Comparison of SASOC, a measure of dental aesthetics, with three orthodontic indices and orthodontist judgment

Abstract – Scores for three malocclusion indices (HLD, TPI and OI) and Orthodontist Judgment (OJ) were available for the 100 orthodontic study models utilized in the development of SASOC, the Social Acceptability Scale of Occlusal Conditions. The ability of SASOC to predict need for treatment using OJ as a standard was compared to the ability of HLD, TPI and OI to predict OJ's decisions. In addition, determinations of need for treatment of each of the 100 models using HLD, OI and OJ were compared to SASOC's rankings for the public's perceptions of aesthetic, acceptability. Finally, the agreement of HLD, OI and OJ with each other in assessing need for treatment was compared. Results indicated: 1) that SASOC's, HLD's, TPI's and OI's "hit rate" in predicting OJ ranged between 73% and 81 %; 2) HLD's, OI's and OJ's assessment of malocclusion paralleled lay perceptions of aesthetic acceptability (SASOC), and 3) there were differences of agreement among HLD, OI and OJ as to which cases had a definite need for treatment. There was more agreement on cases which did not have a definite need for treatment than on those which did. A tool which assesses only the aesthetic component of occlusal configurations was judged to be more suitable in the study of the social and psychological impact of malocclusion than indices and orthodontist judgment which include professional criteria as well as aesthetics in their assessments of malocclusion.     

Perceived aesthetic impact of malocclusion and oral self-perceptions in 14-15-year-old Asian and Caucasian children in greater Manchester

The aims of this study were to evaluate (i) the effect of ethnicity, social deprivation, and normative orthodontic treatment need on orthodontic aesthetic self-perception, self-perceived need for orthodontic treatment, and oral aesthetic impact of malocclusion; (ii) the effect of ethnicity, social deprivation, and gender on perceived orthodontic treatment need and use of orthodontic services; (iii) the influence of perceived oral aesthetic impact of malocclusion on perceived need and wish for orthodontic treatment; and (iv) whether orthodontic treatment experience influences perceived oral aesthetic impact of malocclusion. A stratified, random sample of 434 14-15-year-old children from schools in Manchester, UK, was obtained. Information was collected on orthodontic aesthetic self-perception and orthodontic treatment experience using a questionnaire. The former data were combined to form an Oral Aesthetic Subjective Impact Scale (OASIS). Normative orthodontic treatment need was measured with the Index of Orthodontic Treatment Need (IOTN). Children with higher clinical need for orthodontic treatment perceived themselves as worse off than their peers with lower need. More socially deprived children or those with high IOTN aesthetic component (AC) scores had a higher (i.e. more negative) aesthetic impact (OASIS) score. Asians and females had higher IOTN dental health component (DHC) scores, but a better aesthetic appearance than Caucasians and males. More deprived children were less likely to have received orthodontic treatment. Despite this, OASIS scores were similar between treated and untreated children. Untreated children who wished for orthodontic treatment had higher IOTN AC and OASIS scores.     

Perceptions of occlusal conditions in Australia, the German Democratic Republic and the United States of America

An instrument developed by Jenny et al. (1980) for rating the public's perceptions of the social acceptability of a wide variety of occlusal configurations was administered to children and adults in Australia, the German Democratic Republic and the United States of America and also to US orthodontists. Mean scores for the 7 groups of subjects from the 3 countries were arranged in rank order from the least socially acceptable to the most socially acceptable and compared. The results indicate that use of the social acceptability scale of occlusal conditions (SASOC) is a highly reliable method for scoring and rank-ordering the aesthetic acceptability of occlusal morphologies. Spearman rank-order correlation coefficients between the ranking of SASOC stimuli by all 7 groups of subjects from the 3 countries ranged from 0.85 to 0.97. The probability of such correlations occurring by chance is less than 1 in 10000 (P less than 0.0001). SASOC proved capable of rank-ordering a wide range of occlusal morphologies for aesthetics with excellent consistency along the entire spectrum from the least acceptable to the most socially acceptable in all 3 countries. The data indicate that norms for socially acceptable dental appearance are essentially the same in Australia, the German Democratic Republic and the United States of America.     

Assessment of orthodontic treatment needs in Brazilian schoolchildren according to the Dental Aesthetic Index (DAI)

OBJECTIVE: To assess the distribution, prevalence and severity of malocclusion and orthodontic treatment needs in schoolchildren from the northeast of Brazil aged between 13 and 15 years. RESEARCH DESIGN: Cross-sectional study. PARTICIPANTS: A sample of 600 adolescents (264 males and 336 females) randomly selected and representative of schoolchildren living in Recife (Brazil) was obtained from 12 public schools. METHOD: The need for orthodontic treatment was measured using the Dental Aesthetic Index (DAI). RESULTS: Most of the subjects (77%) were deemed to require orthodontic treatment. Only about 5.8% had a handicapping malocclusion that needed mandatory treatment. A severe malocclusion for which treatment was highly desirable was recorded in 47.5% of the adolescents and 23.7% had a definite malocclusion for which treatment was elective. Three main occlusal features were responsible for allocating subjects into the group of "orthodontic treatment required": crowding (47.3%), tooth loss (22.3%) and maxillary overjet of more than 3 mm (21.8%). There were no significant differences (p > 0.05) in mean DAI scores between males and females. CONCLUSIONS: 77% of adolescents from northeast Brazil were in need of orthodontic treatment for dental health reasons. The distribution of DAI scores among Brazilian adolescents is different from that reported in other populations. This study provides baseline data on the need and demand for orthodontic treatment among Brazilian students.     

The prevalence and severity of malocclusion and the need for orthodontic treatment in 9-, 12-, and 15-year-old Glasgow schoolchildren.

An epidemiological investigation involving 765 Glasgow schoolchildren aged nine, twelve, and fifteen years was undertaken to assess the severity of malocclusion, the need for orthodontic treatment, and the proportion of children in each age group who had previously received treatment. An index termed the Malocclusion Severity Index (MSI) was developed to establish objectively the severity of malocclusion in each individual. Fifty sets of orthodontic study models and six orthodontists assessed the reproducibility and validity of the index. Although there was a significant reduction in the proportion of children in need of orthodontic treatment between 9 and 15 years of age, a considerable number were still in need of treatment; crowding of their dentitions being responsible for the majority of the treatment requirement. The MSI was found to be as precise and valid as previously developed occlusal indices, for estimating the treatment needs of sample populations.     

Malocclusion and orthodontic treatment need evaluated among subjects with Down syndrome using the Dental Aesthetic Index (DAI)

Objective:To determine the prevalence of malocclusion and need for orthodontic treatment among persons with Down Syndrome (DS).Materials and Methods:Study participants were 113 persons with DS from the selected community-based rehabilitation center who fulfilled the inclusion and exclusion criteria. Ten occlusal characteristics of the Dental Aesthetic Index (DAI) were measured on study models to determine the degree of malocclusion. A single score represented the dentofacial anomalies, determined the level of severity, and determined the need for orthodontic treatment.Results:Crowding in the anterior maxillary and mandibular arch was the main malocclusion problems among the subjects with DS. Comparison between age group and genders revealed no significant differences in four categories of orthodontic treatment need (P > .05).Conclusion:Most of the subjects with DS (94; 83.2%) had severe and very severe malocclusion, which indicated a desirable and mandatory need for orthodontic treatment.     

Test of a method to determine socially acceptable occlusal conditions

A method for determining the social acceptability for dental appearance across the full range of occlusal conditions found in a natural population was developed and tested. The strategy used in developing the Social Acceptability Scale of Occlusal Conditions (SASOC) was to present photographs of 100 dental study models to a large sample of high school students (n= 880) and their parents (n= 403) whose responses were measured by asemantic differential instrument. After refinement of the semantic differential instrument scale scores were derived for each study model by computing the mean individual scores. Ranks were assigned to the mean scores. The Pearsonian correlation obtained between parent and student subsamples was 0.95. The reliability and validity of SASOC were assessed. COCSTOC measures of specific occlusal traits for these 100 study models are available. The future task involves the development of a highly reliable regression equation for predicting social acceptability scores from a small number of objective physical measurements.     

Occlusal outcome in patients undergoing orthognathic surgery with internal fixation.

Fifty consecutive patients undergoing orthognathic surgery with internal fixation (IF) were studied retrospectively with a weighted Peer Assessment Rating (PAR) Index to assess occlusal outcome at the end of all active treatment, and compared with 50 patients who had undergone treatment for malocclusion by orthodontic means alone. In the surgically treated patients, the mean percentage reduction in the weighted PAR Index was 83% and 31 out of 38 patients (82%) were 'greatly improved'. This implies a high standard of treatment in terms of the occlusal outcome. There was no difference in the proportion of patients having a final weighted PAR Index of less than 10 and no significant difference in the final weighted PAR Index between the two groups. This suggests that the occlusal outcome is no different whether patients undergo orthognathic surgery or orthodontic treatment alone, and that excellent occlusal results can be achieved in patients undergoing orthognathic surgery with internal fixation.     

Age changes in orthodontic treatment need: a longitudinal study of 10- and 13-year-old children,using the Dental Aesthetic Index

The Dental Aesthetic Index (DAI) was used to assess the prevalence of unmet orthodontic treatment need in 150 13-year-old schoolchildren in Dunedin, New Zealand, and to compare the findings with those obtained in the same children at 10 years of age. Fewer 13-year-olds (27%) had a "mandatory" need of orthodontic treatment than when they were 10 years old (33%), 20% had "no/little" need for orthodontic treatment, 33% had an "elective" need for treatment and 20% had a "desirable" need for treatment. The fall in DAI scores is attributed to over-sensitivity of the Index to mixed dentition traits. When the individual scores were analysed, only 7% of the 10-year-olds were given the same scores as when they were 13 years old, 52% were given higher scores and 41% were given lower scores. This disagreement between scores was masked to a limited extent by the DAI categories: 49% of the 10-year-olds were assigned to the same DAI category at 13 years of age, 20% to a greater treatment-need category and approximately 30% to a lower treatment-need category. The DAI, in common with other malocclusion indices, is unreliable over time because it is affected by developmental changes in the occlusal traits measured.     

Evidence-based orthodontics for the 21st century

BACKGROUND: This article examines some of the data-driven advances in clinical orthodontics and how they might influence the decision-making process in the specialty. TYPES OF STUDIES REVIEWED: Nearly 100 years of orthodontic study has focused on two issues: one-phase versus two-phase treatment of Class II malocclusion and extraction versus nonextraction treatment of arch perimeter deficiencies. The author addresses these issues by presenting data from the first randomized clinical trial in orthodontics and from a survey of the current literature. RESULTS: The clinical trial involved subjects who had Class II malocclusion. The researchers who conducted the trial found no difference in the quality of the dental occlusion between the children who had early treatment and those who did not, as judged by both an occlusal index (Peer Assessment Rating scores) and the percentages of the subjects with excellent and less-than-optimal outcomes. Early treatment did not reduce the eventual need for orthognathic surgery. In a separate study, a researcher reported that the maxillary arch perimeter could be increased by 3 to 4 millimeters by using rapid palatal expansion, or RPE, providing space for incisor alignment to resolve crowding. The author concluded that any added benefit of RPE treatment in patients without a crossbite might be "challenging to define." CLINICAL IMPLICATIONS: The challenge facing orthodontists in the 21st century is the need to integrate the accrued scientific evidence into clinical orthodontic practice.     

A 15-year follow-up study of 30-year-old Danes with regard to orthodontic treatment experience and perceived need for treatment in a region without organized orthodontic care

Abstract – It was the aim to study orthodontic treatment experience and past and present perceived need for treatment in 30-year-old Danes who, at adolescence, had no access to organized orthodontic care. In order to identify the malocclusion traits which elicited treatment or need for treatment, the findings were related to the occurrence of various I rails which had been registered in the same individuals 15 years earlier. From questionnaires (response rate 86%, n = 841) it appeared I hat 10% had received treatment and 20% perceived need for treatment either in childhood or at present. At adolescence, the subjects who had subsequently received treatment, displayed relatively high frequencies of ectopic eruption, anterior cross-bite, extreme maxillary overjet, deep bile, and crowding; among those who perceived need for treatment, extreme maxillary overjet, mandibular overjet and crowding were relatively prevalent.     

Immigrant background and orthodontic treatment need. Quantitative and qualitative studies in Swedish adolescents

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20-year-old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self-perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to "Index of Orthodontic Treatment Need--Dental Health Component" (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 per cent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory "Being under the pressure of social norms" was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.     

Is the adolescent's esthetic concern associated with anterior occlusal conditions or the malocclusion severity level?

ObjectivesTo assess the esthetic impact of anterior occlusal conditions and malocclusion severity levels.Materials and MethodsA population-based cross-sectional study of 700 adolescents aged 15 to 19 years was conducted. The Oral Aesthetic Subjective Impact Scale (OASIS) was used to evaluate the subjective esthetic impact of malocclusion. The Dental Aesthetic Index (DAI) criteria were used to diagnose the anterior occlusal characteristics in isolation and the severity levels of malocclusion. The variables with P < .20 in the individual analyses were tested in multiple logistic regression models, and those with P < .10 remained in the model. The adjusted odds ratio (OR) was estimated with a 95% confidence interval (CI).ResultsOf the adolescents, 42% showed negative self-perception of malocclusion. In addition, 15.4% of adolescents had severe malocclusion (DAI 3) and 18.9% very severe malocclusion (DAI 4). Crowding and spacing were shown to be 2.90 (CI: 2.06–4.09) and 2.53 (CI: 1.65–3.86) times, respectively, more likely to cause a negative esthetic impact in adolescents (P < .05). In addition, adolescents with orthodontic treatment need (DAI 2, 3, and 4) were more likely to report a negative esthetic impact (P < .05).ConclusionsAnterior crowding and spacing are the conditions that most influence the esthetic concern of adolescents. Adolescents with very severe malocclusion and higher orthodontic treatment need are more likely to report a negative esthetic impact.     

Need and demand for orthodontic treatment in an adult Swedish population.

The prevalence of malocclusion, the need for and the demand for orthodontic treatment was studied in a randomly selected adult Swedish population > or = 20 years of age. Nine-hundred-and-twenty subjects were examined of whom 669 had their own teeth in occlusion. From those a group of 157 subjects was selected on the basis of objective need and/or subjective demand for orthodontic treatment. The various regimens of treatment required in this group were investigated. The prevalence of malocclusion ranged from 17 to 53 per cent in the various age groups. The spectrum of malocclusion was similar to that previously reported in Swedish children. The awareness of their malocclusion was higher among younger than older subjects and among those who had severe malocclusion. Objective treatment need, evaluated by two experienced orthodontists, was estimated at 11 per cent of the total population, whilst orthodontic treatment was requested by approximately 5 per cent of the population studied.     

Longitudinal evaluation of the Treatment Priority Index (TPI)

The Treatment Priority Index (TPI) is an epidemiologic tool used to rank malocclusions and assess the need for orthodontic treatment. The purpose of this study was to (1) evaluate the predictability of the TPI as an indicator of malocclusion severity, (2) evaluate the effect of orthodontic treatment on TPI values, and (3) compare the results with a national survey of American children aged 6 to 11 years and 12 to 17 years conducted by the United States Public Health Service. The TPI was recorded annually in a young student population of Juniata County, Pa., from 1975 to 1979, and later in 1985. The mean values of the TPI did not reflect the range of severity in the population. For this reason the Malocclusion Severity Scale (Burlington Growth Center) was used to identify four groups in 1985. Each group was tracked back to 1975. Further evaluation investigated the role of individual factors contributing to malocclusion over time (tooth displacement and occlusal factors). The conclusions are as follows: (1) the TPI is a valid epidemiologic indicator of malocclusion but does not predict the severity of individual malocclusions in the permanent dentition, (2) TPI values decrease with orthodontic treatment, and (3) the average TPI values for this population were higher than the national average between 6 and 11 years of age and slightly lower in late adolescence, but lie within a treatment-need range of slight to elective. A characterization of treatment need relative to malocclusion severity that is different from the available scale is suggested.     

DAI scores and its relation to self-perceived dental aesthetic and orthodontic concern in Bangladesh and Japan

PurposeTo investigate the relationship between the severity of occlusal irregularities and orthodontic treatment concern among the population of a developing country using DAI score and to compare with the relationship found in a developed country.Materials and methodsThe sample comprised 400 randomly selected university students of Bangladesh, a developing country, 210 males and 190 females, aged 20–27 years. A pretested questionnaire was used to assess the subjects’ satisfaction with own dental appearance and orthodontic treatment concern; the actual severity of malocclusion was determined using the Dental Aesthetic Index (DAI). Statistical analysis was carried out using t-test for gender differences; Spearman rank-order correlation coefficients, Scheffe's post hoc test, one way ANOVA and logistic regression analysis were done for correlation between malocclusion severity and response to questionnaire. The data from a similar study that was carried out on the university students of Japan, a developed country, was compared.ResultIn Bangladeshi sample, males were more affected by malocclusion. Moderate correlation was found between malocclusion, self-satisfaction and treatment concern where satisfaction was decreased and treatment desire was increased with the severity of malocclusion. In Japanese sample, the prevalence of malocclusion was found more in females. Self-satisfaction and malocclusion showed weak correlation and no significant correlation was found between treatment concern and malocclusion.ConclusionAlthough DAI can be used universally to evaluate malocclusion and self-perception, it should be used carefully to determine the subjects’ actual desire for orthodontic treatment where the socio-economic condition can be a provocative factor.     

Orthodontic treatment outcomes in the long term: findings from a longitudinal study of New Zealanders

The aim of this study was to use a health services research (HSR) approach to examine the longer-term outcomes of orthodontic treatment. Participants in a longstanding population-based New Zealand cohort study (the Dunedin Multidisciplinary Health and Development Study) were allocated to one of four malocclusion severity categories on the basis of orthodontic data collected at age 12. The outcome of that care by age 26 was evaluated using the key indicators of equity (was it fair?); efficacy (did it work?); effectiveness (did it work in the longer term?); and safety (was it associated with a greater subsequent experience of caries, periodontal disease, or tooth loss?). Data were available for 452 Study members, of whom 56.2% were in the minor/none category, 29.0% were in the definite category, 10.2% were in the severe category, and 4.6% were in the handicapping treatment-need category. No clear differences in treatment uptake by socioeconomic status were apparent, and the proportion treated increased across the malocclusion severity categories, as did the proportion that showed an improvement following treatment. By age 26 a difference between those who had and those who had not been treated was evident, with the percentage of those rating their dental appearance as above average increasing with increasing severity of the age-12 orthodontic treatment need. This was also true for the percentage that considered their orthodontic treatment to have been successful. There were no significant differences in caries experience, periodontal disease occurrence, or tooth loss between those who had and had not been treated by age 26. This study has found the equity, efficacy, effectiveness, and safety of orthodontic treatment in the Dunedin cohort to be acceptable.     

乌鲁木齐562例汉族青少年正畸需要量的研究

目的确定乌鲁木齐市汉族青少年正畸治疗的需要量.方法根据随机化原则,按分层整群抽样的方法选取562例11～19岁汉族青少年的硬石膏模型,应用错严重程度指数(MSI)确定是否需要正畸治疗的量.结果男性MSI分值为21.91±17.09,女性MSI分值为22.28±17.26,无性别差异(P＞0.05).根据MSI的分数分类,男性需正畸治疗者为54.55%,女性为55.40%.结论乌鲁木齐市汉族青少年中需要正畸者较多,应加强防治力量.错严重程度指标是确定正畸需要量的一个准确、可信、使用简便的指数,值得推广应用.     

Orthodontic status and treatment need of 12-year-old children in South Africa using the Dental Aesthetic Index.

OBJECTIVE: The aim of this study was to determine the prevalence and severity of malocclusion and orthodontic treatment needs in a sample of 12-year-old South African school children using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and certain socio-demographic variables. METHODOLOGY: The sample comprised 6142, 12-year-old children attending school in seven of the nine provinces of South Africa. For each subject the standard demographic information such as gender, population group, location type and employment status of the parents was collected, after which an intra-oral examination for occlusal status using the DAI was performed. Before the survey, the examiners were calibrated and trained and only examiners with an agreement score greater or equal to 80 per cent were included in the final study. RESULTS: The results showed that 47.7 per cent of the children in the sample presented with good occlusion or minor malocclusion, just over 52.3 per cent presented with identifiable malocclusion, a DAI score larger than 26. Of these, 21.2 per cent had definite malocclusion, 14.1 per cent had severe malocclusion and 16.9 per cent had very severe or handicapping malocclusion. Malocclusion as defined in this study was found to be significantly associated with the different population groups in South Africa, with gender and with dentition stage, but not with the location type or the employment status of parents. CONCLUSIONS: The results of this study show a high prevalence of malocclusion in 12-year-old South African children. The findings provide reliable base-line data regarding the prevalence, distribution and severity of malocclusion as well as useful epidemiological data on the orthodontic treatment needs of 12-year-old children in South Africa.