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.     

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.     

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。     

A new Norwegian index of orthodontic treatment need related to orthodontic concern among 11-year-olds and their parents

A new index of orthodontic treatment need was introduced in Norway in 1990. On a morphologic and functional basis the four groups very great (A), great (B), obvious (C) and little/no (D) need were defined for social insurance refunding. The purpose of the present study was to investigate to what extent the new index corresponded with orthodontic concern among potential orthodontic patients and their parents. Of 104 randomly selected fourth grade children, 99 (48 girls, 51 boys, mean age 10.7 yr) presented themselves for clinical examination and interview. One parent was asked to accompany the child, and 93 parents attended. On the basis of clinical examination, morphologic measurements on study casts, and X-rays, the children were allocated to one of the four groups defined by the index. In separate questionnaires the children and the parents were asked to assess satisfaction with own/child's dental arrangement and desire for orthodontic treatment. The interview data were transformed into a composite measure representing orthodontic concern. The results indicated that orthodontic concern was significantly related to index group. For the individuals who expressed concern the new index seemed to be meaningful for allocation of public subsidies, as most individuals (85%) who expressed concern exhibited malocclusions fulfilling the criteria for receiving public subsidies of treatment costs. However, more than 50% of the individuals allocated to group B (great need) did not experience a need for treatment.     

壮族青年牙外观满意度及正畸治疗需要指数的调查研究

目的：通过对广西壮族青年行问卷调查确定牙外观满意度、测量牙科美学指数（DAI）确定正畸治疗需要量,从而为口腔卫生资源的合理配置提供参考依据。方法：随机抽取77名壮族青年行牙外观满意度问卷调查,制取石膏模型并测量DAI。结果：广西壮族青年具有较高的牙外观满意度（男性80．8％,女性70．6％）,较大的正畸治疗需要量（男性76．9％,女性84．3％）。错骀畸形的主观评价均不高于50％。壮族女青年（96．1％）较男青年（73．1％）更介意牙齿被染色。部分壮族青年更愿意通过牙齿美白提高牙外观（男性50．0％,女性74．5％）。结论：广西地区部分壮族青年未能客观地认识自身牙外观、对改善牙外观的治疗方式了解不足、正畸治疗需要量较大,应增大对该群体的口腔卫生资源调配及错胎畸形的防治力度。     

正畸治疗难度、结果、需要指数的相关研究

正畸治疗难度、结果、需要指数(ICON)是由9个国家的97位正畸学者共同研究制定的指数,并于2001年正式提出,旨在通过对患者及其模型进行评价,评价患者的治疗需要、治疗难度、治疗的改善程度及治疗结果的可接受度等。近年来ICON在欧美国家得到了广泛的采用,然而国内尚无相关研究报道。本文就近年来对ICON的研究进展作一综述,并探讨该指数在国内应用的研究方向。     

Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia

Abstract The prevalence of different malocclusion features was investigated in 500 14-yr-old male Saudi Arabian children, using a modification of the registration method described by Björk . et al. (3). Most of the children were in dental stage DS4 (all permanent teeth anterior to the first molars erupted). Totally 62.4% of the children had one or more malocclusion features related to dentition, occlusion, or space. The treatment need was evaluated according to the guidelines used in the Norwegian Health Service. About 40% were found to need treatment with fixed appliances, and for 33% extraction of permanent teeth would be part of the treatment. Only about 2.5% would benefit from treatment with simple removable appliances.     

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.     

正畸患者治疗难度、改善程度及客观治疗需要的评价

目的用正畸治疗难度、结果、需要指数（ICON）评价患者的治疗难度,客观治疗需要,以及治疗前后的改善程度。方法随机选取16岁以上的患者114例,用ICON评价治疗前的石膏模型,分析正畸治疗难度和客观治疗需要：随机选取矫治完成的患者20例,用ICON为治疗前后的模型评分,评价错[牙合]畸形的改善程度。结果正畸治疗难度方面,“容易”的占11．4％,“较容易”的占22．8％,“中等”的占18．4％,“困难”的占25．4％,“非常困难”的占22．0％;治疗需要方面,不需要的占28．9％,需要的占71．1％;改善程度方面,“很大”的占75．0％,“较大”的占20．0％,“中等程度”的占5．0％,“轻微改善”和“没有改善或更糟”者均为0例。结论近一半的正畸患者治疗难度较大;就诊的患者中有过度治疗现象;绝大部分患者能得到满意的治疗效果。     

正畸治疗需要客观评价指标指数的研究进展

错畸形包括从个别正常到严重影响口腔功能的错,要评价一个个体是否需要正畸治疗是非常困难的,它不仅取决于个体错畸形严重程度,还受到个体主观愿望的影响。本文对正畸治疗需要的客观评价指标指数的研究进展进行了综述。     

Socio-economic status and orthodontic treatment need

Abstract– Objectives: This study aimed to examine the relationship between socio-economic status and both normatively assessed and self perceived need for orthodontic treatment. Methods: More than six thousand 14-year-old children were assessed for orthodontic treatment by trained and calibrated examiners. The Index of Orthodontic Treatment Need was the measuring instrument along with a questionnaire which asked: “Do you think your teeth need straightening?”Results: Normative need for orthodontic treatment (IOTN > 3) was more common amongst deprived children than among their affluent counterparts. The same was found for perceived need. However, the children who wanted treatment were not necessarily those who needed it and vice versa. Conclusions: Socio-economic status affects normatively measured orthodontic treatment need through, as yet, undefined mechanisms. It also affects a person's perception of need for orthodontic treatment, but these two associations are separate. The mismatch of need and desire for treatment is a problem for orthodontists.     

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.     

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.     

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.     

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.     

Malocclusion and orthodontic treatment need of 15–74-year-old Dutch adults

In 1986 a nationwide dental survey was performed in the Netherlands. This article describes the prevalence of dentofacial anomalies in the age group 15-74 yr, as well as the subjective and objective need for orthodontic treatment. The main findings were: severe crowding in the mandible was found in approximately 15%; an Angle Class II situation was seen in 28%; a maxillary overjet of greater than 5 mm was found in 23%; orthodontic treatment had or was being performed in approximately 25%; 45% of orthodontic treatment was carried out by a general practitioner; using professionally defined need, 39% of the population required treatment whereas only 14% of the people felt that this treatment was necessary.     

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.     

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.     

Orthodontic need of treatment of Swedish schoolchildren from objective and subjective aspects

abstract – Of 5,459 schoolchildren in the town of Umeå, Sweden 26.2 % were regarded as not being in need of orthodontic treatment. As judged according to a four-grade scale the need was objectively little in 29.4 % of the children, moderate in 33.6 % and strong for 10.8 %. Of the children with objective need of treatment, 21.2 % were not interested in orthodontic treatment. In 939 children referred from the district of Västerbotten the need of treatment was little in only 3.2 %, while strong in 52.3 %, and very strong in 6.3 %. Only 47.8 % of the children were interested in orthodontic treatment.