Prospective Evaluation of Psychosocial Impact after One Year of Orthodontic Treatment Using PIDAQ Adapted for Indian Population

An Assessment of the Subjective Psychological and Social Effects of Malocclusion-Related Dental Aesthetics and Its Influence on Body Self-Image and Oral Health-Related Quality of Life in Young Adults

INTRODUCTION

 Malocclusion has a psychological impact related to the patient's age. It also influences the quality of life. This research aims to test the null hypothesis that there is no association between the self-perceived psychosocial impacts of dental aesthetics with the severity of malocclusion, oral health-related quality of life (OHRQoL), and self-image of the body in young adults seeking orthodontic treatment.

MATERIALS AND METHODS

A convenience sample of young adults between 19 and 30 years old was selected for the study. The severity of malocclusion and orthodontic treatment needs were evaluated using the Dental Aesthetic Index (DAI). The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), Oral Health Impact Profile-14 (OHIP-14), and Body Satisfaction Scale (BSS) were used to evaluate the self-perceived effects of malocclusion.

STATISTICAL ANALYSIS

 The Kruskal-Wallis test is used to analyze the distribution of components with different grades of DAI. Spearman's correlation test evaluated the correlation between independent variables and their domains. The study utilized stepwise multiple linear regression analysis to assess the predictive value of independent factors on the PIDAQ and its domains.

RESULTS

 A total of 181 subjects with a mean age of 24.4 ± 1.5 years, 42% males and 58% females, participated in this study. There was a significant correlation (p < 0.05) between all variables (OHIP-14, DAI, and BSS) and PIDAQ. There were significant correlations between the independent variables and the total score of PIDAQ (R2 = 0.16), psychological impact (R2 = 0.09), and social impact (R2 = 0.18), as well as dental self-confidence (R2 = 0.21) and aesthetic concern (R2 = 0.16).

CONCLUSION

In young adults, the self-perceived impact of dental aesthetics is moderated by the severity of malocclusion, oral health-related quality of life, and body satisfaction. The null hypothesis is rejected.

Influence of Dental Education on Esthetics Self-Perception and Shade Selection

A discrepancy is encountered between the esthetic self-perception and the actual need for treatment. The aim was to determine the influence of dental education on the patients' attitude, esthetic self-perceptions, and shade selection. This cross-sectional study asked participants to select the perceived shade of their incisors using a shade guide, and to complete a self-administered questionnaire assessing their attitude regarding teeth shade. The color coordinates (L*, a*, and b*) of their actual shades were recorded clinically, using a digital spectrophotometer. A Pearson correlation assessed the relation between the perceived and actual color coordinates. A linear regression assessed the association between the attitude towards the esthetic self-perception, background factors, and actual shades. A clinical shade selection was done digitally for 536 participants, comprising 40.1% preclinical dental students, 37.3% clinical dental students, and 22.6% non-dental participants. The perceived and actual a* and b* values were significantly correlated in the preclinical students, and L* and b* were correlated in the clinical students. Those who had not received any dental education showed better attitude scores than the clinical students. The color-matching skills were improved by education; therefore, this emphasizes the importance of teaching color selection in dental schools. Dental esthetic self-perception is also improved by increasing knowledge and skills through exposure to a variety of comprehensive dental cases.

Minimal Important Difference of the Psychosocial Impact of Dental Aesthetics Questionnaire Following Orthodontic Treatment: A Cohort Study

(1) This study aimed to do a longitudinal validation of the psychosocial impact of dental aesthetics questionnaire (PIDAQ) and determine its minimal important difference (MID) following orthodontic treatment; (2) 42 adolescents (11 to 18 years old) were recruited for treatment with fixed appliances and the participants answered the Malaysian PIDAQ prior to treatment (T0), mid-treatment (T1), and post-treatment (T2), plus a global health transition scale at T1 and T2. Data analyses included repeated measures ANOVA and paired sample t-tests. Test–retest was administered 2 to 6 weeks from T0; (3) The final sample comprised 37 subjects (response rate = 88.1%). The 95% limits of agreement were −10.3 to 8.5 points. In the anchor-based approach, those who experienced the smallest changes by reporting their dental aesthetics as “a little improved” had an insignificant PIDAQ score change of −5.3 at T1. At T2, the PIDAQ scores of those in this category were reduced significantly (mean change = −26.2; effect size (ES) = 1.0; p = 0.34). In the distribution-based approach, standardized PIDAQ scores were significantly reduced, with medium (0.7) to large (1.5) ES at T1 and T2, respectively; (4) The PIDAQ can detect orthodontic-related changes in patients’ psychosocial well-being. The post-treatment MID is 26 scale points with large ES.

Is Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) Valid for the Indian Population?-A Psychometric Study

Objectives:

A culturally adapted and validated Oral Health-Related Quality of Life (OHRQoL) inventory helps to reliably compare patient perceptions among different populations. The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) evaluates the impact of dental aesthetics on OHRQoL. This study aimed to develop a regional version of PIDAQ (PIDAQ_Mal) for the Indian population and to assess differences in perceptions due to malocclusion in different population groups.

Materials and Methods:

PIDAQ_Mal was derived through the translation process and pilot-tested to assess test–retest reliability. Psychometric properties were tested on 285 subjects (31.2% males, 68.8% females; age range 18–25 years). Normative treatment need was assessed using Index of Orthodontic Treatment Need (IOTN)-Dental Health Component and subjective assessment using IOTN-Aesthetic Component (AC) and Perception of Occlusion Scale (POS). PIDAQ_Mal mean domain scores were compared with those of the previously validated versions to assess difference in perceptions.

Results:

Internal consistency and test–retest reliability were good (Cronbach’s α = 0.83–0.88; Intraclass Correlation Coefficient = 0.74–0.91). IOTN-AC and POS scores showed significant correlation with PIDAQ_Mal scores ensuring convergent validity (P < 0.001). Discriminant validity was confirmed by statistically significant differences (P < 0.001) in PIDAQ_Mal scores between subjects with no treatment need and moderate/definite need. Factor analysis derived four domains with one item showing cross-loading. Difference in mean domain scores among the previously validated versions of PIDAQ confirmed socio-cultural differences in perceptions due to malocclusion.

Conclusion:

PIDAQ_Mal was found to be reliable and valid for the Indian subjects and can be used as a condition-specific OHRQoL measure. Socio-cultural differences in perceptions were brought to light using the translated scale.

Factors affecting dental self-confidence and satisfaction with dental appearance among adolescents in Saudi Arabia: a cross sectional study

Background

Dental appearance affects facial beauty, social interaction and psychological well-being particularly among adolescents. The aim of the current study was to determine factors affecting adolescent dental self-confidence and satisfaction with dental appearance in Saudi Arabia.

Methods

A cross-sectional study was conducted in the Eastern Province of Saudi Arabia among 3500 students attending intermediate and high schools. Data was collected from 2637 students using the translated Arabic version of the psychosocial impact of dental esthetics questionnaire (PIDAQ) in addition to questions about smile esthetics satisfaction and demographic variables including; gender, age, school grade, and parental level of education. Statistical analysis was performed by using logistic regression to assess the effect of demographical variables on PIDAQ and its domains at 5% significance level.

Results

About 80% of the participants were satisfied or somewhat satisfied with their smiles. Tooth alignment and tooth color were the most cited reasons for adolescents’ dissatisfaction about their smile, 34% and 33% respectively. Females and participants’ fathers’ university education figured in a statistically significant way regarding higher PIDAQ and aesthetic concerns. Females were 70%, and those with fathers’ university education were 22% more likely to have a negative psychological impact. Females expressed aesthetic concerns nearly two times more than males. Participants whose fathers possessed university education had an aesthetic concern 1.25 times more compared to those whose fathers had no school or limited school education. Females and those with mothers who had university education were less likely to have positive dental self-confidence.

Conclusions

Most adolescents exhibited satisfaction with their own smiles. Smile dissatisfaction in the remaining participants was related to teeth alignment, color and shape. Females were more concerned with dental esthetics and smile satisfaction than males. Females and participants whose fathers had a university education exhibited higher psychosocial impact than males and those with or without school education. However, males showed greater self-confidence in their dental aesthetics.

Effect of fixed mechanotherapy on psychosocial impact of malocclusion using PIDAQ in the Indian population - A follow up study

Background

The presence of malocclusion in an individual not only distresses the oral form and function but also has a significant impact on the psychological and social well-being of an individual. Adoption of a patient centered approach during the correction of malocclusion serves to benefit both the individual and the orthodontic fraternity, as it aims to improve the function, aesthetics and subsequently, the overall quality of life.

Materials and methods

In this study, the psychosocial impact of malocclusion was evaluated on 93 patients using the IOTN (Index of Orthodontic Treatment Needs) and the PIDAQ (Psychosocial impact of dental aesthetics questionnaire) indices. The questionnaires were paired accordingly and statistically analysed. Association of the age and gender with the psychosocial impact of malocclusion was also assessed.

Results

Mean total and the individual component scores of the PIDAQ were assessed pre and post treatment and a significant reduction in the scores was observed. The IOTN-AC (IOTN - Aesthetic Component) scores also improved drastically with treatment. However, no statistically significant association of age, education level or socioeconomic class with the psychosocial impact of malocclusion was observed.

Conclusion

The significant improvement in the mean PIDAQ and IOTN-AC scores obtained after completion of fixed orthodontic treatment, indicate the high initial psychosocial impact of malocclusion which significantly reduced with treatment, accenting the role of orthodontics in improving the overall psychological and social well-being of an individual.

Factors related to the psychological impact of malocclusion in adolescents

To study the association between orthodontic treatment need and the psychosocial impact of dental aesthetics in a sample of adolescents, as well as other associated factors. A transversal study was conducted on 1,158 adolescents (12–16 years old) examined at the schools selected for the 2018 epidemiological study on oral health in the Comunidad Valenciana (Spain). The need for orthodontic treatment was determined by DAI and IOTN. The psychosocial impact was established by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Other variables considered were sex, social class, DMFT index and Body-Mass Index, and having previously worn or presently wearing an orthodontic device. A lineal regression statistical technique was applied to study the significant associations with the scoring obtained in PIDAQ. The PIDAQ scores revealed a significant and positive lineal relationship with regard to need for orthodontic treatment: DAI (ẞ = 0.20) and IOTN-DHC (ẞ = 4.87), in women (ẞ = 2.66) and a negative one for having previously worn an orthodontic device (ẞ = − 5.74). The rest of the variables had no statistical significance (p > 0.05). The psychosocial impact of dental aesthetics in adolescents is associated with the presence of malocclusion and the female sex, while the condition of having previously worn an orthodontic device reduces the psychosocial impact.

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.

High-fluence low-power laser irradiation promotes odontogenesis and inflammation resolution in periodontitis by enhancing stem cell proliferation and differentiation

Periodontitis can exert a severe impact on the life of patients, and the use of stem cell therapy for this disease is promising. The inflammatory response consequent to periodontitis can promote stem cell proliferation. Activated inflammation triggers inhibitory cytokine secretion, thus reducing inflammation subsequent to stem cell activation. High-fluence low-power laser irradiation (HF-LPLI) has the ability to regulate stem cell function through its effect on inflammation. Thus, the aim of the present study was to examine whether HF-LPLI is able to activate stem cells to promote regeneration in periodontitis by promoting inflammation resolution, as well as to evaluate the underlying mechanism of action if an effect is observed. Stem cells were treated with HF-LPLI following inflammation activation. Reverse transcription-quantitative polymerase chain reaction and EdU assay were used to evaluate cell proliferation and differentiation. Flow cytometry and immunofluorescence were also used to detect the ability of HF-LPLI to regulate the surrounding inflammatory environment. Animal models of periodontal disease were treated with stem cells and HF-LPLI, and regeneration was detected by hematoxylin and eosin staining and in vivo imaging. It was observed that HF-LPLI promoted inflammation resolution by reducing the excessive inflammatory response, and finally stimulated stem cell proliferation and differentiation. Furthermore, in vivo results revealed that stem cells treated with HF-LPLI induced bone regeneration. HF-LPLI stimulated stem cell proliferation and differentiation by promoting inflammation resolution subsequent to stem cell activation, providing a new strategy for the clinical treatment of periodontitis.