Effects of malocclusion and its treatment on the quality of life of adolescents

doi:10.1016/j.ajodo.2008.04.022

American Journal of Orthodontics and Dentofacial Orthopedics

Volume 136, Issue 3, September 2009, Pages 382-392

https://doi.org/10.1016/j.ajodo.2008.04.022 Get rights and content

Introduction

The relationship between malocclusion and quality of life (QoL) is complex and not well understood. The objective of this study was to determine whether malocclusion and its treatment influence an adolescent's general and oral health-related QoL.

Methods

An observational, cross-sectional design with a longitudinal component was used. Clinical and self-reported data were collected from 293 participants aged 11 to 14. The children were recruited from orthodontic and pediatric dental clinics at the University of Washington and a community health clinic in Seattle. The participants were classified into precomprehensive orthodontic (n = 93), postinterceptive orthodontic (n = 44), and nonorthodontic comparison (n = 156) groups. Assessments of dental esthetics and occlusion were evaluated with the Index of Complexity, Outcome, and Need. Three QoL questionnaires were completed: Youth Quality of Life to assess general QoL, Children's Oral Health-Related Quality of Life to assess oral health QoL, and Treatment Expectations and Experiences to evaluate participants' expectations for changes in specific aspects of their lives. Nonparametric tests were used for all analyses.

Results

In general, overall and oral health QoL were high in this population. The instruments were correlated so that when oral health QoL improved, so did general QoL. No differences were found in these measurements between the university and community health clinics. Nor were there differences between the 3 study groups on general QoL and oral health QoL. There was little effect of malocclusion complexity on any QoL measure. Both preorthodontic and postorthodontic participants expected improvements in their health, oral function, appearance, and social well-being after orthodontic treatment; the postinterceptive sample's posttreatment experiences were consistent with their pretreatment expectations in all domains.

Conclusions

Malocclusion and orthodontic treatment do not appear to affect general or oral health QoL to a measurable degree, despite subjective and objective evidence for improved appearance, oral function, health, and social well-being.

Section snippets

Material and methods

Our subjects were recruited from 2 sites—the University of Washington School of Dentistry (UW) and the Odessa Brown Children's Clinic (OBCC), a community health clinic in the Seattle area. At UW, the participants were recruited from the Graduate Orthodontic Clinic and the Graduate Pediatric Dentistry Clinic. At OBCC, the patients were recruited from the orthodontic and pediatric dentistry clinics.

The orthodontic participants from OBCC were part of a larger randomized clinical trial (RCT), an

Results

Table I gives the demographic and occlusion characteristics of this sample. Moderate and high ICON esthetic scores (>4) were compared with low ICON esthetic scores (≤4) in the comparison group (mean ICON esthetic score, 4.0 ± 1.9). This cutoff point represents a need for orthodontic treatment based solely on dental esthetics. There were no differences on any YQoL and COHQoL total or domain scores between adolescents whose ICON esthetic scores were ≤4 or >4, so all subjects in the 2 comparison

Discussion

Adolescent dental patients aged 11 to 14 years generally report high QoL—both general and COHQoL. This was found even among children planning to have orthodontic treatment. This is consistent with previous studies on healthy adolescents by Jokovic et al,22, 32 Topolski et al,²⁹ and Locker et al.³⁸

A few previous studies found improvements in OHQoL after orthodontic treatment.17, 18 However, we found no differences in OHQoL or overall QoL between the 3 groups (precomprehensive, postinterceptive,

Conclusions

1.
In general, 11-to-14 year-old adolescents have high overall and COHQoL scores.
2.
There was no difference in general QoL or COHQoL between precomprehensive orthodontic patients, postinterceptive orthodontic patients, and the comparison group of adolescents who were not seeking treatment.
3.
General QoL and COHQoL scores had a similar pattern of correlation for the 3 groups.
4.
Malocclusion and its treatment have little effect on general QoL or COHQoL, but improved occlusion does improve adolescents'

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No meaningful association exists between the 3 indexes studied and OHRQOL. These findings challenge the validity of current systems for the allocation of Medicaid-funded orthodontic treatment.
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In addition to essential clinical parameters, orthodontic treatment outcomes should also consider patients’ opinions and perceptions, which could be comprehensively clarified with a qualitative scientific approach. Considering that the information on younger patients’ views is scarce, the objective of this study was to investigate how adolescent orthodontic patients perceive malocclusion, and their motivations and expectations concerning orthodontic corrective treatment.
In this descriptive qualitative study, 12 adolescents aged 12 to 14 years and of both genders, covering a heterogeneous collection of malocclusions, were recruited from the waiting list of an Orthodontics Graduate Course. They were individually interviewed before the appliance insertion by an experienced researcher using an interview guide and photographic records to stimulate patients’ self-perception of their oral condition. The interviews proceeded simultaneously with transcription analyses until saturation. After the transcription evaluation, the framework analysis technique was performed.
Data derived from the transcription analyses were grouped into 3 major themes: perceptions concerning the concepts of normality and abnormality regarding oral health; self-perceptions regarding malocclusion and other discrepancies; and motivations for seeking orthodontic treatment and expectations related to the results.
Attractiveness was exceptionally relevant among adolescent patients. Most interviewees seemed to focus their attention on esthetically upsetting dentofacial traits, which they expected to be corrected by orthodontic treatment. In addition to self-oriented appearance-driven motivations, parents, other health professionals, friends, and peers also influenced adolescents’ perception of their need for treatment. The achievement of a normal dentofacial status seems to be closely attached to social and individual aspirations.
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The Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) is an instrument to assess the subjective perception need for orthodontic treatment. The study aimed to determine the psychometric validity and reliability of PIDAQ in Australian adults.
Data were collected from the National Dental Telephone Interview Survey in 2013. The PIDAQ was used, comprising 4 conceptual domains: self-confidence, social impact, psychological impact, and esthetic concern. Psychometric sensitivity was estimated for each item. Confirmatory factor analysis was performed to determine factorial validity in which the ratio of chi-square by degrees of freedom, comparative fit, and root mean square error of approximation were used as indexes of the goodness of fit. Convergent validity was estimated from the average variance extracted and composite reliability, whereas internal consistency was estimated by Cronbach standardized alpha.
The dataset comprised 2936 Australian adults aged ≥18 years and separated randomly into 2 subdata sets. The kurtosis and skewness values indicate an approximation to a normal distribution for each item, with acceptable thresholds for the goodness of fit and convergent validity (average variance extracted ≥0.50 and composite reliability ≥0.70), and discriminant validity was also demonstrated. Internal consistency was adequate in the 4 conceptual domains for PIDAQ for both subdata sets, with Cronbach standardized alpha being ≥0.70.
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Twenty-five adolescents aged between 12 and 18 years participated in the study. Before the treatment, the participants were interviewed, and their food consumption frequency and 24-hour retrospective food consumption records were taken. Participants were followed up for 3 months, that is, in the first, fourth, and 12th week of the treatment. In the interviews, questions about food consumption changes and posttreatment pain were asked to the participants, and 24-hour retrospective food consumption records were obtained.
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The biological basis of treating jaw discrepancies: An interplay of mechanical forces and skeletal configuration
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Citation Excerpt :
Several studies have highlighted the significant role that malocclusion possesses in oral health as well as in the quality of life [3–5]. Particularly, it is reported that oral health in general [6], masticatory function [7], vulnerability to dental trauma [8] and social and emotional welfare [9–11] may be affected to a varying extent depending on the severity of the existed discrepancies. Moreover, the treatment of these cranio-dentofacial problems has been proved to ameliorate oral function and oral health related quality of life [6,12–14], whereas patients with jaw deformities who remain untreated seem to be adversely affected psychologically and physically [15,16].
Jaw discrepancies and malrelations affect a large proportion of the general population and their treatment is of utmost significance for individuals' health and quality of life. The aim of their therapy is the modification of aberrant jaw development mainly by targeting the growth potential of the mandibular condyle through its cartilage, and the architectural shape of alveolar bone through a suture type of structure, the periodontal ligament. This targeted treatment is achieved via external mechanical force application by using a wide variety of intraoral and extraoral appliances. Condylar cartilage and sutures exhibit a remarkable plasticity due to the mechano-responsiveness of the chondrocytes and the multipotent mesenchymal cells of the sutures. The tissues respond biologically and adapt to mechanical force application by a variety of signaling pathways and a final interplay between the proliferative activity and the differentiation status of the cells involved. These targeted therapeutic functional alterations within temporo-mandibular joint ultimately result in the enhancement or restriction of mandibular growth, while within the periodontal ligament lead to bone remodeling and change of its architectural structure. Depending on the form of the malrelation presented, the above treatment approaches, in conjunction or separately, lead to the total correction of jaw discrepancies and the achievement of facial harmony and function. Overall, the treatment of craniofacial and jaw anomalies can be seen as an interplay of mechanical forces and adaptations occurring within temporo-mandibular joint and alveolar bone. The aim of the present review is to present up-to-date knowledge on the mechano-biology behind jaw growth modification and alveolar bone remodeling. Furthermore, future molecular targeted therapeutic strategies are discussed aiming at the improvement of mechanically-driven chondrogenesis and osteogenesis.

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: Supported by NIDCR grant U54DE14254 and the University of Washington Orthodontic Alumni Association.

: The authors report no commercial, proprietary, or financial interest in the products or companies described in this article.

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Original articleEffects of malocclusion and its treatment on the quality of life of adolescents

Introduction

Methods

Results

Conclusions

Section snippets

Material and methods

Results

Discussion

Conclusions

Am J Orthod Dentofacial Orthop

Am J Orthod Dentofacial Orthop

Semin Orthod

Am J Orthod Dentofacial Orthop

Semin Orthod

J Adolesc Health

J Adolesc

J Adolesc

Am J Orthod Dentofacial Orthop

Measuring quality of life: the development of the world health organization quality of life instrument (WHOQOL)

An oral health strategy for England

Northwest/Alaska Center to Reduce Oral Health Disparities NIDCR Disparities Center. Grant #U54DE14254, University of Washington

Treatment expectations versus outcomes among orthognathic surgery patients

Int J Adult Orthod Orthognath Surg

Self-concept, Class II malocclusion, and early treatment

Angle Orthod

Validation of the child perceptions questionnaire (CPQ 11-14)

J Dent Res

Is the child perceptions questionnaire for 11-14 year olds sensitive to clinical and self-perceived variations in orthodontic status?

Community Dent Oral Epidemiol

The impact of two different malocclusion traits on quality of life

Br Dent J

Oral health-related quality of life and the IOTN index as predictors of children's perceived needs and acceptance for orthodontic treatment

Br Dent J

Original article
Effects of malocclusion and its treatment on the quality of life of adolescents