Introduction
Our objective was to assess the effect of different orthodontic treatment needs on the oral health-related quality of life of young adults.
Methods
The study sample comprised 366 young adult orthodontic patients (153 men, 213 women; age range, 21-25 years). Each participant was assessed for orthodontic treatment need and oral health-related quality of life by using the dental health component of orthodontic treatment need index and the shortened version of oral health impact profile questionnaire.
Results
Orthodontic patients who had little or no, borderline, and actual need for orthodontic treatment represented 14.8%, 56%, and 29.2% of the total sample, respectively. Orthodontic treatment need significantly affected mouth aching, self-consciousness, tension, embarrassment, irritability, and life satisfaction in both sexes. Also, orthodontic treatment need significantly affected taste and relaxation in both men and women. However, pronunciation and the ability to do jobs or function effectively were not significantly associated with orthodontic treatment needs in either sex.
Conclusions
These findings emphasize the impact of malocclusion on oral health-related quality of life of young adults.
Traditionally, clinician-based outcome measures were more important for dental researchers than subjective patient-based measures such as perceived functional status and psychological well-being. However, patients and dentists differ in their evaluation of oral health and the perception of oral diseases. Recently, researchers and clinicians have focused more on patients’ own perceptions of oral health status and oral health care systems to understand their needs, satisfaction with treatment, and ultimately the perceived overall quality of health systems.
Oral diseases, including malocclusion, are highly prevalent, and the consequences are physical, economical, social, and psychological. They can impair the quality of life in many people and affect various aspects of life, including function, appearance, and interpersonal relationships. Therefore, considering the oral cavity as an autonomous landmark is now being questioned and more emphasis is placed on how the oral conditions affect health, well-being, and quality of life. According to the concept of oral health-related quality of life (OHRQOL), good oral health is no longer seen as the mere absence of oral diseases and dysfunction. OHRQOL encompasses the absence of negative impacts of oral conditions on social life and a positive sense of dentofacial self-confidence.
Understanding the physical, social, and psychological impact of malocclusion on OHRQOL needs more attention, since it sheds light on the effects of malocclusion on people’s lives and provides more understanding of the demand for orthodontic treatment beyond clinician parameters. In addition, since social and psychological effects are the key motives for seeking orthodontic treatment, OHRQOL can be considered the best measurement for orthodontic treatment need and outcome. Therefore, OHRQOL measurement is recommended for orthodontists to supplement clinical findings, since OHRQOL outcome does not necessarily correlate with such objective findings.
Several indexes were used to evaluate malocclusion. The index of orthodontic treatment need (IOTN) is a scoring system for malocclusion, developed by Brook and Shaw. It includes 2 independent components: the dental health component (DHC), a 5-grade index that records the dental health need for orthodontic treatment, and the esthetic component that records the esthetic need for orthodontic treatment. The IOTN has been used extensively in the literature to evaluate actual and perceptive orthodontic treatment needs. The DHC grades patients’ treatment needs either as no treatment need, little treatment need, borderline need, or treatment required.
The oral health impact profile (OHIP) is an extensively used instrument for the assessment of OHRQOL. The original version of the scale includes 49 items divided into 7 domains. A short form of the OHIP containing only 14 items (OHIP-14) has been developed. The OHIP is designed to determine the perception of the social impact of oral disorders and has well-documented psychometric properties.
The aim of this study was to assess the effect of different orthodontic treatment needs on the OHRQOL of young adults.
Material and methods
A cross-sectional study was conducted of orthodontic patients to assess the relationship between orthodontic treatment needs assessed by the DHC of the IOTN and OHRQOL assessed by the OHIP-14 questionnaire.
A consecutive sample of young adults seeking orthodontic treatment at the Faculty of Dentistry, King Abdulaziz University, were recruited in the study according to the order of registration on the waiting list. Patients who had a perceived need for orthodontic treatment and who were about to undergo orthodontic therapy were included. Exclusion criteria were chronic medical conditions, previous orthodontic treatment, craniofacial anomalies such as cleft lip and palate, untreated dental caries, and poor periodontal health status as indicated by a community periodontal index score of 3 or more. This was to prevent possible confounding effects of these conditions on the participants’ quality of life. After screening, the sample comprised 366 orthodontic patients (153 men, 213 women) from 21 to 25 years of age who were willing to participate in the study.
Ethical approval was obtained at the beginning of the study. The participants were informed about the examination procedures and were assured of the confidentiality of the collected information. Only those who gave consent were included in the research.
Each patient was examined for orthodontic treatment need with the DHC of the IOTN. Examiners were calibrated to use it (kappa, 8.5). Treatment needs of the patients were categorized as (1) little or no treatment need, (2) borderline need, and (3) treatment required. The DHC uses a simple ruler and an acronym—MOCDO (missing teeth, overjet, crossbite, displacements of contact points, overbite)—to identify the most severe occlusal trait for each patient. The final overall score was given to the patient according to the most severe trait.
The data collection instrument for assessment of OHRQOL was the OHIP-14 questionnaire. The questionnaires were administered by the examiners before the clinical examination. Each patient was asked about the frequency that he or she experienced an impact on 14 daily activities. Responses were made on a 5-point Lickert-type scale (never, hardly ever, occasionally, fairly often, and very often). A threshold of occasionally, fairly often, and very often was used to dichotomize responses, thereby indicating participants who had experienced at least some oral health impact.
The daily activities were the following: had problems pronouncing words, felt that the sense of taste worsened, had painful aching in the mouth, found it uncomfortable to eat any food, have been self-conscious, felt tense, had an unsatisfactory diet, had to interrupt meals, found it difficult to relax, have been a bit embarrassed, have been irritable with other people, had difficulty doing useful jobs, felt that life in general was less satisfactory, and have been totally unable to function.
Statistical analysis
Data presentation and statistical analysis were performed with the SPSS statistical package (version 13, SPSS, Chicago, Ill). The chi-square test was used to analyze the qualitative data. The level of significance was 0.05.
Results
Table I shows that men and women were 41.8% and 58.2% of our sample, respectively. The mean age of the total sample was 23 years. In this study, patients who had little or no, borderline, and need for orthodontic treatment were 14.8%, 56%, and 29.2%, respectively. The corresponding percentages were 13.7%, 54.2%, and 32.1% in the men and 15.5%, 57.3%, and 27.2% in the women, respectively.
| Sample characteristics | Men | Women | All combined |
|---|---|---|---|
| Number (%) | 153 (41.8%) | 213 (58.2%) | 366 (100%) |
| Age (y) | |||
| Mean | 24.08 | 22.27 | 23 |
| SD | 1.16 | 1.44 | 1.6 |
| Treatment need | |||
| No or little need (%) | 21 (13.7%) | 33 (15.5%) | 54 (14.8%) |
| Borderline (%) | 83 (54.2%) | 122 (57.3%) | 205 (56%) |
| Need (%) | 49 (32.1%) | 58 (27.2%) | 107 (29.2%) |
In Table II , the chi-square test shows that pronunciation was not significantly affected by the need for orthodontic treatment in either men (χ 2 = 2.6; P = 0.2) or women (χ 2 = 1.11; P = 0.5). Taste, however, was significantly affected by the level of orthodontic treatment need in men (χ 2 = 6.9; P = 0.03) but not in women (χ 2 = 5.6; P = 0.06).
| OHIP-14 Daily activity |
Orthodontic treatment need | |||||||
|---|---|---|---|---|---|---|---|---|
| No or little treatment need |
Borderline treatment need | Treatment need |
χ 2 P |
|||||
| Males 21 |
Females 33 |
Males 83 |
Females 122 |
Males 49 |
Female 58 |
Male | Female | |
| Had problem pronouncing words | ||||||||
| Impact: n (%) | 8 (38) | 15 (45) | 43 (52) | 65 (53) | 29 (59) | 33 (57) | 2.6 | 1.11 |
| No impact: n (%) | 13 (62) | 18 (56) | 40 (48) | 57 (47) | 20 (41) | 25(43) | 0.2 | 0.5 |
| Felt sense of taste worsened | ||||||||
| Impact: n (%) | 9 (43) | 11 (33) | 52 (63) | 69 (57) | 37 (76) | 31 (53) | 6.9 | 5.6 |
| No impact: n (%) | 12 (57) | 22 (67) | 31 (37) | 53 (43) | 12 (24) | 27 (47) | .03 ∗ | 0.06 |
| Had painful aching in mouth | ||||||||
| Impact: n (%) | 8 (38) | 9 (27) | 55 (66) | 70 (57) | 38 (78) | 35 (60) | 10.2 | 10.9 |
| No impact: n (%) | 13 (62) | 24 (73) | 28 (34) | 52 (43) | 11 (22) | 23 (40) | .006 ∗ | .00 ∗ |
| Found it uncomfortable to eat food | ||||||||
| Impact: n (%) | 5 (24) | 14 (42) | 50 (60) | 80 (66) | 33 (67) | 41 (71) | 11.9 | 7.8 |
| No impact: n (%) | 16 (76) | 19 (58) | 33 (40) | 42 (34) | 16 (33) | 17 (29) | .003 ∗ | .02 ∗ |
| Have been self-conscious | ||||||||
| Impact: n (%) | 7 (33) | 10 (30) | 59 (71) | 81 (66) | 40 (82) | 42 (72) | 16.4 | 17.8 |
| No impact: n (%) | 14 (67) | 23 (70) | 24 (29) | 41 (34) | 9 (18) | 16 (28) | .00 ∗ | .00 ∗ |
| Felt tense | ||||||||
| Impact: n (%) | 6 (29) | 11 (33) | 53 (64) | 68 (56) | 36 (74) | 39 (67) | 12.8 | 9.8 |
| No impact: n (%) | 15 (71) | 22 (67) | 30 (36) | 54 (44) | 13 (26) | 19 (33) | .00 ∗ | .00 ∗ |
| Had an unsatisfactory diet | ||||||||
| Impact: n (%) | 8 (38) | 10 (30) | 57 (69) | 79 (65) | 37 (76) | 38 (66) | 9.6 | 13.9 |
| No impact: n (%) | 13 (62) | 23 (70) | 26 (31) | 43 (35) | 12 (24) | 20 (34) | .008 ∗ | .00 ∗ |
| Had to interrupt meals | ||||||||
| Impact: n (%) | 9 (43) | 12 (36) | 53 (64) | 71 (58) | 38 (78) | 42 (72) | 7.9 | 11.3 |
| No impact: n (%) | 12 (57) | 21 (64) | 30 (36) | 51 (42) | 11 (22) | 16(28) | 0.01 ∗ | .00 ∗ |
| Found it difficult to relax | ||||||||
| Impact: n (%) | 7 (33) | 13 (41) | 46 (55) | 71 (58) | 27 (55) | 40 (69) | 3.5 | 6.8 |
| No impact: n (%) | 14 (67) | 20 (59) | 37 (45) | 51 (42) | 22 (45) | 18(31) | 0.17 | .03 ∗ |
| Have been a bit embarrassed | ||||||||
| Impact: n (%) | 8 (38) | 12 (36) | 53 (64) | 70 (57) | 39 (80) | 41 (71) | 11.3 | 10.1 |
| No impact: n (%) | 13 (62) | 21 (64) | 30 (36) | 52 (43) | 10 (20) | 17 (29) | .003 ∗ | .00 ∗ |
| Have been irritable with people | ||||||||
| Impact: n (%) | 6 (29) | 13 (39) | 58 (70) | 71 (58) | 38 (78) | 41 (71) | 16.7 | 8.5 |
| No impact: n (%) | 15 (71) | 20 (61) | 25 (30) | 51 (42) | 11 (22) | 17 (29) | 0.00 ∗ | .01 ∗ |
| Had difficulty doing useful jobs | ||||||||
| Impact: n (%) | 8 (38) | 13 (39) | 45 (54) | 68 (56) | 31 (63) | 32 (55) | 3.8 | 2.9 |
| No impact: n (%) | 13 (62) | 20 (61) | 38 (46) | 54 (44) | 18 (37) | 26 (45) | 0.15 | 0.23 |
| Felt life in general less satisfactory | ||||||||
| Impact: n (%) | 6 (29) | 10 (30) | 55 (66) | 72 (59) | 35 (71) | 41 (71) | 12.5 | 14.2 |
| No impact: n (%) | 15 (71) | 23 (70) | 28 (34) | 50 (41) | 14 (29) | 17 (29) | 0.00 ∗ | .00 ∗ |
| Have been unable to function | ||||||||
| Impact: n (%) | 9 (43) | 18 (55) | 49 (59) | 78 (64) | 25 (51) | 39 (67) | 2.07 | 1.49 |
| No impact: n (%) | 12 (57) | 15 (45) | 34 (41) | 44 (36) | 24 (49) | 19 (33) | 0.35 | 0.4 |
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