Psychosocial implications of malocclusion: a 15-year follow-up study in 30-year-old Danes

An Assessment of the Subjective Psychological and Social Effects of Malocclusion-Related Dental Aesthetics and Its Influence on Body Self-Image and Oral Health-Related Quality of Life in Young Adults

INTRODUCTION

 Malocclusion has a psychological impact related to the patient's age. It also influences the quality of life. This research aims to test the null hypothesis that there is no association between the self-perceived psychosocial impacts of dental aesthetics with the severity of malocclusion, oral health-related quality of life (OHRQoL), and self-image of the body in young adults seeking orthodontic treatment.

MATERIALS AND METHODS

A convenience sample of young adults between 19 and 30 years old was selected for the study. The severity of malocclusion and orthodontic treatment needs were evaluated using the Dental Aesthetic Index (DAI). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile-14 (OHIP-14), and Body Satisfaction Scale (BSS) were used to evaluate the self-perceived effects of malocclusion.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test is used to analyze the distribution of components with different grades of DAI. Spearman's correlation test evaluated the correlation between independent variables and their domains. The study utilized stepwise multiple linear regression analysis to assess the predictive value of independent factors on the PIDAQ and its domains.

RESULTS

 A total of 181 subjects with a mean age of 24.4 ± 1.5 years, 42% males and 58% females, participated in this study. There was a significant correlation (p < 0.05) between all variables (OHIP-14, DAI, and BSS) and PIDAQ. There were significant correlations between the independent variables and the total score of PIDAQ (R2 = 0.16), psychological impact (R2 = 0.09), and social impact (R2 = 0.18), as well as dental self-confidence (R2 = 0.21) and aesthetic concern (R2 = 0.16).

CONCLUSION

In young adults, the self-perceived impact of dental aesthetics is moderated by the severity of malocclusion, oral health-related quality of life, and body satisfaction. The null hypothesis is rejected.

Effect of smile on facial attractiveness before and after orthodontic treatment in females with more attractive and less attractive facial background

INTRODUCTION

One of the goals of orthodontic treatment is to improve facial esthetics. This study aimed to determine the effect of smile on facial attractiveness before and after orthodontic treatment in females with "more attractive" and "less attractive" facial backgrounds. In addition, changes in facial attractiveness after orthodontic treatment were examined.

METHODS

Frontal rest and smile photographs of 60 female patients (mean age, 26.32 years) before and after orthodontic treatment were included in 4 separate online questionnaires. The link for each questionnaire was sent to 40 layperson raters (20 females, 20 males). They were asked to give a score from 0 to 100 on the basis of the visual analog scale for the attractiveness of each image. Then the data were collected and analyzed.

RESULTS

The mean score of the pretreatment smile was significantly smaller than the frontal rest view, and the difference was significantly greater in the "more attractive" group (P = 0.012). After treatment, the smiling view was significantly more attractive than the frontal rest view, and the difference was significantly greater in the "less attractive" group (P = 0.014). In addition, the attractiveness of both smiling and rest views increased significantly after orthodontic treatment, and these changes were significantly greater in the "more attractive" group (P <0.001 and P = 0.011).

CONCLUSIONS

An unesthetic pretreatment smile negatively impacted facial attractiveness, and orthodontic treatment significantly improved facial attractiveness. These negative and positive effects were greater in more attractive facial backgrounds.

Body Image and Psychological Impact of Dental Appearance in Adolescents with Malocclusion: A Preliminary Exploratory Study

BACKGROUND

Body image and psychosocial functioning represent central challenges during adolescence and early adulthood. Malocclusion, defined as an irregularity in the alignment of the teeth, is known to negatively influence psychological outcomes. The current study aimed to elucidate the role of malocclusion, together with age, gender, and dental class, in body image and psychological functioning.

METHODS

A total of 126 participants aged from 12 to 19 years old (mean: 15.87, SD: 2.35, female participants: 52.4%, male participants: 47.6%) were recruited. Participants were visited at the University Hospital of Messina, Italy, and completed a sociodemographic questionnaire, the Body Image Concern Inventory (I-BICI), and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ).

RESULTS

Significant correlations were found between age, dental class, the BICI, and the PIDAQ. In particular, age showed a positive and significant correlation with PIDAQ-total score. The correlations between occlusal status and the BICI variables were all significant and positive. All correlations between occlusal status and the PIDAQ variables were all significant and positive, except for dental self-confidence. The correlations between the variables of the PIDAQ and BICI instruments were all significant and positive, except for dental self-confidence, where the directions were significant and negative. Moreover, age, gender, and occlusal status predicted BICI and PIDAQ scores. Age was a positive predictor for PIDAQ self-confidence, gender for BICI and PIDAQ total scores, along with dysmorphic symptoms, social impact, psychological impact, and aesthetic concerns. Several significant gender differences were highlighted by the analyses, with higher scores in the female group on all the BICI variables, except symptom interference, and all the PIDAQ variables, except dental self-confidence.

CONCLUSIONS

Malocclusion appeared to play a central role in the psychological, representational, and psychosocial life of the participants. This research suggests that malocclusion and dental issues influence the psychological, representational, and psychosocial life of adolescents. Further research is required to examine the psychological impact of dental problems.

Reflection on patients' experience with orthodontic appliances wear and its impact on oral health related quality of life: observational comparative study

BACKGROUND

The objective of this study was to explore and compare patient's experience with the use of a removable functional appliance or fixed orthodontic appliance and its influence on oral health-related quality of life.

MATERIAL AND METHODS

This clinical trial included 81 participants having Class II Division 1 and age ranging between 10 and 16 years. The participants were included in any of a three equal groups according to the set inclusion and exclusion criteria; Group 1: patients treated with a Twin-Block functional appliance; Group 2: patients treated with a fixed orthodontic appliance only; and Group 3 (control group): patients not in orthodontic treatment yet. The COHIP SF-19 was used. Patients were given the questionnaire as follows: Group 1: (1) after at least 8 months from starting treatment; (2) after completing phase 1 by 2-3 months without wearing the appliance; Group 2: (1) just before debonding; (2) after finishing the treatment by 2-3 months without any appliances; and Group 3: (1) at the patient's first visit to the orthodontic clinic; (2) after 2-3 months from the first visit to the orthodontic clinic and before starting any treatment.

RESULTS

The 81 participants were 31 males and 50 females with median age of 13 years. The total COHIP SF-19 scores at baseline were 57 (49-64), 67 (63-72), and 47 (42-53) for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively. Two-month mean scores adjusted to the baseline scores were 64.82 ± 1.15, 65.65 ± 1.47, and 54.45 ± 1.44 for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively.

CONCLUSIONS

Both at baseline and two-months (adjusted to the baseline scores), participants in the malocclusion group showed compromised socio-emotional quality of life and reported the poorest total OHRQoL. At the baseline, better socio-emotional and total OHRQoL was reported by the fixed appliance group compared to the Twin-Block group but, after two months both groups gave similar sores. Therefore; patients' perceptions about their experience with the orthodontic appliance might change.

Optimal gingival display on smiling based on different facial vertical patterns in Iranians

INTRODUCTION

This study aimed to determine the optimal gingival display on smiling on the basis of different facial vertical patterns in Iranians from the perspective of laypeople, maxillofacial surgeons, and orthodontists.

METHODS

Photographs were obtained from short-faced, normal-faced, and long-faced males and females (1 male and 1 female from each group) aged 18-30 years. The original photographs were then modified to have 6, 4, 2, 0, -2, -4, and -6 mm gingival display. Three groups of raters (n = 40), including laypeople, orthodontists, and maxillofacial surgeons, were requested to score each photograph regarding smile attractiveness using a 5-point Likert scale. Data were analyzed using analysis of variance and the Kruskal-Wallis test.

RESULTS

Regarding the photographs of the normal-faced female model, all 3 rater groups gave the highest score to a 2 gingival display. In the normal-faced male model, all 3 rater groups gave the highest and lowest scores to 0 and 6 mm gingival display, respectively. In the long-faced female model, all 3 rater groups gave the same score to 0, 4, and 6 gingival display. In the long-faced male model, the 3 rater groups gave the same score to 0, 2, 4, and 6 gingival display. In the short-faced female model, all 3 rater groups gave the highest score to 0 gingival display. In the short-faced male model, the 3 rater groups gave the same score to all values of gingival display except -4 mm.

CONCLUSIONS

The laypeople, maxillofacial surgeons, and orthodontists all gave the highest score to the photograph of a short-faced Iranian female model with 0 gingival display.

Association between Dentofacial Features and Bullying from Childhood to Adulthood: A Systematic Review

Bullying occurs when an individual is repeatedly victimised by negative actions performed by peers. As oral features, like malocclusion and dental structural defects, can promote psychological distress, which is also found in those who are bullied, we aimed to study the association between orofacial conditions and bullying. A systematic review (PROSPERO CRD42022331693), including articles dealing with bullying and dentofacial traits, was performed following the PRISMA chart. The iterative search of eligible publications was carried out on 27 March 2023 on four databases (PubMed, PubPsych, Web of Science and Cochrane Reviews) and in the grey literature. Among the 25 articles included, 4 referred to qualitative studies, which analysed 632 interviews with children, 8 interviews with parents, 292 letters, and 321 Twitter posts. The other 21 were cross-sectional studies, which included 10,026 patients from 7 to 61 years old. Two of the qualitative studies and seven of the cross-sectional studies rated a low risk of bias, according to Joanna Briggs Institute's Critical Appraisal Tools. The majority of studies (88%) reported a relationship between malocclusion or structural defects and exposure to bullying among young adolescents. Structural dental abnormalities and severe malocclusion should be managed, among others, for psychological questions because they crystallise the loss of self-confidence and increase the risk of bullying.

Prevalence of bullying in orthodontic patients and its impact on the desire for orthodontic therapy, treatment motivation, and expectations of treatment

PURPOSE

This study aims at investigating the prevalence of bullying due to malocclusions in a sample of German orthodontic patients. Thereby, we analyzed the influence of self-reported bullying on initiation, desire and motivation, and expectations of orthodontic therapy.

PATIENTS AND METHODS

Patients completed questionnaires by themselves in three orthodontic practices (n = 1020, mean age 11.8 years). The sample was divided into three groups: (1) subjects bullied due to dentofacial features, (2) subjects bullied due to physical features, and (3) non-bullied control group. The effect of bullying on initiation, desire and motivation, and expectation from orthodontic treatment was assessed and compared between these groups.

RESULTS

Overall prevalence of bullying was 23.7% with male subjects revealing significantly higher values than females (p < 0.001). Subjects from the dentofacial features group (6.3%) initiated orthodontic therapy themselves significantly more often than subjects from the physical features (17.4%; p = 0.030) and control group (76.3%; p < 0.001). The dentofacial features group reported significantly more frequently that 'ugly teeth' were the major motivating factor to seek orthodontic treatment (40.4%). Within this group significantly higher mean scores for the expectation 'keep me from being bullied' were obtained compared with subjects in the physical features (p < 0.001) or control group (p < 0.001).

CONCLUSION

This analysis demonstrated that bullying due to malocclusion impacts attitude towards orthodontic treatment. Victims who experienced bullying due to malocclusion initiate orthodontic treatment more often themselves and expect therapy to prevent them from experiencing further bullying.

Malocclusion severity and smile features: Is there an association?

INTRODUCTION

This observational study investigated the relationship between malocclusion and smiling.

METHODS

Adolescents and young adults (n = 72; aged 16-25 years) were identified according to their Dental Aesthetic Index (DAI) and allocated to 3 groups: (1) malocclusion group (n = 24; DAI ≥31), (2) retention group (n = 24; pretreatment DAI ≥31) with a prior malocclusion that had been corrected by orthodontic treatment, (3) control group with no-to-minor malocclusion (n = 24; DAI ≤25). Participants were requested to watch an amusing video. Based on the Facial Action Coding System, automated pattern recognition was used to detect smile episodes and assess their frequency, duration, genuineness, intensity, and extent of tooth show. Demographics, Big Five personality dimensions, and self-perceived smile esthetics-related quality of life were collected from all participants via questionnaires. Data were analyzed by mixed-model analysis and adjusted for possible confounders.

RESULTS

Patients from the malocclusion and retention groups smiled significantly less than participants from the control group, with the duration of smiles and smiling time being around half those of control subjects. Smile genuineness, smile intensity, and teeth shown did not differ across groups. Personality traits did not differ significantly among the 3 groups, whereas the malocclusion group scored around 30% less for dental self-confidence than the other 2 groups.

CONCLUSIONS

Patients with severe malocclusion tend to smile less, but the features of their smiles are similar to those without malocclusion. A lower propensity to smile in patients with a corrected malocclusion may persist after orthodontic treatment.

Comparison of post-treatment changes with and without retention in adolescents treated for maxillary impacted canines-a randomized controlled trial

Objective

To evaluate whether retention is needed after orthodontic treatment of impacted maxillary canines.

Trial design

Two-arm parallel group single-centre randomized controlled trial.

Materials and methods

Sixty-three patients, 39 girls and 24 boys, were recruited to the study. The inclusion criteria were patients with at least one impacted or unerupted maxillary canine, and moderate irregularity of the maxillary six anterior teeth according to Little’s index (LI). After gaining informed consent from the patient and their custodians, the patients were randomized to one of two groups, i.e. to a non-retention group or a retention group. The randomization process was prepared and carried out by an independent person not involved in the trial and the randomization used blocks of 20 (10 + 10). Primary outcomes were changes in single contact point discrepancy, and LI measured on digitalized three-dimensional study casts 1-year post-treatment. The study casts were anonymized before assessment and the changes were blinded for the assessor. Data were evaluated on an intention-to-treat basis. Thus, all randomized patients were incorporated into the final analysis. In the non-retention group a 10-week interim period was used to detect patients who eventually have a relapse immediately after treatment. If so, the patient got the arch-wire reinserted. Most patients in the retention group received a vacuum-formed retainer and pretreatment spacing cases got a bonded retainer.

Results

Mean irregularity change was 0.4 mm in the retention and 1.3 mm in the non-retention group (P < 0.001). Maximum change was 2.5 mm in the retention and 3.2 mm in the non-retention group (P < 0.001). Most changes in the non-retention group occurred during the 10-week interim period. In the non-retention group, one patient developed contact point discrepancy of >2 mm during the interim period and was realigned.

Harms

One patient met the stopping guideline criteria. This patient had the arch wire reinserted for 2 months. After realignment, the patient received a retention appliance.

Limitations

The trial was a single-centre study and short-term changes were evaluated.

Conclusions

Changes between the retention and the non-retention group were statistically but not clinically significant. Since satisfactory clinical results 1-year post-treatment were found in the non-retention group, retention does not appear to be needed. The 10-week interim period was useful in detecting patients who might have a relapse immediately after treatment.

Trial registration

The trial was not registered.

Modelling risk factors for high/low Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) in the Australian adults

OBJECTIVE

Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception needed for orthodontic treatment (OT). The study aimed to (1) evaluate the psychosocial impact of dental aesthetics and the potential role of OT and (2) determine associations between PIDAQ with self-rated general and oral health, oral health-related quality of life (OHRQOL), and receipt of OT among Australian adults.

METHODS

Data were obtained from the 2013 Australian National Dental Telephone Interview Survey (NDTIS). The PIDAQ was utilized as main outcome, comprising items from four conceptual domains: self-confidence, social impact, psychological impact, and aesthetic concern. Participants reported their socio-demographic, behavioural, self-rated general and oral health as well as the poor OHRQOL using the Oral Impact on Daily Performance (OIDP) instrument and OT. The mean of PIDAQ and four subscales score and their 95% confidence intervals (CI) were estimated. Generalized liner regression was used to estimate association between PIDAQ and covariates by calculating the mean ratio (MR) and their 95% CI.

RESULTS

There were 2936 Australian adults who completed the PIDAQ items. The mean PIDAQ score was 28.8 (95% CI: 28.0-29.6). Higher PIDAQ scores were identified among those who reported non-Australian birth, lower incomes, infrequent dental visits, less than 21 teeth and brushing teeth less than twice a day, fair/poor self-rated general and oral health, and poor OHRQOL. In multivariable modelling, the mean PIDAQ score was 1.91 (95% CI: 1.82-2.00) times higher among those with OIDP score >3 and 1.06 (95% CI:1.01-1.10) times higher in those who had OT, comparing with their counterparts. Also, higher PIDAQ scores were identified among females, last visiting a dentist more than 2 years ago, fair or poor self-rated oral and general health.

CONCLUSIONS

Higher PIDAQ scores that have a greater impact on OHRQOL were associated with poorer self-rated general and oral health. This may be explained by unfavourable dental attendance and oral health habits. The positive correlation with OIDP scores verifies the validity of the PIDAQ. Those who had received OT had lower PIDAQ and OIDP scores.

The Influence of Abnormalities in the Profile and Overjet on Psychological Well-Being

Objective

This study aimed to comparatively evaluate the psychological well-being and health-related quality of life of subjects having either a convex or concave profile and abnormal overjet, with subjects having a straight profile and normal overjet.

Methods

In this study, 163 children and their parents who applied to the Faculty of Dentistry were classified into 3 groups: Group 1: convex profile, Class II molar relationship, and increased overjet (n=62; 28 boys and 34 girls; mean age: 11.6 years); Group 2: concave profile, Class III molar relationship, and negative overjet (n=55; 32 boys and 23 girls; mean age: 11.2 years); and Group 3: straight profile, Class I molar relationship without crowding, and normal overjet (n=46; 24 boys and 22 girls; mean age: 11.0 years). The severity of malocclusion was evaluated using the Index of Orthodontic Treatment Need (IOTN). Self-concept, depression, and state-trait anxiety were evaluated to determine the psychological well-being of the children.

Results

No differences were found among the groups with respect to self-concept, depression levels, state-trait anxiety levels, and quality of life scores. No correlation was found between the IOTN scores and psychological well-being.

Conclusion

Abnormalities in the facial profile and negative or increased overjet have no influence on children's psychological well-being.

Effects of deviations in the nose and chin prominence on facial attractiveness

OBJECTIVE

To assess the effects of deviations in the nose and chin prominence on facial attractiveness.

METHODS

In this study, a reference digital photograph was taken from the facial profile view of an adult female model. Some changes were made in the nose and chin prominence in Photoshop software using the Crumley's analysis. Changes made in the nose prominence yielded a prominent nose (2:11 ratio), a normal nose (3:53 ratio) and a small nose (4:61 ratio). Changes made in the chin prominence were protrusion by +2 and 0 mm and retrusion by -2, -4 and -6 mm (distance from the pogonion to the vertical reference line). In total, 18 orthodontists, 18 oral and maxillofacial surgeons, 18 art students and 18 laypeople evaluated the photographs (n = 15) and expressed their opinion regarding the facial profile attractiveness using a visual analogue scale (0-100). Data were analysed using SPSS version 18.

RESULTS

A significant difference was noted in the ratings of photographs (Greenhouse-Geisser, P < 0.001). Orthodontists gave a significantly higher score than laypeople to photographs with a small nose and deviations of the chin prominence (P = 0.015). Art students gave a significantly higher score than laypeople to photographs with a prominent chin and deviations in the nose prominence (P = 0.012).

CONCLUSIONS

Facial profile with a normal (3:53 ratio) or small (4:61 ratio) nose and chin protrusion/retrusion by 2 mm (pogonion-vertical line) is considered attractive.

Parental Satisfaction with Their Children's Rapid Palatal Expansion Treatment Provided by Orthodontists and Pediatric Dentists

BACKGROUND

Dentofacial problems have a definitive impact on patients' psychological well-being, quality of life, and satisfaction. Therefore, patients' satisfaction with their dentition should be an essential goal for dental caregivers.

AIM

To compare parental satisfaction with their children's rapid palatal expansion treatment outcome provided by orthodontists and pediatric dentists.

MATERIALS AND METHODS

The authors reviewed 605 medical records and contacted 134 parents whose children received early orthodontic treatment from orthodontists and pediatric dentists using a rapid palatal expander. Eighty-eight parents (65.7%) responded to a validated questionnaire about patients' satisfaction with orthodontic treatment outcomes.

RESULTS

At baseline; there were no significant differences in relation to parent-related demographic variables. However, there were statistically significant differences between patients' ages and treatment duration (p < 0.001). Independent t-tests showed statistically significant differences in the means for the subscales of doctor-patient relationship and situational aspects (p < 0.05). Spearman's rho correlation coefficients and multivariate linear regression analysis showed that the overall satisfaction is significantly related to, and can be predicted by, parents' educational level, child's gender, and the specialty of the dentist who provided the treatment (p < 0.05).

CONCLUSION

Overall parental satisfaction with their children's rapid palatal expansion treatment is significantly higher when provided by pediatric dentists as compared with orthodontists. Factors related to doctor-patient relationship and situational aspects (ie, office location and design, appointment waiting, and treatment duration) significantly impacted parental satisfaction.

Parental Reported Bullying among Saudi Schoolchildren: Its Forms, Effect on Academic Abilities, and Associated Sociodemographic, Physical, and Dentofacial Features

Aim

To determine the prevalence of bullying, its forms, and its effect on academic abilities and school attendance, as well as associated sociodemographic, physical, and dentofacial features among Saudi schoolchildren.

Methods

This cross-sectional study recruited a sample of 1131 parents of schoolchildren 8-18 years old and requested them to complete internationally accepted questionnaires for their children. Chi-squared test and logistic regression analysis were used to analyze the data (p < 0.05).

Results

A majority (89.2%) of schoolchildren were bully victims. Physical bullying (48.9%) was the most common form of bullying. The youngest schoolchildren (8-11 years) and those who disliked school classes or neither liked nor hated them, as well as those who were truant from school, were more likely to be victims. In addition, those who had worse grades because of bullying and those who were very often bullied because of good grades or because they showed an interest in school were more likely to be victims. With regard to targeted physical features, teeth were the number one target, followed by the shape of the lips and strength, while tooth shape and color were the most common dentofacial targets, followed by anterior open bite and protruded anterior teeth. Boys and the youngest schoolchildren were more often subjected to bullying because of these features (p < 0.05).

Conclusions

The prevalence of bullying, mainly in a physical form, was high among Saudi schoolchildren, with a negative influence on students' academic abilities. Problems related to teeth, in particular, which can be treated, were targets, mainly for boys and the youngest schoolchildren. More studies are required in Saudi Arabia to explore the issue further among schoolchildren themselves.

Is there a relationship between malocclusion and bullying? A systematic review

Background

Malocclusion is a highly prevalent public health problem, and several studies have shown its negative correlation with quality of life, self-esteem, and social perceptions. However, its association with bullying is still controversial.

Objectives

To evaluate the relationship between malocclusion and bullying in children and adolescents.

Search methods

The databases used for the electronic researches were PubMed, Scopus, Lilacs/BBO, Web of Science, and Cochrane Library. Grey literature was reviewed through Open Grey literature with no language or date restrictions. Selection criteria, based on the PECO strategy, were considered eligible observational studies that included schoolchildren or adolescents (P) with malocclusion (E), compared to those with normal occlusion (C), in which the relationship between malocclusion and bullying was determined (O).

Data collection and analysis

Risk of bias evaluation was made for the qualitative synthesis by the Fowkes and Fulton criteria. Data regarding the age of participants and types of malocclusion and of bullying were extracted among other reported data. The quality of the evidence analyzed was evaluated through the GRADE approach.

Results

From 2744 articles identified in databases, nine met the eligibility criteria and were included in present systematic review, of which two studies were judged with methodological soundness. The quality of the evidence was classified as very low due to very serious problems for “risk of bias” and “other considerations” and serious problems of “indirectness”. The age of participants ranged from 9 to 34 years considering a cohort study, with a bullying recalling perspective. Malocclusion was both evaluated by researchers and self-reported by participants addressing dentofacial characteristics mostly related to the incisors relationship. All studies evaluated the verbal type of bullying, while 3 also considered physical type. Both types were reported as related to malocclusion, although the results showed that extreme maxillary overjet (> 4 mm, > 6 mm, > 9 mm), extreme deep overbite, and having space between anterior teeth or missing teeth were the types of malocclusion with the strongest relations to bullying.

Conclusions

With very low certainty of evidence, the results of this systematic review suggest that conspicuous extreme malocclusion may be related to the occurrence of bullying among children and adolescents.

Epidemiology of orthodontic treatment need in southwestern Ethiopian children: a cross sectional study using the index of orthodontic treatment need

Background

The planning of orthodontic treatment within a public health system requires information on the orthodontic treatment needs of the population. It is important to have epidemiological data to estimate the total need for orthodontic care in any region. The present study aimed to determine the orthodontic treatment need in 12 years old Southwestern Ethiopian children.

Methods

The institution-based cross-sectional study was conducted which involved 347 twelve years old school children randomly selected from seven different public schools in Jimma Town, Southwestern Ethiopia. A structured interview and clinical examination were used to assess the subjects. One examiner used Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to estimate the treatment need. Descriptive statistics and chi-square tests were used for data analysis with statistical significance set at P < 0.05.

Results

According to the DHC of IOTN, almost half of the subjects in the sample were in moderate to the great need for orthodontic treatment. About 15% of the children had a great need for orthodontic treatment based on IOTN-AC. The most prevalent occlusal traits for defining the DHC categorization include increased Overjet (30.8%) and Crowding (23.3%). There was no statistical difference in the distribution of DHC grades and AC scored based on gender.

Conclusion

This study revealed that the need for orthodontic treatment was high. The percentage of the need for orthodontic treatment is higher in comparison to most of the studies conducted in African regions. Therefore, publicly subsidized orthodontic treatment should be planned and provided to those who are in great need for orthodontic treatment. Besides, awareness about orthodontic treatment should also be considered.

Oral health related quality of life of patients with class III skeletal malocclusion before and after orthognathic surgery

BACKGROUND

Orthognathic surgery includes improvement of morphology and function of occlusion as well as psychological perception and oral health-related quality of life (OHRQoL) of patients. The aim of this study was to determine the OHRQoL of patients with class III skeletal malocclusion before and after orthognathic surgery.

MATERIALS AND METHODS

A total of 112 skeletal class III patients including 39 (34.8%) males and 73 (65.2%) females participated in this descriptive quasi-experimental study in three groups: "prior to orthodontic treatment" (n = 25); "under orthodontic treatment and prior to surgery" (n = 65), and "after surgery" (n = 25). All patients filled out a demographic information questionnaire, the oral health impact profile-14 (OHIP-14), and the orthognathic quality of life questionnaire (OQLQ) under the supervision of the examiner. Data were analyzed using ANOVA, independent samples t-test, Mann Whitney test, and Kruskal-Wallis test.

RESULTS

OHRQoL summary score changed from 14.5 prior to orthodontic treatment to 23.4 prior to surgery and during orthodontic treatment to 5.4 after surgery. These OHRQoL changes were statistically significant (P < 0.001).

CONCLUSIONS

Orthognathic surgery matters to patients with class III skeletal malocclusion and significantly improves their OHRQoL.

Impact of malocclusion severity on oral health-related quality of life in an Iranian young adult population

Objective:

This study aimed to assess the relationship between malocclusion severity and oral health-related quality of life (QoL) of 18 to 25-year-old Iranians who sought orthodontic treatment.

Materials and Methods:

A total of 126 patients between 18 and 25 years attending some private orthodontic clinics answered the oral health impact profile-14 (OHIP-14) and a demographic questionnaire. Two calibrated orthodontists recorded the Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) determining the severity of malocclusion (Kappa = 0.8). The IOTN-Aesthetic Component (IOTN-AC) was reported by patients for assessing the perception of their esthetic severity of malocclusion. Logistic regression analysis was used. Level of significance was set at α = 0.05.

Results:

The mean score of OHIP-14 was 20.87 ± 8.6. The frequency of patients with no/slight, borderline, and definite need for orthodontic treatment was determined as 13.4%, 23.8%, and 62.7%, respectively, by IOTN-DHC. There were significant correlations between borderline or definite need treatment and OHIP-14 overall score (P < 0.05). Patients with borderline and definite need for orthodontic treatment had 5 and 21 times lower QoL, respectively, than those with a slight need for orthodontic treatment. Based on IOTN-AC, 50.8% of the patients mentioned slight or no need based on IOTN-AC. No significant association was noted between IOTN-AC and OHIP-14 overall scores.

Conclusions:

The results showed negative impact of malocclusion severity on the QoL. This study highlighted the importance of individual assessment of orthodontic patients.

Distinguishing between global and dental self-esteem in evaluating malocclusions

Objective: When dealing with the impact of malocclusion on self-esteem, the terms global and dental self-esteem are sometimes used. Although these terms are related to one another, they do not depict the same concept. The aims of this paper were to explore if the two forms of self-esteem are distinguishable, to find out if they represent different factors, and to investigate how they are related to malocclusion. Materials and methods: A sample consisting of 150 adolescents, aged 13 years, completed self-assessed measures of Dental and Global Self-Esteem. Orthodontic treatment need for each individual was assessed by the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC). Data were analysed by factor analyses and a 5 (IOTN-DHC grades) by 2 (global vs. dental self-esteem) ANOVA, with the IOTN-DHC grades as the independent and self-esteem (repeated measure) as the dependent variables. Results: The factor analyses showed that the two forms of self-esteem, based on the measures, are distinguishable. More importantly, the results of the ANOVA revealed that Dental and Global Self-Esteem are differentially related to IOTN-DHC. Specifically, Dental Self-Esteem varied across IOTN-DHC scale while Global Self-Esteem did not. There was no effect of gender. Conclusions: Dental self-esteem is related to malocclusion while global self-esteem is not. These findings have implications in areas where the predictive power of dental self-esteem needs to be considered.

Impacts of Orthognathic Surgery on Patient Satisfaction, Overall Quality of Life, and Oral Health-Related Quality of Life: A Systematic Literature Review

Several treatments have been suggested to correct dentofacial abnormalities, including orthognathic surgery. The aim of the present systematic review was to assess the impact of orthognathic surgery on patient satisfaction, overall quality of life, quality of life related to oral health—and to orthognathic surgery in particular—among adult patients. Two investigators independently reviewed the available literature in the databases PubMed/MEDLINE, LILACS, SciELO, EMBASE, Trip, and Google Scholar (gray literature) based on the keywords “orthognathic surgery” and “quality of life.” An analysis of bias was performed based on the MINORS (methodological index for nonrandomized studies). A total of 245 relevant studies were retrieved from the databases, and 6 additional studies were located after a manual search of the references. Following selection based on titles, abstracts, and full-text analysis, 30 studies were included in the present systematic review. To evaluate quality of life before and after orthognathic surgery, 12 studies applied the surgery-related Orthognathic Quality of Life Questionnaire (OQLQ), 12 used the Oral Health Impact Profile (OHIP-14), and 4 used the Short Form Health Survey (SF-36). Orthognathic surgery results in improvements in quality of life both physically and psychosocially after surgery and is associated with high rates of patient satisfaction.

The impact of labial fixed appliance orthodontic treatment on patient expectation, experience, and satisfaction: an overview of systematic reviews

Background

Patient perception with fixed appliance orthodontic treatment is important to improve oral health-related quality of life.

Objective

The main objective of this study was to evaluate the impact of labial fixed appliance orthodontic care on patient perception before, during, and after the treatment.

Search methods

Relevant systematic reviews investigating patient perception with fixed appliance orthodontic treatment were identified by searching electronic databases: MEDLINE via OVID (1946 to 31 December 2018), EMBASE (1974 to 31 December 2018), AMED (Allied and Complementary Medicine Database; 1985 to November 2018), PubMed (inception to 31 December 2018), Web of Science (1900 to 2018), and PsychINFO (1806 to 31 December 2018). Ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.

Selection criteria

Only studies investigating patient perception of fixed appliance orthodontic treatment were included.

Data collection and analysis

Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings.

Results

A total of 163 articles investigating patient expectation, experience, and satisfaction with conventional ligation labial fixed orthodontic appliances were obtained. Of these, 152 observational or interventional studies were excluded, resulting in 11 eligible systematic reviews. Two were excluded as earlier reports of a Cochrane review. The quality of the reviews was variable (critically low, low, and moderate). The findings were as follows: aesthetics represents a primary motive for orthodontic treatment; a temporary deterioration in the quality of life occurs during the initial phases of treatment; gender and ethnicity factors do not have an impact on patient perception of treatment; and a positive relationship between orthodontist–patient–parent is important to achieve patient compliance and satisfaction.

Conclusions

There is a lack of high-quality studies in terms of systematic reviews and meta-analyses for assessing patient perception with fixed appliance orthodontic treatment. The aesthetic impact of malocclusion is the main motive for seeking orthodontic treatment. Quality of life reduces during the initial stages of orthodontic treatment but improves in the later stages of treatment. Assessment before, during, and after orthodontic treatment is necessary to comprehensively assess patient perception at all stages of care.

Trial registration

CRD42019122653.

Conflict of Interest

None to declare.

Effect of orthodontic treatment needs on oral health related quality of life among the young population in Delhi NCR-region of North India

Aim:

To assess the effect of orthodontic treatment needs on oral health-related quality of life among the young people of Delhi NCR.

Methods:

The study was conducted on 12–15 years of individuals attending dental clinic/hospital in Delhi NCR region. Data were collected using Index of Orthodontic Treatment Need -Dental Component and oral health impact profile 14 questionnaire. The Chi-square test was used to analyze the qualitative data. SPSS software version 20 was used for statistical analysis.

Results:

Orthodontic treatment needs had an almost similar impact on the daily activities of both males and females. The sense of taste was not significantly affected by the need for orthodontic treatment in either males or females. The proportions of orthodontic patients found to have the painful arch, embarrassment, tension, and self-conscious both in males and females.

Conclusion:

There is a significant correlation of orthodontic treatment needs among oral health-related quality of life.

Occlusal traits, orthodontic treatment need and treatment complexity among untreated 17-21-year-olds in Estonia

Objective: To analyze data on occlusal traits, orthodontic treatment need and treatment complexity in orthodontically untreated 17-21-year-old Estonians.Materials and methods: Clinical records and plaster casts of 390 untreated young adults (219 females and 171 males, mean age 18.5 years, range 17-21 years) were analyzed. Assessed occlusal traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite and scissor bite. The Index of Complexity, Outcome and Need (ICON) was used to assess orthodontic treatment need and complexity. Participants' opinions regarding their teeth were determined with a questionnaire.Results: The most prevalent occlusal traits were Class I sagittal relationship in canines (76%) and molars (70%), crowding (51%), overbite ≥3.5 mm (48%), the end-to-end sagittal relationship in canines (48%) and overjet ≥3.5 mm (47%). Antero-posterior asymmetry was common both in canines (39%) and molars (37%). According to ICON, 36% of participants had orthodontic treatment need.Conclusions: Desire for orthodontic treatment was associated with crowding and increased overjet, and with no gender difference, participants' main expectation of treatment was an improvement in dentofacial aesthetics. Treatment needs determined with ICON was moderate and in line with the participants' desire for orthodontic treatment.

Self-Perception Of Malocclusion And Barriers To Orthodontic Care: A Cross-Sectional Study In Al-Madinah, Saudi Arabia

PURPOSE

This study was conducted to assess adult levels of knowledge, awareness of malocclusion and barriers to the uptake of orthodontic care alongside the associated factors (sex and gender).

METHODS

A convenience sample aged 18 years and above, residing in Al-Madinah Al-Munawwarah, Saudi Arabia, was recruited. A self-administrated validated questionnaire was used to collect the data, and data descriptive and inferential statistical analysis were performed.

RESULTS

Of the 700 distributed questionnaires, 554 usable were returned (response rate = 79%). The mean±SD age of participants was 26.40 (±7.87) years and 55.2% were females. Over 60% of the participants reported high oral health knowledge with respect to the alignment of teeth being important for esthetics and neglected malocclusion had consequences, eg, caries. Likewise, high percentages were having knowledge that thumb sucking (80%) contributed to malocclusion although early extraction of primary teeth and genetics was reported by just 52% and 40%, respectively. Awareness of the importance of teeth alignment was reported by 81.6%; however, 37.7% were only advised for orthodontic treatment. Notably, most of the aforementioned knowledge and awareness was statistically significantly higher among females compared to counterpart males (p < 0.05). As for barriers, high orthodontic treatment fees were the barrier for 80% of the total participants irrespective of age and gender. Females were statistically significantly more likely to report barriers for orthodontic care, eg, accessibility and length of treatment (p < 0.05).

CONCLUSION

The majority of the participants scored high levels of knowledge and awareness of oral health-specific conditions in relation to malocclusion. Although females were significantly knowledgeable and aware of malocclusion compared to males, social and orthodontic treatment factors were perceived as barriers to uptake of orthodontic care.

Objective assessment of the contribution of dental esthetics and facial attractiveness in men via eye tracking

INTRODUCTION

Recently, greater emphasis has been placed on smile esthetics in dentistry. Eye tracking has been used to objectively evaluate attention to the dentition (mouth) in female models with different levels of dental esthetics quantified by the aesthetic component of the Index of Orthodontic Treatment Need (IOTN). This has not been accomplished in men. Our objective was to determine the visual attention to the mouth in men with different levels of dental esthetics (IOTN levels) and background facial attractiveness, for both male and female raters, using eye tracking.

METHODS

Facial images of men rated as unattractive, average, and attractive were digitally manipulated and paired with validated oral images, IOTN levels 1 (no treatment need), 7 (borderline treatment need), and 10 (definite treatment need). Sixty-four raters meeting the inclusion criteria were included in the data analysis. Each rater was calibrated in the eye tracker and randomly viewed the composite images for 3 seconds, twice for reliability.

RESULTS

Reliability was good or excellent (intraclass correlation coefficients, 0.6-0.9). Significant interactions were observed with factorial repeated-measures analysis of variance and the Tukey-Kramer method for density and duration of fixations in the interactions of model facial attractiveness by area of the face (P <0.0001, P <0.0001, respectively), dental esthetics (IOTN) by area of the face (P <0.0001, P <0.0001, respectively), and rater sex by area of the face (P = 0.0166, P = 0.0290, respectively). For area by facial attractiveness, the hierarchy of visual attention in unattractive and attractive models was eye, mouth, and nose, but for men of average attractiveness, it was mouth, eye, and nose. For dental esthetics by area, at IOTN 7, the mouth had significantly more visual attention than it did at IOTN 1 and significantly more than the nose. At IOTN 10, the mouth received significantly more attention than at IOTN 7 and surpassed the nose and eye. These findings were irrespective of facial attractiveness levels. For rater sex by area in visual density, women showed significantly more attention to the eyes than did men, and only men showed significantly more attention to the mouth over the nose.

CONCLUSIONS

Visual attention to the mouth was the greatest in men of average facial attractiveness, irrespective of dental esthetics. In borderline dental esthetics (IOTN 7), the eye and mouth were statistically indistinguishable, but in the most unesthetic dental attractiveness level (IOTN 10), the mouth exceeded the eye. The most unesthetic malocclusion significantly attracted visual attention in men. Male and female raters showed differences in their visual attention to male faces. Laypersons gave significant visual attention to poor dental esthetics in men, irrespective of background attractiveness; this was counter to what was seen in women.

Accounts of bullying on Twitter in relation to dentofacial features and orthodontic treatment

Social media offers an accessible resource for gaining valuable insights into the social culture of bullying. The purpose of this study was to qualitatively analyse Twitter posts for common themes relating to dentofacial features, braces and bullying. Twitter's database was searched from 2010 to 2014 using keywords relevant to bullying, teeth and orthodontics. Two investigators assessed the Twitter posts, and selected those that conveyed the experiences or opinions of bullying victims. The posts were qualitatively analysed using thematic analysis. Of the 548 posts screened, 321 were included in the final sample. Four primary categories relating to 'dental-related bullying' were identified: (i) morphological features, (ii) psychological and psychosocial impact, (iii) coping mechanisms and (iv) the role of family. Bullied individuals reported a diverse range of psychological impacts and coping mechanisms. Secondary categories were also identified. Family members, for example, were found to play both a contributory and mediatory role in bullying. In summary, social media can provide new and valuable information about the causal factors and social issues associated with oral health-related bullying. Importantly, some coping mechanisms may mitigate the negative effects of bullying.

[Effect of body image in adolescent orthodontic treatment]

OBJECTIVE

This study was designed to probe the psychological factors adolescent orthodontic patients, the role of body image and self-esteem in the whole process of orthodontic treatment and the impact on the efficacy and satisfaction of orthodontic.

METHODS

Five hundred and twenty-eight patients were selected in this study. The Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) , Rosenberg Self-Esteem Scale (SES), Negative Physical Self-General (NPS-G) and other body analysis scale study after orthodontic lasted 18-24 months were used to investigate the role of body image in adolescent orthodontic treatment.

RESULTS

Esthetic evaluation of patients teeth after correction had been significantly improved, patient self-evaluation difference IOTN-AC doctor evaluation, Psychosocial Impact of Dental Aesthetics Questionnaire-tooth confidence, aesthetic concerns, psychological impact and social function were significantly improved. The improvement of the dental aesthetics component (T2 when doctors evaluate IOTN-AC) was positively correlated with the evaluation of the efficacy, and was significantly negatively correlated with the negative emotions of patients at baseline.

CONCLUSIONS

Negative body image-dental dissatisfied-cognitive component and the affective component, the overall negative body image and negative emotions can predict patient satisfaction with treatment efficacy. Orthodontic treatment not only improves the self-aesthetic evaluation of adolescent patients, but also has a positive effect on the mental health of adolescent patients.

Predicting orthodontic treatment need: reliability and validity of the Demand for Orthodontic Treatment Questionnaire

Objectives

To identify key measures in predicting orthodontic treatment need and to propose a self-assessment instrument that improves treatment need assessment.

Subjects and methods

The study included 150 randomly selected 13-year-olds. A set of measures linked to a previous study on daily life impact of malocclusion was processed, resulting in an instrument, the Demand for Orthodontic Treatment Questionnaire (DOTQ), which was analysed regarding dimensionality, reliability and validity. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) grading, representing professionally assessed treatment need, were collected from dental records. The instrument's ability to predict treatment need was tested by randomly splitting the dataset into two subgroups, using multiple regression to predict DHC in one of the groups and the prediction equation to calculate predicted DHC in the other. The outcomes were then correlated to detect the predictive power of the DOTQ, and thereby the validity of the prediction.

Results

The DOTQ-measures were reliable and highly inter-correlated. A high, significant correlation was found between assessed and predicted treatment need for the subgroups (r = 0.59 and 0.49), confirming the validity of the prediction. Independent variables (the measures) explained 47 per cent (R = 0.69) of the variance in treatment need. Four measures contributed significantly to the prediction, with Treatment Demand being the most powerful predictor.

Limitations

The age group and response rate may raise some questions regarding the generalizability of the findings.

Conclusions

The DOTQ is able to predict treatment need as assessed by orthodontic consultants. Its incorporation in the treatment need assessment process will acknowledge patients' self-perceived impact of malocclusion.

Social and Psychological Aspects of Dental Trauma, Behavior Management of Young Patients Who have Suffered Dental Trauma

Introduction:

Injuries concerning the skull, the mouth and thus potentially involving the mouth and teeth are characterized as major public health problems due to their high prevalence and very serious functional and aesthetic consequences. Pain, aesthetic and functional problems arising from dental trauma significantly disrupt normal function, and impact, often dramatically, on young patients’ quality of life.

Procedure:

With regards to the behavior management approach to a child who has suffered a dental trauma, dentist’s first step is to be to reassure child and parents. They should feel that the emergency is being properly treated on the part of the dentist and feel safe. The dentist should offer psychological support to child and parents and focus on alleviating any possible pain the child may feel. But, before that, a good level of communication with the child should be established.

Conclusion:

This can be achieved through the tell-show-do technique, a presentation of the special session’s structure, the positive reinforcement method, the attention distraction method and exploiting the child’s imagination. The detailed description of the treatment to be followed is crucial for reducing the child’s level of stress, as well as that of the parents. Immediately after the completion of treatment, dentist should give listening time to the parents for any queries and include the child who probably wants to share their experience.

An alternative clinical approach to achieve greater anterior than posterior maxillary expansion in cleft lip and palate patients

Cleft lip and palate patients commonly present maxillary constriction, particularly in the anterior region. The aim of this case report was to describe an alternative clinical approach that used a smaller Hyrax screw unconventionally positioned to achieve greater anterior than posterior expansion in patients with complete unilateral cleft lip and palate. The idea presented here is to take advantage of a reduced dimension screw to position it anteriorly. When only anterior expansion was needed (patient 1), the appliance was soldered to the first premolar bands and associated to a transpalatal arch cemented to the first molars. However, when overall expansion was required (patient 2), the screw was positioned anteriorly, but soldered to the first molar bands. Intercanine, premolar, and first molar widths were measured on dental casts with a digital caliper. Pre-expansion and postexpansion radiographs and tomographies were also evaluated. A significant anterior expansion and no intermolar width increase were registered in the first patient. Although patient 2 also presented a greater anterior than posterior expansion, a noteworthy expansion occurred at the molar region. The alternative approach to expand the maxilla in cleft patients reported here caused greater anterior than posterior expansion when the Mini-Hyrax was associated to a transpalatal arch, and its reduced dimension also minimized discomfort and facilitated hygiene.

Patients’ motivations for treatment and their experiences of orthodontic preparation for orthognathic surgery

OBJECTIVE

To determine patients' motivations for undergoing orthognathic surgery and their experiences of the orthodontic aspects of this treatment.

DESIGN

Retrospective questionnaire survey using a patient-centred measure.

SETTING

Thirteen National Health Service (NHS) hospital orthodontic departments.

SUBJECTS

Three-hundred-and-twenty-six patients (58% response rate) who underwent orthognathic surgery during the period 1 January 1995 to 30 September 2001 completed a questionnaire.

MAIN OUTCOME MEASURES

Motivations for treatment and perception of information about treatment and experiences of orthodontic treatment.

RESULTS

Major motivations for treatment were to have straight teeth (80%), to prevent future dental problems (69%) and to improve self-confidence (68%). Females sought treatment to improve self-confidence and their smile. Males wanted treatment to improve their social life. Most of these issues had improved following surgery. Most (94%) respondents felt well-informed about their orthodontics. However, 36% wore braces for longer than they expected. Males and younger patients knew less about the duration of treatment than other groups. Fifty-eight per cent of subjects found their braces difficult to clean and 9% reported that they were very painful. Older patients experienced fewer problems wearing braces than younger patients.

CONCLUSIONS

Improving dental appearance and preventing future dental problems are major motivators for orthognathic patients. Although patients felt well informed about what to expect from their orthodontic treatment, a significant proportion, particularly younger patients and males, were surprised at the length of treatment and the need to wear retainers. This suggests that orthognathic patients might benefit from better information regarding the orthodontic aspects of their care.

The impact of orthodontic treatment on quality of life and self-esteem in adult patients

OBJECTIVES

To assess the impact of fixed orthodontic treatment on oral health related quality of life (OHRQoL) and self-esteem in adults.

SUBJECTS AND METHODS

A prospective study design was applied, within private practice. Sample size estimation revealed a minimum of 52 subjects, allowing for drop outs. All participants completed a set of validated questionnaires at baseline (T0), 1- (T1), 3- (T2), and 6-months (T3) and post-treatment (T4). These included the Rosenberg Self-esteem scale, the Oral Health Impact Profile (OHIP-14) and a socioeconomic status questionnaire. The Dental Health Component of the Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion severity.

RESULTS

Sixty-one subjects were recruited, with only one subject lost to follow-up. A statistically significant difference in OHRQoL scores was seen between: T0 and T1 (P = 0.001); T0 and T2 (P = 0.020). There was no statistical difference between T0 and T3 (P = 0.078) or T4 (P = 0.565), where OHRQoL improved to pre-treatment scores. A significant difference in self-esteem scores was observed between baseline and end of treatment (P = 0.002).

CONCLUSIONS

Undergoing fixed orthodontic therapy had a negative impact on the overall OHRQoL, during the first 3 months of treatment, which then improved to pre-treatment scores, whilst a significant increase was observed in self-esteem as a result of treatment.

A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment

Introduction. Physical, mental, and social consequences of malocclusion may impact the quality of life. The aim of this review is to describe main factors motivating parents for orthodontic treatment for their children. Methods. A systematic review study design was used to identify articles analyzing different motivational factors in orthodontic treatment appearing in Medline database, EMBASE, and Google Scholar. The search terms used were teasing, motivating factors, orthodontics, malocclusion, quality of life, smile attractiveness, and perception of malocclusion. Papers selected up to May 2013 included retrospective and prospective longitudinal studies, randomized control trials, cross-sectional studies, reviews, and meta-analyses. Results. 13 articles included in this review identified aesthetics as the main motivational factor in orthodontic treatment. Children mention teeth crowding, large overbite, missing teeth, and largest maxillary anterior irregularities also as motivational factors. Parents want their children to look nice and worry of being accused of neglecting parental duties. Conclusions. Dissatisfaction with one's appearance, dentist recommendation, interest and worries of parents, and the impact of peers who wear braces rank among the main motivation factors of seeking orthodontic treatment. Understanding these factors allows better planning of resources and better assessment of the requirements and priorities of treatment.

Perceptions of midline deviations among different facial types

INTRODUCTION

The correction of a deviated midline can involve complicated mechanics and a protracted treatment. The threshold below which midline deviations are considered acceptable might depend on multiple factors. The objective of this study was to evaluate the effect of facial type on laypersons' perceptions of various degrees of midline deviation.

METHODS

Smiling photographs of male and female subjects were altered to create 3 facial type variations (euryprosopic, mesoprosopic, and leptoprosopic) and deviations in the midline ranging from 0.0 to 4.0 mm. Evaluators rated the overall attractiveness and acceptability of each photograph.

RESULTS

Data were collected from 160 raters. The overall threshold for the acceptability of a midline deviation was 2.92 ± 1.10 mm, with the threshold for the male subject significantly lower than that for the female subject. The euryprosopic facial type showed no decrease in mean attractiveness until the deviations were 2 mm or more. All other facial types were rated as decreasingly attractive from 1 mm onward. Among all facial types, the attractiveness of the male subject was only affected at deviations of 2 mm or greater; for the female subject, the attractiveness scores were significantly decreased at 1 mm. The mesoprosopic facial type was most attractive for the male subject but was the least attractive for the female subject.

CONCLUSIONS

Facial type and sex may affect the thresholds at which a midline deviation is detected and above which a midline deviation is considered unacceptable. Both the euryprosopic facial type and male sex were associated with higher levels of attractiveness at relatively small levels of deviations.

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.