Impacts on daily performances attributed to malocclusions by British adolescents

Summary  The aim of this study was to assess the prevalence of condition-specific impacts on daily performances attributed to malocclusion in British adolescents. Two hundred 16- to 17-year-old adolescents were randomly selected from 957 children attending a public college in London, UK. During interviews, participants provided information about demographic variables and socio-dental impacts on quality of life attributed to malocclusions, using the Condition-Specific form of the Oral Impacts on Daily Performances (CS-OIDP) index. Adolescents were also clinically examined using the Index of Orthodontic Treatment Need. Statistical comparison by covariates was performed using chi-squared test and chi-squared test for trends. The prevalence of oral impacts on daily performances attributed to any oral condition was 26·5% whereas the prevalence of CS-OIDP attributed to malocclusion was 21·5%. There was no statistically significant difference by sex, age, ethnicity or orthodontic treatment status of schoolchildren in the prevalence of CS-OIDP attributed to malocclusion ( P  ≥ 0·243 for all cases). However, there was a linear trend for the prevalence of CS-OIDP attributed to malocclusion, by level of normative orthodontic treatment need ( P  = 0·042). The prevalence of such impacts increased from 16·8% for adolescents with no/slight need for orthodontic treatment, to 31·7% for those with definite need for orthodontic treatment. Although findings support the idea that malocclusion has physical, psychological and social effects on quality of life of these adolescents, the inconsistencies in findings between the self-reports of impacts of malocclusion and the assessment of normative needs highlight the shortcomings of using only clinical indexes to estimate orthodontic treatment needs.     

Comparison of the discriminative ability of the generic and condition-specific forms of the Child-OIDP index: a study on children with different types of normative dental treatment needs

Abstract – Objective: To compare the discriminative ability of the Generic and Condition‐Specific forms of the Child‐OIDP index on groups defined by their normative treatment need for dental caries, periodontal disease, malocclusion and traumatic dental injuries. Methods: All 1034 11–12‐year‐old children were included from all the primary schools in a municipal area of Suphanburi Province, Thailand. Children were interviewed about sociodental impacts on quality of life in the past 3 months using the Child‐OIDP index, and then clinically examined to assess their normative treatment need for dental caries, periodontal disease, malocclusion and traumatic dental injuries. Discriminative ability of the Generic and the Condition‐Specific Child‐OIDP (CS‐Child‐OIDP) was assessed through differences in overall scores and prevalences of oral impacts between groups, as well as through their respective effect sizes and adjusted Odds Ratios (ORs). Results: Differences in overall scores and prevalences of oral impacts between groups with and without each of the four types of normative dental treatment needs, their corresponding effect sizes and adjusted ORs, were always significant for CS‐Child‐OIDP. However, when the Generic Child‐OIDP was used to discriminate between groups, the respective figures were significant only for groups with and without normative treatment need for dental caries. Conclusions: CS‐Child‐OIDP was better able to discriminate between groups with and without each of the four types of normative dental treatment need. The better performance of CS‐Child‐OIDP compared with the generic Child‐OIDP was independent of the indicator used to assess discriminative ability (i.e. differences between groups, effect sizes or adjusted ORs).     

The impact of orthodontic treatment on the quality of life in adolescents: a case-control study

The aim of this case-controlled study was to assess the effect of orthodontic treatment on the quality of life of Brazilian adolescents. Two hundred and seventy-nine 'cases' (106 males and 173 females) and 558 controls (246 males and 312 females) were randomly selected from 15- to 16-year-old adolescents attending all secondary schools in Bauru, S?o Paulo, Brazil. A case was defined as having at least one condition-specific impact (CSI) attributed to malocclusion during the previous 6 months, based on the Oral Impact on Daily Performances index. Conversely, a control was defined as having no CSI attributed to malocclusion during the same period. Adolescents were also clinically examined for orthodontic treatment need using the Index of Orthodontic Treatment Need (IOTN) and asked about previous orthodontic treatment. Binary logistic regression was used for statistical analysis. Females and adolescents with a definite normative orthodontic treatment need were more likely to report CSI than males and adolescents with no normative need [odds ratio (OR) = 1.48, 95 per cent confidence interval (CI) = 1.08-2.02 and OR = 2.02, 95 per cent CI = 2.09-4.47, respectively], whereas adolescents with a history of orthodontic treatment were less likely to report CSI than their counterparts (OR = 0.15, 95 per cent CI = 0.07-0.31). Furthermore, there was an interaction between a history of orthodontic treatment and the current level of normative need. Brazilian adolescents with a history of orthodontic treatment were less likely to have physical, psychological, and social impacts on their daily performances associated with malocclusion than those with no history of orthodontics. Gender was a confounding factor, whereas current level of normative orthodontic treatment need was an effect modifier. Prospective studies are needed to corroborate the present findings.     

Malocclusions and orthodontic treatment needs in a group of Spanish adolescents using the Dental Aesthetic Index

OBJECTIVE: To evaluate the prevalence of malocclusion and orthodontic treatment need among Spanish adolescents and compare with other populations. METHODS: The study sample comprised 744 schoolchildren from urban and rural populations in Granada province (Southern Spain), aged from 14-20 years, who had received no orthodontic treatment. The measurement instrument was the Dental Aesthetic Index (DAI). RESULTS: The mean DAI score of the whole series was 25.6 (SD, 7.94). The distribution of the four DAI grades was: DAI 1, no anomaly or malocclusion, 58.6%; DAI 2, definite malocclusion, 20.3%; DAI 3, severe malocclusion, 11.2%; DAI 4, very severe or disabling malocclusion, 9.9%. There were no statistically significant differences in DAI score between genders or those in rural vs. urban residence, but a significant difference was found between social classes, with subjects of low social class presenting the worst scores (p<0.05). CONCLUSION: The distribution of DAI scores among Spanish adolescents is similar to that reported in other populations.     

Can Oral Health‐Related Quality of Life Measures Substitute for Normative Needs Assessments in 11 to 12‐year‐old Children?

OBJECTIVES: 1) assess the relationship between a measure of condition-specific oral health-related quality of life (OHRQoL) and the related normative need for dental treatments, and 2) test the diagnostic validity of the condition-specific OHRQoL measure for specific dental conditions in a group of primary school children. METHODS: A cross-sectional study of all 11 to 12 year-olds carried out in a municipal area of Suphanburi province, Thailand. 1034 children (91.8%) were dentally examined to assess their normative needs for 6 types of treatment (dental caries, traumatic dental injuries, enamel defects, periodontal, orthodontic and prosthodontic treatment). OHRQoL was assessed using the Child-OIDP index and its Condition-Specific impacts measure for the 6 treatment types. RESULTS: The prevalence of specific types of normative needs ranged from 3.2% (prosthodontic) to 97.0% (periodontal) and for Condition-Specific oral impacts from 0.7% (prosthodontic) to 50.6% (dental caries). Despite their statistically significant relationship for every treatment type except for periodontal treatment when need was indicated by a CPI score of 1, there were large differences between measures of normative need and oral impacts. High proportions of children had normative need without impacts and vice versa. The biggest differences were for appearance-related conditions (e.g. enamel defects and orthodontic treatment). For every type of treatment, oral impacts poorly predicted the normative needs of individuals. CONCLUSIONS: Although normative needs and OHRQoL are associated, when assessed appropriately, there was considerable discrepancy between them. OHRQoL measures cannot replace normative needs. Instead, both should be used in combination in order to cover different dimensions of oral health.     

Combining normative and psychosocial perceptions for assessing orthodontic treatment needs

Whereas perceptions of malocclusion by the public are mainly subjective, currently orthodontic treatment needs are predominantly determined using normative need. There are considerable differences between normative and subjective perceptions of orthodontic need. Yet clinical measures determine current provision of orthodontic services, whereas subjective oral health-related quality of life (OHRQoL) measures are seldom used and play a small part in need assessment despite predicting perceived need. The sociodental approach to assessing orthodontic treatment needs overcomes deficiencies of the sole use of normative need. It is a gradual integration process, estimating orthodontic needs by combining normative and psychosocial perspectives, as well as considering behavioral factors affecting outcomes of orthodontic treatment and scientific evidence about the effectiveness of interventions. To be appropriately used in needs assessment, an OHRQoL measure should provide condition-specific estimates of the impact of malocclusion on daily life. The sociodental approach attempts to replicate the characteristics of good clinical practice using a structured, rational, and coherent system for assessing orthodontic needs and, therefore, is a useful tool in planning oral health services.     

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.     

Orthodontic treatment need,self‐esteem,and oral health‐related quality of life among 12‐yr‐old schoolchildren

The aim of this study was to investigate the association between orthodontic treatment need and oral health‐related quality of life (OHRQoL) among 12‐yr‐old children. The study also assessed whether self‐esteem modifies and/or moderates this relationship. Cross‐sectional data on 406 schoolchildren aged 12 yr were analyzed. Data on socio‐economic and demographic characteristics, dental pain, self‐esteem, and OHRQoL were collected using validated questionnaires. Orthodontic treatment need was assessed, through dental examinations, using the dental aesthetic index (DAI). Multiple negative binomial regression and path analysis were used to estimate the association of orthodontic treatment need and self‐esteem with OHRQoL. A modifying effect of self‐esteem on the relationship between DAI and OHRQoL was observed. Self‐esteem did not mediate the abovementioned relationship. Children with lower scores of self‐esteem had worse OHRQoL among those with lower orthodontic treatment need (a DAI score of < 31). However, self‐esteem did not influence the association between DAI and OHRQoL in children with greater orthodontic treatment need (a DAI score of ≥ 31). Self‐esteem attenuated the impact of malocclusion on OHRQoL in children with minor or definite malocclusion, but not among those with severe or very severe malocclusion. Self‐esteem appears to buffer the impact of malocclusion on OHRQoL in children with minor orthodontic treatment need.     

The relationship between normative orthodontic treatment need and oral health-related quality of life

OBJECTIVES: The first objective was to assess whether having had orthodontic treatment affected the levels of oral health-related quality of life impacts in Brazilian adolescents. A second objective was to assess the relationship between a normative clinical measure of orthodontic treatment need and two measures of oral health-related quality of life. METHODS: A cross-sectional study was conducted in Bauru, SP, Brazil, on 1675 randomly selected adolescents aged between 15 and 16 years. Adolescents were clinically examined using the Index of Orthodontic Treatment Need (IOTN). Two oral health-related quality of life measures, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used to assess the adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis. RESULTS: Adolescents who had completed orthodontic treatment reported less oral health impacts on their daily life activities than those currently under treatment or those who never had any treatment. Combining the IOTN index with either of the two oral health-related quality of life measures used in this study provided more information about the adolescents' perceived satisfaction with their appearance than the IOTN on its own. CONCLUSION: Current methods of assessing orthodontic need should be complemented by oral health-related quality of life measures with valid psychometric properties, and measures of perceived need.     

Relationship between impacts attributed to malocclusion and psychological stress in young Japanese adults

Identifying risk factors is important to prevent a wide range of health-damaging behaviours and to improve the quality of life of young people. The aim of this study was to investigate the relationship between impacts on daily performance attributed to malocclusion and psychological stress in healthy young Japanese adults. Medical and oral health data were collected during a cross-sectional examination conducted by the Health Service Center of Okayama University. Systemically healthy non-smoking students aged 18 and 19 years (n = 641; 329 males and 312 females) were included. Malocclusion was defined using a modified version of the Index of Orthodontic Treatment Need (IOTN). The impacts on daily performance attributed to malocclusion and psychological stress were assessed using self-reported questionnaires, the condition-specific oral impacts on daily performances (CS-OIDP), and the Hopkins Symptoms Checklist. Mann-Whitney U- and chi-square tests and structural equation modelling (SEM) were used for statistical analysis. Forty per cent of subjects had a malocclusion (n = 255). Subjects with impacts on daily performance had a significantly higher prevalence of malocclusion than those without impacts (P < 0.001). SEM showed that psychological stress, especially interpersonal sensitivity and depression, was significantly correlated with CS-OIDP and malocclusion. Negative impacts on daily performance attributed to malocclusion may contribute to psychological stress in young Japanese adults.     

Impacts on daily performances attributed to malocclusions using the condition-specific feature of the Oral Impacts on Daily Performances Index

OBJECTIVE: To assess the prevalence, intensity, and extent of sociodental impacts attributed to malocclusions by sex, socioeconomic status, and normative orthodontic treatment need level. MATERIALS AND METHODS: One thousand sixty 15- to 16-year-old adolescents without history of previous or current orthodontic treatment were randomly selected from all secondary schools in Bauru, Brazil. Interviews were done to collect information about sociodemographic variables and sociodental impacts on quality of life attributed to malocclusions using the Oral Impacts on Daily Performances Index. Adolescents were also clinically examined using the Index of Orthodontic Treatment Need. Statistical comparison by covariables was performed using chi(2) and Kruskal-Wallis tests. RESULTS: The prevalence of condition-specific impacts (CSIs) was 24.6%. Among adolescents with CSIs, 52.1% reported severe or very severe intensity and 77.4% reported impacts on only one daily performance, commonly, smiling. The prevalence, intensity, and extent of CSIs differed by level of normative orthodontic treatment need but not by sex or socioeconomic status. However, among adolescents with definite normative orthodontic treatment need, 24.5% reported CSIs of severe or very severe intensity, whereas among those with moderate or slight/no need, 13.0% and 7.9%, respectively, experienced CSIs of severe or very severe intensity. CONCLUSIONS: Untreated malocclusions have physical, psychological, and social consequences on quality of life of Brazilian adolescents. However, because adolescents with a definite normative orthodontic need are considered by orthodontists as in need of care, these results raise the issue of whether all these adolescents should be considered for orthodontic attention since most had no perceived impacts on performing their daily life activities.     

Condition-specific sociodental impacts attributed to different anterior occlusal traits in Brazilian adolescents

The aim of this study was to assess the association between different anterior occlusal traits and the presence of condition-specific sociodental impacts on the quality of life attributed to malocclusion. For that, 1,318 15-16-yr-old adolescents were randomly selected from children attending all secondary schools in Bauru, Brazil. Participants were first interviewed and then dentally examined. Condition-specific impacts (CSI) attributed to malocclusion were calculated using the Oral Impacts on Daily Performances (OIDP index). Nine anterior occlusal traits were evaluated: maxillary and mandibular overjet; openbite and overbite; centreline deviation; dental crowding and spacing; and maxillary and mandibular irregularity. Statistical associations were tested using binary logistic regression analysis. The prevalence of CSI attributed to malocclusions was 21.2%. Of the nine occlusal traits evaluated, maxillary and mandibular overjet, centreline deviation, dental spacing, openbite, and maxillary irregularity were, in that order, directly associated with the presence of CSI attributed to malocclusion. No interaction term was identified. This study, designed to overcome the limitations found in the existing literature, supports the idea that malocclusion can affect social interaction and psychosocial wellbeing. Different anterior occlusal traits affected the quality of life differently.     

Establishing malocclusion severity levels on the Dental Aesthetic Index (DAI) scale

The Dental Aesthetic Index (DAI) is an orthodontic index based on socially defined aesthetic standards. It is useful in both epidemiological surveys to identify unmet need for orthodontic treatment and as a screening device to determine priority for subsidized orthodontic treatment. An earlier study established the score of 36 on the DAI scale to identify handicapping malocclusions. The purpose of the present study was to determine decision points on the DAI scale that identify malocclusion severity levels less severe than handicapping. Two sources of data were used: 1) The frequency distribution of DAI scores on a probability sample of 1306 study models representing the untreated occlusions found in half a million adolescents. 2) The per cent distribution of US youths aged 12–17 by specified case severity reported in an assessment of the occlusion of youths? by the National Center for Health Statistics (NCHS). The decision points separating specific case severities on the DAI scale were determined by relating the proportions of the NCHS population with specified case severities to the cumulative percentages of the frequency distribution of DAI scores on the 1306 models. The NCHS report found 45.8 per cent of the sample to have normal or minor malocclusion with no need or slight need for treatment. DAI scores 25 and below corresponded to that proportion of the sample. The NCHS report found 25.2 per cent of the sample to have definite malocclusion with treatment being elective. DAI scores between 26 and 30 corresponded to that proportion of the sample. The NCHS report found 13 per cent of the population to have severe malocclusion with treatment highly desirable. Fifteen per cent were included in this category. DAI scores 31 to 35 corresponded to that proportion of the sample.     

Predictors of fixed orthodontic treatment in 15-year-old adolescents in South Australia

Abstract An understanding of the determinants of the provision of fixed orthodontic treatment would be beneficial in the planning of any system aimed at rationalising supply. The aim of this longitudinal study was to determine those factors which were predictive of the provision of fixed orthodontic treatment in adolescents. Baseline data, at age 13 years, on oral health, the history of orthodontic consultation and interceptive orthodontic care, a dental appearance score (DAI), socio-demographic characteristics and self and parental perceptions of both dental appearance and need for fixed orthodontic treatment were obtained from 2793 adolescents under the care of the South Australian School Dental Service who had not undergone fixed orthodontic treatment. Data on the orthodontic care provided to these adolescents in the ensuing 2 years were collected. At the end of the 24-month period 433 adolescents (15.5%) had undergone fixed orthodontic treatment. Significant bivariate associations were found between the provison of fixed orthodontic treatment and the DAI score, sex of the adolescent, familial history of fixed orthodontic treatment, income, private insurance, orthodontic consultation and interceptive orthodontic care before the age of 13 years and self and parental perceptions of both dental appearance and the need for fixed orthodontic treatment. Logistic regression was used to produce a predictive model of fixed orthodontic treatment. The model explained 30.2% of the variance, with a specificity of 0.94, a sensitivity of 0.49 and a hit rate of 0.84%. Odds ratios greater than one were found for the DAI score, private insurance, females, self and parental perception of need, higher incomes and orthodontic consultation and interceptive orthodontic care before the age of 13 years.     

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.     

Aesthetic impact of malocclusion in the daily living of Brazilian adolescents

Abstract

Objective: The aim of the present study was to determine the biopsychosocial impact of malocclusion on the daily living of Brazilian adolescents (14 to 18 years of age) through normative and subjective records and identify factors directly involved in the self-perception of malocclusions.

Design: Cross-sectional.

Setting: Public and private schools in the city of Belo Horizonte, Brazil.

Subjects and methods: The sample was made up of 403 adolescents, with no prior history of orthodontic treatment, who were selected randomly from a population of 182,291 students in the same age range. The oral impact of malocclusion was assessed using the Oral Impact on Daily Performance (OIDP), whereas clinical criteria were assessed using the Dental Aesthetic Index (DAI). Self-perception of dental aesthetics was assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and self-esteem was assessed using the Global Negative Self-Evaluation (GSE) scale. Other variables were assessed using questionnaires. The chi-square test, simple and multiple logistic regression analyses were used for the statistical analysis.

Results: Ninety five adolescents (24%) reported feeling embarrassed to smile (aesthetic impact). A logistic regression suggested that the following variables were directly involved in the self-perception of malocclusion: upper anterior crowding ?2 mm (P=0.009), median diastema ?2 mm (P=0.040), normative treatment need (highly desirable) (P<0.001) and low economic level (P<0.001).

Conclusion: Negative repercussions on daily living were found in Brazilian adolescents with malocclusions affecting anterior dental aesthetics.     

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 concern of parents compared with orthodontic treatment need assessed by Dental Aesthetic Index (DAI) in Ibadan, Nigeria.

The purpose of this study was to investigate the concerns for orthodontic treatment by parents of adolescents in Ibadan, Nigeria for their children, and to compare the observations with objectively determined orthodontic treatment need using DAI. A total of 271 students aged 12-18 years (mean 14.8 +/- 1.1) drawn from five secondary schools in Ibadan were clinically examined while their parents were asked about their opinions in a questionnaire. About 61.3% of the adolescents had normal or minor malocclusions needing no treatment. The rest needed orthodontic treatments ranging from definite to mandatory treatment needs. No sex difference was noted (P > 0.05). Their psychosocial treatment need indicated by parental orthodontic concern revealed that 86% of them needed no orthodontic treatment. Most parents (87.1%) perceived dental aesthetics to be equally important for girls and boys and no sex difference was observed in their orthodontic concern (P > 0.05). Parents orthodontic concern had significant weak correlation with DAI scores. The results suggest a need for more orthodontic awareness in our community and confirm that there is a difference of opinion on orthodontic treatment need between laypersons and orthodontists, as would be expected.     

Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index

The objectives of this study were to evaluate the frequency and severity of the malocclusion and treatment needs in Peruvian young adults. The second aim was to compare the orthodontic treatment needs according to sex and socio-economic status (SES). This cross-sectional study was conducted at the University Dental Clinic of a private university in Lima, Peru. A total of 267 freshmen (from 16 to 25 years old) were randomly selected from a pool of 780 students. Students wearing an orthodontic appliance or reporting a history of orthodontic treatment were excluded from the study. Clinical examinations were conducted using the Dental Aesthetic Index (DAI). Mann-Whitney and Kruskal-Wallis tests were used to compare the DAI scores according to sex and SES, respectively. The mean DAI score was 28.87 points (IC(95%) 27.77; 29.97, where IC indicates interval of confidence). Around one-third of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. No statistically significant difference was found between the DAI scores according to sex (P = .592) and SES (P = .397). Approximately one-third of the evaluated Peruvian young adults would need orthodontic treatment according to the DAI. In this population, malocclusion was characterized by a relatively high frequency of missing teeth, appreciable dental crowding, and inadequate anteroposterior relationships.     

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.