Oral Health-Related Quality of Life (OHQoL) among adolescents seeking orthodontic treatment

Impact of oral conditions on oral health-related quality of life among Indians- a systematic review and Meta-analysis

OBJECTIVE

This review assessed the impact of oral conditions on Oral Health Related Quality of Life among Indians.

METHODS

Databases, including PubMed and Scopus, CINAHL, Web of Science, PsycInfo were systematically searched for English Language studies conducted among Indians up to July 2022. Two independent reviewers assessed studies selected for retrieval for methodological quality using standardised quality assessment instruments for analytical cross-sectional studies in JBI SUMARI.

RESULTS

Fourty one publications were included in this review (N = 23,090). Studies includes both cross sectional study and Randomized Controlled Trials. Based on the JBI critical appraisal tools, the quality of the included studies was low to high. Twenty-six studies were considered for the meta-analysis. Individuals with dental caries [OR: 3.54 (95% CI 2.24- 5.60), ten studies, 4945 participants] and malocclusion [ OR: 5.44 (95% CI 1.61, 18.39), six studies, 3720 participants] had poor OHRQoL compared to individuals without oral conditions.

CONCLUSIONS

Despite the various definitions of the exposures and instruments used to assess Oral Health-Related Quality of Life, our review found that people with dental caries and malocclusion have a significantly higher experience of poor quality of life.

PROSPERO SYSTEMATIC REVIEW REGISTRATION NO

CRD42021277874.

Factorial structure and measurement invariance of the Chinese version of the Oral Health Impact Profile-14 among clinical populations and non-clinical populations: an evidence for public oral investigations

OBJECTIVE

Oral health-related quality of life (OHRQoL) is a multidimensional concept that is commonly used to examine the impact of oral health status on quality of life. The purpose of this study was to examine the optimal factor model of the Chinese version of the Oral Health Impact Profile (OHIP-14) questionnaire in clinical populations, measurement invariance across clinical status and gender cohorts. This would ensure equal validity of the Chinese version of OHIP-14 in different populations and further support public oral investigations.

METHODS

The Chinese version of OHIP-14 was used to investigate 490 dental patients and 919 college students. Confirmatory factor analysis (CFA), item analysis and reliability, measurement invariance, and the t-test were used for data analyses.

RESULTS

We found that the 7-factor structure had the best-fit index in the sample (CFI = 0.970, TLI = 0.952; SRMR = 0.029, RMSEA = 0.052(0.040,0.063)). The reliability of the scales was satisfactory (Cronbach's α = 0.942). The error variance invariance fitted the data adequately in measurement invariance, indicating that measurement invariance is acceptable both across the clinical and non-clinical populations (∆CFI=-0.017, ∆RMSEA = 0.010) and across genders in the clinical population (∆CFI = 0.000, ∆RMSEA=-0.003). T-test for scores showed that the clinical populations scored significantly higher than the non-clinical populations, as did the overall score (t = 7.046, p < 0.001, d = 0.396), in terms of functional limitation (t = 2.178, p = 0.030, d = 0.125), physical pain (t = 7.880, p < 0.001,d = 0.436), psychological discomfort (t = 8.993, p < 0.001, d = 0.514), physical disability (t = 6.343, p < 0.001, d = 0.358), psychological disability (t = 5.592, p < 0.001, d = 0.315), social disability (t = 5.301, p < 0.001,d = 0.304), social handicap (t = 4.452, p < 0.001, d = 0.253), and that in the non-clinical populations, females scored significantly higher than males, as did in terms of physical pain (t = 3.055, p = 0.002, d = 0.280), psychological discomfort (t = 2.478, p = 0.014, d = 0.222), and psychological disability (t = 2.067, p = 0.039, d = 0.188).

CONCLUSION

This study found that the Chinese version of OHIP-14 has measurement invariance between the clinical and non-clinical populations and across genders in the clinical populations, and can be widely used in OHRQoL assessment for public oral investigations.

Can malocclusion among children impact their oral health-related quality of life? parents' perspective

Background and Aim

Malocclusion can negatively impact the quality of life of children. Therefore, this study assesses the impact of proxy-reported malocclusion and oral health-related quality of life among children in Riyadh, Saudi Arabia, from the parents or guardians' perspectives.

Materials and Methods

A self-administered electronic questionnaire was used to assess the correlation between proxy-reported malocclusion conditions during the early mixed dentition stage (children age 6-12 years) and oral health-related quality of life using the OHIP-14 measure. All collected data were analyzed using SPSS.

Results

Among the 353 participants in the study, anterior open-bite was the most common proxy-reported malocclusion with a prevalence of 19%, followed by unilateral posterior cross bite (13.3%). Furthermore, 31% reported that their children sometimes experienced negative impacts on quality of life from malocclusions. The results also show that OHIP-14 scores were significantly associated with all proxy-reported malocclusion (p < 0.05). The highest OHIP-14 score was found to be significantly associated with the presence of deep-bite from parents' or guardians' perspective.

Conclusion

The presence of some proxy-assessed malocclusion was associated with negative impacts on children's oral health-related quality of life. This is very important to consider when assessing the need for orthodontic intervention, especially at this stage as this age is critical in building a child's confidence and self-esteem.

Assessment of Orthodontic Treatment Need and Oral Health-Related Quality of Life in Asthmatic Children Aged 11 to 14 Years Old: A Cross-Sectional Study

This study investigated the need for orthodontic treatment in asthmatic children aged 11 to 14 years and how the treatment affected their oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

This cross-sectional study was conducted at the dental clinic of the University of Salamanca in 2020-2022. The study selected a consecutive sample of 140 children with asthma (52.1% girls; 47.9% boys). This study used the Orthodontic Treatment Needs Index (OTN) to analyze the need for orthodontic treatment and the Children's Perception Questionnaire (CPQ11-14) to assess OHRQoL.

RESULTS

Sex and age did not significantly influence the need for orthodontic treatment, although age may be considered influential for OHRQoL concerning oral symptoms (p < 0.01), functional limitations (p < 0.05), and total score on the CPQ_11-14 questionnaire (p < 0.05): the younger the age, the greater the effect of the need for orthodontic treatment on OHRQoL. The social well-being of the patients was much more significantly impacted by the need for orthodontic treatment (15.7 ± 1.91) than by oral symptoms (7.64 ± 1.39), which were the least impacted. In all parts of the CPQ_11-14 questionnaire and in the patients' total scores, we observed significant agreement (p < 0.01) that treatment influenced OHRQoL.

CONCLUSION

An inverse relationship exists between the severity of the treatment needed and OHRQoL.

Does orthodontic treatment need have an impact on oral health-related quality of life?

OBJECTIVES

The aims of this study were to determine the frequency of oral health-related quality of life (OHRQoL) impairment in a national representative sample of 8 to 9 year olds in Germany and to evaluate the impact of orthodontic treatment need.

METHODS

Data were collected in the Sixth German Oral Health Study (Sechste Deutsche Mundgesundheitsstudie, DMS 6) and subjects were sampled using a multistage sampling technique. OHRQoL was measured with a modified version of the 5‑item Oral Health Impact Profile (OHIP-5) which was administered in a computer-assisted personal interview. Children were also examined for malocclusion and orthodontic treatment need.

RESULTS

In all, 1892 children aged 8-9 years were invited to take part. Finally, data of 705 children (48.6% female) could be included in the analysis. The OHIP‑5 mean was 1.3 (±2.0). There was no relevant influence from age and gender on the OHIP‑5 summary scores (r < 0.10), but the summary scores differed when analyzed separately regarding orthodontic treatment need or no orthodontic treatment need (1.5 ± 2.0 vs. 1.2 ± 1.9, p = 0.020). Nevertheless, the level appears to be low.

CONCLUSIONS

Malocclusions with orthodontic treatment need have an influence on OHRQoL.

Do malocclusion and orthodontic treatment impact oral health? A systematic review and meta-analysis

INTRODUCTION

Currently, there is limited evidence on the effects of malocclusion on oral health and whether the correction of malocclusion results in an improvement in oral health. In this review, we examined the evidence from randomized controlled trials and prospective cohort studies to provide information on any association between malocclusion and oral health and the effects of orthodontic treatment.

METHODS

We conducted this review in 2 parts: (1) we looked at the impact of malocclusion on oral health, and (2) we reviewed the evidence on the effect of orthodontic treatment on oral health. We searched for randomized controlled trials and prospective cohort studies. The searches were completed for articles published between January 1, 1990 and October 8, 2018 and covered Medline via Ovid, Embase, and the Cochrane Database of Systematic Reviews. References of included articles and previous systematic reviews were hand-searched. No language restrictions were applied. Two members of the study team assessed the quality of the studies using the Appraisal Tool for Cross-Sectional Studies to appraise the quality of studies in part 1. The assessment was performed at the study level. Two authors assessed each study independently, with a third author consulted when a disagreement occurred. For studies in part 2, we used the Newcastle-Ottawa scale to assess the risk of bias. When studies were included in a Cochrane review, we incorporated the risk of bias assessment. We developed data extraction forms for each area of oral health under investigation (trauma, quality of life, caries, and periodontal disease). Each author piloted the form, and we held discussions to inform any necessary refinements. We extracted data from studies into 2 × 2 tables, which provided a binary analysis of malocclusion vs the outcome of interest. If these data were not available from the published paper, then studies were not included in the meta-analysis. The authors were contacted when possible to request data in this format.

RESULTS

For part 1 of the study, we identified 87 studies. The overall quality was low. We could not include any of the data into an analysis because of a large variation in the nature of the studies, data collected, and outcome measures that were selected. For part 2 of the study, we found 7 studies; however, there were similar deficiencies in the data as in part 1, and thus, we could not reach any strong conclusions.

CONCLUSIONS

Overall, there is an absence of published evidence regarding the effects of malocclusion on oral health and the impact of orthodontic treatment on oral health.

Parental influence is the most important predictor of child's orthodontic treatment demand in a preadolescent age

The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11-14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test-retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (β = 0.335, p = 0.002), parental influence (β = 0.221, p = 0.002), and malocclusion severity (β = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4-25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5-12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1-1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0-1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents' cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

Effect of personality on oral health-related quality of life in undergraduates

OBJECTIVES

To evaluate the effects of personality traits and other variables on oral health-related quality of life (OHRQoL) of Chinese undergraduates aged 17 to 24 years with no history of orthodontic treatment.

MATERIALS AND METHODS

A total of 443 undergraduate students aged 17 to 24 years were selected and completed a two-section questionnaire: the Eysenck Personality Questionnaire Short Scale Chinese version and the Oral Health Impact Profile-14 Chinese version (OHIP-14). Malocclusion severity was assessed via clinical examination using the dental health component (DHC) and esthetic component of the Index of Orthodontic Treatment Need (IOTN). Severe dentofacial deformities that required orthognathic surgery were excluded.

RESULTS

The total and all dichotomized OHIP-14 dimensions correlated closely with the neuroticism personality traits ( P < .001). The total and some subscales of OHIP-14 were related with psychoticism. Women had higher OHIP-14 scores than men, especially in the normal occlusion group. Nevertheless, men with more severe malocclusions had higher scores that were similar to those of women. OHRQoL was significantly different between the major of dentistry and other majors.

CONCLUSIONS

Personality affects comprehensive OHRQoL, and the most significant predictor is neuroticism. Female young adults have worse OHRQoL than male young adults, especially among those with mild malocclusion.

Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment

INTRODUCTION

The aim of this study was to evaluate the psychosocial impact of dental esthetics for adults seeking orthodontic treatment.

METHODS

The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered to 393 adults, aged 18 to 30 years. The participants were divided into 2 groups: an intervention group (received orthodontic treatment) and a control group (rejected orthodontic treatment). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The Wilcoxon signed rank test showed no statistically significant difference between the groups for the dental health component (DHC) of the IOTN (P = 0.134). Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTN-DHC grades; self-confidence scores in the control group (F = 1.802; P >0.05) were the exception. Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group. DHC grades, psychological impact, social impact, and aesthetic concern had significant impacts on patients accepting orthodontic treatment.

CONCLUSIONS

The psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment. Importantly, participants with low self-awareness of the potential psychosocial impact rejected orthodontic treatment, despite the need for severe normative treatment.

Relationship of the Dental Aesthetic Index to the oral health-related quality of life

OBJECTIVE

To assess the impact of malocclusion on the quality of life.

MATERIALS AND METHODS

This cross-sectional study involved 150 subjects attending the Primary Care Unit with no history of orthodontic treatment. The Dental Aesthetic Index (DAI) with 10 occlusal characteristics were measured on study models. Oral health-related quality of life (OHRQoL) was assessed with the Malaysian version of the Oral Health Impact Profile questionnaire (OHIP-14). The Spearman rank-order correlation coefficient was used to evaluate the relationship between the malocclusion and quality of life.

RESULTS

Significantly weak correlations (r = .176) were found between the DAI and the OHRQoL. Females and the younger age group (12-19 years) tended to score higher on the OHIP-14 than their counterparts. For males, domain 3 (psychological discomfort; r = .462), domain 4 (physical disability; r = .312), domain 7 (handicap; r = .309), and overall score (r = .289) were weak correlates but significant to the DAI compared with females. The older age group showed a significant weak correlation in domain 3 (psychological discomfort; r = .268) and domain 7 (handicap; r = .238), whereas the younger age group showed no correlation with any domain.

CONCLUSIONS

The DAI score does not predict the effect of malocclusion on the OHRQoL.

Impact of fixed orthodontic appliance or clear-aligner on daily performance, in adult patients with moderate need for treatment

OBJECTIVE

To assess the impact of wearing fixed orthodontic appliance (FOA) or clear-aligner, on daily performance in adult patients.

METHODS

The Oral Impacts on Daily Performance (OIDP) index was assessed in 152 adults aged 25-35 years at baseline (T0), 6 months after bonding (T1), and 12 months after bonding (T2). Participants were randomly divided into two groups: CA group (participants treated with clear-aligner) and a control group (FOA group; participants treated with FOA). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need.

RESULTS

There were no significant differences in sociodemographic variables and OIDP scores at baseline between the two groups. Significant changes in OIDP total and subscale scores were observed while wearing FOA: OIDP total score and subscale scores of eating, cleaning teeth, smiling, and social relation at T1 and T2 were significantly higher than at baseline (P<0.05 or P<0.01). However, only OIDP total score was significantly increased at T1 compared to the baseline in the CA group. OIDP total score and subscale scores of eating, cleaning teeth, smiling, and social relation were significantly higher in patients wearing FOA than in patients wearing clear-aligner at T1 and T2 (P<0.05 or P<0.01).

CONCLUSION

Patients wearing clear-aligner have fewer impacts on daily life than those wearing FOA during treatment, and have no significant changes in OIPD subscale scores at 12 months. FOA therapy significantly impacts daily performance in adult patients during treatment.

The impact of malocclusions on oral health-related quality of life in children-a systematic review and meta-analysis

Introduction

A limited amount of systematic literature reviews on the association between malocclusions and oral health-related quality of life (OHRQOL) summarize inconclusive results. Therefore, we conduct a systematic review and meta-analysis on the association of malocclusions with OHRQOL in children.

Methods

Relevant studies were identified in Pubmed, Embase, Cochrane, Google Scholar and other databases. All studies with data on malocclusions or orthodontic treatment need and OHRQOL in children were included. Methodological quality of the studies was assessed with the Newcastle-Ottawa Scale (NOS). Random effects models were used to estimate summary effect measures for the association between malocclusion and OHRQOL in a continuous and a categorical data analysis. Tests for heterogeneity, publication bias and sensitivity of results were performed.

Results

In total, 40 cross-sectional studies were included in the meta-analyses. Summary measures of the continuous data show that OHRQOL was significantly lowered in children with malocclusions (standardized mean difference (95 % CI] = 0.29 (0.19–0.38)). The summary odds ratio for having an impact on OHRQOL was 1.74 times higher in children with malocclusion than in children without malocclusions. Heterogeneity among studies was partly explained by malocclusion assessment, age of the children and country of study conduction.

Conclusion

Our results provide evidence for a clear inverse association of malocclusion with OHRQOL. We also showed that the strength of the association differed depending on the age of the children and their cultural environment.

Clinical relevance

Dentists benefit from understanding the patient differences regarding the impact of malocclusions.

Electronic supplementary material

The online version of this article (doi:10.1007/s00784-015-1681-3) contains supplementary material, which is available to authorized users.

Oral health-related quality of life of children seeking orthodontic treatment based on child oral health impact profile: A cross-sectional study

Aims:

The aim of this study was to assess oral health-related quality of life (OHRQoL) using short form (SF) of child oral health impact profile (COHIP) in children aged 11–15 years who sought orthodontic treatment. A comparison was done between these children and age-matched peers who never had or sought orthodontic treatment.

Methodology:

This cross-sectional study included 227 children aged 11–15 years. A total of 110 participants had sought orthodontic treatment at KSR Institute of Dental Science and Research (orthodontic group) and 117 participants from a nearby school who had never undergone or sought orthodontic treatment (comparison group). OHRQoL was assessed with the SF of the COHIP, and malocclusion severity was assessed with the index of orthodontic treatment needs. Data presentation and statistical analysis were performed with the Statistical Package for the Social Sciences Software (Version 19, SPSS, Chicago, IL, USA). The Chi-square test and Fischer exact tests were used to analyze the qualitative data.

Results:

Children with little to borderline treatment needs have a better quality of life when compared to children with definitive treatment needs (P = 0.049). No statistically significant difference in COHIP-SF scores was found between boys and girls (P > 1.000). In the orthodontic group, children with little to borderline treatment needs were 4.8 times (P = 0.037) more likely to report better OHRQoL when compared to children with definitive treatment needs.

Conclusion:

Children who sought orthodontic treatment had lower quality of life scores than those who never had or never sought treatment.

Genotoxic and cytotoxic effects and gene expression changes induced by fixed orthodontic appliances in oral mucosa cells of patients: a systematic review

CONTEXT

The accumulation of chronic or severe acute DNA and cellular damage in oral mucosa cells is one of the main factors that help initiate a wide range of malignant lesions in the oral cavity. There has been considerable controversy in the literature about the effect of such sustained genotoxic and cytotoxic damage to oral mucosa cells.

OBJECTIVE

The aim of this systematic review, reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, is to investigate the effects of such interventions.

METHODS

Electronic and manual searches were performed (15 May 2015) for Randomized Clinical Trials/quasi-Randomized Clinical Trials that analyzed the genotoxic/cytotoxic effects of these types of oral appliances in humans. A primary outcome (cell/DNA damage) and a number of secondary outcomes were examined. Two reviewers carried out the study selection and performed a "risk of bias" assessment [Cochrane Collaboration's tool]. Wherever possible the meta-analysis was conducted on homogenous groups.

RESULTS

From the electronic search (2797), 6 studies met the eligibility criteria. Most studies (5/6) observed significant differences in most comparisons at the short-term (1-3 months) and long-term (24-48 months) evaluations, with respect to critically acute genotoxic/cytotoxic effects. Some of the studies (2/3) concluded that the post-removable effects at DNA/cellular levels were not significant (p > 0.05) with respect to the controls.

CONCLUSIONS

Acute DNA/cellular damage in oral mucosa cells is induced by orthodontic appliances. Nevertheless, even though these effects were no longer detected after removing the appliances, more rigorous RCTs are needed to explore the extent to which acquired damage can be observed in the oral mucosa.

Agreement between adolescents and parents/caregivers in rating the impact of malocclusion on adolescents' quality of life

OBJECTIVE

To assess the agreement between adolescents and their parents/caregivers regarding the impact of malocclusion on adolescents' oral health-related quality of life (OHRQoL).

MATERIALS AND METHODS

A consecutive sample of 141 adolescent and parent/caregiver pairs was selected. Adolescents answered the short version of the Child Perceptions Questionnaire (CPQ11-14), while parents answered the Parental-Caregiver Perceptions Questionnaire (P-CPQ). The CPQ11-14 and the P-CPQ have 14 items in common that are organized through four subscales: oral symptoms (OS), functional limitations (FL), emotional well-being (EW), and social well-being (SW). Agreement on the overall score and agreement on the subscales were determined using comparison and correlation analysis. The comparison analysis was carried out by comparing the mean directional and absolute differences, and the correlation analysis was performed using the intraclass correlation coefficient (ICC).

RESULTS

A total of 135 pairs of adolescents and parents/caregivers agreed to answer the questionnaires, providing a response rate of 95.7%. The mean age of the adolescents was 11.50 years. The mean directional difference was significant for the OS (P < .001) and FL (P = .040) subscales as well as for the overall score (P = .007). Adolescents' reports were higher than parents/caregivers' reports. The mean absolute difference for the overall score was 7.26, representing 12.9% of the maximum possible overall score. The ICC was 0.16 for the overall score, indicating poor agreement.

CONCLUSION

Poor agreement was observed between adolescents and their parents/caregivers in rating the impact of malocclusion on adolescents' OHRQoL.

Malocclusion, orthodontic treatment, and the Oral Health Impact Profile (OHIP-14): Systematic review and meta-analysis

OBJECTIVE

To synthesize evidence on the impact of malocclusion and its associated treatment on people's quality of life across studies that used the Oral Health Impact Profile (OHIP-14) questionnaire in the adult population.

MATERIALS AND METHODS

A systematic search of the English literature using Medline, PubMed, and EMBASE yielded 98 unique citations. Studies using OHIP-14 with individuals 15 years of age and older were included. After initial screening, 64 citations were excluded and another 9 were excluded after reading full text reports; the remaining 25 were included in the review. All studies were observational and used one of three study designs: 11 compared the same group before and after treatment (pre-post design), 10 compared groups with and without malocclusion (independent groups design) and four compared an orthodontically treated group with an independent group requiring treatment (treated-untreated groups design). Only three studies using the pre-post design and four using the independent groups design reported comparable OHIP-14 data and were combined in separate meta-analyses. Meta-analysis was carried out using metan command in Stata.

RESULTS

The standardized mean difference (SMD) in OHIP-14 total score was 1.29 (95% CI: 0.67 to 1.92) for the three studies using the pre-post design. Similarly, the SMD score was 0.84 (95% CI: 0.25 to 1.43) for the four studies using the independent groups design. There was evidence of high heterogeneity and publication bias among the studies included.

CONCLUSIONS

This meta-analysis revealed that OHIP-14 scores were significantly lower after receiving treatment for malocclusion and in individuals without malocclusion/orthodontic treatment need compared to those with such condition (independent groups).

Psychosocial impact of malocclusion in Spanish adolescents

Objective

To evaluate the psychosocial impact of malocclusion, determine its relationship with the severity of malocclusion, and assess the influence of gender and social class on this relationship in adolescents.

Methods

A random sample of 627 Spanish adolescents aged 12 - 15 years underwent intraoral examinations by 3 calibrated examiners (intraexaminer and interexaminer kappa > 0.85) at their schools. Psychosocial impact was measured through a self-rated Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). The severity of malocclusion was measured by the Index of Orthodontic Treatment Need (IOTN). Gender and social class were also recorded.

Results

The total PIDAQ score and those of its 4 subscales, social impact, psychological impact, aesthetic concern, and dental self-confidence, presented significant differences (p ≤ 0.05 by analysis of variance) and linear relationships with the IOTN grades (p ≤ 0.05 by linear regression). Stepwise linear regression models showed that the IOTN dental health component was a predictive variable of the total and subscale PIDAQ scores. Neither gender nor social class was an independent predictive variable of this relationship, except the linear model for psychological impact, where gender was a predictive variable. The occlusal conditions responsible for higher PIDAQ scores were increased overjet, impeded eruption, tooth displacement, and increased overbite.

Conclusions

Malocclusion has a psychological impact in adolescents and this impact increases with the severity of malocclusion. Social class may not influence this association, but the psychological impact seems to be greater among girls.

Association between gingival bleeding and gingival enlargement and oral health-related quality of life (OHRQoL) of subjects under fixed orthodontic treatment: a cross-sectional study

Background

There are scarce evidences that evaluated the impact of periodontal disease on oral health-related quality of life (OHRQoL) taking marginal gingival alterations into consideration. Thus, this study aimed to verify the association between OHRQoL and gingival enlargement and gingival bleeding in subjects under fixed orthodontic treatment (FOT).

Methods

330 participants under FOT for at least 6 months were examined by a single, calibrated examiner for periodontal variables and dental aesthetic index. Socio-economic background, body mass index, time with orthodontic appliances, and use of dental floss were assessed by oral interviews. OHRQoL was evaluated using the oral health impact profile (OHIP-14) questionnaire. The assessment of associations used unadjusted and adjusted Poisson regression models.

Results

Higher impacts on the OHIP-14 overall were observed in subjects who presented higher levels of anterior gingival enlargement (RR 2.83; 95% CI 2.60-3.09), were non-whites (RR 1.29; 95% CI 1.15-1.45), had household income lower than five national minimum wages (RR 1.85; 95% CI 1.30-2.61), presented body mass index > 25 (RR 1.14; 95% CI 1.01-1.29), and showed a dental aesthetic index > 30 (RR 1.32; 95% CI 1.20-1.46).

Conclusions

Anterior gingival enlargement seems to influence the OHRQoL in subjects receiving orthodontic treatment.