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.     

上海地区青少年正畸治疗需要的调查研究

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

基于牙美学指数对青年人群正畸需要的评估

目的：使用牙美学指数评估青年人群的正畸需要,并分析牙外观自我评估值同牙美学指数分值之间的关系。方法：358名大学生参加了牙美学指数检查,同时每位被调查者使用视觉模拟量表对牙外观进行自我评估。对牙美学指数分值和牙外观自我评估进行简单线性相关分析,并基于牙美学指数分组对牙外观自我评估进行秩合检验。结果：37.7%的被调查对象牙美学指数分值≥31,属于需要正畸治疗人群。牙美学指数与牙外观自我评估间呈中度负相关（P〈0.001）,基于牙美学指数分组对牙外观自我评估进行秩合检验表明4组间得分差异有统计学意义（P〈0.001）。结论：本样本中,37.7%的被调查对象需要正畸治疗;牙美学指数与牙外观自我评估呈反向关系。表明牙美学指数可用于青年人群口腔健康相关生活质量的相关研究。     

Malocclusion and orthodontic treatment need of handicapped individuals in South Canara,India

AIMS: To estimate the prevalence and the severity of malocclusion and treatment need for 329 handicapped individuals. SUBJECTS AND SETTING: 329 handicapped individuals aged 11-30 years, attending eight different nonresidential special schools of South Canara, India. METHOD: Examination and recording using the Dental Aesthetic Index (DAI). RESULTS: 53% had a dental appearance which required no orthodontic treatment, 24% had a definite malocclusion, where treatment was 'elective' and treatment for a further 12% was considered to be 'highly desirable'. The remaining subjects (11%) had a handicapping malocclusion where treatment was considered mandatory. CONCLUSIONS: The prevalence of definite and severe malocclusions was higher in the mentally subnormal individuals when compared to other handicapping conditions. Orthodontic services for the handicapped have generally been neglected.     

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.     

Relative esthetic importance of orthodontic and color abnormalities

OBJECTIVE: To assess the relative importance of an orthodontic esthetic index, dental fluorosis and nonfluoride opacities, with respect to parents' satisfaction with their children's dental esthetics. MATERIALS AND METHODS: Dental examinations of Iowa Fluoride Study participants assessed fluorosis and nonfluoride opacities in the mixed dentition. Dental casts of 200 randomly selected subjects were scored using the Dental Aesthetic Index (DAI) criteria. Parent satisfaction was assessed via multiple items on a questionnaire. Associations were evaluated using logistic regression. RESULTS: Nineteen percent of parents were somewhat or very dissatisfied with their children's dental esthetics. Overall DAI score was positively associated with dissatisfaction (P < .001), as was fluorosis (P = .003). CONCLUSIONS: In addition to changes related to DAI scores, parent esthetic satisfaction decreased with the presence of fluorosis. Dental professionals should address both the issues of tooth positioning and color aberration with respect to dental esthetics.     

Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria.

The main purpose of this study was to analyze the current psychosocial implications of malocclusion in Ibadan, Nigeria. The study sample comprised 614 secondary school children (327 males and 287 females) aged 12-18 years (mean age, 14.9 +/- 2.9 SD) who filled in a questionnaire containing general questions about body image and specific inquires concerning self-perception and social implications of dental appearance. The children's occlusions were also assessed using the Dental Aesthetic Index (DAI) and the malocclusion traits related to body image, self-perception, and social implications of dental appearance. Subjects with malocclusion rated only the teeth significantly least satisfactory among other twelve items of body image. The lowest rating was observed in subjects with crowding of the maxillary and mandibular incisor segments. Highly significant differences (P < 0.001) were found between subjects with normal or minor malocclusion and those with marked malocclusion in indicating awareness of malocclusion, dissatisfaction with the appearance of the teeth, and unfavourable appearance of the teeth compared with those of peers. Schoolmates' teasing occurred significantly more often in the presence of malocclusion (P < 0.001). Unfavourable perceptions of the teeth were expressed significantly more often by subjects with anterior maxillary irregularities of up to 1 mm and more, spacing of both maxillary and mandibular incisor segments, midline diastema, crowding (especially of the mandibular incisor segment), anterior open bite and molar relation deviations. It was concluded that certain malocclusions, especially occlusal and space anomalies, may adversely affect body image and self-concept of Nigerian adolescents.     

Reliability and validity of the Dental Satisfaction Questionnaire in a population of 23-year-olds in Norway

OBJECTIVE: The aim of this study was to explore the internal structure, reliability, and construct validity of the Dental Satisfaction Questionnaire (DSQ) in a population of young adults in Norway. METHODS: The DSQ scale was mailed to a representative sample of 968 subjects aged 23 years in two Norwegian counties. The reliability assessment of the instrument was based on internal consistency analysis (Cronbach's alpha). A factor analysis (principal component) was used to confirm the internal structure of the scale. The construct validity of the DSQ was indicated by: (i) its correlation with the patients' beliefs regarding the way dentists deliver care, indexed by the Dental Beliefs Survey (DBS); and (ii) differences in DSQ scores between subjects who had dropped out from dental care at the age of 23 years and regular attenders. RESULTS: The response rate was 69%. The alpha (Cronbach's) coefficient for the overall construct of DSQ was 0.81 (n = 655), and 0.65 or more for the subscales pain management, quality, and access. The correlation coefficient between the sum-scores of DSQ and DBS for the entire sample was r = -0.69. Subjects in the dropout group had significantly lower satisfaction with dental care than the rest of the group (P < 0.001). CONCLUSIONS: This study generally confirms the structure of the DSQ instrument and indicates that it is a reliable and valid instrument in cultures other than the one for which it was previously tested.     

Malocclusion and treatment need in children and adolescents with sickle cell disease

Objective:To assess the prevalence of malocclusion and treatment need in children and adolescents with sickle cell disease (SCD).Materials and Methods:In this cross-sectional study, the sample size comprised 35 five-year-old children and 36 adolescents of both sexes, aged between 12 to 18 years, with SCD. Dental occlusion was assessed using two indexes: the Malocclusion Index (World Health Organization) and the Dental Aesthetic Index (DAI).Results:The prevalence of malocclusion in the preschool children was 62.9%. The main malocclusions observed in this age group were Class II (37.1%), increased overjet (28.6%), reduced overbite (28.6%), and open bite (17.1%). In the 12- to 18-year-old subjects, the prevalence of malocclusion was 100%, and the most prevalent types of malocclusion were maxillary overjet (63.9%) and maxillary misalignment (58.3%). It is noteworthy that the majority of adolescents (80.6%) had very severe or disabling malocclusions.Conclusion:The results revealed a high prevalence of malocclusion in children and adolescents with SCD. According to DAI score, the majority of the sample presented with very severe malocclusion and a compulsory treatment need.     

Assessing malocclusion--the time factor.

Abstract

Assessment of occlusal status for orthodontic purposes may be undertaken by subjective assessment or by means of an index of occlusion. The assessment method should be reproducible and should achieve the intended outcomes. This study investigated another possible modifying factor--performance over time. Photographs and dental casts of 45 subjects at 12 years of age were compared with follow-up records at 16 years of age. No orthodontic intervention had occurred during the 4 years. Subjective severity assessments and Aesthetic Component (AC) scores of the Index of Treatment Need (IOTN) for first and second series records were made by four orthodontists. Scores of the Dental Aesthetic Index (DAI) and Dental Health Component (DHC) of the IOTN were made by one of the authors. Implications for hypothetical decisions to treat were considered. There was a significant reduction in the subjective severity and DAI scores across the whole sample and in the mixed dentition subgroup. There was a non-significant reduction in the AC (IOTN) scores across the whole samples, but there was a significant reduction in the AC (IOTN) scores in the mixed dentition subgroup. The DHC (IOTN) categorisations proved to be more stable over the period of study.     

Mediation and moderation effect of the big five personality traits on the relationship between self-perceived malocclusion and psychosocial impact of dental esthetics

Objective:To explore the mediation and moderation effects of personality traits on the relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics.Materials and Methods:The sample included 252 subjects (62% female) aged 12–39 years. Self-perceived malocclusion was estimated using the 10-point scale Aesthetic Component of the Index of Orthodontic Treatment Need. The Psychosocial Impact of Dental Aesthetics Questionnaire was used to assess the psychological impact and the Big Five Inventory for personality traits. Moderation and mediation effects were evaluated with Pearson correlations and stepwise regression analysis, respectively.Results:Self-perceived malocclusion ranged from 1 to 8 and was the most significant predictor of psychosocial impact of dental esthetics, whose unique contribution accounted for 11%–36.4% of variability, while age and sex accounted for 1.2%–2.5%. Personality traits had no mediating effect on this relationship. The moderating effect of agreeableness was present in the relationship between self-perceived degree of malocclusion and Social Impact (SI), Psychological Impact (PI), and Aesthetic Concern (AC) (ΔR2  =  0.035, 0.020, and 0.013, respectively; P < .001), while conscientiousness affected the relationship between perception of malocclusion and SI and PI (ΔR2  =  0.018 and 0.016, respectively; P < .05). In people with lower agreeableness and conscientiousness, increasing the severity of self-perceived malocclusion leads to less increase in SI and PI. In people with lower agreeableness, the increase influences AC in a similar manner. Extraversion, neuroticism, and openness do not have a moderating effect.Conclusions:The relationship between self-perceived malocclusion and the psychosocial impact of dental esthetics appears to be moderated and not mediated by personality traits. Adolescents and young adults with lower agreeableness and conscientiousness seem to be less affected by the increased severity of self-perceived malocclusion, as demonstrated in reporting some psychosocial impacts.     

Potential application of the dental aesthetic index to prioritize the orthodontic service needs in a publicly funded dental program.

Resources for publicly funded dental programs may never be sufficient to accommodate unlimited orthodontic service demands. There is therefore an obligation to ensure that they are preferentially provided to those patients most likely to derive the greatest benefits. To address this strategic concern, the pretreatment records of 38 patients were prioritized on a visual-analog scale relative to their differential orthodontic service needs by 16 independent orthodontic specialists. Unfortunately, inconsistencies in these assessments were unacceptable for a publicly funded program. When these same records were prioritized relative to their scores derived from the Dental Aesthetic Index, their assessments proved more consistent, especially when based on a modified Dental Aesthetic Index. The relevance of such Dental Aesthetic Index scores proved controversial, because the need for orthodontic services is dependent on other factors in addition to esthetics. The lack of established clinical guidelines to delineate the most appropriate service and timing for specific occlusal discrepancies further hampers the prioritization of orthodontic service needs. Dental Aesthetic Index case-scores may therefore be considered as just 1 of many criteria to prioritize orthodontic service needs, although the potential impact of the others has yet to be quantified.     

Validation of an Indian (Kannada) translation of the Family Impact Scale questionnaire and the impact of malocclusion on the families of adolescent school children

Objectives: The objectives of this study were to validate an Indian translation of the Family Impact Scale (FIS) questionnaire and assess the impact of malocclusion on the families of adolescent school children between 12 and 15 years old across socio-economic strata (SES). Materials and methods: The sample consisted of 768 school children aged between 12 and 15 years from randomly selected schools in Udupi district. The FIS and informed consent forms were sent through the children to be completed by their parents. Information was collected on socio-demographic details, past dental visit in the last year, type of school and SES. Clinical examination for malocclusion using the Dental Aesthetic Index was conducted by a single trained and calibrated examiner. Results: The prevalence of malocclusion was 59.9%. The intra-class correlation for the total FIS score of 0.95 and Cronbach’s alpha value of 0.88 demonstrated internal consistency. There was a significant difference in the overall and subscale scores of FIS between parents of children with and without malocclusion (P < 0.001). Parents of children who had malocclusion had significantly higher FIS scores across all SES (P < 0.001). Parents of children with malocclusion had 1.86 (P < 0.001, 95% CI = 1.60−2.17) times higher FIS scores than parents of children without malocclusion after adjusting for age, gender, SES, and past dental visits in the last year. Conclusion: The psychometric properties of the FIS were found satisfactory for assessing the effect of a child’s oral condition on his/her family. Malocclusion in children had a significant negative influence on the family impact scores.Key words: Family, impact, malocclusion, oral health, quality of life     

深圳市成人牙科畏惧症患者的口腔健康相关生活质量研究

目的：研究牙科畏惧症（DF）患者的口腔健康相关生活质量。方法：选择在深圳市第五人民医院口腔科门诊就诊的358名18～75岁初诊患者,应用口腔焦虑量表（CDAS）和口腔健康影响程度量表（OHIP-14中文版）、人口统计学一般项目表进行调查。结果：DF患者的OHIP-14的分值中位数为21.25,明显高于一般就诊患者（中位数11.20）。且在生理性疼痛、心理不适和心理障碍等领域影响最大。CDAS与OHIP-14分值间的相关系数为0.255。结论：在牙科畏惧症患者中,牙科畏惧程度与口腔健康影响程度之间存在相关性,焦虑程度越高的患者口腔健康相关生活质量越差。对牙科畏惧症患者进行有效的心理干预可以提高其相关生活质量。     

Orthodontic treatment needs: comparison of two indices.

The Index of Orthodontic Treatment Needs (IOTN) and the Dental Aesthetic Index (DAI) were developed and both claimed to contain the aesthetic and dental components in their criteria of assessing malocclusion. This study was undertaken to assess the reliability of these two indices in assessing orthodontic treatment needs. The indices were applied to 120 pre-treatment study models selected from orthodontic patient records treated at the Department of Orthodontics, University of North Carolina, United States of America. The sample consisted of 60 African-Americans (Black) and 60 American Caucasians (White), age ranged from 12 to 16 years (Mean 13.8). The results showed that the IOTN and the DAI were highly correlated and highly associated statistically (p < 0.0001). The findings of this study indicated that the two indices could be used consistently to identify orthodontic treatment needs in different ethnic groups and are capable of classifying the subjects according to their malocclusion severity for those subjects eligible for treatment in fund constrained situation.     

Dental anxiety and dental avoidance among 12 to 18 year olds in Norway

The aim of this study was to explore the prevalence and possible explanatory factors of dental avoidance due to dental anxiety among 12 to 18 year olds treated within the Norwegian Public Dental Service. A total of 754 20-yr-olds completed a questionnaire and three psychometric scales, the Dental Fear Scale (DFS), the Dental Beliefs Survey (DBS) and the Geer Fear Scale (GFS), and gave their consent to collect data from their dental records. A total of 169 subjects (22.4%) had high dental anxiety (DFS>59 or DBS>47 at age 20 yr), and 124 subjects (16.4%) had high frequency of missed/cancelled appointments (20% or more) during the period 12-18 yr. Forty-seven subjects (6.2%) fulfilling both of the above criteria constituted the dental avoidance group. An analysis using a stepwise regression model indicated that having had more than one painful or unpleasant treatment experience increased the risk of being included in the avoidance group by a factor of 10.9. Equally, adolescents who were not attending school (working or without specified occupation) increased the risk by a factor of 6.9, having a high caries experience by a factor of 5.0, and not having their dental treatment completed at the age of 18 yr by a factor of 4.4.     

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.     

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.     

Reliability and validity of a faces version of the Modified Child Dental Anxiety Scale

BACKGROUND: A new version of the Modified Child Dental Anxiety Scale (MCDAS) was formed by adding a faces rating scale to the original numeric form. AIMS: To describe the psychometric properties of the faces version of the Modified Child Dental Anxiety Scale (MCDAS(f)), and to provide normative data for dental anxiety for children using the MCDAS(f). DESIGN: To determine the test-retest reliability, 287 schoolchildren aged 8-10 years completed the MCDAS(f) on two separate occasions 17 weeks apart. To determine the criterion validity, 207 schoolchildren aged 10-12 years completed the MCDAS(f) and the CFSS-DS at the same sitting. Construct validity was assessed using a cohort of 206 consecutive child dental patients and their parents. RESULTS: The MCDAS(f) showed good test-retest reliability (intraclass correlation coefficient = 0.80) and internal consistency (Cronbach's alpha = 0.82). The MCDAS(f) significantly correlated with the CFSS-DS (r = 0.80, P < 0.001). Dental anxiety assessed using the MCDAS(f) was related to the dmft (t = -2.17, P = 0.03), DMFT (t = -4.19, P < 0.001), and dental general anaesthetic experience (t = -4.46, P < 0.01). The mean MCDAS(f) score for the normative sample (n = 475) was 19.81 (95% CI: 19.20, 20.43). CONCLUSIONS: The MCDAS(f) is a reliable and valid measure of dental anxiety in children aged 8-12 years.     

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.