The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients

OBJECTIVES

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort.

MATERIALS AND METHODS

Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14).

RESULTS

Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect.

CONCLUSION

Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression.

CLINICAL RELEVANCE

Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Psychological impact and perceptions of orthodontic treatment of adult patients with different motivations

INTRODUCTION

Motivations, perceptions, and psychosocial states of adult patients with orthodontic disorders in China have not been widely studied. The study assessed the psychosocial states and perceptions of adult patients undergoing orthodontic treatments with different motivations.

METHODS

Two hundred forty-three adult patients (mean age, 30.2 ± 7.4 years; women, 79.0%) undergoing orthodontic treatment were recruited from a tertiary stomatology hospital. The patients answered a patient-centered questionnaire regarding motivations and perceptions of orthodontic treatment and the Psychosocial Impact of Dental Aesthetics Questionnaire. Data were analyzed using the chi-square test on the basis of multiple responses. Multiple linear regression analyses were performed to determine the association between motivation factors and the Psychosocial Impact of Dental Aesthetics Questionnaire subscale scores (P <0.05).

RESULTS

Patients with various motivations were as follows: occlusal function reason (70.4%), dental esthetic reason (54.7%), facial esthetic reason (24.3%), and following others' suggestions (18.5%). Patients with esthetic or occlusal motivations exhibited significantly greater need and interest for orthodontic treatment (P <0.001). Multiple linear regression analyses revealed that the scores of social impact, psychological impact, and esthetic concern subscales were significantly associated with both dental and facial esthetic motivations (P <0.001).

CONCLUSIONS

The primary motivations of Chinese patients were observed to be improved esthetics and occlusal function. Patients with esthetic or occlusal motivations exhibited significantly greater need and interest in treatment. Patients with facial or dental esthetic motivations experienced greater impacts of psychosocial states. Therefore, the patient motivations and impacts of esthetic-related psychosocial states on them should be considered during treatment.

Does Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) reflect the impact of malocclusion on facial aesthetics?

INTRODUCTION

Malocclusion is presumed to have adverse effects on dental and facial attractiveness, leading to deleterious psychosocial impact and Quality of life(QoL) of the individual. The Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ) has proved to be effective for assessment of psychosocial impact of malocclusion on dental aesthetics, but it's effectiveness for assessing facial aesthetics is unknown.

OBJECTIVE

The aim of the present study was to assess the effectiveness of PIDAQ on its ability to reflect the psychosocial impact of malocclusion on facial attractiveness, using the Facial Aesthetic index (FAI) after its translation and validation in the regional language.

METHODS

The 23-item PIDAQ, after translation process, cross-cultural adaptation and pilot testing, was administered to 330 subjects (62.5 % females and 37.5 % males; age range 18-30 years) with varying degrees of severity of malocclusion, assessed by the two components of the Index of Orthodontic Treatment Need (Dental Health Component, IOTN-DHC, for normative need; and self-administered Aesthetic Component, IOTN-AC, for subjective need) and FAI.

RESULTS

The internal consistency and test-retest reliability were good (Cronbach's alpha = 0.859 - 0.958; Intraclass correlation coefficient =0.984). FAI, IOTN-DHC and IOTN-AC scores showed highly significant correlation with PIDAQ scores, depicting strong convergent validity (p< 0.001). One-way analysis of variance (ANOVA) and Bonferroni post-hoc test showed highly significant correlations (p-value < 0.001) for all comparisons. There were no significant differences between responses of males and females. The regional version of PIDAQ had excellent reliability.

CONCLUSIONS

PIDAQ showed good psychometric properties and was able to effectively reflect the psychosocial impact of malocclusion on altered facial aesthetics.

What impact do personality traits have on self-perception of dental aesthetics?

BACKGROUND

Malocclusion has significant social, psychological and physical impacts on the quality of life. This study aimed to study psychosocial impact of dental aesthetics among students, and how it was modified by personality traits.

METHODS

Chinese version of Eysenck Personality Questionnaire Short Scale of (EPQ-RSC) and Chinese version of Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) were used to investigate 555 undergraduate students, aged 18 to 24 years. The participants and investigators self-rated their own dental aesthetics using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The malocclusion was assessed by two independent investigators using the Dental Health Component (DHC) of IOTN.

RESULTS

No statistically significant difference was found for gender (p = 0.829) nor for majors (p = 0.598) in the psychosocial impact of dental aesthetics. Total and subscale PIDAQ scores differed significantly among the 3 IOTN grades. PIDAQ scores strongly correlated with Eysenck personality. The dimensions of extraversion and neuroticism, and dental health component grades had significant impact on participants' psychosocial well-being of dental aesthetics.

CONCLUSIONS

Neurotic people with high self-concerns perceived greater psychosocial impact. Outgoing people appear to be less affected psychosocially by dental aesthetics.

Cross-Cultural Adaptation and Validation of the Portuguese Version of the Psychosocial Impact of Dental Aesthetics Questionnaire

The aim of this study was to cross-culturally adapt and validate the psychosocial impact of dental esthetics questionnaire (PIDAQ) to the Portuguese language. The PIDAQ was culturally translated and adapted according to international guidelines. In this cross-sectional study, we enrolled 501 subjects in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal) in June 2022. The participants answered the Portuguese version of the PIDAQ (PIDAQ-PT), which was a 23-item scale with four conceptual domains (self-confidence, social impact, psychological impact and esthetic concern factor). Psychometric properties were estimated using content validity, construct validity, internal consistency and test−retest reliability. The PIDAQ-PT presented an intraclass correlation coefficient (ICC) of 0.84, and a 95% confidence interval (0.73−0.90, p < 0.001), with values for the Cronbach’s alpha coefficient of the subconstructs ranging from 0.93 to 0.98. In the confirmatory factor analysis (CFA), the final models presented a good fit, with the comparative fit indices (CFIs) ranging from 0.905 to 0.921 and the root mean squared error of approximation (RMSEA) ranging between 0.088 and 0.090. The PIDAQ-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures.

The Psychosocial Impact of Dental Esthetics in Undergraduates with Borderline Malocclusion

Background

The study investigates the existing correlation between self-perceived malocclusion, the psychosocial impact of dental esthetics, and whether this link involves personality traits.

Methods

The 179 questionnaires from 615 undergraduates in Wenzhou were used for analysis after applying the exclusion criteria. The Psychosocial Impact of the Dental Aesthetics Questionnaire (PIDAQ) was administered to evaluate participants' perceptions of the psychosocial impacts of malocclusion. The need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN). The Chinese version of the Eysenck Personality Questionnaire-Short Scale (EPQ-RSC) evaluated participants' personality characteristics. The Kruskal-Wallis test was used to assess differences between the IOTN-Dental Health Component (DHC) and expectations of orthodontic treatment. Linear regression was applied with PADAQ and its subscale scores against possible variables.

Results

The total and subscale PIDAQ scores were positively correlated with neuroticism. Total PIDAQ scores, the DHC, and the Aesthetic Component (AC) were significantly positively correlated with the subjective AC. The DHC was significantly negatively correlated with extroversion.

Conclusions

We confirmed a modest link between the need for orthodontic treatment and the psychosocial impact of dental esthetics.

Validation of the Psychosocial Impact of Dental Aesthetics Questionnaire in the Australian population

INTRODUCTION

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception need for orthodontic treatment. The study aimed to determine the psychometric validity and reliability of PIDAQ in Australian adults.

METHODS

Data were collected from the National Dental Telephone Interview Survey in 2013. The PIDAQ was used, comprising 4 conceptual domains: self-confidence, social impact, psychological impact, and esthetic concern. Psychometric sensitivity was estimated for each item. Confirmatory factor analysis was performed to determine factorial validity in which the ratio of chi-square by degrees of freedom, comparative fit, and root mean square error of approximation were used as indexes of the goodness of fit. Convergent validity was estimated from the average variance extracted and composite reliability, whereas internal consistency was estimated by Cronbach standardized alpha.

RESULTS

The dataset comprised 2936 Australian adults aged ≥18 years and separated randomly into 2 subdata sets. The kurtosis and skewness values indicate an approximation to a normal distribution for each item, with acceptable thresholds for the goodness of fit and convergent validity (average variance extracted ≥0.50 and composite reliability ≥0.70), and discriminant validity was also demonstrated. Internal consistency was adequate in the 4 conceptual domains for PIDAQ for both subdata sets, with Cronbach standardized alpha being ≥0.70.

CONCLUSIONS

The psychometric sensitivity, validity, and reliability of the PIDAQ instrument in a sample of the Australian adult population were found to be adequate. Both subdata sets drawn from the sample demonstrated acceptable goodness of fit and internal consistency.

Orofacial Esthetic Scale and Psychosocial Impact of Dental Aesthetics Questionnaire: development and psychometric properties of the Finnish version

OBJECTIVE

To develop the Finnish version of the Orofacial Esthetic Scale (OES-Fi) and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ-Fi) and estimate the psychometric properties of these instruments applied to adult Finns.

METHODS

The English versions of the instruments were translated into Finnish and back-translated. Thereafter, OES-Fi and PIDAQ-Fi were established in a pilot study. The factorial validity was estimated using Confirmatory Factor Analysis (CFI, TLI, SRMR) in independent samples (Test and Validation samples). The measurement invariance of the factorial models was tested using multigroup analysis (ΔCFI). Convergent validity [Average Variance Extracted (AVE)] and reliability [Composite Reliability (CR) and α] were estimated.

RESULTS

A total of 3636 individuals [mean age = 32.0 (SD = 11.6) years, 75% women] participated in the study. After refinements, the factorial model of the instruments showed an adequate fit to the data (CFI ≥0.94, TLI ≥0.90, SRMR ≤0.07) and showed measurement invariance in two independent samples (|ΔCFI| <0.01). Convergent validity (AVE = 0.54-0.82) and reliability (α = 0.86-0.94) were adequate.

CONCLUSION

The data obtained using OES-Fi and PIDAQ-Fi were valid and reliable. Thus, these instruments could be useful for evaluating individual satisfaction with orofacial appearance and the psychosocial impact of dental aesthetics in a clinical or research setting.

Validity and Reliability of the Arabic Version of the Psychosocial Impact of Dental Aesthetics Questionnaire for Yemeni Adolescents

(1) Objectives: This paper aimed to cross-culturally adapt the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into an Arabic language version (PIDAQ(A)) for measuring the oral health related quality of life related to dental aesthetics among 12-17-year-old Yemeni adolescents. (2) Material and methods: The study comprised three parts, which were linguistic validation and qualitative interview, comprehensibility assessment, and psychometric validations. Psychometric properties were examined for validity (exploratory factor analysis (EFA), partial confirmatory factor analysis (PCFA), construct, criterion, and discriminant validity) and reliability (internal consistency and reproducibility). (3) Results: The PIDAQ(A) contained a new item. EFA extracted three factors (item factor loading 0.375 to 0.918) comprising dental self-confidence, aesthetic concern, and psychosocial impact subscales. PCFA showed good fit statistics (comparative fit index (CFI) = 0.928, root-mean-square error of approximation (RMSEA) = 0.071). In addition, invariance across age groups was tested. Cronbach's α values ranged from 0.90 to 0.93 (intraclass correlations = 0.89-0.96). A criterion validity test showed that the PIDAQ(A) had a significant association with oral impacts on daily performance scores. A construct validity test showed significant associations between PIDAQ(A) subscales and self-perceived dental appearance and self-perceived need for orthodontic braces (p < 0.05). Discriminant validity presented significant differences in the mean PIDAQ(A) scores between subjects having severe malocclusion and those with slight malocclusion. No floor or ceiling effects were detected.

Translation and validation of the Swedish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) for adolescents

OBJECTIVE

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument developed for assessment of orthodontic aspects of oral health-related quality of life (OHRQoL). This study aimed to translate and validate the Swedish version of PIDAQ for use in Swedish adolescents 12-19 years of age.

MATERIAL AND METHODS

The translation was made according to the process described in 'Guidelines for Establishing Cultural Equivalency of Instruments' by Ohrbach et al. Field testing was performed in a group of consecutive patients who were about to start orthodontic treatment (untreated group) and a group of consecutive patients who had recently finished orthodontic treatment (treated group).

RESULTS

During the translation procedure, a Swedish version of PIDAQ was formed. In the field testing, a total of 144 questionnaires, 72 from untreated patients (mean age 14.6 years) and 72 from treated patients (mean age 17.3 years) were collected. The exploratory factor analysis detected two factors, which differs from the factor structure in the original questionnaire. The mean total PIDAQ score was significantly higher (p < .001) in the untreated group, 40.6 (20.3), than in the treated group, 9.4 (10.5), implying a high discriminant validity. Reliability was excellent, with internal consistency Cronbach's alpha values varying from 0.94 to 0.97.

CONCLUSION

The Swedish version of PIDAQ demonstrates good validity and excellent reliability and is suitable for future research on the effect of malocclusion on OHRQoL in Swedish 12- to 19-year-olds.

Is Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) Valid for the Indian Population?-A Psychometric Study

Objectives:

A culturally adapted and validated Oral Health-Related Quality of Life (OHRQoL) inventory helps to reliably compare patient perceptions among different populations. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) evaluates the impact of dental aesthetics on OHRQoL. This study aimed to develop a regional version of PIDAQ (PIDAQ_Mal) for the Indian population and to assess differences in perceptions due to malocclusion in different population groups.

Materials and Methods:

PIDAQ_Mal was derived through the translation process and pilot-tested to assess test–retest reliability. Psychometric properties were tested on 285 subjects (31.2% males, 68.8% females; age range 18–25 years). Normative treatment need was assessed using Index of Orthodontic Treatment Need (IOTN)-Dental Health Component and subjective assessment using IOTN-Aesthetic Component (AC) and Perception of Occlusion Scale (POS). PIDAQ_Mal mean domain scores were compared with those of the previously validated versions to assess difference in perceptions.

Results:

Internal consistency and test–retest reliability were good (Cronbach’s α = 0.83–0.88; Intraclass Correlation Coefficient = 0.74–0.91). IOTN-AC and POS scores showed significant correlation with PIDAQ_Mal scores ensuring convergent validity (P < 0.001). Discriminant validity was confirmed by statistically significant differences (P < 0.001) in PIDAQ_Mal scores between subjects with no treatment need and moderate/definite need. Factor analysis derived four domains with one item showing cross-loading. Difference in mean domain scores among the previously validated versions of PIDAQ confirmed socio-cultural differences in perceptions due to malocclusion.

Conclusion:

PIDAQ_Mal was found to be reliable and valid for the Indian subjects and can be used as a condition-specific OHRQoL measure. Socio-cultural differences in perceptions were brought to light using the translated scale.

Translation and validation of the Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

OBJECTIVES:

To develop and test the validity and reliability of an Arabic version of the psychosocial impact of dental aesthetics questionnaire (PIDAQ).

MATERIALS AND METHODS:

The original English version was translated into Arabic, back-translated, pre-tested, and cross-culturally adapted before being administered to 205 individuals aged between 18–30 years from Medina, Saudi Arabia. Cronbach's alpha coefficient was used to test internal consistency, and the intraclass correlation coefficient (ICC) was used to assess test–retest reliability. Construct validity was assessed using factor analysis, and convergent validity was tested by comparing PIDAQ scores to the aesthetic components of the Dental Aesthetic Index (DAI) and Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC), while discriminant validity was assessed by comparing PIDAQ scores to participants' self-evaluation of orthodontic treatment need. Gender and age differences in the PIDAQ score were assessed.

RESULTS:

Cronbach's alpha coefficient was 0.940, corrected item-total correlation coefficients were between 0.509 and 0.719, and the ICC was 0.937. Principal component factor analysis extracted three domains, and factor loading ranged from 0.563 to 0.843. Total PIDAQ score and subscale scores had significant correlations with the DAI and IOTN-AC. The questionnaire discriminated well between participants who had a perceived need for orthodontic treatment and those with no perceived need. There were no significant age or gender differences in participants' PIDAQ scores.

CONCLUSIONS:

The Arabic version of the PIDAQ had excellent psychometric properties with sufficient reliability and validity to be used for the assessment of the orthodontic-related quality of life in young Arab adults.

A biopsychosocial-cultural model for understanding oral-health-related quality of life among adolescent orthodontic patients

Background

Based on previous theoretical oral-health-related quality of life (OHRQoL) models and most recently framework, as well as sociocultural model of body image dissatisfaction, the current study aimed to investigate the effect of individual (dental aesthetics and dental appearance social comparison) and sociocultural factors (social reinforcement from parents, peers and mass media on dental aesthetics) as well as their interaction on psychosocial dimension of OHRQoL among adolescent orthodontic patients.

Methods

In this cross-sectional study comprising 427 adolescent orthodontic patients (151 boys and 276 girls) aged between 11 and 16 years old, the psychosocial dimension of OHRQoL was measured by Psychosocial Impact of Dental Aesthetics Questionnaire. Individual predictor of dental aesthetics was defined by the Aesthetic Component of the Index of Orthodontic Treatment Need, and dental appearance social comparison was assessed by four items adapted from Physical Appearance Comparison Scale. Sociocultural predictor of social reinforcement was measured by six items adapted from Perceived Sociocultural Pressure Scale. Spearman correlations, path analyses, and structural equation modeling were used to build up several predictive models.

Results

As hypothesized, two direct pathways were observed that patients’ dental aesthetics and all three sources of social reinforcement directly predicted the psychosocial dimension of OHRQoL. Meanwhile, we observed one indirect pathway, that three sources of social reinforcement predicted the psychosocial dimension of OHRQoL, in part, through dental appearance social comparison.

Conclusions

This study provides preliminary evidence indicating that dental aesthetics, social reinforcement and dental appearance comparison are reliable predictors of psychosocial dimension of OHRQoL among adolescent orthodontic patients.

Validity and reliability of the Persian version of the psychosocial impact of dental aesthetics questionnaire

BACKGROUND

The psychosocial impact of dental aesthetics questionnaire (PIDAQ) is an efficient tool for assessment of oral health-related quality of life (OHRQoL). It evaluates the effect of dental esthetics on the psychosocial status of young adults. This questionnaire has been translated to many languages so far. However, it has not yet been translated to Persian. This study aimed to assess the validity and reliability of the Persian version of PIDAQ for use among the young adults.

MATERIAL AND METHOD

The questionnaire was translated to Persian, back-translated to English and underwent cultural adaptation and pretesting. It was then filled out by 398 young adults (215 females and 183 males) between 18 to 30 years in Shiraz, Iran. The Persian version of PIDAQ along with the index of orthodontic treatment need-aesthetic component (IOTN-AC) and the perception of occlusion (POS) index were administered among participants to assess its discriminant validity.

RESULTS

Factor analysis extracted four domains and the factor loading of domains ranged from 0.479 to 0.837. The Cronbach's alpha for the Persian version of PIDAQ ranged from 0.809 to 0.886. The mean score for each of the domains and the total score for PIDAQ, classified according to IOTN-AC and POS, showed a significant difference. The mean score acquired by subjects requiring orthodontic treatment was significantly higher than the score acquired by those not requiring orthodontic treatment (P = 0.00).

CONCLUSION

The Persian version of PIDAQ has optimal validity, reliability and responsiveness for assessment of the psychosocial impact of malocclusion on the Iranian young adults.

Development and validation of a new condition-specific instrument for evaluation of smile esthetics-related quality of life

OBJECTIVE

Orofacial esthetics raises psychosocial issues. The purpose was to create and validate new short instrument for psychosocial impacts of altered smile esthetics.

MATERIALS AND METHODS

A team of an orthodontist, two prosthodontists, psychologist, and a dental student generated items that could draw up specific hypothetical psychosocial dimensions (69 items initially, 39 in final analysis). The sample consisted of 261 Caucasian subjects attending local high schools and university (26% male) aged 14 to 28 years that have self-administrated the designed questionnaire. Factorial analysis, Cronbach's alpha, Pearson correlation, paired samples t-test and analysis of variance were used for analyses of internal consistency, construct validity, responsiveness, and test-retest.

RESULTS

Three dimensions of psychosocial impacts of altered smile esthetics were identified: dental self-consciousness, dental self-confidence and social contacts that can be best fitted by 12 items, 4 items in each dimension. Internal consistency was good (α in range 0.85-0.89). Good stability in test-retest was confirmed. In responsiveness testing, tooth whitening induced increase in dental self-confidence (P = 0.002), but no significant changes in other dimensions.

CONCLUSION

The new instrument, Smile Esthetics-Related Quality of Life (SERQoL), is short and has proven to be a good indicator of psychosocial dimensions related to perception of smile esthetics.

CLINICAL SIGNIFICANCE

Smile Esthetics-Related Quality of Life questionnaire might have practical validity when applied in esthetic dental clinical procedures.

Validity of the Psychosocial Impact of Dental Aesthetics Questionnaire for use on Brazilian adolescents

Introduction:

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a multi-item psychometric instrument used to assess patients' perspective of the impact specifically related to Orthodontics. The cross-culturally adapted Brazilian version of the PIDAQ has demonstrated good reliability, validity and acceptability.

Objective:

The aim of the present study was to test the validity and reliability of the Brazilian version of the PIDAQ for use among adolescents aged between 11 and 14 years old.

Methods:

Having established the possibility of maintaining the operational characteristics of the Brazilian version of PIDAQ for the target age group, 194 individuals in the city of Belo Horizonte, Brazil, completed the questionnaire. The subjects were examined for the presence/absence of malocclusion based on the criteria of the Dental Aesthetic Index (DAI) to test discriminant validity. Internal consistency was measured by means of Cronbach's alpha coefficient which ranged from 0.59 to 0.86 for the subscales. Test-retest reliability was assessed by means of intraclass correlation coefficient which ranged from 0.54 to 0.89 for aesthetic concern and psychological impact.

Results:

Discriminant validity revealed that subjects without malocclusion had different PIDAQ scores in comparison to those with malocclusion.

Conclusion:

These findings suggest that the Brazilian version of PIDAQ for adolescents has satisfactory psychometric properties and is applicable to this age group in Brazil.

Prospective Evaluation of Psychosocial Impact after One Year of Orthodontic Treatment Using PIDAQ Adapted for Indian Population

INTRODUCTION

The impact of dental appearance, malocclusion and treatment for the same on psychological and functional well-being has drawn increasing attention over the past decade. Various psychometric instruments alongside normative indices have been used to predict orthodontic concerns. Evaluating the patients' experience during the orthodontic treatment can help us understand the true benefits and advantages of orthodontic therapy.

AIM

The aim of the present study was to evaluate the change in the psychosocial impact of malocclusion using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) adapted for the Indian population after one year of fixed orthodontic treatment.

MATERIALS AND METHODS

This interventional study was conducted on 93 patients requiring fixed orthodontic treatment. Brazilian, Chinese, Spanish, Nepali and Moroccan versions of the PIDAQ have been published but the questionnaire is not available in Hindi. In the present study, the original PIDAQ was translated into Hindi language to adapt it for the Indian population and was validated by back translation and pretest. All the subjects answered the Hindi version of the questionnaire at pretreatment (T1) and at one year of orthodontic treatment (T2). Additionally, the Index of Orthodontic Treatment Need (IOTN) was applied to measure the severity and self-perception of malocclusion. The data were analysed using paired t-test, Wilcoxon signed rank test and Kruskal-Wallis test.

RESULTS

Significant reduction was found in the total PIDAQ score and each factor's score (p<0.001) after one year of orthodontic treatment. There was a positive association of the psychosocial impact of malocclusion with the IOTN-AC (IOTN-Aesthetic Component). Adolescent females were found to be most concerned with their dentofacial appearance.

CONCLUSION

Results showed significant improvement in the psychosocial impact of malocclusion with a reduction in the self-perceived needs of patients with orthodontic treatment. The psychometric instrument used may be recommended as an Oral Health Related Quality of Life (OHRQoL) assessment tool for the population in India for further research.

Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Validation and reliability of the Malaysian English version of the psychosocial impact of dental aesthetics questionnaire for adolescents

Background

The Malay version of the Psychosocial Impact of Dental Aesthetics Questionnaire has been validated for use by Malaysian adolescents. Although Malay is their national language, English is widely used as the lingua franca among Malaysians of different ethnicities. This study aimed to validate an English version of the PIDAQ adapted for use by Malaysian adolescents to optimize data capture from adolescents who prefer English as the medium for communication.

Methods

The published English version of PIDAQ was pilot tested on 12- to 17-year-old adolescents, resulting in a few modifications to suit the Malaysian variety of English. Psychometric properties were tested on 393 adolescents who attended orthodontic practices and selected schools. Malocclusion was assessed using the Malocclusion Index, an aggregation of Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need, by the subjects (MI-S) and investigators (MI-D). Data were analysed for internal consistency and age-associated invariance, discriminant, construct and criterion validities, reproducibility and floor and ceiling effects using AMOS v.20 and SPSS v.20.

Results

The item Don’t like own teeth on video of the Aesthetic Concern (AC) subscale was not relevant to a large proportion of participants (11.7%). Therefore, it was removed and the Malaysian English PIDAQ was analysed based on 22 items instead of 23 items. Confirmatory factor analysis showed good fit statistics (comparative fit index: 0.902, root-mean-square error of approximation: 0.066). Internal consistency was good for the Dental Self-Confidence, Social Impact and Psychological Impact subscales (Cronbach’s alpha: 0.70-0.95) but lower (0.52–0.62) though acceptable for the AC subscale as it consisted of only 2 items. The reproducibility test was acceptable (intra-class correlations: 0.53–0.78). For all PIDAQ subscales, the MI-S and MI-D scores of those with severe malocclusion differed significantly from those with no or slight malocclusion. There were significant associations between the PIDAQ subscales with ranking of perceived dental appearance, need for braces and impact of malocclusion on daily activities. There were no floor or ceiling effects.

Conclusion

The adapted Malaysian English PIDAQ demonstrated adequate psychometric properties that are valid and reliable for assessment of psychological impacts of dental aesthetics among Malaysian adolescents.

Validation and reliability of the translated Malay version of the psychosocial impact of dental aesthetics questionnaire for adolescents

BACKGROUND

This paper describes the cross-cultural adaptation of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Malay version (Malay PIDAQ), an oral health-related quality of life (OHRQoL) instrument specific for orthodontics for Malaysian adolescents between 12 and 17 years old.

METHODS

The PIDAQ was cross-culturally adapted into Malay version by forward- and backward-translation processes, followed by psychometric validations. After initial investigation of the conceptual suitability of the measure for the Malaysian population, the PIDAQ was translated into Malay, pilot tested and back translated into English. Psychometric properties were examined across two age groups (319 subjects aged 12-14 and 217 subjects aged 15-17 years old) for factor structure, internal consistency, reproducibility, discriminant and construct validity, criterion validity, and assessment of floor and ceiling effects.

RESULTS

Fit indices by confirmatory factor analysis showed good fit statistics (comparative fit index = 0.936, root-mean-square error of approximation = 0.064) and invariance across age groups. Internal consistency and reproducibility tests were satisfactory (Cronbach's α = 0.71-0.91; intra-class correlations = 0.72-0.89). Significant differences in Malay PIDAQ mean scores were observed between subjects with severe malocclusion and those with slight malocclusion based on a self-rated and an investigator-rated malocclusion index, for all subscales and all age groups (p < 0.05). Construct validity of the Malay PIDAQ subscales with those who rated themselves with excellent to poor dental appearance and those who felt they needed or did not need braces, showed significant associations for all age groups (p < 0.05). Criterion validity also showed significant association between the Malay PIDAQ scores with those with and without impact on daily activities attributed to malocclusion. There were no ceiling effects detected but floor effects were detected for the Aesthetic Concern subscale.

CONCLUSION

The study has provided initial evidence for the validity and reliability of the Malay PIDAQ to assess the impact of malocclusion on the OHRQoL of 12-17 year old Malaysian adolescents.

Translation and validation of the Turkish version of the Psychosocial Impact of Dental Aesthetics Questionnaire

Objective

The aim of this study was to translate the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Turkish, validate the questionnaire, and provide a cross-cultural adaptation.

Methods

The translation process included the following steps, which were performed by a translation committee: (1) translation into Turkish, (2) back translation into English, (3) pretesting, and (4) cross-cultural adaptation. The Turkish version of the PIDAQ was produced subsequent to the translation process. Validity and reliability were measured using the Perception of Occlusion Scale and the aesthetic component of the Index of Orthodontic Treatment Need. The questionnaire was administered to 260 individuals (age range, 18–30 years; mean age, 20.50 ± 1.9 years). Structural validity was assessed via factor analysis, and internal consistency was measured using Cronbach's alpha coefficient.

Results

Factor analysis revealed a four-factor structure, with factor loadings for included items ranging from 0.380 to 0.868. Few questions were shuffled among domains various factor loadings. Cronbach's alphas for the Turkish version of the PIDAQ ranged from 0.534 to 0.904. Mean scores for the PIDAQ subscale and total scores differed significantly according to Index of Orthodontic Treatment Need and Perception of Occlusion Scale scores.

Conclusions

This study provided a Turkish version of the PIDAQ, which could be a useful tool in the evaluation of the psychosocial impact of malocclusion in young Turkish adults.

Psychosocial impact of dental aesthetics and desire for orthodontic treatment among Chinese undergraduate students

OBJECTIVE

The objective of this study is to evaluate the psychosocial impact of dental aesthetics in undergraduate students in the People's Republic of China and to investigate the association between normal orthodontic treatment needs, psychosocial impact of dental aesthetics, and desire for orthodontic treatment.

MATERIALS AND METHODS

A cross-sectional study was carried out in two universities in a city of the People's Republic of China with 374 young adults aged between 19 years and 24 years. The students answered a Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and addressed their desire for orthodontic treatment. Objective malocclusion severity was assessed with the Index of Orthodontic Treatment Need (IOTN). Statistical analysis was performed by the SPSS software (Version 15.0).

RESULTS

There was no statistical sex difference in relation to the dental health component of IOTN (P=0.893) and PIDAQ scores (P=0.06), but it was found that the desire for orthodontic treatment was significantly stronger among females. The total and subscale PIDAQ scores and malocclusion severity differed significantly among the five grades of desire (P<0.01). Significant positive correlation was found among desire for orthodontic treatment, IOTN-dental health component grades, and total or subscale PIDAQ scores (P<0.01). High correlation was found between desire and PIDAQ score (r=0.93).

CONCLUSION

The desire for orthodontic treatment is higher among female young adults who have the same orthodontic treatment needs compared to males. The desire for orthodontic treatment has high positive correlation with PIDAQ scores and increases with the increase in self-perceived psychosocial impacts of malocclusion and the needs for orthodontic treatment.

Adaptation and validation of the Moroccan Arabic version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

Objective

The aims of this study were to translate and culturally adapt the PIDAQ native English version into Moroccan Arabic, and to assess the psychometric characteristics of the version thereby obtained.

Materials and methods

The PIDAQ original English version was sequentially subjected to translation into Moroccan Arabic, back-translation into English, committee review, and pre-testing in 30 subjects seeking orthodontic treatment.

Results

The final Moroccan Arabic version further underwent an analysis of psychometric properties on a random sample of 99 adult subjects (84 females and 15 males, aged 20.97 ± 1.10 years). The intraclass coefficient correlation of the scores of the responses obtained after administration of the questionnaire twice at a 1-month interval to a random sample of 30 subjects ranged from 0.63 for “Self-confidence” to 0.85 for “Social Impact”. Cronbach α coefficients ranging from 0.78 for “Aesthetic Concerns” to 0.87 for “Self-confidence” were obtained; the different subscales of the Moroccan Arabic version of the PIDAQ showed good correlation with the perception of aesthetics and orthodontic treatment need.

Conclusion

The results of the present study indicate that the Moroccan Arabic version of the PIDAQ obtained following thorough adaptation of the native form is both reliable and valid. It is able to capture self-perception of orthodontic aesthetic and treatment need and is consistent with normative need for orthodontic treatment.

Translation and validation of a Nepalese version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ)

OBJECTIVE

The aim of this study was to develop a reliable and valid Nepali version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ).

DESIGN

Cross-sectional descriptive validation study.

SETTINGS

B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

METHODS

A rigorous translation process including conceptual and semantic evaluation, translation, back translation and pre-testing was carried out. Two hundred and fifty-two undergraduates, including equal numbers of males and females with an age ranging from 18 to 29 years (mean age: 22·33±2·114 years), participated in this study. Reliability was assessed by Cronbach's alpha coefficient and the coefficient of correlation was used to assess correlation between items and test-retest reliability. The construct validity was tested by factorial analysis. Convergent construct validity was tested by comparison of PIDAQ scores with the aesthetic component of the index of orthodontic treatment needs (IOTN-AC) and perception of occlusion scale (POS), respectively. Discriminant construct validity was assessed by differences in score for those who demand treatment and those who did not.

RESULTS

The response rate was 100%. One hundred and twenty-three individuals had a demand for orthodontic treatment. The Nepali PIDAQ had excellent reliability with Cronbach's alpha of 0·945, corrected item correlation between 0·525 and 0·790 and overall test-retest reliability of 0·978. The construct validity was good with formation of a new sub-domain 'Dental self-consciousness'. The scale had good correlation with IOTN-AC and POS fulfilling convergent construct validity. The discriminant construct validity was proved by significant differences in scores for subjects with demand and without demand for treatment.

CONCLUSION

To conclude, Nepali version of PIDAQ has good psychometric properties and can be used effectively in this population group for further research.

Relationship between perception of malocclusion and the psychological impact of dental aesthetics in university students

Introduction and Objectives: The objectives were to assess the relationship between perceived smile aesthetics and perceived psychological impact as measured by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and their own perception of it using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a Visual Analog Scale (VAS); relate the IOTN-AC and VAS to the PIDAQ; and study the predictive capacity of the scales for psychological impact. Material and Methods: A cross-sectional study was conducted in 447 college students in Spain and Portugal (average age 20.4 years, 33.1% men and 66.9% women). The online self-completed surveys used the recently-validated Spanish and Portuguese versions of the PIDAQ to assess the self–reported psychological impact of the students’ dental aesthetics and IOTN-AC and an ad hoc 100 mm VAS for their perception of their dental aesthetics. Results: PIDAQ was linearly correlated with IOTN AC and VAS. Pearson’s coefficient was 0.55 for PIDAQ and IOTN-AC (CI 95% 0.48-0.61) and -0.72 for PIDAQ and VAS (CI 95% -0.66 - -0.76). VAS and IOTN-AC were predictive variables in a linear regression model of the total PIDAQ score. The VAS diagnosed individuals whose dental aesthetics had a self-perceived psychological impact (area under the curve 0.827, CI 95% 0.787-0.868) more precisely than the IOTN-AC (area under the curve 0.742, CI 95% 0. 696-0.788). Conclusions: In adults patients, there is a significant linear relationship between perceived smile aesthetics and self-perceived psychological impact.

Key words:Visual Analog Scale, Index of Orthodontic Treatment Need, malocclusion, psychological, aesthetics.

Cross-cultural adaptation and validation of the Italian Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ)

PURPOSE

To validate and cross-culturally adapt the Italian version of the Psychological Impact of Dental Aesthetics Questionnaire (PIDAQ) among Italian young adults.

METHODS

After translation, back translation, and cross-cultural adaptation of the English PIDAQ, a first version of the Italian questionnaire was pretested. The final Italian PIDAQ was administered to 598 subjects aged 18-30 years, along with two other instruments: the aesthetic component of the index of orthodontic treatment need (IOTN-AC) and the perception of occlusion scale (POS), which identified the self-reporting grade of malocclusion. Structural validity was assessed by means of factorial analysis, internal consistency was measured with Cronbach's alpha coefficient (α), convergent validity was assessed by means of Spearman correlation, and test-retest reliability was calculated with intra-class correlation coefficient (ICC) and standard measurement error. Criterion validity was evaluated by multivariate and univariate analysis of variance with Bonferroni post hoc tests.

RESULTS

The α of the Italian PIDAQ domains ranged between 0.79 and 0.92. The ICC was between 0.81 and 0.90. The mean scores of each PIDAQ domain showed a statistically significant difference when analysed according to the IOTN-AC and POS scores.

CONCLUSION

The satisfactory psychometric properties make PIDAQ a usable tool for future studies on oral health-related quality of life among Italian young adults.

[Translation and cultural adaptation of a french version of the psychosocial impact of dental aesthetics questionnaire: PIDAQ]

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is a tool developed and validated to specifically assess subject's quality of life related to orthodontic anomalies. The aims of the present study were to translate and culturally adapt the PIDAQ's native English version into French, and to test the psychometric characteristics of the version thereby obtained. Toward these ends, the PIDAQ's original English version was translated into French and back-translated into English following the prescribed guidelines. Each of the versions obtained from the translation process was further subjected to a committee review. The final French version which is named QIPEO underwent an analysis of psychometric properties on a sample of 42 subjects (33 females and 9 males, aged 24.60 ± 8.66 years). Internal consistency was good with Cronbach ff coefficients ranging from 0.67 for "aesthetic concerns" to 0.87 for "social impact". The reproducibility of the responses given by 14 subjects after 15 days interval was correct with intraclass coefficients ranging from 0.72 for "social impact" to 0.90 for "aesthetic concerns". Furthermore, the different subscales of the French version of the PIDAQ showed excellent correlation with the perception of aesthetics and fairly good correlation with self-perception of orthodontic treatment need. Definite need for orthodontic treatment, as assessed normatively by the IOTN, was significantly associated with lower scores of "self-confidence" and higher scores of "social impact", "psychological impact" and "aesthetic concerns". Overall, the French version of the PIDAQ was shown to be reliable and has some validity for use in this population. Further studies including a larger sample size is recommended to reassess the validation and the responsiveness of this French version.

Psychosocial impact of malocclusion in Spanish adolescents

Objective

To evaluate the psychosocial impact of malocclusion, determine its relationship with the severity of malocclusion, and assess the influence of gender and social class on this relationship in adolescents.

Methods

A random sample of 627 Spanish adolescents aged 12 - 15 years underwent intraoral examinations by 3 calibrated examiners (intraexaminer and interexaminer kappa > 0.85) at their schools. Psychosocial impact was measured through a self-rated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). The severity of malocclusion was measured by the Index of Orthodontic Treatment Need (IOTN). Gender and social class were also recorded.

Results

The total PIDAQ score and those of its 4 subscales, social impact, psychological impact, aesthetic concern, and dental self-confidence, presented significant differences (p ≤ 0.05 by analysis of variance) and linear relationships with the IOTN grades (p ≤ 0.05 by linear regression). Stepwise linear regression models showed that the IOTN dental health component was a predictive variable of the total and subscale PIDAQ scores. Neither gender nor social class was an independent predictive variable of this relationship, except the linear model for psychological impact, where gender was a predictive variable. The occlusal conditions responsible for higher PIDAQ scores were increased overjet, impeded eruption, tooth displacement, and increased overbite.

Conclusions

Malocclusion has a psychological impact in adolescents and this impact increases with the severity of malocclusion. Social class may not influence this association, but the psychological impact seems to be greater among girls.

The psychosocial impacts of implantation on the dental aesthetics of missing anterior teeth patients

OBJECTIVE

The aim of the current study was to investigate the psychosocial impact of dental aesthetics among patients who received anterior implant-supported prostheses.

METHODS

The current study is a cross-sectional evaluation involving 115 individuals who had gone through treatment at the dental clinics of general hospitals. Participants completed the Chinese version of the psychosocial impact of dental aesthetics questionnaire (PIDAQ) before implantation and six months after crown restoration. Basic demographic information was recorded. Six months after implant crown restoration, participants were asked to self-assess their own oral aesthetics compared to before implantation.

RESULTS

A total of 106 patients completed the study. PIDAQ scores correlated significantly with the self-assessment of the degree of oral aesthetics. Six months after crown restoration, the two factors (social impact and aesthetic attitude) decreased and the dental self-confidence score increased significantly compared to pre-implantation scores. Gender and education level significantly affected PIDAQ.

CONCLUSIONS

Anterior implant-supported prostheses significantly affected the patients' psychosocial perception. Implantation of missing anterior teeth can significantly improve patients' negative psychosocial impact of dental aesthetics. Gender and education level are correlated with the degree of improvement. The PIDAQ can be used in assessing the psychosocial effects of implantation in missing anterior teeth.

Validation of the psychosocial impact of dental aesthetics questionnaire (Pidaq) in Spanish adolescents

Objectives: The purpose of this study was to assess the validity and reliability of the Spanish version of PIDAQ for application in adolescents. Study Design: The questionnaire was translated, cross-culturally adapted and completed by 627 adolescents (366 12-year-olds and 261 15-year-olds). The adolescents were also examined by 4 examiners who had been calibrated against a gold standard and relative to each other (Kappa >0.85) in determining treatment need with the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need (IOTN) DHC and AC components. Results: Cronbach´s alpha of the translated PIDAQ was 0.90. The 23 items of the questionnaire were divided into four domains that explained 60% of the variance. The test-retest reliability of the questionnaire was 0.93. Discriminant validity revealed a significant association between the scores for the questionnaire and its subscales or domains and those for the DAI, IOTN-DHC and IOTN-AC treatment need indices. Adolescents with orthodontic treatment need scored higher in the questionnaires. Conclusions: The results show that the Spanish version of PIDAQ has a very similar internal structure and psychometric properties to those of the original questionnaire and demonstrate its validity for use with Spanish adolescents.

Key words:Orthodontics, epidemiology, quality of life, malocclusion.