Psychosocial impact of dental esthetics on quality of life in adolescents

Aesthetic perceptions and psychosocial impact of malocclusion: comparison between cleft and non-cleft patients and their parents

Objective

To evaluate the influence of dentofacial attractiveness using the 'Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ), Satisfaction with Life Scale (SWLS) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) in patients with cleft lip/palate (CLP), and non-cleft orthodontic patients (Non-CLP) and their parents.

Materials and methods

Eighty patients (aged 11-19 years) comprising 40 CLP and 40 non-CLP were administered the PIDAQ and SWLS questionnaires to be rated individually by the patients, along with IOTN-AC rated by the patients and their parents, respectively. The subjects were also sub-divided according to their age, i.e. pre-adolescent and adolescent.

Results

The PIDAQ subpart scores for aesthetic concern differed between the two groups, with a significantly (P < 0.02) lower scoring for the CLP group. The adolescent CLP group scored more negatively than the pre-adolescent group in the dental self-confidence and social impact sub-parts of PIDAQ. No significant differences were observed for satisfaction with life. The parents' IOTN-AC score for both groups was significant (P < 0.05) greater than the patient's score, especially for adolescent subjects.

Limitations

Non-condition specific questionnaires with restrictive sampling sizing and non-inclusion of parameters like stress coping mechanism etc.

Conclusion

The parents rated the malocclusion of their child more critically than the child itself. A majority of the CLP group had a problem in identifying themselves using the IOTN-AC as no photo existed depicting a Class III or edge-to-edge malocclusion. Attitudes, especially perceptions of the aesthetics of front teeth, are crucial factors influencing patient's psychological self-concept, social confidence, and treatment need in CLP patients and non-CLP patients, having more relevance as the patient matures towards adolescence and adulthood.

Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study

Background/objectives

The aesthetic impact of malocclusion can have negative repercussions on quality of life, social interaction, interpersonal relationships, and psychological well-being. The aim of this study was to evaluate the impact of malocclusion on the quality of life of Brazilian adolescents.

Methods

A representative cross-sectional study of 1612 adolescents from Belo Horizonte, Minas Gerais was conducted. The adolescents responded to the Brazilian version of the Child Perception Questionnaire (CPQ11-14-ISF:16) to assess the impact of the condition on quality of life. Cases of malocclusion were diagnosed using the Dental Aesthetic Index while clinical examination was performed by three calibrated examiners. Data regarding traumatic dental injuries, dental caries, gender, type of school, age and social vulnerability was collected. Data analysis was performed using bivariate and multivariate Poisson regression with robust variance (P < 0.05).

Results

The prevalence of malocclusion was 31.3%. The presence of definite malocclusion (PR = 1.28; CI = 1.13-1.45), severe malocclusion (PR = 1.24; CI = 1.04-1.47) and handicapping malocclusion (PR = 1.55; CI = 1.31-1.84) was associated with a greater negative impact on Emotional Well-Being. The presence of definite malocclusion (PR = 1.18; CI = 1.02-1.36), severe malocclusion (PR = 1.46; CI = 1.21-1.76) and handicapping malocclusion (PR = 1.61; CI = 1.35-1.94) was also associated with a greater negative impact on Social Well-Being.

Conclusions

Adolescents with handicapping malocclusion, where the need for treatment was mandatory, suffered from a greater negative impact on quality of life, with emotional and social aspects most affected.

Psycho-social impact of orthodontic treatment in Romanian teenagers and young adults

Background and aims

This survey evaluated the psycho-social impact of oral health on the quality of life in Romanian teenage and young adult orthodontic patients.

Methods

Of the 300 standard questionnaires distributed in four dental offices, 125 questionnaires were returned. Each questionnaire contained 110 items, focusing on aspects like patients’ satisfaction, self-confidence, school/work performances and aesthetic concern, in relation to oral health. The patients were 16–25 years of age and all were undergoing or had undergone orthodontic treatment in the previous two years. Data analysis was performed using the Statistical Package for the Social Science software (SPSS), version 19.0.

Results

57.90% of the orthodontic patients participating in this study were happy about their dental status, 56.52% declared themselves not shy because of their oral health issues, 52.33% considered themselves as attractive to other people, and 57.29% replied (awarding a score between 8 and 10) that they were confident when smiling. Regarding self-confidence and school/work performances, 58% of the participants declared they avoided speaking in public because of the aspect of their teeth and 47.42% considered that their school/work performances during the fix appliance therapy stayed the same as before appliance. Nevertheless, the self-perceived facial aspect improved during orthodontic treatment (64.74% of replies had scores between 8 and 10 during the treatment versus 24.67% before the treatment). Several correlations were found between aspects such as psycho-social and functional variables, physical self-evaluation, and oral health issues.

Conclusion

Patients’ satisfaction was improved during and after appliance therapy, for more than half of the participants. Self-confidence was low in relation to school/work performances; almost half of the patients reported stagnation in their school/work performances during the fix appliance therapy. However, more than 64% of the patients participating in this study were quite satisfied about their facial aspect during and after the orthodontic treatment. Thus, the common concerns of the patients anxious about their aspect during appliance therapy are not supported by the findings of this study.

Smile Aesthetics Satisfaction Scale: development and validation of a new brief five-item measure of satisfaction with smile aesthetics in adults and the elderly

OBJECTIVE

To create and validate a brief questionnaire designed for the assessment of satisfaction with smile aesthetics and to test its efficiency as a patient-centred outcome measure of aesthetic interventions in dentistry.

MATERIALS AND METHODS

A team of three specialists - two from prosthodontics and one psychologist - used a self-evaluation scale consisting of five elements in order to rate self-perceived smile aesthetics. A total of 671 subjects (63% female), 18-86 years of age, were included in the investigation. The internal consistency, validity and stability of the questionnaire, along with the responsiveness induced by the tooth-whitening procedure, were evaluated. The relationship between self-perceived satisfaction with the smile aesthetics and the clinical status of the dentition was assessed.

RESULTS

The questionnaire had one dimension accounting for 64.3% of variance and showed a high level of reliability (Cronbach α = 0.859). It measured a construct similar to concern with tooth appearance and the desire to improve this appearance (r = -0.403 and r = -0.353, respectively; P < 0.001). High test-retest reliability was demonstrated (intraclass correlation coefficient = 0.985). The questionnaire was able to detect an increase in satisfaction with smile aesthetics as a result of the tooth-whitening procedure (P = 0.016). Clinical predictors of greater satisfaction with smile aesthetics were greater tooth display when smiling, decreased chroma and the absence of gingivitis, as well as absence of crowded, fractured and restored teeth in the anterior segment.

CONCLUSIONS

A new questionnaire, titled the Smile Aesthetics Satisfaction Scale (SASS), showed good psychometric properties and its use can be recommended.

Open Up and Let Us In: An Interprofessional Approach to Oral Health

Dental caries is the single most common chronic disease of childhood in the United States. Access to dental care is one of the barriers to improved oral health for children. Primary care providers who routinely treat children have an established role in prevention and early identification of health problems; thus, they are ideal front-line providers who can detect oral health discrepancies and begin the process of care and prevention.

Self perceived psychosocial impact of dental aesthetics among young adults: a cross sectional questionnaire study

Background Oral health is not merely the absence of oral disease and dysfunction, but also influences the subject's social life and dento-facial self confidence. Objective To assess and correlate self perceived psychosocial impact of dental aesthetics among young adults based on gender. Subjects A convenience sample of Young adults of degree college in the age group of 18-23 years of Hyderabad city, India. Method Self perceived psychosocial impact of dental aesthetics was assessed using the psychosocial impact of dental aesthetics questionnaire (PIDAQ). The dental aesthetic index (DAI) was used to evaluate dental aesthetics among participants which includes 10 parameters of dento-facial anomalies related to both clinical and aesthetic aspects of the anterior teeth. Results The majority of the study population were 18 years of age (96; 31.4%) with a mean age of 19.2 ± 1.1 years. When the mean total score and individual domain scores of PIDAQ was compared based on gender, females showed higher statistical mean (p ≤ 0.05) for all except the psychology impact domain (p = 0.12). Based on DAI grading and gender, among both males [70 (32.9%)] and females [31 (33.3%)] the majority of them had a DAI score of ≤25 (grade1; normal/minor dental malocclusion). A significant negative correlation was observed between DAI, with PIDAQ and its domains (p ≤ 0.05) except for the dental self confidence (p = 0.72). Conclusion This study had examined the relationship between self-perceived psychosocial impact and dental aesthetics. So, early preventive or interceptive procedures should be carried out to prevent further psychosocial impacts on human life.

Association between Global Life Satisfaction and Self-Rated Oral Health Conditions among Adolescents in Lithuania

Background: This study aims to explore the extent to which the perceived oral conditions predict adolescent global life satisfaction (GLS); Methods: The sample in a cross-sectional survey consisted of 1510 Lithuanian adolescents (41.7% boys) aged 11-18. The survey was conducted by means of self-report questionnaires that were administrated in school classrooms ensuring confidentiality and anonymity of the participants. The schoolchildren rated their GLS and answered the questions about perceptions of their oral health. The relationship between GLS and oral health variables was estimated using unadjusted and adjusted binary logistic regression and nonparametric correlation analyses; Results: The research showed that the majority of adolescents rated their GLS highly; however, girls, older adolescents and adolescents from less affluent families were less likely to report high scores. GLS was significantly associated with subjective overall oral health assessment. The odds of reporting low GLS were 50% higher for adolescents with good oral health (OR = 1.51; p < 0.001; 95% CI = 1.18-1.93), and two and half time as higher for adolescents with perceived fair/poor oral health (OR = 2.78; p < 0.001; 95% CI = 1.72-4.50) compared to adolescents with subjectively excellent/very good oral health. Nonparametric correlations indicated lower GLS to be significantly associated with higher scores of Child Perceptions Questionnaire (.

Associations between Malocclusion and Oral Health-Related Quality of Life among Mongolian Adolescents

Malocclusion may affect oral health-related quality of life (OHR-QoL), however, the previously detected associations were affected by confounding factors. We hypothesized that there is indeed an association between OHR-QoL and malocclusion and investigated in a population-based study of 420 Mongolian adolescents mean age: 12.6 (standard deviation (SD) = 1.09) years from two secondary schools, located in an urban and a suburban area. We randomly selected two classes from each school. The Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion. OHR-QoL was assessed using the Child Perceptions Questionnaire (CPQ). Multivariate analysis was used to determine whether malocclusion had an independent effect on OHR-QoL. Overall, the existence of any type of malocclusion was not significantly associated with CPQ results. However, increased overjet was significantly associated with oral symptoms (coefficient: 0.66, 95% CI: 0.14–1.19), functional limitations (coefficient: 0.62, 95% CI: 0.17–1.08), and social well-being (coefficient: 0.50, 95% CI: 0.06–0.93). Deep bite was also significantly associated with oral symptoms (coefficient: 0.54, 95% CI: 0.23–0.84) and functional limitations (coefficient: 0.45, 95% CI: 0.19–0.72). Although malocclusion per se was not significantly associated with OHR-QoL, specific types of malocclusion, i.e., increased overjet and deep bite, were associated with OHR-QoL.

Impact of Dental Disorders and its Influence on Self Esteem Levels among Adolescents

INTRODUCTION

Self esteem is more of a psychological concept therefore, even the common dental disorders like dental trauma, tooth loss and untreated carious lesions may affect the self esteem thus influencing the quality of life.

AIM

This study aims to assess the impact of dental disorders among the adolescents on their self esteem level.

MATERIALS AND METHODS

The present cross-sectional study was conducted among 10 to 17 years adolescents. In order to obtain a representative sample, multistage sampling technique was used and sample was selected based on Probability Proportional to Enrolment size (PPE). Oral health assessment was carried out using WHO type III examination and self esteem was estimated using the Rosenberg Self Esteem Scale score (RSES). The descriptive and inferential analysis of the data was done by using IBM SPSS software. Logistic and linear regression analysis was executed to test the individual association of different independent clinical variables with self esteem.

RESULTS

Total sample of 1140 adolescents with mean age of 14.95 ±2.08 and RSES of 27.09 ±3.12 were considered. Stepwise multiple linear regression analysis was applied and best predictors in relation to RSES in the descending order were Dental Health Component (DHC), Aesthetic Component (AC), dental decay {(aesthetic zone), (masticatory zone)}, tooth loss {(aesthetic zone), (masticatory zone)} and anterior fracture of tooth.

CONCLUSION

It was found that various dental disorders like malocclusion, anterior traumatic tooth, tooth loss and untreated decay causes a profound impact on aesthetics and psychosocial behaviour of adolescents, thus affecting their self esteem.

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.

Dental aesthetics perception and eating behavior in adolescence

BACKGROUND

This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment.

METHODS

Sixty-one adolescents, aged between 12 and 22 years (mean=15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire.

RESULTS

Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student's t-test and using Pearson's correlation analysis.

CONCLUSION

Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

The impact of an educational pamphlet on the awareness of parents about 4‒6-year-old children's oral habits and dentofacial discrepancies

Background. This study aimed to evaluate whether the parents’ knowledge about the adverse effects of oral habits and dentoskeletal discrepancies would improve by an educational pamphlet.

Methods. A parallel-group randomized clinical trial was conducted on parents in kindergartens of Shiraz, Iran, 2013. The parents completed a designed questionnaire to determine the pre-intervention score. The study group received an educational pamphlet on the oral habits and dentoskeletal discrepancies, in contrast to the control group. Three weeks later, the parents in both groups took the questionnaire again (post-intervention score). The primary outcome was a change in the parents’ knowledge about oral habits and dentoskeletal discrepancies, which was measured by 13 questions of the questionnaire. Each correct answer was given a positive point and each incorrect answer a negative point. The total pre- and post-intervention scores were calculated by summing up the points and compared using Mann–Whitney U test.

Results. A total of 550 subjects were assessed for eligibility and 413 were randomized. Of the study group, 203 subjects (98.56%), and of the control group, 204 parents (98.54%) completed the questionnaire for the second time. The score of the study group in the "normal occlusion" section of the questionnaire had significantly improved (P < 0.001) and in the "oral habits" section the score of both groups had improved but in the study group the improvement was significantly higher (P < 0.001).

Conclusion. The educational pamphlet can be effective in increasing the level of parents’ knowledge about normal occlusion and complications of oral habits.

Impact of malocclusion on oral health-related quality of life in 10-14-year-old children of Mumbai, India

Aims and Objectives:

The aim and objective of this study was to establish the relationship of oral health-related quality of life (OHRQoL) as assessed by the Child Perception Questionnaire (CPQ 11–14) with the Index of Orthodontic Treatment Need (IOTN) and the child's apprehension with his/her dental appearance and how upset the child would feel if he/she is unable to obtain orthodontic treatment.

Materials and Methods:

An observational cross-sectional study was conducted among 604 children between the age group of 10–14 years to analyze the effect of malocclusion on the quality of life of children on the basis of impact on oral symptoms, functional limitation, emotional well-being, and social well-being. Malocclusion was evaluated using the IOTN, and the CPQ 11–14 was used to study the OHRQoL in children. The collected data were then subjected to statistical analysis.

Statistical Analysis:

Spearman's correlation coefficient was used to analyze the data statistically.

Results:

Out of the 604 children examined, boys showed effect on emotional well-being, whereas girls showed a significant correlation on both emotional and social well-being. There was a statistically significant correlation between IOTN and all the four domains of CPQ scores with respect to the two questions that were added to the CPQ questionnaire.

Conclusion:

A questionnaire when developed specifically for determining the effect of malocclusion on OHRQoL focusing more on emotional and psychological impact and less on oral symptoms and functional limitation will provide advantages of having limited questions, being less time-consuming, and providing better understanding of the patients’ concern.

Craniodentofacial characteristics, dental esthetics-related quality of life, and self-esteem

INTRODUCTION

Self-esteem is a psychological trait that may develop in interaction with craniodentofacial esthetics. The aim of this study was to explore the relationship among craniodentofacial characteristics, dental esthetics-related quality of life, and self-esteem in adolescents and young adults.

METHODS

The study was cross-sectional; the sample included 200 pupils and university students (58% female) aged 13 to 33 years. The Rosenberg Self-Esteem Scale and the Psychosocial Impact of Dental Aesthetics Questionnaire were used. Craniodentofacial features were estimated by the method of Martin and Saller, the Index of Orthodontic Treatment Need, and the Index of Complexity, Outcome and Need.

RESULTS

When malocclusion severity increases, dental esthetics-related quality of life decreases. The multiple linear regression showed that with the control of all other predictors in the model, the social impact of dental esthetics, borderline dental self-confidence, and facial type contribute the most to explain the variability of self-esteem, accounting for 3.2%, 1.3%, and 1.4%, respectively, of the variability values. The whole model accounts for 24.2% of the variability of self-esteem.

CONCLUSIONS

In adolescents and young adults, self-esteem appears to be more influenced by the self-perceived psychosocial impacts of dental esthetics than the normative level of malocclusion, craniofacial typology, sex, or age.

Mediation and moderation effect of the big five personality traits on the relationship between self-perceived malocclusion and psychosocial impact of dental esthetics

OBJECTIVE

To explore the mediation and moderation effects of personality traits on the relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics.

MATERIALS AND METHODS

The sample included 252 subjects (62% female) aged 12-39 years. Self-perceived malocclusion was estimated using the 10-point scale Aesthetic Component of the Index of Orthodontic Treatment Need. The Psychosocial Impact of Dental Aesthetics Questionnaire was used to assess the psychological impact and the Big Five Inventory for personality traits. Moderation and mediation effects were evaluated with Pearson correlations and stepwise regression analysis, respectively.

RESULTS

Self-perceived malocclusion ranged from 1 to 8 and was the most significant predictor of psychosocial impact of dental esthetics, whose unique contribution accounted for 11%-36.4% of variability, while age and sex accounted for 1.2%-2.5%. Personality traits had no mediating effect on this relationship. The moderating effect of agreeableness was present in the relationship between self-perceived degree of malocclusion and Social Impact (SI), Psychological Impact (PI), and Aesthetic Concern (AC) (ΔR2  =  0.035, 0.020, and 0.013, respectively; P < .001), while conscientiousness affected the relationship between perception of malocclusion and SI and PI (ΔR2  =  0.018 and 0.016, respectively; P < .05). In people with lower agreeableness and conscientiousness, increasing the severity of self-perceived malocclusion leads to less increase in SI and PI. In people with lower agreeableness, the increase influences AC in a similar manner. Extraversion, neuroticism, and openness do not have a moderating effect.

CONCLUSIONS

The relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics appears to be moderated and not mediated by personality traits. Adolescents and young adults with lower agreeableness and conscientiousness seem to be less affected by the increased severity of self-perceived malocclusion, as demonstrated in reporting some psychosocial impacts.

Association of malocclusion, happiness, and oral health-related quality of life (OHRQoL) in schoolchildren

OBJECTIVE

The aim of this study was to assess the impact of malocclusion on children's oral health-related quality of life (COHRQoL) and self-reported happiness.

METHODS

A cross-sectional study was conducted in a representative sample of 12-year-old schoolchildren from Santa Maria, South Brazil. Four calibrated examiners carried out clinical exams to evaluate malocclusion [Dental Aesthetic Index (DAI)], dental caries (DMFT), and dental trauma (O'Brien classification, used in the Children's dental health survey in the UK, 1994). Participants answered the Brazilian versions of the Child Perceptions Questionnaire (CPQ11-14 ) and the Subjective Happiness Scale (SHS). Parents completed a structured questionnaire regarding socioeconomic status. Data analysis was conducted using multilevel Poisson regression models.

RESULTS

A total of 1,134 adolescents (boys: 45.8 percent; girls: 54.1 percent) were enrolled in the study. The DAI overall score ranged from 13 to 63 (mean: 25.19, standard error: 0.19); 57.6 percent of the subjects had minor or no malocclusion and 24.4 percent had definite malocclusion. Severe malocclusion and handicapping malocclusion were found in 10.4 percent and 7.4 percent of the subjects, respectively. After adjustment, the severity of malocclusion was associated with high mean values of the CPQ11-14 overall score, and the emotional well-being and social well-being domains were the most affected. Lower levels of happiness were also associated with the severity of malocclusion: those with definite malocclusion presented lower scores on the SHS scale (Rate Ratio 0.97; 95 percent CI 0.94-0.99).

CONCLUSION

Malocclusion had a negative impact on COHRQoL and happiness, mainly on the emotional and social domains.

Dissatisfaction with dentofacial appearance and the normative need for orthodontic treatment: determinant factors

Objective

This study aims at assessing the normative need for orthodontic treatment and the factors that determine the subjective impact of malocclusion on 12-year-old Brazilian school children.

Methods

A total of 451 subjects (215 males and 236 females) were randomly selected from private and public schools of Juiz de Fora, Brazil. The collected data included sociodemographic information and occlusal conditions. The esthetic subjective impact of malocclusion was assessed by means of the Orthodontic Aesthetic Subjective Impact Score - OASIS, whereas the malocclusion and the need for orthodontic treatment were assessed by means of the Dental Aesthetic Index (DAI) and the Index of Orthodontic Treatment Need-Aesthetic Component (IOTN-AC).

Results

Prevalence of normative need for orthodontic treatment was 65.6% (n = 155), and prevalence of orthodontic esthetic subjective impact was 14.9%. The following variables showed significant association with esthetic subjective impact of malocclusion: female (p = 0.042; OR = 0.5; CI = 0.2-0.9), public school student (p = 0.002; OR = 6.8; CI = 1.9-23.8), maxillary overjet ≥ 4 mm (p = 0.037; OR = 1.7; CI = 1-3) and gingival smile ≥ 4 mm (p = 0.008; OR = 3.4; CI = 1.3-8.8).

Conclusion

The normative need for orthodontic treatment overestimated the perceived need. Occlusal and sociocultural factors influenced the dissatisfaction of schoolchildren with their dentofacial appearance.

[Need for orthodontic treatment among Brazilian adolescents: evaluation based on public health]

OBJECTIVE

To identify the prevalence and the severity of malocclusions and to analyze factors associated with the need for orthodontic treatment of Brazilian adolescents.

METHODS

This exploratory, cross-sectional study was carried out based on secondary data from the national epidemiological survey on oral health in Brazil (2002-2003). Socio-demographic conditions, self-perception, and the existence and degree of malocclusion, using the Dental Aesthetic Index, were evaluated in 16,833 adolescent Brazilians selected by probabilistic sample by conglomerates. The dependent variable - need orthodontic treatment - was estimated from the severity of malocclusion. The magnitude and direction of the association in bivariate and multivariate analyzes from a Robust Poisson regression was estimated.

RESULTS

The majority of the adolescents needed orthodontic treatment (53.2%). In the multivariate analysis, the prevalence of the need for orthodontic treatment was larger among females, non-whites, those that perceived a need for treatment, and those that perceived their appearance as normal, bad, or very bad. The need for orthodontic treatment was smaller among those that lived in the Northeast and Central West macro-regions compared to those living in Southeast Brazil and it was also smaller among those that perceived their chewing to be normal or their oral health to be bad or very bad.

CONCLUSIONS

There was a high prevalence of orthodontic treatment need among adolescents in Brazil and this need was associated with demographic and subjective issues. The high prevalence of orthodontic needs in adolescents is a challenge to the goals of Brazil's universal public health system.

Translation and validation of a Nepalese version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ)

OBJECTIVE

The aim of this study was to develop a reliable and valid Nepali version of the Psychosocial Impact of Dental Aesthetic Questionnaire (PIDAQ).

DESIGN

Cross-sectional descriptive validation study.

SETTINGS

B.P. Koirala Institute of Health Sciences, Dharan, Nepal.

METHODS

A rigorous translation process including conceptual and semantic evaluation, translation, back translation and pre-testing was carried out. Two hundred and fifty-two undergraduates, including equal numbers of males and females with an age ranging from 18 to 29 years (mean age: 22·33±2·114 years), participated in this study. Reliability was assessed by Cronbach's alpha coefficient and the coefficient of correlation was used to assess correlation between items and test-retest reliability. The construct validity was tested by factorial analysis. Convergent construct validity was tested by comparison of PIDAQ scores with the aesthetic component of the index of orthodontic treatment needs (IOTN-AC) and perception of occlusion scale (POS), respectively. Discriminant construct validity was assessed by differences in score for those who demand treatment and those who did not.

RESULTS

The response rate was 100%. One hundred and twenty-three individuals had a demand for orthodontic treatment. The Nepali PIDAQ had excellent reliability with Cronbach's alpha of 0·945, corrected item correlation between 0·525 and 0·790 and overall test-retest reliability of 0·978. The construct validity was good with formation of a new sub-domain 'Dental self-consciousness'. The scale had good correlation with IOTN-AC and POS fulfilling convergent construct validity. The discriminant construct validity was proved by significant differences in scores for subjects with demand and without demand for treatment.

CONCLUSION

To conclude, Nepali version of PIDAQ has good psychometric properties and can be used effectively in this population group for further research.

The influence of normative and subjective oral health status on schoolchildren's happiness

Background

Traditional methods to measure oral health based on clinical standards are limited because they do not consider psychosocial and functional aspects of oral health. It has been recommended that these measures need to be supplemented by data obtained from patients regarding their individual perceptions on oral health-related quality of life (OHRQoL). Happiness is a multidimensional construct comprising both emotional and cognitive domains, and has been defined as “the degree to which an individual judges the overall quality of his or her life as a whole favorably”. It has been associated with several health outcomes, including oral health. The aim of this study was to assess the impact of oral health conditions, oral health-related quality of life (OHRQoL), and socioeconomic factors on the subjective happiness of Brazilian adolescents.

Methods

A cross-sectional study was conducted in 2012 on a representative sample of 12-year-old schoolchildren in Santa Maria-RS, Brazil. The data were collected through dental examinations and structured interviews. The participants underwent an evaluation aimed at detecting dental caries, traumatic dental injuries, malocclusion, and gingival bleeding. They also completed the Brazilian versions of the Child Perceptions Questionnaire-short form (CPQ11–14 – ISF: 16) and the Subjective Happiness Scale (SHS), which was our outcome variable. Socioeconomic conditions were evaluated through a questionnaire that was completed by the participants’ parents. Poisson regression analysis was used to determine the association between the explanatory variables and the outcome. Moreover, a correlation analysis was performed to determine the relationship between the SHS scores and the overall and domain scores of the CPQ11–14 –ISF: 16.

Results

A total of 1,134 children were evaluated. Unadjusted analyses showed that happiness was associated with socioeconomic indicators, the use of dental services, clinical status, and scores on the OHRQoL measure. After adjustment, household overcrowding (RR: 0.96; 95% CI: 0.93-0.98), dental caries (RR: 0.98; 95% CI: 0.97-0.99), malocclusion (RR: 0.98; 95% CI: 0.96-0.99), and the severity associated with the CPQ11-14 (RR: 0.95; 95% CI: 0.93-0.97) still showed a significant association with lower levels of the mean SHS score.

Conclusions

Happiness is influenced by oral conditions, socioeconomic status, and OHRQoL.

Impact of malocclusion on oral health-related quality of life in young adults

OBJECTIVE

To assess oral health-related quality of life (OHRQoL) in young adult patients with malocclusion and to measure the association between orthodontic treatment need and OHRQoL.

MATERIALS AND METHODS

The study sample comprised 190 young adults aged 18 to 25 years who were attending orthodontic clinics at the Faculty of Dentistry. The Index of Orthodontic Treatment Need-Dental Health Component was used to measure orthodontic treatment need. Each participant was assessed for OHRQoL before and after treatment by using the Oral Health Impact Profile, Chinese version (OHIP-14).

RESULTS

Patients who had little or no, borderline, and actual need for orthodontic treatment represented 21.6%, 50.5%, and 27.9% of the total sample, respectively. OHRQoL (total OHIP-14 score and score for each domain) improved after treatment (P < .05). Significant differences in summary OHIP-14 scores were apparent with respect to orthodontic treatment need. Participants with high treatment need reported a significantly greater negative impact on the overall OHRQoL score. The greatest impact was seen in the psychological discomfort domain and the psychological disability domain.

CONCLUSION

Malocclusion has a significant negative impact on OHRQoL. This is greatest for the psychological discomfort and psychological disability domains. The orthodontic treatment of malocclusion improves OHRQoL of patients.

Effect of malocclusion or orthodontic treatment on oral health-related quality of life in adults

Objective

The purpose of this study was to evaluate the effect of malocclusion or orthodontic treatment on oral health-related quality of life (OHRQoL) in adults.

Methods

The sample consisted of 860 adults (378 men and 482 women, aged 18-39 years) who were clinically evaluated for malocclusion or orthodontic treatment experience. Participants were divided into 4 groups as follows: normal occlusion, malocclusion, fixed treatment, and retention. OHRQoL was assessed with the short form of the Oral Health Impact Profile (OHIP-14) and Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ).

Results

The malocclusion group and the fixed treatment group had significantly higher OHIP-14 scores than the normal occlusion group and the retention group (p < 0.001). The malocclusion group had the highest PIDAQ score, while the normal occlusion group and the retention group had the lowest PIDAQ score (p < 0.001). Women had higher OHIP-14 and PIDAQ scores than men. A significant positive correlation was found between OHIP-14 and PIDAQ scores (p < 0.01).

Conclusions

Malocclusion has a negative impact on OHRQoL, but this could be improved in adults through orthodontic treatment. These OHRQoL questionnaires can provide additional useful information on specific aspects of orthodontic patients' psychological state.

The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies

BACKGROUND

Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life.

OBJECTIVES

To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents.

MATERIALS AND METHODS

Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.

RESULTS

The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL.

CONCLUSION

The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.

Development of the Chinese version of the Oro-facial Esthetic Scale

The aim of this study was to investigate the psychometric properties of the Oro-facial Esthetic Scale among Chinese-speaking patients. The original Oro-facial Esthetic Scale was cross-culturally adapted in accordance with the international standards to develop a Chinese version (OES-C). Unlike the original Oro-facial Esthetic Scale, the version employed in this study used a 5-point Likert scale with items rated from unsatisfactory to most satisfactory. Psychometric evaluation included the reliability and validity of the OES-C. The reliability of the OES-C was determined through internal consistency and test-retest methods. The validity of OES-C was analysed by content validity, discriminative validity, construct validity and convergent validity. The corrected item-total correlation coefficients of the OES-C ranged from 0·859 to 0·910. The inter-item correlation coefficients between each two of the eight items of the OES-C ranged from 0·766 to 0·922. The values of ICC ranged from 0·79 (95% CI = 0·54-0·98) to 0·93 (95% CI = 0·87-0·99), indicating an excellent agreement. Construct validity was proved by the presence of one-factor structure that accounted for 83·507% of the variance and fitted well into the model. Convergent validity was confirmed by the association between OES-C scores and self-reported oral aesthetics and three questions from the Oral Health Impact Profile related to aesthetics (correlation coefficients ranged from -0·830 to -0·702, P < 0·001). OES-C scores discriminated aesthetically impaired patients from healthy controls. This study provides preliminary evidence concerning the reliability and validity of the OES-C. The results show that the OES-C may be a useful tool for assessment of oro-facial esthetics in China.

Malocclusion impacts adolescents' oral health-related quality of life

OBJECTIVE

To test the hypothesis that malocclusion does not have an independent and negative effect on quality of life of adolescents.

MATERIALS AND METHODS

The cross-sectional design study comprised a sample of 519 children, aged 11 to 14 years, attending public schools in Osorio, a city in southern Brazil. One calibrated examiner carried out clinical examinations and recorded dental caries (decayed/missing/filled teeth), malocclusion (Dental Aesthetic Index), and dental trauma. Participants completed the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14), Impact Short Form, and their parents or guardians answered questions about socioeconomic status. Simple and multivariate linear regressions were performed to assess covariates for the overall CPQ11-14 scores.

RESULTS

Greater impacts on oral health-related quality of life were observed for girls (P  =  .007), children with a lower household income (P  =  .016), those living in nonnuclear families (P < .001), and those with more decayed/missing/filled teeth (P  =  .001). Malocclusion was also associated with oral health-related quality of life: the severity of malocclusion was significantly related to higher scores of CPQ11-14 even after scores were adjusted for control variables. CPQ11-14 increased by approximately 1 point for each increase in the severity of malocclusion.

CONCLUSIONS

Malocclusion has a negative effect on adolescents' quality of life, independent of dental caries or traumatic dental injuries. Socioeconomic inequalities and clinical conditions are important features in adolescents' quality of life.

Psychosocial predictors of affect in adult patients undergoing orthodontic treatment

In this paper we propose to study the role of psychosocial variables in affect in adult patients undergoing orthodontic treatment, considering that affect is a key variable in treatment adherence. Seventy-four patients (average age 33,24 ± 10,56) with metal multibracket-fixed orthodontic treatment were included. Patients were assessed twice. The first stage, at the beginning of treatment, included assessment of dental impact (Psychosocial Impact of Dental Aesthetics Questionnaire), trait anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg's self-esteem scale), and self-efficacy (General Self-efficacy Scale). In the second stage, 6 months later, positive and negative affect towards treatment was assessed using the Positive and Negative Affect Scale. Dental social impact differentiates between patients with high and low negative affect, while self-efficacy differentiates between patients with high and low positive affect. Trait anxiety and self-esteem differentiate between both types of affect (positive and negative). Trait anxiety and self-esteem (when trait anxiety weight is controlled) are significant predictor variables of affective balance. These results have important practical implications, because it seems essential to adopt a bio-psychosocial model incorporating assessment methods focusing on day-to-day changes in mood and well-being.

Malocclusion, dental aesthetic self-perception and quality of life in a 18 to 21 year-old population: a cross section study

BACKGROUND

Aesthetic alterations in the face can be self-perceived and can affect quality of life. For young people, physical attractiveness is an important factor affecting social relationships. The aim of this study was to estimate the prevalence of malocclusion, identify the most common types and test its association with oral aesthetic self-perception in 18 to 21 year-old population of male young adults.

METHODS

A cross-sectional study was carried out involving 138 Brazilian Army soldiers. Data collection included socio demographic profile, malocclusion status through the Dental Aesthetic Index (DAI) and oral aesthetic self-perception as indicated by the Oral Aesthetic Subjective Impact Scale (OASIS). The chi-square and Fisher's exact test were used to test for homogeneity of proportions. The stepwise multivariate logistic regression analysis was used to test for the relationship between the poorer oral aesthetic self-perception and parental and soldier's education, per capita income, history of caries in all teeth and only on anterior teeth, dental trauma, previous orthodontic treatment and malocclusion.

RESULTS

The prevalence of malocclusion was 45.6%. Incisor teeth crowding and misalignment of lower incisors were the most common types of malocclusions. A statistically significant and independent association between malocclusion and poorer oral aesthetic self-perception in the multivariate analysis was observed. Subjects with severe malocclusion conditions showed 88% higher prevalence [prevalence ratio =1.88 (95% CI, 1.30 - 2.72); p = 0.001] of poorer aesthetic self-perception comparing to those with minor malocclusion.

CONCLUSIONS

A high prevalence of malocclusion was observed. The young adults presenting severe malocclusion had a higher and independent prevalence of poorer oral aesthetic self-perception.

Malocclusion and oral health-related quality of life in Brazilian school children

OBJECTIVE

To test the hypothesis that malocclusion and its impact on quality of life has no effect on 8- to 10-year-old Brazilian schoolchildren as measured by an oral health-related quality of life (OHRQoL) instrument.

MATERIALS AND METHODS

A cross-sectional study was carried out with a population-based sample of 1204 8- to 10-year-old children attending elementary schools in Belo Horizonte, Brazil. Dental examinations were carried out by two calibrated examiners. OHRQoL was assessed using the Brazilian version of the Child Perceptions Questionnaire. The Dental Aesthetic Index was used for the clinical assessment of malocclusion. Dental caries and socioeconomic factors were used as controlling variables. Bivariate analysis involved the chi-square test and the Fisher exact test. A Poisson regression model was employed for the multivariate analysis (P < .05).

RESULTS

Anterior segment spacing and anterior mandibular overjet were significantly associated with impact on OHRQoL (P < .05). Schoolchildren with malocclusion were 1.30-fold (95% CI: 1.15-1.46; P < 0.001) more likely to experience a negative impact on OHRQoL than those without malocclusion. Children belonging to families with an income less than or equal to two times the minimum wage were 1.59-fold (95% CI: 1.35-1.88; P < 0.001) more likely to experience a negative impact on OHRQoL than those belonging to families with the highest income.

CONCLUSIONS

Schoolchildren with malocclusion from lower-income families experience a greater negative impact on OHRQoL.

Effect of incisor position on the self-perceived psychosocial impacts of malocclusion among Chinese young adults

OBJECTIVE

To evaluate the impact of the incisor position on the self-perceived psychosocial impacts of malocclusion among Chinese young adults.

MATERIALS AND METHODS

This cross-sectional study included a convenience sample of 17.1- to 22.3-year-old young adults (n = 1005). The five groups represented were normal occlusion as well as incisor Class I, Class II/1, Class II/2, and Class III malocclusion. For clinical assessment, the incisor relationship was evaluated according to the British Standards Institute Incisor Classification, and the self-perception of dental esthetics was assessed using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Statistical analysis involved the analysis of variance and Tukey multiple-comparison post hoc tests.

RESULTS

Psychosocial impacts were different among the five groups for the four PIDAQ domains (P < .001 for all four domains). Statistically significant differences were found between the four malocclusion groups and the normal occlusion group in all four domains (P < .001 for all four domains). Furthermore, statistically significant differences were found between four malocclusion groups.

CONCLUSIONS

All four malocclusion groups had more severe psychosocial impacts than the normal occlusion group in the four PIDAQ domains. Statistically significant differences were also found between the four malocclusion groups; these malocclusion groups ranked by score, highest to lowest, were Class III, Class II/1, Class II/2, and Class I.

The impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions

OBJECTIVE

To investigate the impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions and to identify components of malocclusion that may contribute to these outcomes.

MATERIALS AND METHODS

The sample comprised 704 secondary school adolescents aged 12 to 13 years from Balneário Camboriú, Brazil. A trained and calibrated orthodontist examined the severity of malocclusion using the Dental Aesthetic Index (DAI). A pretested questionnaire was used to assess reported dental appearance, self-perception of speech, and self-perception of masticatory function using a 5-point scale of oral health status. The outcomes of the present study were dissatisfaction with dental appearance and dissatisfaction with oral functions. Simple and multivariate logistic regression analysis was performed to explore the association between DAI and outcomes and to quantify the effect of DAI components on dissatisfaction with dental appearance.

RESULTS

Each DAI unit increase led to a significant increase of 5% in the likelihood of dissatisfaction with dental appearance (OR: 1.05; 95% CI 1.01-1.08). DAI components that exerted influence on dissatisfaction with dental appearance were: missing teeth (P  =  .010), largest maxillary anterior irregularity ≥3 mm (P  =  .013), and largest mandibular anterior irregularity ≥2 mm (P  =  .008). There was no association between severity of malocclusion and dissatisfaction with oral functions.

CONCLUSIONS

Severity of malocclusion interfered with satisfaction of dental appearance in this population. Missing teeth and anterior irregularity were identified as factors influencing this outcome.

Malocclusions and perceptions of attractiveness, intelligence, and personality, and behavioral intentions

INTRODUCTION

In this study, we explored how others perceive persons with normal occlusion or different malocclusions (open bite, deepbite, underbite, overjet, crowding, and spacing). The objectives were to investigate (1) how occlusion affects others' perceptions of attractiveness, intelligence, and personality, and their desire to interact in personal and professional settings, and (2) whether these assessments are affected by the target person's sex or the respondent's characteristics.

METHODS

Survey data were collected from 889 patients or accompanying adults (46% male, 54% female; age range, 18-90 years) who evaluated target photos that had been manipulated to display either a normal occlusion or 1 of 6 malocclusions.

RESULTS

The ratings of attractiveness, intelligence, conscientiousness, agreeableness, and extraversion differed significantly depending on the occlusion status depicted. Persons with normal occlusion were rated as most attractive, intelligent, agreeable, and extraverted, whereas persons with an underbite were rated as least attractive, intelligent, and extraverted. Female targets were rated more positively than male targets. Younger respondents and more educated respondents were more critical in their evaluations than were older and less educated respondents.

CONCLUSIONS

Occlusion status affects a person's perceptions comprehensively. Subjects with normal occlusion were rated the most positively.

Influence of dental esthetics on social perceptions of adolescents judged by peers

INTRODUCTION

The relationship between physical appearance and social attractiveness is well established in the literature. The purpose of this study was to determine whether dental esthetics influenced the perceptions of teens when judging a peer's athletic, social, leadership, and academic abilities.

METHODS

The frontal-face smiling photographs of 10 teenage volunteers were each altered to create 1 image with an ideal arrangement of teeth and 1 with a nonideal arrangement. Two parallel surveys were constructed with 1 photo displaying either an ideal or a nonideal smile image of each subject. If the ideal smile image appeared in 1 survey, then the nonideal smile appeared in the other. Two hundred twenty-one peer evaluators successfully rated the pictures in 1 of the surveys by indicating their perception of each subject's athletic, social, leadership, and academic abilities.

RESULTS

The subjects' photographs with ideal smile esthetics were consistently rated higher on average than the same subjects' images with nonideal smile esthetics. The differences in ratings between ideal and nonideal smiles were significant for perceptions of athletic performance (P = 0.0141), popularity (P <0.0001), and leadership ability (P <0.0001), but not for academic performance (P = 0.0548).

CONCLUSIONS

On average, ratings for the ideal smiles in perceived athletic, social, and leadership skills were about 10% higher than those given for images with nonideal smiles. Based on these findings, it would be expected that orthodontic treatment resulting in improved smile esthetics can provide modest social benefits for adolescent patients.