Comparison of the Opinions of Adolescents With Different Orthodontic Treatment Needs

BACKGROUND

The aim of this study was to compare oral health-related quality of life (OHRQoL) among adolescents granted (G) versus not granted (NG) publicly funded orthodontic treatment.

MATERIALS AND METHODS

Adolescents aged 15-20 years who were granted versus not granted publicly funded orthodontic treatment responded to a web-based survey, assessing OHRQoL in relation to functional impact, psychological impact, and motivators for orthodontic treatment. Before the survey, pretesting of the questionnaire was conducted to ensure its reliability. Differences between the groups were tested using the chi-squared and Mann-Whitney U-tests. Reliability was assessed using Cohen's κ and Pearson's correlation coefficient during the pretest phase.

RESULTS

One hundred and forty patients, equally distributed between a G and an NG group, responded to the survey. Gender, age, and demographic distribution were comparable in both groups. All respondents expressed a high subjective treatment need and similar answers regarding functional aspects. Orthodontic treatment motivators (G: 86.2% and NG: 94.7%, p = 0.443) were primarily related to improved self-esteem, overall well-being, facial appearance, and being able to laugh without embarrassment. The NG group expressed a more negative OHRQoL impact due to the appearance of their teeth compared with the G group (p < 0.001) and a negative impact caused by the position of their teeth (p < 0.001).

CONCLUSIONS

Orthodontic treatment need indices should aim to reinforce subjective measures as adolescents express similar motivators for orthodontic treatment, regardless of the clinician's objectively based decision about treatment need.

Socioeconomic status in life course is associated with dental appearance dissatisfaction

The present study aimed to investigate the prevalence of dissatisfaction with dental appearance among 24-year-old Brazilian adults and the associated factors in life course. A subsample (n = 720) of the 1982 Pelotas Birth Cohort in southern Brazil was investigated at the ages of 15 and 24 years using clinical (caries and periodontal) examinations and interviews. The outcome was dissatisfaction with dental appearance at the age of 24 years. Covariate variables included socioeconomic factors, oral health, and dissatisfaction with general appearance collected during different periods of life. Poisson regression models with robust variance were applied. The prevalence of dissatisfaction with dental appearance was 43.5% (95%CI: 39.8-47.1). Individuals with downward income mobility (PR = 1.22, 95%CI: 1.07-1.79) and those always poor (PR = 1.21, 95%CI: 1.00-1.57) presented a higher prevalence of dissatisfaction with their dental appearance even after oral health variables and dissatisfaction with general appearance were controlled for. Moderate/severe malocclusion at 15 years (PR = 1.34, 95%CI: 1.13-1.59), highest experience of untreated dental caries at 24 years (PR = 1.82, 95%CI: 1.46-2.27), and dental pain experience at 24 years (PR = 1.29, 95%CI: 1.22-1.75) were associated with the outcome. Also, the prevalence of dissatisfaction with dental appearance was 20% higher (PR = 1.20, 95%CI: 1.01-1.43) among those dissatisfied with their general appearance. Our findings demonstrated a high prevalence of dissatisfaction with dental appearance among young adults. Lifetime economic disadvantage and dental problems (malocclusion at 15 years, untreated dental caries at 24 years, and dental pain at 24 years) were associated with dissatisfaction with dental appearance among young adults.

The association between self-esteem and aesthetic component of smile among adolescents

OBJECTIVES

Self-esteem plays a crucial role during adolescence in a shaping of an individual's overall well-being and confidence. The aim of this study was to explore the relationship between the self-esteem in adolescents and their smile aesthetics, as well as to assess the alignment of opinions on this matter between adolescents and dentists.

METHODS

Sample included 413 students in Split-Dalmatia County, aged 13 to 18 (60% females). Data on demographic issues, orthodontic history, and desire for orthodontic treatment were collected by the self-administrated questionnaire. Coopersmith's Self-Esteem Inventory was also used. Smile aesthetics was assessed by each participant and dentist independently using an Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN AC).

RESULTS

Self-esteem was higher in adolescents who rated their smile aesthetics equally to the dentist than in those who considered their aesthetics to be worse than the dentist (18.5 vs. 16; P = 0.011). The multiple linear regression revealed that the self-esteem of adolescents was positively related to undergone previous orthodontic treatment (β = 1.286, P = 0.020) while negatively related to the female gender (β = -2.531, P ≤ 0.001) and IOTN AC assessed by dentist (β = -0.356, P = 0.015). It was not related to educational level or desire for orthodontic treatment.

CONCLUSION

The self-esteem in adolescence is influenced the most by gender, but the orthodontic treatment and better smile aesthetics might also contribute.

[Malocclusion in adolescents in the State of São Paulo: spatial and hierarchical analysis]

The scope of this study was to analyze the spatial distribution of malocclusion (MO), estimate the prevalence and evaluate the associated factors in adolescents. It was a study with results of 5,558 adolescents aged 15 to 19 from the São Paulo Oral Health (SB) 2015 survey. The outcome was MO. Sociodemographic aspects, access to dental services, dental caries and tooth loss were the independent variables. A total of 162 municipalities in the state of São Paulo were included and spatial statistics techniques were applied. Hierarchical logistic regression models were performed. The prevalence of MO was 29.3%. There was a spread pattern between the types of MO and positive detachment (p<0,05). Non-white adolescents (OR=1.32, 95%CI: 1.24-1.42), with less years of schooling (OR=1.30, 95%CI: 1.22-1.42), with teeth extracted due to caries (OR=1.40, 95%CI: 1.03-1.88) were more likely to have MO. Adolescent access to dental consultation did not contribute to reducing the chance of developing MO, regardless of whether the dental consultation occurred less (OR=2.02, 95%CI: 1.65-2.47) or more than one year before (OR=1.63, 95%CI: 1.31-2.03). Thus, the occurrence of MO is unequally distributed in the state of São Paulo and associated with sociodemographic conditions, access to consultations and tooth loss due to caries.

Parental influence in orthodontic treatment: a systematic review

The reasons for searching orthodontic treatment in pediatric/adolescent patients are multifactorial. The aim of this systematic review was to study the parental influence in this process. This study comprises a systematic review of the literature, based on the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes. We analyzed 41 articles related to the study hypothesis, 29 of which followed the general inclusion criteria, and 21 specific studied the parental influence in orthodontic treatment. The results demonstrated that dental aesthetics and facial appearance were the main triggering factors related to the search for orthodontic treatment. Pair influence also plays an important role. The perception of malocclusion and the motivation are factors that emphasize the importance of parents in this process. Parental support was identified as a positive factor in orthodontic success reported in most of the studies. Parental influence has a positive effect on orthodontic treatment and should be understood by clinicians as a central factor in achieving the desired treatment plans.

Statistical Study on the Motivation of Patients in the Pediatric Dentistry

Our statistical study included 344 participants selected from the patients of the Pedodontics–Orthodontics Discipline of the Tîrgu-Mureş University of Medicine and Pharmacy. The patients’ age was between 6 and 18 years, with an average of 13.70 and a standard deviation of 4.62. The study participants were informed and agreed to complete two questionnaires of our conception regarding their health status, oral hygiene, and motivation for pedodontics or orthodontic treatment. The results of the two questionnaires were interpreted according to the gender and age of the patients. Data processing was performed with NCSS/PASS Dawson Edition statistical software, using the CHI2 test, considering a p of less than 0.05 as significant for comparative results. Results showed that girls were more motivated than boys in addressing pedodontic services due to dental, periodontal, and articular problems. Children, aged between 11 and 14 years, were less intrinsically motivated to solve oral health problems due to their low frequency. The intrinsic motivation for a more beautiful dentition was very strong, regardless of age and sex. Girls were more intrinsically motivated for orthodontic treatment than boys. There was a linear increase together in the age of those who wanted to improve their smile and facial appearance. Children between 11 and 14 years had the best self-perception of the appearance of their teeth, mouth, smile, and facial harmony. The strongest extrinsic motivation for orthodontic treatment came from parents or another doctor. The most important reason for orthodontics was dental malpositions, the last one was the improvement of masticatory efficiency. The extrinsic motivation from parents for orthodontics decreases linearly with age, along with the increase in motivation from the person with whom the participants relate emotionally and from the group of friends.

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.

Impact of severity of malocclusion and self-perceived smile and dental aesthetics on self-esteem among adolescents

BACKGROUND

The psychological impact of malocclusion, social acceptance, self-esteem, and the development of personality traits are considerations that can affect the demand for orthodontic treatment. The aim of this study was to assess the effect of malocclusion severity and self-perceived smile and dental aesthetics on self-esteem among adolescents in Lagos, Nigeria.

METHODS

This analytical cross-sectional study was performed among 393 adolescents (210 females and 183 males) at a university teaching hospital in Nigeria. The need for orthodontic treatment was assessed using the Dental Aesthetic Index, whereas self-esteem was measured using the Rosenberg Self-Esteem Scale. Smile analysis was performed on photographs of posed smiles, whereas photographs of posed smiles and intraoral frontal view with teeth in centric occlusion were rated with the Visual Analog Scale for self-perception of smile and dental aesthetics. A comparison of variables among self-esteem groups was made using the ANOVA and Tukey post hoc tests, whereas an association among all variables was examined using the correlation coefficient. Stepwise regression analysis examined the effects of independent variables on self-esteem.

RESULTS

A significant correlation was found between self-esteem and self-perceived smile (r = 0.294; P < 0.001) and dental aesthetics (r = 0.212; P < 0.001). Adolescents with high self-perceived smile (mean ± standard deviation, 7.66 ± 2.20) and dental aesthetics (6.68 ± 2.58) had higher self-esteem than participants with low self-perceived smile (4.75 ± 2.73) and dental aesthetics (4.36 ± 2.29). Self-perceived smile aesthetics had the most predictive impact on self-esteem.

CONCLUSIONS

The results showed that self-perception of smile and dental aesthetics is a significant factor that influences self-esteem among adolescents.

Age and Gender Are Associated with the Component of Psychosocial Impact of Dental Aesthetics Questionnaire in Young People: A Cross-Sectional Study

(1) The aim of the study was to investigate the association between age, gender, and the component of psychosocial impact of dental aesthetics (PIDAQ) in Malaysian young people. (2) Cross-sectional data on the PIDAQ (comprised of dental self-confidence, social impact, psychological impact, and aesthetic concern variables) of Malaysian youth (n = 1425) recruited through multi-stage sampling were analyzed for mediation and moderated mediation analyses using the PROCESS macro on SPSS software. (3) Participants (mean age 16.0 ± 2.8) represented 54.8% of girls and 45.2% of boys. In the mediation model, psychological impact and aesthetic concern completely mediated the effects of social impact on dental self-confidence. In the moderated mediation model, social impact directly influenced dental self-confidence amongst participants at one standard deviation below the sample mean age and among boys. However, psychological impact completely mediated the influence of social impact on dental self-confidence amongst participants at the sample mean age and at one standard deviation above the sample mean ages, and among girls. Neither age nor gender moderated the effect of aesthetic concern on dental self-confidence. (4) Age and gender moderated the influence of social impact and psychological impact on dental self-confidence.

Orthodontic Adolescent Patients’ Attitudes toward Protective Face Mask Wearing during the COVID-19 Pandemic

Background and Objectives: The COVID-19 pandemic led to restrictive measures, which aimed to limit the spread of the SARS-CoV-2 virus. These restrictions impacted all areas of life, including the activity of dental offices. For patients with orthodontic appliances, closing the dental offices was a major issue, as most orthodontic treatments last for more than a year and require regular checkups. The aim of this research was to assess the impact that the restrictive measures that were imposed during the COVID-19 pandemic, and, especially, wearing a face mask had on a sample of Romanian teenagers undergoing fixed orthodontic treatment. Material and Methods: The study group consisted of 277 orthodontic patients, with ages between 12 and 17.9 years, from North-Western Romania. They completed a 9-item questionnaire. The control group consisted of 231 participants, with ages between 12 and 17.9 years. They completed an 8-item questionnaire. Results: Most patients from the study group were not worried that wearing a protective face mask would hide their braces (never—49.5%; rarely—26.7%), and their desire to undergo an orthodontic treatment was not affected by the compulsoriness of face mask wearing (never—51.6%; rarely—26%). In contrast to that, in the control group, more than 50% of the participants were worried to some degree that wearing a protective face mask would hide their smile (occasionally—29.9%; frequently—18.2%; very frequently—2.2%). The majority of the participants from the study group did not consider interrupting the orthodontic treatment due to the COVID-19 pandemic (62.5%), and the majority of the participants from the control group did not consider not going to the dentist due to the COVID-19 pandemic (70.6%). Most of the participants from the study group were not happy that they had to wear a face mask, which covered their orthodontic appliances, during the orthodontic treatment (68.6%). The attitude was similar to that of the participants from the control group, who were not happy that they had to wear a face mask, that covered their smile (51.1%). In the study group, most patients did not want face mask wearing to continue to be compulsory, given the fact that their orthodontic appliances were no longer visible (52%). In the control group, the attitude was similar, with 48.1% of the participants not wanting face mask compulsoriness to be maintained. Conclusions: In conclusion, although, most patients would not like to continue wearing a face mask as a mandatory regulation, they were not concerned or negatively affected by wearing a protective face mask, even though face masks hid their braces.

Alamoudi R, Alturki G. Factors influencing the desire for orthodontic treatment among patients and parents in Saudi Arabia: A cross-sectional study

OBJECTIVES:

MATERIALS AND METHODS:

RESULTS:

CONCLUSIONS:

Characteristics of patients seeking orthodontic retreatment

BACKGROUND

The aim of this cross-sectional study was to investigate patients' experiences with previous orthodontic treatment for those seeking retreatment, and their expectations and motivation for doing so.

METHODS

A total of 72 patients were invited to answer an anonymous questionnaire. Of these, 36 (13 men and 23 women, mean age 26.3 ± 5.8 years) were seeking retreatment (study group), and 36 (13 men and 23 women, mean age 25.5 ± 6.8 years) were seeking treatment for the first time (control group). Casts from both groups were assessed with the index of complexity, outcome, and need (ICON) score, to objectively determine the treatment need and complexity. Student`s t test for independent samples, and paired Student`s t test, were performed for comparisons between the retreatment and control groups, and between retreatment and previous treatment, respectively.

RESULTS

There was no statistically significant difference between retreatment patients` motivation for the previous treatment and motivation for the retreatment. However, the mean visual analog scale (VAS) scores for motivation differed significantly between the retreatment and control groups (73.8 ± 23.9 and 87.5 ± 14.5, respectively). The mean ICON score of the retreatment group was lower than that for the control group (25 ± 14 and 31 ± 16, respectively).

CONCLUSIONS

Patients seeking retreatment were less motivated for treatment, and tooth irregularity was the chief reason for seeking treatment in both groups. Although an objective treatment need was not observed in the 2 groups, all of them had some occlusal traits that clinically justified the orthodontic treatment.

Is the adolescent's esthetic concern associated with anterior occlusal conditions or the malocclusion severity level?

OBJECTIVES

To assess the esthetic impact of anterior occlusal conditions and malocclusion severity levels.

MATERIALS AND METHODS

A population-based cross-sectional study of 700 adolescents aged 15 to 19 years was conducted. The Oral Aesthetic Subjective Impact Scale (OASIS) was used to evaluate the subjective esthetic impact of malocclusion. The Dental Aesthetic Index (DAI) criteria were used to diagnose the anterior occlusal characteristics in isolation and the severity levels of malocclusion. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI).

RESULTS

Of the adolescents, 42% showed negative self-perception of malocclusion. In addition, 15.4% of adolescents had severe malocclusion (DAI 3) and 18.9% very severe malocclusion (DAI 4). Crowding and spacing were shown to be 2.90 (CI: 2.06-4.09) and 2.53 (CI: 1.65-3.86) times, respectively, more likely to cause a negative esthetic impact in adolescents (P < .05). In addition, adolescents with orthodontic treatment need (DAI 2, 3, and 4) were more likely to report a negative esthetic impact (P < .05).

CONCLUSIONS

Anterior crowding and spacing are the conditions that most influence the esthetic concern of adolescents. Adolescents with very severe malocclusion and higher orthodontic treatment need are more likely to report a negative esthetic impact.

Correlation between esthetic expectations for orthognathic treatment and psychological characteristics among Chinese adult patients

INTRODUCTION

This study aimed to evaluate the association of esthetic expectations with self-reported personal characteristics, anxiety, depression, self-esteem, oral health-related quality of life, and the Orthognathic Quality of Life Questionnaire (OQLQ) in Chinese adult patients before orthognathic treatment.

METHODS

This study involved 213 patients with clinically significant skeletal deformity requiring orthognathic surgery for comprehensive treatment. Each patient completed a series of Chinese version scales, including the self-rating anxiety scale, self-rating depression scale, self-esteem scale, the Oral Health Impact Profile-14 questionnaire, and the OQLQ. The patients' self-reported personal characteristics were also recorded, including facial appearance ratings before and after orthognathic treatment, highest education level, mean monthly income, and enthusiasm toward orthodontic or orthognathic treatment. The Least Absolute Shrinkage and Selection Operator multivariate linear regression model was conducted for the selection of the above factors. The final multivariate linear regression model was built with variables identified under the optimal tuning parameter.

RESULTS

A total of 213 patients (87 men and 126 women) were included in this study. The patients' esthetic expectation scores were significantly associated with their total scores, which encompassed the education level, mean monthly income, enthusiasm toward orthodontic or orthognathic treatment, self-esteem scale, the Chinese version of the 14-item Oral Health Impact Profile questionnaire, OQLQ, etc. In the multivariate linear regression model, the OQLQ, enthusiasm toward orthognathic treatment, depression, and expected facial appearance score after the treatment were the most important factors to predict esthetic expectation.

CONCLUSIONS

High esthetic expectations for orthognathic treatment were mostly associated with higher expected facial appearance scores after the treatment, greater enthusiasm toward orthognathic treatment, worse depression (confusion), and 2 domains (social aspects of deformity and oral function) of OQLQ. Therefore, OQLQ, enthusiasm toward orthognathic treatment, and expected facial appearance score after treatment may be used to predict patients' esthetic expectations before commencing orthognathic treatment in daily clinical practice.

Mean Shearing Stroke Frequency of Orthodontic Brackets under Cycling Loading: An In Vitro Study

Based on the development of many adhesive systems and bonding techniques, bonding strength of orthodontic brackets has become even more important in modern clinical orthodontics. The aim of this study was to determine mean shearing stroke frequency of different orthodontic bracket types and bonding agents under cycling loading. Therefore, 10 different types of orthodontic bracket from 4 different brands were divided into 2 groups. Two different adhesives, namely Transbond™ XT etch-and-rinse for Group 1 and Transbond™ Plus self-etching-primer adhesive for Group 2 were considered. The brackets were tested under cycling loading force of 10-N and a crosshead speed of 300 mm/min and 40 cycle/min. The frequency of strokes that the brackets failed were determined and these data were analyzed by statistical analysis using an independent sample t-test and one-way analysis of variance (ANOVA). The level of significance was set at p < 0.05. Generally, differences between the frequency of shearing strokes of the bracket failures were found to be statistically significant depending on the type of adhesives and brackets (p < 0.05). The bonding technique for Group 1 was found to have a significantly higher shear bonding strength than Group 2. It is also seen that different types of bracket belonging to the same or different brands had different shear bonding strength. It may be concluded that: (i) all bracket types used in this study can be applied with both bonding techniques, (ii) in order to minimize the risk of hard tissue damage, ceramic brackets should be carefully bonded using the self-etching primary adhesive technique.

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.

Self-perceived dental treatment need among adolescents: A hierarchical analysis

OBJECTIVES

The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents.

METHODS

A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model.

RESULTS

Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI = 1.20-1.60]; P < .001), who sought dental services solely for curative treatment (OR 1.58; [95% CI = 1.46-1.72]; P < .001), reported toothaches in the previous six months (OR 2.88; [95% CI = 2.53-3.28]; P < .001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI = 5.03-7.01]; P < .001), had caries in the posterior teeth only (OR 3.04; [95% CI = 2.77-3.33]; P < .001) or had caries in the anterior teeth (OR 4.75; [95% CI = 4.05-5.56]; P < .001).

CONCLUSIONS

The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.

Accuracy of computer-aided prediction in soft tissue changes after orthodontic treatment

INTRODUCTION

An accurate prediction in the soft tissue changes is of great importance for orthodontic treatment planning. Previous studies on the accuracy of the Dolphin visual treatment objective (VTO) in predicting treatment results were mainly focused on orthognathic treatment. The accuracy of Dolphin VTO prediction for orthodontic treatment is, however, poorly understood. The aim of this study was to evaluate the accuracy of Dolphin VTO prediction in soft tissue changes after orthodontic treatment by comparing the changes between predicted and actual values.

METHODS

A total of 157 patients were screened for eligibility, and 34 young adult patients (8 males, 26 females; mean age 24.8 ± 3.9 years) were finally included in the study based on the inclusion and exclusion criteria. The landmarks and parameters of the Holdaway soft tissue analysis were used for the cephalometric analyses. The cephalometric tracings of the actual treatment result and the Dolphin predicted treatment outcome were superimposed to calculate the prediction errors. Paired t test was used to compare the statistical differences between the predicted and actual treatment outcomes of the parameters used in the Holdaway soft tissue analysis.

RESULTS

There were significant differences between the predicted and actual values in parameters of the Holdaway soft tissue analysis (P < 0.05). The prediction of the landmarks in the lips region (ie, subnasale, soft tissue A-point, upper lip, lower lip, and soft tissue B-point) was inclined to be overestimated horizontally and underestimated vertically, whereas the prediction of the landmarks belonging to the chin region (ie, soft tissue pogonion, soft tissue gnathion, and soft tissue menton) was inclined to be underestimated horizontally and overestimated vertically. The most accurate prediction was found in the soft tissue A-point, whereas the least accurate one was found in the soft tissue in the chin region. The prediction was relatively more accurate in the vertical direction than in the horizontal direction.

CONCLUSIONS

The Dolphin VTO prediction in soft tissue changes after the orthodontic treatment in patients with bimaxillary protrusion is the most accurate for the soft tissue A-point and the least accurate for the soft tissue chin region.

Dental Cingulum and Position of Fixed Orthodontic Appliance as Source of Morphological and Therapeutic Identifiers: An Unusual Case Report

Orthodontic records, such as photographs, radiographs, and dental casts, provide information useful for identification purposes because it may reveal important morphological, therapeutic, and pathological dental identifiers. Among these identifiers, the type and position of orthodontic appliances figure as distinctive tools for human identification. In this context, the present study aims to report an uncommon case of identification of a putrefied body, found near to a forest region in Brazil. The postmortem (PM) examination showed that the victim had part of a fixed orthodontic appliance installed in the maxillary and mandibular dental arches. To identify the body, relatives of the potential victim presented orthodontic examinations containing panoramic radiography and photographs of the orthodontic treatment. The body was identified based on the analysis of the radiographs and photographs that confirmed the presence of the orthodontic appliances observed PM. More specifically, the identification was supported by the analysis of bracket bonding position of the maxillary and mandibular incisors and the presence of distinctive morphological traits of the canines and incisors, as well dental roots observed radiographically. The present case highlights the importance of orthodontic records as a source of morphological dental identifiers for cases in which only unrestored teeth are available.

Oral health of 12-year-old children in Quito, Ecuador: a population-based epidemiological survey

BACKGROUND

There is a paucity of population-based surveys on oral health conditions in Ecuador. Thus, the aim of this study was to conduct an epidemiological survey with a representative sample of children aged 12 years from public schools of Quito, Ecuador. The aim of this initial report was to describe the methodology used in the survey, as well to present results regarding calibration procedures and prevalence of oral-health related outcomes.

METHODS

We invited 33 public schools' coordinators from the urban area of Quito, and 1100 children (12 years old) to take part in this study. Six trained and calibrated examiners conducted clinical examinations using oral mirrors and ball-ended probes to assess: dental caries, traumatic dental injuries, malocclusion, gingival bleeding, presence of calculus and fluorosis. Children also responded a questionnaire on Oral Health-Related Quality of Life (OHRQoL). Individual sociodemographic data was collected through a questionnaire sent to parents. Moreover, some contextual data on school environment (infrastructure conditions, promotion of health practices and negative episodes) were also evaluated. Prevalence values, crude and weighted by sampling weights, and 95% confidence intervals (95%CI) were calculated.

RESULTS

Nine hundred and ninety-eight children from 31 schools were examined from March to May 2017. The adjusted prevalence values (95%CI) for the six outcomes evaluated were: dental caries = 60.3% (55.3 to 65.0%); traumatic dental injuries = 20.7% (17.2 to 24.8%); dental fluorosis = 63.7% (58.5 to 68.5%); gingival bleeding = 92.0% (87.1 to 95.2%); presence of calculus = 69.9 (60.5 to 77.9%); and malocclusion = 25.8% (21.8 to 30.3%). Adjusted mean of number of decayed, missed or filled permanent teeth (DMF-T) was 1.61 (1.37 to 1.84). Results on OHRQoL and other contextual variables will be reported in other articles.

CONCLUSION

The prevalence of the majority of oral health problems in 12-year-old children from public schools in Quito-Ecuador was compatible with those observed in other similar cities. However, periodontal health and fluorosis seem to be highly prevalent in children from Quito.

Impact of the onset of fixed appliance therapy on adolescents' quality of life using a specific condition questionnaire: A cross-sectional comparison between male and female individuals

OBJECTIVE

To evaluate the impact of the first six months of orthodontic treatment with fixed appliances on the oral health-related quality of life (OHRQoL) of adolescents, comparing boys and girls, using a specific condition questionnaire.

DESIGN

Cross-sectional.

SETTING

School of Dentistry of the Federal University of Minas Gerais, Belo Horizonte, Brazil.

PARTICIPANTS

Adolescents aged 10-17 years.

METHODS

Forty-six adolescents participated in this study. Adolescents' OHRQoL was evaluated using the Brazilian version of the questionnaire Impact of Fixed Appliances Measure. This questionnaire comprises 43 questions distributed across nine domains: aesthetics; functional limitation; dietary impact; oral hygiene impact; maintenance impact; physical impact; social impact; time constraints; and travel/cost/inconvenience implications. The answer options follow the Likert scale, in the range of 1-5. A higher score indicates a more negative impact on the OHRQoL. Adolescents' malocclusion was assessed using the Dental Aesthetic Index. Information on family income, adolescents' age and tooth extraction was also collected. A directed acyclic graph was used to identify potential confounders. Statistical analysis involved the chi-square test, the Student's t test and the analysis of covariance. The minimal clinically important difference was also calculated.

RESULTS

Of the 46 participants, 25 were girls and 21 were boys. The female adolescents presented a more negative impact from the orthodontic treatment on the quality of life when compared to the male adolescents (P < 0.001), regardless of the influence of the confounding variables. The most negative repercussions were identified in the domains of oral hygiene (P = 0.002), physical impact (P < 0.001) and social impact (P < 0.001).

CONCLUSION

The impact of the first six months of orthodontic treatment on OHRQoL is more negative in female individuals than in male individuals. The results of this study may be useful for the oral healthcare provider during the counselling of adolescents undergoing fixed appliance therapy.

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.

Impact of malocclusion on oral health-related quality of life among schoolchildren

The aim of the present study was to evaluate the prevalence and impact of malocclusion on oral health-related quality of life (OHRQoL) among schoolchildren aged 8 to 10 years and their parents in Diamantina, a town in the southeast of Brazil. A cross-sectional study was conducted with a sample of 390 randomly selected children who were subjected to a clinical oral examination. The Dental Aesthetic Index was used to diagnose malocclusion and the need for orthodontic treatment. The Child Perceptions Questionnaire (CPQ (8-10)) was used to evaluate the impact of malocclusion on OHRQoL. The children's parents answered the Brazilian Economic Criterion Questionnaire for the socioeconomic classification. Data analysis involved the nonparametric Kruskal-Wallis test and Spearman's correlation coefficients. The variables were grouped into a hierarchy of categories ranging from distal to proximal determinants. Poisson regression analysis with robust variance was performed at each level to correlate the total CPQ (8-10) score with the independent variables. The prevalence of malocclusion was 78.7%. Crossbite remained significantly associated with a negative impact on OHRQoL (PR = 1.28; 95%CI:1.17-1.39; p < 0.001). The prevalence of malocclusion was high in the sample investigated and exerted a negative impact on OHRQoL.

Patient Satisfaction with Orthodontic Treatment Received in Public and Private Hospitals in Dammam, Saudi Arabia

BACKGROUND:

The demand for orthodontic treatment is on the rise, and there are high patient expectations for improved dentofacial appearance. Patient satisfaction with orthodontic treatment is associated with improving treatment outcomes.

OBJECTIVE:

To evaluate patient satisfaction with orthodontic treatment received in public and private hospitals.

MATERIAL AND METHODS:

This cross-sectional study was conducted on a calculated sample of patients who received orthodontic treatment in public and private hospitals in Dammam, Saudi Arabia. A validated questionnaire (five-point Likert scale) was used to assess patient satisfaction with orthodontic treatment.

RESULTS:

A total of 229 out of 243 patients completed the survey (response rate = 94.2%). The mean age of the participants was 22.69 ± 6.34 years. More females (65.5%) than males (34.5%) participated in the study. The participants gave the highest satisfaction score to the doctor-patient relationship (mean score 4.33). This was followed by dentofacial improvement (mean score 4.23), dental functions (mean score 4.20), and psychosocial improvement (mean score 3.94). The participants provided significantly more positive perspective about doctor-patient relationship in public than private hospitals (P = 0.014). The patients treated in private hospitals were more satisfied with dental functions domain than those who received treatment in public hospitals (P = 0.023). The patients treated by public orthodontists were significantly more satisfied with other domains (situational aspect and residual category) than by the private orthodontists.

CONCLUSION:

The doctor-patient relationship was the most important factor in satisfaction with orthodontic treatment. Overall, patients treated in public hospitals were more satisfied with orthodontic treatment than those in private hospitals.

The association between patient's compliance and age with the bonding failure of orthodontic brackets: a cross-sectional study

Background

An efficient orthodontic treatment must aim the best occlusal result in the shortest possible time. One of the factors that can interfere in this goal is the bracket debonding during the treatment. This study aimed at assessing the different factors related to brackets failure, highlighting age and patient cooperation with treatment.

Methods

The sample comprised 199 orthodontic patients of both genders (103 women and 96 men); divided into two groups—adolescents (12 to 18 years old, 118 patients) and adults (19 to 59 years old, 81 patients). A questionnaire was applied regarding the motivation of patients to seek treatment and whether they had received information on appliance care; patients also filled out their level of cooperation with treatment in a visual analog scale (VAS). Additionally, other variables were assessed, such as the teeth with bracket debonding, the presence of deep overbite, and the use of bite plate. The Mann-Whitney test was used, and a 5% significance level was applied for analyses.

Results

It was observed that 20.1% of patients presented at least one tooth with bracket failure, and the lower arch was the most prevalent site (47.5%). Adolescents presented more debonding (25.4%) than adults (12.3%). Individuals with better VAS scores on cooperation sought treatment on their own (p = 0.042), were adults (p ≤ 0.001), and showed lower rate of failure of brackets (p ≤ 0.001). The factors related to malocclusion and treatment performed had no statistical significance.

Conclusion

Greater cooperation was expected from adult individuals who sought treatment on their own and presented low rate of bracket failure.

Predicting orthodontic treatment need: reliability and validity of the Demand for Orthodontic Treatment Questionnaire

Objectives

To identify key measures in predicting orthodontic treatment need and to propose a self-assessment instrument that improves treatment need assessment.

Subjects and methods

The study included 150 randomly selected 13-year-olds. A set of measures linked to a previous study on daily life impact of malocclusion was processed, resulting in an instrument, the Demand for Orthodontic Treatment Questionnaire (DOTQ), which was analysed regarding dimensionality, reliability and validity. Dental Health Component of the Index of Orthodontic Treatment Need (IOTN-DHC) grading, representing professionally assessed treatment need, were collected from dental records. The instrument's ability to predict treatment need was tested by randomly splitting the dataset into two subgroups, using multiple regression to predict DHC in one of the groups and the prediction equation to calculate predicted DHC in the other. The outcomes were then correlated to detect the predictive power of the DOTQ, and thereby the validity of the prediction.

Results

The DOTQ-measures were reliable and highly inter-correlated. A high, significant correlation was found between assessed and predicted treatment need for the subgroups (r = 0.59 and 0.49), confirming the validity of the prediction. Independent variables (the measures) explained 47 per cent (R = 0.69) of the variance in treatment need. Four measures contributed significantly to the prediction, with Treatment Demand being the most powerful predictor.

Limitations

The age group and response rate may raise some questions regarding the generalizability of the findings.

Conclusions

The DOTQ is able to predict treatment need as assessed by orthodontic consultants. Its incorporation in the treatment need assessment process will acknowledge patients' self-perceived impact of malocclusion.

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.

Impact of Malocclusion on the Quality of Life of Brazilian Adolescents: A Population-Based Study

The objective of this study was to evaluate the impact of malocclusion on the quality of life (QOL) of adolescents in Brazil. We carried out a cross-sectional study in a sample population of 1015 schoolchildren aged 12 to 15 years from São Luís, Maranhão, Brazil. The explanatory variable was malocclusion, evaluated on the basis of the normative need or the adolescent’s self-perceived need for dental treatment. Normative need for dental treatment was determined by professional diagnosis, made on the basis of Angle’s classification, the Dental Aesthetic Index, and other morphological deviations (e.g., posterior crossbite, posterior open bite, and deep overbite). We analyzed the impact of malocclusion on the QOL using the Portuguese version of the Oral Health Impact Profile-14. Associations were estimated by using the prevalence ratio (PR) in Poisson regression analysis, with hierarchized modeling. An alpha of 5% was adopted as the criterion for statistical significance. The QOL of adolescents was impacted by malocclusion, classified by a normative need for treatment according to the Dental Aesthetic Index (PR = 1.27; 95% confidence interval [CI] = 1.03–1.56) or by the self-perceived need for treatment (PR = 2.54; 95% CI = 1.81–3.56). Certain sociodemographic variables, including the head of the family (PR = 1.52; 95% CI = 1.02–2.23), greater educational level of the head of the family (PR = 0.32; 95% CI = 0.17–0.61), and female sex (PR = 1.40; 95% CI = 1.05–1.89), had negative associations with QOL. We conclude that malocclusion has a negative impact on the QOL of adolescents, associated with socioeconomic conditions and the cosmetic effects of malocclusion.

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.