The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech, and orthodontic treatment need

Prevalence of malocclusion and orthodontic treatment needs among adolescents in Najran City, Saudi Arabia

AIM

To determine the prevalence of malocclusions and the need for orthodontic treatment in a sample of school-going adolescents in the Najran city, Kingdom of Saudi Arabia (KSA).

METHODOLOGY

This cross-sectional study was conducted among 1094 school-going Saudi male adolescents. The age range of the sampled adolescents was 13-18 years, and none of them had any history of orthodontic treatment. A survey chart related to malocclusion was designed and filled up after clinical examination by a single experienced and calibrated examiner. The need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULT

The present study's findings demonstrated 61.2% of the samples with Angle's Class I malocclusions, 27.5% with Class II, and 11.4% of samples with Class III malocclusion. A significant difference was observed between the different classes of malocclusion (P < 0.001). Most samples presented normal overjet, crossbite, and no reverse overjet, deep bite, or open bite. The number of samples with no treatment need was 573 (52.37%), with slight treatment in 185 (16.91%) samples, moderate treatment needs in 123 (11.24%) samples, and severe and extreme treatment needs were 109 (9.96%) and 104 (9.50%), respectively. A significant difference was observed between the samples with no or slight treatment need (grades 1 and 2), moderate need (grade 3), and definite treatment need (grades 4 and 5) (p < 0.001).

CONCLUSION

The prevalence of malocclusion and IOTNs among the sample of school-going adolescents in the Najran city was 47.63%. However, 9.63% of those samples required immediate attention for orthodontic treatment.

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.

Evaluation of Orthodontic Treatment Need—An Ethnic and Gender Prospective

Introduction:

Index for Orthodontic Treatment Need is a widely used index to assess the orthodontic treatment need among various populations.

Aim:

The aim of this study is to evaluate and compare orthodontic treatment needs of Nepali among gender and ethnicity.

Materials and Methods:

A total of 800 children (400 males and 400 females) above 14 years of age were selected from different schools of Kathmandu using multistage sampling technique. The study sample was grouped into 2 ethnic groups: Indo-Aryan and Janajati. Two trained and calibrated examiners examined school-going children using Index for Orthodontic Treatment Need tool. Statistical comparison of the study variables by gender and ethnicity was done.

Results:

Dental Health Component showed 36.75% male and 34.5% female, and 39% Indo-Aryan and 29.76% Janajati had great treatment need. The Aesthetic Component (AC) showed 13.75% male and 12.25% female, and 12.5% Indo-Aryan 14.58% Janajati had great/severe need.

Conclusions:

Males had great/severe need of treatment for both Dental Health Component and Aesthetic Component (AC). Indo-Aryan showed higher degree of great/severe need for Dental Health Component and lesser degree of great/severe need for Aesthetic Component (AC) than Janajati.

Perception and attitude of Mongolians on malocclusion

Background/purpose

This study assessed the perception and attitude of Mongolians on malocclusion and compared the perceptions with researchers’ perceptions on malocclusion, and this study aimed to determine factors influencing the self-perception of laypeople.

Materials and methods

In addition, we evaluated the correlation between the subjective and objective perceptions of participants. In a random sample of 133 people (39.8% men and 60.2% women) aged 18–55 years, subjective perceptions were assessed using a questionnaire (oral aesthetic subjective impact scale), and objective perceptions were assessed using 10 intraoral frontal photographs of the aesthetic component of index of orthodontic treatment need (AC-IOTN) and six intraoral lateral photographs of the aesthetic component of lateral occlusion (AC-LO).

Results

A significant association was observed between participants' self-perception and researchers' ratings (P < 0.001). The appearance of teeth was significantly correlated with participants’ self-rating by using AC-IOTN and AC-LO. Most people (74%) believed that well-aligned teeth improve the overall facial appearance. Sex, monthly income, and education level significantly influenced the self-perception of participants on malocclusion.

Conclusion

Patients’ perception and attitude cannot be overlooked because they are some of the crucial aspects of the entire treatment.

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.

Relationship between normative and self-perceived criteria for orthodontic treatment need and satisfaction with esthetics and mastication in adolescents

INTRODUCTION

Orthodontic treatments are performed to improve esthetics and masticatory functions. In general, clinical criteria are used to recommend such treatments without considering the opinion of the patient. This study aimed to evaluate the relationship between technically defined orthodontic need (normative criteria) and the need for treatment perceived by adolescent patients.

METHODS

A total of 215 students aged between 15 and 19 years were selected and asked to respond to a questionnaire concerning their perception of need for orthodontic treatment and their satisfaction with their own esthetics and mastication. One trained and calibrated examiner obtained normative data using the Dental Aesthetic Index (DAI) on the need for orthodontic treatment of these students.

RESULTS

Associations were found between the DAI score and the patient's perception of need for orthodontic treatment (P <0.001), satisfaction with esthetics (P = 0.003), and satisfaction with mastication (P = 0.047). When occlusal characteristics were analyzed separately, associations between several normative and perceived needs, as well as for satisfaction with esthetics, were found. Satisfaction with mastication analysis was only found to be associated with open bite malocclusion (P = 0.003).

CONCLUSIONS

The DAI revealed a consistent opinion in adolescents to link their perceived malocclusion-related conditions to esthetics.

Orthodontic Treatment Need and the Psychosocial Impact of Malocclusion in 12-Year-Old Hong Kong Children

Objectives

To determine the prevalence of orthodontic treatment need in 12-year-old children in Hong Kong and its relationship with the psychosocial impact of malocclusion and to assess their associations with sociodemographic factors.

Materials and Methods

A random sample of 687 12-year-old children was recruited from 45 secondary schools in Hong Kong. Orthodontic treatment need was assessed on study models by five indices: the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC), the Aesthetic Component of the IOTN (IOTN-AC), the Dental Aesthetic Index (DAI), the Index of Complexity Outcome and Need (ICON), and the Peer Assessment Rating (PAR). The psychosocial impact of malocclusion on participants and sociodemographic factors were obtained from a questionnaire. Logistic regression was used to examine the correlations between treatment need and the psychosocial impact of malocclusion as well as their associations with sociodemographic factors.

Results

The final number of participants was 667 (339 boys and 328 girls, participation rate 667/687 = 97.1%). The prevalence of orthodontic treatment need varied depending on the indices used (10.9–47.8%), but significant correlations were found among the five indices (p < 0.01). The uptake of treatment among the cohort was 2.3%. Boys had higher IOTN-DHC (p < 0.05), DAI (p < 0.05), and PAR (p = 0.05) scores than girls. IOTN-AC was significantly associated with the psychosocial impact of malocclusion (p < 0.05). Parents' level of education and household income were not significantly associated with either treatment need or the psychosocial impact of malocclusion (p > 0.05).

Conclusion

The need for orthodontic treatment in 12-year-old children in Hong Kong remained high, and the uptake of treatment was low. Boys had a higher normative treatment need than girls. Among the five indices, IOTN-AC appears to be the best indicator of the psychosocial impact of malocclusion.

Agreement and association between normative and subjective orthodontic treatment need using the Index of Orthodontic Treatment Need

AIMS:

To determine the association and level of agreement between young adults’ perception of orthodontic treatment need (subjective need) and the orthodontists’ assessment of treatment need (normative objective need).

METHODOLOGY:

For this study, 670 students [280 males and 390 females; mean age (standard deviation) of 15.32 (1.81) years] were selected from public and private schools from different demographic areas of Jeddah city, Saudi Arabia, and divided into two age groups (12–15 years) and (16–19 years). All the participants were examined, and the Index of Orthodontic Treatment Need (IOTN) components [dental health component (DHC) and aesthetic component (AC)] were recorded.

RESULTS:

Kappa statistics showed a statistically significant but fair agreement between clinician AC (CAC) and student AC (SAC) assessments in both age groups (k = 0.343 and 0.334, respectively; P < 0.001), whereas Spearman's correlation coefficient showed a statistically significant but moderate association (r = 0.487 and 0.517, respectively; P < 0.001). The degrees of agreement were 76.4% and 76.7% at the no-need and mild-need levels of treatment, respectively. There was a statistically significant but weak association between the subjective and normative needs (SAC and IOTN-DHC) in both age groups (r = 0.336 and 0.360, respectively; P < 0.001). However, the degrees of agreement were 58.9% and 61.5% at the no-need and mild-need levels of treatment, respectively.

CONCLUSION:

Significant but weak positive association was found between the normative and subjective orthodontic treatment needs, indicating a lack of understanding of the nature of malocclusion and its consequences. Thus, promoting further knowledge and awareness of malocclusion are indicated.

Agreement of young adults and orthodontists on dental aesthetics & influencing factors of self-perceived aesthetics

BACKGROUND

The aim of this study is to assess the agreement between orthodontist's and Chinese young adult's self-perceived aesthetics, the normative treatment need based on the Index of Orthodontic Treatment Need (IOTN), and the main factors affecting the self-perceived aesthetics.

METHODS

A random sample of 348 Chinese young adults (116 males and 232 females) aged 17-24 years were recruited in this study. Two orthodontists were involved in rating the cases. Orthodontic treatment need was assessed according to the Index of Orthodontic Treatment Need, including Aesthetic components and Dental Health Components (AC and DHC). Personality traits were assessed according to Eysenck Personality Questionnaire (EPQ). Cohen's kappa test was used to assess the agreement, and spearman's correlation coefficient was used to analyze the association among all variables.

RESULTS

A statistically significant level of agreement was observed between young adult's perception and orthodontist's perception in IOTN (kappa = 0.14). A positive relationship (p < 0.001)existed between the young adult's AC and the orthodontist' s AC (r = 0.275), and between the young adult' s AC and the normative need DHC (r = 0.195). The orthodontist's AC was strongly related to the normative need (r = 0.743, p < 0.001). Association between the young adult's AC and gender and EPQ-E were also observed.

CONCLUSIONS

Young adults tend to be less critical in assessing orthodontic treatment needs than orthodontists. The orthodontist's AC reflecting subjective treatment need is strongly connected to the normative need. The adult's perception of aesthetic component is affected by factors such as gender and personality traits.

Assessment of orthodontic treatment need among tribal children of Indore division, Central India

Introduction

India is home to many tribes which have an interesting and varied history of origins, customs and social practices. Oral health care in tribal areas is limited due to shortage of dental manpower, financial constraints and the lack of perceived need for dental care among tribal masses.

Objective

To assess orthodontic treatment need among tribal children of Indore division, Central India.

Methods

A cross-sectional house to house survey was carried out among 800 tribal children aged 5 to 15 years old in two major tribal districts of Indore division. Permissions and consent were obtained from local administrative authorities, ethical committee and parents respectively. A structured proforma was used to record demographic data. Examination for dentofacial anomalies was conducted according to WHO 1997 survey methods. Descriptive tables and analytical tests like ANOVA, post-hoc and chi-square test were employed.

Results

The mean age was 9.75(±2.43) years. The mean DAI score among 12 to 15 years old children was 23.19±5.22. Female exhibited higher (24.51±5.34) mean DAI score compared to males (22.12±4.87) (p<0.05). The Patelia tribes (24.38±5.13) reported higher mean DAI score than Bhilala (23.02±5.69) and Bhil tribe (22.73±4.79) (p<0.005).

Conclusion

The tribal children had minor malocclusion with no or slight treatment need. Categorization of orthodontic treatment need according to malocclusion severity is particularly important for the planning of corresponding public policies. The isolation of the villages, lack of transportation options imposes limitations on the availability of health professionals to provide dental services.

Objective method for evaluating orthodontic treatment from the lay perspective: An eye-tracking study

INTRODUCTION

Currently, few methods are available to measure orthodontic treatment need and treatment outcome from the lay perspective. The objective of this study was to explore the function of an eye-tracking method to evaluate orthodontic treatment need and treatment outcome from the lay perspective as a novel and objective way when compared with traditional assessments.

METHODS

The scanpaths of 88 laypersons observing the repose and smiling photographs of normal subjects and pretreatment and posttreatment malocclusion patients were recorded by an eye-tracking device. The total fixation time and the first fixation time on the areas of interest (eyes, nose, and mouth) for each group of faces were compared and analyzed using mixed-effects linear regression and a support vector machine. The aesthetic component of the Index of Orthodontic Treatment Need was used to categorize treatment need and outcome levels to determine the accuracy of the support vector machine in identifying these variables.

RESULTS

Significant deviations in the scanpaths of laypersons viewing pretreatment smiling faces were noted, with less fixation time (P <0.05) and later attention capture (P <0.05) on the eyes, and more fixation time (P <0.05) and earlier attention capture (P <0.05) on the mouth than for the scanpaths of laypersons viewing normal smiling subjects. The same results were obtained when comparing posttreatment smiling patients, with less fixation time (P <0.05) and later attention capture on the eyes (P <0.05), and more fixation time (P <0.05) and earlier attention capture on the mouth (P <0.05). The pretreatment repose faces exhibited an earlier attention capture on the mouth than did the normal subjects (P <0.05) and posttreatment patients (P <0.05). Linear support vector machine classification showed accuracies of 97.2% and 93.4% in distinguishing pretreatment patients from normal subjects (treatment need), and pretreatment patients from posttreatment patients (treatment outcome), respectively.

CONCLUSIONS

The eye-tracking device was able to objectively quantify the effect of malocclusion on facial perception and the impact of orthodontic treatment on malocclusion from the lay perspective. The support vector machine for classification of selected features achieved high accuracy of judging treatment need and treatment outcome. This approach may represent a new method for objectively evaluating orthodontic treatment need and treatment outcome from the perspective of laypersons.

Impact of malocclusion on oral health-related quality of life in 10-14-year-old children of Mumbai, India

Aims and Objectives:

The aim and objective of this study was to establish the relationship of oral health-related quality of life (OHRQoL) as assessed by the Child Perception Questionnaire (CPQ 11–14) with the Index of Orthodontic Treatment Need (IOTN) and the child's apprehension with his/her dental appearance and how upset the child would feel if he/she is unable to obtain orthodontic treatment.

Materials and Methods:

An observational cross-sectional study was conducted among 604 children between the age group of 10–14 years to analyze the effect of malocclusion on the quality of life of children on the basis of impact on oral symptoms, functional limitation, emotional well-being, and social well-being. Malocclusion was evaluated using the IOTN, and the CPQ 11–14 was used to study the OHRQoL in children. The collected data were then subjected to statistical analysis.

Statistical Analysis:

Spearman's correlation coefficient was used to analyze the data statistically.

Results:

Out of the 604 children examined, boys showed effect on emotional well-being, whereas girls showed a significant correlation on both emotional and social well-being. There was a statistically significant correlation between IOTN and all the four domains of CPQ scores with respect to the two questions that were added to the CPQ questionnaire.

Conclusion:

A questionnaire when developed specifically for determining the effect of malocclusion on OHRQoL focusing more on emotional and psychological impact and less on oral symptoms and functional limitation will provide advantages of having limited questions, being less time-consuming, and providing better understanding of the patients’ concern.

Comparing a quality of life measure and the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN) in assessing orthodontic treatment need and concern

OBJECTIVE

To compare the use of the Aesthetic Component (AC) of IOTN and the Child Perceptions Questionnaire (CPQ) in assessing orthodontic treatment need and concern.

DESIGN

Cross-sectional observational study.

SUBJECTS AND METHODS

The subjects were 204 children aged 10-12 years studying in 10 schools in Bristol, UK. They completed a questionnaire comprising the CPQ and questions regarding orthodontic concern. AC scores as rated by the child and by the calibrated examiner were recorded.

MAIN OUTCOME MEASURES

CPQ scores were calculated from the responses in the questionnaire. AC scores and responses to questions regarding orthodontic concern were recorded.

RESULTS

The children gave themselves lower AC scores compared to the examiner (p<0.001). The only section of the CPQ that correlated significantly with Examiner AC was the emotional impacts section (rho=0.151). CPQ scores had a slightly higher correlation with self-perceived AC than Examiner AC. However, the correlations were still very low. The emotional impacts section of CPQ (rho=0.332) and overall CPQ score (rho=0.282) were better than the examiner AC (rho=0.209) at reflecting how bothered the children were by the alignment of their teeth, and how upset they would be if they couldn't receive orthodontic treatment (rho=0.464, 0.428 and 0.214, respectively). Children with a normative need for orthodontic treatment, based on examiner AC did not have a worse oral health-related quality of life.

CONCLUSION(S)

The CPQ and IOTN AC measure different attributes. There should be a shift towards using quality of life measures to supplement the IOTN in assessing the perceived need for orthodontic treatment.

Evaluation of orthodontic treatment needs using the dental aesthetic index in Iranian students

BACKGROUND

In the contemporary orthodontics, the number of people who demand orthodontic treatment to improve their psychosocial issues related to facial esthetic is constantly increasing. Even in treatment plans, appearance and esthetic gain more attention.

OBJECTIVES

The purpose of this study was to determine the need for orthodontic treatment on the basis of the dental aesthetic index (DAI) in the Iranian students of Ahvaz city.

MATERIAL AND METHODS

This cross sectional study was performed on 900 students aged between 11 - 14 years (450 boys, 450 girls). Schools were selected based on random cluster sampling from different parts of the city. Students\ who had or were having orthodontic treatment including those on interceptive orthodontics, were excluded from the study. Two questionnaires were used; the first one included different DAI criteria, and the second one included two questions about orthodontic treatment need and satisfaction of personal dental appearance. The results were analyzed by Chi-Square and T test.

RESULTS

In 70.9% of the students, DAI score was 13 - 25, 19.2% of the samples had a DAI score of 26 - 30, the DAI score of 7.8% was 31 - 35, and in 2.1% the DAI score was greater than 35. The association between the DAI score and sex was not statistically significant (P = 0.778). In relation to orthodontic treatment need, 44.8% of students answered positively, while in 55.2% the answer was negative. In relation to satisfaction with appearance, 21% of the students were satisfied with their appearance, 59% were relatively satisfied, and 19.9% were not satisfied with their appearance. The association between DAI score and the need for orthodontic treatment and satisfaction of dental appearance was significant (P = 0.000).

CONCLUSION

In comparison to other studies, the students in Iran (Ahvaz) have a better dental appearance and less need for orthodontic treatment. Significantly positive correlations were found between the DAI and satisfaction of dental appearance, orthodontic treatment need and student's perception.

Malocclusion impacts adolescents' oral health-related quality of life

OBJECTIVE

To test the hypothesis that malocclusion does not have an independent and negative effect on quality of life of adolescents.

MATERIALS AND METHODS

The cross-sectional design study comprised a sample of 519 children, aged 11 to 14 years, attending public schools in Osorio, a city in southern Brazil. One calibrated examiner carried out clinical examinations and recorded dental caries (decayed/missing/filled teeth), malocclusion (Dental Aesthetic Index), and dental trauma. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14), Impact Short Form, and their parents or guardians answered questions about socioeconomic status. Simple and multivariate linear regressions were performed to assess covariates for the overall CPQ11-14 scores.

RESULTS

Greater impacts on oral health-related quality of life were observed for girls (P  =  .007), children with a lower household income (P  =  .016), those living in nonnuclear families (P < .001), and those with more decayed/missing/filled teeth (P  =  .001). Malocclusion was also associated with oral health-related quality of life: the severity of malocclusion was significantly related to higher scores of CPQ11-14 even after scores were adjusted for control variables. CPQ11-14 increased by approximately 1 point for each increase in the severity of malocclusion.

CONCLUSIONS

Malocclusion has a negative effect on adolescents' quality of life, independent of dental caries or traumatic dental injuries. Socioeconomic inequalities and clinical conditions are important features in adolescents' quality of life.

Prevalence of malocclusion and its relationship with caries among school children aged 11 - 15 years in southern India

Objective

To assess the prevalence of malocclusion and its relationship with dental caries among school children in southern India.

Methods

This cross-sectional study included 1,800 students aged 11 - 15 years whose Dental Aesthetic Index (DAI) and dentition status were recorded and analyzed. The chi-square test, ANOVA, and Spearman's correlation tests were carried out.

Results

The mean DAI score ± the standard deviation was 18.61 ± 6.1. Approximately 85% of the students (83.0% males, 86.8% females) had DAI scores of < 26 and were classified as not requiring orthodontic treatment. One tenth of the sample had mean DAI scores between 26 - 30 (indicating definite malocclusion and elective treatment), while about 3% had mean scores between 31 - 35 (indicating severe malocclusion and treatment desirability). Only 29 children (1.6%; 16 boys, 13 girls) had a DAI score of > 35, which suggested very severe or handicapping malocclusion requiring mandatory treatment. The mean decayed, missing, filled teeth (DMFT) was 2.28 ± 1.47. A DMFT of > 0 was observed in 91.8% of the study subjects. Children with a DAI score of > 35 were found to have significantly (p < 0.001) higher caries experience as compared to other children. Moreover, the DAI scores showed a significant correlation with the mean DMFT scores (r = 0.368, p < 0.05).

Conclusions

A positive correlation was found between the severity of malocclusion and dental caries.

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.

Self-Perception of Malocclusion Among Nigerian Adolescents Using The Aesthetic Component of The IOTN

Introduction:

The practice of orthodontics is very young in South-South Nigeria and there is need for base line data for informed planning. This study was carried out to investigate the self-perception of malocclusion among Nigerian school children aged 12 to 18 years in order to compare their perception with that of an orthodontist and also to determine the influence of gender and age on self-perception.

Materials and Methodology:

A total of 612 randomly selected schoolchildren comprising 299 (48.9%) males and 313 (51.1%) females with a mean age of 15 + 2.0 years were included in the study, the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was the instrument used to measure the perception of malocclusion by both the school children and the orthodontist.

Results:

Majority of the students (82.5%) rated their teeth towards the more attractive end of the scale (Grades 1-4). Although self - perception was not found to be related to gender, older children (16-18 years) had an increased level of perception of need. Males and older children were found to be more in need of treatment by the orthodontist.

Conclusions:

A significant difference was found between the orthodontist’s rating and the students’ ratings of the attractiveness of their occlusions. Age and gender were not found to influence self- perceived orthodontic treatment need. Therefore, for effective orthodontic care, self- perception and not only professional assessment must be taken into consideration when formulating treatment plans to ensure patient satisfaction.

Self-perception and malocclusion and their relation to oral appearance and function

The aim of this study was to evaluate the relationship between malocclusion and self-perception of oral appearance/function, in 12/15-year-old Brazilian adolescents. The cluster sample consisted of 717 teenagers attending 24 urban public (n=611) and 5 rural public (n=107) schools in Maringá/PR. Malocclusion was measured using the Dental Aesthetic Index (DAI), in accordance with WHO recommendations. A parental questionnaire was applied to collect information on esthetic perception level and oral variables related to oral health. Univariate and multiple logistic regression analyses were performed. Multiple logistic regression confirmed that for 12-year-old, missing teeth (OR=2.865) and presence of openbite (open occlusal relationship) (OR=2.865) were risk indicators for speech capability. With regard to 15-year-old, presence of mandibular overjet (horizontal overlap) (OR=4.016) was a risk indicator for speech capability and molar relationship (OR=1.661) was a risk indicator for chewing capability. The impact of malocclusion on adolescents' life was confirmed in this study. Speech and chewing capability were associated with orthodontic deviations, which should be taken into consideration in oral health planning, to identify risk groups and improve community health services.

Perceptions of dental aesthetics of Class III and anterior open bite malocclusions: a comparison between 10- to 11-year-old schoolchildren and orthodontists

OBJECTIVE

To compare perceptions of dental aesthetics of Class III and anterior open bite (AOB) malocclusions between 10- to 11-year-old Birmingham schoolchildren and orthodontists.

MATERIALS AND METHODS

Thirty-one orthodontists practicing in Birmingham (UK) and 383 school children aged 10-11 years from a random and representative sample of seven primary schools in South Birmingham participated in the study. Participants were asked to assess five anterior photographs of the dentition representing varying degrees of aesthetic impairment of Class III and AOB malocclusions. Perceptions of dental aesthetics were determined using the aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN).

RESULTS

Perceptions of dental aesthetics were similar among males and females (P > .05). Both groups allocated the highest median AC score to the photo representing severe Class III malocclusion and the lowest to the photo representing mild Class III and AOB malocclusion. Differences in perceived dental aesthetics were significant for photos representing severe Class III and moderate AOB malocclusions, with orthodontists perceiving greater aesthetic impairment for severe Class III and schoolchildren for moderate AOB, respectively (P < .05).

CONCLUSIONS

Schoolchildren and orthodontists perceived Class III malocclusions to have greater aesthetic impairment compared to AOB malocclusions. Surprisingly, none of the median AC scores allocated to the five photos were in the "Definite need" for treatment category. The IOTN may not be sensitive to these types of malocclusions. This finding merits further investigation.

An analysis of reproducibility of DAI and IOTN indexes in a brazilian scene

The aim of this study was to evaluate the ability of the indexes DAI and IOTN in predicting the need of orthodontic treatment based in one property: reproducibility. The index DAI was developed in USA in 1989 and can identify 10 occlusal alterations that result, mathematically, in scores, with weights based in its relative importance according with the judgment of laypeople. The IOTN was developed in England also in 1989 and incorporates an aesthetic component AC and a component of dental health DHC. The AC component consists on a scale illustrated with 10 photos which had been divided in bands of degrees in accordance with a hierarchic scale and classifies the patients in degrees of treatment needed. The instruments of collection of the data were: plastic rule of DHC component and an aesthetic visual scale of component AC praised for the IOTN and one periodontal OMS probe praised for DAI. The sample was composite by 60 patients. The results indicated that both indexes were highly reproducible in accordance with Pearson and Spearman coefficients, which were strengthened by t-tests of Student and Wilcoxon, respectively. The correlation results between the examiners had varied between r=0.85 and r=1.00.

Orthodontic concerns of Brazilian children and their parents compared to the normative treatment need

The objective of the present study was to evaluate the interest of both children and parents towards orthodontic treatment and compare it to the normative treatment need as well as to determine the factors related to such an interest. The sample consisted of 407 schoolchildren aged between 9 and 12 years and their parents from Nova Friburgo (Rio de Janeiro), Brazil. The orthodontic concern expressed by children and parents was obtained by means of a questionnaire. The normative need was evaluated using two components of the Index of Orthodontic Treatment Need (IOTN). Data analysis involved multiple logistic regression. Normative treatment need was greater than the children's self-perceived treatment need. The parents expressed more interest towards orthodontic treatment of their children than the children themselves. The orthodontic concern expressed by both groups was greater than the normative need for orthodontic treatment, and such a finding was associated with gender of the children (female) and self-perceived treatment need expressed by them. The lack of a relationship between the normative treatment need and the orthodontic concern of children and parents shows that such assessments should be performed when orthodontic treatment is indicated, particularly in terms of public health, as the demand is greater than the services supplied.

Association between normative and self-perceived orthodontic treatment need among 12- to 15-year-old students in Shiraz, Iran

Self-perception of dental attractiveness is an important factor affecting orthodontic treatment need. The purpose of this study was to investigate the association between normative and self-perceived orthodontic treatment need and to evaluate the influence of gender and socioeconomic background such as family size, parental education and father's employment. The subjects were 900 male and female junior high school students (450 males, 450 females) aged 12-15 years, from four districts in the city of Shiraz, Iran. The participants were asked to complete a questionnaire and then underwent a dental examination. Normative treatment need was assessed clinically using the Dental Aesthetic Index (DAI) according to the World Health Organization guidelines. Statistical analysis was undertaken using t- and chi-squared tests. There was no statistically significant correlation between DAI scores and demographics. The results showed a significant correlation between DAI scores and a subject's awareness of malocclusion and their satisfaction with dental appearance. There were no differences between genders concerning the questionnaire data. The results suggest that the DAI score might reflect a self-perceived need for orthodontic treatment.

Objective, subjective, and self-assessment of preadolescent orthodontic treatment need--a function of age, gender, and ethnic/racial background?

Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment.

OBJECTIVES

To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES).

METHODS

Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need.

RESULTS

Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions.

CONCLUSIONS

Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.

Preadolescent orthodontic treatment need: objective and subjective provider assessments and patient self-reports

INTRODUCTION

In the age of evidence-based dentistry, an interesting question is whether dentists' subjective or general assessments of preadolescent orthodontic treatment need are correlated with objectively determined need. In addition, because children from socioeconomically disadvantaged and underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment, it is worthwhile to investigate whether unmet orthodontic treatment need is correlated with preadolescent smile assessments and desire for braces. Our objectives were to explore (1) whether pediatric residents' objective and subjective assessments of preadolescent orthodontic treatment need are correlated and also correlate with the treatment recommendations made, (2) whether preadolescent responses concerning their smile-related quality of life and desire for braces are correlate, and (3) whether dentist and patient assessments are related.

METHODS

Data were collected from 1566 preadolescents (age range, 8-11 years; 47.3% boys, 52.7% girls; 55.7% black, 39.7% white, 2.9% Hispanic) in oral examinations and face-to-face interviews. Malocclusion was determined with the index of orthodontic treatment need.

RESULTS

Objective and subjective orthodontic treatment need indicators were correlated (r = .719, P <0.001). Pediatric residents' recommendations for orthodontic treatment were correlated with both the objective assessment of treatment need (r = .547, P <0.001) and the subjective assessment of treatment need (r = .522, P <0.001). Both sets of malocclusion indicators correlated with the patients' self-perceptions (r = -.145, P <0.001; r = -.177, P <0.001) and their desire for braces (r = .106, P = 0.001; r = .141, P <0.001). Patient desire for braces was significantly correlated with smile-related quality-of-life scores (r = .665, P <0.001).

CONCLUSIONS

Although subjective and objective assessments of preadolescent orthodontic treatment need are rather consistent, the percentage of actual treatment recommendations exceeded both the subjective and objective assessments of treatment need. Preadolescent self-assessments and desire for braces were significantly correlated, and also correlated with the treatment recommendations and the objective and subjective components of the index of orthodontic treatment need score.

The relationship of dental aesthetic index with dental appearance, smile and desire for orthodontic correction

Objective: The purpose of this study was to determine the relationship between dental aesthetic index (DAI) and self – satisfaction with dental appearance, smile and desire for orthodontic care.

Methods: A survey of 103 school children, 51 boys and 52 girls was carried out in Annamalai Nagar, Chidambaram. The subjects were interviewed using a questionnaire consisting of questions concerning smile, dental appearance and desire for orthodontic treatment. They were also assessed using the dental aesthetic index.

Results: Statistically significant correlations were between subjective assessments of dental appearance and DAI (P = 0.042) and need for orthodontic treatment and DAI (P = 0.045). The strongest correlations were found between DAI and comparative evaluations of dental appearance (P < 0.005).

Conclusion: This study has shown significant correlations between DAI and subjective perceptions of dental appearance.

Evaluation of the Relationship between Subjects? Perception and Professional Assessment of Esthetic Treatment Needs

PURPOSE

The purposes of the present study were to (1) evaluate the esthetic dental treatment need by means of two special questionnaires, (2) determine the reliability and the construct validity of the measurement scales derived from these questionnaires, and (3) investigate the relationship between Greek subjects' perception and a professional examiner's assessment regarding the esthetic treatment need.

MATERIALS AND METHODS

Participants in this survey consisted of 132 subjects (48 males with mean age 39.0 +/- 14.5 years old, 84 females with mean age 41.7 +/- 14.5 years old) with natural teeth and fixed restorations. Subjects were asked to complete a special self-evaluation questionnaire consisting of 12 items. During the next stage, all participants were clinically examined by an experienced examiner and the data collected were used to fill out a second special professional assessment questionnaire consisting of 20 items. The forms structure used were in accordance with well-established indices used in orthodontics for assessing esthetic treatment need.

RESULTS

The reliability of the multiple correspondence analysis (MCA) analysis-derived scales was very satisfactory (Cronbach's a coefficient: a =0.82) for the total scale of the self-evaluation measurement. For the professional assessment scale, the reliability of the total scale was almost perfect (a=0.92). The MCA revealed one reliable factorial construct for the self-evaluation measurement scale and two reliable constructs for the professional measurement scale. Pearson's correlation coefficient indicated a very low agreement between self-evaluation and professional measurement scales.

CONCLUSION

The findings of this survey suggest that there was a relative disagreement between subjects' perception and professional assessment regarding the need for esthetic dental treatment. CLINICAL SIGNIFICANCE In the present survey, the agreement between subjects' perception and clinical assessment of esthetic dental treatment need was found to be very low, which highlighted the discrepancies between patients' and dentists' perceptions of esthetic needs.

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

Perception of personal dental appearance in Nigerian adolescents

BACKGROUND

The purpose of this study was to investigate the relationship among Nigerian adolescents' awareness of malocclusion, their satisfaction with personal dental appearance, and the severity of their occlusal irregularities.

MATERIAL

The sample consisted of 577 randomly selected secondary school adolescents-306 (53%) boys and 271 (47%) girls aged 12 to 17 years (mean age, 14.73 +/- 1.12). A pretested questionnaire was used to assess the subjects' awareness of malocclusion and satisfaction with personal dental appearance; the actual severity of malocclusion was determined by using the dental aesthetic index (DAI), performed by an orthodontist in a school environment under natural illumination.

RESULTS

Statistically significant, negative, weak correlations were found between awareness of malocclusion and satisfaction at the various DAI scores as follows: < or =25 (r = -0.3774, P < .001), 26 to 30 (r = -0.4305, P < .001), 31 to 35 (r = -0.5137, P < .001), and > or =36 (r = -0.5104, P < .001). Analysis of variance (ANOVA) did not show a significant value of any of the 3 factors. Multivariate analysis with age as the covariate did not show a significant effect. Also, the association between socioeconomic status and the variables was not significant ( P > .05). Generally, no statistically significant sex differences were found in relation to the DAI scores, awareness, or satisfaction ( P > .05).

CONCLUSIONS

Significant, negative, weak correlations were found between Nigerian adolescents' awareness of malocclusion and satisfaction with personal dental appearance at the various severity levels of malocclusion. It would be worthwhile to assess such a relationship with the index of orthodontic treatment need in the Nigerian population.

Self-perceived orthodontic treatment need evaluated through 3 scales in a university population

OBJECTIVE

To evaluate the self-perceived orthodontic treatment need in a university population evaluated through 3 scales that used different approaches.

DESIGN

Cross-sectional survey.

SETTING

University dental clinic, Lima, Peru, 2001.

MATERIALS AND METHODS

Questionnaires that gathered perceptions on dentofacial aesthetic perception and orthodontic treatment need were applied to a randomly selected sample (329) of first year university students (729). Subjects undergoing orthodontic treatment at the time of examination were excluded.

MAIN OUTCOME MEASURES

Aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN), Oral Aesthetics Subjective Index Scale (OASIS) and a visual analogue scale (VAS) were used.

STATISTICAL ANALYSIS

Descriptive statistics, Spearman correlation test, Kruskall-Wallis test and Mann-Whitney U-test were used.

RESULTS

For the AC, 87.5% were in the "without treatment need" category, 10.6% in the "borderline need" category and 1.8% in the "treatment need" category. The mean AC score was 3.02 (+/-1.49). The mean OASIS score was 11.81 (+/-4.84), and the VAS score was 40.16 (+/-18.16). Correlations between the 3 self-assessment scales were moderate (AC-OASIS 0.416, AC-VAS 0.541 and OASIS-VAS 0.457). Gender or previous orthodontic treatment had no influence (p<0.05) on the scales.

CONCLUSIONS

Differences in the approaches used by each scale to evaluate the self-perception of the aesthetical arrangement of the front teeth may explain the moderate correlation values.

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics, function and speech amongst secondary school children in Ibadan, Nigeria

OBJECTIVE

The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients.

METHODS

An epidemiological survey of 614 secondary school students, 327 males (53.3%) and 287 females (46.7%) was carried out in Ibadan, Nigeria. Children aged 12-18 years (mean age, 14.9+/-2.9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5-point Likert scale.

RESULTS

Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r=0.174; P<0.01) and between biting/chewing and appearance of teeth (r=0.095; P<0.05). Statistically significant correlations were found between appearance of teeth and speech (r=0.148; P<0.01) and biting/chewing and speech. The last showed the strongest correlation (r=0.268; P<0.01).

CONCLUSION

The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.

An assessment of relationship between self-esteem, orthodontic concern, and Dental Aesthetic Index (DAI) scores among secondary school students in Ibadan, Nigeria

OBJECTIVE

To ascertain the correlation between self-esteem, orthodontic concern and orthodontic status using DAI scores in a group of Nigerian potential orthodontic patients.

DESIGN

A cross-sectional analytical study.

SETTING

Secondary schools reflecting a good socio-economic spread of adolescents in the town.

PARTICIPANTS

Randomly selected 520 junior and senior students 276 (53.1%) males and 244 (46.9%) females with mean age of 15.02 +/- 3.26 (SD) years participated in the study.

METHODS

Each student was asked to fill in the questionnaire on orthodontic concern and Global Negative Self-Evaluation scale (GSE) with subsequent assessment of the occlusion according to the DAI by one orthodontist. After obtaining consent, thirty students were re-examined to test intra-examiner reliability which was good (r = 0.98, P < 0.001).

RESULTS

The correlations between self-esteem, orthodontic concern and DAI scores were tested using Spearman rank order correlation coefficient. Significant positive correlations were observed between self-esteem and orthodontic concern according to DAI treatment category needs (r = 0.274, p<0.01; r = 0.396, p<0.01; r = 0.347, p<0.05) except for the severe malocclusion group which was positive but not statistically significant (r = 0.136, p> 0.05). Significant correlation was equally noted between DAI scores and orthodontic concern (r = 0.191, p<0.01).

CONCLUSION

Significant positive correlation existed between self-esteem in a group of Nigerian adolescents and their orthodontic concern as well as between their DAI scores and orthodontic concern. DAI should be a relevant and useful occlusal index for the Nigerian orthodontic population.

The role of minimal intervention in orthodontics

Less than 15% of the population develops a normal occlusion as defined by Angle in the permanent dentition. The term 'ideal' may therefore be a more appropriate description, and deviations from this esthetic and functional optimum should not be considered abnormalities in the true sense of the word. Current research indicates that few malocclusions compromise dental, periodontal or temporomandibular health. To determine whether or not protruded, irregular or maloccluded teeth merit orthodontic intervention is therefore a major challenge. Another challenge is to determine to what extent a limited treatment strategy may be successful in correcting the occlusal problems according to the perceived needs of the patients. I discuss these issues in my present communication and conclude that the major reasons for recommending orthodontic treatment are psychosocial in nature. I also conclude that the majority of the orthodontic cases require comprehensive treatment to achieve successful results. Orthodontic patients are typically satisfied with the outcome of the orthodontic intervention, reporting that the esthetic improvements and the increased functional comfort of the dentition have made significant contributions to their quality of life. Technological advances have made orthodontic treatment simpler and safer over the years. Considering the potential for long-lasting results and the low risk of iatrogenic effects if the patients comply with appropriate oral hygiene measures during active appliance therapy, I conclude that treatment of minor occlusal deviations may also be justified in subjects expressing a clearly defined subjective need for treatment.

The relationship between Index of Complexity, Outcome and Need, and patients' perceptions of malocclusion: a study in general dental practice

AIM

To examine the relationship between the Index of Complexity, Outcome and Need (ICON) and the subjective opinions of patients attending for routine dental care.

MATERIALS AND METHODS

This study was undertaken at two general dental practices in Cardiff and Bedford. 50 patients aged between 11-14 years and 50 patients aged 30-40 years presenting for routine dental treatment were selected in each. The subjects were assessed objectively using the ICON guidelines by two examiners trained and calibrated in the use of this index. The scores were recorded directly from the patient. Subjective assessments were obtained from the patients by means of a questionnaire consisting of four simple questions addressing aesthetics, function, speech and treatment need using a five point Likert scale.

RESULTS

The mean ICON scores for the different genders and age groups participating in this study were; 11-14 year old males 58.4 (SE 3.17); 11-14 year old females 51.8 (SE 3.51); 30-40 year old males 51.2 (SE 2.70); 30-40 year old females 45.3 (SE 2.56). There were statistically significant differences in ICON scores between the younger and older groups (P = 0.024) and females and males (P = 0.04). Adult patients were more likely to reject treatment than younger patients. Analysis of the professional scores in relation to subjective assessments, using the Spearman rank correlation coefficient, for 11-14 and 30-40 year olds, and for the male and female genders, revealed that the ICON has a significant correlation with patients' perceptions of aesthetics, function, speech and treatment need (r2 = 0.01 to 0.28). The only exceptions were patients' perceptions of speech in the 30-40 year old group, and function in the female gender, which did not show a statistically significant correlation to the professional assessments.

CONCLUSION

In this study, the ICON was found to correlate with patients' opinions of aesthetics, function, speech and treatment need. The strength of association, however, was low. It can be concluded that the ICON alone is not necessarily a suitable predictor for appearance, function, speech or treatment need for those individuals attending general dental practice for routine dental care. In combination with a simple question to assess the patients desire for treatment, the shared decision for any particular individual to enter the treatment process can be determined.