Introduction
Satisfaction with dentofacial appearance and expectations of orthodontic treatment have been analyzed in many studies. In 2002, in a study in The Netherlands, significant correlations were found between dental satisfaction and orthodontic treatment expectations. Satisfaction significantly decreased with increasing age. The aim of this study was to compare the satisfaction and expectations of current patients with the results of a study 10 years ago.
Methods
A questionnaire about dentofacial satisfaction and a questionnaire about the expectations of orthodontic treatment were completed by 146 subjects. The mean scores in the present study were compared with the mean scores 10 years ago.
Results
The subjects in the present study were more satisfied with their dental appearance. Differences in expectations were found on the subscales of general well-being and self-image. As in the study in 2002, no significant correlations were found between sex, satisfaction, and expectations of orthodontic treatment. Dentofacial satisfaction predicts expectations about orthodontic treatment, especially in the group of subjects aged 17 years and above.
Conclusions
The subjects in this study had greater expectations of orthodontic treatment about general well-being and were more satisfied with their dental appearance than were the subjects studied 10 years ago.
Highlights
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Dentofacial satisfaction and treatment expectations were examined.
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Results from this study were compared with the results from a study 10 years ago.
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The subjects in this study had higher expectations of orthodontic treatment.
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The subjects in this study were more satisfied with their dental appearance.
You never get a second chance to make a first impression. In verbal and nonverbal communication, the face matters. The advantages of beauty seem to be true, at least at first meeting. Facial attractiveness is positively associated with high school marks, good work performance, positive peer relations, social acceptance, high social status, positive body image, and good self-concept. It has also been proven that a malocclusion can have a negative effect on the quality of life.
Tooth color, missing teeth, and poor tooth alignment are the most common reasons for dissatisfaction with dentofacial appearance. It is therefore not surprising that people seek esthetic dental and orthodontic care. Inconsistent results have been found regarding the association between dentofacial satisfaction, age, and sex. In some studies, no sex differences were found regarding dentofacial satisfaction and treatment expectations, but other studies showed that female subjects were less satisfied than were male subjects.
However, it seems that dentofacial satisfaction is significantly correlated with expectations of orthodontic patients about general well-being, improvement of self-image, and future dental health. Also, orthodontic patients seem to expect improvements in esthetics and self-esteem, regardless of their sex.
Attitudes about dental health change over time. In an epidemiologic dental study in The Netherlands, more patients were undergoing orthodontic treatment in 2005 than in 1999. Also, a change in orthodontic treatment need was found. The question is whether these findings are related to current dentofacial satisfaction and expectations of orthodontic patients at the start of treatment.
In this study, we replicated the study by Bos et al and compared our results with those results. Because of controversy about the impact of malocclusion on dentofacial satisfaction and treatment expectations in the orthodontic literature, we examined the effect of malocclusion on dentofacial satisfaction and treatment expectations as well.
Based on the results of previous studies, female patients were expected to be less satisfied with their dentofacial appearance than male patients. Based on the results of Bos et al, younger subjects were assumed to be more satisfied with their dentofacial appearance than older subjects. Furthermore, significant correlations between dentofacial satisfaction and treatment expectations were expected. We explored whether dentofacial satisfaction and orthodontic treatment expectations have changed over time. Finally, based on the results of Zhang el, we expected that malocclusion would have no effect on dentofacial satisfaction and treatment expectations.
Material and methods
From November 2011 to June 2012, we sent 2 questionnaires to every person applying for orthodontic treatment at the Academic Centre of Dentistry Amsterdam in The Netherlands. The first questionnaire included 16 items about satisfaction with facial appearance before orthodontic treatment to be scored on a 5-point response scale (from “I am very unsatisfied” to “I am very satisfied”). It was a modification of the body-cathexis scale introduced by Secord and Jourard in 1953 and was further developed in the 1980s. It gives an assessment of perceived dentofacial appearance; a high score shows greater satisfaction with the dentofacial body part being measured. The second questionnaire included 23 items about expectations of orthodontic treatment to be scored on a 7-point response scale (from “worse” to “much better”). It was initially developed for patients undergoing orthognathic surgery and was adjusted for orthodontic patients. It measures long-term expectations of orthodontic treatment.
The same subscales were used as in the study by Bos et al. The questionnaire about satisfaction with facial appearance was divided into 2 subscales (facial satisfaction and dental satisfaction). The questionnaire about expectations of orthodontic treatment was divided into 4 subscales (general well-being, self-image, oral function, and future dental health).
The questionnaires were sent to 220 persons applying for orthodontic treatment at the Academic Centre of Dentistry in Amsterdam; none had visited the orthodontic department before. To this type of social science research, the Dutch Medical Research on Humans Act was not applicable. The questionnaires were returned by 146 subjects (53 male, 93 female), resulting in a response rate of 67%. There were no significant differences in age and sex between responding and nonresponding persons. Subjects with more than 3 missing responses (n = 10) were excluded from the analysis. There were no significant differences in age and sex between subjects who completed the questionnaire and those who did not.
Subjects older than 60 years (n = 1) and younger than 8 years (n = 1) were excluded from the study. The mean age of the remaining 134 subjects was 19.6 years (SD, 13.49 years; median, 13 years; age range, 8-60 years). After the initial analysis, the subjects were divided into 2 age groups, as Bos et al did in 2003. The first group included subjects from 8 to 16 years old (n = 84; 35 boys; mean age, 11.42 years; SD, 1.78 years); the second group included subjects from 17 to 60 years (n = 50; 15 men; mean age, 33.36 years; SD, 13.43 years). All subjects were invited for a first consultation. During this consultation, the subjects (n = 123) were scored with a Class I (n = 59), Class II (n = 57), or Class III (n = 7) malocclusion.
Statistical analysis
First, the internal consistencies of the scales and subscales were determined using the Cronbach alpha. To analyze the effects of sex and age on dental and facial satisfaction and expectations of orthodontic treatment, the Mann-Whitney U test was used. Also, the mean scores of the subscales for the subjects with a Class I malocclusion were compared with the mean scores for subjects with a Class II malocclusion using the Mann-Whitney U test. The Spearman correlation coefficient was calculated for satisfaction with dental and facial appearance and expectations of orthodontic treatment. Next, a multiple regression analysis was performed to estimate the effect of the initial facial and dental satisfactions on expectations of orthodontic treatment. To analyze changes in satisfactions and expectations over time, the mean scores in our study were compared with the mean scores from the study by Bos et al using 1-sample t tests.
Results
The internal consistency in 2012 of the questionnaire on satisfaction was satisfactory. The Cronbach alpha for the total scale was 0.93. Internal consistency values for the 2 subscales were 0.93 and 0.52, respectively, for satisfaction with facial appearance and dental appearance. The internal consistency of the questionnaire on expectations was satisfactory as well. The Cronbach alpha for the total scale was 0.94, and the internal consistency values for the 4 subscales were 0.94 for general well-being, 0.91 for self-image, 0.83 for future dental health, and 0.85 for oral function.
No significant differences on the subscales and total scales were found between the male and female subjects for age and sex differences in 2012. However, age was significantly related to facial satisfaction ( U = 1403.500; P = 0.004), dental satisfaction ( U = 1461.500; P = 0.003), and expectations about self-image ( U = 1536; P = 0.049). Patients younger than 17 years of age were more satisfied with their facial and dental appearances, and they had lower expectations of orthodontic treatment with regard to improvements in self-image in comparison with older subjects.
The group of subjects with a Class III malocclusion (n = 7) was relatively small and was therefore excluded from the analysis. The scores for subjects with a Class I malocclusion (n = 59) were compared with the scores for subjects with a Class II malocclusion (n = 57). The Mann-Whitney U test showed no significant differences in the subscales and the total scale between subjects with Class I and Class II malocclusions (facial satisfaction: U = 1486.50, P = 0.527; dental satisfaction: U = 1433.00, P = 0.163; general well-being: U = 1287.50, P = 0.295; self-image: U = 1285.00, P = 0.131; future dental health: U = 1576.00, P = 0.908; and oral function: U = 1306.00, P = 0.275).
In Table I , the Spearman correlations between the different variables were analyzed for the 2 age groups. Satisfaction with facial appearance was significantly correlated with expectations about general well-being and oral function only for subjects 17 years and older. No correlation was found between sex and expectations of orthodontic treatment.
| Expectation | General well-being | Self-image/appearance | Future dental health | Oral function |
|---|---|---|---|---|
| Age ≤16 years | ||||
| Satisfaction with facial appearance | 0.97 | 0.36 | 0.33 | 0.78 |
| Satisfaction with dental appearance | 0.64 | 0.11 | 0.69 | 0.13 |
| Age ≥17 years | ||||
| Satisfaction with facial appearance | 0.31 ∗ | 0.29 | 0.29 | 0.30 ∗ |
| Satisfaction with dental appearance | −0.15 | −0.24 | −0.14 | −0.07 |
A multiple regression analysis was used to determine which variables affected the expectations of orthodontic treatment for the 2 age groups. Table II shows that facial satisfaction and dental satisfaction are significant predictors for expectations about future dental health for subjects younger than 17 years. Dental and facial satisfaction together explained 12% of the variance of the subjects’ expectations about future dental health. Dental satisfaction was also a significant predictor for expectations about oral function for subjects younger than 17 years.
| Expectation | General well-being | Self-image/appearance | Future dental health | Oral function | ||||
|---|---|---|---|---|---|---|---|---|
| β | P | β | P | β | P | β | P | |
| Satisfaction with facial appearance | 0.176 | 0.260 | 0.121 | 0.435 | 0.436 | 0.005 † | 0.251 | 0.194 |
| Satisfaction with dental appearance | −0.177 | 0.258 | −0.246 | 0.114 | −0.458 | 0.003 † | −0.323 | 0.036 ∗ |
| R | 0.146 | 0.189 | 0.351 | 0.245 | ||||
| Adjusted R 2 | −0.006 | 0.009 | 0.123 | 0.034 | ||||
Table III shows that satisfaction with facial appearance was a significant predictor for all expectations of orthodontic treatment for subjects 17 years and older. Dental satisfaction was a significant predictor only for expectations about self-image. Dental and facial satisfaction explained 16% of the variance on subjects’ expectations about self-image.
| Expectation | General well-being | Self-image/appearance | Future dental health | Oral function | ||||
|---|---|---|---|---|---|---|---|---|
| ß | P | ß | P | ß | P | ß | P | |
| Satisfaction with facial appearance | 0.441 | 0.004 † | 0.372 | 0.011 ∗ | 0.345 | 0.025 ∗ | 0.343 | 0.028 ∗ |
| Satisfaction with dental appearance | −0.149 | 0.314 | −0.385 | 0.009 † | −0.203 | 0.180 | −0.098 | 0.523 |
| R | 0.413 | 0.437 | 0.331 | 0.324 | ||||
| Adjusted R 2 | 0.133 | 0.156 | 0.071 | 0.064 | ||||
In Table IV , the mean scores and standard deviations on all subscales of both questionnaires are presented for both groups in 2002 and 2012. The mean scores from the present study were compared with the mean scores from the study of Bos et al. Significant differences between the subjects in this study and those from the earlier study were found for dental satisfaction and expectations about general well-being. The subjects in 2012 were significantly more satisfied with their teeth than were those in 2002 and had higher expectations of orthodontic treatment for their general well-being.
| Subscale | Total groups | t | P | |||
|---|---|---|---|---|---|---|
| 2002 (n = 100) | 2012 (n = 134) | |||||
| Mean | SD | Mean | SD | |||
| Satisfaction questionnaire | ||||||
| General facial satisfaction | 56.04 | 10.59 | 56.76 | 10.24 | 0.804 | 0.420 |
| Dental satisfaction | 5.99 | 1.86 | 6.49 | 1.87 | 3.116 | 0.002 † |
| Expectation questionnaire | ||||||
| General well-being | 26.54 | 10.93 | 28.90 | 13.21 | 1.986 | 0.049 ∗ |
| Self-image/appearance | 18.00 | 7.53 | 18.73 | 7.88 | 1.055 | 0.294 |
| Future dental health | 19.70 | 5.97 | 19.35 | 5.93 | −0.680 | 0.497 |
| Oral function | 9.56 | 4.30 | 9.92 | 4.77 | 0.849 | 0.397 |
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