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.     

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.     

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.     

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.     

Objective,Subjective, and Self‐Assessment of Preadolescent Orthodontic Treatment Need – A Function of Age,Gender, and Ethnic/Racial Background?

Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment. Objectives: To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES). Methods: Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need. Results: Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions. Conclusions: Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.     

Orthodontic treatment need and demand in Senegalese school children aged 12-13 years. An appraisal using IOTN and ICON

OBJECTIVE: To assess the normative need, knowledge of, and demand for orthodontic treatment in Senegalese schoolchildren aged 12-13 years. MATERIALS AND METHODS: The sample consisted of 665 Senegalese schoolchildren randomly selected from different ethnic and socioeconomic backgrounds. The normative orthodontic treatment need was assessed using the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and the Index of Complexity, Outcome, and Need (ICON). Knowledge of and demand for orthodontic treatment were assessed with a questionnaire. RESULTS: The DHC and the AC of the IOTN and the ICON classified respectively 42.6%, 8.7%, and 44.1% of the children as having a definite need for orthodontic treatment. There were no ethnic or gender differences with respect to normative orthodontic treatment need. The mean ICON score ranged from 42.31 to 44.46 according to the ethnic group. Only 10% of the children had some knowledge of orthodontics. However, between 17% and 30% of the children clearly expressed a need for orthodontic treatment, and the distribution between ethnic groups was significant. In contrast, there were no significant gender differences concerning this demand for treatment. CONCLUSIONS: The present study shows that the need for orthodontic treatment far exceeds the actual available supply.     

A sociodental approach to assessing dental needs of children: concept and models

OBJECTIVES: Traditional normative methods of assessing dental needs do not correspond to current concepts of 'health' and 'need'. Although there is dental research on quality of life, evidence-based practice, and oral behaviours, those concepts are rarely applied to dental needs estimation. Dental needs are usually calculated mainly from clinical data and are likely to be inaccurate. A structured comprehensive method for assessing dental needs is required. The objectives of this study are to develop and test a new sociodental system of needs assessment for overall dental needs of primary schoolchildren. Furthermore, normative and sociodental estimates of need are compared. DESIGN: The study developed a theoretical framework and pathway algorithms of sociodental needs assessment and applied them to assessing overall dental needs. Normative dental needs were assessed using standard normative criteria. The child oral impacts on daily performances (Child-OIDP) was used to assess oral impacts, and a self-administered questionnaire was used to obtain information on demographic variables and oral behaviours. Data were analysed according to the developed algorithms. SETTING: A cross-sectional survey in Suphanburi Province, Thailand. PARTICIPANTS: All 1,126 children aged 11-12 years in a town. MAIN RESULTS: The sociodental approach was acceptable and not costly. In all, 54.4% had normative need under the dental needs model for life-threatening and progressive conditions, but only 16.6% had high propensity-related need; the remaining 37.8% would require dental health education or oral health promotion (DHE/OHP) or both and appropriately adjusted clinical interventions. Under the basic model of dental needs, 45.1% had normative need. Two-thirds of them (30.9%) had impact-related need and the remaining 14.2% did not have oral impacts and therefore should only receive dental health education. Only one-third of those with impact-related need had high propensity and were suitable for evidence-based conventional treatments; the remaining two-thirds should receive DHE/OHP and alternative clinical interventions. CONCLUSIONS: A sociodental system of dental needs assessment was developed and tested on school children. It decreased the estimates of conventionally assessed dental treatment needs and introduced a broader approach to care.     

Orthodontic treatment needs in Caribbean dental clinics

This study was undertaken to determine the normative and perceived orthodontic treatment need of patients in Trinidad, a Caribbean island. The study sample comprised 30 child dental health clinic patients, 30 of their accompanying parents, and 52 adult patients from other University of the West Indies clinics and the Dental Hospital in Mount Hope, Trinidad. Two clinicians used the Dental Health Component of the Index of Orthodontic Treatment Need (IOTN) to assess normative need, and the patient's perceived needs were assessed using the Aesthetic Component (AC) of the IOTN and the Oral Aesthetic Subjective Impact Scale (OASIS). Fisher's exact test was used to determine the differences between the subgroups of the sample for both normative and perceptive treatment need. Association between normative need and perception assessment measures was tested using Spearman's correlation coefficient. Two-thirds of the sample of 112 subjects were female and each subgroup had a similar gender distribution. The results also indicate that approximately four out of five Trinidadians have a great (or very great) orthodontic treatment need. The perception of orthodontic treatment need differed significantly (P < 0.05) from normative need in this sample and this was seen more clearly when the OASIS was used.     

Oral Health-Related Quality of Life (OHQoL) among Adolescents Seeking Orthodontic Treatment

Aim: The aim of this study was to assess the effect of different orthodontic treatment needs on the OHQoL of adolescents. Materials and methods: 200 subjects (100 males and 100 females), 11 to 15 years of age were recruited for the study. OHQoL was assessed with the short form of the oral health impact profile (OHIP-14), and malocclusion severity was assessed with the index of orthodontic treatment need (IOTN). The Chi-square test was used to analyse the qualitative data. The level of significance was 0.05. Results: The more severe the malocclusion the worse was the impact on the OHQoL. Orthodontic treatment need had almost similar impact on the daily activities of both males and females. Pronunciation and taste was not significantly affected by the need for orthodontic treatment in either males or females. The proportions of orthodontic patients who found it uncomfortable to eat any food and had to interrupt their meals were significantly correlated with orthodontic treatment needs in both males and females. Conclusion: Orthodontic treatment need had an impact on OHQoL of adolescents with no significant difference between males and females. Clinical significance: Orthodontists should be aware of the impact caused by malocclusion and orthodontic treatment on the quality of life of the patients and should provide regular positive reinforcements to them. Keywords: Oral health-related qualtiy of life, Orthodontic treatment need, Malocclusion. How to cite this article: Manjith CM, Karnam SK, Manglam S, Praveen MN, Mathur A. Oral Health-Related Quality of Life (OHQoL) among Adolescents Seeking Orthodontic Treatment. J Contemp Dent Pract 2012;13(3):294-298. Source of support: Nil Conflict of interest: None declared.     

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.     

Preventing and treating white-spot lesions associated with orthodontic treatment: a survey of general dentists and orthodontists

BackgroundThe authors investigated the prevention and treatment of white-spot lesions (WSLs) during and after orthodontic therapy from the perspective of general dentists and orthodontists.MethodsThe authors administered a cross-sectional survey to general dentists (n = 191) and orthodontists (n = 305) in Virginia, Maryland and North Carolina.ResultsSixty-nine percent of general dentists and 76 percent of orthodontists recommended in-office fluoride treatment for patients with severe WSLs immediately after orthodontic treatment. Sixty-nine percent of general dentists reported that they had treated WSLs during the previous year, and 37 percent of orthodontists reported that they had removed braces because of patients' poor oral hygiene. Sixty percent of orthodontists referred patients with WSLs to general dentists for treatment. Eighty-five percent of orthodontists responded that they encouraged patients to use a fluoride rinse as a preventive measure. More than one-third of general dentists indicated that severe WSLs after orthodontic treatment could have a negative effect on their perception of the treating orthodontist.ConclusionsWSLs are a common complication of orthodontic treatment and their presence can result in a negative perception of the treating orthodontist by the patient's general dentist.Clinical implicationsGeneral dentists and orthodontists should work together to prevent the development of WSLs in their patients. Treatment with fluoride supplements and motivating and training patients to practice good oral hygiene will help achieve this goal. Treatment after debonding should include the topical application of low concentrations of fluoride.     

Comparison of treatment result and compliance between private practice Medicaid and non-Medicaid orthodontic patients--a brief communication

Treatment result and compliance for orthodontic Medicaid patients were assessed and compared to non-Medicaid patients of similar initial severity. All 55 North Carolina practices providing orthodontic treatment covered by Medicaid were asked to submit their last five Medicaid cases and five non-Medicaid cases of similar initial treatment complexity Nine practices agreed to participate. Initial models, final models, and progress notes were obtained for all subjects. Casts were scored using the Peer Assessment Rating (PAR) Index to assess initial and posttreatment orthodontic status, and progress notes were reviewed for compliance data. No clinically important differences were seen between the Medicaid and non-Medicaid groups with respect to initial PAR, final PAR, percent PAR reduction, broken appointments, broken appliances, or poor oral hygiene. In this study, Medicaid and non-Medicaid patients did not differ substantially with respect to effectiveness of treatment received or their compliance with treatment.     

The seven-year outcome of an early orthodontic treatment strategy

The benefits of early orthodontic treatment are continuously discussed, but studies are few. We examined whether definite need for orthodontic treatment could be eliminated in public health care by systematically focusing on early intervention. One age cohort living in a rural Finnish municipality (N = 85) was regularly followed from ages 8 to 15 years, and persons with malocclusions were treated according to a pre-planned protocol. Treatment need was assessed according to the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need, and treatment outcome by the Peer Assessment Rating Index (PAR). Fifty-two percent of the cohort received treatment, and definite treatment need decreased from 33% to 9%. In the treated group, the mean PAR score reduction was 63%, and 51% showed more than 70% improvement. The results suggest that an early treatment strategy may considerably reduce the need for orthodontic treatment in public health care with limited specialist resources.     

The provision and outcome of orthodontic services in a Norwegian community: a longitudinal cohort study

In a systematic child dental care system, professionals, consumers, and purchasers have a common interest in ensuring that provision and outcome of orthodontic care fulfill the goals of the service and the public's expectations. The purpose of this prospective study was to examine whether treatment was in fact provided to children with a normative treatment need, and also to assess the outcome of treatment. The baseline data were established for a sample of 83 11-year-olds before decisions about orthodontic treatment had been made, by recording the individuals' orthodontic concern as reported in questionnaires and their occlusal condition according to an index of orthodontic treatment need (NOTI). At re-examination at the age of 16 years, it was also recorded whether the individual had received orthodontic treatment. Most individuals (83%) with a normative need had been treated as well as some individuals without need but who had expressed orthodontic concern. Treatment had resulted in occlusal improvement ('health gain') in most patients, and generally this improvement paralleled a decrease in concern. The goals of the orthodontic service seem to have been fulfilled to the extent that residual treatment need was infrequent. The high treatment rate (63%) and standard may explain why all individuals, both treated and untreated, expressed satisfaction with their dental appearance at 16 years of age.     

Correlation between oral health-related quality of life and orthodontic treatment need in children and adolescents—a prospective interdisciplinary multicentre cohort study

Purpose

Oral health-related quality of life (OHRQoL) is a construct for assessing the self-perceived oral health of patients. The aim of this study was to investigate the correlation between OHRQoL and orthodontic treatment need in consideration of demographic and psychological factors.

Patients and methods

This multicentre study included 250 patients with an indication for orthodontic diagnostics. In cooperation with the Institute of Clinical Psychology at the University of Würzburg, validated and internationally acknowledged questionnaires were selected to assess OHRQoL (COHIP-G19) and health-related quality of life (HRQOL). Self-esteem and behavioural problems were taken into consideration as possible psychological factors. Orthodontic treatment need was assessed using the Index of Orthodontic Treatment Need—Dental Health Component (IOTN-DHC), the Index of Orthodontic Treatment Need—Aesthetic Component (IOTN-AC) and the Dental Aesthetic Index (DAI). Possible significant correlations between the collected parameters and OHRQoL were evaluated by means of linear regression analysis.

Results

Objective orthodontic treatment need (IOTN-DHC and DAI) was significantly correlated with OHRQoL. Further factors significantly influencing OHRQoL in children and adolescents were age, HRQOL, self-esteem and behavioural problems.

Conclusions

Objective orthodontic treatment need significantly influences OHRQoL in children and adolescents. Further studies are required to investigate if OHRQoL may be improved by correcting misaligned teeth and jaws.

     

Orthodontic treatment need in a 12-year-old population in the Western Sahara

The aim of this study was to establish orthodontic treatment need according to the Dental Aesthetic Index (DAI) and Aesthetic Component (AC) and Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and to determine its association with gender among Saharan schoolchildren. The study was carried out in accordance with World Health Organization (WHO) recommendations for oral health surveys at 12 years of age. The sample comprised 248 Sahrawi children (135 girls and 113 boys) living in refugee camps in Tindouf, Algeria. None of the children had previously received any orthodontic treatment. A chi-square test was used to analyse the IOTN results by gender, and a Student's t-test was employed for the DAI results. The mean DAI was 23.32 with a standard deviation of 6.05, 4 percent with a very severe and 9.2 per cent with severe malocclusion. Orthodontic treatment need was 16.1 and 2.0 percent, respectively, according to grades 4 and 5 of the IOTN DHC, 13.7 percent according to the IOTN AC, and 28.6 percent according to the modified IOTN (IOTN DHC grades 4-5 and/or IOTN AC grades 8-10). There were no statistically significant differences by gender. The orthodontic treatment need of Western Saharan schoolchildren is similar to that reported by many recent studies in European and in Sub-Saharan countries.     

The relationship between patient, parent and clinician perceived need and normative orthodontic treatment need

The aim of the present study was to compare patient, parent and clinician perceived need for orthodontic treatment in relation to normative orthodontic treatment need as measured by the Index of Orthodontic Treatment Need (IOTN). A prospective cross-sectional study was designed to address this aim. The sample comprised 103 patients attending the 'new' patient clinic at the Jordan University Hospital. The patients' mean age was 15.3 years (standard deviation 3.8 years); 33 per cent were males and 67 per cent females. One clinician scored the patients' normative orthodontic treatment need using the IOTN, then determined perceived need using a 10 cm visual analogue scale (VAS). The subjects then assessed their own perceived need and aesthetic component (AC) score and the parents carried out similar assessments for their children. All scoring was carried out blind. The parents had the highest average perceived need scores, followed by patient and clinician scores (6.6, 6.1 and 5.4 cm, respectively). A significant difference was found between the parents and the clinician (P < 0.05). When the relationship between perceived need and clinician-measured normative orthodontic treatment need was investigated, significant differences were found with the dental health component (DHC) for all three groups (P < 0.05). Differences between AC and perceived need scores were also significant for the patients and parents, but not for the clinician (P > 0.05). The present study has shown that perceptions of orthodontic treatment need are multifactorial and influenced by elements other than health measures of normative orthodontic treatment need and perceptions of 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.     

Normative and self-perceived orthodontic treatment need in Nigerian school children

Abstract

Objective. The aim of this study was to assess the normative and self-perceived need for orthodontic treatment in Nigerian children, and to evaluate distribution of orthodontic treatment need according to gender and age. Materials and methods. The sample consisted of 441 randomly selected school children, aged 11–18 years in Benin City, Nigeria. The subjects were further sub-grouped according to gender (229 males and 212 females) and age (246 11–13 years old and 195 14–18 years old). The Dental health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) were used to assess orthodontic treatment need normatively. Self-perceived need was evaluated by asking the subjects to rate their dental aesthetics on the Aesthetic Component scale of IOTN. Chi-square tests were used to evaluate gender and age differences in distribution of treatment need. Results. A definite need for orthodontic treatment was found among 21.5% (grades 4–5 of DHC) and 6.3% (grades 8–10 of AC) of the subjects; 3.9% of the subjects perceived a definite need for orthodontic treatment (grades 8–10 of AC). There were no statistically significant gender and age differences in distribution of orthodontic treatment need among the subjects (p > 0.05). Conclusion. The study revealed a need for orthodontic treatment in slightly more than one fifth (21.5%) of this sample of Nigerian children. The sample population has a lower need on aesthetic grounds and their normative and self-perceived orthodontic treatment needs were not influenced by gender and age.     

Agreement between normative and perceived orthodontic need amongst deprived multiethnic school children in London

The Index of Orthodontic Treatment Need (IOTN) has been used in dental epidemiology and to prioritize orthodontic treatment. The aim of this paper was to use the aesthetic component (AC) of the IOTN to measure agreement between normative and perceived orthodontic need amongst school children. Three hundred and seventy-eight children aged 11-14 years, enrolled in London UK state schools participated in this survey. The study focused on three ethnic groups: white, black and South Asian. Townsend deprivation scores suggested that the children were from areas of high socio-economic deprivation. Logistic regression analysis was carried out for agreement between normative and perceived need at each threshold value. Perceived need for braces, ethnic background, social class and hours of television viewing were significant variables. Black pupils were significantly less likely to concur on normative and perceived need scores, tending to perceive less need for treatment than did the dentist. Subjects from lower social classes were significantly more likely to concur on normative and perceived need scores. In conclusion, the study showed that using the IOTN AC at various points along the scale, different influences play a significant role in agreement/disagreement between normative and perceived needs, indicating that patient-clinician agreement regards orthodontic treatment is sensitive to several cultural factors.