Negative self-perception of smile associated with malocclusions among Brazilian adolescents

Satisfaction with smile appearance mediates oral health-related quality of life in adolescents regardless of orthodontic treatment need – a cross-sectional study

OBJECTIVES

To explore the relationship between adolescents' oral health-related quality of life (OHRQoL), satisfaction with smile appearance, treatment need and treatment demand through direct and serial mediation models.

MATERIALS AND METHODS

This cross-sectional study included 215 11-14-year-olds and their parents. The instruments included the Child Perceptions Questionnaire and the Index of Orthodontic Treatment Need. Satisfaction with smile appearance, orthodontic treatment demand and parental perception of their child's orthodontic treatment need was recorded on a Likert scale (0 = not at all to 4 = very much). Serial mediation models were used to assess the effects of malocclusion on the OHRQoL.

RESULTS

Objective treatment need explained less than 5% of the adolescents' OHRQoL. Serial mediation models through satisfaction with smile appearance, parental perception of their child's orthodontic treatment need, and patients' orthodontic treatment demand explained 23-25% of the variance.

CONCLUSIONS

Satisfaction with smile appearance mediates the OHRQoL in adolescents. Parents have no direct influence, but their perception of the need to correct their child's teeth might amplify adolescents' orthodontic treatment demand, leading to lower OHRQoL.

Esthetic impact of maxillary midline diastema and mandibular crowding in children in the mixed dentition

INTRODUCTION

This study aimed to investigate the esthetic impact of mandibular crowding and maxillary midline diastema in children in the mixed dentition.

METHODS

The sample for this cross-sectional study comprised 785 children, aged 8-10 years, in the late mixed dentition. Mandibular crowding and maxillary midline diastema were evaluated clinically with the Dental Aesthetic Index. Mandibular crowding and maxillary midline diastema were evaluated to determine tooth size-arch length discrepancies. The sample was stratified as group 1, children without maxillary midline diastema or mandibular crowding (n = 177); group 2, children with maxillary midline diastema (n = 256); group 3, children with mandibular crowding (n = 208); and group 4, children with maxillary midline diastema and mandibular crowding (n = 144). The subjective esthetic impact was evaluated using the Orthodontic Aesthetic Subjective Impact Score. Descriptive and exploratory analyses of the data were performed. A generalized linear model was applied, adjusted for the possible confounding variables (age, gender, and race) with a significance level of 5% because the Orthodontic Aesthetic Subjective Impact Score did not meet the assumptions of analysis of variance.

RESULTS

Children in groups 2 and 3 showed greater esthetic concern than group 1 (P <0.05). Children in groups 2 and 3 did not show a significant difference with children in group 4 (P >0.05).

CONCLUSIONS

Children with mixed dentition with mandibular crowding or maxillary median diastema reported significantly more esthetic concern than children without these conditions.

The relationship between malocclusion and oral health-related quality of life among adolescents: a systematic literature review and meta-analysis

BACKGROUND

Malocclusion is a deviation from an anatomical norm that occurs in various populations. Evidence shows that it has physical and psychological implications as well as an influence on the patient's oral health-related quality of life (OHRQoL). Self-perception of oral health plays an important role in the understanding of malocclusion's influence on the quality of life. Malocclusion has been reported to impair a patient's function, appearance, interpersonal relationships and psychological well-being.

OBJECTIVES

The aim of this study was to investigate whether adolescents aged between 11 and 18 years with malocclusion are at increased risk for having a high level of OHRQoL compared with those without malocclusion.

SEARCH METHODS

The Ovid Medline, Embase and Scopus databases were used to identify studies measuring the association between malocclusion and HRQoL.

SELECTION CRITERIA

Only cross-sectional studies were included, and the following inclusion criteria were used: subjects were systemically healthy; data were available for untreated malocclusion and OHRQoL; malocclusion was measured by Dental Aesthetic Index and Index of Orthodontic Treatment Needs; OHRQoL was assessed by Child Perception Questionnaire, Child Oral Health Impact Profile and Child Oral Health Impact Profile; and the paper was published in English.

DATA COLLECTION AND ANALYSIS

Data were extracted by two independent reviewers. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to establish the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence quality assessment tool was used to assess the impact of malocclusion on adolescents across studies.

RESULTS

The initial search yielded 530 papers. Eleven cross-sectional studies were included in the meta-analyses, and all data describing the relationship between malocclusion and OHRQoL were gathered via a structured questionnaire. Our results showed that malocclusion is linked to decreased OHRQoL in children and adolescents aged between 11 and 18 years in continuously analysed studies. However, in dichotomously analysed studies, it was shown that young people without malocclusion are linked to decreased OHRQoL.

CONCLUSIONS

Adolescents with severe levels of malocclusion might have among the worst levels of OHRQoL. The effects of malocclusion on OHRQoL were influenced by the age of the adolescents as well as by their culture and environment.

REGISTRATION

PROSPERO (CRD42020178657).

Impact of oral-health-related quality of life and self-esteem on patients with missing maxillary lateral incisor after orthodontic space closure: a single-blinded, randomized, controlled trial

BACKGROUND

The maxillary lateral incisor is one of the teeth most likely to suffer agenesis, resulting in spacing between the central incisor and the canine.

OBJECTIVE

To compare maxillary lateral incisor agenesis with space closure treatment versus non-treatment based on measurements of the self-perceived oral-health-related quality of life (OHRQoL) and self-esteem of the participants.

SUBJECTS AND METHODS

A total of 44 people, aged 17-49 years, with missing lateral incisors were randomly assigned to two groups (n = 22 in each)-a treated group in which the space was orthodontically closed (TG) and a control group that remained untreated (CG). Randomization was performed by a researcher who was not involved in the clinical part of the study. The outcomes were assessed using the Oral Health Impact Profile and Rosenberg's Self-Esteem Scale, which were applied before (phase 1) and after (phase 2) the orthodontic treatment in the TG, and at baseline (phase 1) and 12 months after (phase 2) in the CG. All the data were blindly evaluated, supporting the single-blinded design of the study.

RESULTS

All participants finished the randomized controlled trial, and the demographic characteristics were similar between the groups. In phase 1, the levels of self-esteem and OHRQoL at baseline were similar (P = 0.079, P = 0.693, respectively). In phase 2, the self-esteem scores of the CG decreased and the OHRQoL increased (P = 0.005, P < 0.001, respectively), while self-esteem increased in the TG and the OHRQoL decreased (P < 0.001). The CG had lower scores than the TG for self-esteem, but the opposite was observed for OHRQoL (P < 0.001).

LIMITATIONS

Information bias may have occurred. Since the questionnaires could not have been applied at the same time in both groups, the time difference between the two assessments may have led to random and systematic error.

CONCLUSIONS

The spacing resulting from missing maxillary lateral incisors had a negative impact on the OHRQoL and self-esteem of the participants, while orthodontically closing those spaces had a positive impact on those aspects.

CLINICAL TRIAL REGISTRATION

This study was not registered.

PROTOCOL

The protocol was not published before trial commencement.

A cross-sectional evaluation of the impact of Class II Division 1 malocclusion in treated and untreated adolescents on oral health-related quality of life

INTRODUCTION

The relationship between malocclusion, orthodontic treatment, and oral health-related quality of life (OHRQOL) is complicated, with some traits, such as increased overjet, having a potentially greater adverse effect on an adolescent's OHRQOL. The aim of this study was to evaluate the impact of malocclusion and orthodontic treatment on OHRQOL in adolescents presenting with Class II Division 1 malocclusion and explore the relationship between OHRQOL using a condition-specific and generic instrument and occlusal outcome.

METHODS

Two groups of adolescents were recruited from a United Kingdom university hospital: a pretreatment group of adolescents with Class II Division 1 malocclusion and a treated (posttreatment) group whose Class II Division 1 malocclusion had been corrected. Self-reported OHRQOL was assessed using the malocclusion impact questionnaire (MIQ) and the short form of Child Oral Health Impact Profile questionnaires. Occlusion severity and outcome were assessed using Peer Assessment Rating scores.

RESULTS

A total of 241 participants (106 male; 135 female) were recruited. MIQ scores differed significantly between the pretreatment and posttreatment groups, with scores being 11.35 times lower posttreatment than pretreatment, after adjusting for age and sex (95% confidence interval, -17.28 to -5.42; P <0.001). Females had higher total MIQ scores by 2.6 (95% confidence interval, 0.38 to 4.82), which was statistically significant (P = 0.022). There was a moderate correlation between MIQ and Peer Assessment Rating scores, but this relationship strengthened when omitting the global MIQ questions (Spearman's correlation coefficient, 0.59).

CONCLUSIONS

Increased overjet was associated with impaired OHRQOL using a condition-specific measure. A deeper understanding of associations between malocclusion, orthodontic treatment, and OHRQOL would benefit from longitudinal evaluation.

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.

Validation of an Indian (Kannada) translation of the Family Impact Scale questionnaire and the impact of malocclusion on the families of adolescent school children

OBJECTIVES

The objectives of this study were to validate an Indian translation of the Family Impact Scale (FIS) questionnaire and assess the impact of malocclusion on the families of adolescent school children between 12 and 15 years old across socio-economic strata (SES).

MATERIALS AND METHODS

The sample consisted of 768 school children aged between 12 and 15 years from randomly selected schools in Udupi district. The FIS and informed consent forms were sent through the children to be completed by their parents. Information was collected on socio-demographic details, past dental visit in the last year, type of school and SES. Clinical examination for malocclusion using the Dental Aesthetic Index was conducted by a single trained and calibrated examiner.

RESULTS

The prevalence of malocclusion was 59.9%. The intra-class correlation for the total FIS score of 0.95 and Cronbach's alpha value of 0.88 demonstrated internal consistency. There was a significant difference in the overall and subscale scores of FIS between parents of children with and without malocclusion (P < 0.001). Parents of children who had malocclusion had significantly higher FIS scores across all SES (P < 0.001). Parents of children with malocclusion had 1.86 (P < 0.001, 95% CI = 1.60-2.17) times higher FIS scores than parents of children without malocclusion after adjusting for age, gender, SES, and past dental visits in the last year.

CONCLUSION

The psychometric properties of the FIS were found satisfactory for assessing the effect of a child's oral condition on his/her family. Malocclusion in children had a significant negative influence on the family impact scores.

Difference and Commonness Among CLP, NON-CLP Patients and Their Parents Seeking for Orthodontic Treatment: A Questionnaire Applying Q Methodology to Investigate Motives

PURPOSE

Based on Q methodology, this study investigated the motivation of orthodontic treatment for patients and their parents. Through investigation, this paper attempts to explore the motivational factors of CLP and NON-CLP children and their parents, which are different or general.

PATIENTS AND METHODS

Q methodology involves 4 phases. (1) Interviews of CLP (N=5), NON-CLP (N=5) patients generated 30 statements (Q-set 1) and CLP (N=5), NON-CLP (N=5) patients' parents produced 36 statements (Q-set 2) about different reasons to pursue orthodontic care. (2) P-set: recruitment participants. The sample comprised 40 CLP patients (G1) and 40 NON-CLP patients (G2) aged 9-16 years, 40 CLP patients' parents (G3) and 40 NON-CLP patients' parents (G4) wanting their children to have orthodontic treatment. (3) Q-sort: 4 groups ranked statements in order of comparative significance using enforced distribution grids (G1, G2 ranked Q-set 1; G3, G4 ranked Q-set 2). (4) Analysis: using the PQMehtod 2.35 vision to analyze data.

RESULTS

Three factors in each group were identified as representing the most widespread views of the majority of the participants, described as G1: (1) aesthetics, (2) preparation for other oral treatments, (3) timely. G2: (1) admiration of others, aesthetics, (2) oral function, (3) oral hygiene and improvement of smile. G3: (1) worrying about the future of children, parents' responsibilities, children's feelings; (2) mental health, timely; (3) parents' responsibilities, ready for treatment. G4: (1) aesthetics, children's will; (2) future problems, timely; (3) timely, parents' responsibility and no need to worry about physical problems.

CONCLUSION

CLP and NON-CLP patients and parents have different orthodontic treatment motives, yet, they still shared 3 global motivation themes, respectively. Consideration of these motives may help clinicians develop their treatment discussions with patients and parents, which could consequently improve their cooperation and may achieve a more satisfactory outcome.

Prevalence of dental developmental anomalies of permanent teeth in children and their influence on esthetics

OBJECTIVE

The aim of this study was to determine the prevalence of dental developmental anomalies in permanent teeth and their influence on esthetics.

MATERIALS AND METHODS

The records of 473 subjects, which comprised of orthopantomograms, clinical examination, and anamnestic data, were explored for dental developmental anomalies. Subjects with dental anomalies completed the modified questionnaire. Data on reasons for seeking the treatment as well as factors affecting the patients' satisfaction were collected. The data were processed using the Chi-square test.

RESULTS

It was found that 79 subjects (16.7%) had at least 1 dental developmental anomaly. The most common anomalies were hypodontia (7.2%), followed by talon cusps (3.4%), and microdontia (2.5%). Hypodontia, microdontia, and talon cusps were found more prevalent in females than males, whereas hyperdontia and macrodontia were more common in males. The reason for dissatisfaction with their smile in most cases was due to missing teeth or spacing between anterior teeth (excess space 2.9 mm ± 1.1 mm), followed by crowding of anterior teeth (lack of space 3.1 mm ± 0.8mm), difficulty maintaining oral hygiene and midline asymmetry (1.8 mm ± 0.9 mm). All subjects were treated using a fixed orthodontic appliance and 30 (37.9%) of them had additional dental specialists included to achieve good esthetics and function. Overall, 92.4% of subjects were satisfied with their resulting appearance after treatment.

CONCLUSIONS

Dental developmental anomalies are clinically evident abnormalities. They may be the cause of various dental problems and can influence esthetics and the development of orthodontic problems.

CLINICAL SIGNIFICANCE

This paper evaluates the distribution of dental developmental anomalies and their influence on esthetics and function. Careful observation and appropriate investigation are required to diagnose the condition and institute treatment. The therapeutic approach to some dental anomalies should be interdisciplinary.

Ceramic Veneers for Esthetic Restoration of Retained Primary Teeth: A 4-year Follow-up Case Report

Retained primary teeth in the smile zone can cause patient dissatisfaction, especially if associated with malposition of teeth. Orthodontic and prosthetic treatment options to treat the situation may not be accepted by some patients. Therefore, these patients tend to maintain their primary teeth and seek different esthetic options. Ceramic veneers may provide an esthetic treatment option to restore these teeth. However, the survival rates of ceramic restorations in such cases have not yet been established. This case report provides a step-by-step clinical description of the use of ceramic veneers for the restoration of retained primary canines and mild teeth malalignment, with a 4-year follow-up report, in a 28-year-old female patient. During restorative treatment, an effort was made to maintain the occlusion in group function to minimize stress and eliminate destructive forces on the retained primary teeth. After 4 years of function, the patient was still satisfied with the provided treatment.

Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a cross-sectional study

BACKGROUND

The normative orthodontic treatment need, established by dental professionals during the dental appointment, becomes ineffective when it does not evaluate all the factors that influence the decision-making process, including individuals' perception and satisfaction with their dental appearance. Therefore, the purpose of this study was to investigate the perception of children and their mothers as regards orthodontic treatment need and satisfaction with dental aesthetics and test if these variables are associated with the objective orthodontic treatment needs, assessed by the Dental Aesthetic Index (DAI).

METHODS

A cross-sectional study was conducted on 308 children aged 12 years, and their mothers were randomly selected by cluster sampling (primary schools). The variables "orthodontic treatment need," "satisfaction with chewing," and "dental appearance" were assessed by means of a questionnaire. The questions were answered individually at school or home, in cases of children or mothers, respectively. DAI was assessed to make an objective clinical assessment. The variables were dichotomized and statistically analyzed by the chi-square and Fisher's exact tests, contingency coefficient C, and logistic regression.

RESULTS

The results of the clinical evaluation (DAI) were statistically associated with the perception of orthodontic treatment need and satisfaction with dental appearance in children (p ≤ 0.01). However, no association was observed with regard to satisfaction with chewing and DAI (p = 0.10). The children's perception of orthodontic treatment need and satisfaction with the appearance of their teeth was statistically associated (p ≤ 0.01) with their mothers' perception. Maxillary overjet, maxillary and mandibular misalignment, and dental crowding were associated with the orthodontic treatment need by children and their mothers, with p value -0.05 and 5 % level of significance. Maxillary overjet was a significant predictor for the perception of orthodontic treatment need in children (OR 1.86, 95 % CI 0.98-3.55) and mothers (OR 3.02, 95 % CI 1.54-5.92).

CONCLUSIONS

Children and parents realize the need for orthodontic treatment according to the different types of malocclusion, as noted in the association between orthodontic treatment need and dental appearance perceived by children and their mothers, which was also observed-with low correlation-with regard to DAI.

Dentofacial abnormalities among adolescents: A study on the prevalence and severity

Background

The objectives of this investigation were to assess prevalence and severity of dentofacial abnormalities and orthodontic treatment need among adolescents in Mangalore taluk.

Material and Methods

A cross-sectional study was conducted among 1340 children from randomly selected high schools. A proforma was used to record demographic data and components of the Dental Aesthetic Index [DAI] for each subject. The Chi squared test was used for analysis with p-value of < 0.05 considered statistically significant.

Results

Dentofacial abnormalities (DAI scores ≥ 26) were recorded in 38.5% subjects. Mean DAI score of the study population was 24.59 ± 6.09. Female subjects presented with higher prevalence and higher mean DAI scores than their male counterparts (p > 0.05). Assessment of severity of malocclusion between age groups revealed no differences (p > 0.05). Orthodontic treatment was highly desirable in 11% and mandatory in 5.2% subjects.

Conclusions

A high prevalence of dentofacial abnormalities was found among adolescents in Mangalore taluk pointing towards a need for designing effective programs for early diagnosis and treatment of this condition, especially among adolescents.

Key words:Adolescents, Dental Aesthetic Index [DAI], dentofacial abnormalities, malocclusion, orthodontic treatment need, prevalence, severity.