Combining Normative and Psychosocial Perceptions for Assessing Orthodontic Treatment Needs

Comparison of anxiety, pain, and quality of life in individuals with mild or moderate malocclusion between conventional fixed orthodontic treatment versus Invisalign: a randomised clinical trial

BACKGROUND

We evaluated anxiety, pain, and oral-health-related quality of life in individuals treated with conventional fixed appliances (Group A) and clear aligners (Group B) for moderate malocclusion during the initial phase of orthodontic treatment.

METHODS

Sixty individuals, separated into Group A (n = 30) and Group B (n = 30), were included in the study. They completed the Anxiety Levels, Oral Health Impact Profile-14, and Oral Health Related Quality of Life - United Kingdom/Surveys after the application of attachments on days 0 (T1), 10 (T10), and 20 (T20). Their pain levels were evaluated with the Visual Analogue Scale on days 0, 2, and 6 in the 2nd and 6th hours and on the 1st, 3rd, 7th, 14th, and 21st days.

RESULTS

Per the VAS questionnaire, pain levels in the 2nd hour, 6th hour, 1st day, and 3rd day were significantly lower in Group B than in Group A. In the OHIP-14 survey results, the comparison between Group A and Group B showed a significant difference only on the 1st day. The STAI and OHRQoL-UK survey results did not differ significantly between the groups.

CONCLUSIONS

We found no significant difference between the two groups in terms of anxiety levels, and pain among individuals in Group A was higher than in Group B only at the beginning of the treatment. No significant differences were observed in terms of individuals' quality of life.

TRIAL REGISTRATION

NCT06133296 (retrospectively registered)- Registration Date:15/11/2023.

Associations between body dysmorphic disorder (BDD) with the dental health component of the index of orthodontic treatment need (IOTN-DHC) and other BDD risk factors in orthodontic patients: A preliminary study

Objective

Body dysmorphic disorder (BDD) is a form of obsessive-compulsive disorder that may be negatively associated with the self-image. It might be associated with orthodontic treatment demand and outcome, and therefore is important. Thus, this study was conducted.

Methods

The Yale-Brown Obsessive-Compulsive Scale modified for Body Dysmorphic Disorder (BDD-YBOCS) questionnaire was used in 699 orthodontic patients above 12 years of age (222 males, 477 females), at seven clinics in two cities (2020-2021). BDD diagnosis and severity were calculated based on the first 3 items and all 12 items of the questionnaire. The dental health component of the index of orthodontic treatment need (IOTN-DHC) was assessed by orthodontists. Multivariable and bivariable statistical analyses were performed on ordinal and dichotomized BDD diagnoses to assess potentially associated factors (IOTN-DHC, age, sex, marital status, education level, and previous orthodontic consultation) (α = 0.05).

Results

IOTN-DHC scores 1-5 were seen in 13.0%, 39.9%, 29.8%, 12.4%, and 4.9% of patients. Age/sex/marital status/education were not associated with IOTN-DHC (p > 0.05). Based on 3-item questionnaire, 17.02% of patients had BDD (14.02% mild). Based on 12-item questionnaire, 2.86% had BDD. BDD was more prevalent or severer in females, married patients, patients with a previous history of orthodontic consultation, and patients with milder IOTN-DHCs (p < 0.05).

Conclusions

IOTN-DHC was negatively/slightly associated with BDD in orthodontic patients. Being female and married may increase BDD risk.

Smile Attractiveness and Treatment Needs of Maxillary Midline Diastema with Various Widths: Perception among Laypersons, Dental Students, and Dentists in Malaysia

Smile attractiveness and the need for treatment of maxillary midline diastema with various widths are perceived differently between dentally trained and nondentally trained individuals of different sociodemographic backgrounds. This study aims to evaluate how laypersons, dental students, and dentists in Malaysia differ in their perceptions on smile attractiveness and treatment needs of maxillary midline diastema. A smiling photograph with well-aligned maxillary central incisors with proportionate width-to-height ratio and healthy gingival tissues was selected and digitally manipulated to create maxillary midline diastema with 0.5, 2.0, and 4.0 mm widths. The smile attractiveness and the perceived need for treatment of varying widths of maxillary midline diastemas were rated by laypersons, dental students, and dentists using the Likert scale via a single set of self-administered questionnaires. The impact of sociodemographic variables on aesthetic perception of different gap widths was tested using univariate analysis followed by a multiple linear regression model. A total of 158 laypersons, 118 dental students, and 138 dentists participated in this study. Both laypersons and dentists showed significantly higher mean aesthetic scores for 0.5 mm maxillary midline diastema, lower mean aesthetic scores, and hence higher mean treatment needs scores for 4.0 mm maxillary midline diastema as compared with dental students (p < 0.05). In general, female respondents perceived a gap width of up to 2.0 mm as aesthetically pleasing. Higher educational group and the Malay ethnicity had tolerance threshold of 0.5 mm gap width. The older group considered 4.0 mm gap width as aesthetically unpleasing. In conclusion, both laypersons and dentists accepted a 0.5 mm maxillary midline diastema as an attractive smile but considered 4.0 mm maxillary midline diastema as unpleasing smile which required treatment. Perceptions of laypersons and dentists were significantly different from dental students. Educational level, gender, ethnicity, and age were significantly associated with smile attractiveness of maxillary midline diastema at different investigated widths.

Malocclusion and oral health-related quality of life among young Danish adults. Is there a difference between subjects who received orthodontic treatment during adolescence and subjects without treatment need? A cross-sectional study

OBJECTIVES

To evaluate and compare malocclusion traits and oral health-related quality of life (OHRQoL) between untreated young adults assessed to have no orthodontic treatment need during childhood, and young adults treated orthodontically during childhood. In addition, to investigate the relationship between malocclusion and OHRQoL.

MATERIALS AND METHODS

One hundred undergraduate students were screened for eligibility. Subjects had intraoral scans and completed OHIP-14 questionnaires. Angle molar relationship, overjet, overbite, arch length and width, Little's Irregularity Index (LII), Peer Assessment Rating (PAR) index and Dental Aesthetic Index (DAI) scores were assessed. Unpaired t-tests were used to compare outcomes between treated and untreated subjects. Multiple regression analyses were conducted to model the relationship between OHIP-14 and several prognostics simultaneously.

RESULTS

Ninety-six subjects were included (mean age ± SD = 23.7 ± 1.8 years): 41 treated and 55 untreated. The untreated subjects had significantly higher LII (p = .02), PAR (p = .01), DAI (p < .01) and overbite (p = .03). The treated subjects had significantly larger inter-canine and inter-premolar distances. No relationship was found between OHIP-14 and LII, PAR, DAI, age, gender and presence/absence of previous orthodontic treatment. However, the DAI score was significantly correlated with the OHIP-14 functional limitation domain.

CONCLUSIONS

Untreated subjects had significantly higher LII, PAR and DAI scores than the treated subjects. DAI score was significantly correlated with the OHIP-14 functional limitation domain.

Quality of Life Assessment in Patients with Malocclusion Undergoing Orthodontic and Orthognathic Treatment

Introduction

The objective of this study was to assess pre-treatment quality of life and the relevant clinical variables in adult patients with malocclusion in order to improve orthodontic treatment strategies.

Methods

The study was conducted in 240 consecutive adult patients with malocclusions divided into two groups: patients for whom an orthodontic treatment plan was considered, and patients for whom an orthognathic treatment plan was selected. Patients were examined between December 2015 and February 2017, at the School of Dental Medicine, University of Belgrade. Malocclusion severity was recorded using the Peer Assessment Rating index pre-treatment score. Skeletal malocclusion parameters were measured using lateral cephalometric radiographs. Quality of life was assessed by means of a generic questionnaire (Medical Outcomes Study Short Form-36 (SF-36)), and the disease-specific Orthognathic Quality of Life Questionnaire (OQLQ).

Results

There were significant differences in the mean values of the OQLQ domain scores between orthodontic and orthognathic patients. Patients for whom orthodontic treatment was planned had statistically significantly lower scores in comparison to those for whom orthognathic treatment was planned. This was the case in all OQLQ domains except for “Awareness of facial deformity”. Statistically significant correlations (p<0.05) were presented between OQLQ scores and following demographic and clinical variables: gender, age, malocclusion severity, maxillary and mandibular sagittal, maxillary vertical, and lower incisor positions, intermaxillary angle, and the Beck Depression Inventory and Beck Anxiety Inventory levels. The independent predictors for the planning of orthodontic and orthognathic treatment in patients with malocclusion were two OQLQ domains, “Facial aesthetics” and “Awareness of facial deformity”, as well as total OQLQ score, after adjustment for demographic characteristics, skeletal parameters, anxiety and depression.

Conclusions

Our findings suggest that patients for whom orthodontic treatment was planned demonstrated better quality of life according to the OQLQ scores in comparison to those for whom orthognathic therapy was planned.

How is orthodontic treatment need associated with perceived esthetic impact of malocclusion in adolescents?

INTRODUCTION

The purpose of this research was to evaluate the esthetic impact of orthodontic treatment need in adolescents.

METHODS

This cross-sectional study was performed with 1172 adolescents aged 12 (n = 638) years and 15 (n = 534) years from Salvador, Bahia, Brazil. The esthetic impact was the following outcome variables: Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale. The normative orthodontic treatment need was assessed by the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) and by the Dental Aesthetic Index (DAI). Logistic regression models were adjusted, estimating crude odds ratio with the respective 95% confidence intervals. The variables with P ≤0.20 in the individual analyses were tested in multiple logistic regression models, remaining the variables with P ≤0.05.

RESULTS

The results showed a statistically significant association for the esthetic impact (Aesthetic Component of the Index of Orthodontic Treatment Need and the Oral Aesthetic Subjective Impact Scale) when assessing the normative orthodontic treatment need by the DAI (P <0.05). However, there was no significant association between subjective esthetic impact and normative needs when using the IOTN-DHC (P >0.05).

CONCLUSIONS

DAI was more associated with the adolescents' esthetic concern than IOTN-DHC and should be the Index of Orthodontic Treatment Need to be selected to complement the patient's self-perception.

Relationships of Dental Caries and Malocclusion with Oral Health-Related Quality of Life in Lithuanian Adolescents Aged 15 to 18 Years: A Cross-Sectional Study

There is a lack of evidence of the moderating effects of caries lesions and malocclusions on oral health-related quality of life (OHRQoL) among older adolescents. This study aimed to evaluate the relationship of dental caries and malocclusion with OHRQoL among Lithuanian adolescents aged 15 to 18 years. A survey in a representative sample of adolescents included a clinical examination to assess dental health status using the DMFT (Decayed, Missing, and Filled Permanent Teeth) index, and malocclusion using the Index of Complexity, Outcome, and Need (ICON). The Child Perceptions Questionnaire (CPQ) was used to evaluate respondents’ OHRQoL. Negative binomial regression was fitted to associate the clinical variables with the CPQ scores. A total of 600 adolescents were examined. The overall mean DMFT score was 2.7. A need for orthodontic treatment was detected among 27.7% of adolescents. Subjects with caries lesions (DMFT > 3) had higher CPQ scores in the domains of functional limitations and social wellbeing (relative risks were 1.35 (95% confidence interval: 1.09–1.67) and 1.30 (1.03–1.64), respectively), while subjects with a need for orthodontic treatment (ICON > 43) had higher CPQ scores in the domains of emotional wellbeing and social wellbeing (relative risks were 1.81 (1.40–2.22), and 1.69 (1.34–2.14), respectively). It was concluded that both dental caries and malocclusion have negative relationships with OHRQoL in adolescents above 15 years, but their effects occur differently in each OHRQoL domain.

Dental treatment needs using a sociodental approach among south Indian youths: a cross-sectional study

AIM

The aim of this study was to compare the normative dental needs and sociodental needs in a sample of 18-21-year-old students in Davangere city in South India.

METHOD

This cross-sectional survey was conducted on a sample of 250 students aged 18-21 years. Data was collected using a self-administered questionnaire and clinical examination. The normative needs were assessed by different indices. The impact of oral diseases on their quality of life was assessed using the standard Oral Impact on Daily Performance (OIDP) scale and propensity-related needs (PRNs) were assessed using three standard questions.

RESULTS

About 85.6% of the subjects fulfilled the criteria for professionally judged normative treatment need. Among them, 42% of the subjects were suffering from emergency/progressive oral conditions and the remaining 43.6% subjects were suffering from non-progressive oral conditions. In turn, a total of 28.4% of the subjects with non-progressive oral conditions fulfilled the criteria of impact-related treatment need. Finally, only 1.2% had sociodental needs (high PRNs).

CONCLUSIONS

A substantial reduction in treatment needs were found with the sociodental approach among youths in India. The considerable proportion of the children with impact-related need (IRN) did not have a high behavioral propensity, hence potentially needing alternative interventions and programs.

Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment

INTRODUCTION

The aim of this study was to evaluate the psychosocial impact of dental esthetics for adults seeking orthodontic treatment.

METHODS

The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered to 393 adults, aged 18 to 30 years. The participants were divided into 2 groups: an intervention group (received orthodontic treatment) and a control group (rejected orthodontic treatment). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The Wilcoxon signed rank test showed no statistically significant difference between the groups for the dental health component (DHC) of the IOTN (P = 0.134). Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTN-DHC grades; self-confidence scores in the control group (F = 1.802; P >0.05) were the exception. Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group. DHC grades, psychological impact, social impact, and aesthetic concern had significant impacts on patients accepting orthodontic treatment.

CONCLUSIONS

The psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment. Importantly, participants with low self-awareness of the potential psychosocial impact rejected orthodontic treatment, despite the need for severe normative treatment.

Relationship between oral clinical conditions and daily performances among young adults in India - a cross sectional study

Objective of the present study was to investigate relationship between oral health-related quality of life using Oral Impacts on Daily Performances (OIDP) scale and specific clinical dental measures. A cross sectional descriptive survey was conducted among 800 students. Oral health status and impacts were assessed using WHO guidelines and OIDP index respectively. Chi square test and multiple logistic regressions were employed for statistical analysis. Participants with caries were significantly (p ⩽ 0.05) more likely to have an impact on cleaning (OR = 2.487) and sleeping and relaxing (OR = 8.996). Similarly participants with oral mucosal conditions were more likely to have an impact on eating (OR = 3.97), cleaning (OR = 2.966) and physical activities (OR = 11.190). Dental Aesthetic Index (DAI) impacted on cleaning (OR = 2.134), emotional stability (OR = 3.957) and social contact (OR = 3.21). OIDP Index showed acceptable psychometric properties in the context of an oral health survey. Subjects presented a strong and consistent relationship between dental status and perceived impacts.

Oral health, socio-economic and home environmental factors associated with general and oral-health related quality of life and convergent validity of two instruments

Background

The objective of this study was to evaluate the convergent validity between the domains of the Autoquestionnaire Qualité de Vie Enfant image (AUQUEI) and the Child Perceptions Questionnaire instrument (CPQ_11–14) among schoolchildren and to assess the difference between socio-economic and clinical variables associated with their scores.

Methods

An analytical cross-sectional study was conducted in Juiz de Fora, Minas Gerais, Brazil, with 515 schoolchildren aged 12 years from 22 public and private schools, selected with the use of a random multistage sampling design. They were clinically examined for dental caries experience (DMFT and dmft index) and orthodontic treatments needs (DAI index) and were asked to complete the Brazilian versions of Child Perception Questionnaire (CPQ_11–14) and Autoquestionnaire Qualité de Vie Enfant image (AUQUEI). In addition, a questionnaire was sent to their parents inquiring about their socio-economic status and home characteristics. The convergent validity of the Brazilian versions of CPQ_11–14 and AUQUEI instruments was analyzed by Spearman’s correlation coefficients. For comparison between the summarized scores of each questionnaire with regard to the schoolchildren’s socio-environmental and clinical aspects the nonparametric Mann–Whitney was used at level of significance of 5%.

Results

The mean DMFT index was 1.09 and 125 (24.3%) children had orthodontic treatment needs (DAI ≥ 31). There was a similarity and a weak correlation between the scores of the domains of CPQ_11–14 and AUQUEI (r ranged between −0.006 and 0.0296). In addition, a significant difference was found between the scores of the two instruments according to the socio-economic variables (p < 0.05) and presence of teeth with carious lesions (p < 0.05).

Conclusions

The general and oral health-related quality of life instruments AUQUEI and CPQ_11–14 were both found to be useful, and significant influence of socio-economic and clinical variables were detected with both instruments.

Oral health-related quality of life in patients with dentofacial deformity: a new concept in decision-making treatment?

BACKGROUND

The parameters for the indication of surgical-orthodontic treatment by professionals do not always coincide with the factors which motivate patients to seek treatment.

PURPOSE

The purpose of this review is to check the main applications of oral health-related quality of life (OHRQoL) assessment in the treatment of dentofacial deformities and discuss how this approach enriches the traditional diagnostic evaluation and the treatment plan.

RESULTS

The indicators of OHRQoL are psychometric tools which can help orthodontists and maxillofacial surgeons in making individual treatment decisions, which include the following: (1) public health triage, (2) decision to treat or not to treat, (3) stipulating the ideal time for treatment, (4) decision making in borderline cases, (5) estimating if the patient will follow the treatment, and (6) they also act as tools to evaluate health services and patient satisfaction or dissatisfaction with the treatment performed.

CONCLUSION

It was concluded that the psychometric and morphological information tended to complement each other and helped to achieve better results, thereby leading to successful professional-patient relationships.

Daily life impact of malocclusion in Swedish adolescents: a grounded theory study

OBJECTIVE

To explore how malocclusions affect daily life in adolescents and how adolescents cope with malocclusion-related distress.

MATERIALS AND METHODS

Twelve strategically selected teenagers, seven girls and five boys aged 13-14 years, participated in this study. Open, tape-recorded in-depth interviews based on Focus Group Discussions (FGD) were performed using a theme guide and analyzed according to the qualitative method of classic grounded theory (GT).

RESULTS

A core category was identified and named 'Repeatedly reminded of the malocclusion'. Associated to the core category, five categories were generated and labeled 'Being directed by the media's ideal image', 'Monitoring others' teeth', 'Struggling with low self-esteem', 'Hiding one's teeth' and 'Striving for cure'. Low self-esteem appeared to be frequently reinforced through the concerns for the malocclusion and handled via different coping strategies, such as hiding the teeth and striving to receive orthodontic treatment. Such processes were further enforced through the influence of media. Low self-esteem could be associated to a visible malposition of teeth, according to the informants. Having to wait for orthodontic treatment was frustrating the adolescents.

CONCLUSIONS

Adolescents with malocclusion are often reminded of their condition, which can lead to avoiding strategies to minimize the negative feelings associated with the teeth and low self-esteem. Clinicians may therefore need to be aware of potential irrational behaviors when interacting with adolescents with malocclusions. The findings also suggest that there might be a discrepancy of attitudes between professionals focusing on oral health aspects of malocclusions and the adolescents focusing on esthetic aspects.

The impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions

OBJECTIVE

To investigate the impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions and to identify components of malocclusion that may contribute to these outcomes.

MATERIALS AND METHODS

The sample comprised 704 secondary school adolescents aged 12 to 13 years from Balneário Camboriú, Brazil. A trained and calibrated orthodontist examined the severity of malocclusion using the Dental Aesthetic Index (DAI). A pretested questionnaire was used to assess reported dental appearance, self-perception of speech, and self-perception of masticatory function using a 5-point scale of oral health status. The outcomes of the present study were dissatisfaction with dental appearance and dissatisfaction with oral functions. Simple and multivariate logistic regression analysis was performed to explore the association between DAI and outcomes and to quantify the effect of DAI components on dissatisfaction with dental appearance.

RESULTS

Each DAI unit increase led to a significant increase of 5% in the likelihood of dissatisfaction with dental appearance (OR: 1.05; 95% CI 1.01-1.08). DAI components that exerted influence on dissatisfaction with dental appearance were: missing teeth (P  =  .010), largest maxillary anterior irregularity ≥3 mm (P  =  .013), and largest mandibular anterior irregularity ≥2 mm (P  =  .008). There was no association between severity of malocclusion and dissatisfaction with oral functions.

CONCLUSIONS

Severity of malocclusion interfered with satisfaction of dental appearance in this population. Missing teeth and anterior irregularity were identified as factors influencing this outcome.

Disability assessment in temporomandibular disorders and masticatory system rehabilitation

The consequences of a disease or condition such as temporomandibular disorders (TMD) include functional limitation and psychosocial disability. These two concepts refer to the individual's experience of limitations in function associated with the affected part of the body and to disarray in one's life, respectively. Models of disability emphasize the individual's self-report in describing these states and the centrality of these concepts as part of the disease and illness process. However, assessment approaches typically used in medicine and especially in dentistry do not yet routinely include these domains. TMD, as a musculoskeletal pain condition, can clearly lead to both limitation and disability, and the available evidence suggests that dentofacial disorders can also lead to both consequences. The relatively low contribution of disease impairment (measured changes in function through objective tests), however, to the reported limitation or disability in either TMD or dentofacial disorders remains complex and poorly understood. This article reviews the overall model of disablement, the necessary properties of measures to assess disablement, the present state of knowledge about these concepts, and what measures should be considered as part of routine assessment.

Fatores associados à necessidade subjetiva de tratamento odontológico em idosos brasileiros

A transição demográfica pela qual o Brasil vem passando nos últimos anos produz como efeito um fenômeno mundialmente conhecido como envelhecimento populacional. Dessa forma, o objetivo deste estudo foi conhecer os fatores relacionados à necessidade de tratamento odontológico percebida por idosos brasileiros. Foi realizado um aprofundamento dos resultados encontrados no levantamento epidemiológico nacional de saúde bucal de 2003. O tamanho total da amostra foi de 5.349 indivíduos. Modelos de regressão de Poisson foram realizadas para identificar as variáveis individuais envolvidas na autopercepção de necessidade de tratamento odontológico. As variáveis associadas à necessidade subjetiva de tratamento odontológico foram diferentes para idosos edêntulos e não edêntulos. Estes achados são importantes para o planejamento da oferta de serviços de saúde bucal para a população, fornecendo uma estimativa sobre os principais problemas que estes indivíduos demandam e quantos necessitariam de atendimento.