A 15-year follow-up study of 30-year-old Danes with regard to orthodontic treatment experience and perceived need for treatment in a region without organized orthodontic care

The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies

BACKGROUND

Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life.

OBJECTIVES

To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents.

MATERIALS AND METHODS

Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.

RESULTS

The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL.

CONCLUSION

The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

Oral findings in adults with osteogenesis imperfecta

This paper describes oral findings in an adult population with osteogenesis imperfecta (OI) in Norway (n=94). All participants underwent a structured interview and an oral examination. Panoramic radiographs were analyzed. The findings were compared with data from other Nordic epidemiological studies. Seventeen individuals (19%) had clinical signs of dentinogenesis imperfecta (DI). Persons with OI had twice as many missing teeth as the general population, and the number of endodontically treated teeth was higher than in the general population. All persons in the study had an acceptable state of tooth tissue loss. Almost all (97%) of the participants in the study group visited a dentist or a dental hygienist regularly. The results of the study indicated a low prevalence of clinical DI compared with previous reported studies. Oral health was not as good in the population with OI when compared with the general population, although daily oral health habits were good and dental visits were regular.

An analysis of the qualitative factors which influence young people's acceptance of orthodontic care

INTRODUCTION AND METHOD

The qualitative data volunteered as responses to open questions in a self-administered questionnaire study were analysed to identify the psychological factors influencing young people's behaviour in relation to orthodontic care and to gain an understanding of the psychological factors which influence adolescents' acceptance of orthodontic care. The study was conducted in all Walsall and Dudley secondary schools.

RESULTS AND DISCUSSION

The responses of the young people who were in year 10 of education with an average age of 15.0 years demonstrated the importance of personal constructs, peer group and media influences, parental influences, conflicting messages, teasing, symptom perception, appearance and self-image, and interpersonal relationships in determining whether or not young people either seek and accept or reject orthodontic treatment.

CONCLUSION

The study concluded that it is essential that clinicians involve patients fully and honestly in discussions concerning their orthodontic therapy in order to enable them to make a considered consent.

Adult patients' view of orthodontic treatment outcome compared to professional assessments

One important aspect in evaluating the outcome and quality of orthodontic treatment is the patient's own assessment. The objective of this study was to evaluate the course and outcome of orthodontic treatment in adults from the patient's vs the operator's point of view. In a previous study, the orthodontic treatment of 88 adults was evaluated using the IOTN and PAR Index before and after treatment. Fifty-nine patients answered treatment questionnaires on 1. the reason for seeking treatment, 2. dentofacial aesthetics, 3. treatment outcome, 4. course of treatment, 5. attitude, 6. social well-being. Depending on the original treatment goal, the patient population was divided into an Ideal Group and a Compromise Group. In 75% of the patients, dissatisfaction with dental aesthetics was the prime motive for seeking treatment; correlations with PAR parameters (overjet and maxillary anterior teeth) were weak. In general, a high degree of patient satisfaction with orthodontic treatment was registered. As regards satisfaction with post-treatment dental aesthetics there were no significant differences between the groups. Comparison of professional assessment with the subjective rating by patients revealed discrepancies in that the patients' rating of outcome tended to be more positive. The differentiation between ideal and compromise treatment goals proved useful. In the Compromise Group, a high level of patient satisfaction was attained with a shorter treatment duration and lower appliance involvement. 92% considered their major pre-treatment need to have been met, and 95% would have had the treatment performed again.

The provision and outcome of orthodontic services in a Norwegian community: a longitudinal cohort study

In a systematic child dental care system, professionals, consumers, and purchasers have a common interest in ensuring that provision and outcome of orthodontic care fulfill the goals of the service and the public's expectations. The purpose of this prospective study was to examine whether treatment was in fact provided to children with a normative treatment need, and also to assess the outcome of treatment. The baseline data were established for a sample of 83 11-year-olds before decisions about orthodontic treatment had been made, by recording the individuals' orthodontic concern as reported in questionnaires and their occlusal condition according to an index of orthodontic treatment need (NOTI). At re-examination at the age of 16 years, it was also recorded whether the individual had received orthodontic treatment. Most individuals (83%) with a normative need had been treated as well as some individuals without need but who had expressed orthodontic concern. Treatment had resulted in occlusal improvement ('health gain') in most patients, and generally this improvement paralleled a decrease in concern. The goals of the orthodontic service seem to have been fulfilled to the extent that residual treatment need was infrequent. The high treatment rate (63%) and standard may explain why all individuals, both treated and untreated, expressed satisfaction with their dental appearance at 16 years of age.

Attitudes to malocclusion among 18- and 35-year-old Norwegians

Knowledge about age-related changes in attitudes to dental appearance and orthodontic treatment may guide the orthodontist in educating and providing advice to potential patients and their parents. The purpose of the present study was to compare attitudes to malocclusion in groups of young and middle-aged adults from populations having been exposed to similar provision of care. The material comprised samples of orthodontically untreated 18-yr-olds (n = 50) and 35-yr-olds (n = 73) from Oslo, Norway. From a clinical examination, radiographs, and measurements on dental study casts, the subjects were classified according to the Need for Orthodontic Treatment Index (NOTI) used by the Norwegian Health Insurance System. Satisfaction with dental appearance and desire for orthodontic treatment were investigated using questionnaires. The 35-yr-olds exhibited significantly more malocclusion compared to the 18-yr-olds (P < 0.01). Among subjects classified to have obvious need for orthodontic treatment, 54% and 21% expressed dissatisfaction at ages 18 yr and 35 yr, respectively, indicating a lower level of concern for malocclusion in the older age group.

Factors associated with subjective need for orthodontic treatment among Finnish university applicants

Subjective orthodontic treatment need and associated factors were studied in a sample of 226 young Finnish adults. The subjects, applicants to enter the University of Helsinki, were interviewed immediately after their entrance examination. A need for treatment was felt by 14% of the subjects. For 47% of those expressing such a need their reason was appearance only, and for 25% it was both appearance and their ability to chew. Among subjects who reported a visible dental irregularity, 38% were dissatisfied with their dental appearance, and 25% felt the need for orthodontic treatment. Women were more often dissatisfied with their dentition than men. Subjective need for treatment was significantly associated with perceived visible dental irregularity and infrequent socializing but not with orthodontic treatment in childhood, pattern of dental attendance, or district of residence. Of various perceptions of anterior teeth, irregularly and wrongly positioned teeth were most often connected with treatment need.

Malocclusion prevalence in an ethnic Chinese population

Population norms derived from one ethnic group may not necessarily be valid and accurate for other ethnic groups. With the increasing number of ethnic Chinese immigrants in Australia, Europe, and America, it would be useful for dental practitioners to be informed about malocclusion prevalence among Chinese. This study was carried out on 1050 Chinese school children (aged 12-14 years) to assess both qualitatively and quantitatively certain occlusal features. The population was found to have a high incidence of Class III malocclusions compared with caucasians. However, the incidence of Class II malocclusions was quite similar to those reported in caucasians. Normal occlusions occurred in about 7 per cent of this population. Although this percentage was much lower than those reported in blacks, it was similar to those reported in caucasians. Crowding occurred in about 50 per cent of cases, which was slightly less than for those reported for caucasians. Increased overbites were also less common in this Chinese population compared with caucasians. Compared with caucasians, crossbites were also less frequent in this Chinese population.

Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores

Clinical impressions by Indian Health Service (IHS) dentists of a greater frequency of severe dental malrelations among Native Americans than in the general US population have never been objectively confirmed. This study uses the DAI as the standard to determine whether there is a greater prevalence of severe malocclusions among Native Americans. Four hundred eighty-five Native American students in grades 7-12 from two remote sites--Pine Ridge, SD, and Many Farms, AZ--and one nonremote site--Lapwai, ID--were scored for the DAI. The mean scores from each reservation, as well as the mean score from the three reservations combined, were significantly higher, indicating poorer aesthetics, than the mean DAI score from a large sample of the general US population. These data confirm the clinical impressions of IHS dentists that Native Americans residing on reservations have significantly poorer dental aesthetics than the aesthetics found in the general US population; therefore, Native Americans have greater needs for orthodontic treatment.

A study of adult orthodontic patients and their treatment

This retrospective epidemiological study was undertaken to assess factors related to adult orthodontic treatment and to identify any associated trends. Case records of all patients (676) aged 18 years or over at the start of active orthodontic treatment at the Eastman Dental Hospital, London were examined. Variables associated with patients and their treatment (age, sex, source of referral, malocclusion, type of appliance, and interdisciplinary treatment including orthognathic surgery) were studied and the data analysed statistically. Findings revealed that the number of adult patients undergoing orthodontic treatment has increased significantly, especially since 1985. The age of the patients treated was also found to increase in recent years. The percentage of female patients (72 per cent) Class III malocclusions (21.6 per cent) and Class III skeletal bases (26.2 per cent) was higher than found in studies on children. Most of the treatments required fixed appliances and over half involved interdisciplinary treatment, with an increase in the percentage of orthognathic surgical cases. Surgery was significantly more common in males (P less than 0.01) and highly significantly associated with Class III malocclusions and skeletal III bases (P less than 0.001). Twenty-five per cent of adult patients were found to have had a previous course of orthodontic treatment though these patients were not significantly different from adult patients presenting for the first course of treatment.

Individual changes in malocclusion from adolescence to 35 years of age

It was the aim of this follow-up study to assess the extent of individual changes in the occurrence of specific pronounced traits of malocclusion in a sample of 176 subjects who were selected from a catchment population examined in adolescence in 1965-66 and who were re-examined in 1986-87 (mean age, 35.5 years). Orthodontic treatment had been received by 10% of the subjects, and extraction rates were low. Deep overbite and mandibular crowding, especially in the incisor segment, tended to increase in frequency. However, on the whole, the various malocclusion traits remained remarkably stable in the orthodontically untreated individuals.

Relationship between malocclusion and maintenance of teeth

The relationship between the presence of malocclusion and maintenance of teeth in adulthood was studied in a randomly drawn sample of 499 35-44-yr-old Danes. Maintenance of teeth in the past was expressed through the number of teeth present, attachment level and information of regularity of dental visits. Maintenance at present was expressed as caries present, plaque and gingivitis. The relationship of these parameters to the presence of a malocclusion symptom was analyzed directly and the indirect influence was studied through the influence of a subjectively perceived malocclusion and its impact on satisfaction. It appeared that satisfaction was significantly related to maintenance of teeth and to a positive dental behavior. A perceived malocclusion was shown to have a negative influence on satisfaction and thus indirectly on maintenance. If a public orthodontic service is aiming at lifetime maintenance of teeth, malocclusions leading to dissatisfaction with teeth and a subjectively perceived need should be taken into consideration when ranking children with regard to treatment priority.

Effect of separate malocclusion traits on concern for dental appearance

Effects of separate traits of malocclusion on concern for dental appearance were isolated by means of multiple regression analysis in a 15-yr follow-up study of 30-yr-old Danes. On the basis of questionnaires (response rate 86%, n = 841), the dependent "concern-for-dental-appearance" variable was constructed from the respondents' replies about recalled perceptions and societal reactions concerning their dental appearance at the time of adolescence. In the same individuals, separate traits of malocclusion had been recorded clinically 15 yr earlier. These traits were inserted as independent dummy variables into the regression model. In both sexes the closest relationship with the dependent variable was displayed by the most conspicuous traits in the anterior region of the dentition. Some traits showed significant associations only in women, whose regression coefficients were, in general, higher than those of men. About half of the variation in the dependent variable was explained by the model.

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

Long-term psychosocial effects of malocclusion should be studied longitudinally from childhood to adulthood in orthodontically untreated populations. In 1965-66, the occurrence of morphologic traits of malocclusion was recorded in 977 Danish adolescents who had no access to organized orthodontic care. In a follow-up study 15 years later, a questionnaire was mailed to the subjects; this contained general questions about body image and specific inquiries concerning self-perception and social implications of dental appearance. The response rate was 86%. Ten percent had received orthodontic treatment. In the remaining individuals, only one entry among thirteen items of body image--the teeth--was rated significantly less satisfactory by subjects with malocclusion at adolescence than by subjects without malocclusion at adolescence. The lowest ratings were observed in subjects with extreme maxillary overjet, extreme deep bite, and crowding. Highly significant differences were found between the two groups (subjects with and without malocclusion) in recalling adolescent awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavorable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred seven times more often in the presence of malocclusion. Differences were less marked in the perceptions of the same individuals in adulthood. However, in both adolescence and adulthood unfavorable perceptions of the teeth were expressed significantly more often by subjects with extreme maxillary overjet, extreme deep bite, and crowding. No association was found between malocclusion and present occupational status. It was concluded that certain malocclusions, especially conspicuous occlusal and space anomalies, may adversely affect body image and self-concept, not only at adolescence but also in adulthood.

Orthodontic treatment-service studied retrospectively in a group of Danish children aged 15-16 years

In a group of adolescent children in 9th grade attending a municipal dental health service, a certain amount of orthodontic treatment has been performed. 27% of the children had completed, or were undergoing, orthodontic appliance therapy. 9% of the children had completed extraction therapy only. 4% were recorded as discontinued appliance treatments and 3% as discontinued after extraction of permanent teeth as the only treatment. 21% had no anomalies and no treatment and 36% had a malocclusion but no treatment carried out. The effect of the orthodontic service was studied on the group as a whole according to the frequency and pattern of change in four selected malocclusion symptoms and to the degree of personal satisfaction about dental appearance and any orthodontic appliances. The individuals most satisfied with the results from their orthodontic treatment were found in the three middle socioeconomic groups.

Malocclusion at adolescence related to self-reported tooth loss and functional disorders in adulthood

It has been argued that malocclusion may predispose to tooth loss and functional disorders of the masticatory system. It was the purpose of this study to examine relationships between untreated malocclusion, recorded at adolescence, and self-reported tooth loss and functional disorders in adulthood. In 1965-66, the occurrence of morphologic traits of malocclusion was recorded in 977 Danish adolescents who did not have access to organized orthodontic care. Fifteen years later, 841 (86%) of these subjects responded to a questionnaire screening for tooth loss, symptoms involving the temporomandibular joints and muscles, and some other symptoms of dysfunction. The occurrence of malocclusion was related to the symptoms of the temporomandibular joints and muscles and other functional symptoms. Only a few significant coefficients of correlation were observed. Extreme maxillary overjet (greater than 9 mm) and frontal open bite showed significant correlations with unsatisfactory biting ability. Crossbite was correlated positively with speech defects but negatively with tenderness or fatigue of the cheeks; unilateral crossbite was associated with locking of the mandible. It was concluded that the untreated morphologic traits of malocclusion did not seem to predispose to tooth loss or functional disorders of the masticatory system as reported at the age of 30 years.