Prospective evaluation of the psychosocial impact of the first 6 months of orthodontic treatment with fixed appliance among young adults

A Detailed Correlation of Oral-Health-Related Quality of Life of Patients Undergoing Fixed Orthodontic Therapy

Malocclusion is a dental condition that can affect both children's and adolescents' oral-health-related quality of life (OHRQoL), and the seriousness of the condition is indicated by the patient's requirement for orthodontic therapy. The patient or his or her caretaker may personally report the necessity for orthodontic therapy, or the doctor or orthodontist may quantify it objectively. However, discrepancies in the requirement for either objective orthodontic therapy or subjective orthodontic therapy have been noted. The OHRQoL measurements should be used in conjunction with the indicator of orthodontic therapy requirement to represent the patient's anticipated treatment requirement. Some systematic reviews have revealed evidence that malocclusion has a detrimental effect on OHRQoL. In addition to the effects of malocclusion, the impact of orthodontic therapy on OHRQoL has also been documented. There is a dearth of related follow-up studies, particularly those documenting OHRQoL improvements in adolescents both before the beginning of treatment and termination of orthodontics treatment. Additionally, it has been hypothesized that self-esteem affects OHRQoL, albeit there is insufficient data to support either its specific function or its connection to perceptions of oral health. As a result, the purpose of this literature review is to determine whether patients receiving fixed orthodontic therapy report any changes in their reported OHRQoL. There was an extensive review of available original research, case reports, systematic reviews, literature reviews, etc., available in reliable sources of information like PubMed, Scopus, Web of Science, etc. The review found that the process of receiving orthodontic therapy might be unpleasant, affecting OHRQoL. The discomfort caused by orthodontic equipment, which are foreign things put into a delicate portion of the body, is both psychological and physical. Such discomfort may have a detrimental effect on the patient's willingness to receive therapy, their participation, and the treatment's effectiveness. The main sources of discomfort that patients undergoing fixed orthodontic treatment report are the appliance's design, amount of force used in the early stages of their therapy, prior painful memories, emotional variables, cognitive variables, and environmental factors such as age, sex, and culture. As a result, orthodontic treatment may have negative effects on a person's QoL that, in most situations, are temporary.

A Cross-Sectional Online Survey on Knowledge, Awareness, and Perceptions of Hollywood Smile Among the Saudi Arabia Population

Background:

Hollywood smile has gained popularity in recent times to improve aesthetics among the general population. Since patients’ perceptions of dental aesthetics play a vital role in planning and evaluating cosmetic dental treatment, it is essential to understand their knowledge, awareness, and factors that influence their perceptions of dental aesthetics.

Objectives:

The objective of this study was to assess the knowledge, awareness, and perceptions of Hollywood smile among the general population in Saudi Arabia.

Methods:

A close-ended questionnaire consisting of demographic information and 20 questions related to Hollywood smile was circulated through social media in Saudi Arabia. Statistical analyses of the data obtained were performed using Statistical Package for Social Sciences software (SPSS version 17, USA). Frequencies, percentages, and mean and standard deviation were calculated using descriptive statistics. Pearson chi-squared test was employed to test the association between the demographic variables, such as age, gender, and education levels, with the questionnaire items.

Results:

A total of 4104 participants responded to the study questionnaire. The responses to the questionnaire revealed that nearly half of the participants were not satisfied with their dental appearance (48.6%). The majority of the participants had heard or known about Hollywood smile (98%). About 42% of study participants were aware of the complications involved in the procedure. The results revealed that the younger generation (18 to 30 years) had more awareness and felt more need for dental aesthetics (p=0.001). The proportion of male participants who underwent Hollywood smile correction were more than females (p=0.001). Graduates showed more awareness regarding smile, dental aesthetics, and Hollywood smile than the other categories (p=0.001).

Conclusion:

This study has shown that the younger generation, female participants, and graduates had more awareness regarding smile, dental aesthetics, and Hollywood smile.

Personality traits, psychosocial effects and quality of life of patients submitted to dental bleaching

Background

Perception is defined as the ability to distinguish through the senses. All perception is dependent on factors such as personality, previously lived experiences and cultural elements. When planning an aesthetic treatment, consider the way the patients perceive the changes and outcomes is essential for reaching their expectations. The objective of this study was to assess if there was predominance of a personality trait of patient undergoing dental bleaching and if this treatment could promote changes in this traits, in the psychosocial impact and quality of life of these individuals.

Methods

The assessment of personality characteristics, quality of life, psychosocial and self-perception was a cross-sectional observational study and it was carried out by applying questionnaires to 55 patients that were submitted to a clinical phase. The psychometric instruments used were NEO FFI-R (personality), PIDAQ (psychosocial effect) and WHOQOL-BREF (quality of life). Each test domain was prior and after bleaching by Wilcoxon Signed Rank test (α = 0.05). The internal consistencies of each scale were evaluated by Cronbach's alpha.

Results

No statistical significant differences among personality traits means were observed among participants but there was predominance of two predominant personality traits in this study: conscientiousness (45.5%) and extraversion (34.5%). In four test domains of the PIDAQ, significant differences were observed before and after dental bleaching. The overall perception of the PIDAQ was also statistically significant demonstrating an improvement. There were no differences on overall or specific domains scores of the WHOQOL before and after treatment.

Conclusions

Subjects who underwent dental treatment improved their self-confidence and reduced concerns about dental aesthetics, social and personality impact of dental alterations.

Trial registration

This study was conducted in parallel to a clinical investigation that aimed to evaluate tooth sensitivity related to dental bleaching technique and registered in REBEC clinical registry under protocol RBR-6pt2n3 in 13 November 2013.

Psychosocial dental impact in adult orthodontic patients: what about health competence?

Background

Several studies have assessed the psychological benefits of orthodontic treatment; however, the impact of competence on psychological benefits remains unknown.

Aims: To analyze the change of the perception of psychosocial dental impact in a sample of adults undergoing orthodontic treatment (mild/moderate dental malocclusions) and to assess the possible moderating effect of health competence level.

Methods

A longitudinal prospective design was used. Three time points were included: baseline (T0), 6 months after starting orthodontic treatment (T1) and once treatment had finished (T2). The pretreatment sample consisted of 78 patients recruited from the Rey Juan Carlos University Dental Clinic, all of whom had moderate malocclusions and were going to undergo orthodontic treatment for approximately 18 months with fixed metal multibrackets. All participants were instructed to complete the Spanish version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) and the aesthetic component of the Index of Orthodontic Treatment Need (IOTN-AC) on the three points of the research. Statistical analysis involved the General Linear Model (GLM) repeated-measures ANOVA to test if the outcome measures of psychosocial dental impact significantly changed over time during orthodontic treatment (baseline, at 6-month evaluation and posttreatment). To assess the effect of the previous health competence levels (high/low) in the change from baseline to the 6-month assessment, for each PIDAQ dimension, a 2*2 (time*group) repeated measures ANOVA was performed.

Results

A significant increase was observed in dental self-confidence values (T0-T1 and T0-T2). Similar results were observed for the psychological impact variables and for the IOTN-AC scores, which showed significant decreases between T0 and T1 and between T0 and T2. Finally, significantly decreases were observed between T0 and T2 in aesthetic concern. Interaction effects were found regarding the health competence variable from T0-T1 for the psychological impact, social impact and aesthetic concern and the IOTN-AC index, with significant development results regarding the high competence group.

Conclusions

The first 6 months of orthodontic treatment seemed to be key to the development of psychosocial dental impact perception, during which the role of health competence was of great importance to developing a positive change. It is necessary to follow a biopsychosocial approach towards orthodontic treatment.

The impact of labial fixed appliance orthodontic treatment on patient expectation, experience, and satisfaction: an overview of systematic reviews

Background

Patient perception with fixed appliance orthodontic treatment is important to improve oral health-related quality of life.

Objective

The main objective of this study was to evaluate the impact of labial fixed appliance orthodontic care on patient perception before, during, and after the treatment.

Search methods

Relevant systematic reviews investigating patient perception with fixed appliance orthodontic treatment were identified by searching electronic databases: MEDLINE via OVID (1946 to 31 December 2018), EMBASE (1974 to 31 December 2018), AMED (Allied and Complementary Medicine Database; 1985 to November 2018), PubMed (inception to 31 December 2018), Web of Science (1900 to 2018), and PsychINFO (1806 to 31 December 2018). Ongoing systematic reviews were searched using Prospero and a grey literature search was undertaken using Google Scholar and OpenGrey (www.opengrey.eu/). No language restriction was applied.

Selection criteria

Only studies investigating patient perception of fixed appliance orthodontic treatment were included.

Data collection and analysis

Screening, quality assessment [using the AMSTAR 2 tool (A Measurement Tool to Assess Systematic Reviews)], and data extraction were performed by two authors independently. Information was categorized and narratively synthesized for the key findings.

Results

A total of 163 articles investigating patient expectation, experience, and satisfaction with conventional ligation labial fixed orthodontic appliances were obtained. Of these, 152 observational or interventional studies were excluded, resulting in 11 eligible systematic reviews. Two were excluded as earlier reports of a Cochrane review. The quality of the reviews was variable (critically low, low, and moderate). The findings were as follows: aesthetics represents a primary motive for orthodontic treatment; a temporary deterioration in the quality of life occurs during the initial phases of treatment; gender and ethnicity factors do not have an impact on patient perception of treatment; and a positive relationship between orthodontist–patient–parent is important to achieve patient compliance and satisfaction.

Conclusions

There is a lack of high-quality studies in terms of systematic reviews and meta-analyses for assessing patient perception with fixed appliance orthodontic treatment. The aesthetic impact of malocclusion is the main motive for seeking orthodontic treatment. Quality of life reduces during the initial stages of orthodontic treatment but improves in the later stages of treatment. Assessment before, during, and after orthodontic treatment is necessary to comprehensively assess patient perception at all stages of care.

Trial registration

CRD42019122653.

Conflict of Interest

None to declare.

A randomized clinical trial of the effectiveness of 0.018-inch and 0.022-inch slot orthodontic bracket systems: part 2-quality of treatment

OBJECTIVE

To compare the quality of orthodontic treatment between 0.018-inch and 0.022-inch slot bracket systems.

SUBJECTS AND METHODS

Eligible participants aged 12 years or over were allocated to the 0.018-inch or 0.022-inch slot MBT appliance (3M-Unitek, Monrovia, California, USA) using block randomization in groups of 10. Outcome measures included: 1. ABO cast-radiograph evaluation (CR-EVAL), 2. peer assessment rating (PAR) scores, 3. incisor inclination, and 4. patient perception using the Index of Orthodontic Treatment Need aesthetic component (IOTN AC) and three validated questionnaires before, during and after treatment. Parametric tests [independent samples t-test and two-way analysis of variance (ANOVA)] and non-parametric tests (chi-square with Fisher's exact tests and Mann-Whitney U-test) assessed differences between groups (P < 0.05).

RESULTS

Of the 187 participants randomized (1:1 ratio), 34 withdrew or were excluded (protocol deviations or poor cooperation). There were 77 patients in the 0.018-inch slot group and 76 patients in the 0.022-inch slot group (overall mean age: 19.1 years). Baseline characteristics were similar between groups (P > 0.05). The mean total ABO CR-EVAL scores were 34.7 and 34.5; mean percentage PAR score reduction 74.1 per cent and 77.1 per cent; mean change for maxillary incisor inclination 2.9 degrees and 1.6 degrees and for mandibular incisor inclination 2.7 degrees and 1.4 degrees for the 0.018-inch and 0.022-inch groups, respectively. Improvement in patient perception of aesthetics after treatment was statistically significant for both groups (P < 0.05). However, there were no statistically significant differences between the two treatment groups for ABO CR-EVAL, percentage PAR score reduction, incisor inclination, and patient perception of treatment (P > 0.05). No adverse events were observed during treatment.

LIMITATIONS

It was impossible to blind clinicians or patients to allocation and oral hygiene and periodontal outcomes were not assessed.

CONCLUSIONS

There were no statistically or clinically significant differences in the quality of occlusal outcomes, incisor inclination and patient perception of treatment between 0.018-inch and 0.022-inch slot bracket systems.

REGISTRATION

The trial was registered with ClinicalTrials.gov on 5 March 2014, registration number: NCT02080338.

PROTOCOL

The protocol was published at DOI: 10.1186/1745-6215-15-389.