Perceived Occupational Stress and Its Psychosocial Predictors Among Indian Orthodontists

BACKGROUND

Orthodontists, like any other medical professional, are susceptible to cumulative stressors and their undesirable consequences. The study aims to assess the self-perceived occupational stress levels and the psychological link between predictors and stress among orthodontic practitioners in India.

MATERIALS AND METHODS

The participants in this cross-sectional study are active members of the Indian Orthodontic Society (IOS). The data for the survey were collected by a previously validated closed-ended occupational stress assessment (OSA) questionnaire and a job satisfaction questionnaire, which were sent through the registered e-mails. A five-point Likert scale was used to assess the severity of individual stressors, and an overall severity score was obtained by summing up the individual scores. The predictors of stress based on socio-demographic parameters were assessed using a binomial multiple logistic equation. Statistical significance was set at a p-value of <0.05.

RESULTS

A total of 311 responses were received. Male orthodontists, unmarried, in the age group of 30-40 years, working in urban areas without any academic attachment were more stressed compared to the other groups in the respective categories. Tiredness/headache (39%) was reported as the most common consequence of occupational stress. The most concerning stressor was patients not wearing retainers. Orthodontists showed overall job satisfaction that is negatively correlated to overall stress (p <0.0001)(r = -0.260).

CONCLUSION

A profound variation in stress levels was found among the orthodontists with their socio-demographic and professional characteristics. Despite the stress, orthodontists were highly satisfied with their careers.

Global Trends in Knowledge, Attitude, and Awareness of Orthodontists Regarding the Management of Patients with Cleft lip and/or Palate: A Systematic Review

The aim of the present systematic review was to assess the trends in knowledge, attitude, awareness, and practice among orthodontists regarding the management of patients with cleft lip and/or palate.

An a priori protocol was developed as per the best practices of evidence-based medicine and registered in Prospero (CRD42022306107). The literature search was conducted electronically, using MeSH-terms, keywords, and Boolean-operators "AND" and "OR" in different combinations in multiple databases and screening of titles and abstracts followed by full-text evaluation was performed. The risk of bias (ROB) was assessed using Joanna Briggs Institute critical appraisal checklist.

Five studies were included in the qualitative synthesis and three of them showed a high ROB. When participants were questioned about which other specialists worked in the cleft team in addition to the orthodontists, 84% of them in one study reported it to be general dentists. Furthermore, the absence of an interdisciplinary team was reported in two studies from Africa. When asked about the percentage of their practice devoted to the care of patients with cleft lip and palate (CLP) one study reported that 52% of orthodontists had treated <10 such patients in their entire career.

The present systematic review highlights the lack of knowledge and experience among orthodontists and orthodontic residents regarding the management of patients with CLP. Efforts must be made to design validated questionnaires and conduct methodologically sound studies in different geographical locations to develop adequate modules for improving the knowledge of orthodontists in this domain.

Preferences and Satisfaction Toward an Orthodontic Clinical App

OBJECTIVES

 To promote the development of professional orthodontic apps and to grow app engagement, many contributing factors should first be scrutinized. The main purpose of this research was to assess whether gap analysis facilitates strategic app design.

MATERIALS AND METHODS

 Gap analysis was first conducted to reveal users' preferences. Then, the OrthoAnalysis app was developed on an Android operating system using Java programming language. Finally, a self-administered survey was issued to 128 orthodontic specialists to assess their satisfaction toward usage of the app.

STATISTICAL ANALYSIS

 The content validity of the questionnaire was ascertained using an index of Item-Objective Congruence of more than 0.5. The reliability of the questionnaire was also analyzed with Cronbach's Alpha reliability coefficient (ɑ = 0.87).

RESULTS

 Besides the most important factor, "content," many issues were listed, and all were required to engage users. A strong and engaging app should show accurate, trustworthy, and practical clinical analysis that operates smoothly and fast with ease, along with a user-friendly, appealing, and trustworthy interface. In short, because of the preliminary gap analysis that was done to evaluate the potential app engagement power prior to app design, the result of the satisfaction assessment showed that nine traits including overall satisfaction were of high levels.

CONCLUSIONS

 Orthodontic specialists' preferences were assessed using gap analysis and an orthodontic app was designed and appraised. This article presents the orthodontic specialists' preferences and summarizes the process of achieving app satisfaction. Therefore, to create a clinical app with strong engagement power, a strategic initial plan using gap analysis can be recommended.

Esthetic Perception of Different Clinical Situations of Maxillary Lateral Incisor Agenesis According to Populations with Dental and Non-Dental Backgrounds: A Systematic Review and Meta-Analysis

Treatment of unilateral or bilateral maxillary lateral incisor agenesis is challenging, time-consuming, expensive, and requires careful treatment planning, predictability, and esthetics. This review aimed to identify differences in esthetic perception among orthodontists, general dentists, differentiated dentists, and laypersons, which may interfere with treatment options. EBSCO, PubMed, ScienceDirect, Cochrane Library databases, and Google Scholar were searched using keyword pairing and a Boolean expression, "(congenitally missing OR agenesis OR hypodontia) AND (maxillary lateral incisors) AND (esthetic perception OR smile) AND (laypersons OR dental professional OR general dentist OR orthodontists)." Reviews and case studies were excluded. A total of 13 studies were selected for qualitative analysis (adapted ROBINS-I) and 11 were selected for meta-analysis (p < 0.05) after being sub-grouped into "Opening vs. Closure" and "No remodeling vs. Dental remodeling vs. Dental and gingival remodeling" groups. A meta-analysis evaluated the magnitude of the difference between groups based on differences in means and effect sizes (α = 0.05; 95% CI; Z-value 1.96), revealing that the esthetic perception of maxillary lateral incisor agenesis treatment remains controversial even among professionals. Gingival remodeling was not valued compared to isolated dental remodeling. Studies lack rigorously comparable methodologies. Discussion with the patient is pertinent in doubtful situations, as the best treatment option remains unclear, and overtreatment should be avoided.

[Some aspects of the organization and analysis of the performance of the orthodontic service in Ryazan and the Ryazan region]

OBJECTIVE

Conducting a retrospective analysis of the indicators of orthodontic care provided in Ryazan and the Ryazan region from 1999 to 2017.

MATERIAL AND METHODS

During the study, institutions providing orthodontic care were divided into three levels of dental organizations. Level 1 medical care centers provide assistance to residents of districts of the region, the results of the work of clinics located in 2 districts of the region were analyzed for the period since 2005 to 2017. Level 2 StMO includes state dental clinics and private dental clinics in the city of Ryazan, where you can get orthodontic care. The work of state structures was analyzed from 1999 to 2011 with a step of 3 years, from 2011 to 2017. - yearly. Level 3 SMEs include specialized departments of universities, where only consultative and diagnostic assistance is provided. An analysis was made of the orthodontic pathology with which the patients treated, as well as an analysis of the orthodontic equipment used for treatment during the study period.

RESULTS

The prevalence of AFA among the child population of the region's districts is at the level of 80.10±0.68%, fixed equipment is used 3 times more often in level 1 SMO than in level 2 SMI, and removable equipment is used only 10-20% less often. in the SMC and levels 1 and 2, the main part of the contingent is the child population (97.7-99.1% and 67.82-0.63%, respectively), but in the region for this type of assistance, the appealability among patients over 18 years of age is 10% less than in the city.

CONCLUSION

The data obtained indicate the need for changes in the structure of orthodontic care. It is required to allocate at least 2 rates of an orthodontist in each district to provide assistance to the population living in the Ryazan region.

[Satisfaction with dentist-patient interaction at the municipal polyclinic: level and affecting factors]

OBJECTIVE

The study level of patient satisfaction with interaction with doctors of various specialties in the municipal dental clinic.

MATERIAL AND METHODS

596 patients who received dental care at the Severodvinsk Dental Polyclinic State Autonomous Healthcare Institution participated in the cross-sectional study. Satisfaction was studied across 10 domains using a questionnaire. The average values of the scores obtained for different specialties of the doctor were compared using a variance analysis for each of the domains. The relationship between patient satisfaction and factor characteristics - specialty and age of the doctor, gender and age of the patient or legal representative was evaluated using multivariate linear regression analysis with the calculation of regression coefficients and 95% confidence intervals (CI).

RESULTS

At least a good level of satisfaction was found in all 10 domains for doctors of all specialties. The age of the doctor was inversely related to the domains "Communication on equal terms" and "Active listening". Respondents were statistically significantly less satisfied with interaction with dental therapists, dental surgeons and pediatric dentists in all domains compared to interaction with orthodontists, except for the domain "Prognosis". Satisfaction did not depend on the gender and age of the patients.

CONCLUSIONS

Lower satisfaction in different domains can be explained by limited time for patient admission and/or insufficient training of dentists in terms of communication with patients. The assessment of satisfaction with the doctor's appointment is an important indicator for determining the ways of developing the education of specialists and the organization of medical care in dentistry.

Associations between Oral Health and Cannabis Use among Adolescents and Young Adults: Implications for Orthodontists

Cannabis use is prevalent among adolescents and young adults in the US. Virtually all modes of cannabis consumption involve the oral cavity, and previous studies have linked cannabis use with poorer oral health. We sought to identify associations between cannabis use and various oral health outcomes and behaviors among individuals 12-25 years of age, and to discuss implications for orthodontists who largely interact with this age group over an extended period of treatment time. We examined data from patient electronic health records (N = 14,657) obtained between 2015 and 2021. Associations between lifetime and current self-reported cannabis use and several oral health outcomes or related behaviors that reflect periodontal health, caries status, oral lesions, and physical integrity of tooth structure and restorations were examined in a bivariable and multivariable manner, controlling for patient age, sex, and self-reported tobacco and alcohol use. Reporting lifetime cannabis use was associated with higher risk for having oral lesions (aPR = 1.41, 95% CI: 1.07-1.85), bruxism (aPR = 1.31, 95% CI: 1.09-1.58), and frequent consumption of sugary beverages and snacks (aPR = 1.27, 95% CI: 1.12-1.41). Reporting current cannabis use was associated with higher risk for oral lesions (aPR = 1.45, 95% CI: 1.03-2.06) and frequent consumption of sugary beverages and snacks (aPR = 1.26, 95% CI: 1.07-1.48). Cannabis users aged 12-25 are at increased risk for bruxism, oral lesions, and frequent consumption of sugary beverages and snacks. Orthodontists and other dental professionals should probe for drug use and be cognizant of increased risk for oral health problems in patients that report actively using cannabis.

The Pandemic Impact of COVID 19 on Orthodontic Practice: A Cross Sectional Study

AIM

The objective of this study was to determine the problem encountered by an orthodontist due to suspended treatment during and after lockdown COVID 19 and to assess the pandemic impact on orthodontic practices.

MATERIALS AND METHODS

This was a cross-sectional web-based questionnaire survey conducted among orthodontist in India. The pilot study was conducted to estimate the sample size and final sample size is 263 participants. The predesigned and validated, self-administered, structured 10 questions related to the impact of an orthodontist and their orthodontic practices during and after COVID 19 are used. The statistical analysis was done using Statistical Package for Social Sciences SPSS (V 22.0) the frequency distribution was computed.

RESULTS

The result showed that 81% orthodontist were reported that routine orthodontic treatment was disturbed due to this COVID 19 lockdown, about 79.1% reported hospital/clinic was closed due to lockdown with a duration of more than 1 month. Still, 64.6% orthodontist handling their orthodontic emergencies through telecommunication and 47.9% of orthodontist received a complaint about fixed appliance among all other appliances. Due to the current situation, 41.4% orthodontist suggested 3-6 months' period required to normalize the current situation and 66.9% agreed that there will be decline in orthodontic treatment need after COVID 19.

CONCLUSION

Owing to the high virulence activity, elective procedures have been postponed and can manage a patient through virtual teleconsultation. Reassurance of the patient is needed regarding prolonged treatment duration due to this COVID 19 pandemic.

A Survey of Retention Practices and Protocols Followed Among Orthodontists in India

Background:

There are different types of retention protocols and retainers prescribed by the orthodontists across the globe.

Aim:

The study was conducted with the aim of evaluating the retention practices followed by the orthodontists in India.

Materials and Methods:

A questionnaire link with a set of 29 questions was generated using the Google Forms App. The questions related to the basic demographic details followed by retention procedures in maxilla and mandible as related to the type of retainer, duration of wear, retention check-ups, and adjunctive procedures being followed. The Google forms were mailed to 1147 registered life members of the Indian Orthodontic Society.

Results:

The overall response rate was 20.1%. On receiving of the completed questionnaires, the data were statistically analyzed. Dual mode of retention, fixed retainers with removable thermoplastic resin (TR)/vacuum formed retainers (VFR) (24%) were the common type of retention in maxilla whereas the fixed bonded retainer (44.5%) was more commonly used in mandible. Full time wear of maxillary retainer was recommended by 85.2% of the respondents. The recommended duration of the fixed retainer is for 2–5 years (41.9%).

Conclusion:

A trend towards more dual retention instead of solitary removable or solitary fixed retention, more VFR instead of Hawley-type retainers has been demonstrated in the survey.

Norwegian Orthodontists' Experience and Challenges With Treatment of Patients With Cleft Lip and Palate

Background:

Patients born with cleft lip and/or palate (CL/P) have orthodontic treatment challenges due to maxilla deficiency, malocclusions, and dental abnormalities. In Norway, orthodontic treatment is done by centralized CL/P teams. Due to traveling restrictions, this treatment might be done locally in the future. The experience of Norwegian community orthodontists in managing such patients has not been investigated previously.

Objective:

To assess Norwegian orthodontists’ management of patients with CL/P and need for further education.

Material and Methods:

All orthodontists in Norway were sent a questionnaire about their experience, challenges, and knowledge and asked about their need of further theoretical education and clinical training in the management of patients with CL/P.

Results:

Norwegian orthodontists’ standard of knowledge of CL/P treatment is adequate. However, few respondents have treated a high number of cleft patients. Eighty-six percent of the participants believed that treating CL/P patients involves challenges, such as time-consuming treatment and technical difficulties. Increased perceived need for more education was revealed among participants stated unpreparedness during education (4 folds), encountered challenges, and lack of knowledge (almost 3 folds).

Conclusions:

The study revealed that community orthodontists in Norway lack experience and acknowledged the challenges in treating patients with CL/P. Most of the respondents perceived a need for additional education and clinical training to treat CL/P patients competently. The findings suggested more focus on patients with CL/P management in the curricula and more collaboration between centralized CL/P teams and community orthodontists.

Choice of radiography in orthodontic treatment on children and adolescents: A questionnaire-based study performed in Sweden

The aim was to investigate the objective and choice of different radiographic examinations used in orthodontic treatment of children and adolescents, using a web-based questionnaire directed toward specialists in orthodontics. The questionnaire was distributed to 255 orthodontists in Sweden. In total, 142 responses were received, and 11 specialists were interviewed. Questions were related to the use of radiography during different treatment stages; modifications to the treatment regimen owing to radiographic findings; and the use of and/or need for guidelines in radiography. Radiographic examinations were performed in all treatment stages and mainly during treatment planning. Panoramic radiographs were always or often used by the respondents (99%), less frequently used were lateral radiographs (66%) and intra-oral radiographs of the incisor regions (69%). Cone beam computed tomography (CBCT) was sparsely employed. A majority of the respondents considered that radiographic findings often or occasionally affected the treatment. Local- or clinic-specific guidelines were used by 85% of respondents. The need for national guidelines was considered low. The frequent use of panoramic radiography together with application of local guidelines, may indicate that radiographic selection criteria are not individualised. National guidelines might facilitate updates on radiographic techniques, and on radiation doses and risks in young patients.

The COVID-19 pandemic and orthodontic practice in Nigeria

OBJECTIVES

This study was aimed at assessing the knowledge and awareness of orthodontists and orthodontic residents in Nigeria about the COVID-19 pandemic and the appropriate infection control measures required to mitigate its spread in orthodontic practice.

MATERIALS AND METHODS

It was a cross-sectional descriptive study of orthodontists and orthodontic residents. Ethical approval for the study was obtained from the Institutional Review Board. Data collection was via an online questionnaire designed using Google forms and these were sent to the phone numbers of study participants. Data analysis was done using Statistical Package for Social Sciences version 20.

RESULTS

A total of 73 respondents with a mean age of 43.41 ± 9.21 years participated in the study. About 90% of the respondents had a very good knowledge of COVID-19, including its etiology, modes of transmission, signs, and symptoms. However, very few respondents were aware of the less common symptoms such as skin rash (16.4%) and red eyes (26%). Over 80% of the respondents knew the appropriate measures to take to prevent the spread of the virus in the dental clinic, in addition to the appropriate personal protective equipment (PPE) to use.

CONCLUSION

The respondents had a very good knowledge of the basic epidemiology of COVID-19 and the means of prevention of its transmission in the dental clinic. However, there was limited knowledge of the less common symptoms of the infection. In addition, majority of the respondents had a very good idea of the appropriate PPE to be used.

Musculoskeletal disorders and related factors in the Colombian orthodontists' practice

Objective. This study aimed to characterize the symptoms of musculoskeletal disorders (MSDs) and their related factors in a group of orthodontists in the city of Medellín (Colombia). Methods. A cross-sectional study was conducted in a sample of 100 orthodontists. A survey provided sociodemographic and work-related information. MSDs were recorded through the Nordic questionnaire. Descriptive and bivariate analyses were carried out by determining the prevalence of MSD symptoms by anatomical zone and selected variables. Results. Prevalence of MSDs was 81% for males and 88% for females. Anatomical regions were the neck (males 44%, females 59%), shoulders (males 44%, females 48%), lower back-lumbar zone (males 63%, females 51%), elbow-forearm (males 15%, females 15%) and wrist-hand (males 32%, females 51%). The frequency of symptoms was higher in males >41 years old, with more than a work contract or females who worked >40 h per week, and in orthodontists (males-females) who reported higher work-related dissatisfaction levels. Conclusions. A high prevalence of MSDs was found among orthodontists, with differences in the frequency of symptoms related to sociodemographic and work-related factors. Preventive strategies related to health and work safety would be advisable considering the particular needs of this dentist group.

The ability of orthodontists and maxillofacial surgeons in predicting spontaneous eruption of mandibular third molar using panoramic serial radiographs

OBJECTIVE

To evaluate the skill of orthodontists and oral/maxillofacial surgeons (OMFS) in providing a prognosis of mandibular third molars spontaneously erupted, through follow-up panoramic analysis.

METHODS

22 orthodontic patients treated without extraction, presenting spontaneously erupted mandibular third molars (n = 44) were analyzed through panoramic serial radiographs. The first panoramic radiograph was obtained just after orthodontic treatment (PR1), in patients aging from 13 to 19 years. A second panoramic radiograph (PR2), was obtained in average two years later. The radiographs were randomly analyzed by 54 specialists, 27 orthodontists and 27 OMFS, to obtain the opinion about the approach to be adopted to these teeth in PR1. Then, another opinion was collected by adding a serial radiograph (PR1+2).

RESULTS

The concordance of the answers was moderate for OMFS (Kappa 0.44; p< 0.0001) and significant for orthodontists (Kappa 0.39; p< 0.0001). In the analysis of the first radiograph (PR1) of the spontaneously erupted molars, OMFS indicated extraction in 44.5% of cases, while orthodontists indicated in 42%, with no difference between groups (p= 0.22). In PR1+2 analysis, orthodontists maintained the same level of extraction indication (45.6%, p= 0.08), while surgeons indicated more extractions (63.2%, p< 0.0001).

CONCLUSIONS

Orthodontists and OMFS were not able to predict the eruption of the third molars that have erupted spontaneously. Both indicated extractions around half of the third molars. A follow-up analysis, including one more radiograph, did not improve the accuracy of prognosis among orthodontists and worsened for OMFS.

Assessment of Reliability of YouTube Videos on Orthodontics

Objective

In addition to being an entertainment channel, YouTube is also one of the most popular visual information sources today. People search YouTube to consult also on orthodontics, as well as on many other topics. The objective of the present study was to analyze the quality and reliability of information of the videos on YouTube about orthodontics.

Methods

YouTube was searched systematically by two researchers on orthodontics by using the keywords "Orthodontics," "Orthodontist," and "Orthodontic Treatment." Videos on the first three pages (60 videos) for each keyword were assessed. Researchers evaluated the reliability of the videos by using the Reliability Score (adapted from DISCERN) and the quality of the videos by using the Global Quality Score (GQS).

Results

The mean GQS results were 2.6±1.3 for videos in the "Orthodontist" group, 3.2±1.3 for videos in the "Orthodontics" group, and 2.3±1.2 for videos in the "Orthodontic Treatment" group on a 5-point scale. The Reliability Score results were 2, 2, and 1.5 for videos in the "Orthodontist," "Orthodontics," and "Orthodontic Treatment" groups, respectively, on a 5-point scale. The Intraclass Correlation Coefficient results presented a positive relationship between the researchers.

Conclusion

Owing to the lack of peer-review process and pre-upload scientific evaluation process, videos on YouTube can lead the public to misinformation.

An assessment of job satisfaction: A cross-sectional study among orthodontists of Saudi Arabia

AIM OF THE STUDY:

The main objective of the present study was to investigate the level of job satisfaction among professional orthodontists in relation to some significant intrinsic and extrinsic factors that generally affect their performance.

MATERIALS AND METHODS:

A cross-sectional study was conducted among orthodontists working in the Kingdom of Saudi Arabia using an online survey questionnaire through Survey Monkey. A total of 161 responses were received; among those, 57.8% of the respondents were Saudi and 42.2% were non-Saudi.

RESULTS:

On an overall satisfaction basis, a majority of orthodontists (80.7%) were satisfied with orthodontics as their profession irrespective of their gender. Only 4.4% showed dissatisfaction, whereas the remaining 14.9% were moderately satisfied with orthodontics as a profession. In-depth analysis revealed that a majority of the respondents (56.2%) showed reservations over having ample time for their family life. 52.8% of the respondents strongly agreed that they are assigned significant paperwork. Likewise, 66.5% of the orthodontists showed moderate to dissatisfaction over time adherence by the patients.

CONCLUSION:

The findings of the present investigations depicted a higher level of passion and commitment among the male and female respondents for the profession in spite of the fact that they do not have adequate time for their personal life. The working efficiency of orthodontists may be significantly enhanced by sparing them from too much paperwork and ensuring that their patients appear on time.

Motion analysis in the field of dentistry: a kinematic comparison of dentists and orthodontists

OBJECTIVES

To conduct a kinematic comparison of occupational posture in orthodontists and dentists in their workplace.

DESIGN

Observational study.

SETTING

Dentist surgeries and departments of orthodontics at university medical centres in Germany.

PARTICIPANTS

A representative sample of 21 (10 female, 11 male) dentists (group G1) and 21 (13 female, 8 male) orthodontists (G2) with one male dropout in G2.

OUTCOME MEASURES

The CUELA (computer-assisted acquisition and long-term analysis of musculoskeletal loads) system was used to analyse occupational posture. Parallel to the recording through the CUELA system, a software-supported analysis of the activities performed (I: treatment; II: office; III: other activities) was carried out. In line with ergonomic standards the measured body angles are categorised into neutral, moderate and awkward postures. Activities between the aforementioned groups are compared using the stratified van Elteren U test and the Wilcoxon-Mann-Whitney U test. All p values are subject to the Bonferroni-Holm correction. The level of significance is set at 5%.

RESULTS

The percentage of time spent on activities in categories I-II-III was as follows: dentists 41%-23%-36% and orthodontists 28%-37%-35%. The posture analysis of both groups showed, for all percentiles (P5-95), angle values primarily in the neutral or moderate range. However, depending on the activity performed, between 5% and 25% of working hours were spent in unfavourable postures, especially in the head-and-neck area. Orthodontists have a greater tendency than dentists to perform treatment activities with the head and torso in unfavourable positions. The statistically significant differences between the two groups with regard to the duration and the relevance of the activities performed confirm this assumption for all three categories (p<0.01, p<0.05).

CONCLUSIONS

Generally, both groups perform treatment activities in postures that are in the neutral or medium range; however, dentists had slightly more unfavourable postures during treatment for a greater share of their work day.

Orthodontist's Role in Orthognathic Surgery

Orthognathic surgery can eliminate severe esthetic and functional deformities and be a life-changing event for a patient. An orthodontist's role in orthognathic surgery can be divided into several phases: the initial evaluation, presurgical orthodontics, surgical planning, and postsurgical orthodontics. At each of these phases, collaboration between the orthodontist and the surgeon is critical. The ability of an orthodontist and a surgeon to coordinate their efforts during this time is what will lead to a successful outcome.

The role of the posed smile in overall facial esthetics

OBJECTIVE

To evaluate the role of the posed smile in overall facial esthetics, as determined by laypersons and orthodontists.

MATERIALS AND METHODS

Twenty orthodontists and 20 lay evaluators were asked to perform six Q-sorts on different photographs of 48 white female subjects. The six Q-sorts consisted of three different photographs for each of two time points (pre- and posttreatment), as follows: (1) smile-only, (2) face without the smile, and (3) face with the smile. The evaluators determined a split-line for attractive and unattractive images at the end of each Q-sort. The proportions of attractive patients were compared across Q-sorts using a Wilcoxon signed-rank test for paired data. The evaluators also ranked nine facial/dental characteristics at the completion of the six Q-sorts.

RESULTS

Evaluators found the pretreatment face without the smile to be significantly more attractive than the face with the smile or the smile-only photographs. Dissimilar results were seen posttreatment; there was not a significant difference between the three posttreatment photographs. The two panels agreed on the proportion of "attractive" subjects but differed on the attractiveness level of each individual subject.

CONCLUSIONS

The presence of a malocclusion has a negative impact on facial attractiveness. Orthodontic correction of a malocclusion affects overall facial esthetics positively. Laypeople and orthodontists agree on what is attractive. Overall facial harmony is the most important characteristic used in deciding facial attractiveness.