Relationship between occlusion and satisfaction with dental appearance in orthodontically treated and untreated groups. A longitudinal study

Adult patient expectations and satisfaction: Can they be influenced by viewing the three-dimensional predicted outcome before fixed orthodontic treatment of dental crowding?

BACKGROUND

Investigating the possible changes in patients' expectations of and satisfaction with the orthodontic treatment outcomes when they were given the three-dimensional digital prediction of their teeth alignment before the beginning of treatment.

METHODS

A prospective non-controlled single-group clinical trial was conducted on 28 (18 females, 10 males, mean age: 20.68 ± 1.91 years) patients with Class I malocclusion and moderate dental crowding who required a nonextraction orthodontic treatment. Patients were given the expectations questionnaire on their first visit (T0). Then, patients were shown a three-dimensional digital setup-created by Orthoanalyzer software (3Shape, Copenhagen, Denmark)-of the proposed treatment results before orthodontic treatment (T1) and received two questionnaires, the second expectations questionnaire and the satisfaction with the proposed changes questionnaire. Treatment was then initiated using the fixed appliances and completed. After debonding, a question about patients' satisfaction with the achieved changes was completed (T2).

RESULTS

Patients' expectations level significantly increased after watching the predicted alignment of teeth compared with the initial levels in terms of chewing (x¯ = 5.54 and x¯= 6.71), speech (x‾ =5.93 and x¯= 6.93), and oral hygiene improvement (x‾= 7.93 and x¯=8.61 ± 1.06; at T0 and T1, respectively). The remaining items showed no significant differences between the two assessment times. Patients had a higher level of satisfaction at the end of treatment than after watching the proposed outcome. There were significant statistical differences in the items related to teeth appearance (x¯= 9.12 and x¯= 9.60 at T1 and T2, respectively), and teeth engagement (x¯= 8.92 and x¯= 9.40 at T1 and T2, respectively) CONCLUSIONS: Watching the predicted alignment outcome increased patients' expectations of chewing, speech, and oral hygiene improvement compared with the initially recorded levels. Patients were more satisfied with the final result than what was recorded after viewing the predicted plan. However, these results were not clinically significant.

Evaluation of the Impact of Orthodontic Treatment on Patients' Self-Esteem: A Systematic Review

Malocclusion may affect interpersonal relationships, self-esteem (SE), and psychological well-being, weakening patients' psychological and social activities. Several studies investigated the effect of orthodontic treatment on these social and psychological aspects, such as SE. However, the direct relationship between SE and orthodontic treatment has not yet been confirmed. This systematic review aimed to evaluate the existing evidence in the literature concerning the influences of orthodontic treatment on patients' SE systematically and critically. An electronic search in the following databases was done in September 2022: PubMed®, Web of Science™, Scopus®, Embase®, GoogleTM Scholar, Cochrane Library databases, Trip, and OpenGrey. Then, the reference list of each candidate study was checked for any potentially linked papers that the electronic search might not have turned up. Inclusion criteria were set according to the population/intervention/comparison/outcome/study design (PICOS) framework. For the data collection and analysis, two reviewers extracted data separately. The risk of bias 2 (RoB-2) and the risk of bias in non-randomized studies (ROBINS-I) tools were used to assess the risk of bias for randomized controlled trials (RCTs) and non-RCTs, respectively. The grading of recommendations assessment, development and evaluation (GRADE) approach was employed to evaluate the quality of the evidence for each finding. Sixteen studies (five RCTs, seven cohorts, and four cross-sectional) were included in this review. Unfortunately, the results could not be pooled into a meta-analysis. Only six studies have reported an increase in SE after orthodontic treatment (P<0.05 in these studies). No agreement between the included studies was observed regarding the influence of fixed orthodontic treatment, gender, or age on SE. The quality of evidence supporting these findings ranged from very low to low. There is low evidence indicating that fixed orthodontic treatment can improve patients' SE. In addition, unclear data are available about the influence of patients' gender and age on SE after orthodontic treatment. Therefore, high-quality RCTs are required to develop stronger evidence about this issue.

A Study to Assess Indian Patients' Expectations of Check-Up and Diagnosis or Discussion about Treatment at their Initial Orthodontic Visit

Aim

To access the patient's expectations of orthodontic treatment at the first visit.

Materials and Methods

Three hundred new patients to the orthodontics department were included in the analysis. Their demographic details and their opinions on what they hoped to gain from orthodontic treatment were gleaned from their replies to a well-crafted questionnaire.

Results

Most respondents were more concerned with the cosmetic results of orthodontic treatment than they were with the therapy's practical benefits. They hoped that after having their teeth straightened, they would feel more comfortable interacting with others and have a better overall appearance. In terms of improving one's job and making one's speaking simpler, the mean scores were the lowest. The female participants averaged higher marks than the male participants across all areas studied, with the greatest mark coming in the area of improved smiles.

Conclusion

An effective outcome from orthodontic therapy requires full patient participation. Before beginning treatment, it is important for the orthodontist and patient to have an agreement on the patient's reasonable expectations for the therapy's outcomes.

The associations of dental aesthetics, oral health-related quality of life and satisfaction with aesthetics in an adult population

AIM

The aim of this study was to investigate the gender-specific associations between dental aesthetics, oral health-related quality of life (OHRQoL), and satisfaction with dental aesthetics in an adult population.

MATERIALS AND METHODS

The study population consisted of 1780 individuals (822 males and 958 females) from the Northern Finland Birth Cohort 1966 (NFBC1966). Dental aesthetics were evaluated from digital 3D dental models using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Layperson and orthodontist panels evaluated the dental aesthetics of a smaller sample (n = 100). OHRQoL was measured using the Oral Health Impact Profile (OHIP-14) questionnaire. Satisfaction with dental aesthetics was asked with one separate question. Gender-specific analyses consisted of Mann-Whitney U-tests and Spearman's correlation coefficients.

RESULTS

More than half of the population had an aesthetically acceptable occlusion, and most of the individuals were satisfied with the aesthetics. The most severe aesthetic impairments were associated with the psychological dimensions of OHIP-14. There were significant but weak associations of AC and satisfaction with aesthetics, and satisfaction with aesthetics and OHRQoL. Significant gender differences were found, men having higher mean AC scores but women reporting lower OHRQoL.

CONCLUSION

At the population level, most of the individuals were satisfied with their aesthetics, despite different dental aesthetic conditions. The most severe aesthetic impairments were associated with decreased psychological well-being, women reporting more impacts compared to men.

Evaluation of Orthodontic Treatment Need—An Ethnic and Gender Prospective

Introduction:

Index for Orthodontic Treatment Need is a widely used index to assess the orthodontic treatment need among various populations.

Aim:

The aim of this study is to evaluate and compare orthodontic treatment needs of Nepali among gender and ethnicity.

Materials and Methods:

A total of 800 children (400 males and 400 females) above 14 years of age were selected from different schools of Kathmandu using multistage sampling technique. The study sample was grouped into 2 ethnic groups: Indo-Aryan and Janajati. Two trained and calibrated examiners examined school-going children using Index for Orthodontic Treatment Need tool. Statistical comparison of the study variables by gender and ethnicity was done.

Results:

Dental Health Component showed 36.75% male and 34.5% female, and 39% Indo-Aryan and 29.76% Janajati had great treatment need. The Aesthetic Component (AC) showed 13.75% male and 12.25% female, and 12.5% Indo-Aryan 14.58% Janajati had great/severe need.

Conclusions:

Males had great/severe need of treatment for both Dental Health Component and Aesthetic Component (AC). Indo-Aryan showed higher degree of great/severe need for Dental Health Component and lesser degree of great/severe need for Aesthetic Component (AC) than Janajati.

Malaysian Patients’ Expectations of Orthodontic Treatment in Indian Dental Care Set up: A Questionnaire Survey

Materials and Methods

A cross-sectional study was conducted on 349 Malaysian patients (182 females and 167 males) aged 18–30 years. A questionnaire consisting of ten items developed by Sawyers and Newton was administered to the patients who visited the department of Orthodontics seeking orthodontic treatment. Outcome measures. Descriptive analysis of the responses and comparison of male and female expectations.

Results

Most of the patients expected only a check-up/diagnosis/discussion at their initial appointment, anticipated a fixed type of orthodontic treatment, did not prefer extraction/removal of their teeth, thought the treatment to be painful, and can restrict what they could eat or drink. Positive expectations from the patient included better tooth alignment, enhanced smile, improved confidence, and advancement in professional career. At the same time, nearly half of the patients' assumed speech/mastication does not get affected during the treatment. Moreover, very few patients believed it would be easier to eat/speak/keep their teeth clean after the treatment. Compared to males, more females had significantly anticipated fixed types of orthodontic treatment, thinking the treatment to be painful and restrictive in terms of what they could eat or drink. Most of the females were unsure about the length of the orthodontic treatment and had significantly higher expectations concerning career improvement.

Conclusions

To meet the varied expectations of each of the patients, effective communication between the orthodontist and the patient is essential.

Cross-Cultural Adaptation and Validation of the Portuguese Version of the Psychosocial Impact of Dental Aesthetics Questionnaire

The aim of this study was to cross-culturally adapt and validate the psychosocial impact of dental esthetics questionnaire (PIDAQ) to the Portuguese language. The PIDAQ was culturally translated and adapted according to international guidelines. In this cross-sectional study, we enrolled 501 subjects in a population-based epidemiological survey conducted at the Egas Moniz Dental Clinic (Almada, Portugal) in June 2022. The participants answered the Portuguese version of the PIDAQ (PIDAQ-PT), which was a 23-item scale with four conceptual domains (self-confidence, social impact, psychological impact and esthetic concern factor). Psychometric properties were estimated using content validity, construct validity, internal consistency and test−retest reliability. The PIDAQ-PT presented an intraclass correlation coefficient (ICC) of 0.84, and a 95% confidence interval (0.73−0.90, p < 0.001), with values for the Cronbach’s alpha coefficient of the subconstructs ranging from 0.93 to 0.98. In the confirmatory factor analysis (CFA), the final models presented a good fit, with the comparative fit indices (CFIs) ranging from 0.905 to 0.921 and the root mean squared error of approximation (RMSEA) ranging between 0.088 and 0.090. The PIDAQ-PT was shown to be a valid and reliable tool to assess oral health values in a Portuguese population. Further studies should evaluate the psychometric properties of the oral personal representation on dental specialties and its impact on dental appointments and procedures.

Patient-Reported Outcome Measures on Oral Hygiene, Periodontal Health, and Treatment Satisfaction of Orthodontic Retention Patients up to Ten Years after Treatment-A Cross-Sectional Study

Background: This cross-sectional study evaluated patient-reported outcome measures (PROMs) on (1) oral hygiene, (2) periodontal health, (3) retainer failure, (4) orthodontic treatment satisfaction, and (5) outcome satisfaction in orthodontic retention patients. The purpose of the study was to evaluate whether orthodontic retention treatment is associated with patient-reported outcome measures on oral hygiene, periodontal health, and treatment satisfaction. Methods: A ten-item questionnaire on the five PROMs was conducted among 211 consecutive retention patients up to ten years following orthodontic treatment. Linear regression models were computed to detect possible associations between the PROMs and retention treatment or patient characteristics. Results: The presence of a fixed lingual retainer was not associated with the reduced ability to perform oral hygiene, self-perceived periodontal health, or orthodontic outcome satisfaction. Older patients were more content with the orthodontic treatment result (p < 0.05). Patients with fixed lingual retainers in the mandible were less satisfied with the course of orthodontic treatment (p < 0.05). Smokers more often reported gingival bleeding (p < 0.05). Females reported increased gingival recessions (p < 0.05) and perceived their teeth as longer than before treatment (p < 0.05). Longer orthodontic treatment duration corresponded to retainer failure (p < 0.05). Conclusions: In general, long-term orthodontic retention patients were satisfied with orthodontic treatment. These patients reported the satisfactory ability to perform adequate oral hygiene and periodontal health, and they communicated a high degree of treatment and outcome contentment. However, patients with a retainer in the mandible were less satisfied with orthodontic treatment.

A comparison of patient testimonials on YouTube of the most common orthodontic treatment modalities: Braces, in-office aligners, and direct-to-consumer aligners

INTRODUCTION

The aims of this study were to (1) investigate and compare the educational value of the most popular YouTube (www.youtube.com; Google, San Bruno, Calif) orthodontic patient testimonials between braces, in-office aligners (IOA), and direct-to-consumer aligners (DTCA), and (2) classify the emotional response of the viewers through sentiment analysis of the video comments.

METHODS

Three different phrases relevant to braces, IOA, and DTCA were searched on YouTube. The 20 most popular patient testimonial videos meeting the criteria for each group were selected for a total of 60 videos. Using the YouTube application program interface for each video, 13 video metrics were extracted. An information completeness score was assigned, and the video comments were analyzed using sentiment analysis software.

RESULTS

The 60 videos included were viewed 34.4 million times by internet users. Braces videos had significantly more likes, comments, and a higher viewer interaction score than the IOA and DTCA videos. IOA videos had a higher median information completeness score than braces and DTCA videos. Of the 5149 video comments with polarity, 53.6% were positive, and 46.4% were negative (P <0.0001). There was no significant association between the treatment modality and positive or negative comments (P = 0.5679).

CONCLUSIONS

There is high user engagement on YouTube with orthodontic patient testimonials. YouTube users interact with braces patient testimonials the most. YouTube viewers' comments on orthodontic patient testimonials express more positive sentiment than negative sentiment. There was no significant difference in positive and negative sentiment between the video comments for the 3 different treatment modalities.

What causes failure of fixed orthodontic retention? - systematic review and meta-analysis of clinical studies

BACKGROUND

Orthodontic retention aims to maintain optimal teeth positions after active treatment. The stability is affected by numerous factors, including patients' individual features, thus retention should be adjusted in the most optimal way. Bonding a retainer makes retention less dependent on patient's compliance.

QUESTIONS ARISE

What wire or fiber splint type provides the best treatment stability? What materials should be used to bond the wire or fiber splint? Should be the bonding procedure be direct or indirect? The aim of the study is to assess and synthesize available controlled trials investigating failures of fixed retainers.

METHODS

Literature searches of free text and MeSH terms were performed in Scopus, Web of Science, Embase and PubMed Central in order to find studies, referring to failures of fixed retention (12th February 2021). The keywords were: ("orthodontic retainers AND failure AND wire"). The framework of this systematic review according to PICO was: Population: orthodontic patients; Intervention: fixed orthodontic retainer bonding; Comparison: Different protocols of fixed orthodontic retention applied; Outcomes: failure rate, survival rate. Three different specific scales from the Cochrane Collaboration Handbook were used, according to each study type. Additionally, a meta-analysis was conducted to compare the effectiveness of retention using fiber reinforced composite and multistranded steel wire.

RESULTS

The search identified 177 potential articles: 114 from PubMed, 41 from Scopus, 20 from Web of Science and 2 from Embase. After excluding studies inconsistent with selection criteria, 21 studies were included and subjected to qualitative analysis. The main outcome investigated was failure rate. This systematic review has some potential limitations due to the heterogeneity of design between included studies.

CONCLUSIONS

No retainer is proved to guarantee a perfect stability of dental alignment. The retainer should be bonded to all adherent teeth, preferably with additional use of bonding resin. No wire or fiber splint present superior characteristics concerning failure rate. Fiber reinforced composite retention is more sensitive to operator skills, and with imperfect bonding technique, failure rate is much higher. During the first 6 months after bonding retainer the patient should be under frequent control. The study protocol was registered in PROSPERO database with the number CRD42021233406.

Self-Esteem and Oral Health-Related Quality of Life within a Cleft Lip and/or Palate Population: A Prospective Cohort Study

(1) Objective: To investigate the oral health-related quality of life (OHRQoL) and self-esteem (SE) of a population with cleft lip and/or palate (CLP) and to compare it with a non-affected control cohort. (2) Materials and methods: This study comprised 91 CLP patients and a control group of 790 individuals, seeking orthodontic treatment. OHRQoL and SE were assessed by the Child’s Perception Questionnaire (CPQ) and the Dutch adaptation of the Harter’s Self-Perception Profile for Adolescents. Treatment need and self-perception of oral aesthetic were assessed using the Index of Orthodontic Treatment Need (IOTN) and the Oral Aesthetic Subjective Impact Scale (OASIS). Patients’ expectations and motivation for treatment were also scored. Linear models were used for statistical comparisons between groups. (3) Results: The cleft group scored higher in all domains of the CPQ, OASIS, IOTN and regarding SE for the domains of scholastic competence, athletic competence, physical appearance and behavioral conduct. The cleft group was not only more motivated and expected less discomfort during treatment but also had higher expectations for the treatment outcome. (4) Conclusions: The OHRQoL of CLP patients is strongly correlated with the presence of an oral cleft, while SE remains a personal resource not influenced by the malocclusion or medical condition.

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.

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.

A comparison of self-esteem and social appearance anxiety levels of individuals with different types of malocclusions

OBJECTIVE

The aim was to compare Rosenberg self-esteem scale (RSES), sensitivity to criticism scale (STCS) and social appearance anxiety scale (SAAS) scores of individuals with different types of malocclusions, and investigate the correlation between these scores and the index of complexity, outcome and need (ICON) score.

MATERIALS AND METHODS

One hundred and twenty individuals, who did not have any previous orthodontic treatment, were included. Group 1 included 40 patients with Class I malocclusion (median age of 14 years), Group 2 included 40 patients with Class II malocclusion (median age of 14.25 years) and Group 3 included 40 patients with Class III malocclusion (median age of 15.15 years). ICON scores were 46, 53 and 56 for Groups 1, 2 and 3, respectively. RSES, STCS and SAAS questionnaires were performed to the patients. Student's t-test, one-way analysis of variance (ANOVA), Mann-Whitney's U and Kruskal-Wallis's tests were used for the statistical analysis.

RESULTS

Group 1 showed significantly higher level of RSES scores compared to Groups 2 and 3 (p<.05). STCS scores were found to be significantly higher in Group 2, compared to other groups (p<.05). Group 1 (32.53 ± 8.94) showed significantly lower level of SAAS scores compared to Group 2 (39.63 ± 9.28) and Group 3 (39.42 ± 10.54) (p<.05). A significant positive correlation was found between the ICON and SAAS scores (r = 0.247, p=.007).

CONCLUSIONS

Adolescents with Class II and III malocclusions reported higher levels of social appearance anxiety scores, and lower levels of self-esteem scores compared to Class I. Complexity of orthodontic treatment need showed a significant impact on social appearance anxiety.

Parental Satisfaction with Their Children's Rapid Palatal Expansion Treatment Provided by Orthodontists and Pediatric Dentists

BACKGROUND

Dentofacial problems have a definitive impact on patients' psychological well-being, quality of life, and satisfaction. Therefore, patients' satisfaction with their dentition should be an essential goal for dental caregivers.

AIM

To compare parental satisfaction with their children's rapid palatal expansion treatment outcome provided by orthodontists and pediatric dentists.

MATERIALS AND METHODS

The authors reviewed 605 medical records and contacted 134 parents whose children received early orthodontic treatment from orthodontists and pediatric dentists using a rapid palatal expander. Eighty-eight parents (65.7%) responded to a validated questionnaire about patients' satisfaction with orthodontic treatment outcomes.

RESULTS

At baseline; there were no significant differences in relation to parent-related demographic variables. However, there were statistically significant differences between patients' ages and treatment duration (p < 0.001). Independent t-tests showed statistically significant differences in the means for the subscales of doctor-patient relationship and situational aspects (p < 0.05). Spearman's rho correlation coefficients and multivariate linear regression analysis showed that the overall satisfaction is significantly related to, and can be predicted by, parents' educational level, child's gender, and the specialty of the dentist who provided the treatment (p < 0.05).

CONCLUSION

Overall parental satisfaction with their children's rapid palatal expansion treatment is significantly higher when provided by pediatric dentists as compared with orthodontists. Factors related to doctor-patient relationship and situational aspects (ie, office location and design, appointment waiting, and treatment duration) significantly impacted parental satisfaction.

Factors related to the psychological impact of malocclusion in adolescents

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

Negative online reviews of orthodontists: Content analysis of complaints posted by dissatisfied patients

INTRODUCTION

Patients may express views about their orthodontic care by posting publicly available reviews on the Internet. This study analyzed online reviews of orthodontists with an emphasis on the types and frequency of complaints expressed in negative reviews.

METHODS

A random sample of 10.6% of the American Association of Orthodontists membership was evaluated to identify members practicing in a North American office that is limited to orthodontics and has an online presence. Information regarding those orthodontists and their offices was collected. For offices with Google and/or Yelp reviews, all negative (1- or 2-star) reviews were saved for content analysis. If an office posted a response to a negative review, those responses were also collected for analysis.

RESULTS

Of the 807 eligible orthodontists, 92.4% had reviews on Google and/or Yelp. Average ratings of orthodontists were very positive (ie, 4- and 5-star reviews constituted >97% of Google reviews and >88% of Yelp reviews), yielding an average orthodontist rating of 4.72 on Google and 4.42 on Yelp. However, approximately half of those orthodontists (50.9%) also had at least 1 negative review. The 3 most frequently mentioned categories of complaints were regarding quality of care and/or service, interpersonal interactions, and money and/or financial issues. An analysis of the specific kinds of complaints is described. Orthodontists posting responses to negative reviews had significantly better average ratings than those who did not, but this association does not demonstrate a causal relationship.

CONCLUSIONS

Understanding the complaints orthodontic patients express in online reviews may suggest strategies to improve patient satisfaction and an orthodontist's online reputation.

Adult orthodontic retreatment: A survey of patient profiles and original treatment failings

INTRODUCTION

A growing number of adult patients are seeking orthodontic treatment. This research aimed to analyze the particulars of patients seeking retreatment and identify the causes of their original treatment failure.

METHODS

An online questionnaire survey of adults seeking first-time orthodontic treatment (control) and retreatment (study) was conducted. Index of complexity, outcome, and need (ICON) scores were determined. Appraisal of treatment records was carried out to identify the causes of original treatment failure.

RESULTS

No significant differences were found between retreatment adult patients and first-timers regarding reasons for seeking orthodontic treatment, malocclusion type, self-perception of malocclusion, level of self-motivation, willingness for surgery, expectations of treatment improvement and duration. The predominant reason for seeking treatment in both groups was for aesthetic concerns. Retreatment patients presented with lower ICON scores (39.4; standard error, 0.26) than the first-time patients (54.3; standard error, 0.23), P ≤0.001. The predominant reasons for original treatment failings were poor treatment, maturational changes, inadequate retention, shortcomings in diagnosis and treatment planning, and unfavorable growth. Other causes were related to transverse deficiency, secondary malocclusion (after periodontal breakdown), poor retention compliance, and temporomandibular joint degeneration.

CONCLUSIONS

Adult orthodontic retreatment and first-time seekers' profiles are remarkably similar. Aesthetic concerns were the leading reasons patients sought treatment. ICON was not a useful proxy of patient profiles. Poor treatment was the chief reason for the failure of the original treatment. In terms of clinical significance, clinicians should be mindful of the patient profiles of retreatment seekers and vigilant about the possible causes of failings of orthodontic treatment to avoid suboptimal outcomes.

Factors Affecting Satisfaction with the Process of Orthodontic Treatment in Young Adults: A Questionnaire Study

Introduction: Recently, there has been an increase in adults undergoing orthodontic treatment in both the public and the private sector. Satisfaction during and after the orthodontic treatment process has not been widely discussed so far, however, and few research studies have emphasized patient satisfaction with treatment outcome and the factors affecting patient satisfaction.

Aim: To investigate factors affecting patient satisfaction with the process of orthodontic treatment in young adults.

Material and methods: Fifty-eight patients (33 girls and 25 boys with a mean age of 25.05 years, SD 2.83) were included in the survey. All patients were young adults who had completed their orthodontic treatment with fixed appliances and were taken from two centers (a teaching hospital and a private practice). Data was collected using online survey forms and was analyzed using content thematic analysis. Five main factors were identified related to patient satisfaction with the process of orthodontic treatment: communication, faculty (orthodontist), physical surroundings, consultation/appointments, and impact of appliance treatment.

Results: Effective communication was the most prominent factor among all five factors considered, especially detailed explanation given during treatment and making patients feel comfortable under their care. Median values were generally high for satisfaction with treatment results. There was a clear correlation ( p < 0.001) between patient satisfaction and treatment outcome. Age, sex and treatment time did not have any correlation with treatment satisfaction.

Conclusion: In general, young adults were observed to be satisfied with the treatment process, and good communication played a dominant role in this. Though there were many differences in working models between public and private sectors, many similarities were observed when comparing the factors between the two centers.

Psychological impact of orthodontic treatment on quality of life - A longitudinal study

OBJECTIVE

(1) To assess the psychosocial, functional and aesthetic changes in young adults pre- and post-orthodontic treatment. (2) To assess the changes in quality of life in individuals having malocclusion before and after orthodontic appliance therapy. (3) To evaluate the effect of severity of malocclusion pre- and post-orthodontic treatment on quality of life among males and females.

MATERIALS AND METHODS

This longitudinal study included a convenience sample of 18.1 to 25.3-year-old young adults (n=400). The self-perception of dental aesthetics pre- and post-treatment related to gender variations and severity of malocclusion (Angle's class I, II, III) were also assessed using the Psychosocial Impact of Dental Aesthetics Questionnaire with additions (PIDAQ) according to the needs of Indian ethnic group. Cronbach alpha of each domain at baseline score and Wilcoxon signed ranked test was carried out.

RESULTS

Statistically positive psychosocial impacts were observed after orthodontic treatment for the six PIDAQ domains (P<0.001 for all six domains). There was a similar influence of gender and severity on the improvement of scores over the period in all the domains though males showed the least psychological impact on matrimonial concerns both pre- and post-treatment. The severity of malocclusion showed a difference only in functional concerns. There was less improvement in class III malocclusion group as compared to class I and class II groups.

DISCUSSION

Orthodontic treatment has a positive psychological impact, as there was a significant improvement in self-esteem and social interaction of the individuals. Significant changes occurred in functional and aesthetic domain measures of quality of life in orthodontically treated cases. The severity of malocclusion has a negative impact on the quality of life and a significant improvement in the quality of life was observed before and after orthodontic treatment with no gender difference.

Satisfaction with Orthodontic Care Provided in a University Orthodontic Clinic

Objective:

To evaluate patients’ satisfaction with their orthodontic care at the Department of Orthodontics of University of Athens.

Materials and Methods:

The study sample comprised of 100 individuals whose orthodontic treatment had been completed during the period May to October 2010. A questionnaire was designed and piloted before the telephone interviews were carried out. Questions concerned socio-demographic characteristics, reason for seeking care at the Dental School, level of satisfaction with treatment outcome, fees paid for treatment, and various aspects of organisation of care provision, assessed on 1-very dissatisfied to 5-very satisfied Likert type items.

Results:

Satisfaction score was particularly high as far as treatment outcome (53% were “very satisfied” and 31% were “satisfied”), dentist’s response to an emergency (81% were “very satisfied”), and personnel’s behavior at initial examination (81% were “very satisfied”) were concerned. Factors appearing to require improvement were the waiting time from initial examination to the beginning of treatment, the waiting room and the duration of treatment. Overall satisfaction was found to be significantly associated with total duration of treatment, fees paid by patients, treatment outcome, the behaviour of personnel who conducted first clinical examination, and dentist’s response to an emergency. Overall satisfaction was confirmed as the vast majority of patients (97%) would recommend the Orthodontic Clinic.

Conclusion:

While the Orthodontics Clinic enjoys overall highly satisfied patients, there is scope for improvement of organizational aspects of care provision like the waiting time between the initial examination and the beginning of treatment, the waiting room and the duration of treatment.

[Discontinuation of Orthodontic Treatment: what are the early predictive factors?]

INTRODUCTION

Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment.

MATERIALS AND METHODS

We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance.

RESULTS

In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance.

CONCLUSION

Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

Patient Satisfaction with Orthodontic Treatment Received in Public and Private Hospitals in Dammam, Saudi Arabia

BACKGROUND:

The demand for orthodontic treatment is on the rise, and there are high patient expectations for improved dentofacial appearance. Patient satisfaction with orthodontic treatment is associated with improving treatment outcomes.

OBJECTIVE:

To evaluate patient satisfaction with orthodontic treatment received in public and private hospitals.

MATERIAL AND METHODS:

This cross-sectional study was conducted on a calculated sample of patients who received orthodontic treatment in public and private hospitals in Dammam, Saudi Arabia. A validated questionnaire (five-point Likert scale) was used to assess patient satisfaction with orthodontic treatment.

RESULTS:

A total of 229 out of 243 patients completed the survey (response rate = 94.2%). The mean age of the participants was 22.69 ± 6.34 years. More females (65.5%) than males (34.5%) participated in the study. The participants gave the highest satisfaction score to the doctor-patient relationship (mean score 4.33). This was followed by dentofacial improvement (mean score 4.23), dental functions (mean score 4.20), and psychosocial improvement (mean score 3.94). The participants provided significantly more positive perspective about doctor-patient relationship in public than private hospitals (P = 0.014). The patients treated in private hospitals were more satisfied with dental functions domain than those who received treatment in public hospitals (P = 0.023). The patients treated by public orthodontists were significantly more satisfied with other domains (situational aspect and residual category) than by the private orthodontists.

CONCLUSION:

The doctor-patient relationship was the most important factor in satisfaction with orthodontic treatment. Overall, patients treated in public hospitals were more satisfied with orthodontic treatment than those in private hospitals.

Treatment satisfaction and its influencing factors among adult orthodontic patients

INTRODUCTION

The aim of this study was to investigate the level of satisfaction for orthodontic treatment among adult patients. In addition, the influencing host factors were monitored for their associations with satisfaction.

METHODS

A questionnaire was designed to measure the level of satisfaction in 10 items; overall satisfaction, tooth alignment, facial appearance, eating and chewing, confident smile and self-image, retention state, treatment duration, treatment costs, intention to recommend, and relief of previous concerns, using a 5-point Likert scale. Total satisfaction was calculated by averaging the Likert scores from the 10 items. The survey was conducted, and the results from 298 adults were evaluated.

RESULTS

For the overall satisfaction item, 45.0% were very satisfied, and 39.9% were satisfied, resulting in a satisfaction ratio of 84.9%. Total satisfaction score was 3.9. The level of satisfaction for tooth alignment and confident smile and self-image were significantly higher than facial appearance and eating and chewing (P <0.001). Patients aged 50 and above were more satisfied than the younger ones, and men were more satisfied than women (P <0.05).

CONCLUSIONS

Overall, adult patients were highly satisfied with orthodontic treatment. Age, sex, motivation, expected concern, and discomfort influenced the level of satisfaction.

Relationship between the psychosocial impact of dental aesthetics and perfectionism and self-esteem

Background

Awareness of the influence of personality traits such as self-esteem and perfectionism on the aesthetic self-image can help clinicians to improve their patients’ satisfaction and quality of life. The main objective of this study was to examine the relationship between self-esteem, perfectionism and the psychosocial impact of dental aesthetics, and their association with gender.

Material and Methods

A descriptive-analytical cross-sectional study was conducted in a sample of 301 students of the Faculty of Medicine and Dentistry of the University of Valencia, aged between 18 and 30 years. Each participant was asked to complete a survey comprising three questionnaires: PIDAQ (Psychosocial Impact of Dental Aesthetics Questionnaire), MPS (Multidimensional Perfectionism Scale) and RSS (Rosenberg Self-esteem Scale). The response rate was 79%.

Results

The mean age was 20.8 years; 226 were women (75 %) and 75 were men (25 %). A negative correlation (Pearson = -0.387) was found between the total PIDAQ score and self-esteem. The correlation with perfectionism was found to be positive (Pearson = 0.281). On comparing the questionnaire and subscale scores by gender, the only statistically significant differences were in perfectionism (men 97.4, women 89.1) and self-confidence (men 22.1, women 23.5).

Conclusions

The students most affected by poor dental aesthetics had lower self-esteem and higher levels of perfectionism. The men presented higher levels of perfectionism than the women, while the latter displayed greater self-confidence in their dental aesthetics. Clinicians should pay greater attention to these traits and to their implications for treating these patients.

Key words:Psychosocial impact of dental aesthetics questionnaire, multidimensional perfectionism scale, rosenberg self-esteem scale, students.

Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample

Objective:

To compare self-esteem scores in 12 to 16-year-old adolescents with different Angle malocclusion types in a Peruvian sample.

Material and Methods:

A cross-sectional study was conducted in a sample of 276 adolescents (159, 52 and 65 with Angle Class I, II and III malocclusions, respectively) from Trujillo, Peru. Participants were asked to complete the Rosenberg Self-Esteem Scale (RSES) and were also clinically examined, so as to have Angle malocclusion classification determined. Analysis of covariance (ANCOVA) was used to compare RSES scores among adolescents with Class I, II and III malocclusions, with participants' demographic factors being controlled.

Results:

Mean RSES scores for adolescents with Class I, II and III malocclusions were 20.47 ± 3.96, 21.96 ± 3.27 and 21.26 ± 4.81, respectively. The ANCOVA test showed that adolescents with Class II malocclusion had a significantly higher RSES score than those with Class I malocclusion, but there were no differences between other malocclusion groups. Supplemental analysis suggested that only those with Class II, Division 2 malocclusion might have greater self-esteem when compared to adolescents with Class I malocclusion.

Conclusion:

This study shows that, in general, self-esteem did not vary according to adolescents' malocclusion in the sample studied. Surprisingly, only adolescents with Class II malocclusion, particularly Class II, Division 2, reported better self-esteem than those with Class I malocclusion. A more detailed analysis assessing the impact of anterior occlusal features should be conducted.

Perception of orthodontic treatment need among Swedish children, adolescents and young adults

OBJECTIVE

Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

MATERIALS AND METHODS

A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

RESULTS

The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2 ± 1.5), than among subjects, age 15 (3.6 ± 1.2) (p = .0009), and subjects, age 19 (3.5 ± 1.2) (p = .00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p = .002 and .001, respectively) and (ii) previous orthodontic treatment (p = .005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p = .002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p = .047) than Swedes, age 19.

CONCLUSIONS

The lower limit for orthodontic treatment need among subjects, age 10, was higher - compared to subjects, ages 15 and 19 - and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.

Occlusal traits and orthodontic treatment need in 7- to 10-year-olds in Estonia

The aim of this study was to evaluate the distribution of occlusal traits and orthodontic treatment need and complexity in Estonian 7- to 10-year-old children. This data provides solid information for planning of orthodontic care. Data of 392 Estonian children (198 girls and 194 boys, mean age 9.0 years, range 7.1-10.4 years) was analysed in this cross-sectional study. Assessed traits included first molar and canine sagittal relationship, overjet, overbite, crowding, midline diastema, crossbite, and scissor bite. Orthodontic treatment need and complexity were assessed using the Index of Complexity, Outcome, and Need. Parents' opinion regarding their child's teeth was determined using a questionnaire. The most prevalent occlusal traits were canine class I sagittal relationship (73.7%), midline diastema (73.0%), molar class I sagittal relationship (57.4%), and overbite ≥3.5 mm (51.8%). According to the Index of Complexity, Outcome, and Need, 64.3% of Estonian elementary school children were in need of orthodontic treatment. Treatment complexity was simple in 12.5%, mild in 38.8%, moderate in 22.7%, difficult in 14.0%, and very difficult in 12.0% of the children. Approximately 66.4% of the parents felt that their child needed orthodontic treatment. This study confirms earlier findings indicating that the most frequent sagittal relationship is class I in the first molars and class I in the canines. However, the sagittal relationship was asymmetric in more than half of the children. Correlation between objectively defined treatment need and parents' desire for treatment was high in Estonia.

A comparative study of aesthetic perceptions of malocclusion among general practice dentists, orthodontists and the public using a visual analogue scale (VAS) and the IOTN-AC

Background

Perception of malocclusion varies among individuals and among patients and practitioners. Although several indices that tend to coincide in many aspects and unify criteria, no single index has been recognised as the most suitable for assessing orthodontic treatment need. Moreover, orthodontists are not always aware of the differences in perception of malocclusion between patients and practitioners.

Objetives

To examine the perception of dental anaesthetics amongst dentists, orthodontists and the general population, study the relationship between the perception of dental aesthetics and the severity of the malocclusion, using the visual analogue scale and the IOTN-AC, and investigate relationships among the resulting data.

Study Design

Frontal intraoral photographs of 24 cases were classified by the severity of their malocclusion according to the DAI index. The photographs were examined by 150 individuals (30 orthodontists, 30 general dental practitioners and 90 members of the general population), who assessed them on a visual analogue scale and according to the IOTN-AC.

Results

The orthodontists gave the lowest scores on the visual analogue scale, although the differences between the three groups were not significant. For DAI grades 1, 3 and 4, significant differences were found in the IOTN-AC assessments. Here too, the orthodontist group was the most critical.

Conclusions

In general, in all three groups, both the visual analogue scale and IOTN-AC scores increased or decreased in line with the severity of the malocclusion according to the DAI. However, the correlation between these scores was low. The orthodontists scored the malocclusions more critically than the general dentists or the general population with the IOTN-AC, but this difference was not found with the visual analogue scale.

Key words:IOTN-AC, DAI, 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.

Impact of three malocclusion traits on the quality of life of orthodontic patients

BACKGROUND/OBJECTIVES

Malocclusion can have a negative impact on the quality of life, affecting the individual physically and psychosocially. The aim of this study was to determine the impact of three malocclusion traits on the quality of life of the patients.

METHODOLOGY

This was a clinic-based, comparative, cross-sectional study involving 120 patients between 10 and 20years of age, with crowding, spacing and increased overjet. There were also 40 control subjects. The quality of life was determined using the Oral Health Impact Profile short-form (OHIP-14).

RESULTS

Each of the malocclusion traits studied was found to significantly affect the oral health-related quality of life (OHRQoL) of the patients relative to the controls. Thirty-two percent of those with malocclusion had impact on their quality of life compared with three percent of those in the control group.

CONCLUSION

OHQoL was poorer in patients with malocclusion and patients with increased overjet recorded the highest level of impact on their quality of life.

Translation and validation of the Turkish version of the Psychosocial Impact of Dental Aesthetics Questionnaire

Objective

The aim of this study was to translate the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) into Turkish, validate the questionnaire, and provide a cross-cultural adaptation.

Methods

The translation process included the following steps, which were performed by a translation committee: (1) translation into Turkish, (2) back translation into English, (3) pretesting, and (4) cross-cultural adaptation. The Turkish version of the PIDAQ was produced subsequent to the translation process. Validity and reliability were measured using the Perception of Occlusion Scale and the aesthetic component of the Index of Orthodontic Treatment Need. The questionnaire was administered to 260 individuals (age range, 18–30 years; mean age, 20.50 ± 1.9 years). Structural validity was assessed via factor analysis, and internal consistency was measured using Cronbach's alpha coefficient.

Results

Factor analysis revealed a four-factor structure, with factor loadings for included items ranging from 0.380 to 0.868. Few questions were shuffled among domains various factor loadings. Cronbach's alphas for the Turkish version of the PIDAQ ranged from 0.534 to 0.904. Mean scores for the PIDAQ subscale and total scores differed significantly according to Index of Orthodontic Treatment Need and Perception of Occlusion Scale scores.

Conclusions

This study provided a Turkish version of the PIDAQ, which could be a useful tool in the evaluation of the psychosocial impact of malocclusion in young Turkish adults.

A Patient- and Family-Centered Care Approach to Orthodontics: Assessment of Feedbacks from Orthodontic Patients and Their Families

Objective

This study aimed to evaluate orthodontic patients and their families' clinical satisfaction and their perception of dentists in the framework of the Patient and Family Centered Care (PFCC) concept.

Methods

The study population comprised patients treated at the Orthodontics clinic and their families. A mixed method research with quantitative and qualitative components was employed by conducting questionnaires with 62 patients and 65 parents. Collected data were recorded on the computer, and analyses were performed.

Results

A majority of the patients who received treatment at our clinic were high school graduates, while their parents were university graduates. The patient's and their parents' overall satisfaction were similar. We also found that the patients and their parents expected doctors to have ethical perception and professional behavior in the treatment process.

Conclusion

According to the results obtained from the survey questionnaires, the patients and their parents expect a dentist to have the following qualities: courtesy, friendliness, respect, punctuality, communication skills, and knowledgeableness. Dentists can optimize clinical and patient satisfaction by providing care and attention based on the principles of patient centered care (PCC) and PFCC and shaped in accordance with the expectations of the patients and their parents.

The Facial Aesthetic index: An additional tool for assessing treatment need

Objectives:

Facial Aesthetics, a major consideration in orthodontic diagnosis and treatment planning, may not be judged correctly and completely by simply analyzing dental occlusion or osseous structures. Despite this importance, there is no index to guarantee availability of treatment or prioritize patients based on their soft tissue treatment needs. Individuals having well-aligned teeth but unaesthetic convex profiles do not get included for treatment as per current malocclusion indices. The aim of this investigation is to develop an aesthetic index based on facial profiles which could be used as an additional tool with malocclusion indices.

Materials and Methods:

A chart showing typical facial profile changes due to underlying malocclusions was generated by soft tissue manipulations of standardized profile photographs of a well-balanced male and female face. A panel of 62 orthodontists judged the profile photographs of 100 patients with different soft tissue patterns for assessing profile variations and treatment need. The index was later tested in a cross-section of school population. Statistical analysis was done using “irr” package of R environment version 2.15.1.

Results:

The index exhibited very good reliability in determining profile variations (Fleiss kappa 0.866, P < 0.001), excellent reproducibility (kappa 0.9078), high sensitivity, and specificity (95.7%). Testing in population yielded excellent agreement among orthodontists (kappa 0.9286).

Conclusions:

A new Facial Aesthetic index, based on patient's soft tissue profile requirements is proposed, which can complement existing indices to ensure treatment to those in need.

Relationships among satisfaction, treatment motivation, and expectations in orthodontic patients: a prospective cohort study

BACKGROUND

Few research projects have looked at patient satisfaction with treatment outcome and factors contributing to satisfaction. The aim of this study was to examine treatment motivation and expectation associated with treatment-outcome satisfaction in a group of adolescent nonextraction orthodontic patients. We hypothesized that there would be significant correlations among treatment-outcome satisfaction, motivation, and expectations.

SUBJECTS AND METHODS

A sample of 120 patients who received orthodontic treatment at the Second Affiliated Hospital of Zhejiang University School of Medicine completed two questionnaires. Before treatment, questionnaire 1 was given to patients to assess treatment motivation and expectations. When treatment had been completed, questionnaire 2, concerning treatment satisfaction, was assessed. Spearman's rank correlation and regression analyses were used to assess the relationships among treatment satisfaction, expectations, and motivation.

RESULTS

A total of 110 patients completed the two questionnaires. There was a tendency toward significant correlations between treatment motivation and overall satisfaction with treatment (β-coefficient -0.264, 95% confidence interval -0.456 to 2.314; P<0.001). However, correlations among treatment motivation and satisfaction with changes made and satisfaction with one's appearance posttreatment were more fragmented. No relationship between treatment expectation and satisfaction was found (β-coefficient -0.126; 95% confidence interval -0.024 to 0.524; P>0.05).

CONCLUSION

Motivation was correlated with satisfaction with treatment outcome. Patients' expectations had no correlation with treatment satisfaction.

Normative and self-perceived orthodontic treatment need in Nigerian school children

OBJECTIVE

The aim of this study was to assess the normative and self-perceived need for orthodontic treatment in Nigerian children, and to evaluate distribution of orthodontic treatment need according to gender and age.

MATERIALS AND METHODS

The sample consisted of 441 randomly selected school children, aged 11-18 years in Benin City, Nigeria. The subjects were further sub-grouped according to gender (229 males and 212 females) and age (246 11-13 years old and 195 14-18 years old). The Dental health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) were used to assess orthodontic treatment need normatively. Self-perceived need was evaluated by asking the subjects to rate their dental aesthetics on the Aesthetic Component scale of IOTN. Chi-square tests were used to evaluate gender and age differences in distribution of treatment need.

RESULTS

A definite need for orthodontic treatment was found among 21.5% (grades 4-5 of DHC) and 6.3% (grades 8-10 of AC) of the subjects; 3.9% of the subjects perceived a definite need for orthodontic treatment (grades 8-10 of AC). There were no statistically significant gender and age differences in distribution of orthodontic treatment need among the subjects (p > 0.05).

CONCLUSION

The study revealed a need for orthodontic treatment in slightly more than one fifth (21.5%) of this sample of Nigerian children. The sample population has a lower need on aesthetic grounds and their normative and self-perceived orthodontic treatment needs were not influenced by gender and age.

Comparison of personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment

OBJECTIVE

To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment.

MATERIALS AND METHODS

One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences.

RESULTS

Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11).

CONCLUSIONS

Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.

Relationship between perception of malocclusion and the psychological impact of dental aesthetics in university students

Introduction and Objectives: The objectives were to assess the relationship between perceived smile aesthetics and perceived psychological impact as measured by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and their own perception of it using the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) and a Visual Analog Scale (VAS); relate the IOTN-AC and VAS to the PIDAQ; and study the predictive capacity of the scales for psychological impact. Material and Methods: A cross-sectional study was conducted in 447 college students in Spain and Portugal (average age 20.4 years, 33.1% men and 66.9% women). The online self-completed surveys used the recently-validated Spanish and Portuguese versions of the PIDAQ to assess the self–reported psychological impact of the students’ dental aesthetics and IOTN-AC and an ad hoc 100 mm VAS for their perception of their dental aesthetics. Results: PIDAQ was linearly correlated with IOTN AC and VAS. Pearson’s coefficient was 0.55 for PIDAQ and IOTN-AC (CI 95% 0.48-0.61) and -0.72 for PIDAQ and VAS (CI 95% -0.66 - -0.76). VAS and IOTN-AC were predictive variables in a linear regression model of the total PIDAQ score. The VAS diagnosed individuals whose dental aesthetics had a self-perceived psychological impact (area under the curve 0.827, CI 95% 0.787-0.868) more precisely than the IOTN-AC (area under the curve 0.742, CI 95% 0. 696-0.788). Conclusions: In adults patients, there is a significant linear relationship between perceived smile aesthetics and self-perceived psychological impact.

Key words:Visual Analog Scale, Index of Orthodontic Treatment Need, malocclusion, psychological, aesthetics.

Smile aesthetics and malocclusion in UK teenage magazines assessed using the Index of Orthodontic Treatment Need (IOTN)

OBJECTIVE

There is a significant demand for orthodontic treatment within the UK from adolescent girls, a group known to be influenced by the media portrayal of body form and body image, which may extend to the presentation of malocclusions. This study examined the portrayal of malocclusion in a media type that targets teenage girls under 16 years of age.

MATERIALS AND METHODS

A representative selection of 1 month's magazines targeting this group were investigated, and the frequency and severity of malocclusions displayed were assessed. Two calibrated examiners viewed all the smiles (on two occasions) using a modification of Index of Orthodontic Treatment Need (IOTN) and assigned an Aesthetic Component Score to each smile.

RESULTS

It was found that the aesthetic score is low (less than 7) for the majority of models (92.8%) indicating no need or a borderline need for treatment. Only 7.2% of models exhibited a definite need for treatment.

CONCLUSION

It appears that the portrayal of malocclusion in teenage magazines does not reflect the general treatment need of the adolescent population.

Orthodontic treatment for disabled children: a survey of parents' attitudes and overall satisfaction

Background

Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities.

Methods

The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed.

Results

Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children.

Conclusions

Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.