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Objective: To investigate if the orthodontic treatment expectations of Black British children and their primary carers vary compared with White British children and their primary carers., Setting: A hospital orthodontic department (Queen Mary's Hospital, Sidcup, London, UK)., Participants: Patients and their accompanying primary carers who had not received fixed orthodontic appliance treatment and were aged between 12 and 14 years old., Method: Informed consent was obtained from 100 patients and their primary carers, who completed a psychometrically validated questionnaire, to measure their expectations before a new patient orthodontic consultation. This cohort consisted of 50 Black British patients and their primary carers and 50 White British patients and their primary carers., Results: Mean responses from patients and their primary carers for each ethnic group were compared using the independent groups t-test. Significant statistical differences were found between the two ethnic groups. The greatest statistical differences occurred between Black British patients and their primary carer and Black British primary carers and White British primary carers. Patients tended to have similar orthodontic expectations. There were no statistical significant differences in expectations between White British children and their primary carers., Conclusion: Differences in expectations of orthodontic treatment were more common between Black British and White British primary carers, than their children. White British primary carers had higher expectations at their child's initial appointment and expected dental extractions to be part of the orthodontic treatment plan. These differences have some implications for the provision of orthodontic care. A clinicians understanding of patients and their primary carer's expectations at the start of treatment can help in the quality and delivery of orthodontic care provided.

The experience-based design (ebd) approach is a method of measuring patient experience, which deliberately draws out subjective, emotional and personal feelings of the patients using a service. We describe how the experience-based design approach has been used to measure the experiences of teenage patients at orthodontic consultation appointments in a district general hospital. This has allowed us to identify the points in the patient's journey where they experience most anxiety and nervousness and to target service improvements in these areas. We found the ebd approach effective in measuring patient experience in a teenage patient population. We demonstrate how the service improvements implemented have reduced negative feelings during new patient consultations., (© 2014 British Orthodontic Society.)

Objectives: To evaluate adolescents oral health-related quality of life (OHRQoL) in the first 4 months of fixed orthodontic appliance treatment using parents and caregivers as proxies., Design: Descriptive study., Setting: Department of Pediatric Dentistry and Orthodontics at Universidade Federal de Minas Gerais, Belo Horizonte, Brazil., Participants: A sample of parents and caregivers of 95 adolescents undergoing orthodontic treatment with a fixed appliance., Methods: Participants were required to answer the Brazilian version of the Parental-Caregivers Perceptions Questionnaire (P-CPQ) before adolescent's treatment (T1) and 4 months after bonding of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed rank test and the Bonferroni correction for the domains of P-CPQ., Results: Among the 95 participants, there were 73 mothers, 18 fathers and 4 were other relations. There was a statistically significant improvement in the overall score as well as in both emotional and social wellbeing subscales (P<0·001)., Conclusion: Parents and caregivers report an improvement on their adolescent's OHRQoL in the first 4 months of orthodontic treatment with a fixed appliance., (© 2014 British Orthodontic Society.)

Patients' expectations of their treatment are a key determinant in their satisfaction with treatment. Expectations may encompass not only notions of the outcome of treatment, but also the process of treatment. This article explores the processes by which expectations are formed, differences in expectations across patient groups, and the psychopathology of individuals with unrealistic expectations of treatment manifest in body dysmorphic disorder.

Aim: To determine the impact that information leaflets have on patient expectations of orthodontic treatment., Design: A prospective, randomized controlled study., Setting: The Orthodontic Department at Queen Mary's Sidcup, South London Healthcare NHS Trust., Participants: Eighty adolescents, aged 12-14 years,attending their first orthodontic consultation appointment., Intervention: PARTICIPANTS completed a previously validated questionnaire about their expectations of orthodontic before the consultation.They were then randomly assigned to two groups. The control group (n = 40)received additional written information about fluoride, while the intervention group (n = 40) received additional written information about orthodontic treatment. Both groups then had their orthodontic consultation following which they completed the expectation questionnaire for a second time., Outcomes: The questionnaire consisted of 10 questions.Eight questions used a 10 mm VAS response code. Two questions had categorical response codes. ANCOVA was undertaken using post-consultation scores as the outcome and pre-consultation scores as the covariant. Chi-squared tests were undertaken to assess the categorical variables., Results: All 80 participants recruited to the trial completed the questionnaire on two occasions. No significant differences between the control group and the intervention in their expectations of orthodontic treatment were found, except for one item related to the expectation of a discussion about treatment at the initial appointment (P = 0·04)., Conclusion: Information leaflets did not have an immediate impact on patients' expectations of orthodontic treatment. The cost implication of providing information leaflets to patients must be weighed against the limited benefit they provide.

Objective: To assess the impact of wearing a fixed orthodontic appliance on oral health-related quality of life (OHRQoL) among Brazilian children., Design: Cross-sectional study., Setting: The Department of Paediatric Dentistry and Orthodontics at Federal University of Minas Gerais, Belo Horizonte, Brazil., Participants: Sample of 579 children aged 11-14 years. The children were divided into two groups: wearing (n = 160)and not wearing (n = 419)a fixed orthodontic appliance., Methods: A clinical examination was performed by a single examiner to determine whether or not a fixed orthodontic appliance was worn,the presence of a malocclusion using the Dental Aesthetic Index (DAI)and cavitated carious lesions. The impact of wearing a fixed orthodontic appliance on OHRQoL was measured using the short form of the Brazilian version of the Child Perceptions Questionnaire (CPQ(11-14)). Data analysis involved descriptive statistics, Mann-Whitney test and univariate/multiple logistic regression., Results: The total CPQ(11-14) score revealed a more frequent impact among children who wore a fixed orthodontic appliance than those who did not (P = 0·002).Similar findings were observed for the FL (P = 0·005),EWB (P = 0·006) and SWB (P = 0·003) subscales.There was no statistically significant difference between the two groups regarding the score on the OS subscale (P = 0·124).While females were 1·76 times more likely to have a worse OHRQoL than males, the use of a fixed orthodontic appliance was also significantly associated with a greater chance (OR = 1·60; CI = 1·11-2·33)of impacting OHRQoL when both variables were inserted together in the regression model., Conclusion: Children wearing a fixed orthodontic appliance had significantly worse OHRQoL compared with a control group with no malocclusion and not wearing a fixed appliance.

Objectives: To measure the self-reported frequency and severity of bullying amongst patients referred for orthodontic treatment and to investigate whether there is a relationship between levels of self-reported bullying, malocclusion and need for orthodontic treatment and an individual's self-esteem and oral health-related quality of life (OHRQoL)., Design and Setting: Cross-sectional study of an adolescent group referred for orthodontic assessment at three UK hospitals., Subjects and Methods: Three hundred and thirty-six participants aged between 10 and 14 years were recruited. Validated questionnaires were used to measure the self-reported frequency and severity of bullying, self-esteem and OHRQoL. Orthodontic treatment need was assessed using IOTN., Results: The prevalence of bullying was 12·8%. Being bullied was significantly associated with Class II Division 1 incisor relationship (P = 0·041),increased overbite (P = 0·023),increased overjet (P = 0·001)and a high need for orthodontic treatment assessed using AC IOTN (P = 0·014).Bullied participants also reported lower levels of social competence (P<0·001),athletic competence (P<0·001), physical appearance related self-esteem (P<0·001)and general self-esteem (P<0·001). Higher levels of oral symptoms (P = 0·032),functional limitations (P<0·001), emotional (P<0·001)and social impact (P<0·001) from their oral condition, resulting in a negative impact on overall OHRQoL (P<0·001),were also reported., Conclusions: Significant relationships exist between bullying and certain occlusal traits, self-esteem and OHRQoL.

Objective: There is evidence to suggest that social judgements are made on the basis of dental appearance. This study sought to determine how children view other children with fixed orthodontic appliances., Design: Cross-sectional, self-completion questionnaire., Subjects and Methods: Year 7 (aged 11-12 years) and year 10 (aged 14-15 years) school children (the participants) were invited to look at colour photographs of one girl and one boy (the subjects) and to make a social judgement about these children. Participants were randomly allocated either pictures of the two children without fixed orthodontic appliances or pictures of the same children with fixed orthodontic appliances. Using a previously validated child-centred questionnaire, participants rated subjects using a four-point Likert scale for three negative and six positive attributes. Multivariate analysis of variance was used to determine whether participant year group or gender and the presence of the orthodontic appliance had a significant effect on total attribute score., Results: Three hundred and twenty-two children completed the questionnaires, giving a response rate of 69%. There was a significant effect of year group (P = 0.003) and gender of the participant (P = 0.031) on the attribute score. There was no effect according to the presence or absence of an orthodontic appliance (P = 0.791). Female participants gave more positive ratings than their male peers., Conclusion: This study has found that children do not make social judgements about other children purely on the basis of wearing a fixed orthodontic appliance, suggesting that they are viewed as part of a normal dental appearance in adolescence.

Objectives: The aim of this study was to develop a measure to assess orthognathic patients' perceptions of referral to a mental health professional., Design: Prospective qualitative study., Setting: UCLH Foundation Trust., Subjects and Methods: The study was divided into two parts. The first phase involved developing a patient-centred questionnaire by carrying out semi-structured interviews with 10 orthognathic patients and 10 clinicians involved in orthognathic treatment provision. The transcripts from these interviews were then analysed using the N6 software package for qualitative research and thematic content analysis was carried out. As key themes and theories of patients' perceptions of referral to a mental health professional began to emerge from the data, this directed the source of further interviews, allowing exploration and validation of all theories. When new themes ceased to arise, it was assumed that data saturation was reached, and no further interviews were undertaken. A questionnaire was then developed using the key themes from the interviews and this was piloted., Results: Analysis of the interviews revealed that patient views could be divided into two main themes: service provision and perceptions of mental health professionals. These themes were incorporated into a questionnaire., Conclusions: A new measure of patients' perceptions of referral to a mental health professional is presented.

Objectives: There is evidence to suggest that clinicians are reluctant to refer orthognathic patients for psychological evaluation due to fear of the patient reacting badly to the suggestion. The aim of this study was to assess orthognathic patients' perceptions of referral to a psychiatrist/psychologist using a previously developed patient-centred questionnaire., Methods: The study was divided into two parts. Stage 1 (presented previously) involved developing the questionnaire using qualitative methodology and stage 2 involved distribution of the questionnaire to 63 orthognathic patients. This paper describes the findings of stage 2., Setting: UCLH Foundation Trust., Results: The majority of patients viewed referral to a psychiatrist/psychologist positively (95.2%), the main benefits being having someone neutral to talk to who could explain and prepare them for treatment. Patients said they would prefer the referral to be made by the clinician they are most familiar with and to see the psychiatrist/psychologist on a one-to-one basis (79.4%) in an environment they are familiar with. The main perceived drawback of seeing a psychiatrist was the inconvenience of an additional visit., Conclusions: Fear of the patient reacting badly to being referred to a mental health professional appears to be unfounded in this study of patients from a large teaching hospital and should not prevent clinicians referring patients whom they think would benefit from this.

Objective: To describe patients' and their parents' expectations of orthodontic treatment., Design: A questionnaire survey of 100 patients and their primary care-givers attending a new patient orthodontic consultant clinic, at a teaching hospital., Setting: GKT Orthodontic Department, King's College Dental Hospital, London, UK., Subjects: The sample consisted of 100 participants who completed the questionnaire, including 50 patients aged 12-14 years who had been referred to the orthodontic department for treatment. One parent of each patient was also invited to participate., Materials and Methods: Participants completed a valid questionnaire measure of orthodontic expectations that was tested for reliability and validity. Descriptive analysis of the responses was undertaken, and comparisons of children's and parents' expectations, in addition to ethnicity, were made., Results: Patients and parents have similar expectations of treatment, with the exception of expectations of duration of orthodontic treatment (P<0.01), having a brace fitted at the initial visit (P<0.05), and restrictions with regard to what one can eat and drink as a result of orthodontic treatment (P<0.05). Among the patient participants, different ethnic groups displayed different expectations of the initial orthodontic assessment visit, the likelihood of wearing headgear, the impact of orthodontic treatment on diet, and the reaction of peers to treatment (P<0.05). For patients, ethnic group differences were reported for expectations regarding the initial visit, headgear and dietary restrictions (P<0.05)., Conclusions: Patients and their parents share similar expectations of orthodontic treatment for most aspects of care, although parents are more realistic in their estimation of the duration of treatment and the initial visit. The expectations of patients differ from those of their parents with regard to dietary and drink restrictions in relation to orthodontic treatment. Ethnicity significantly influences expectations of orthodontic treatment, and this may relate to differences in the patients' and their parents' assessed outcome of care.

Objective: The development of a questionnaire to measure patients' and their parents' expectations before orthodontic treatment, and to test the reliability and validity of this measure., Design: A two-stage methodology, with open-ended interviews to identify themes and concepts followed by development and testing of the questionnaire., Setting: GKT Orthodontic Department, King's College Dental Hospital., Subjects: The sample consisted of 140 participants, 70 patients aged 12-14 years, who had been referred to the orthodontic department for treatment. One parent of each patient was also recruited., Materials and Methods: The study was in two phases. In the first phase 30 participants (15 new patients and their 15 parents) participated in open-ended interviews, which were analysed qualitatively. Information from these interviews was used to construct a questionnaire. During the second phase, the questionnaire was piloted on 10 participants, five new consecutive patients and their parents. The questionnaire was then distributed to 174 subjects (87 new patients and their 87 parents). Seventy-eight subjects (39 new patients and their 39 parents) completed the questionnaire before their orthodontic consultation. Another 96 subjects (48 new patients and their 48 parents) were invited to complete the questionnaire prior to and at their orthodontic consultation. Test-retest analysis was conducted on 22 participants (11 patients and their 11 parents), who completed the questionnaire previous to and at their orthodontic consultation, and contributed to the psychometric validation of this questionnaire., Main Outcome Measures: A questionnaire was devized using the key themes and concepts identified in the open-ended interviews. As a result, 10 questions, some with sub-questions were constructed using a visual analogue scale as the response format., Results: The questionnaire developed had good face validity. Internal consistency of the questionnaire using Cronbach's alpha, produced an overall inter-item reliability > 0.7 along with item-total correlations > 0.3 in over 50% of questions. Test-retest reliability was statistically significant using Spearman's correlation., Conclusion: This study provides a valid and reliable measure of orthodontic expectations in participants aged 12-14 years and their parents.

Objective: To identify issues of importance to adolescent patients surrounding the delivery of orthodontic treatment under the National Health Service (NHS), which can form the basis of a tool to examine patients' perceptions of NHS orthodontic treatment., Design: Study using qualitative research methods., Setting: Patients were recruited from the orthodontic departments at Derriford Hospital and Bristol Dental Hospital, and from Specialist Orthodontic Practices in Plymouth and Solihull., Subjects: A rolling sample of patients from a list of orthodontic patients under treatment at each site was selected. Twenty-six patients took part in five focus group meetings. Three patients took part in semi-structured telephone interviews., Methods: Participants were invited to participate in either a focus group meeting or a telephone interview. The transcripts of these meetings were analysed by two researchers working independently. Issues of importance to patients regarding the delivery of orthodontic treatment under the NHS were identified., Results: The issues identified included being treated with respect by the clinician and being included in discussions about treatment. Participants tended to rely on their peers for advice about what to expect from treatment. The patients also discussed the benefits to them of undergoing orthodontic treatment. These included an improved appearance and increased self-confidence., Conclusion: This qualitative research has identified issues that are important to adolescent orthodontic patients. These issues will be used to form the basis of a patient-centred measure for auditing patients' perceptions of orthodontic treatment under the NHS.

Objective: To compare the use of the Aesthetic Component (AC) of IOTN and the Child Perceptions Questionnaire (CPQ) in assessing orthodontic treatment need and concern., Design: Cross-sectional observational study., Subjects and Methods: The subjects were 204 children aged 10-12 years studying in 10 schools in Bristol, UK. They completed a questionnaire comprising the CPQ and questions regarding orthodontic concern. AC scores as rated by the child and by the calibrated examiner were recorded., Main Outcome Measures: CPQ scores were calculated from the responses in the questionnaire. AC scores and responses to questions regarding orthodontic concern were recorded., Results: The children gave themselves lower AC scores compared to the examiner (p<0.001). The only section of the CPQ that correlated significantly with Examiner AC was the emotional impacts section (rho=0.151). CPQ scores had a slightly higher correlation with self-perceived AC than Examiner AC. However, the correlations were still very low. The emotional impacts section of CPQ (rho=0.332) and overall CPQ score (rho=0.282) were better than the examiner AC (rho=0.209) at reflecting how bothered the children were by the alignment of their teeth, and how upset they would be if they couldn't receive orthodontic treatment (rho=0.464, 0.428 and 0.214, respectively). Children with a normative need for orthodontic treatment, based on examiner AC did not have a worse oral health-related quality of life., Conclusion(s): The CPQ and IOTN AC measure different attributes. There should be a shift towards using quality of life measures to supplement the IOTN in assessing the perceived need for orthodontic treatment.

Objective: To assess whether Brazilian adolescents who had completed orthodontic treatment had lower levels of impacts on their oral health-related quality of life., Design: A cross-sectional study., Setting: The study was conducted in public and private secondary schools in Bauru-SP, Brazil., Participants: 1675 randomly selected adolescents aged between 15 and 16 years., Methods: 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 adolescents' oral health-related impacts. Multiple logistic regression was used in the data analysis., Results: A response rate of 100% was obtained. Adolescents who had completed orthodontic treatment had fewer oral health-related impacts compared to the other two groups. They were 1.85 times (95% CI 1.30 to 2.62) less likely to have an oral health impact on their daily life activities than adolescents currently under treatment or 1.43 (1.01 to 2.02) times than those who never had treatment., Conclusions: Adolescents who had completed orthodontic treatment had a better oral health-related quality of life than those currently under treatment or those who never had treatment.

Aim: To determine the relationship between treatment need assessment scores of orthodontists, general practitioners, and pediatric dentists., Study Design: Observational., Sample: Ten general dental practitioners, 18 orthodontists and 15 pediatric dentists reviewed 137 dental casts and recorded their opinion on whether orthodontic treatment was needed., Results: We found a high level of agreement between pediatric dentists, orthodontists and general practitioners (Kappa range 0.86-0.95). Between the groups, the amount of agreement was lower., Conclusions: Orthodontists, general dental practitioners, and pediatric dentists in this sample exhibit high levels of agreement on orthodontic treatment need.

Objective: The aim of this study was to describe thoughts and values influencing young people's choices to undergo orthodontic treatment., Subjects and Methods: Twenty-eight patients (11 boys), aged 13-19 years, at an orthodontic clinic in the western part of Sweden participated. Open, taped interviews, lasting about 1 hour, were conducted with each subject and analysed by the grounded theory method. Five descriptive categories, each related to several subcategories, were generated in the analysis and labelled: 'being like everyone else', 'being diagnosed', 'focusing on the mouth', 'obeying social norms' and 'forced decision-making'., Outcome: Category forced decision-making was identified as a core category, describing the power in the social process, resulting in the decision to undergo orthodontic treatment., Conclusions: Motivation for the decision to undergo orthodontic treatment seemed to be social norms, and the beauty culture in their reference group and in society in general. The teenagers were not fully conscious of these external influences. Their opinion, as a group, was that they had made an independent decision to undergo orthodontic treatment.

Over the last 10-15 years, the terms quality of life (QOL) and health-related quality of life (HRQL) have been seen increasingly in medical literature. Much of the orthodontic treatment that is undertaken is justified on the basis of improving health-related quality of life. With this in mind, studying HRQL in orthodontic patients has the potential to provide information about treatment needs and outcomes, and may also facilitate improved care. Clinicians should therefore be aware of some of the ways in which health-related quality of life may be assessed. The first part of this review article looks at the general concepts of health-related quality of life, whilst the second section focuses on dentistry and orthodontics.