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

Perception of facial and dental asymmetries and their impact on oral health-related quality of life in children and adolescents

BACKGROUND

The aim of this study was to investigate the perception of facial and dental asymmetries in children and adolescents and how these asymmetries affect their psychosocial and emotional well-being.

METHODS

The study included 66 children and adolescents (7-15 years) with a deviation between the maxillary and mandibular dental midlines of > 0.5 mm. The soft tissues of the face were scanned using stereophotogrammetry. Psychosocial and emotional impairments were assessed using the German version of the Child Perceptions Questionnaire (CPQ-G8-10 and 11-14).

RESULTS

The mean midline deviation of the study group was 2.3 mm with no significant gender differences. Girls perceived facial asymmetry significantly more often than boys (p < 0.01). However, stereophotogrammetry showed no significant differences in facial morphology between subjects who perceived their face as asymmetrical and those who perceived it as symmetrical. Interestingly, we observed a significant correlation between the deviation of the dental midline and the lateral displacement of gonion (p < 0.05) and cheilion (p < 0.01). Psychosocial and emotional impairment was significantly higher in girls than in boys (p < 0.05). However, there was no significant correlation with the measured facial asymmetries. In contrast, the CPQ subscale score was 2.68 points higher in individuals with a dental midline shift ≥ 3 mm (p < 0.01), independent of age and gender.

CONCLUSION

Although girls perceived facial asymmetries more strongly than boys do, this perception could not be objectified by extraoral measurements. A midline shift of 3 mm or more had a negative impact on the oral health-related quality of life of affected children and adolescents.

Overbite recognition and factors affecting esthetic tolerance among laypeople

OBJECTIVES

To determine recognition ability and the levels of esthetic tolerance of deep bite and anterior open bite (AOB) among laypeople and investigate the factors affecting levels of tolerance.

MATERIALS AND METHODS

Using a questionnaire, laypeople (N = 100) were examined, and overbite was measured. They were tested for whether they recognized deep bite and AOB. Esthetic tolerance thresholds for deep bite and AOB were selected by incremental depiction in grayscale images. Stepwise logistic regression analyses were used to quantify the effect of recognition and other factors (age, sex, education level, occupation, history of orthodontic treatment, interest in orthodontic treatment or retreatment, and overbite presence) affecting the tolerance of overbite problems (α = 0.05).

RESULTS

Of the participants, 55% and 94% recognized deep bite and AOB, respectively. Participants with a deep bite were significantly more likely to esthetically tolerate deep bite compared with those without a deep bite (odds ratio [OR], 3.57; 95% confidence interval [CI], 1.29-9.89). Participants who recognized a deep bite problem had significantly lower esthetic tolerance to deep bite compared with participants who did not recognize a deep bite (OR, 0.17; 95% CI, 0.06-0.45). None of the other eight chosen factors significantly affected the tolerance level of AOB (P > .05).

CONCLUSIONS

Participants with a deep bite or those who did not recognize a deep bite had significantly higher esthetic tolerance of deep bite than those without or those who recognized the problem (P < .05).

Prevalence of Occlusal Features and Their Relation to Sociodemographic Variables in Northwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Malocclusion affects the chewing, dental aesthetics, jaw development, and overall attractiveness of individuals. The negative impact of malocclusion is high, particularly in adolescents who can be the target of teasing, intimidation, and name-calling. Even if, malocclusion is a common problem in developing countries, there was a paucity of data in Ethiopia. Therefore, this study aimed to determine the prevalence and associated factors of malocclusion in northwest Ethiopia.

METHODS

This cross-sectional study was done at the University of Gondar comprehensive hospital from December 1, 2019, to October 30, 2020. Four hundred seventy-six study participants were selected using a systematic random sampling method. Data collection was done using a structured interviewer-administered questionnaire. Qualified dental professionals examined malocclusion traits according to the WHO oral health survey tool and evaluated for the presence of malocclusion in terms of angles classification, open bite, crossbite, spacing, and crowding. Data entry was done using Epi-Info 7, and analyzed by SPSS 26. Descriptive statistics and logistic regression was done to analyze the data.

RESULTS

A total of 476 subjects were included in the study with a mean age of 29.83 (SD±14.013). The prevalence of malocclusion was 55.9% (95% CI: 51.39-60.28). The common occlusal traits were class-I malocclusion with minor discrepancy (34.9%), anterior crowding (22.9%), and anterior open bite (21.6%). The prevalence of anterior crossbite, posterior crossbite, class-II, and class-III malocclusion was 5.9%, 3.8%, 10.9%, and 8.0%, respectively. Males (AOR=1.6, 95% CI: 1.11, 2.30), urban residents (AOR=1.64, 95% CI: 1.06, 2.56), monthly income of ≤2500 Ethiopian Birr (AOR=1.27, 95% CI: 1.02, 1.59) and mouth breathers (AOR=2.50, 95% CI: 1.72, 2.63) were significantly associated with malocclusion.

CONCLUSION

Significant amount of the study participants had malocclusion. Males, urban residents, low monthly income, and mouth breathing habits were independent factors for a malocclusion. Therefore, early attention to the development of the dentition and occlusion, and necessary functional correction during childhood are important to reduce its prevalence and lifelong adverse effect. Moreover, publicly financed orthodontic treatment should be scheduled, and supplied to individuals in desperate need of orthodontic care.

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.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Prevalence and factors related to malocclusion, normative and perceived orthodontic treatment need among children and adolescents in Bangladesh

OBJECTIVE

The purpose of the present study was to assess the prevalence of normative and perceived orthodontic treatment need in schoolchildren and adolescents, related risk factors, and children/parent's aesthetic perception, compared to orthodontist's opinion, in Dhaka city, Bangladesh.

METHODS

A random sample of 800 schoolchildren aging 11-15 years was selected from different schools in the city of Dhaka, Bangladesh. The Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) were assessed as normative treatment need. The Decayed, Missing, Filled Teeth (DMFT) index was used to record caries experience. Children were interviewed on the perception of orthodontic treatment need. Parents also completed a questionnaire on the perception of their child's orthodontic treatment need, assessed by AC/ IOTN.

RESULTS

According to the DHC/IOTN, only 24.7% were in the category of definite need (grade 4-5) for orthodontic treatment. A significant difference was found between the clinician/children and clinician/parents perceived AC score of IOTN (p= 0.0001). Multiple logistic regression showed children with a higher DMFT were significantly more likely to need orthodontic treatment, according to the DHC of IOTN.

CONCLUSION

A low proportion of schoolchildren needs normative orthodontic treatment in the city of Dhaka, Bangladesh. Children with a higher DMFT score were significantly more likely to need orthodontic treatment, according to the DHC of IOTN.

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

AIMS:

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

METHODOLOGY:

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

RESULTS:

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

CONCLUSION:

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

Perception of orthodontic treatment need among Swedish children, adolescents and young adults

OBJECTIVE

Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

MATERIALS AND METHODS

A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

RESULTS

The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19.

CONCLUSIONS

The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

Association between normative and self-perceived orthodontic treatment need in a Lebanese population

The aims of this study were to investigate the association between normative and perceived orthodontic treatment need in a Lebanese population and the effect of sociodemographic status on orthodontic treatment need. A prospective cross-sectional clinical study was designed using a sample of 150 subjects (81 males and 69 females) aged 11-18years seeking dental treatment at Beirut Arab University. Normative orthodontic treatment need was scored using the two components of the Index of Orthodontic Treatment Need (IOTN), the Dental Health Component (DHC) and the Aesthetic Component (AC). Perceived need for orthodontic treatment was evaluated by scoring the AC of the IOTN. A total of 31.3% of the sample were in great need of orthodontic treatment according to the DHC of the IOTN. On the other hand, only 9% of the sample perceived their need to be definite. A significant positive but weak correlation was found between the normative and perceived need for orthodontic treatment. There was also a significant association between age and normative treatment need.

Impact of malocclusion on affective/romantic relationships among young adults

OBJECTIVE

To evaluate the extent to which different types of malocclusion influence the development of affective/romantic relationships among young adults of both sexes.

MATERIALS AND METHODS

A cross-sectional study was conducted with 360 men and women ranging in age from 18 years to 25 years. Criteria for exclusion from the sample were the following: participants could not be married, visually impaired, or students of a higher education course in the area of health. In this study, images of young adult men and women in the same age range as that of the evaluators were used. These images were manipulated to create different types of malocclusion: diastema, open bite, crowding, gingival (or gummy) smile, little exposure of teeth. Six groups of images containing six images each were formed and consisted of two experimental images (digitally manipulated) and four control images. These images were provided to the participants, who evaluated them by means of a questionnaire and a visual analog scale. The Kruskal-Wallis, Mann-Whitney, chi-square, and Fisher exact tests were used for data analysis.

RESULTS

All malocclusions had a negative impact on acceptance by the evaluators for the purposes of affective/romantic relationships, with crowding being the type of malocclusion that led to the highest level of rejection (P < .01).

CONCLUSION

Malocclusions have a negative influence on the development of affective/romantic relationships among young adults. Individuals with good occlusion are seen in a more positive light, from the perspective of affective life.

Malocclusion and early orthodontic treatment requirements in the mixed dentitions of a population of Nigerian children

INTRODUCTION

The aims of this study were to establish the prevalence of dental features that indicate a need for early intervention and to ascertain the prevalence of different methods of early treatment among a population of Nigerian children in mixed dentition.

METHODS

Occlusal relationships were evaluated in 101 children in mixed dentition between the ages of 6 and 12 years who presented at the Orthodontic Unit, Department of Child Dental Health, Lagos University Teaching Hospital over a 2 years period. The need for different modes of early orthodontic treatment was also recorded.

RESULTS

Anterior tooth rotations (61.4%) and increased overjet (44.6%) were the most prevalent occlusal anomalies. Others included deep bite (31.7%), reverse overjet (13.9%), and anterior open bite (14.8%). Severe maxillary spacing and crowding were exhibited in 12.0% and 5.0%, respectively. About a third (35.7%) of the subjects presented with crossbite while lip incompetence was observed in 43.6% of the subjects. About 44% of the subjects also presented with various oral habits with digit (15.8%) and lip sucking (9.9%) being the most prevalent. Subjects were recommended for treatment with 2 by 4 fixed orthodontic appliances (22.3%), habit breakers (20.7%), removable orthodontic appliances (16.5%), and extractions (15.7%).

CONCLUSIONS

Increased overjet and anterior tooth rotation were the majority of occlusal anomalies seen, which are not only esthetically displeasing but may also cause an increased susceptibility to trauma to these teeth. Treatment options varied from extractions only to the use of appliance therapy.

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.

Agreement between orthodontist and patient perception using Index of Orthodontic Treatment Need

OBJECTIVES

The primary objective of the study was to assess the agreement between orthodontist and patient perception regarding the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) at pre-orthodontic treatment levels. The secondary objective was to determine how well the subjective assessment of malocclusion (IOTN-AC) correlated with the normative Dental Health Component of the IOTN (IOTN-DC).

MATERIALS AND METHODS

A cross-sectional analytical study was conducted on patients between the ages of 16 and 25, presenting for initiation of orthodontic treatment with no history of prior orthodontic treatment. The mean age of the total sample population was 19.50 ± 3.15 years. The mean age of the males was 19.05 ± 3.09 years and for females it was 19.75 ± 3.18 years. The sample consisted of 41 males and 80 females. Patients were shown their pretreatment monochrome intraoral frontal photographs to rate according to the IOTN-AC. Simultaneously, the orthodontist reviewed the photographs with each patient. The IOTN-DHC of pretreatment casts was also recorded by the orthodontist. The frequency of specific traits that had led to increased severity of malocclusion was also identified. All readings were recorded manually on a data collection form. The data were assessed using the chi-square test, Spearman's correlation and Cohen's kappa test. Intra- and inter-examiner reliability was assessed using Spearman's correlation.

RESULTS

A significant positive relationship (p < 0.05) was observed between orthodontist and patient perception (r = 0.516), orthodontist perception and the normative need (r = 0.430), and between the patient perception and the normative need (r = 0.252). A statistically significant level of agreement was observed between orthodontist and patient perception (kappa = 0.339, p ⩽ 0.001, 95% CI, 0.207-0.470) and between orthodontist perception and the normative need (kappa = 0.331, p ⩽ 0.001, 95% CI, 0.197-0.424). A weak and insignificant level of agreement was observed between patient perception and normative treatment need (kappa = 0.107, 95% CI, 0.02-0.187).

CONCLUSIONS

Patient understanding of their treatment need or aesthetic classification may not always be as accurate as that of orthodontists. This may be a cause for concern when an orthodontist finds a certain condition to be severe, and a patient who does not agree may limit their treatment needs.

Assessment of the Self-Perception of Dental Appearance, Its Comparison with Orthodontist's Assessment and Demand for Treatment in Eastern Nepalese Patients

Aims. The aim of this study was to assess the self-perception of dental appearance among Eastern Nepalese patients using aesthetic component (AC) of the index of orthodontic treatment need (IOTN) and to compare it with that of an orthodontist's assessment using the same scale and determine whether gender, area of residence, and level of education influence subject's self-perception and orthodontist's ratings. Methods. A total of 252 subjects (equal number of male and female) were conveniently selected. The average ages of subjects were 22.33 ± 2.114 years. The level of subject's perception and orthodontist's assessment was analyzed by nonparametric Chi square test. Kappa coefficient was done to verify its agreement. The Spearman's correlation test was used to check the association of educational level and age. Mann-Whitney test was used to check the associations of sex and areas of residence. Results. The demand for treatment was significantly associated with the perception of the subject and orthodontist's assessment. However, age, gender, and educational level were statistically insignificant in influencing subject perception and orthodontist's assessment. Conclusion. Patient's self-perception should be given equal importance while planning orthodontic treatment.