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 among children in Swedish dental care: The impact from malocclusions or orthodontic treatment need

Objectives. To describe oral health-related quality-of-life (OHRQoL) and the impact of malocclusions or orthodontic treatment need in a cohort of children in Swedish dental care, using the Swedish version of the Child Perceptions Questionnaire–Impact Short Form (CPQ_11–14–ISF:16). Subjects and methods. Two hundred and fifty-seven children (mean age = 11.5 years, SD = 0.8, range = 9.8–13.5 years) completed the CPQ_11–14–ISF:16 in conjunction with a clinical examination. In addition to malocclusions and orthodontic treatment need (based on the Index of Orthodontic Treatment Need–Dental Health Component), possible confounders (caries, enamel defects, dental trauma, headache and socio-economic markers) were recorded. Children also rated their own dental fear on the Children’s Fear Survey Schedule–Dental Sub-scale (CFSS-DS). Results. The mean total CPQ_11–14–ISF:16 score was 9.31. The logistic regression analyses revealed an impact of orthodontic treatment need on OHRQoL (CPQ), but no clear association between higher severity and higher impact on OHRQoL was seen. Dental fear and headache appeared to discriminate for poorer OHRQoL. No impact from caries, enamel defects, dental trauma, or socio-economic markers was revealed. Conclusions. This cohort of children reported good self-perceived OHRQoL. Effects on OHRQoL from malocclusions or orthodontic treatment need were limited and inconsistent. Dental fear and headache were found to be more distinct impact factors on OHRQoL than were malocclusions or orthodontic treatment need.     

Perception of dental and other individual problems: adolescents versus young adults

Abstract The importance of dental problems in comparison with general health problems and psychological problems was judged by 642 adolescents. The methods used were paired comparison and direct ranking of nine stimuli. Adolescents were quite consistent in their choices. The agreement within the group was statistically significant. Adolescents judged dental problems as less important than general health problems and as more important than psychological problems. The correlation between the methods of paired comparison and direct ranking was high. The results were compared retrospectively with findings from a study of 51 older subjects. Adolescents and adults did not differ much from each other except for the ordering of the nine problems. Adults ranked dental problems as the least important.     

Subjective and objective orthodontic treatment need among orthodontically treated and untreated Finnish adolescents

Abstract Subjective orthodontic treatment need was studied in a sample of 340 Finnish adolescents with and without previous orthodontic treatment. The subjects, who were attending two schools preparing students for college, first filled in a questionnaire. Of the 340 subjects, 24.4% of the treated and 24.0% of the untreated expressed subjective orthodontic treatment need (NS). For the clinical examination, 110 subjects were systematically sampled from four groups; subjects who had received orthodontic treatment in the past and a) felt, b) did not feel subjective orthodontic treatment need and subjects who had not received orthodontic treatment in the past and c) felt, d) did not feel subjective orthodontic treatment need. A total of 106 subjects were examined by an orthodontist. Objective treatment need was assessed by using the Treatment Priority Index. Of those clinically examined, 29.4% of the treated subjects were still found to be in objective need of orthodontic treatment; among the untreated subjects, the corresponding figure was 54.5% (P < 0.05). The sensitivity of the orthodontist to detect treatment need felt by the adolescents was, among the treated, 40.0% and the specificity 75.0%. Among the untreated subjects the corresponding figures were 75.9% and 69.2%. Of those treated who had objective treatment need, 40.0% expressed the need themselves (NS). However, of the untreated who had objective treatment need, 73.3% expressed such a need (P < 0.001). Subjects judged to have a very attractive denial appearance (IOTN, Aesthetic Component) were more often detected among those treated than among the untreated. As a clear discrepancy can be observed between objective and subjective treatment need estimates, in orthodontic counseling an understanding of how the patient perceives his/her dentition is essential.     

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.     

Unmet orthodontic treatment need in rural Nigerian adolescents

Abstract A survey of orthodontic treatment need was carried out among randomly selected rural Nigerian adolescents using the index of orthodontic treatment need. Altogether, 704 subjects (381 boys and 323 girls) aged 12–18 years (mean 14.8, SD 1.79) were recruited in the study. The results indicated that 12.6% of the population were in objective need of orthodontic treatment. Whilst there was a discrepancy in the proportions of Nigerian adolescents needing orthodontic treatment on aesthetic and dental health grounds, girls were found to have a more attractive dental appearance and less orthodontic treatment need than boys. However, the differences were not statistically significant (P > 0.05). The correlation between the orthodontist's and the subject's rating of dental appearance was found to be low (r=0.35). The study also provided reliable baseline data for planning orthodontic services in Nigeria especially in areas where there are no dental services.     

Effect of oral hygiene education on children with and without subsequent orthodontic treatment

Abstract – The aim of the present investigation was to study whether an intense period of individual oral hygiene education would result in proper dental health behavior and to compare the effects of such education on 30 individuals undergoing subsequent orthodontic treatment and 30 controls without such treatment. The investigation consisted of two experimental periods: one period of oral hygiene education during which information on proper plaque control was given fortnightly for 6 weeks and one follow-up period of 30 months corresponding to the orthodontic treatment phase. The results suggest that it is possible to achieve and maintain a high standard of dental health behavior following an intense period of individual oral hygiene education. A certain deterioration of the gingival status was observed after 3 months in the orthodontically treated children. This was interpreted as being due to the influence of subgingivally located orthodontic bands. After 30 months a high level of oral hygiene and gingival status as well as a low caries activity were still apparent with only minor and insignificant differences between the children subject to orthodontic treatment and the controls.     

Inter- and intraexaminer variability in assessment of orthodontic treatment need

ABSTRACT Two examiners assessed subjectively the orthodontic treatment need of a group of 183 10-year-old children. The examiners did not standardize the criteria establishing treatment, need. Intraexaminer agreement was reached in 79.8 % of the cases. Intraexaminer agreement was 91.7 % for Examiner A and 93.4 % for Examiner B. The paper highlights the subjective element in deciding orthodontic treatment need.     

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.     

Perception of treatment need among orthodontic patients compared with professionals

The aim was to evaluate estimated need for orthodontic treatment, as judged from intraoral photographs, among orthodontic patients and professionals. Twenty consecutive prospective orthodontic patients, 20 consecutive orthodontically treated patients, 10 randomized general dentists, and 10 orthodontists participated. Seventy pairs of anonymous intraoral photographs of dentitions with varying degrees of objective treatment need were randomly arranged in a notebook. The general dentists and orthodontists rated orthodontic treatment need on a visual analog scale in a similar way among themselves and were more reserved than both patient categories, who also scored similarly among themselves. Professional raters also had similar inter- and intra-rater reliability among themselves, and it was higher than in either of the patient categories. Treatment providers appear to be more restrictive, consistent, and reliable in their judgement of orthodontic treatment need from intraoral photographs than the target group, patients positive toward orthodontic treatment.     

Caries incidence rates in Swedish adolescents and young adults with particular reference to adjacent approximal tooth surfaces: a methodological study

OBJECTIVES: The objective was to assess the dependence of the caries status of the adjacent approximal surface on the incidence of approximal caries. METHODS: At baseline, the material consisted of a cohort of 536 Swedish children. The individuals were followed through annual bitewing radiographs from the age of 11-13 to 21-22 years. A radiographic scoring system was used to assess the caries status of the surfaces: scores 0 and 1 = sound surface to score 4 = caries in the outer half of the dentine. A model was used to calculate the dependence of the caries status of adjacent approximal tooth surfaces. The unit of analysis was a pair of adjacent approximal surfaces and in all, 12 pairs of posterior approximal surfaces were analysed. RESULTS: The individual caries rates of the 24 posterior approximal surfaces ranged from 1.3 to 8.3 new caries lesions per 100 tooth surface-years. The caries rate of an approximal tooth surface depended on the caries status of the adjacent surface: a sound surface next to a sound surface had a relatively small risk of developing caries, while the risk increased 1.6-32.3 times if the adjacent surface was in a caries state as judged radiographically. The distal surface of the first molar developed caries more often than the mesial surface of the second molar. CONCLUSIONS: The caries rate of an approximal tooth surface was 1.6-32.3 times higher if the adjacent surface was in a caries state compared to when the latter was sound.     

Concern for dental appearance among Norwegian young adults in region with low uptake of orthodontic treatment

Abstract – The purpose of the present study was to examine orthodontic concern among orthodontically untreated young adults living in an area where the relative number of children receiving treatment was only 15–20% and to compare orthodontic concern among these individuals with that of untreated persons from an area with a higher treatment frequency. All the subjects were clinically examined and impressions for dental study casts, radiographs and photographs were taken. The subject's occlusion was classified according to two methods: 1) allocation to one of four groups according to the national Need for Orthodontic Treatment Index (NOTI), and 2) allocation to one of three groups according to presence or absence of six Anterior Occlusal Traits (AOT). Frequencies of NOTI scores demonstrated that in the study group more individuals were in need of treatment relative to the comparison group. Reported concern was at the same level in both groups, and significantly related to NOTI and AOT scores. The individuals in the area with the low treatment frequency were generally less aware of their anterior traits compared to the individuals in the area with a higher treatment frequency. The results indicated that a long-term low uptake of orthodontic treatment among children in the particular area was not accompanied by a similar increase in concern about own dental appearance in early adulthood.     

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.     

Dental aesthetics assessed against orthodontic treatment complexity and need in Nigerian patients with sickle-cell anemia

This study investigates the relationship between dental aesthetics and orthodontic treatment complexity and need in a group of patients with sickle-cell anemia (SCA) in Nigeria. The study sample consisted of 176 individuals — 77 (43.8%) male and 99 (56.3%) female subjects with SCA (aged 10 to 35 years) who were coming for routine medical care to two outpatient clinics. Dental aesthetics were assessed using the Standardized Continuum of Aesthetic Need component of the Index of Orthodontic Treatment Need. Treatment complexity and need were assessed according to the Index of Complexity, Outcome and Need and Dental Aesthetic Index. Both parametric and nonparametric statistics were employed in the data analysis. Significant positive relationships were found between dental aesthetics and orthodontic treatment complexity as well as treatment need according to both indices ( p = .000). The correlations of the scores for dental aesthetics and the objectively derived treatment complexity and need were significant ( p = .01). About 50% of the subjects had poor dental aesthetics and this correlated with their high orthodontic treatment complexity and need.     

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.     

Self-perceived orthodontic treatment need and culturally related differences among adolescents in Sweden

The aim of this investigation was to compare Swedish and immigrant groups of 12- and 13-year-old boys and girls with respect to: (1) self-perceived need for and attitude to orthodontic treatment, (2) attitude to own teeth and general appearance, (3) behaviour pattern and psychosocial functioning, and (4) self-perceived need for orthodontic treatment in relation to psychosocial functioning.The subjects comprised 508 students, aged 12 and 13 years, living in Sweden, who were grouped according to nationality: (A) both parents born in Sweden (139 girls and 131 boys); at least one parent born in: (B) eastern Europe (27 girls and 34 boys); (C) Asia (66 girls and 61 boys) and (D) other countries (23 girls and 27 boys). Each student answered a questionnaire in the classroom. The questions concerned demographic data, self-perceived treatment need, attitude to orthodontic treatment, own teeth and general appearance, behaviour pattern and psychosocial functioning.The results showed that, on average, 20 per cent of the students had a self-perceived treatment need, more girls than boys, 24 per cent of Swedes (A), 12 per cent from eastern Europe (B), 18 per cent from Asia (C) and 14 per cent from other countries (D). Seventy-two per cent of the Swedish students were prepared to undergo fixed appliance therapy, compared with 58 per cent of immigrant students. Nine per cent of the Swedish students considered their general appearance to be less favourable compared with 7 per cent of their peers (not significant). While some differences in behaviour pattern were observed, these did not seem to influence the well-being of the subjects.The conclusion is that perceived orthodontic treatment need is lower in immigrant students than in Swedish students.     

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.