Effectiveness of training dental students in two occlusal indices

The purpose of this study was to evaluate the ability of students in a U.S. dental school to learn and apply two indices of orthodontic need: the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome, and Need (ICON). Dental students were randomly selected and separated into three groups: control, IOTN, and ICON. Each evaluated thirty casts that had previously been evaluated by a panel of thirteen orthodontists to develop a gold standard of orthodontic treatment need for these casts. Students re-evaluated the same thirty casts after IOTN and ICON training for their own group, while the control group did not receive any training. Logistic regression of pre- and post-training agreement with the gold standard was calculated for each group to create a clear quadratic relationship. Significant differences were not found between pre- and post-training evaluation for either the IOTN or the ICON groups as compared to the control. However, the IOTN group did show more improvement when compared with the ICON group. This study demonstrates that the use of the IOTN index improved assessment in predoctoral dental students to determine orthodontic treatment need.     

Appropriateness of orthodontic referrals: self-perceived and normative treatment needs of patients referred for orthodontic consultation

OBJECTIVES: The aims of this prospective study were to evaluate the self-perceived and normative orthodontic treatment needs of children referred for orthodontic consultation and to determine the proportion of children who were inappropriately referred. METHODS: The sample consisted of 257 children with a mean age of 12.0 years (SD = 2.4). An orthodontist assessed the children's normative treatment need using the dental health component (DHC) of the index of orthodontic treatment need (IOTN), and for patients in the mixed dentition the need for interceptive treatment was assessed. Questionnaires were answered by both the child and the parent to assess satisfaction with dental appearance and desire for treatment. RESULTS: The distribution of the IOTN grades showed that 73% of the children had definite need while 27% had borderline/no need for orthodontic treatment. Twenty-six per cent of children and 17% of parents did not express orthodontic concern, even though more than half of these children were in definite need of treatment as assessed by IOTN. The children's orthodontic concern was significantly related to the DHC scores. Out of the 103 children who were in the mixed dentition, only about 16% required interceptive treatment. CONCLUSIONS: The results indicated that a significant number of children were inappropriately referred for orthodontic treatment. Referring dentists need to assess the normative treatment needs of the children as well as the children's and parents' commitment and desire for orthodontic treatment before deciding on the need for referral.     

The views and attitudes of parents of children with a sensory impairment towards orthodontic care

A questionnaire was sent to the parents of 77 visually impaired (VI), 210 hearing impaired (HI) and 494 control children seeking their views on their child's dental appearance, orthodontic treatment need and issues that might influence the child undertaking treatment. The parents' views were compared with a dentist's assessment of treatment need using the Index of Orthodontic Treatment Need (IOTN). There was disagreement between the dentist's assessment and the parents' perceptions in all groups. However, the least disagreement was seen in the HI group. There was a statistically significant (P < 0.05) association between control and HI parents' views of their children's treatment needs and their opinion on their dental appearance. Most parents thought that orthodontic treatment was difficult to obtain and expensive and that their child would find difficulty coping with the treatment. Furthermore, parents of VI children considered that treatment was unlikely to be undertaken due to their child's reduced concern for their appearance. The study indicates that the awareness of treatment need for VI and HI children differs between their parents and dentists.     

A validation study of three indexes of orthodontic treatment need in the United States

Abstract The purpose of this study was to compare the reliability and validity of three occlusal indexes of orthodontic treatment need in predicting the opinion of treatment need of a panel of 18 orthodontists. A set of 160 study casts representing all types of malocclusion was used. The casts were scored with the following occlusal indexes: the Index of Orthodontic Treatment Need (IOTN), the Handicapping Labio-Lingual Deviations index (HLD), and the Handicapping Malocclusion Assessment Record (HMAR modified). The diagnostic accuracy or validity of each index was calculated using the mean opinion of the orthodontic raters as a “gold standard”. Receiver Operating Characteristic curves were plotted for each index. The overall diagnostic accuracy, as determined by percent area under the curve, was similar for each index: IOTN 98.6%; HLD 96.1%; HMAR 96.6%. The score optimizing the sensitivity and specificity relationship for each index was as follows: IOTN (dental health component) 4; HLD 13; HMAR 12. These results indicate that the three occlusal indexes provided valuable information for determining orthodontic treatment need.     

Index of orthodontic treatment need as a predictor of orthodontic treatment uptake

INTRODUCTION: The aim of this study was to evaluate whether the index of orthodontic treatment need (IOTN) could be weighted by using consumer-based sociodental measures to predict the uptake of orthodontic services. METHODS: The sample consisted of 525 schoolchildren, 11 to 12 years old, from Greater Manchester, United Kingdom. Child-perceived IOTN aesthetic component (AC), examiner IOTN AC and dental health component, and child socioeconomic status (Townsend score) were recorded. Two consumer sociodental measures (utility and oral aesthetic subjective impact scale values) were recorded. Three years later, the proportion of the subjects who had received orthodontic treatment or were on a waiting list for orthodontic treatment was recorded, and the rate of service uptake was determined. RESULTS: Sociodental indicators did not predict uptake of orthodontic services. A child with higher normative clinical treatment need was 3 times more likely to receive orthodontic treatment than a child with low clinical need (P < .05). CONCLUSIONS: Consumer-based sociodental information does not predict future use of orthodontic services. Factors such as clinical IOTN and child-perceived IOTN AC will adequately predict use of orthodontic services.     

Conference Report

Abstract

The criteria that dentists use to judge the need for orthodontic treatment are not clear. This study investigates variation in dentists' perception of orthodontic treatment need. Seventy-four dentists were asked to assess 320 dental casts in relation to aesthetic and dental health need. The results of this investigation revealed that the panel was divided as what constituted a need for orthodontic treatment on dental health grounds. It is suggested that one method of achieving a more uniform evaluation of orthodontic treatment need is the use of an occlusal index. Until an occlusal index is accepted and used by the profession, the distortion of need and demand for orthodontic treatment by dentists' unequal perceptions will continue.     

Factors influencing the decision about orthodontic treatment

The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need.     

A cultural comparison of treatment need

The aims of this study were two-fold. First to compare the perceptions of African dental aesthetics as determined by a panel of black African Senegalese and French Caucasian judges, and second to compare the sensitivity and specificity of both components of the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome and Need (ICON) in relation to the opinions of African and Caucasian judges. Ninety-eight colour digital dental images of black adolescents and adults were scored for attractiveness on a 100 mm visual analogue scale (VAS) by 45 Caucasian and 41 black African judges. In addition the judges were asked to classify the level of treatment need. Both components of the IOTN and ICON were recorded for the 98 cases. The results indicated that Caucasian judges perceived the majority of images to be less attractive than African judges. African and Caucasian judges showed similar levels in the estimation of treatment need. The aesthetic component (AC) of the IOTN and ICON showed similar levels of sensitivity. Taking all factors into account, it would appear that the ICON is marginally better at identifying those individuals who are perceived to need orthodontic treatment.     

Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents, and dentists

The aims of the present study were to compare rankings of dental aesthetics and the threshold at which orthodontic treatment would be sought among patients, parents, and dentists. A prospective cross-sectional study was designed to address these aims. The study sample comprised 100 patients and parents and 23 dental specialists. The patients were equally divided between males and females and their mean age was 14.7 years (standard deviation 2.3 years). The aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN) represented impairment of dental aesthetics. The 10 numbered photographs of the AC were cut into equal-sized rectangles and subjects were asked to arrange them from 'the one that looks best' to 'the one that looks worst'. The subjects were then presented with the 10 photographs of AC in sequence and asked to identify the cut-off point between 'teeth that need orthodontic treatment' and 'no treatment'. Statistical analysis was undertaken with a Mann-Whitney test. The results showed that median rankings of dental aesthetics were similar among the three groups (P > 0.05). The median ranking of photographs 1, 2, 3, 4, and 10 were identical to the AC of IOTN. The photographs representing IOTN AC 7 and 8 were allocated the same median rank of 7 and AC 5 and 9 were allocated corresponding median ranks of 6 and 8, respectively. There were no significant differences in median cut-off points for treatment need among the three groups of subjects (P > 0.05), indicating that the mean threshold at which treatment would be sought was AC 4.     

Orthodontic treatment need in Nigerian children

OBJECTIVE: The purpose of this study was to assess the need for orthodontic treatment among Nigerian children aged 12-14 years old in Benin City, south-southern region of Nigeria. RESEARCH DESIGN: The sample consisted of 261 randomly selected school children, 122 boys (47%) and 139 girls (53%) with mean age of 12.9 +/- 0.1. The survey was conducted by clinical examination and both components of the Index of Orthodontic Treatment Need (IOTN) were used to determine the need for orthodontic treatment. RESULTS: The results revealed that 50 (19.2%) of the children had a definite need for orthodontic treatment according to dental health component while aesthetic component of IOTN indicated definite need in 12 (4.6%). Increased overjet, severe contact displacements and impeded eruption of teeth were the common occlusal features in the definite treatment need group. CONCLUSION: This study provided data on the need for orthodontic treatment among Nigerian school children which is useful to plan and prioritise orthodontic care and services.     

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.     

Orthodontic treatment need and demand in 12-14-year-old north Jordanian school children

This study was undertaken to assess the need and demand for orthodontic treatment among 12-14-year-old north Jordanian school children. In total, 1002 students randomly selected to represent five geographical areas of Irbid were examined. The examinations were carried out twice, first on the pupils in the school premises and then using study models taken from each student. The dental health (DHC) and aesthetic (AC) components of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment. The demand for orthodontic treatment was measured by asking the students 'if it was necessary, would they like to have their teeth straightened by an orthodontist'. The results showed that approximately one-third (34 per cent) of the children examined had a definite need for orthodontic treatment. Within this group, 73.5 per cent were in need of orthodontic treatment according to the DHC, 23.5 per cent had both DHC and AC great need scores, and 3 per cent were in need according to the AC only. Severe contact point displacement of more than 4 mm was the most common occlusal feature in the definite treatment need group, followed by impeded eruption of teeth, hypoplasia of a single tooth and increased overjet of more than 6 mm but less than or equal to 9 mm. The demand for orthodontic treatment among the students was 49 per cent. Approximately half of them (54 per cent) had a definite need for orthodontic treatment. This study provides baseline data on the need and demand for orthodontic treatment among a Jordanian population, which is important for planning public orthodontic and dental services.     

The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11-14 years of age, and 250 patients, 11-14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38.8 per cent of Turkish school population showed great need treatment, 24.0 per cent moderate need treatment and slight or no need was 37.2 per cent. On the other hand, the referred population represented an 83.2 per cent great need treatment, 12.0 per cent moderate need treatment, 4.8 per cent no need treatment according to the DHC. The AC of IOTN in school population resulted in 4.8 per cent great need, 4.8 per cent moderate need, 90.4 per cent no need. These percentage were 36.8 per cent great need, 17.6 per cent moderate need, 45.2 per cent no need in referred population. Grade 8 was 28.8 per cent out of the 36.8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.     

上海地区青少年正畸治疗需要的调查研究

目的:调查上海地区青少年人群的正畸治疗需要及自身美学评价。方法:随机抽取上海地区11～13岁青少年686例(男355例,女331例),由正畸专科医师采用正畸治疗需要指数(index of orthodontic treatment need,IOTN)评定受试者正畸治疗需要。IOTN包括学(dental health component,DHC)及美学(aesthetic component,AC)2部分。同时采用IOTN的美学部分让受试者对自身美观程度进行评价(self-perceived aesthetic component,SAC)。采用描述性统计及卡方检验对调查结果进行统计分析。结果:DHC评分显示26.0%的受试者明确需要正畸治疗,19.8%的受试者为临界病例;AC评分显示5.5%的受试者明确需要正畸治疗,31.7%为临界病例;SAC评分显示1.7%的受试者明确需要正畸治疗,6.4%为临界病例。在明确需要正畸治疗的受试者中,最常见的特征是严重接触点异常(>4 mm)。DHC与AC在评价治疗需要时77.8%结果一致,AC与SAC在评价治疗需要时65.0%结果一致。结论:将近一半的青少年人群明确需要正畸治疗或为临界病例,受试者在进行自身美观程度评价有从轻的倾向。     

青年与正畸医生对正畸需要的感知差异及其影响因素的调查

目的:了解16～22岁青年人群与正畸医生对正畸需要的感知差异,及其相关社会影响因素。方法:选择南京陆军指挥学院门诊部口腔科就诊的204名16～22岁青年,应用一般人口调查问卷、IOTN量表和DHC自评调查问卷,通过统计学分析青年与正畸医生对正畸需要的感知差异及其影响因素。结果:16～22岁青年与正畸医生对正畸需要的感知差异明显,男性青年在牙齿美观方面的正畸需要不强烈,青年和他们父母学历越高对牙齿健康方面的正畸需要越强烈。结论:性别、学历和父母学历对正畸需要的感知差异存在影响。     

Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children.

The aim of this study was to assess the opinions of Tanzanian children on dental attractiveness and their perceptions of orthodontic treatment need in relation to their own dental attractiveness as measured by the aesthetic component (AC) of the index of orthodontic treatment need (IOTN). In a random sample of 386 school children (48% boys, 52% girls), aged 9 to 18 years, the subjective need was assessed by using a prestructured questionnaire, and attractiveness was scored by using 18 intraoral frontal photographs. Orthodontic treatment need was measured with the IOTN, and 11% of the children definitely needed orthodontic treatment (grades 8-10 of the AC with 4-5 of the dental health component [DHC]). The AC indicated that 11% of the children needed orthodontic treatment, whereas the DHC indicated 22%. Although 38% of the children said they needed treatment, 33% and 31% were unhappy with the arrangement and the appearance of their teeth, respectively. Most children (85%) recognized well-aligned teeth as important for overall facial appearance. Photographs showing severe deviations including crowding were regarded as the most unattractive, with older children tending to dislike them the most (P <.0005). This suggests that, from the children's point of view, grades 8-10 of the AC and 4-5 of the DHC could be given the first priority when considering an orthodontic treatment policy in Tanzania.     

The Use of the Index of Orthodontic Treatment Need (IOTN) in a School Population and Referred Population

Abstract

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11–14 years of age, and 250 patients, 11–14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38?8 per cent of Turkish school population showed great need treatment, 24?0 per cent moderate need treatment and slight or no need was 37?2 per cent. On the other hand, the referred population represented an 83?2 per cent great need treatment, 12?0 per cent moderate need treatment, 4?8 per cent no need treatment according to the DHC.

The AC of IOTN in school population resulted in 4?8 per cent great need, 4?8 per cent moderate need, 90?4 per cent no need. These percentage were 36?8 per cent great need, 17?6 per cent moderate need, 45?2 per cent no need in referred population. Grade 8 was 28?8 per cent out of the 36?8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.     

Perceptions of orthodontic treatment need: Receiver Operating Characteristic analysis

Abstract This study aimed to investigate the variations in dentists' perception of need for orthodontic treatment. Sixteen dentists viewed forty clinical vignettes and recorded their decisions according to the certainty with which they would offer treatment for each case. Receiver Operating Characteristic (ROC) analysis was performed on this data, using the Index of Orthodontic Treatment Need (IOTN) as the ‘gold standard'. The data suggest that dentists treatment decisions do not concur with current guidelines in use in the UK.     

The use of index of orthodontic treatment need in an Iranian population

This study aims to evaluate the need for orthodontic treatment between 11 and 14 year old school children in Shiraz. A sample of 2000 students consisting of 1200 boys and 800 girls from various parts of the city was selected. The index of orthodontic treatment need (IOTN) was used by two calibrated examiners. The data was recorded in questionnaires to assess dental health components (DHC). Aesthetic components (AC) were evaluated both by students (AC) and examiners (ACE). The results for DHC of IOTN were: 18.39% of population showed severe and very severe need for treatment, 25.8% were in border line category, 48.1% had a slight need and the percentage for no need to treatment was 7.63%. In evaluating AC, 91.93% were in no need or little need, 3.91% in moderate need and 4.11% in great need to treatment group. Where as ACE resulted in: 91.31% no need and little need, 2.44% moderate need and 6.21% great need to treatment. There was a slight statistical correlation (0.54) between AC and ACE, but a very weak correlation between DHC and AC was observed. According to DHC, boys showed more need for treatment than girls (P=0.001). Grade 8 showed the most percentage in great need category in both AC and ACE (3.41% of 4.11% and 5.74% of 6.21%, respectively). The results indicate that the need for orthodontic treatment was less than other studies and most of the students were in the category of little need for treatment.     

The need for treatment and satisfaction with dental appearance among young Finnish adults with and without a history of orthodontic treatment.

The aim of this investigation was to evaluate orthodontic treatment need and patient satisfaction among young adults living in a city where free-of-charge orthodontic treatment was provided. A total of 281 18- to 19-year-old subjects randomly selected from the population register of the city of Vantaa took part in the study. The drop-out rate was 30%. Treatment need was clinically assessed according to the Index of Orthodontic Treatment Need (IOTN), consisting of a Dental Health Component (DHC) and an Aesthetic Component (AC). Information on previous orthodontic treatment was based on the patient records. Satisfaction of the subjects with their dental appearance and with the orthodontic treatment received was obtained using a questionnaire. The rate of orthodontic treatment among the subjects was 46% (54% for the females and 37% for the males, p < 0.05). 4% had discontinued treatment. A definite need for treatment (DHC 4 to 5/AC 8 to 10) was assessed in 15% of the subjects, and borderline/moderate need (DHC 3/AC 5 to 7) in 36%. No difference in IOTN scores between the treated and untreated subjects was found. Females had significantly more often no treatment need (DHC 1 to 2/AC 1 to 4) compared with males (p < 0.05). The majority of subjects (89%) reported that they were very or quite satisfied with their dental appearance. The odds of being satisfied were significantly higher for the treated subjects (OR = 2.71, p < 0.05) and lower for those at the non-attractive end of the AC scale (OR = 0.14, p < 0.01). Neither gender nor DHC grade significantly affected the odds of being satisfied among the subjects. The results indicate that the majority of young adults in this study were satisfied with their dental appearance regardless of objective treatment need of various degrees. The high treatment rate in relation to unnoticed treatment need calls for reevaluation of priorities in patient selection.