Perception of orthodontic treatment need among Swedish children,adolescents and young adults

Objective: Perceptions of orthodontic treatment need and perceptions of dental aesthetics was investigated among subjects ages 10, 15 and 19.

Materials and methods: A total of 489 subjects completed a questionnaire after inspecting 10 photographs in the Aesthetic Component scale of the Index of Orthodontic Treatment Need to (i) reveal the lower limit for orthodontic treatment need and (ii) rate their dental aesthetics by selecting the most similar photo.

Results: The mean lower limit for orthodontic treatment need was significantly higher (and closer to literature-based standards) among subjects, age 10 (4.2?±?1.5), than among subjects, age 15 (3.6?±?1.2) (p?=?.0009), and subjects, age 19 (3.5?±?1.2) (p?=?.00002). Among subjects ages 15 and 19, the lower limit for orthodontic treatment need was lower in groups with (i) self-perceived orthodontic treatment need (p?=?.002 and .001, respectively) and (ii) previous orthodontic treatment (p?=?.005 and .035, respectively). Self-perceived orthodontic treatment need was present in more than one-third of subjects, age 19, who had previously received orthodontic treatment. Subjects of foreign origin reported that their dental aesthetics were worse (p?=?.002) and those same subjects, age 19, set the lower limit for orthodontic treatment lower (p?=?.047) than Swedes, age 19.

Conclusions: The lower limit for orthodontic treatment need among subjects, age 10, was higher – compared to subjects, ages 15 and 19 – and closer to literature-based standards. Subjects with self-perceived orthodontic treatment need, subjects with previous orthodontic treatment, and subjects age 19 of foreign origin, have higher aesthetic demands.     

Estimates of orthodontic treatment need in Danish schoolchildren

ABSTRACT Orthodontic treatment need has been assessed on the basis of complete orthodontic records in a random sample of 293 Danish children aged 13–17 years by a group of postgraduate orthodontic students and by three orthodontists. The estimates of treatment need ranged from 45 % to 61 %. Interexaminer agreement in pairs was observed in 77 %– 92 % (mean 83 %) of the cases. Uniformity in four individual assessments was reached in 69 % of the cases: 38 % were considered in need of treatment and 31 % were considered not to present such need; conversely, 31 % gave rise to disagreement. It is argued that, at present, the orthodontist's subjective estimate of treatment need probably constitutes a more realistic approach to the problem of assigning treatment priority than the various indices of malocclusion.     

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.     

Disparity in orthodontic utilization and treatment need among high school students

OBJECTIVES: The aim of this cross-sectional study was to assess the disparity in utilization of orthodontic services among high school students and to measure and characterize the extent of unmet treatment needs among untreated students at the time of examination. METHODS: The sample consisted of 2,808 tenth grade students enrolled in different public and private high schools. All subjects completed a dental survey that included questions on demographic, dental health, and orthodontic services, and assessment of smile using the visual analog scale. A subsample of dental study casts that were available for 561 untreated subjects were scored using the Dental Aesthetic Index (DAI) to estimate unmet treatment need. RESULTS: The orthodontic utilization rate was 37 percent. The odds of being orthodontically treated were 8.7 times greater among those with dental visits within the past year than among those without, and three times greater among Caucasians than among other ethnic groups. The DAI indicated that the unmet treatment need was 29 percent, with ethnic minority groups having 2.6 greater odds of needing treatment than Caucasians. CONCLUSION: Minority groups and infrequent dental attenders may experience disparities in unmet orthodontic treatment need.     

Oral health-related quality-of-life in patients to be treated with fixed or removable partial dental prostheses

Abstract

Objectives. The aims of this study were to measure and describe the Oral Health-Related Quality-of-Life (OHRQoL) in a population about to receive removable dental prostheses (RDP) or fixed dental prostheses (FDP). Materials and methods. The Oral Health Impact Profile 49 (OHIP-49) was completed by 410 patients about to receive treatment with either RDP or FDP. Objective variables were: gender, age, number of teeth, type of replacement planned (FDP/RDP) and location (one jaw or both) and zone (aesthetic/masticatory/both) of missing teeth to be replaced. Results. Women had a worse OHRQoL than men in the RDP group. Higher age was significantly correlated with a better OHRQoL independent of treatment modality. Participants about to receive FDP in one jaw in the masticatory zone only had a better OHRQoL than RDP participants in the same group. The most frequently reported problems in all groups concerned functional limitations, discomfort and physical disabilities. Little variance in reported items was seen between the sub-groups and social handicap was not frequently reported. Conclusions. The difference in OHRQoL between participants about to receive RDP and FDP was limited. The most frequently reported problems concerned functional limitations, discomfort and physical disabilities. Social handicap was not frequently reported.     

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.     

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.     

Need of orthodontic treatment in 7-year-old Finnish children

The purpose of the investigation was to determine the need of orthodontic treatment in 7-year-old Finnish children. The series consisted of 200 Finnish children, 100 girls and 100 boys. With regard to the main lines of occlusion a close agreement was observed between the prevalence of malocclusion in this and other. Scandinavian series. The need of orthodontic treatment was assessed using a treatment scale for the age group concerned. No treatment was required in 42% of the children, while 23.5% were in immediate need of orthodontic treatment. In 34.5% it was considered necessary to follow the occlusal development.     

Modified IOTN: an orthodontic treatment need index for use in oral health surveys

This paper reports the results of a study of the reliability of a modified version of the Index of Orthodontic Treatment Need (IOTN) for use in oral health surveys. Twelve non-specialist dental examiners were trained in the use of the Modified IOTN using a standardised teaching protocol lasting approximately 1.5 hours. Following a school-based calibration exercise it was found that nearly all the examiners achieved either good or excellent agreement (mean Kappa=0.74). The average sensitivity and specificity scores were 0.90 and 0.84, respectively. The Modified IOTN appears to overcome the training and reliability problems that often accompany the use of orthodontic indices by non-specialists in oral health surveys.     

Variability in assessment of need for orthodontic treatment when using certain treatment-need indices

Abstract The need for orthodontic treatment was assessed in a sample of 29 children by using four treatment-need indices (TSMHB by the Swedish Medical Health Board, HMAR by Salzmann, INOT by Ingervall & Ronnerman, and TPI by Grainger). Furthermore, the need for treatment was evaluated clinically according to the criteria of Jarvinen. When scoring the cases, and when selecting the cases with the highest scores, the study showed a marked variation between the indices, and indicated that the different methods selected different groups of children for treatment. Indirectly, the conclusion could be drawn that there were differences in the validity of the indices, even though it was not possible to evaluate the degree of validity on the basis of the knowledge we have today about the disadvantages and consequences of malocclusions.     

Impact of social and economic characteristics on orthodontic treatment among children and teenagers in France

Germa A, Kaminski M, Nabet C. Impact of social and economic characteristics on orthodontic treatment among children and teenagers in France. Community Dent Oral Epidemiol 2010. © 2009 John Wiley & Sons A/S Abstract – Objectives: This study aimed to estimate the prevalence of orthodontic treatment in France among children and teenagers aged 8–18 years, by sex and by age, and to investigate the specific role of social and economic characteristics on use of orthodontic treatment. Methods: We analyzed data from the cross‐sectional national health survey conducted in France in 2002–2003, which included a sample of 5988 children aged 8–18 years. All data were collected by interview including the question on orthodontic treatment. Other data used in our study were family social status and income, maternal educational attainment and place of birth, whether the child was covered by a supplementary health insurance and whether the residence was urban or rural. We also calculated the density of orthodontists in the district. Multivariate logistic regression analyses were used to study the relationships between these social and economic factors and orthodontic treatment. Results: The prevalence of orthodontic treatment was 14% of all children aged 8–18, 15% for girls, and 13% for boys, and 23% in the 12 to 15‐year age group. Children were less likely to have orthodontic treatment when parents were service or sales workers compared with children whose parents were managers or professionals (aOR = 0.50; 95%CI: [0.34;0.76]), when family income was in the lowest, compared with highest quartile (aOR = 0,62; 95% CI: [0.45;0.85]), when children had no supplementary insurance compared with children covered by private insurance (aOR = 0.53; 95% CI: [0.34; 0.81]), or when they lived in rural compared with urban areas (aOR = 0.70; 95% CI: [0.54; 0.91]). Conclusion: There are social inequalities in orthodontic treatment in France, associated mainly with social status, annual income, supplementary insurance, and the residence area.     

Hypodontia in 9-year-old Norwegians related to need of orthodontic treatment

The present study reports on the prevalence of hypodontia in a Norwegian population and classifies children with hypodontia according to need of orthodontic treatment. Orthopantomograms of 1953 children (960 girls and 993 boys) at the age of 9 were available for examination. Of the boys registered with hypodontia of second premolars at the age of 9, 11.3% showed late mineralization between the ages of 9 and 12. Only 2.9% of the girls showed late mineralization. The corrected prevalence of hypodontia, excluding third molars, in the girls was 7.2%, in the boys 5.8%, and in both sexes combined 6.5%, the difference between sexes not being statistically significant. Of the children with hypodontia, 86.6% lacked only one or two permanent teeth. The most frequently missing teeth were the mandibular second premolars, the maxillary second premolars, and the maxillary lateral incisors, in that order. Classification of children with hypodontia according to need of orthodontic treatment showed that about two-thirds had hypodontia only of single posterior teeth with a moderate need of treatment. About one-third had hypodontia involving anterior teeth, and only 3.1% had hypodontia of two or more teeth in the same quadrant with a great need of treatment.     

The dental manifestations and orthodontic implications of hypoparathyroidism in childhood

The presence of short dental roots can present challenges to the orthodontist both in terms of identifying its aetiology and in subsequent treatment planning. Uncommon causes include hypoparathyroidism and pseudohypoparathyroidism, where short roots may be seen in combination with other oral manifestations including enamel hypoplasia secondary to low calcium levels. This case report highlights these features and the orthodontic treatment proposed.     

Assessment of orthodontic treatment need: a comparison of study models and facial photographs

Abstract – Objectives: The current study aims to examine how orthodontic treatment need is prioritized depending upon whether dental study models or facial photographs are used as the means of assessment. Methods: A group of three orthodontists and three postgraduate orthodontic students assessed: (i) dental attractiveness; and (ii) need for orthodontic treatment in 40 subjects (19 males, 21 females). The 40 subjects displayed a range of malocclusions. Separate assessments were made from study models and facial photographs. Results: There was a bias towards higher scores for dental attractiveness from facial photographs compared with assessment of study casts, for all examiners. This was statistically significant for five of the six examiners (P = 0.001–0.101). The need for orthodontic treatment was rated as 20% higher from study models compared with facial photographs (P < 0.001); overall the level of need for orthodontic treatment was rated as 18.9% higher from study models compared with facial photographs (P < 0.001). Reproducibility analyses showed that there was a considerable variation in the intra‐ and inter‐examiner agreement. Conclusions: This study shows that a group of three orthodontists and three postgraduate students in orthodontics: (i) rated orthodontic treatment need higher from study models compared with facial photographs and; (ii) rated dental attractiveness higher from facial photographs compared with study models. It is suggested that the variable intra‐examiner agreement may result from the assessment of orthodontic treatment need and dental attractiveness in the absence of any specific assessment criteria. The poor reproducibility of assessment of orthodontic treatment need and dental attractiveness in the absence of strict criteria may suggest the need to use an appropriate index.     

Assessment of the validity of HLD (CalMod) in identifying orthodontic treatment need

Cooke M, Gerbert B, Gansky S, Miller A, Nelson G, Orellana M. Assessment of the validity of HLD (CalMod) in identifying orthodontic treatment need. Community Dent Oral Epidemiol 2010; 38: 50–57. © 2009 John Wiley & Sons A/S   Abstract – 
Objective:  The purpose of this study was to assess the validity of the Handicapped Labio-Lingual Deviation index with California modifications, HLD (CalMod), in identifying handicapping malocclusions.
Methods:  A set of 153 study casts representing all types of malocclusion was utilized in this study. Models were randomly chosen the UCSF Division of Orthodontics clinic. Treatment need was determined by the HLD (CalMod) index and by a panel of 13 orthodontists, conventionally established as the 'gold standard'. Spearman Rank correlation analysis was used to evaluate the correlation between HLD (CalMod) and the gold standard. The Classification and Regression Tree (CART) modeling was used to determine the HLD (CalMod) cut-off point of orthodontic treatment need according to the gold standard.
Results:  A Spearman Rank correlation Coefficient of 0.71 demonstrated a moderately high correlation between HLD (CalMod) and the gold standard. The CART modeling determined a value of 18.5 as the cut-off point of HLD (CalMod) for orthodontic treatment need, considerably lower than the cut-off point of 26 currently used by Medi-Cal. At a value of 26 points as the cut-off HLD (CalMod) displayed a low sensitivity (25.9%) and high specificity (96.8%).With a cut-off point of 18.5, specificity decreased to 55.6% while sensitivity increased dramatically to 92.9%.
Conclusion:  Our results show that the HLD (CalMod) with a cut-off point of 26 fails to indentify a considerable percentage of handicapping malocclusions. More studies should be done assessing the efficacy of the HLD (CalMod) in identifying handicapping malocclusion.     

Oral impact on daily performance: need and use of dental prostheses among Brazilian adults

Although there is a large amount of evidence that demonstrates the relationship between oral health status and oral impact daily performance, there are few studies that have evaluated the impact of prosthetic status, particularly the need for a dental prosthesis. Therefore, the aim of this study was to investigate the relationship between need and use of dental prostheses and the prevalence of oral impact on daily performance. A sample of 720 subjects, aged between 50 and 74 years, was evaluated using a cross‐sectional study. Participants were selected through a multistage proportional random sampling. The impact of oral health status on daily performance (oral impact on daily performance – OIDP) and socio‐demographic data was assessed using a standardised questionnaire, and clinical data were assessed by oral examination. The outcome was the prevalence of impact. The association between the explanatory variables and the outcome was analysed through two models of multivariate Poisson regression. In the adjusted model, the variables need of upper and lower prosthesis and use of lower prosthesis maintained a statistically significant association. No statistically relevant relation between socio‐demographic variables and outcomes was found. Findings show that the need and use and of a prosthesis are related to oral health quality of life.     

Oral health disparities in Appalachia: orthodontic treatment need and demand

BACKGROUND: Significant oral health disparities affect people in West Virginia and elsewhere in Appalachia. Although oral diseases such as caries are a major problem, little is known about the occlusal status of this under-served group. METHODS: Fifty-eight adolescents (ages 12-17 years) and 78 of their parents underwent an orthodontic examination as part of a larger study on oral health in two rural West Virginia counties. Two orthodontists used a standardized index to rate their need for orthodontic care. Participants were interviewed regarding their demand for and history of orthodontic care. RESULTS: The study results show that parents had a high rate of complete or partial edentulism, an infrequent history of orthodontic treatment, great unmet orthodontic need and less demand for orthodontic care than was suggested by their clinically determined need. The adolescents were similar to national norms with regard to orthodontic treatment history and need, but lower with regard to demand. CONCLUSIONS: The adolescents' similarity to general population norms with regard to previous orthodontic care and level of occlusal status is promising. Nevertheless, their lower recognition of a need for treatment suggests possible future oral health problems and a lower oral health quality of life. Their parents, however, were considerably worse off, in comparison with their adolescent children and adult comparison samples, with regard to orthodontic care and other oral health status measures. CLINICAL IMPLICATIONS: Culturally sensitive psychoeducational methods to promote recognition of oral health needs may be required among adolescents in Appalachia to have an impact on oral health values and to prevent oral health problems. Issues of orthodontic care utilization and, perhaps, access to care need to be addressed among adults in Appalachia.