Does psychological well-being influence oral-health-related quality of life reports in children receiving orthodontic treatment?

Effects of wearing fixed orthodontic appliance on dynamic balance, reaction time, and pain perception in adolescents and young adult elite athletes

OBJECTIVE

To investigate the effects of using fixed orthodontic appliance on dynamic balance, auditory/visual reaction times, as well as pain perception in adolescent and young adult elite athletes.

METHODS

A total of 34 elite athletes (n = 19 males) aged 16-21 years from different sports (track and field sprint, long jump and discus throw) were randomly allocated to treatment (n = 17) or control (n = 17) groups. The treatment group received self-ligating brackets with 0.04 cm super-elastic nickel-titanium arch wire, placed in the brackets to correct the teeth position. Perceived pain (i.e., visual analogue scale), dynamic balance (i.e., Y balance test), and auditory reaction time and visual reaction time using Direct RT software were assessed before (day-1), and on five occasions after fixed orthodontic appliance placement (day+1, +3, +7, +14, and +30). The two groups' quantitative data [expressed as mean (standard deviation)] for each occasion were compared using the Student's t-test. Comparisons of the Y-balance test, auditory reaction time, visual reaction time, and pain visual analogue scale data were each made between the 6 occasions via a factorial A × B analysis of variance in order to check for the possible interaction between the two groups and the (6) consecutive days (occasions).

RESULTS

Compared to the control group, the treatment group showed significantly (i) lower values of anterior reach for both the dominant ([78(4) vs. 75(3)%, respectively]) and the non-dominant [76(3) vs. 74(4)%, respectively] legs at day+3, and (ii) higher values of pain visual analogue scale at day+1, day+3, and day+7 [0.00(0.00) vs. 4.94(1.25); 0.00(0.00) vs. 4.12(1.17), and 0.00(0.00) vs. 0.41(0.51), respectively). Factorial analysis of variance revealed that only pain visual analogue scale values were different between the two groups at day+1 and day+3.

CONCLUSION

FOA induced a high pain level during the first week following its placement in elite athletes.

The effect of somatic pain and comorbid mental distress on oral health-related quality of life in orthodontic patients

OBJECTIVES

The purpose of the present study was to evaluate the prevalence of somatic pain in orthodontic patients and determine whether somatic pain contributes to worsening oral health-related quality of life (OHRQoL) through the mediating effect of psychological discomfort.

MATERIALS AND METHODS

Scale measurements and analyses were conducted on a cohort of 769 orthodontic outpatients, encompassing Patient Health Questionnaire-15-pain (PHQ-15-P), Hua-Xi Emotional-Distress Index (HEI), Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and Oral Health Impact Profile-14 (OHIP-14).

RESULTS

Among the respondents, 56.3% (N = 433) reported somatic pain and 20.0% (N = 154) had mental discomfort based on PHQ-15-P and HEI scores. Patients with somatic pain symptoms had significantly higher scores of HEI and OHIP-14 (P < 0.001), and higher PHQ-15-P and HEI scores emerged as statistically significant predictors of lower OHIP-14 scores (P < 0.001). HEI scores which assessed anxiety and depression partially mediated the correlation between PHQ-15-P and OHIP-14 scores, of which anxiety accounted for 52.9% of the overall mediation effect, dominating the indirect effect.

CONCLUSION

Orthodontic patients reporting somatic pains were at a significantly higher risk of worsening OHRQoL during treatment, and this adverse effect is partially mediated by anxiety and depression.

CLINICAL RELEVANCE

Our findings highlight the necessity for the assessment of general health and mental well-being during orthodontic interventions. To prevent delays in treating general disorders and the potential failure of orthodontic treatments, we encourage increased attentiveness towards patients with somatic symptoms and consideration of the adverse effects of comorbid mental distress.

Orthodontic Patients with Poor Oral Health-Related Quality of Life are More Likely to Have Emotional Distress: A Cross-Sectional Study

OBJECTIVE

This study aims to investigate the relationship between oral health-related quality of life (OHRQoL) and emotional distress (ED), including anxiety and depression, in orthodontic patients.

METHODS

A cross-sectional study was conducted involving 603 orthodontic patients, consisting of 401 females (66.5%) with a mean age of 24.15 ± 7.72 and 202 males (33.5%) with a mean age of 24.16 ± 7.72. A questionnaire containing questions of demographic information, the Oral Health Impact Profile (OHIP-14) and the Huaxi emotional-distress index (HEI) was employed to assess OHRQoL and ED. According to the HEI score, the respondents were divided into ED group (HEI > 8) and non-ED group (HEI ≤ 8). Data were analyzed using Kolmogorov-Smirnov test, Mann-Whitney test and logistic regression analysis with the significance level set at p < 0.05.

RESULTS

The prevalence of poor OHRQoL and ED of the study sample was 28.4% and 19.57%, respectively. There was a significantly higher prevalence of ED among poor OHRQoL patients (35.67%) compared to those with good OHRQoL (13.19%) (p < 0.001). Poor OHRQoL and risky drinking behavior addressed higher significant correlation with ED patients than non-ED patients (p < 0.05). There were no statistical differences in other factors such as gender, age, and appliance type (p > 0.05). Poor OHRQoL orthodontic patients were at a higher risk of suffering from anxiety and depression compared to those with good OHRQoL (age-risky drinking behavior-sex-adjusted: OR = 4.00; all p < 0.001).

CONCLUSION

Oral health-related quality of life (OHRQoL) is related to emotional stress. Namely, patients with poor OHRQoL are more likely to experience anxiety and depression. As a result, orthodontists should consistently assess the emotional well-being and OHROoL of patients over the treatment course for better treatment outcomes.

Body Image and Psychological Impact of Dental Appearance in Adolescents with Malocclusion: A Preliminary Exploratory Study

BACKGROUND

Body image and psychosocial functioning represent central challenges during adolescence and early adulthood. Malocclusion, defined as an irregularity in the alignment of the teeth, is known to negatively influence psychological outcomes. The current study aimed to elucidate the role of malocclusion, together with age, gender, and dental class, in body image and psychological functioning.

METHODS

A total of 126 participants aged from 12 to 19 years old (mean: 15.87, SD: 2.35, female participants: 52.4%, male participants: 47.6%) were recruited. Participants were visited at the University Hospital of Messina, Italy, and completed a sociodemographic questionnaire, the Body Image Concern Inventory (I-BICI), and the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ).

RESULTS

Significant correlations were found between age, dental class, the BICI, and the PIDAQ. In particular, age showed a positive and significant correlation with PIDAQ-total score. The correlations between occlusal status and the BICI variables were all significant and positive. All correlations between occlusal status and the PIDAQ variables were all significant and positive, except for dental self-confidence. The correlations between the variables of the PIDAQ and BICI instruments were all significant and positive, except for dental self-confidence, where the directions were significant and negative. Moreover, age, gender, and occlusal status predicted BICI and PIDAQ scores. Age was a positive predictor for PIDAQ self-confidence, gender for BICI and PIDAQ total scores, along with dysmorphic symptoms, social impact, psychological impact, and aesthetic concerns. Several significant gender differences were highlighted by the analyses, with higher scores in the female group on all the BICI variables, except symptom interference, and all the PIDAQ variables, except dental self-confidence.

CONCLUSIONS

Malocclusion appeared to play a central role in the psychological, representational, and psychosocial life of the participants. This research suggests that malocclusion and dental issues influence the psychological, representational, and psychosocial life of adolescents. Further research is required to examine the psychological impact of dental problems.

The Associations among Dental Anxiety, Self-Esteem, and Oral Health-Related Quality of Life in Children: A Cross-Sectional Study

BACKGROUND

The current evidence on the relationships among child oral health-related quality of life, dental anxiety, and self-esteem indicates that we need to investigate these relationships to improve our understanding of the associations. Therefore, the current research aimed to enhance this evidence and provide an overview of the participating children's oral-health-related quality of life (as measured by the CPQ_8-10), self-esteem (as measured by the Coopersmith SEI-SF), and dental anxiety (as measured by the CFSS_DS) and how these child-related outcome measures interacted and were related to one another.

METHOD

A cross-sectional survey was conducted on a random sample of school children (n = 1900) aged 8 to 10 years. The questionnaire was collected through validated self-report measures: dental anxiety, COHRQoL, and self-esteem. Structural equation modelling (SEM) was used to test the strength of the association of our model to explore the relationships among these three psychological constructs. The moderating effects of age, gender, location, and the educational board were analysed for their possible influence on these relationships.

RESULTS

Significant relationships between COHRQoL and child dental anxiety and between COHRQoL and SE were detected. The relationship subscale between COHRQoL and child dental anxiety was 0.24, (p < 0.001). A stronger correlation between COHRQoL, and SE was found, with B = -0.77, (p < 0.001). Although the association between CDA and SE was small, it was statistically significant (p = 0.03). These findings provide some important background information for designing effective educational programs for children.

Impact of malocclusion treatments on Oral Health-Related Quality of Life: an overview of systematic reviews

OBJECTIVE

To perform an overview of systematic reviews (SR) assessing the impact of malocclusion treatments (Orthodontic Treatment - OT and/or Orthodontic Surgical Treatment - OST) on Oral Health-Related Quality of Life (OHRQoL).

MATERIALS AND METHODS

A search strategy was conducted in electronic databases until June 7th, 2021, followed by a manual search in grey literature and registration databases. Two independent authors applied the eligibility criteria, extracted the data, assessed the risk of bias (AMSTAR-2), and performed the certainty of evidence (GRADE) evaluation. Meta-analysis was planned to be carried out in RevMan 5.3 (with 95% confidence intervals (CI) considering p < 0.05), in case of homogeneous studies considering OHRQoL instrument and time of follow-up.

RESULTS

A total of 126 articles were accessed on the database, 18 registers, 33 records on grey literature and 3 articles by means of citation searching. After duplicates removal and eligibility criteria analyses, 15 SR were included. From that, 13 showed improvement in OHRQoL after OT and/or OST. The methodological quality ranges from high (n = 2), to critically low (n = 9). Meta-analysis was conducted. Improvement on OHRQoL after a 6-month OST using the OQLQ-22 (p < 0.00001; 19.65; CI: 12.60-26.70) and OHIP-14 instruments (p < 0.00001; 10.70; CI: 9.89-11.51); and after a 6-month OT using the CPQ 11-14 instrument (p = 0.010; 3.57; CI: 0.86-6.28) with very low certainty of the evidence for all outcomes was observed.

CONCLUSIONS

Although most SR selected in this overview are characterized by a critically low quality, as well as very low certainty of the evidence, OT and/or OST seem to have a positive impact in improving the OHRQoL.

CLINICAL RELEVANCE

The overview of existing systematic reviews compiled that OT and/or OST seem to have a positive impact on improving the OHRQoL. This information will facilitate clinical decision-making considering the clinical and psychological parameters.

Einfluss der Dauer kieferorthopädischer Behandlung auf das subjektive Empfinden der mundgesundheitsbezogenen Lebensqualität

Hintergrund Aufgrund der aktuell noch geringen Datenlage war es Ziel dieser Studie, den Einfluss der Dauer einer kieferorthopädischen Behandlung auf die mundgesundheitsbezogene Lebensqualität (MLQ) zu untersuchen.

Methode Die beobachtende, prospektive Längsschnittstudie erfolgte mit der deutschen Basisversion des Oral Health Impact Profile (OHIP-G14) im Zeitraum von 2008–2018. Die MLQ wurde zu drei Zeitpunkten (T1, T2, T3) bei 598 Patient*innen innerhalb ihrer kieferorthopädischen Behandlung erhoben und die Ergebnisse statistisch analysiert. Ein durchschnittlicher Anstieg (∆OHIP-G14) von>2,00 Punkten wurde als klinisch relevant (Minimal Important Difference, MID) und Zeichen einer herabgesetzten mundgesundheitsbezogenen Lebensqualität definiert.

Ergebnisse Von initial 598 eingeschlossenen Patient*innen füllten 79 ProbandInnen die Fragebögen zu allen drei Zeitpunkten vollständig aus und konnten in die Studie aufgenommen werden. Das Durchschnittsalter lag zu Beginn der Behandlung bei 11,5 Jahren (SD=3,3), am Ende der Behandlung bei 16,3 Jahren (SD=3,1). Die durchschnittliche Behandlungsdauer betrug 4,7 Jahre (SD=2,3). Ein Vergleich der erreichten Summenwerte zu den Zeitpunkten T1, T2, T3 der ernannten Subgruppen (Geschlechter, Altersgruppen, Behandlungsapparatur und -zeitraum) untereinander zeigte in keiner der Gruppen signifikante Unterschiede (Mann-Whitney-U-Test, Kruskal-Wallis-Test, Chi-Quadrat-Test p<0,05). Ein Vergleich der Gesamtwerte der jeweiligen Zeitpunkte zeigte eine klinisch (∆OHIP-G14>2,00) und statistisch signifikante Abnahme der MLQ während der initialen Behandlungsphase (T1 vs. T2, p<0,001). Die Verbesserung der MLQ am Ende der Behandlung (T2 vs. T3) war statistisch nicht signifikant (p=0,128) und hatte keine klinische Auswirkung (MID ∆OHIP-G14<2,00). Weitere Analysen der Behandlungsdauer und der OHIP-Summenwerte ergaben zu keinem Zeitpunkt signifikante Abhängigkeit oder Korrelation zwischen Behandlungsdauer und MLQ (β2=− 0,078, β3=0,191, multiple lineare Regression, p=0,05; r2=0,073, r3=0,103, Spearman Korrelation, p=0,05).

Schlussfolgerung Im Vergleich zu T1 war die MLQ während der Behandlung sowohl zu T2 als auch T3 leicht herabgesetzt. Es kann jedoch festgestellt werden, dass der Durchschnitt der erhobenen Summenwerte zu allen drei Zeitpunkten der Befragung (T1, T2 und T3) im Normbereich der gesunden Allgemeinbevölkerung lag. Hinsichtlich der Kernfrage dieser Studie konnte kein Zusammenhang zwischen Behandlungsdauer und MLQ gezeigt werden. Das Anstreben eines guten Behandlungsergebnisses im Rahmen einer differenzierten kieferorthopädischen Therapie sollte daher nach Möglichkeit einem raschen Abschluss der Behandlung vorangestellt werden.

Satisfaction with smile appearance mediates oral health-related quality of life in adolescents regardless of orthodontic treatment need – a cross-sectional study

OBJECTIVES

To explore the relationship between adolescents' oral health-related quality of life (OHRQoL), satisfaction with smile appearance, treatment need and treatment demand through direct and serial mediation models.

MATERIALS AND METHODS

This cross-sectional study included 215 11-14-year-olds and their parents. The instruments included the Child Perceptions Questionnaire and the Index of Orthodontic Treatment Need. Satisfaction with smile appearance, orthodontic treatment demand and parental perception of their child's orthodontic treatment need was recorded on a Likert scale (0 = not at all to 4 = very much). Serial mediation models were used to assess the effects of malocclusion on the OHRQoL.

RESULTS

Objective treatment need explained less than 5% of the adolescents' OHRQoL. Serial mediation models through satisfaction with smile appearance, parental perception of their child's orthodontic treatment need, and patients' orthodontic treatment demand explained 23-25% of the variance.

CONCLUSIONS

Satisfaction with smile appearance mediates the OHRQoL in adolescents. Parents have no direct influence, but their perception of the need to correct their child's teeth might amplify adolescents' orthodontic treatment demand, leading to lower OHRQoL.

Impacts of using orthodontic appliances on the quality of life of children and adolescents: systematic review and meta-analysis

BACKGROUND

Although there are previous systematic reviews about the oral health-related quality of life (OHRQoL) impact among children and adolescents after orthodontics treatment, there is no definition for the magnitude of these impacts during the therapy.

OBJECTIVE

To systematically analyse the literature on changes in the quality of life of children and adolescents during orthodontic treatment.

LIMITATIONS

Almost all the studies included in this review are non-randomized clinical trials, which are susceptible to several biases that affect the certainty of evidence obtained, especially by confounding factors and the lack of a control group.

CONCLUSIONS AND IMPLICATIONS

Based on very low certainty of evidence, wearing appliances does not seem to have a significant negative impact during the first year of orthodontic treatment. However, the meta-analytic results suggest that functional limitations in the first 3 months of treatment can be slightly more critical for the impact on the oral health quality of life and consequent patient adherence to treatment.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (CAPES), Conselho Nacional de Desenvolvimento Científico e Tecnológico - Brazil (CNPq), and Fundação de Amparo à Pesquisa do Estado de Minas Gerais - Brazil (FAPEMIG).

REGISTRATION

CRD42021234407.

Orthodontic treatment demand in young adolescents - Are parents familiar with their children's desires and reasons?

AIM

To assess the levels of agreement between parents and adolescents about young adolescents' orthodontic treatment demand and to what extent is treatment demand conditioned by family and psychosocial impacts and oral function.

DESIGN

This cross-sectional study included 221 adolescents (11-14 years, 54% female) and their parents. A 5-point scale was used to assess orthodontic treatment demand. Adolescents self-administered the Child Perceptions Questionnaire, and parents self-administered the Parental-Caregivers Perceptions Questionnaire and Family Impact Scale. The Index of Orthodontic Treatment Need Dental Health Component (IOTN DHC) was used for determining malocclusion severity. Intraclass correlation coefficient and Cohen's kappa coefficient were used for the assessment of agreement between two informants.

RESULTS

The parent-child agreement on children's orthodontic treatment demand was weak, concording in 67.4% of cases. The most common reasons for seeking orthodontic treatment derive from the emotional (EW) and social well-being domains for both informants. In linear regression, the adolescent's reporting of impaired EW and IOTN DHC was the only significant linear predictor of orthodontic treatment demand.

CONCLUSION

Parents cannot correctly assess the orthodontic treatment demand of their children. Impaired EW is the most significant self-reported determinant of adolescents' demand for orthodontic treatment. Family relationships and parental perspective have a low influence.

Influence of personality traits on a patient's decision to accept orthognathic surgery for correction of dentofacial deformity

OBJECTIVES

To investigate the influence of personality traits in addition to quality of life (QoL) on the decision to accept orthognathic surgery.

MATERIALS AND METHODS

A total of 108 patients (68% female) aged 14-53 years (median, 18 years; interquartile range, 17-25.75 years), with skeletal malocclusions of Index of Orthognathic Functional Treatment Need grades 3-5 (moderate to very great need for surgery) were included in this cross-sectional study. Personality traits of extraversion, neuroticism, agreeableness, openness, consciousness, perfectionism, and self-esteem and dimensions of Orthognathic Quality of Life Questionnaire were compared between patients who accepted orthodontic preparation for orthognathic surgery and those who refused (n = 55 vs 53).

RESULTS

Patients who accepted the suggested surgical procedure had higher age, perfectionism, facial esthetic (FE) concern, social aspect, and impairment of oral function (OF) as well as lower self-esteem with small to medium effect sizes (P ≤ .040; r = 0.198-0.399). Other personality traits and awareness of dentofacial deformity did not differ between the groups. In multiple logistic regression analysis, while controlling for sex, perfectionism, and self-esteem, the following predictors of acceptance of orthognathic surgery were higher: FE concern (odds ratio [OR], 3.4; 95% confidence interval [CI], 1.3-9.1), OF (OR, 3.0; 95% CI, 1.0-8.6), and age ≥18 years (OR, 2.7; 95% CI, 1.0-7.1; P < .001).

CONCLUSIONS

Extraversion, neuroticism, agreeableness, conscientiousness, and openness do not significantly affect a patient's decision to accept orthognathic surgery. The influence of self-esteem and perfectionism is primarily on perception of alteration of QoL induced by dentofacial deformity.

Dentoskeletal effects of early class III treatment protocol based on timing of intervention in children

Background

To detect the optimal timing of intervention based on different cervical vertebral maturation stage (CS1-2 vs. CS3-4) for the treatment of Class III malocclusion with early Class III protocol.

Methods

A total sample of 43 patients (23 females, 20 males) ranging between 7 and 13 years of age with dentoskeletal Class III malocclusion treated with the modified SEC III (Splints, Elastic and Chincup) protocol divided into two groups based on the cervical vertebral maturation stages (CS1-2 and CS3-4) was included in this retrospective observational longitudinal study. Patient compliance was assessed using a 2-point Likert scale. Statistical comparisons between the two groups were performed with independent sample t tests.

Results

No statistically significant differences for any of the cephalometric variables describing the baseline dentoskeletal features were found between the two groups except for the mandibular unit length that was significantly greater in the pubertal group (P = 0.005). The modified SEC III protocol produced favorable sagittal outcomes in both groups, whereas no statistically significant T1-T2 changes were found between the CS1-2 and CS3-4 groups for any of the angular and linear measurements. No significant differences were found in the prevalence rates of the degree of collaboration between the two groups (P = 1.000).

Conclusions

No significant differences between prepubertal and pubertal patients were found in the sagittal and vertical dentoskeletal changes with the modified SEC III protocol. Thus, this early Class III treatment produced similar favorable effects in growing subjects regardless of the cervical vertebral maturation stages from CS1 to CS4.

A Comparative Study of Oral Health-Related Quality of Life among Cleft Lip and Palate Patients and Their Families during Orthodontic Treatment

(1) Background: It has been recognized that CLP condition may affect oral health-related quality of life (OHRQoL) due to dental anomalies and abnormal craniofacial development. Aim: To assess whether orthodontic treatment affected the levels of OHRQoL in CLP patients and their families. (2) Methods: 226 individuals (111 with cleft and 115 control) and their parents were invited to complete the Oral Health Impact Profile-14 (OHIP-14) and Family Impact Scale (FIS), respectively. The Mann–Whitney test was used for quantitative variables and the Fisher’s exact test for categorical variables. The Spearman Rank Correlation Coefficient was used to correlate the results of the OHIP and FIS questionnaires. (3) Results: No significant difference was found between groups in OHIP-14 but FIS score revealed a significant difference between the two groups evaluated (p < 0.001). Only the social limitation in OHIP score revealed a significant difference (p = 0.001). Regarding FIS score, the most affected dimensions were family activities (p < 0.001), parental emotions (p = 0.001), and family conflict (p = 0.011). (4) Conclusion: Undergoing orthodontic treatment had a similar impact on the overall quality of life in CLP patients and non-cleft patients. Parents of cleft children had a poorer OHRQoL compared to what was perceived by their children and parents of non-cleft children.

A qualitative study of orthodontic patients' experiences in quarantine during the COVID-19 pandemic outbreak

Introduction

Methods

Results

Conclusions

Validation of the Psychosocial Impact of Dental Aesthetics Questionnaire in the Australian population

INTRODUCTION

The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception need for orthodontic treatment. The study aimed to determine the psychometric validity and reliability of PIDAQ in Australian adults.

METHODS

Data were collected from the National Dental Telephone Interview Survey in 2013. The PIDAQ was used, comprising 4 conceptual domains: self-confidence, social impact, psychological impact, and esthetic concern. Psychometric sensitivity was estimated for each item. Confirmatory factor analysis was performed to determine factorial validity in which the ratio of chi-square by degrees of freedom, comparative fit, and root mean square error of approximation were used as indexes of the goodness of fit. Convergent validity was estimated from the average variance extracted and composite reliability, whereas internal consistency was estimated by Cronbach standardized alpha.

RESULTS

The dataset comprised 2936 Australian adults aged ≥18 years and separated randomly into 2 subdata sets. The kurtosis and skewness values indicate an approximation to a normal distribution for each item, with acceptable thresholds for the goodness of fit and convergent validity (average variance extracted ≥0.50 and composite reliability ≥0.70), and discriminant validity was also demonstrated. Internal consistency was adequate in the 4 conceptual domains for PIDAQ for both subdata sets, with Cronbach standardized alpha being ≥0.70.

CONCLUSIONS

The psychometric sensitivity, validity, and reliability of the PIDAQ instrument in a sample of the Australian adult population were found to be adequate. Both subdata sets drawn from the sample demonstrated acceptable goodness of fit and internal consistency.

Effect of treatment of transverse maxillary deficiency using rapid palatal expansion on oral health-related quality of life in children: A randomized controlled trial

INTRODUCTION

This trial aimed to longitudinally evaluate the effect of the treatment of transverse maxillary deficiency using rapid palatal expansion (RPE) on self-perceived oral health-related quality of life (OHRQOL) in children.

METHODS

Eighty participants aged 8-10 years with transverse maxillary deficiency and bilateral posterior crossbite were randomly assigned to 2 groups (n = 40 each): a group treated with RPE using hyrax-type appliances and a nontreated control group. OHRQOL was assessed by using the Child Perceptions Questionnaire for 8-10-year-olds at 4 times: before RPE, during RPE (T₁), at the end of RPE (T₂), and 1 month after the appliance removal (T₃). Generalized mixed models were used for data analysis (α = 0.05).

RESULTS

Both groups exhibited similar demographic characteristics and OHRQOL scores at baseline. All participants completed the study. RPE had a time-dependent effect on OHRQOL. At T₁ and T₂, this therapy is expected to increase the overall OHRQOL scores by 1.17 times (ie, ∼17% increase; T₁ 95% confidence interval [CI], 1.08-1.26; T₂ 95% CI, 1.09-1.27; P = 0.001). In contrast, the overall OHRQOL scores at T₃ are expected to be 0.28 times the baseline scores (ie, ∼72% reduction; T₃ 95% CI, 0.26-0.31; P = 0.001). All individual domains of the OHRQOL evidenced a positive impact of treatment at T₃ (P = 0.001). Only the oral symptoms and social well-being domains showed a significantly negative impact of the treatment at T₁ and T₂.

CONCLUSIONS

Correction of the transverse maxillary deficiency by RPE in children aged 8-10 years improves OHRQOL. There is a temporary worsening of OHRQOL during the treatment of this condition using RPE.

REGISTRATION

This trial was not registered.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

This study was financed by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil, Financing Code 001.

Associations between psychological wellbeing, depression, general anxiety, perceived social support, tooth brushing frequency and oral ulcers among adults resident in Nigeria during the first wave of the COVID-19 pandemic

INTRODUCTION

The aims of this study were to determine the associations between psychological wellbeing, and the frequency of tooth brushing and presence of oral ulcers during the COVID-19 pandemic; and to identify the mediating roles of psychological distress (general anxiety and depression) and perceived social support in the paths of observed associations.

METHODS

This cross-sectional study recruited 996 adults in Nigeria between June and August 2020. Data collected through an online survey included outcome variables (decreased frequency of tooth brushing and presence of oral ulcers), explanatory variable (psychological wellbeing), mediators (general anxiety symptoms, depression symptoms and perceived social support) and confounders (age, sex at birth, educational and employment status). Multivariate logistic regression was used to determine the risk indicators for the outcome variables. A path analysis was conducted to identify the indirect effect of mediators on the association between the outcome and explanatory variables.

RESULTS

Of the 966 respondents, 96 (9.9%) reported decreased tooth-brushing frequency and 129 (13.4%) had oral ulcers during the pandemic. The odds of decreased tooth-brushing during the pandemic decreased as the psychological wellbeing increased (AOR: 0.87; 95% CI: 0.83-0.91; p < 0.001) and as generalized anxiety symptoms increased (AOR: 0.92; 95% CI: 0.86-0.98; p = 0.009). The odds of having an oral ulcer was higher as the generalized anxiety symptoms increased (AOR: 1.15; 95% CI: 01.08-1.21; p < 0.001). Only generalized anxiety (indirect effect: 0.02; 95% CI: 0.01-0.04; P = 0.014) significantly mediated the relationship between wellbeing and tooth-brushing accounting for approximately 12% of the total effect of wellbeing on decreased toothbrushing. Generalized anxiety (indirect effect 0.05; 95% CI: - 0.07-0.03; P < 0.001) also significantly mediated the relationship between wellbeing and presence of oral ulcer accounting for 70% of the total effect of wellbeing on presence of oral ulcer. Depressive symptoms and perceived social support did not significantly mediate the associations between psychological wellbeing, decreased frequency of tooth brushing and the presence of oral ulcers.

CONCLUSION

Patients who come into the dental clinic with poor oral hygiene or oral ulcers during the COVID-19 pandemic may benefit from screening for generalized anxiety and psychological wellbeing to identify those who will benefit from interventions for mental health challenges.

Impact of self-esteem on the relationship between orthodontic treatment and the oral health-related quality of life in patients after orthodontic treatment - a systematic review

Objective

The treatment protocol in the modern health care paradigm has shifted considerably towards enhancing the quality of life in the last decade. This is particularly important in cosmetic and elective treatments, and hence the interest in oral health-related quality of life (OHRQoL) also has increased. OHRQoL always been measured by endogenous, functional, social, or psychological determinants. Self-esteem (SE) is one of the internal factors that affect the perception of malocclusion and hence OHRQoL before and after treatment. The purpose of this review is to assess whether there exists any correlation between the Oral Health-Related Quality of Life, Self-esteem (SE) in patients following orthodontic treatment.

Methods

A literature search was confined to the English language using Medical Subject Heading terms (MeSH) in PubMed, Cochrane Library, and Ovid® covering the period from January 1, 1951 to May 15, 2020. Search in Google Scholar, grey literature, and hand search on cross-references was performed to find additional data. The studies found to be suitable were selected based on the predefined inclusion and exclusion criteria. The quality of assessment and risk of bias for the included studies were evaluated independently by two invigilators utilizing "The Cochrane Collaboration's tool for assessing the risk of bias" and "Modified version of the Newcastle Ottawa scale" for Randomized Controlled Trials (RCTs) and non-randomized trials respectively.

Results

A total of 7688 studies were retrieved from all the sources. After screening all the titles and excluding the duplicates, 28 studies were finally included for text review, and all of them were fit for quality appraisal. The design of the final studies included comprised of 3 RCTs, 14 cohort studies, 9 cross-sectional studies, and 2 case-control studies.

Conclusion

There is moderate evidence to show that fixed orthodontic treatment improves OHRQoL and SE in children. OHRQoL also increased in adolescents and adults. However, there is a weak correlation between SE and OHRQoL. More evidence-based studies are needed to analyze the relationship.

Modelling risk factors for high/low Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) in the Australian adults

OBJECTIVE

Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception needed for orthodontic treatment (OT). The study aimed to (1) evaluate the psychosocial impact of dental aesthetics and the potential role of OT and (2) determine associations between PIDAQ with self-rated general and oral health, oral health-related quality of life (OHRQOL), and receipt of OT among Australian adults.

METHODS

Data were obtained from the 2013 Australian National Dental Telephone Interview Survey (NDTIS). The PIDAQ was utilized as main outcome, comprising items from four conceptual domains: self-confidence, social impact, psychological impact, and aesthetic concern. Participants reported their socio-demographic, behavioural, self-rated general and oral health as well as the poor OHRQOL using the Oral Impact on Daily Performance (OIDP) instrument and OT. The mean of PIDAQ and four subscales score and their 95% confidence intervals (CI) were estimated. Generalized liner regression was used to estimate association between PIDAQ and covariates by calculating the mean ratio (MR) and their 95% CI.

RESULTS

There were 2936 Australian adults who completed the PIDAQ items. The mean PIDAQ score was 28.8 (95% CI: 28.0-29.6). Higher PIDAQ scores were identified among those who reported non-Australian birth, lower incomes, infrequent dental visits, less than 21 teeth and brushing teeth less than twice a day, fair/poor self-rated general and oral health, and poor OHRQOL. In multivariable modelling, the mean PIDAQ score was 1.91 (95% CI: 1.82-2.00) times higher among those with OIDP score >3 and 1.06 (95% CI:1.01-1.10) times higher in those who had OT, comparing with their counterparts. Also, higher PIDAQ scores were identified among females, last visiting a dentist more than 2 years ago, fair or poor self-rated oral and general health.

CONCLUSIONS

Higher PIDAQ scores that have a greater impact on OHRQOL were associated with poorer self-rated general and oral health. This may be explained by unfavourable dental attendance and oral health habits. The positive correlation with OIDP scores verifies the validity of the PIDAQ. Those who had received OT had lower PIDAQ and OIDP scores.

A cross-sectional evaluation of the impact of Class II Division 1 malocclusion in treated and untreated adolescents on oral health-related quality of life

INTRODUCTION

The relationship between malocclusion, orthodontic treatment, and oral health-related quality of life (OHRQOL) is complicated, with some traits, such as increased overjet, having a potentially greater adverse effect on an adolescent's OHRQOL. The aim of this study was to evaluate the impact of malocclusion and orthodontic treatment on OHRQOL in adolescents presenting with Class II Division 1 malocclusion and explore the relationship between OHRQOL using a condition-specific and generic instrument and occlusal outcome.

METHODS

Two groups of adolescents were recruited from a United Kingdom university hospital: a pretreatment group of adolescents with Class II Division 1 malocclusion and a treated (posttreatment) group whose Class II Division 1 malocclusion had been corrected. Self-reported OHRQOL was assessed using the malocclusion impact questionnaire (MIQ) and the short form of Child Oral Health Impact Profile questionnaires. Occlusion severity and outcome were assessed using Peer Assessment Rating scores.

RESULTS

A total of 241 participants (106 male; 135 female) were recruited. MIQ scores differed significantly between the pretreatment and posttreatment groups, with scores being 11.35 times lower posttreatment than pretreatment, after adjusting for age and sex (95% confidence interval, -17.28 to -5.42; P <0.001). Females had higher total MIQ scores by 2.6 (95% confidence interval, 0.38 to 4.82), which was statistically significant (P = 0.022). There was a moderate correlation between MIQ and Peer Assessment Rating scores, but this relationship strengthened when omitting the global MIQ questions (Spearman's correlation coefficient, 0.59).

CONCLUSIONS

Increased overjet was associated with impaired OHRQOL using a condition-specific measure. A deeper understanding of associations between malocclusion, orthodontic treatment, and OHRQOL would benefit from longitudinal evaluation.

The effect of vestibular, lingual, and aligner appliances on the quality of life of adult patients during the initial stages of orthodontic treatment

Background

Patient quality of life (QoL) during orthodontic treatment is an important consideration that requires greater academic investigation as greater focus is placed on enhancing patient experience. Quality of life (QoL) was assessed in three orthodontic appliance groups, i.e., vestibular, lingual, and aligners during the initial stages of treatment. The sample was comprised of 117 adult patient-subjects distributed into 3 groups: vestibular (n = 41), lingual (n = 37), and aligner (n = 39). A WHOQOL-BREF questionnaire surveyed four domains (physical health, psychological health, social relationships, and environment).

Results

Mean scores for domain 1, physical health, showed that the aligner group (28.1) had significantly greater scores than that of the vestibular (22.7) or lingual (22) groups. Domain 2, psychological health, demonstrated significant differences (P < 0.001) between all groups, with the aligner group scoring the highest (23.2), followed by the lingual (18.4) and vestibular (15.2) groups. Domain 3, social relationship, showed that aligner (10.9) and lingual (10.2) scores were significantly greater (P < 0.001) than those of the vestibular group (7.8). Domain 4, environment, displayed significant differences between all groups, with the aligner group scoring highest (32.1), followed by the lingual group (29.3), and lastly the vestibular group (26.4). Overall, the highest mean score was obtained by the aligner group (23.1) and the lowest mean score was by the vestibular group (18). The mean domain scores for all three groups were significantly different (P ≤ 0.005) from each other (Table 2).

Conclusions

Overall, patients undergoing Aligner therapy reported the overall highest QoL scores, followed by lingual and vestibular groups.

Oral health and happiness in adolescents: A cohort study

OBJECTIVES

To investigate the influence of oral health conditions, socioeconomic status and dental care utilization on subjective happiness and identify the factors associated with changes in happiness among adolescents.

METHODS

Data were collected in 2012 and 2014. Oral health conditions were evaluated by performing clinical examinations; socioeconomic status and dental care utilization were assessed by using a questionnaire. The participants answered the Child Perceptions Questionnaire 11-14 for the evaluation of the impact of these variables on oral health-related quality of life (OHRQoL). Happiness was assessed using the Brazilian version of the Subjective Happiness Scale. For longitudinal data analysis, a mixed-effect model of linear regression was used to assess the factors related to happiness and multinomial logistic regression to appraise prospective changes in happiness.

RESULTS

A total of 1134 12-year-old adolescents were examined at baseline (response rate: 93%), and 770 were reevaluated after 2 years (retention rate: 68%). The adolescents who lived in households with lower equivalized income and greater overcrowding, had not visited the dentist in the later 6 months, had a higher number of cavitated carious lesions, and reported a higher impact on OHRQoL in 2012 presented lower happiness levels. Additionally, the adolescents with a higher number of decayed, missing or filled teeth and who reported a higher impact on OHRQoL were more likely to belong to the most unfavourable happiness trajectory categories.

CONCLUSIONS

The presence of dental caries, socioeconomic conditions, dental care utilization and OHRQoL influence happiness in adolescents. Having more teeth affected by dental caries and worse self-perception in early adolescence can lead to a decrease in happiness.

Impact of fashion braces on oral health related quality of life: a web-based cross-sectional study

BACKGROUND

Orthodontic braces have become symbols of wealth and fashion accessories in some parts of the world. However, there is a scarcity of information about the effects of fashion braces on various aspects of quality of life. Therefore, our aim was to investigate the effects of fashion braces on oral health related quality of life (OHRQoL).

METHODS

A cross-sectional study was carried out with data collection from a Google form questionnaire distributed in Saudi Arabia via various forms of social media over a period of 4 months. OHRQoL was assessed using the validated Arabic version of the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The fashion braces group included respondents who had braces installed for fashion purposes only. Therapeutic braces group included subjects who were wearing braces to treat any malocclusion problems. Control group included subjects who did not have any kind of braces. People who had previously completed orthodontic treatments were excluded from the study. The negative impacts were divided into seven domains and a total OHIP score was calculated. Statistical analyses and data illustration were performed with SPSS v25 (IBM, NY).

RESULTS

A total of 1141 people voluntarily participated in the study. More than 60% of the participants were in the control group while 33.7% had conventional braces for therapeutic reasons and 3.4% had fashion braces. Sociodemographic distributions varied among the groups, with the majority of the fashion braces group having education below the university level and family incomes less than average. There were significant group differences in OHIP domains. Physical pain was the most frequently reported complaint by all subjects and was the highest in the therapeutic braces group. People with therapeutic braces reported significantly higher functional limitation and physical disability than the controls. Fashion braces group reported significantly lower psychological discomfort and disability, social disability and handicap compared to control groups.

CONCLUSIONS

The illustrated effects of fashion braces on OHRQoL suggest the need to study the role of social media and educate the public on the use of braces to minimize the negative effects experienced by individuals.

Malocclusion traits and oral health-related quality of life in children with osteogenesis imperfecta: A cross-sectional study

BACKGROUND

The incidence of malocclusion is higher among people with osteogenesis imperfecta (OI) than the general population, and treatment options are limited due to the weak structure of bones and teeth. Focusing on those malocclusion traits that might have a high impact on a patient's oral health-related quality of life (OHRQoL) is warranted.

METHODS

A total of 138 children and adolescents with OI were examined for malocclusion traits. OHRQoL was measured using age-specific versions (8 through 10 years and 11 through 14 years) of the Child Perceptions Questionnaire (CPQ), considering the following domains: oral symptoms, functional limitation, emotional well-being, and social well-being. Higher scores implied worse OHRQoL. Multivariable ordinal logistic regression was used to estimate the association between malocclusion traits and OHRQoL.

RESULTS

Among children aged 8 through 10 years (n = 56), the CPQ and its constituent domain scores were relatively similar between those with malocclusion (higher scores) and those without. In the adolescent (n = 82) group aged 11 through 14 years; however, those with posterior crossbite (odds ratio, 5.01; 95% confidence interval, 1.40 to 12.41) or open bite (odds ratio, 3.21; 95% confidence interval, 1.21 to 10.23) experienced statistically significantly higher degrees of functional limitations (a higher functional limitation score) than those without.

CONCLUSIONS

Adolescents with OI and posterior open bites or crossbites have substantial self-reported functional limitations and worse oral symptoms, which warrants additional investigation and therapeutic trials in an attempt to improve the malocclusion. In addition, the authors found that the CPQ can be a useful tool in a clinical trial of orthodontic interventions in OI.

Association between adverse childhood experiences, bullying, self-esteem, resilience, social support, caries and oral hygiene in children and adolescents in sub-urban Nigeria

BACKGROUND

Adverse childhood experiences (ACE) and bullying have negative effects on oral health. Promotive assets (resilience, self-esteem) and resources (perceived social support) can ameliorate their negative impact. The aim of this study was to determine the association between oral diseases (caries, caries complications and poor oral hygiene), ACE and bully victimization and the effect of access to promotive assets and resources on oral diseases.

METHODS

This was a secondary analysis of data collected through a cross-sectional school survey of children 6-16-years-old in Ile-Ife, Nigeria from October to December 2019. The outcome variables were caries, measured with the dmft/DMFT index; caries complications measured with the pufa/PUFA index; and poor oral hygiene measured with the oral hygiene index-simplified. The explanatory variables were ACE, bully victimization, resilience, self-esteem, and social support. Confounders were age, sex, and socioeconomic status. Association between the explanatory and outcome variables was determined with logistic regression.

RESULTS

Of the 1001 pupils with complete data, 81 (8.1%) had poor oral hygiene, 59 (5.9%) had caries and 6 (10.2%) of those with caries had complications. Also, 679 (67.8%) pupils had one or more ACE and 619 (62.1%) pupils had been bullied one or more times. The median (interquartile range [IQR]) for ACE was 1(3), for bully victimization was 1(5), and for self-esteem and social support scores were 22(5) and 64(34) respectively. The mean (standard deviation) score for resilience was 31(9). The two factors that were significantly associated with the presence of caries were self-esteem (AOR: 0.91; 95% CI: 0.85-0.98; p = 0.02) and social support (AOR: 0.98; 95% CI: 0.97-1,00; p = 0.02). No psychosocial factor was significantly associated with caries complications. Self-esteem was associated with poor oral hygiene (AOR: 1.09; 95% CI: 1.09-1.17; p = 0.03).

CONCLUSION

There was a complex relationship between ACE, bully victimization, access to promotive assets and resources by children and adolescents, and oral health. ACE and bully victimization were not associated with oral health problems. Though self-esteem was associated with caries and poor oral hygiene, the relationships were inverse. Promotive assets and resources were not associated with caries complications though resources were associated with lower prevalence of caries.

The association of socio-economic status, dental anxiety, and behavioral and clinical variables with adolescents' oral health-related quality of life

PURPOSE

It is not clear which factors hold more weight in predicting oral health-related quality of life (OHRQoL). Therefore, this study explored which component of factors (e.g., socio-economic status, clinical status or oral health behaviors, dental anxiety, oral health knowledge) has a better predictive value in different aspects (e.g., oral symptoms, functional limitations, social and emotional conditions) of adolescents' OHRQoL.

METHODS

Participants were randomly selected from Grade Two (S2) students within 12 secondary schools in Hong Kong. The independent variables include the following : socio-economic (monthly family income, parents' educational background), oral health behaviors (the frequency of brushing and having snacks like chocolate or biscuits), and oral health-related factors (oral health knowledge, dental anxiety, dental caries and bleeding index). Adolescents' OHRQoL was evaluated using the 16-item Child Perception Questionnaire (CPQ_11-14-ISF:16). Frequencies and means were used for data description. Different variables were analyzed as predictors of OHRQoL by multi-level linear regression analysis.

RESULTS

1207 adolescents (46.6% females) participated in this study. The mean total CPQ_11-14-ISF:16 was 14.2 (9.8). Mean scores of oral symptoms, functional limitations, and emotional and social well-being were 4.4 (2.8), 4.2 (2.8), 3.2 (3.1), and 2.4 (2.7), respectively. In the final model, adolescents with poorer oral health knowledge, higher dental anxiety levels, brushed their teeth less than once a day and consumed chocolates or biscuits more regularly as reported by a statistically worse OHRQoL (p < 0.05). In addition, gingival bleeding was a predictor of the oral symptom domain (β = 0.7, p = 0.027); the emotional well-being of adolescents whose father went to college had a better OHRQoL (β =  - 0.9, p = 0.014) and adolescents from the higher-income family had a statistically better social well-being (p = 0.015).

CONCLUSION

Our study indicates that adolescents with poorer oral health knowledge, higher dental anxiety levels, brushing their teeth less than once a day, or having a daily consumption of chocolate or biscuits had statistically worse OHRQoL. These findings can provide guidance for future oral health promotion in improving OHRQoL among adolescents.

Self-esteem and oral health behavior in adolescents

This study investigated the mediation of self-esteem in adolescents' oral health behaviors. The Rosenberg self-esteem scale was used to assess self-esteem, whereas data from socio-demographic and behavior characteristics were analyzed by questions validated in previous surveys. The teenagers had good oral health behavior, except unhealthy diet. The number of adolescents with high self-esteem was a lot smaller than those with low self-esteem. The use of dental services, even when associated with high self-esteem, lost significance after being adjusted by sex, age and tooth brushing frequency. Nevertheless, multiple logistic regression analysis, using unadjusted estimates and adjusted with their respective Confidence Intervals of 95%, showed a relationship of self-esteem with age (p-value=0.001) and tooth brushing frequency (p-value=0.019). Regardless of the sex, students over 16 years old with high self-esteem brush their teeth more often, having probably better oral health. These results confirm the modulation of self-esteem in oral health, and then it is necessary the analysis and the use of these psychosocial factors in the young oral health care.

Impact of malocclusion severity on oral health-related quality of life in an Iranian young adult population

Objective:

This study aimed to assess the relationship between malocclusion severity and oral health-related quality of life (QoL) of 18 to 25-year-old Iranians who sought orthodontic treatment.

Materials and Methods:

A total of 126 patients between 18 and 25 years attending some private orthodontic clinics answered the oral health impact profile-14 (OHIP-14) and a demographic questionnaire. Two calibrated orthodontists recorded the Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) determining the severity of malocclusion (Kappa = 0.8). The IOTN-Aesthetic Component (IOTN-AC) was reported by patients for assessing the perception of their esthetic severity of malocclusion. Logistic regression analysis was used. Level of significance was set at α = 0.05.

Results:

The mean score of OHIP-14 was 20.87 ± 8.6. The frequency of patients with no/slight, borderline, and definite need for orthodontic treatment was determined as 13.4%, 23.8%, and 62.7%, respectively, by IOTN-DHC. There were significant correlations between borderline or definite need treatment and OHIP-14 overall score (P < 0.05). Patients with borderline and definite need for orthodontic treatment had 5 and 21 times lower QoL, respectively, than those with a slight need for orthodontic treatment. Based on IOTN-AC, 50.8% of the patients mentioned slight or no need based on IOTN-AC. No significant association was noted between IOTN-AC and OHIP-14 overall scores.

Conclusions:

The results showed negative impact of malocclusion severity on the QoL. This study highlighted the importance of individual assessment of orthodontic patients.

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.

Reported changes in oral health-related quality of life in children and adolescents before, during, and after orthodontic treatment: a longitudinal study

OBJECTIVES

To investigate the changes in oral health-related quality of life (OHRQoL) before, during, and after orthodontic treatment, determine the relationship with the original treatment need and evaluate the influence of self-esteem (SE).

MATERIALS AND METHODS

OHRQoL questionnaires were used in an ongoing observational prospective cohort study at baseline (T0), 1 year after start (T1), and 1 month after the end of active orthodontic treatment (T2). Participants were 11-16-year-old at baseline and 215 complete cases were obtained from a total of 498. OHRQoL was scored by using the Child Perception Questionnaire (CPQ11-14), SE was assessed by the Dutch adaptation of the Harter's Self-Perception Profile for Adolescents and treatment need was defined by the Index of Orthodontic Treatment Need (IOTN). The Oral Aesthetic Subjective Impact Scale (OASIS) was included to score perceived treatment need. Data were analyzed with Spearman correlation, Mann-Whitney U-test and linear models for longitudinal data.

RESULTS

A significant decrease in IOTN and in OASIS was noted from T0-T1-T2 (P < 0.0001). CPQ results show a decrease from T0 to T2, from T1 to T2 and an increase from T0 to T1 (P < 0.0001). This was valid for the overall CPQ scores and its subdomains except for emotional well-being (EW), which decreases from T0-T1-T2. A correlation was found between baseline SE and the change of total CPQ scores between T0 and T2, also for EW (r = 0.325 and r = 0.354).

CONCLUSIONS

OHRQoL ameliorates after orthodontic treatment. High baseline SE works as a protective factor for OHRQoL.

Association between oral health-related quality of life and depressive symptoms in Chinese college students: Fitness Improvement Tactics in Youths (FITYou) project

BACKGROUND

This study aimed to investigate a gender-specific association between oral health-related quality of life (OHRQoL) and depressive symptoms in college students, as there are limited relevant studies conducted among youths.

METHODS

In 2017, a cross-sectional study of 3461 Chinese college students was conducted in Shenyang, China. OHRQoL and depressive symptoms were screened by a 14-item oral health impact profile questionnaire and a Self-rating Depression Scale, respectively. A multivariable logistic regression analysis was performed to examine the association of OHRQoL with depressive symptoms.

RESULTS

The number of youths reported to have depressive symptoms was 20.7%. A univariate analysis showed that categories with a OHRQoL score over 6 were more likely to have a higher prevalence of depressive symptoms compared to the category with a score of 0 (male: ORs [95% CI]: 3.10, 2.05-4.68, P < 0.001; female: ORs [95% CI]: 3.11, 2.38-4.05, P < 0.001). Similar results were observed after adjusting for sociodemographic, anthropometric, and lifestyle-related covariates (male: ORs [95% CI]: 3.07, 1.98-4.76, P < 0.001; female: ORs [95% CI]: 2.90, 2.21-3.81, P < 0.001).

CONCLUSIONS

College students who have higher OHRQoL tend to have a lower prevalence of depressive symptoms.

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

Background

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

Objective

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

Search methods

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

Selection criteria

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

Data collection and analysis

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

Results

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

Conclusions

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

Trial registration

CRD42019122653.

Conflict of Interest

None to declare.

Item-level analysis of the relationship between orthodontic treatment need and oral health-related quality of life in Korean schoolchildren

INTRODUCTION

This study aimed to evaluate the associations between normative orthodontic treatment need and oral health-related quality of life (OHRQoL) at an item level as well as subscale and total score levels among schoolchildren.

METHODS

A cross-sectional study was conducted on 2,010 randomly selected children aged approximately 8, 10, 12, and 15 years residing in the Gyeonggi province, Korea. Children were clinically examined with the Index of Orthodontic Treatment Need (IOTN). To measure OHRQoL, the Child Oral Health Impact Profile (COHIP) was used.

RESULTS

In the physical health domain of COHIP, crooked teeth, discoloration, "food sticking," and "difficulty keeping teeth clean" were significantly associated with IOTN levels (P < 0.05), whereas pain, sensitivity and bleeding, bad breath, mouth breathing, and dry mouth were not. In addition, present and future dental health were significantly associated with IOTN levels, although self-confidence, attractiveness, and future health were not. As expected, the 5 subscale scores and total score of COHIP were significantly associated with IOTN levels after adjustment for gender, age, socioeconomic level, and caries state.

CONCLUSIONS

This study suggests the importance of in-depth investigation at the item level of OHRQoL assessment scales to better evaluate the impact of malocclusion that might be alleviated by orthodontic treatment.

Oral health-related quality of life in children using the child perception questionnaire CPQ11-14: a review

OBJECTIVES

The Child Perceptions Questionnaire 11-14 (CPQ11-14) is the most common and effective indicator of paediatric oral health-related quality of life. The aim of this review was to verify if CPQ11-14 can be considered a valid instrument for assessing the impact of oral health on the quality of life of adolescents for the paediatric population aged between 11 and 14 years old and which dental conditions mainly affect it.

STUDY DESIGN

A literature research from Pubmed Medline database was adopted to identify the eligible studies among the published articles related to CPQ 11-14 using keyword search strategy. From 170 initial articles, a total of 128 articles were included for the full text reading.

RESULTS

Conditions that mainly interest the oral health-related quality of life are untreated dental caries, dental trauma, increased dental protrusion, wearing orthodontic appliances, and severe periodontal disease.

CONCLUSION

CPQ 11-14 seems to be a solid and valid indicator to measure oral health-related quality of life, because it has been widely tested and validated in several states including developed, developing and underdeveloped countries.

Oral health-related quality of life of adolescents after orthodontic treatment. A systematic review

Background

Given the prevalence of malocclusions and the impact they have on oral health, patients' quality of life assessments provide useful information, not only in terms of patients' needs and expectations before treatment, but about whether or not orthodontic treatments meet them satisfactorily. The present systematic review was carried out to evaluate changes in the quality of life of adolescent patients after orthodontic treatment.

Material and Methods

An electronic search was conducted in the Pubmed, Embase, Cochrane and Scopus databases. The review followed PRISMA guidelines for systematic reviews and meta-analyses.

Results

Of the 817 studies identified in the initial search, only 10 met the inclusion criteria. In relation to the instrument used to assess oral health-related quality of life (OHRQoL), half the studies used the oral health impact profile-14 (OHIP-14) and the other half the child perceptions questionnaire (CPQ 11-14). All the studies, with the exception of Benson et al., reported a significant improvement in OHRQoL at the end of treatment.

Conclusions

There is a positive association between OHRQoL and orthodontic treatment in adolescent patients. Key words:Quality of life, life quality, oral health related quality of life, QoL, OHRQoL, orthodontic treatment, adolescents, teenagers.

Oral health-related quality of life in children and adolescents with osteogenesis imperfecta: cross-sectional study

Background

Osteogenesis imperfecta (OI) affects dental and craniofacial development and may therefore impair Oral Health-Related Quality of Life (OHRQoL). However, little is known about OHRQoL in children and adolescents with OI. The aim of this study was to explore the influence of OI severity on oral health-related quality of life in children and adolescents.

Methods

Children and adolescents aged 8–14 years were recruited in the context of a multicenter longitudinal study (Brittle Bone Disease Consortium) that enrolls individuals with OI in 10 centers across North America. OHRQoL was assessed using the Child Perceptions Questionnaire (CPQ) versions for 8 to 10-year-olds (CPQ_8–10) and for 11 to 14-year-olds (CPQ_11–14).

Results

A total of 138 children and adolescents (62% girls) diagnosed with OI types I, III, IV, V and VI (n = 65, 30, 37, 4 and 2, respectively) participated in the study. CPQ_8–10 scores were similar between OI types in children aged 8 to 10 years. In the 11 to 14-year-old group, CPQ_11–14-scores were significantly higher (i.e. worse) for OI types III (24.7 [SD 12.5]) and IV (23.1 [SD 14.8]) than for OI type I (16.5 [SD 12.8]) (P < 0.05). The difference between OI types was due to the association between OI types and the functional limitations domain, as OI types III and IV were associated with significantly higher grade of functional limitations compared to OI type I.

Conclusion

The severity of OI impacts OHRQoL in adolescents aged 11 to 14 years, but not in children age 8 to 10 years.

Electronic supplementary material

The online version of this article (10.1186/s13023-018-0935-y) contains supplementary material, which is available to authorized users.

Oral-Health-Related Quality of Life in Children and Adolescents

This article describes child oral health-related quality of life measures and provides some examples of their use in determining the effect of clinical interventions, such as dental treatment under general anesthesia, orthodontic treatment, and treatment of orofacial clefting.

Patient satisfaction and quality of life changes after Invisalign treatment

INTRODUCTION

Our objective was to assess patient satisfaction and changes in oral health-related quality of life immediately after orthodontic treatment using the Invisalign system (Align Technology, Santa Clara, Calif).

METHODS

Adult patients were recruited from private practices in Canada and surveyed using a combination of 2 validated questionnaires: Dental Impact of Daily Living and Patient Satisfaction Questionnaire. This 94-question assessment focused on various dimensions of satisfaction and changes in quality of life. Multivariate analysis of variance, regression analysis, and canonical correlation analysis were applied in the data analysis.

RESULTS

A total of 81 patients, 29.6% men and 70.4% women, exclusively treated with the Invisalign system participated. The most significant improvements were seen in the appearance and eating and chewing categories, with patients responding positively to more than 70% of the questions in those categories. Food packing between teeth, affecting 24% of the participants, and pain affecting 16% were the most common sources of dissatisfaction. However, these negative experiences were not strong enough to reduce the overall positive experience that patients reported. Appearance and dentofacial improvement were strongly correlated. Canonical correlation of the Patient Satisfaction Questionnaire factors showed that doctor-patient relationship had a significant correlation with situational aspects, dentofacial improvement, and the residual category. Phrases from the doctor-patient relationship category such as "the orthodontist treated me with respect" and "carefully explained what treatment would be like" were associated with higher patient satisfaction.

CONCLUSIONS

Although positive changes in appearance and eating categories were linked with patient satisfaction, doctor-patient relationship was the factor that correlated better with multiple aspects of patient satisfaction.

Extraversion and openness to experience moderate the relationship between orthodontic treatment need and oral health-related quality of life in adolescents: A cross-sectional study

OBJECTIVE

To investigate the effects of personality traits to moderate the relationships between orthodontic treatment need and oral health-related quality of life (OHRQoL) in adolescents.

MATERIALS AND METHODS

A cross-sectional study was performed that included 230 subjects (125 girls and 105 boys) aged 11-14 years. Orthodontic treatment need was measured using the Index of Complexity, Outcome and Need (ICON). The Child Perceptions Questionnaire, the Basic Personality Traits Inventory (BPTI), and the Revised Life Orientation Test were used to assess the OHRQoL, basic personality dimensions, and dispositional optimism respectively. Potential moderation effects were evaluated with Spearman's correlations and multiple regression analyses.

RESULTS

There were weak correlations between orthodontic treatment need and quality of life with social and emotional well-being dimensions ( r = 0.238, r = 0.296 and r = 0.209). A moderating effect of extraversion was observed in the relationship between orthodontic treatment need and OHRQoL, emotional well-being, and social well-being (SWB) (Δ R² = 0.03, Δ R² = 0.02, and Δ R² = 0.04, respectively). Openness to experience affected relationships between orthodontic treatment need and OHRQoL, and emotional well-being (EWB) (Δ R² = 0.03 and Δ R² = 0.04, respectively). In children with higher extraversion, the increase in ICON scores resulted in less increase in CPQ total, EWB, and SWB scores. In children with higher openness to experience, the increase influenced CPQ total and EWB scores similarly.

CONCLUSIONS

The relationship between orthodontic treatment need and quality of life is moderated by personality traits. Early adolescents with higher extraversion and openness to experience are less affected by increased orthodontic treatment need.

Impact of orthodontic treatment on adolescents' quality of life: a longitudinal evaluation of treated and untreated individuals

PURPOSE

To assess the impact of fixed appliance therapy on the quality of life of a cohort of Brazilian adolescents.

METHODS

The treatment group was composed of individuals who started orthodontic treatment. The control group was composed of individuals not selected for immediate treatment. Adolescents answered the Brazilian short form of the Child Perceptions Questionnaire (CPQ_11-14). Higher scores indicate a greater negative impact on quality of life. Adolescents in the treatment group completed four sets of interviews: prior to appliances' bonding (T1), 1 month (T2), 6 months (T3) and 12 months (T4) after appliances' placement. Adolescents in the control group were assigned to a comparable schedule. Statistics included inter-group comparisons, Friedman and Wilcoxon tests, and mixed-effects models.

RESULTS

In the treatment group, the functional limitation score was higher at T1 (p = 0.004) and T2 (p = 0.007) compared to T4. The emotional well-being score was higher at T1 compared to T2 (p < 0.001), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ_11-14 score was higher at T1 compared to T2 (p = 0.005), T3 (p < 0.001) and T4 (p < 0.001). The overall CPQ_11-14 score was also higher at T2 compared to T3 (p = 0.001). No significant change was found in the control group. In the mixed-effects models, the interaction between group (treatment) and time was significant for functional limitations (p < 0.001), emotional well-being (p < 0.001), social well-being (p = 0.004) and the overall CPQ_11-14 score (p < 0.001).

CONCLUSION

Quality of life improved among adolescents undergoing orthodontic treatment. Orthodontists should inform patients what they might expect regarding the physical and the psychosocial repercussions of appliance therapy.

Long-term changes in oral health-related quality of life of standard, cleft, and surgery patients after orthodontic treatment: A longitudinal study

INTRODUCTION

The aim of this study was to assess long-term changes and describe the trajectories of oral health-related quality of life (OHRQoL) in a cohort of cleft, surgery, and standard patients who received orthodontic treatment.

METHODS

Standard (n = 16), cleft (n = 19), and orthognathic surgery (n = 22) patients completed the short-form of the Oral Health Impact Profile (OHIP-14) before treatment, immediately posttreatment, and approximately 5 years posttreatment.

RESULTS

An overall reduction in OHIP-14 scores (improvement in OHRQoL) occurred after orthodontic treatment; however, this was only significant for the surgery and standard groups (P <0.05). The total OHIP-14 score increased significantly from posttreatment to 5 years follow-up for all 3 study groups (P <0.05). Relative to pretreatment, however, there were significant reductions in total OHIP-14 scores at 5 years posttreatment in the surgery group (-57.4%; P <0.05), but not in the standard sample (-24.2%; P >0.05). By contrast, the OHIP-14 score in the cleft group increased but not significantly (40.2%; P >0.05). Using a mixed model analysis, a significant interaction was detected between patient group and time (ie, study time point) (F = 6.0; P <0.0001), after adjusting for age and sex.

CONCLUSIONS

Distinct patient groups showed different OHRQoL trajectories after orthodontic treatment. Treatment-related improvements in OHRQoL are maintained over time for surgery patients, but not for those with standard malocclusions and orofacial clefts.

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

Objectives

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

Subjects and methods

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

Results

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

Limitations

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

Conclusions

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