[Orthodontic re-treatment. A qualitative study of patients]

A growing number of patients go to orthodontic practices to receive orthodontic re-treatment, but their reasons for seeking re-treatment are uncertain. By means of a standardized questionnaire this study investigates the patients'experiences with the initial orthodontic treatment, applied retention procedures, and the patients'expectations and motivational reasons for re-treatment. In total 100 patients were asked to complete the questionnaire, 88 of them actually filled it out. The study subjects showed an above average educational level, with a considerably higher percentage of females than males seeking re-treatment. Fixed appliances were used most frequently during the first course of treatment and most patients had been fitted with a removable retention plate or fixed retention wire at the conclusion of their first treatment; almost 40% of the patients did not receive any kind of retention appliance. Patients sought re-treatment mostly on their own initiative, as opposed to their initial treatment, when they were mostly referred by dentists or orthodontists. This revealed itself in patients' high levels of motivation for re-treatment. Moreover, patients appeared to have realistic impressions of the time and cost involved in re-treatment.

Body dysmorphic disorder in adult orthodontic patients

INTRODUCTION

Body image plays an important role for patients seeking orthodontic treatment. It affects how patients feel about their physical appearance and, in extreme cases, can lead to subjective fears of ugliness. When there is a physical defect that, although within normal limits, seems far more noticeable to the patient, this may be diagnosed as body dysmorphic disorder (BDD). This interview-based study was designed to assess BDD in adults attending the Orthodontic Department at the Eastman Dental Hospital in London for their initial consultations for orthodontic treatment and also in the general public.

METHODS

A total of 70 members of the general public and 40 patients, all over 18 years of age, were assessed. The BDD modification of the Yale-Brown obsessive compulsive scale was used for diagnosis of BDD.

RESULTS

BDD was diagnosed in 2 members of the general public (2.86%) and 3 patients (7.5%).

CONCLUSIONS

It is important to have an understanding of body image and to be able to identify orthodontic patients who have BDD. These patients are rarely satisfied with the results of treatment, and it is therefore important to recognize them to avoid unnecessary treatment and to refer them for appropriate management.

The impact of malocclusion and its treatment on quality of life: a literature review

AIM

The aim of this paper is to review the literature relating to the impact of malocclusion, and the treatment of malocclusion, on physical, social and psychological health (i.e. quality of life, QoL).

DESIGN

English-language papers, including cross-sectional studies, retrospective and prospective longitudinal studies, randomized controlled trials, and reviews and meta-analyses were reviewed to determine the impact of malocclusion and its treatment on QoL.

RESULTS

Malocclusion and its treatment can affect physical health in terms of pain (e.g. temporomandibular disorders, and dental and gingival trauma), speech and mastication. In terms of psychological health, malocclusion and its treatment is reported to affect self-concept. Socially, malocclusion and its treatment can affect perceived attractiveness by others, social acceptance and perceived intelligence. However, the evidence is conflicting owing to differences in study designs, population's studied and methods of assessment of psychical, social and psychological health.

CONCLUSION

Much controversy exists about the impact of malocclusion and its treatment on QoL. There is a need for a more comprehensive and rigorous assessment of the impact of malocclusion and its treatment on QoL, employing standardized, valid and reliable data collection instruments.

Awareness and concern about malocclusion among 12-15 year-old children in Moshi, Tanzania

OBJECTIVE

To assess awareness and concern about malocclusion in 12-15 year-olds in Moshi, Tanzania.

DESIGN

A cross-sectional study.

SETTING

Moshi Municipality in Kilimanjaro region, Tanzania.

SUBJECTS

Two hundred and ninety eight randomly selected Public primary school children aged 12-15 years (158 males and 140 females).

RESULTS

About 56% of the respondents thought their teeth were properly aligned. However only 29.1% of the respondents reported being dissatisfied with the way their teeth appeared in their mouth. About 25% of the respondents found their teeth to have been worse than most of their age-mates. Children who reported to have been teased due to their malocclusion comprised 25.8%. Those who thought it was unpleasant to stay with malaligned teeth constituted 55.7% of the respondents. Subjective orthodontic treatment need was reported by 69.1% of the sample. Majority of the children (75%) were ready to accept orthodontic treatment. There were significant correlations between factors of awareness and those of concern about malocclusion among the subjects.

CONCLUSIONS

In spite of very little orthodontic treatment exposure in this population, awareness and concern about malocclusion was reported by a significant proportion of the children. These findings form a baseline line for future studies on the trends of awareness and concern towards malocclusion in this population. They will also be useful in the planning of orthodontic services in Tanzania.

Factors affecting patient satisfaction after orthodontic treatment

The objective of this study was to identify factors that may affect patients' satisfaction with their dentition after orthodontic treatment. Fifty patients (20 males and 30 females; mean age 20.7 +/- 4.2 years) who successfully had finished fixed orthodontic treatment were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances for an average duration of 19 +/- 4 months and were in retention stage (6-12 months) with upper Hawley and lower fixed bonded retainers. Dental Impact on Daily Living questionnaire was used to assess the effect of orthodontic treatment on daily living and satisfaction with the dentition in the study sample. The NEO Five Factor inventory was used to assess personality profiles in the study sample. Comparisons between groups were made using chi-square test. Personality traits were found to be correlated with patients' satisfaction with their dentition after orthodontic treatment. Higher neuroticism scores had a significant negative relationship with total satisfaction with the dentition (P < .05). Age, sex, and pretreatment orthodontic treatment need had no relationship with the patient's satisfaction. Patients treated nonextraction showed more dissatisfaction with their dentition (P < .05). In orthodontically treated patients, higher neuroticism scores were associated with lower levels of satisfaction with the dentition.

Dental esthetic self-perception in young adults with and without previous orthodontic treatment

The aim of this study was to determine which dental esthetic self-perception evaluation tool discriminated better between orthodontically treated or untreated Peruvian young adults. A total of 630 students were randomly chosen from the 2000 admitted in 2002 to a private university in Peru. Students undergoing active orthodontic treatment at the time of examination were excluded. Self-perceived dental esthetic appearance was evaluated through Standardized Continuum of Aesthetic Need, Oral Aesthetic Subjective Index Scale, and Visual Analogue Scale (VAS). A stepwise multivariate discriminant analysis was developed to classify orthodontic treatment according to the three evaluation tools. A total of 199 students (31.6%) reported a history of orthodontic treatment. Differences between orthodontically treated and untreated groups were found only for the mean VAS score (P < .001). Although three different approaches were used to evaluate dental esthetic self-perception, only VAS allowed the discrimination of the self-perceived dental appearance between orthodontically treated and untreated Peruvian university young adults. Similarities in the self-perceived dental appearance of treated and untreated groups reported in previous epidemiological studies could be explained because different evaluation instruments were used. Further studies are required to support current findings.

[Attitudes towards orthodontic treatment. A comparison of treated and untreated adolescents]

Dutch adolescents' attitudes towards orthodontic treatment and the determinants of these attitudes are unknown. The aim of the present study was to evaluate treated and untreated adolescents' attitudes towards orthodontic treatment, and to examine possible determinants of these attitudes. Previously treated adolescents were found to have a more positive attitude towards orthodontic treatment than untreated adolescents. Age, but not gender, was found to be a significant predictor for their general attitude towards orthodontic treatment. Consequently, it was concluded that attitudes were not determined by one specific aspect, but by a combination of several determinants.

Using written material to support recall of orthodontic information: a comparison of three methods

The objective was to determine the effect of three different methods of presenting information on the recall of information in orthodontic patients in the short and long term. Thirty orthodontic patients at the commencement of their treatment were allocated randomly to groups receiving supporting written information in one of the three formats: mind map, acronym, and information leaflet. Short-term retention was assessed by administration of a nine-item questionnaire 10 to 15 minutes after receiving the information, and long-term retention was assessed after six weeks by repeating the same questionnaire without repetition of the information. Correct answers to the questions were compared across the three groups at short-term recall and long-term recall. A total knowledge score was determined by summing the number of correct answers across all nine items, and an analysis of covariance (ANCOVA) was conducted to determine the effect of the method of information on long-term retention of the information. There were significant differences in recall between the three methods of presentation at both time 1 and time 2 (Fshort-term = 5.97, P < .01; Flong-term = 3.19, P < .05). Participants who were given a written information leaflet recalled less information on both occasions of testing. ANCOVA revealed that the three methods did not differ in the rate of forgetting of the material (F = 1.96, nonsignificant). Mind maps and acronyms convey a small but significant advantage in patient recall of information over written information leaflets.