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 (Vl) 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.

[Patient perception of functional and cosmetic outcome of orthognathic surgery. Retrospective analysis of 45 patients]

INTRODUCTION

Orthognathic surgery is generally indicated for the treatment of maxillo-mandibular deformities. Surgery is performed to repair functional abnormalities, but also has a cosmetic impact.

MATERIAL AND METHODS

We conducted a retrospective study of 60 patients who underwent orthognathic surgery in 1996 and 1997 in order to assess patient perception of functional and cosmetic outcome. A questionnaire was sent to all patients one year after their surgery; 45 responded.

RESULTS

We noted cosmetic, functional, and psychological changes. Patients considered that the changes were for the better. For functional abnormalities, 88.9% considered their occlusion had improved and 80% their chewing; 73.4% reported psychological improvement stating they had more self-confidence; 97.8% considered their cosmetic aspect had improved.

DISCUSSION

This study enabled us to assess patients' perception of surgical outcome. It must be recalled that the patient basically decides to undertake surgery for cosmetic reasons while the surgeon proposes surgery to improve function. The psychological consequences of orthognathic surgery must be taken into account because the impact is considerable.

The child perception questionnaire is valid for malocclusions in the United Kingdom

INTRODUCTION

The purpose of this study was to validate the child perception questionnaire (CPQ(11-14)) with a sample of schoolchildren in Greater Manchester, United Kingdom.

METHODS

We made a longitudinal survey of children from 1999 to 2002, using the index of orthodontic treatment need (IOTN) at baseline when the children were 11 to 12 years old, the CPQ(11-14), and their uptake of orthodontic treatment 3 years later.

RESULTS

CPQ(11-14) scores corresponded to differences in IOTN scores. These were related to the child's emotional and social well-being. Regression analysis showed that CPQ(11-14) scores were higher for girls, for higher grades of the dental health component of the IOTN, and for children who thought that their teeth needed straightening.

CONCLUSIONS

CPQ(11-14) has acceptable reliability and validity, and is likely to be a useful measure for orthodontic trials. The impact of malocclusion on a child's quality of life might be substantial.

Patients’ perception of improvement after orthognathic surgery: Pilot study

We aimed to find out what patients thought of their quality of life after they had had an orthognathic operation. Thirty-two patients returned three questionnaires and 15 were further interrogated by telephone. Preoperatively the patients mentioned mainly functional problems as a reason for asking for the operation, but expectation of aesthetic improvement was also an important factor. They were generally satisfied with the outcome of the operation. Postoperative improvement was mentioned in terms of chewing, appearance, headaches, and bullying. Patients felt more secure in company with other people postoperatively. We conclude that patients' perceptions after orthognathic operations were generally favourable but there is a need for improved information to patients during the treatment.

Psychosomatic norm in orthodontics: problems and approach

The term "psychosomatic norm" is not commonly used directly or indirectly in orthodontic discussions. However, at times, this may be the most important factor affecting patient satisfaction with treatment outcome. Psychosomatic norm is a norm based on a subjective psychosocial assessment of what is the patient's norm. A norm that significantly differs from the clinician's somatic norm, which is based on objective anatomic assessment, may end in a dilemma of unexplainable and unpredictable dissatisfaction with the orthodontic treatment outcome if not properly handled by the orthodontist. This review article attempts to approach and solve this clinically problematic situation.

Patient- and clinician-perceived need for orthognathic surgery

INTRODUCTION

To better understand why patients believe they need orthognathic treatment, a study was undertaken to examine perceived need for treatment by patients and clinicians. This questionnaire-based study was undertaken at The John Radcliffe Hospital, Oxford, United Kingdom.

SUBJECTS AND METHODS

Forty patients were recruited from combined orthodontic-surgical clinics. They were asked to rate their perceived need for treatment based on facial appearance, dental appearance, function, and overall need. Twenty orthodontists and 20 maxillofacial surgeons were asked to rate perceived need for treatment based on the same parameters, using study models and clinical photographs. Ratings were marked on visual analog scales.

RESULTS

Significant differences were found between patients and clinicians in perceived need for treatment based on facial appearance (orthodontists compared with patients, P = .023; surgeons compared with patients, P = .001). In addition, maxillofacial surgeons rated a significantly greater overall need for treatment than patients (P = .027), and they rated treatment need based on facial appearance (P = .005) and function (P < .001) significantly higher than orthodontists.

CONCLUSIONS

Clinicians rated greater need for orthognathic treatment based on facial appearance than did patients. Surgeons also rated greater overall need for treatment than patients. In addition, surgeons rated treatment need based on facial appearance and function significantly higher than orthodontists, but large variations existed in both clinician groups.

The theory of reasoned action and patient compliance during orthodontic treatment

OBJECTIVES

The aim of the present study was to investigate the potential of the theory of reasoned action (TRA) for the prediction and understanding of patients' intention to comply during orthodontic treatment and to analyze the effect of two additional variables in the model, namely perceived behavioral control and anticipated regret. Moreover, (the determinants of) intentions of orthodontic patients to comply during treatment were compared with (the determinants of) intentions of parents to stimulate this cooperation.

METHODS

A questionnaire was handed out to patients and parents visiting the Department of Orthodontics of the Academic Centre of Dentistry in Amsterdam. In both the patient and parent sample, independent-sample t-tests, correlation analyses and stepwise regression analyses were conducted. Variables in both samples were compared and tested.

RESULTS

The extended version of the TRA explained 20% of the variance in the patients' intention to comply. The patients' anticipated regret, attitude and motivation to comply were significant determinants of the patients' intention to comply. In addition, the parents' attitude toward compliance was a significant predictor. The role of parents in enhancing patients' intentions to comply cannot be neglected.

CONCLUSION

Our findings suggest that patients' intentions to comply during orthodontic treatment are influenced by factors outside of the TRA. Therefore, it is recommended to develop a new model, in which factors of the TRA are included, which can be used specifically for the study of compliance in orthodontics.

Personality traits in adolescence and satisfaction with orthodontic treatment in young adulthood

OBJECTIVE

This study aimed to determine whether personality traits are associated with satisfaction with orthodontic treatment by age 26.

METHODS

A prospective observational cohort study was conducted with 1,037 individuals, one-third of whom had received orthodontic treatment by age 26. A comprehensive personality assessment was conducted at age 18 using the multidimensional personality questionnaire. At age 26, orthodontic outcome was rated as either 'Excellent', 'Pretty good', 'Fair' or 'Poor'.

RESULTS

Those who were less satisfied (rating their treatment outcome as 'Fair' or 'Poor') scored lower on the personality traits of control and social closeness, and higher on stress reactivity. Individuals with low scores on social closeness were twice as likely (Odds ratio: 2.07) to be less satisfied with their orthodontic result.

CONCLUSIONS

Individuals who are impulsive, stress-reactive or socially isolated are more likely to be disappointed with their orthodontic outcome. Pretreatment knowledge about certain aspects of personality might be useful to practising orthodontists.

Occlusal perceptions of children seeking orthodontic treatment: Impact of ethnicity and socioeconomic status

INTRODUCTION

With the growth of orthodontic intervention at younger ages and increased interest in improving dentofacial appearance among the general public, it is important to assess whether demand for treatment is uniform across ethnic and socioeconomic groups.

METHODS

This study compared 3 groups of children who varied by location, payment source, and ethnicity. The sample consisted of 150 children in the Bronx, NY, and 100 in Seattle, Wash, who were undergoing or anticipating orthodontic treatment in publicly funded dental clinics. Ethnic minorities comprised 69% and 92%, respectively, of these groups. The third group consisted of 84 children in Seattle, Anchorage (Alaska), and Chicago who had sought treatment by private practitioners; ethnic minorities comprised 22% of this group. Data were collected from children and parents or guardians by questionnaires.

RESULTS

Desire for treatment was higher among children in the publicly funded clinics and among black children than whites or Asian Americans. Children in publicly funded clinics rated themselves as having worse occlusions as determined by anterior crowding, overbite, overjet, diastema, and open bite. Children in the Bronx clinic accepted a wider range of occlusion as attractive. Stage of treatment affected judgments of attractiveness. Vicarious experience with orthodontics through parents or siblings made children more tolerant of dentofacial disharmony, with more favorable ratings of malocclusion in this group than among children who had no family experience with orthodontics. Hispanic and mixed-ethnicity children rated themselves more negatively on all dimensions.

CONCLUSIONS

These results suggest that both socioeconomic status and ethnicity play roles in children's desire for treatment, self-assessed need, and judgments of esthetics. A clinician's sensitivity to such differences can improve patient cooperation with treatment.

Parents' satisfaction with their child's orthodontic care: a comparison of orthodontists and pediatric dentists

PURPOSE

The purpose of this study was to compare the quality of orthodontic care between orthodontists and pediatric dentists when measured by parental satisfaction.

METHODS

Six pediatric dentists and 5 orthodontists participated in the study. Quality of care was measured using the peer assessment rating (PAR) occlusal index, treatment duration, and parental satisfaction. Parental satisfaction was evaluated using a 25-item questionnaire measuring 3 dimensions: (1) treatment process; (2) psychosocial effects of treatment; and (3) treatment outcomes. The questionnaire items were scored on a scale of "strongly disagree" to "strongly agree."

RESULTS

At baseline, no differences were seen in the gender, starting dentition, and permanent teeth extractions of patients treated by the orthodontist and pediatric dentists. Statistically significant differences were seen in patients': (1) pretreatment age; (2) race; (3) primary teeth extractions; (4) treatment stages; and (5) pre-PAR scores. No statistically significant differences between orthodontists and pediatric dentists were observed regarding overall parental satisfaction or the dimensions of satisfaction. These results did not change after controlling for potential confounding factors such as patient's age, gender, starting dentition, treatment stage, extraction recommendations, pre-PAR score, treatment duration, and percentage PAR reduction.

CONCLUSIONS

The quality of orthodontic care, when measured by parental satisfaction, was similar between orthodontists and pediatric dentists. This indicates that, as far as parents are concerned, pediatric dentists performed orthodontic treatment to the same high standard as orthodontists.

Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults

INTRODUCTION

The aim of this study was to investigate whether young adults with varying dental esthetics and histories of orthodontic treatment also differ in oral-health attitudes, preventive behaviors, and self-perceived oral health.

METHODS

The sample comprised 298 young adults, 18 to 30 years old, with at least 13 years of primary and secondary school education. The subjects were asked to complete questionnaires dealing with various measures related to oral-health attitudes, preventive behaviors, and perceptions of oral health. Dental esthetics were assessed by means of the aesthetic component of the index of orthodontic treatment need. Dental plaque accumulation was assessed in a subsample of respondents.

RESULTS

Subjects with high dental-esthetics scores reported more favorable oral-health attitudes, such as internal control, dental awareness, value of occlusion, and preventive behavior expectations than subjects with lower scores. Subjects with previous orthodontic treatment showed greater internal control and dental awareness than those who had not previously been treated. Subjects ranking high in dental esthetics and those with previous orthodontic treatment reported stricter oral-hygiene adherence than others. Self-perceived oral health was better in high scorers on dental esthetics. Less plaque accumulation was found in subjects with higher dental esthetic scores and in those with previous orthodontic treatment.

CONCLUSIONS

These findings suggest that favorable dental esthetics and previous orthodontic treatment might be important variables in explaining individual differences in oral-health attitudes and behaviors.

Patient compliance: a determinant of patient satisfaction?

Recent studies have shown that there is a distinct relationship between patient satisfaction and patient compliance in orthodontic treatment. The aim of this study was to investigate whether patient compliance, as noticed and recorded by the orthodontist during treatment, can be used as a determinant of patient's satisfaction in the long run. Documentation of 100 patients who completed active orthodontic treatment in the year 2000 at the Academic Centre of Dentistry Amsterdam was analyzed, and compliance scores for patients were computed. Three years after completion of active orthodontic treatment, a questionnaire about satisfaction was sent to all subjects. Items were divided over six subscales on the basis of item content. Compliance and satisfaction scores of both sexes were compared, and correlations between compliance and satisfaction were explored. Regression analyses were done to examine the predictive value of sex and compliance on patient satisfaction. No significant correlations between compliance and satisfaction scores were found. Sex, but not compliance, predicted the patient's satisfaction with the doctor-patient relationship and the situational aspects of the treatment. Compliance, as noticed and recorded by the orthodontist during treatment, is not a decisive determinant of patient satisfaction in the long run. Sex, however, is a predictor of patient satisfaction with regard to the doctor-patient relationship and the situational aspects of the orthodontic treatment.

Does orthodontic treatment affect patients' and parents' anxiety levels?

The aims of this study were (1) to determine and compare the anxiety levels of two groups of patient and parents, (2) to identify possible gender differences between male and female subjects and (3) to evaluate any changes in anxiety levels after 1 year of treatment. The first group consisted of 40 subjects with a mean age of 15.6 +/- 1.2 years awaiting orthodontic treatment, plus one parent of each subject (mean age 43.4 +/- 2.3 years). The second group comprised 43 patients with a mean age of 16.0 +/- 1.1 years who had been undergoing treatment for a period of 1 year, plus one parent of each patient (mean age 41.0 +/- 1.9 years).Personal information forms and Spielberger's 'State and Trait Anxiety Inventory' (STAI) were applied to both groups. To compare the two groups and to determine the differences between males and females, independent-sample t-tests were used. Internal consistencies for the two scales of the STAI were evaluated with Cronbach's alpha coefficient. Trait anxiety levels of parents (51.05 +/- 5.1) and state anxiety levels of subjects (58.57 +/- 6.73) who were about to start orthodontic treatment were both high. The difference between the groups was statistically significant (P < 0.05). In patients who had undergone treatment for 1 year, the scores were found to be normal (43.28 +/- 5.91). However, their parents' high levels of trait anxiety remained unchanged (50.41 +/- 4.2).

Towards a comprehensive model for the study of compliance in orthodontics

The aims of the present study were to explore methods used by Dutch orthodontists in daily practice to estimate and stimulate patient compliance, and to develop a theoretical model of compliance. A questionnaire, containing 38 items, was distributed among participants at the annual congress of the Dutch Society of Orthodontists in September 2002. The items concerned the need for and the level of patient adherence during orthodontic treatment, modes of estimating and stimulating compliance, and perceived reasons for non-compliance. Based on this pilot study and on an extensive literature search, a model for future research was developed in which concepts related to compliance in orthodontics were systematically organized. Of the 88 orthodontists who attended the congress, 51 responded (mean age 47 years, 22 per cent females). The respondents considered compliance to be of vital importance for a successful treatment result. Most patients were regarded as moderate compliers. The respondents believed that a lack of awareness of dental problems, a lack of motivation to co-operate, and personal problems were the main reasons for non-compliance. Only indirect methods were used to estimate compliance. It was concluded that Dutch orthodontists used subjective methods to measure compliance in daily practice, and that a theoretical model was needed to be able to examine compliance in orthodontics in a more systematic way. A multiple assessment of compliance, using a variety of research methods, seems to be the most appropriate way at present to ensure accuracy in measuring levels of patient compliance in orthodontics.

Self-perception of malocclusion among north Jordanian school children

This study was undertaken to assess the factors affecting self-perception and the demand for orthodontic treatment among north Jordanian school children. In total, 1404 students randomly selected to represent five geographical areas of northern Jordan were examined. The students were further subgrouped according to gender (858 females, 546 males), age (985 13 year olds, 419 17 year olds) and rural/urban place of residence (212 rural, 1192 urban). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) was used as an assessment measure of the need for orthodontic treatment. The self-perception of malocclusion was evaluated by asking each student to identify which photograph on the AC scale most closely matched the appearance of their anterior teeth. The demand for orthodontic treatment was measured by asking the students: "Do you feel it is necessary to have your teeth straightened by an orthodontist?" Differences between the self-perception of malocclusion among the different groups were tested using the chi-squared test.The results showed that the majority of students rated their dentition from grades 1 to 4, with a tendency for the females and older school children to score their teeth as more attractive than males and younger children (P < 0.05, P < 0.001, respectively). Rural and urban school children did not differ in the perception of their own dentition. The self-perception scores of subjects within the no aesthetic need, borderline need and definite need groups differed significantly (P < 0.001). The subjects who reported a definite need perceived their teeth to be worse than the other two groups. The demand for orthodontic treatment was found to be affected by gender (P < 0.01) and rural/urban areas of living (P < 0.05).

Effect of facial convexity on antero-posterior lip positions of the most favored Japanese facial profiles

Soft tissue analyses are basic tools in planning orthodontic treatment. However, the perception of a well-balanced Japanese facial profile has not yet been established, particularly with respect to changes in facial convexity. The purpose of this study was to assess and determine the range of antero-posterior (A-P) lip positions of the top three most favored, well-balanced profiles from a series of various facial silhouettes with changing facial convexity. The average profile was constructed from the profiles of 30 Japanese males and females with Class I occlusions. Changes in facial convexity were established by altering the A-P chin position by protruding or retruding the chin in increments of 5 degrees and 10 degrees from the average profile. A series of 11 profiles were developed from each of the four changes in facial convexity. The lips were then protruded or retruded in one-mm increments from the average profile. Forty orthodontists were asked to rate the top three most favored, well-balanced profiles. We found that the raters tended to prefer more retruded lip positions as facial convexity decreased, for both males and females. The raters also tended to prefer slightly more protruded lip positions as the facial convexity increased. Because chin position is inherent in each patient, others may equate a retrusive or protrusive chin with certain personalities, thus, it is important for orthodontists to take into account the balance between the lips and the chin.

Expectations of orthodontic treatment and satisfaction with dental appearance among Nigerian parents [corrected]

The aim of this study was to investigate correlations between satisfaction with dental appearance and expectation of orthodontic treatment. The effects of sex and age on these variables were also explored. A sample of 466 parents comprising 238 (51.1%) males and 228 females (48.9%) were randomly surveyed in Ibadan Nigeria. Their ages ranged from 18 to 73 with mean age of 36.89 +/- 12.27 (SD). They were asked whether they were satisfied or otherwise with their dental appearance and to indicate their expectation of orthodontic treatment. A multiple regression analysis was used to estimate the effect of the dental satisfaction on expectation of orthodontic treatment as well as the influence of age and sex on orthodontic expectations. Significant correlation was not found between satisfaction between dental appearance and parents' expectations. These correlations were invariant over gender, but not over age. It was concluded that satisfaction with dental appearance is not a significant predictor of parents' expectations of orthodontic treatment among the study sample but age was.

[Psychology and psychosomatics of the orthodontic treatment]

Psychosomatic problems related to orthodontic treatment are a special group of oral psychosomatic disorders. The most frequent complaints are related to aesthetics and occlusion. Most of the patients are children, adolescence or young adults, with special emotional problems. Authors reviewed the most important knowledge related to this specific field, but some general aspects of oral psychosomatics are also discussed.

Patients' attitudes towards compliance with retainer wear

OBJECTIVES

The objectives of this survey were to determine patients' attitudes towards retainers and their compliance in wearing retainers.

METHODS

Three hundred dental school patients were selected at random and survey questionnaires were distributed. Twelve private orthodontists were willing to participate in the survey and each was given 20 questionnaires for distribution to their patients. The questionnaire was designed to gather information regarding compliance in wearing removable retainers, perception of the comfort level of retainers and acceptance of the appearance of removable and fixed retainers.

RESULTS

The results revealed that compliance in wearing an upper retainer was related to its comfort level and acceptance. Discomfort was the main reason given by dental school patients and forgetfulness was the major reason given by private patients for not wearing retainers. Higher proportions of patients found fixed retainers more comfortable to wear and were more willing to accept the appearance of fixed retainers. A higher proportion of private patients accepted the appearance of retainers compared with dental school patients, while a higher proportion of dental school patients found retainers less comfortable to wear than private patients.

CONCLUSIONS

There was a strong relationship between compliance and comfort level in wearing upper removable retainers. Patients found fixed retainers more acceptable than removable types because of appearance and comfort.

An orthodontic information package designed to increase patient awareness

BACKGROUND

Most patients and their parents experience difficulty in fully appreciating the implications and demands of orthodontic treatment. This is largely because of inadequate understanding of the process of treatment or the commitment required.

OBJECTIVES

To determine if a specifically developed video information package could significantly increase patient awareness of the implications of a full course of orthodontic treatment. Changes in attitude to orthodontic treatment after viewing the package were also measured.

METHODS

Year 7 (12 year-old) students in two primary schools in the City of Gold Coast, Australia were randomly allocated to either a study group or a control group. Knowledge of and attitude to orthodontic treatment were measured with self-administered questionnaires before and after viewing the information package.

RESULTS

The intervention group showed a 15 per cent gain in knowledge (p < 0.001). There was no gain in knowledge for the 45 students in the control group. There was no measured change in perception of need for orthodontic treatment in the study group. There was, however, an increase in potential compliance and positive attitude to the appearance of orthodontic appliances. There was a small increase in willingness to undertake treatment, but this was not statistically significant.

CONCLUSIONS

The information package developed for this study increased awareness of the implications and practical difficulties which may be encountered during a course of orthodontic treatment, and produced some changes in attitude to treatment.

Attitudes towards orthodontic treatment: a comparison of treated and untreated subjects

The aims of the present study were to evaluate treated and untreated subjects' attitudes towards orthodontic treatment and to examine possible determinants of these attitudes. It was hypothesized that orthodontically treated individuals would differ from untreated respondents in their attitude towards orthodontists and orthodontic treatment, and that female subjects would have a more positive attitude towards orthodontics than male subjects. Untreated individuals (n = 220) were used as a comparison group in the evaluation of orthodontic health care by previously treated subjects (n = 246). Two questionnaires were completed. The first, based on the Dental Attitude Questionnaire, contained 32 items about general attitude towards orthodontic treatment and was completed by both groups. The second questionnaire contained 46 negatively and positively based statements concerning different aspects of orthodontic treatment, and was completed by previously treated subjects. The reliability of both questionnaires was satisfactory. Previously treated subjects were found to have a significantly more positive attitude towards orthodontics than untreated subjects. The subject's attitude towards the relationship with the orthodontist, satisfaction with the treatment result and experiences with follow-up appointments predicted the general attitude towards orthodontics. Age, but not gender, was found to be a significant predictor for a subject's general attitude towards orthodontics.

Self-perceived orthodontic treatment need and culturally related differences among adolescents in Sweden

The aim of this investigation was to compare Swedish and immigrant groups of 12- and 13-year-old boys and girls with respect to: (1) self-perceived need for and attitude to orthodontic treatment, (2) attitude to own teeth and general appearance, (3) behaviour pattern and psychosocial functioning, and (4) self-perceived need for orthodontic treatment in relation to psychosocial functioning. The subjects comprised 508 students, aged 12 and 13 years, living in Sweden, who were grouped according to nationality: (A) both parents born in Sweden (139 girls and 131 boys); at least one parent born in: (B) eastern Europe (27 girls and 34 boys); (C) Asia (66 girls and 61 boys) and (D) other countries (23 girls and 27 boys). Each student answered a questionnaire in the classroom. The questions concerned demographic data, self-perceived treatment need, attitude to orthodontic treatment, own teeth and general appearance, behaviour pattern and psychosocial functioning. The results showed that, on average, 20 per cent of the students had a self-perceived treatment need, more girls than boys, 24 per cent of Swedes (A), 12 per cent from eastern Europe (B), 18 per cent from Asia (C) and 14 per cent from other countries (D). Seventy-two per cent of the Swedish students were prepared to undergo fixed appliance therapy, compared with 58 per cent of immigrant students. Nine per cent of the Swedish students considered their general appearance to be less favourable compared with 7 per cent of their peers (not significant). While some differences in behaviour pattern were observed, these did not seem to influence the well-being of the subjects. The conclusion is that perceived orthodontic treatment need is lower in immigrant students than in Swedish students.

Evaluation of the aesthetic component of the Index of Orthodontic Treatment Need by Swedish orthodontists

The aim of the present study was to evaluate if the majority of orthodontists in Sweden agree with the ranking of the photographs in the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN), and its treatment need classification. Ten separate colour photographs (originals from the AC) and two questionnaires were sent to 272 orthodontists in Sweden. Eighty-one per cent (219) returned one or both questionnaires. One hundred and ninety-four orthodontists answered the AC 'grading of dental attractiveness' and 217 the AC 'need for orthodontic treatment' (nine of the integrated questions had to be excluded because more than one alternative had been chosen). The aesthetic ranking by the orthodontists was compared with the original AC and the deviation was estimated. The results showed that the grading of photographs 2-9 varied greatly among the orthodontists, but the agreement was almost complete for photographs 1 and 10. The establishment of treatment need for each photograph had good agreement with the original index for photographs 1, 2, and 8-10, while the majority of the orthodontists considered that photographs 5 and 7 should be treated and that photograph 6 showed a borderline case. The participating Swedish orthodontists' aesthetic ranking of the photographs was: 1, 2, 3, 4, 6, 5, 7, 9, 8, and 10. Regarding treatment need, no need for treatment was set for photographs 1-4, borderline for photograph 6 and a need for treatment for photographs 5, 7-10. Further studies are needed to evaluate if laymen in Sweden make the same judgements as Swedish orthodontists.