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

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

INTRODUCTION

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

MATERIALS AND METHODS

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

STATISTICAL ANALYSIS

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

RESULTS

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

CONCLUSION

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

Effect of weight satisfaction on adolescent facial and dental satisfaction

PURPOSE

To investigate if facial and dental satisfaction is related to body fat percentage and body weight satisfaction.

METHODS

A self-administered questionnaire was applied to adolescents from a Private School in Southern Brazil containing sociodemographic (sex and age) and self-perception variables. Adolescents were asked about their perceptions concerning dental problems. Body fat percentage was collected using bioelectrical impedance analysis.

RESULTS

A total of 372 adolescents were examined. Most adolescents were satisfied with their dental (81.7%) and facial appearance (87.6%), while 39% of adolescents were satisfied with their body weight. Poisson regression model showed that adolescents who expressed satisfaction with their body weight (PR = 1.12, 95%CI 1.06-1.19) and were satisfied with their dental appearance (PR = 1.24, 95% CI 1.08-1.41) exhibited a positive association with facial satisfaction. Adolescents dissatisfied with dental color (PR = 0.88, 95%CI 0.80-0.97), those reporting dental pain (PR = 0.88, 95%CI 0.80-0.97), and individuals with obesity (PR = 0.91, 95%CI 0.83-0.99) demonstrated a decrease in facial satisfaction. Adolescents aged 16 to 19 years (PR = 1.08, 95% CI 1.01-1.15) and those satisfied with their facial appearance (PR = 1.20, 95%CI 1.01-1.43) exhibited a higher prevalence of dental satisfaction. Conversely, adolescents dissatisfied with dental color (PR = 0.74, 95% CI 0.66-0.82) and those with misaligned teeth (PR = 0.63, 95%CI 0.55-0.73) reported lower levels of dental satisfaction. Parametric g-formula analysis found that the association between body fat and facial satisfaction was mediated by body weight satisfaction (p = 0.001).

CONCLUSIONS

While dental satisfaction was not influenced by corporeal characteristics, facial satisfaction was influenced by dental and body weight satisfaction. Obese adolescents had low facial satisfaction.

Dental anxiety, Quality of Life and body image: gender differences in Italian and Spanish population

BACKGROUND

Dental anxiety is an excessive and irrational negative emotional state experienced by population; the dental anxiety is common throughout the lifespan and is an obstacle to improving oral health behaviors and outcomes. The aim of this study was to assess gender differences in dental anxiety and to investigate if oral health impacts patients' Quality of Life and the perception of their body image.

METHODS

The sample consisted of 366 subjects selected in Italy and Spain (January 2021-September 2021). For this study, data were gathered using Google Forms (Google LLC, Mountain View, CA, USA). Data were collected including the Dental Anxiety Scale (DAS), Oral Health Impact Profile (OHIP-14) questionnaires and Body Uneasiness Test.

RESULTS

Women showed higher scores than men for the dental anxiety. The regression analysis showed that gender, age, and Oral Health Impact are predictors of "dental anxiety." A borderline significance emerges for the independent variable body uneasiness.

CONCLUSIONS

The dental anxiety is widespread in the population, with a higher prevalence among women and increases with increasing age. It can negatively affect patients' Quality of Life, well-being, and self-esteem. These results underline the importance of addressing both individual and group strategies for preventing or treating dental anxiety.

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.

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.

The development of a guide to borderline orthodontic need

Objective

To produce a guide for dentists and orthodontists to determine orthodontic treatment need in borderline cases (dental health component DHC 3) and to compare views of different panels of judges on treatment need.

Materials and methods

Prospective, observational study. Photographs of one hundred subjects displaying borderline occlusal traits (DHC3) were collected. Three panels of judges consisting of 25 orthodontists, 25 dentists and 25 lay persons assessed photographs based on orthodontic treatment need on aesthetic grounds.

Results

Spearman’s correlation coefficient showed no statistical difference between the panels of judges (p < 0.001). The judges identified a ‘high need’ for treatment on aesthetic grounds for those with anterior open bites and reverse overjets. Kappa analysis showed moderate intra-rater agreement for the orthodontic and dental panels of judges (k = 0.47 and 0.45, respectively) and fair agreement (k = 0.26) for the lay panel, highlighting the intrinsic difficulty of assessing borderline malocclusions.

Conclusion

There was no statistical difference in the way the orthodontic, dental and lay panels of judges perceived treatment need for DHC 3 cases. Anterior open bites and reverse overjets were predominantly found to be in high need of treatment by all panels of judges. A ‘Guide to Borderline Orthodontic Need’ (GBON) is proposed consisting of 8 photographs of subjects with borderline occlusal traits (DHC3) determined unambiguously by lay, dental and orthodontic panels as either ‘needing’ or ‘not needing’ orthodontic treatment on aesthetic grounds. It is anticipated that this will assist users to make judgments on aesthetic grounds on the need for treatment in borderline cases.

Assessment of Handicapping Labio-Lingual Deviation index scoring methods and their effect on orthodontic treatment coverage by Medicaid

BACKGROUND

The purpose of this study was to assess the validity and reliability of Handicapping Labio-Lingual Deviation index (HLDI) scoring methods as calculated by digital models (DM) and visual inspection (VI) and their agreement to either meet or fail to meet the Medicaid coverage threshold. An additional objective was to assess the agreement with Medicaid managed care organizations (MCO) coverage decisions.

METHODS

The study included the orthodontic records of 401 patients who applied for Medicaid coverage. Two methods were used to calculate HLDI scores: (1) Measurements derived from DMs using OrthoCAD software; and (2) VI of intraoral photographs. The levels of agreement between the two methods and the Medicaid coverage decision by a MCO were evaluated.

RESULTS

The study results show a high level of agreement between the two HLDI calculation methods, DM and VI evaluation methods(Cramer's V = 0.812). The agreement on coverage decisions (eligible/not eligible) between VI methods and the official MCO decision was Cramer's V = 0.318. The agreement on coverage decisions between the DM method and the official MCO decision was Cramer's V = 0.318.

CONCLUSIONS

MCO assessment results of the patients using HLDI showed low agreement with the results obtained by DM and VI scoring methods used in this study. The Illinois Medicaid system is apparently using unknown factors other than the HLDI score when determining when approving or disapproving orthodontic coverage.

PRACTICAL IMPLICATIONS

MCO decisions on eligibility for orthodontic treatment coverage were not consistent with patients' treatment needs.

The impact of malocclusion on the oral health related quality of life of 11-14-year-old children

Background

The relationship between malocclusion and the oral health related quality of life (OHRQoL) of children needs to be explored further as existing literature presents conflicting evidence. This study aims to determine the association between malocclusion and OHRQoL of 11–14-year-old children.

Methods

This cross-sectional study was conducted among 250 caregiver/child dyads seeking orthodontic consultation at a tertiary care hospital. The OHRQoL was assessed using child perception questionnaire for 11–14-year-old children (CPQ_11–14) and the severity of malocclusion was assessed using the Dental Aesthetic Index (DAI). CPQ_11–14 scores ranged from 0 to 64, with lower scores representing better quality of life. Analysis of variance (ANOVA) was used to assess differences between domain and total CPQ_11–14 scores.

Results

The mean CPQ_11–14 score was 19.89 ± 9.8. Mean scores for the oral symptoms, functional limitations, emotional well-being, and social well-being domains were 5.26 ± 3.22, 3.67 ± 3.58, 3.98 ± 3.89 and 2.08 ± 2.98, respectively. Normal or slight malocclusion was seen in 37.6%, definite malocclusion was seen in 22.4%, severe malocclusion in 15.2% and handicapping malocclusion in 24.8% of the subjects. In comparisons by pairs, it was found that children with handicapping malocclusion had significantly (p < 0.05) higher scores for the social well-being domain as compared with children having normal/minor malocclusion, indicating a poorer quality of life.

Conclusion

Handicapping malocclusion had a significant negative impact on the social well-being domain of OHRQoL among 11–14-year-old children in this population.

Parents’ Awareness of Early Orthodontic Consultation: A Cross-Sectional Study

Objective: The aim of this paper is to assess parents’ knowledge about early orthodontic consultation and treatment, and to determine the association of this knowledge with number of children, monthly income, children’s age and perceived dental problems. Methods: A questionnaire was distributed to 3000 school children aged 6–11 years. The children were asked to take the questionnaire to their parents and bring it back the next day. It consisted of 13 questions. Some of these questions were related to the gender of the child, number of children, and parents’ monthly income. The remaining questions assessed the parents’ awareness of their children’s need for orthodontic treatment. Results: In total, 2538 parents completed the questionnaire. Of these, 2014 (79%) of the parents thought that their children’s teeth would have a significant impact on their personality. Moreover, 1637 (64.5%) parents thought that their children had a problem with their teeth; 1080 (66%) of these parents consulted a dentist. Of these 1080 parents, 821 (76%) consulted an orthodontist, and of these 821 parents, 449 (55%) initiated the required orthodontic treatment. The number of children who visited an orthodontist was found to increase with an increase in age (p = 0.0057). Moreover, a perceived overjet was associated with a higher number of orthodontic consultations (p = 0.0326). Conclusion: Although parents’ awareness regarding their children’s orthodontic treatment is important, other factors, such as the age of the child, the severity of the malocclusion and the consulted dentist, play a role in initiating orthodontic treatment.

The Influence of Abnormalities in the Profile and Overjet on Psychological Well-Being

Objective

This study aimed to comparatively evaluate the psychological well-being and health-related quality of life of subjects having either a convex or concave profile and abnormal overjet, with subjects having a straight profile and normal overjet.

Methods

In this study, 163 children and their parents who applied to the Faculty of Dentistry were classified into 3 groups: Group 1: convex profile, Class II molar relationship, and increased overjet (n=62; 28 boys and 34 girls; mean age: 11.6 years); Group 2: concave profile, Class III molar relationship, and negative overjet (n=55; 32 boys and 23 girls; mean age: 11.2 years); and Group 3: straight profile, Class I molar relationship without crowding, and normal overjet (n=46; 24 boys and 22 girls; mean age: 11.0 years). The severity of malocclusion was evaluated using the Index of Orthodontic Treatment Need (IOTN). Self-concept, depression, and state-trait anxiety were evaluated to determine the psychological well-being of the children.

Results

No differences were found among the groups with respect to self-concept, depression levels, state-trait anxiety levels, and quality of life scores. No correlation was found between the IOTN scores and psychological well-being.

Conclusion

Abnormalities in the facial profile and negative or increased overjet have no influence on children's psychological well-being.

Association between 2 indexes for evaluating malocclusion in the mixed dentition

INTRODUCTION

This study aimed to associate 2 indexes for evaluating malocclusion in the mixed dentition.

METHODS

A population-based cross-sectional study was conducted involving 743 children aged 8-10 years, divided into early and late mixed dentition. The Dental Aesthetic Index (DAI) and criteria proposed by Grabowski were used to evaluate malocclusion. Associations between the DAI (outcome variable) and the other independent variables (gender, race, and mixed dentition stage) were analyzed using logistic regression models. Simple logistic regression models were constructed, estimating the crude odds ratios with the respective 95% confidence intervals (CIs). The variables with P < 0.20 in the simple analyses were tested in multiple logistic regression models, estimating adjusted odds ratios with the respective 95% CIs.

RESULTS

We found that 84.01% (185/220) of the diagnoses were coincidental between the Grabowski Index and DAI in patients without malocclusion. In contrast, 59.80% (439/734) of the patients were diagnosed by both indexes (Grabowski and DAI) with malocclusion. Children with malocclusion, diagnosed by the Grabowski Index, were 5.85 (P = 0.0001 and 95% CI: 4.08-8.39) times more likely to show malocclusions when diagnosed by the DAI.

CONCLUSIONS

DAI and the criteria proposed by Grabowski were expressed differently in relation to malocclusion in the mixed dentition. This study suggests the importance of specific criteria for the evaluation of malocclusion at this stage of development.

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

INTRODUCTION

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Relationship between normative and self-perceived criteria for orthodontic treatment need and satisfaction with esthetics and mastication in adolescents

INTRODUCTION

Orthodontic treatments are performed to improve esthetics and masticatory functions. In general, clinical criteria are used to recommend such treatments without considering the opinion of the patient. This study aimed to evaluate the relationship between technically defined orthodontic need (normative criteria) and the need for treatment perceived by adolescent patients.

METHODS

A total of 215 students aged between 15 and 19 years were selected and asked to respond to a questionnaire concerning their perception of need for orthodontic treatment and their satisfaction with their own esthetics and mastication. One trained and calibrated examiner obtained normative data using the Dental Aesthetic Index (DAI) on the need for orthodontic treatment of these students.

RESULTS

Associations were found between the DAI score and the patient's perception of need for orthodontic treatment (P <0.001), satisfaction with esthetics (P = 0.003), and satisfaction with mastication (P = 0.047). When occlusal characteristics were analyzed separately, associations between several normative and perceived needs, as well as for satisfaction with esthetics, were found. Satisfaction with mastication analysis was only found to be associated with open bite malocclusion (P = 0.003).

CONCLUSIONS

The DAI revealed a consistent opinion in adolescents to link their perceived malocclusion-related conditions to esthetics.

The implementation of the Handicapping Labio-Lingual Deviation index on access to orthodontic care

OBJECTIVES

In 2017, the state of Illinois changed the system by which they define severe malocclusion from the DentaQuest Orthodontic Criteria Index to the Handicapping Labio-Lingual Deviation Index (HLD). The purpose of this study was to compare subjects who were submitted for coverage under either the DentaQuest Orthodontic Criteria Index or the HLD index to see if a difference exists in the number of subjects who received coverage and the type of malocclusions that were covered.

METHODS

All subjects evaluated for orthodontic coverage by the Illinois Department of Human Services for treatment at the University of Illinois, College of Dentistry during the years 2016 and 2017 were included in this study. One hundred consecutively approved and 100 consecutively denied subjects from both 2016 and 2017 were selected for further analysis.

RESULTS

There was a statistically significant decrease in the overall rate of approval in 2017 compared to 2016. No difference was found in the approval rate of Class I, II, or III subjects, but there was a significant decrease in the approval rate of subjects with impacted teeth.

CONCLUSIONS

The implementation of the HLD index has significantly decreased access to orthodontic care for Medicaid patients in Illinois.

The effect of enamel fractures on oral health-related quality of life in adolescents

BACKGROUND/AIM

Enamel fractures are the most common type of traumatic dental injury (TDI) in children and adolescents. Recognizing the impact of these fractures on oral health-related quality of life (OHRQoL) could contribute to the establishment of treatment protocols. The aim of this study was to assess and quantify the impact of enamel fractures on overall OHRQoL and domain scores in adolescents.

MATERIALS AND METHODS

A cross-sectional study was conducted with 775 adolescents aged 11 to 14 years in the city of Santo Ângelo in southern Brazil. Sociodemographic variables were collected from parents/caregivers using a structured questionnaire. The adolescents answered the Child Perceptions Questionnaire (CPQ_11-14 ). Physical examinations were performed by an examiner who had undergone training and calibration exercises for the investigation of TDI (Andreasen criteria), dental caries (WHO criteria), and malocclusion (Dental Aesthetic Index). Data analysis involved Poisson regression with robust variance.

RESULTS

The prevalence of TDI was 11.9% and enamel fractures accounted for 79.3% of all injuries. In the multivariate analysis, adolescents with enamel fractures had 29% higher CPQ_11-14 scores (worse OHRQoL) than those without TDI, even after adjustment for sociodemographic and clinical variables (mean ratio = 1.29; 95% CI: 1.09-1.53; P = .003). Enamel fractures exerted a negative impact on the functional limitation, emotional well-being, and social well-being domains.

CONCLUSIONS

Enamel fractures exert a negative impact on the OHRQoL of adolescents, suggesting that subjective measures should be incorporated in the evaluation of patients with this traumatic injury.

Does dental trauma influence the social judgment and motivation to seek dental treatment by children and adolescents? Development, validation, and application of an instrument for the evaluation of traumatic dental injuries and their consequences

BACKGROUND

One's smile clearly plays a significant role in the perception and judgment that others have of one's appearance and personality.

AIM

We sought to develop and validate a questionnaire related to the social judgment of children and adolescents and to evaluate, through its application, the perceptions and judgment of children and adolescents regarding their view of different traumatic dental injuries and their consequences (TDIs-Cs) as well as the motivation to seek dental treatment.

DESIGN

The aspects of acceptability, discriminative properties, internal consistency, test-retest reliability, and construct validity were evaluated in the developed questionnaire. A cross-sectional study was conducted involving 100 boys and girls aged 10-15 years. Images of an adolescent male and female were either manipulated or not (control) to create different types of TDI-C (eg, enamel fracture, enamel and dentin fracture, crown colour change, and tooth loss/avulsion). These images were analysed by the participants, using a previously validated questionnaire with a six-positive-point and six-negative-point scale, in relation to their social physical and psychosocial characteristics. The data were analysed with the Friedman, Wilcoxon, and Mann-Whitney tests (P < 0.05).

RESULTS

The developed questionnaire presented high acceptability, strong discriminative properties, satisfactory internal consistency, and satisfactory test-retest reliability, but weak construct validity. The presence of TDI-C had a negative effect on all characteristics evaluated (P < 0.001). Tooth loss had the highest level of rejection. Additionally, the presence of TDI-C had a greater negative impact on the aspects of 'starting fights', 'being given a nickname', and 'being ashamed to smile' in males than in females (P < 0.05). Children and adolescents with TDI-C were judged as needing to seek dental treatment (P < 0.001).

CONCLUSION

The questionnaire developed showed properties of validity and reliability in its administration in a child and adolescent population. TDIs-Cs have a negative influence on the social judgment of children and adolescents.

Malocclusion and social vulnerability: a representative study with adolescents from Belo Horizonte, Brazil

Malocclusion is public health problem because of its high prevalence, treatment possibility, and impact on the individual's quality of life. This article aims to determining the prevalence of malocclusion in adolescents and to test its association with social vulnerability. A representative transversal study was performed with 1612 adolescents aged between 11 and 14 years old who came from public and private schools in Belo Horizonte, Brazil. The adolescents were examined by three calibrated examiners for diagnosis of malocclusion, using the Dental Aesthetic Index. The Social Vulnerability Index from Belo Horizonte was used to determine the degree of social vulnerability from adolescents. The data were analyzed using Poisson regression with robust variance (p<0,05). Most adolescents presented absence/minor malocclusion (68.7%). Dental crowding was diagnosed in 51.9% from the sample, diastema in 23.7%, anterior open bite in 7.6 %. Malocclusion was associated with social vulnerability (PR=1.25;95% CI=1.01-1.55). Dental crowding was the most prevalent type of malocclusion. The more socially vulnerable adolescents had worse indicators of malocclusion.

Individual factors associated to malocclusion in adolescents

The study aimed to identify the severity of malocclusions and associated factors among Brazilian adolescents. Data from 5,445 adolescents participating in the Brazilian Oral Health Survey (SBBrasil 2010) were evaluated, of which 4,276 were included in the study based on the inclusion criteria. The dependent variable was severe and very severe malocclusion, according to the Dental Aesthetic Index (DAI > 30). The independent variables were place of residence, macro-region, self-reported ethnicity, income, gender, schooling, access to dental care, untreated caries and front and back teeth loss due to caries. A hierarchical multiple logistical regression analysis was performed, considering the complex cluster sampling plan. Prevalence of severe/very severe malocclusions was 17.5%. After adjustments, black/brown ethnicity group (OR = 1.59, 95% CI: 1.09-2.34), lower household income (OR = 0.67, 95% CI: 0.55-0-82), front (OR = 2.32, 95% CI: 1.14-4.76) and back teeth (OR = 1.45, 95% CI: 1.14-1.84) loss due to caries were associated with the outcome. Therefore, we conclude that black/brown ethnicity, lower household income and greater number of front and back teeth loss due to caries increased the odds for severe/very severe malocclusion.

Influence of sense of coherence on adolescents' self-perceived dental aesthetics; a cross-sectional study

Background

Sense of coherence (SOC) is a psychosocial factor capable of influencing perception of health, improving one’s ability to manage life. It is the central construct of salutogenesis. SOC allows for identification and mobilization of resources to effectively manage or solve problems, promoting health and quality of life. Using Wilson-Cleary’s conceptual model we hypothesized that SOC might contribute to self-perception of dental aesthetics. The aim of this study was to investigate whether SOC levels were related to self-perception of dental aesthetics against assessed normative orthodontic treatment need among adolescents.

Methods

A cross-sectional study was conducted with 615 male and female adolescents aged 12 to 15 years. Data collection comprised socio-demographic and socio-economic characteristics, SOC (SOC 13), self-perceived dental aesthetics (Oral Aesthetic Subjective Impact Scale), and assessment of orthodontic treatment need (Dental Aesthetic Index). Statistical analysis involved Pearson’s chi-square test, Kruskal-Wallis test, Mann-Whitney test and multiple linear regression. Spearman’s correlation coefficient was calculated for the determination of the strength of correlations among the numerical variables. The level of significance was set at 5% (p < 0.05).

Results

50.1% of the participants were classified as having a high SOC (≥ median). Overall, SOC was associated with self-perceived dental aesthetics (p = 0.048). In the adolescents with no orthodontic treatment need, those with a low SOC perceived their dental aesthetics more negatively than those with high levels of SOC. The multiple regression analysis demonstrated an inverse relationship between SOC and: 1) age (p = 0.007), SOC being higher in the younger age group; 2) self-perceived dental aesthetics (p = 0.001), a higher SOC being associated with those who had a positive dental self-perception.

Conclusions

SOC was associated with self-perceived dental aesthetics and adolescents with a high SOC were more likely to perceive their dental aesthetics more positively. SOC did not seem to influence self-perception of dental aesthetics in adolescents who were clinically assessed as having an orthodontic treatment need, however, in those where there was no orthodontic treatment need, a low SOC was associated with a negative self-perception of dental appearance.

Effect of malocclusion on the self-esteem of adolescents

INTRODUCTION:

Esthetics plays an essential role in orthodontic treatment. The psychological effects of malocclusion are an inspiration to improve one's esthetics and seek treatment.

OBJECTIVES:

This study aimed to assess relationships between self-esteem and malocclusion severity and type in adolescents using a self-esteem measurement scale and the index of treatment need (IOTN) and to investigate the influence of age, sex, and school type in these relationships.

MATERIALS AND METHODS:

Adolescent students aged 12–19 years randomly selected from four private and two governmental schools were enrolled for this study. After completing the self-esteem questionnaire, participants were examined by researchers to evaluate malocclusion severity and type using the IOTN.

RESULTS:

The sample consisted of 886 participants: 558 females (62.9%) and 328 males (37.1%) with a mean age of 16 years. Chi-square analysis showed that 17.1% of males and 31% of females showed low levels of self-esteem, with a statistically significant difference (P < 0.001). Cases with multiple malocclusions showed significantly lower self-esteem (P = 0.018) compared with single-category malocclusion. Anterior teeth spacing, crowding, and overjet malocclusion showed the highest percentages of low self-esteem.

CONCLUSIONS:

The present study supports that malocclusion has negative effects on self-esteem; multiple malocclusions with spacing, crowding, and overjet had the greatest effects.

Perception of children and mothers regarding dental aesthetics and orthodontic treatment need: a cross-sectional study

BACKGROUND

The normative orthodontic treatment need, established by dental professionals during the dental appointment, becomes ineffective when it does not evaluate all the factors that influence the decision-making process, including individuals' perception and satisfaction with their dental appearance. Therefore, the purpose of this study was to investigate the perception of children and their mothers as regards orthodontic treatment need and satisfaction with dental aesthetics and test if these variables are associated with the objective orthodontic treatment needs, assessed by the Dental Aesthetic Index (DAI).

METHODS

A cross-sectional study was conducted on 308 children aged 12 years, and their mothers were randomly selected by cluster sampling (primary schools). The variables "orthodontic treatment need," "satisfaction with chewing," and "dental appearance" were assessed by means of a questionnaire. The questions were answered individually at school or home, in cases of children or mothers, respectively. DAI was assessed to make an objective clinical assessment. The variables were dichotomized and statistically analyzed by the chi-square and Fisher's exact tests, contingency coefficient C, and logistic regression.

RESULTS

The results of the clinical evaluation (DAI) were statistically associated with the perception of orthodontic treatment need and satisfaction with dental appearance in children (p ≤ 0.01). However, no association was observed with regard to satisfaction with chewing and DAI (p = 0.10). The children's perception of orthodontic treatment need and satisfaction with the appearance of their teeth was statistically associated (p ≤ 0.01) with their mothers' perception. Maxillary overjet, maxillary and mandibular misalignment, and dental crowding were associated with the orthodontic treatment need by children and their mothers, with p value -0.05 and 5 % level of significance. Maxillary overjet was a significant predictor for the perception of orthodontic treatment need in children (OR 1.86, 95 % CI 0.98-3.55) and mothers (OR 3.02, 95 % CI 1.54-5.92).

CONCLUSIONS

Children and parents realize the need for orthodontic treatment according to the different types of malocclusion, as noted in the association between orthodontic treatment need and dental appearance perceived by children and their mothers, which was also observed-with low correlation-with regard to DAI.

Comparison of esthetics perception and satisfaction of facial profile among male adolescents and adults with different profiles

Objective:

To evaluate esthetics perception and satisfaction of the facial profile among Iranian male adolescents and adults.

Materials and Methods:

In this cross-sectional study, male subjects referred to Orthodontic Department of Mashhad Dental School were enrolled (n = 84) and were divided into two groups: Adolescents (n = 39), and adults (n = 45). They were also assigned to straight, convex, or concave profile groups based on the facial profile angle (G-Sn-Pog’). An ideal silhouette of the lower facial profile was designed in Adobe® Photoshop® CS2 software (Kansas, USA). Then, eight other silhouettes representing different relations of the maxilla and mandible were constructed. Patients were asked to use numbers 1–10 to rank the facial profiles in the order of the attractiveness, and choose a silhouette that best closely resembled their own profile. Moreover, using a questionnaire patients were asked to rank their satisfaction with their profile, and asked to assign a number (1–5) to each question as follows; one represented the least satisfaction, while five reflected the highest satisfaction.

Results:

Adult and adolescent subjects with straight (adults: 12.0 ± 1.9, adolescents: 12.8 ± 1.05) and concave (adults: 10.0 ± 2.14, adolescents: 10.0 ± 2.08) profile showed the highest and the least satisfaction with their own profile, respectively. Both adult and adolescent group selected “retrognathic maxilla, prognathic mandible” as the least attractive profile. Overall, “straight” and “bimaxillary dentoalveolar retrusion” were chosen as the most attractive silhouettes in adolescent and adults, respectively. In comparison to a professional opinion (clinician ranking), 42.9% of adolescents and 22% of adults were able to correctly diagnose their own profiles type.

Conclusion:

Most of the male adolescents and especially adults diagnosis of their own profile differed with a professional assessment.

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

Aims and Objectives:

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

Materials and Methods:

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

Statistical Analysis:

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

Results:

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

Conclusion:

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

[Dental spacing problems and associated factors among Brazilian adolescents]

The scope of this study was to estimate the prevalence of dental spacing problems and associated factors among adolescents using data from the SB Brazil 2010 survey. The outcomes evaluated were dental spacing problems: space deficit (crowding and misalignment) and excess space (diastema and spacing) obtained using the DAI index. The association of independent variables with outcomes was assessed using a hierarchical model with four levels: contextual, socioeconomic and demographic characteristics, access to services and dental morbidity. Statistical analysis was performed using the chi-square test and univariate and multivariate Poisson distribution to estimate prevalence ratios (PR). The overall prevalence of space problems was 71.43%, with misalignment being the most common type (56.4%). The following aspects were significantly associated with excess space: age of 16, 18 and 19 years; being non-Caucasian (PR = 1.75), perception of speech problems (PR = 1.72) and periodontal pockets 4-5mm (RP = 1.56). For space deficit: family income up to 3 minimum wages, dental visit 1 year or more previously (PR = 1.19) and having one or more decayed teeth on average (PR = 1.32). There was a prevalence of spacing problems, especially with socioeconomic and demographic variables and morbidity as potential risk factors.

A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment

Introduction. Physical, mental, and social consequences of malocclusion may impact the quality of life. The aim of this review is to describe main factors motivating parents for orthodontic treatment for their children. Methods. A systematic review study design was used to identify articles analyzing different motivational factors in orthodontic treatment appearing in Medline database, EMBASE, and Google Scholar. The search terms used were teasing, motivating factors, orthodontics, malocclusion, quality of life, smile attractiveness, and perception of malocclusion. Papers selected up to May 2013 included retrospective and prospective longitudinal studies, randomized control trials, cross-sectional studies, reviews, and meta-analyses. Results. 13 articles included in this review identified aesthetics as the main motivational factor in orthodontic treatment. Children mention teeth crowding, large overbite, missing teeth, and largest maxillary anterior irregularities also as motivational factors. Parents want their children to look nice and worry of being accused of neglecting parental duties. Conclusions. Dissatisfaction with one's appearance, dentist recommendation, interest and worries of parents, and the impact of peers who wear braces rank among the main motivation factors of seeking orthodontic treatment. Understanding these factors allows better planning of resources and better assessment of the requirements and priorities of treatment.

Change in frequency of the maxillary midline diastema appearing in photographs of Caucasian females in two fashion magazines from 2003 to 2012

OBJECTIVES

To ascertain if there has been a change in the frequency of appearance of maxillary midline diastema in two leading women's fashion magazines over a decade.

METHODS

Two observers counted the frequency of maxillary midline diastema that appeared in Caucasian female models featured in British Vogue and Glamour (UK).

RESULTS

An increase in the frequency of maxillary midline diastema appearing in both publications was observed between 2003 and 2012.

CONCLUSIONS

This change may indicate an increase in the acceptance of the maxillary midline diastema, which may in turn, influence orthodontic and aesthetic dentistry treatment planning.

Malocclusion impacts adolescents' oral health-related quality of life

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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

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

OBJECTIVE

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

MATERIALS AND METHODS

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

RESULTS

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

CONCLUSIONS

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