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Objective: To synthesize evidence on the impact of malocclusion and its associated treatment on people's quality of life across studies that used the Oral Health Impact Profile (OHIP-14) questionnaire in the adult population., Materials and Methods: A systematic search of the English literature using Medline, PubMed, and EMBASE yielded 98 unique citations. Studies using OHIP-14 with individuals 15 years of age and older were included. After initial screening, 64 citations were excluded and another 9 were excluded after reading full text reports; the remaining 25 were included in the review. All studies were observational and used one of three study designs: 11 compared the same group before and after treatment (pre-post design), 10 compared groups with and without malocclusion (independent groups design) and four compared an orthodontically treated group with an independent group requiring treatment (treated-untreated groups design). Only three studies using the pre-post design and four using the independent groups design reported comparable OHIP-14 data and were combined in separate meta-analyses. Meta-analysis was carried out using metan command in Stata., Results: The standardized mean difference (SMD) in OHIP-14 total score was 1.29 (95% CI: 0.67 to 1.92) for the three studies using the pre-post design. Similarly, the SMD score was 0.84 (95% CI: 0.25 to 1.43) for the four studies using the independent groups design. There was evidence of high heterogeneity and publication bias among the studies included., Conclusions: This meta-analysis revealed that OHIP-14 scores were significantly lower after receiving treatment for malocclusion and in individuals without malocclusion/orthodontic treatment need compared to those with such condition (independent groups).

Objective: To compare personality traits, attitude toward orthodontic treatment, and pain perception and experience before and after orthodontic treatment., Materials and Methods: One hundred subjects (50 male and 50 female) were included in this study. The mean (SD) age was 17.5 (2.05) years at T1 and 19.15 (2.32) years at T2. The instruments for data collection were questionnaires that included assessment of patients' personality traits, attitudes toward orthodontic treatment, and pain perception/experience. Subjects completed the questionnaires at two different times: before orthodontic treatment (T1) and after fixed orthodontic treatment (T2). Subjects were treated by fixed orthodontic appliances for an average (SD) period of 18.64 (0.35) months. Paired sample t-test and chi-square test were used to detect any differences., Results: Significant changes in personality traits were detected after orthodontic treatment irrespective of gender. Neuroticism, openness, agreeableness, and conscientiousness scores were improved (P < .001). A positive attitude toward orthodontic treatment was reported at T1 (4.31 [±1.26]) and improved at T2 (3.98 [±1.16]) irrespective of gender (P < .05). The average (SD) expected pain score (T1) was 4.73 (1.88) and the average (SD) experienced pain score (T2) was 4.63 (1.58). Significant difference in the expected and experienced pain scores was not detected (P  =  .11)., Conclusions: Personality traits and attitude toward orthodontic treatment improved after orthodontic treatment. Reported actual pain experience during orthodontic treatment was similar to that expected before treatment.

Objective: To estimate the prevalence of the desire for orthodontic treatment and investigate associated factors among adolescents in southern Brazil., Materials and Methods: A cross-sectional study was carried out with 704 adolescents aged 12 and 13 years at municipal public schools in the city of Balneário Camboriú (southern Brazil). The adolescents answered a previously tested questionnaire addressing satisfaction with their dental appearance, speech function, chewing function, and the desire for orthodontic treatment. The parents/guardians answered a questionnaire addressing satisfaction with their child's dental appearance and socioeconomic variables. A trained and calibrated orthodontist collected clinical data on malocclusion using the Dental Aesthetic Index (DAI). Statistical analysis was performed using multivariate Poisson regression with robust variance., Results: The prevalence of the desire for orthodontic treatment was 69.6% (490/704). In the adjusted analysis, the outcome was significantly more prevalent among girls (P < .001), those with difficulty chewing (P  =  .026), those dissatisfied with their dental appearance (P < .001), and those with greater malocclusion severity (P < .001). The following orthodontic characteristics were associated with the desire for orthodontic treatment in the multivariate model: diastema in anterior segment (P < .001), anterior maxillary irregularity (P < .001), maxillary overjet ≥6 mm (P < .001), and mandibular overjet (P  =  .047)., Conclusions: The desire for orthodontic treatment among 12- and 13-year-old adolescents is influenced by gender, dissatisfaction with one's dental appearance, difficulty chewing, malocclusion severity, and orthodontic characteristics. These findings should be considered together with normative indications regarding the need for orthodontic treatment in adolescents.

Objectives: To examine factors associated with treatment outcome satisfaction in a group of adolescent patients., Materials and Methods: One hundred and twenty patients (60 girls and 60 boys; mean age, 14.3 years; standard deviation [SD], 1.73 years) were consecutively recruited. The inclusion criteria for all patients were as follows: adolescents with a permanent dentition in need of orthodontic treatment and a treatment plan involving extractions (two or four premolars) followed by fixed appliances in both jaws. Questionnaire 1, concerning treatment motivation and expectations, was assessed prior to treatment start. Questionnaire 2 was assessed after active treatment and included questions about satisfaction with treatment outcome, quality of care and attention, and perceived pain and discomfort during active treatment., Results: One hundred and ten patients completed the trial (54 boys and 56 girls; mean age, 16.9 years; SD, 1.78 years). Median values for satisfaction with treatment outcome were generally high. There was a clear correlation (P ≤ .001) between satisfaction with treatment outcome and patients' perception of how well they had been informed and cared for during treatment. Pain and discomfort during treatment also strongly affected treatment satisfaction. Sex, treatment time, and Peer Assessment Rating index pre- and posttreatment as well as expectations for future treatment showed no correlation with treatment satisfaction., Conclusions: Care and attention was the variable showing the highest correlation with satisfaction with treatment outcome. Patients' perceptions of pain and discomfort during treatment had an overall negative correlation with treatment satisfaction. Satisfaction with treatment outcome is a complex issue and requires further exploration in future research.

Objective: To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups., Materials and Methods: Fifty-two patients (36 women, 16 men; age 18-61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need., Results: Oral health-related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health-related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups., Conclusion: Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health-related quality of life, particularly by decreasing psychological discomfort and psychological disability.

Objective: To investigate the content of orthodontic-related Twitter posts in order to improve our understanding of orthodontic patients' perceptions and treatment experiences., Materials and Methods: Some 131 consecutive posts were collected from Twitter over a 5-day period. Twitter's advanced-search function was used to limit the sampling frame to New Zealand. The posts were qualitatively analyzed for themes using discourse analysis., Results: Four main themes were identified: (1) excitement about getting braces off, (2) problems with braces, (3) positive comments about braces, and (4) negative comments about braces. Various language tools and symbols were often used to convey different degrees of emotion. The present study explores these themes and discusses how they relate to modern-age orthodontics., Conclusion: This is the first study to qualitatively analyze orthodontic-related posts in the social media era. Our findings suggest that orthodontic patients use social media sites such as Twitter to convey positive and negative feelings about braces.

Objective: To establish an association between patient personality traits and potential willingness to undergo various orthodontic treatments., Materials and Methods: One hundred adolescent individuals aged 12-16 years completed an anonymous electronic questionnaire via Survey Monkey. The 24-item questionnaire contained three major sections: patient demographics, a modified Big Five Inventory (BFI)-10 personality index, and a willingness to undergo treatment assessment. Multiple-variable linear regression analyses were used to determine the associations among age, gender, ethnicity, and the five personality traits simultaneously with willingness to undergo treatment. Statistical significance was set at P ≤ .05., Results: Ninety-six of the 100 individuals were included in the statistical analysis. Age, ethnicity, and gender failed to correlate with potential willingness to undergo orthodontic treatment. Several personality dimensions within the modified BFI-10 (agreeableness, conscientiousness, and neuroticism) were significantly associated with willingness to undergo various orthodontic treatments (P ≤ .05). Agreeableness demonstrated positive correlations with five treatment modalities, while both conscientiousness and neuroticism exhibited negative associations with a single treatment modality. Openness and extraversion were the only personality dimensions that failed to associate with any of the treatment modalities. Four of the nine treatment modalities had no association with patient demographics or a patient's personality dimensions., Conclusions: Personality traits are useful in predicting a patient's potential willingness to participate in various orthodontic treatments. The agreeableness dimension provided the most utility in predicting patient willingness. Age, ethnicity, and gender were not significant in predicting patient willingness.

Objective: To investigate the relationship between personality traits and a person's attitude toward orthodontic treatment and perception of pain during orthodontic treatment., Materials and Methods: The sample consisted of two groups: group 1 consisted of 200 untreated subjects (100 males, 100 females; average age, 21.50 +/- 3.35 years), and group 2 consisted of 200 treated subjects (100 males, 100 females; average age, 20.92 +/- 2.48 years). The instrument for data collection was a questionnaire that included assessment of patients' personality profiles, pain expectation for untreated subjects, pain experience for treated subjects, and attitudes toward orthodontic treatment., Results: Gender, treatment status, and personality traits did not affect subjects' average attitude toward orthodontic treatment, whereas gender was the only variable that affected subjects' average pain perception (P < .01). The average attitude score in subjects who experienced pain during orthodontic treatment was 5.06 +/- 1.43, compared to 4.32 +/- 1.35 for subjects who did not experience pain (P < .001). The average pain perception scores in treated subjects with previous knowledge of orthodontic treatment was 5.29 +/- 1.94, compared to 6.07 +/- 1.95 in subjects who did not have previous knowledge of orthodontic treatment (P < .01)., Conclusions: Personality traits did not affect attitude toward orthodontic treatment and pain perception/experience during orthodontic treatment. A more positive attitude was found in patients who experienced less pain during orthodontic treatment.

Objective: To test the hypothesis that lower facial height has no influence on frontal facial attractiveness and treatment need perception of lay people., Materials and Methods: Frontal facial silhouettes of a man and a woman with normal lower facial height values (male: 81.5 mm; female: 70.5 mm) were modified by increasing and decreasing their lower facial heights in steps of 1 mm to obtain frontal images with different lower facial height alterations ranging from +6 mm to -6 mm for each sex. A panel of 100 lay people scored each silhouette's attractiveness on a 100-mm visual analogue scale (VAS) and also indicated whether they would seek treatment if the image represented their own. The Wilcoxon signed rank test was used to compare the VAS scores., Results: Unaltered +/-1-mm and +/-2-mm silhouettes got the highest VAS scores. Scores were significantly lower (P < or = .001) as the divergence from the normal value exceeded 2 mm. Beyond +3 mm and -4 mm in females and +4 mm and -3 mm in males the difference between the scores became statistically insignificant. At +/-4 mm, more than 75% of the raters elected to have treatment., Conclusion: The hypothesis was rejected.

Objective: To identify factors associated with patient satisfaction at least 5 years after orthodontic treatment., Materials and Methods: A total of 209 orthodontic patients were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances. Dental casts (n = 627) were examined using the Peer Assessment Rating (PAR) Index pretreatment (T1), at the end of treatment (T2) and at a long-term follow-up (mean, 8.5 years; T3). At T3, a Dental Impact on Daily Living questionnaire was used to assess the long-term effects of orthodontic treatment on daily living and satisfaction with the dentition. Multiple regression analyses were used to quantify associations between patient satisfaction and changes produced by the orthodontic treatment (PAR T2-T1), posttreatment stability (PAR T3), age at the start of treatment (T1), treatment duration (T2-T1), gender, and extraction., Results: Orthodontic treatment produced a significant improvement of 94.2% in the PAR Index (T2-T1), but this change was not associated with the level of satisfaction when the patient was questioned at least 5 years after treatment. Regression analysis showed that satisfaction was significantly associated only with the long-term posttreatment PAR index (r(2) = 0.125, P < .0001). No significant association was observed with the severity of malocclusion at the beginning (PAR-T1) or end of the orthodontic treatment (PAR-T2), age at T1, the amount of time taken during orthodontic treatment, gender, or extraction., Conclusions: Over the long term, patient satisfaction is slightly associated with the stability of the orthodontic treatment regardless of the initial occlusal condition or the final result of the orthodontic treatment.

Objective: To discern patients' opinions regarding responsibility for orthodontic retention and to determine whether patient attitudes toward retention are related to perceptions of treatment success., Materials and Methods: Questionnaires regarding orthodontic retention were distributed to first-year undergraduate college students (n = 158), first-year dental students (n = 183), and retention patients at orthodontic offices (n = 214). Items included treatment satisfaction, perceived responsibility for retention, type of retainer prescribed, reasons for discontinuing use of retainers, and relapse experienced., Results: Four hundred twenty-eight of 555 participants indicated that they had received orthodontic treatment. Most indicated they were either "satisfied" or "very satisfied" with their teeth, both at the end of treatment (96%) and currently (84%). There was a strong relationship between the perception of stability of tooth position and current satisfaction level (P < .0001). Most individuals (88%) indicated that they themselves were responsible for maintaining the alignment and fit of their teeth. Those who indicated that someone else was responsible were nearly twice as likely to be dissatisfied with their teeth (P = .0496). Patients who had been prescribed clear, invisible retainers were significantly more likely to be "very satisfied" currently (50%) compared to those with Hawley (35%) or permanently bonded (36%) retainers (P = .0002). Patients with Hawley retainers were significantly less likely to be wearing them currently as prescribed (45%) than those with invisible (65%) or bonded (68%) retainers (P < .0001)., Conclusions: Satisfaction with orthodontic results after treatment is related to patient perceptions of responsibility for retention and perceived stability of tooth position. Patients should play a contributory role in formulating orthodontic retention plans.

Objectives: To test the null hypotheses that supplementation of verbal information with written information when obtaining consent to orthodontic treatment has no effect on (1) anxiety, motivation and apprehension related to treatment and (2) compliance in the early stages of fixed appliance therapy., Materials and Methods: Seventy-six adolescents who were due to start fixed appliance therapy were randomly allocated to receive verbal information only or verbal and written information before orthodontic treatment. Participants' anxiety, motivation, and apprehension were assessed using a questionnaire that was completed prior to meeting the orthodontic clinician (T1), following consent to treatment (T2), and after 12 weeks of treatment (T3). Appointment attendance, appliance breakages, and periodontal scores were used as measures of patient compliance., Results: Sixty participants completed the study. At T2 there was no change in anxiety scores for either group (P = .412); however, increased motivation was detected in the group that had been given both written and verbal information (P = .049). At T3 both groups demonstrated similar reductions in anxiety (P = .311) and apprehension (P = .790) and similar levels of motivation (P = .756). A reduction in periodontal scores (P = .065), better appointment attendance (P = .732), and fewer breakages (P = .525) were reported in the group that was given additional information, although these changes were not statistically significant., Conclusions: Supplementation of verbal information with written information resulted in improved motivation for orthodontic treatment but had no statistically significant effect on anxiety, apprehension, or patient compliance.

Objective: To determine whether adolescents' satisfaction with orthodontic treatment outcomes is correlated with the degree to which (1) the adolescents focused on and (2) were energized by imagining their posttreatment possible selves before the treatment, and whether parents' assessments of their children's pretreatment motivation would correlate with their children's posttreatment satisfaction., Methods: Data were collected from 75 former adolescent orthodontic patients (28 male, 47 female; 60 European American, 14 other) and from 72 parents (59 female, 12 male, 1 missing) with mailed questionnaires. Satisfaction with the treatment outcome was assessed with a revised version of Kiyak's Post-Surgical Patient Satisfaction Questionnaire., Results: The more the patients had focused on the posttreatment esthetics and functioning and the more they were energized by thinking about their posttreatment possible selves before the treatment, the more satisfied they were with the outcomes (r = .337, P = .004; r = .231, P = .053; r = .465, P < .001). The more the parents believed that their children were energized by thinking about posttreatment possible selves, the more satisfied the parents were with the outcomes (r = .326, P = .007)., Conclusions: Increasing adolescents' possible self considerations before orthodontic treatment is likely to increase their own and their parents' posttreatment satisfaction.

Objective: To test the scientific properties of a patient-based questionnaire developed to measure adolescent patient's satisfaction with the process of orthodontic treatment., Materials and Methods: Forty-nine consecutive patients aged 9 to 17 years undergoing orthodontic treatment were asked to complete the questionnaire on two separate occasions. Test-retest reliability, readability, ease of administration, criterion validity, and construct validity were tested. All patients answered the questionnaire at time 1 and took part in the construct validity study. Ten patients took part in an ease of administration study and 17 patients took part in the criterion validity study., Results: Thirty-one patients completed the questionnaire at time 2, giving a response rate of 63.3%. The test-retest reliability was excellent in one section, moderate in six sections, and poor in one. The questionnaire had a Flesch Reading Score of 79.8, equivalent to a reading age of 10 years and was easily administered in 5 to 15 minutes. Although the construct validity of the questionnaire was excellent in five of the six measures and moderate in the other, the criterion validity was poor for 7 of the 14 items selected to test., Conclusion: This pilot study demonstrates the need to test a questionnaire before use in audit or research.

Objective: To assess the current evidence of the relationship between malocclusion/orthodontic treatment need and quality of life (QoL)., Materials and Methods: Four electronic databases were searched for articles concerning the impact of malocclusion/orthodontic treatment need on QoL published between January 1960 and December 2007. Electronic searches were supplemented by manual searches and reference linkages. Eligible literature was reviewed and assessed by methodologic quality as well as by analytic results., Results: From 143 reviewed articles, 23 met the inclusion criteria and used standardized health-related QoL (HRQoL) and orthodontic assessment measures. The majority of studies (18/23) were conducted among child/adolescent populations. Seventeen of the papers were categorized as level 1 or 2 evidence based on the criteria of the Oxford Centre for Evidence-Based Medicine. An observed association between HRQoL and malocclusion/orthodontic treatment need was generally detected irrespective of how they were assessed. However, the strength of the association could be described as modest at best. Key findings and future research considerations are described in the review., Conclusions: Findings of this review suggest that there is an association (albeit modest) between malocclusion/orthodontic treatment need and QoL. There is a need for further studies of their relationship, particularly studies that employ standardized assessment methods so that outcomes are uniform and thus amenable to meta-analysis.

Objective: To define a grade in the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) that would differentiate between esthetically acceptable and unacceptable occlusions and that would also be both subjectively and objectively meaningful., Materials and Methods: Dental appearance and self-perceived orthodontic treatment need were analyzed in a group of Finnish young adults (171 males, 263 females, age range 16-25 years). Subjective data were gathered using a questionnaire, and the respondents were requested to score their dental appearance on a visual analog type 10-grade scale. Professional assessment of dental appearance was performed by two orthodontists using the AC of the IOTN. The cutoff value between esthetically acceptable and unacceptable occlusions was defined using receiver operating characteristic curves., Results: Sixty-six percent of orthodontically treated and 74% of the untreated respondents were satisfied with their own dental appearance. Every third respondent reported one or more disturbing traits in their dentition. The most frequently expressed reason for dissatisfaction was crowding; girls expressed dissatisfaction more often than boys did (P = .005). A self-perceived treatment need was reported infrequently by 8% of orthodontically treated and 6% of untreated respondents. In the logistic regression analysis, self-perceived need for orthodontic treatment was the only significant factor explaining dissatisfaction with own dental esthetics. On the applied scales, grades 1 and 2 fulfilled the criteria for satisfactory dental esthetics., Conclusion: The results suggest that the AC grade 3 could serve as a cutoff value between esthetically acceptable and unacceptable occlusions.

Objective: To examine, in adolescents with mild to moderate malocclusion, the relationship between self-concept and demographic characteristics, a clinical assessment of malocclusion, self-perception of malocclusion, and self-perception of facial attractiveness., Methods and Materials: Fifty-nine consecutive patients ages 9 to 15 years scheduled for initial records in a graduate orthodontic clinic consented to participate. Each subject independently completed the Multidimensional Self-Concept Scale (MSCS), the Facial Image Scale, and the Index of Treatment Need-Aesthetic Component (IOTN-AC). Peer Assessment Rating (PAR) scores were obtained from the patients' diagnostic dental casts. Forward multiple-regression analysis with a backward overlook was used to analyze the effect of the demographic, clinical, and self-perception measures on each of the six self-concept (MSCS) domains., Results: Self-perception of the dentofacial region was the only statistically significant predictor (P < .05) for the Global, Competence, Affect, Academic, and Physical domains of self-concept, while age, parental marital status, and the adolescent's self-perception of the dentofacial region were statistically significant predictors (P < .05) of Social Self-Concept., Conclusion: The self-perceived level of the attractiveness or "positive" feelings toward the dentofacial region is more strongly related to self-concept than the severity of the malocclusion as indicated by the PAR score or by the adolescent's perception of their malocclusion.

Objective: To establish the relationship between the personality traits of the adolescent and his or her cooperation with the orthodontic treatment., Materials and Methods: From a sample of 70 adolescent orthodontic patients (46 girls and 24 boys) between 12 and 15 years of age (average age, 13.4 +/- 1.1 years), the patients' personality traits were evaluated by using a personality questionnaire (16 Personality Factors-Adolescent Personal Questionnaire) and the degree of patient cooperation was assessed through the cooperation test (Orthodontic Patient Cooperation Scale [OPCS]). The cutting point for the assessment of cooperation on the OPCS questionnaire (noncooperation vs cooperation) was carried out through the receiver operating characteristic (ROC) analysis of curves. A chi2 test with Yates correction (P < or = .05) was applied to evaluate the associations between the degree of cooperation and the scales of personality, gender, or age., Results: The cutting point for cooperation as assessed by the OPCS by means of ROC analysis was 380. No statistically significant relations were found between the degree of cooperation and the scales of personality, gender, or age., Conclusions: The results of the current study indicate that the personality traits alone of adolescents do not predict cooperation during treatment.

Objective: To determine patients' expectations, acceptance, and experience of pain with microimplant surgery compared to other orthodontic procedures., Materials and Methods: Seventy-eight microimplants were placed in 37 patients as an anchorage unit for orthodontic treatment. Patients were asked to rate anticipated pain and pain experienced with various orthodontic procedures (tooth extraction, insertion of separators, initial tooth alignment, and microimplant surgery) on a visual analog scale (VAS) over a 7-day period. One month after insertion of microimplants, patients were asked to rate their acceptance of the procedure using a structured questionnaire., Results: Unlike other orthodontic procedures, patients expected to experience a significantly higher level of pain with microimplant surgery than they experienced (P < .001). The postoperative pain experienced decreased continuously from day 1 to day 7 for all orthodontic procedures (P < .05). The total area under the curve (AUC) of pain experienced over the 7-day period was significantly larger for initial tooth alignment than for microimplant surgery (P < .05). Most patients were satisfied with the microimplant surgery (76%) and would recommend it to a friend or family member (78%)., Conclusions: Patients tended to overestimate the pain anticipated with microimplant surgery. Patients were accepting of the surgery and would recommend it to others.

Objective: To investigate whether the oral health of young male adults was related to (1) the degree of self-perceived malocclusion, (2) the degree of experienced negative psychosocial impact of dental esthetics, and (3) the history of orthodontic treatment and its duration., Materials and Methods: The study subjects were 470 male naval recruits undergoing a routine dental health checkup. They answered the Perception of Occlusion Scale (POS) and Negative Impact of Dental Aesthetics Scale (NIDAS). The Approximal Plaque Index (API), the Sulcus Bleeding Index (SBI), and the number of decayed teeth (DT) and missing teeth (MT) were examined by a staff dentist. Statistical procedures were one-way analyses of variance in the API and SBI and nonparametric Kruskal-Wallis, Mann-Whitney, and chi(2) tests in DT and MT as dependent variables., Results: (1) The subjects ranging within the upper POS quartile scored higher on the SBI (contrast: P = .003) and DT (P = .002) than did those in the lower POS quartiles. (2) In contrast to the subjects reporting minor negative impacts in the NIDAS, those with strong impacts had higher scores on the API and MT (each P < .001). (3) In the subjects with a history of orthodontic treatment lasting 30 months and longer, lower API (P < .05), SBI and DT (each P = .002), and MT (P = .007) scores were found than in the subjects without previous orthodontic treatment., Conclusion: The results suggest that self-perceived dental irregularity and negative impact of dental esthetics might affect oral health, whereas previous extensive orthodontic treatment may have favorable effects by improving dental health compliance.

Objective: To compare patients' expectations of the impact of wearing fixed orthodontic appliances on life quality with realities experienced over a 6-month period., Materials and Methods: Two-hundred and seventeen consecutive orthodontic patients (mean age 13.1 +/- 1.5 years) self-completed a 37-item Child Perception Questionnaire (CPQ) in relation to how they expected wearing fixed orthodontic appliances would affect their QoL during orthodontic treatment. The CPQ assessed the attributes of oral symptoms, functional limitations (FL), emotional well-being (EWB), and social well-being (SWB). Expectations were compared with the patients' pretreatment values and reported experiences at 1 week, 1 month, 3 months, and 6 months after insertion of the fixed appliances., Results: The response rate was 91% (197/217). Patients expected that wearing fixed appliances would considerably compromise their overall oral health-related QoL (OHQoL) compared with pretreatment (P < .001). At 1 week they reported that EWB (P < .001) and SWB (P < .05) were less compromised than expected. At 1, 3, and 6 months, FL (P < .001), EWB (P < .001), SWB (P < .001), and overall OHQoL (P < .001) were less compromised than expected., Conclusions: This study indicated the impact on QoL after insertion of fixed orthodontic appliances was considerately less than what child patients expected.

Objective: To evaluate the reliability of a questionnaire that assessed the expectations and experiences of adolescent patients about orthodontic treatment., Materials and Methods: The study included two groups of patients: 30 consecutive patients (19 girls and 11 boys, mean age 14.6 years, SD 2.3 years) naïve to orthodontic treatment, and 30 consecutive adolescent patients (17 girls and 13 boys, mean age 15.1 years, SD 2.0 years) in active orthodontic treatment with fixed appliances in both jaws. A questionnaire comprising 46 items was developed, based upon focus group interviews and previous established questionnaires. The questionnaire covered the following domains: Treatment motivation; treatment expectations; pain and discomfort from teeth, jaws, and face; functional jaw impairment; and questionnaire validity. Internal consistency as well as temporal stability with the test-retest method was investigated., Results: A majority of the questions exhibited acceptable test-retest reliability, and composite scores yielded excellent reliability for all domains. Internal consistency was acceptable and good face validity was found for all domains., Conclusion: The questionnaire can be recommended for use in the assessment of expectations and experiences of orthodontic treatment.

The objective of this study was to identify factors that may affect patients' satisfaction with their dentition after orthodontic treatment. Fifty patients (20 males and 30 females; mean age 20.7 +/- 4.2 years) who successfully had finished fixed orthodontic treatment were included in the study. All subjects were treated with upper and lower fixed orthodontic appliances for an average duration of 19 +/- 4 months and were in retention stage (6-12 months) with upper Hawley and lower fixed bonded retainers. Dental Impact on Daily Living questionnaire was used to assess the effect of orthodontic treatment on daily living and satisfaction with the dentition in the study sample. The NEO Five Factor inventory was used to assess personality profiles in the study sample. Comparisons between groups were made using chi-square test. Personality traits were found to be correlated with patients' satisfaction with their dentition after orthodontic treatment. Higher neuroticism scores had a significant negative relationship with total satisfaction with the dentition (P < .05). Age, sex, and pretreatment orthodontic treatment need had no relationship with the patient's satisfaction. Patients treated nonextraction showed more dissatisfaction with their dentition (P < .05). In orthodontically treated patients, higher neuroticism scores were associated with lower levels of satisfaction with the dentition.

The aim of this study was to determine which dental esthetic self-perception evaluation tool discriminated better between orthodontically treated or untreated Peruvian young adults. A total of 630 students were randomly chosen from the 2000 admitted in 2002 to a private university in Peru. Students undergoing active orthodontic treatment at the time of examination were excluded. Self-perceived dental esthetic appearance was evaluated through Standardized Continuum of Aesthetic Need, Oral Aesthetic Subjective Index Scale, and Visual Analogue Scale (VAS). A stepwise multivariate discriminant analysis was developed to classify orthodontic treatment according to the three evaluation tools. A total of 199 students (31.6%) reported a history of orthodontic treatment. Differences between orthodontically treated and untreated groups were found only for the mean VAS score (P < .001). Although three different approaches were used to evaluate dental esthetic self-perception, only VAS allowed the discrimination of the self-perceived dental appearance between orthodontically treated and untreated Peruvian university young adults. Similarities in the self-perceived dental appearance of treated and untreated groups reported in previous epidemiological studies could be explained because different evaluation instruments were used. Further studies are required to support current findings.

The objective was to determine the effect of three different methods of presenting information on the recall of information in orthodontic patients in the short and long term. Thirty orthodontic patients at the commencement of their treatment were allocated randomly to groups receiving supporting written information in one of the three formats: mind map, acronym, and information leaflet. Short-term retention was assessed by administration of a nine-item questionnaire 10 to 15 minutes after receiving the information, and long-term retention was assessed after six weeks by repeating the same questionnaire without repetition of the information. Correct answers to the questions were compared across the three groups at short-term recall and long-term recall. A total knowledge score was determined by summing the number of correct answers across all nine items, and an analysis of covariance (ANCOVA) was conducted to determine the effect of the method of information on long-term retention of the information. There were significant differences in recall between the three methods of presentation at both time 1 and time 2 (Fshort-term = 5.97, P < .01; Flong-term = 3.19, P < .05). Participants who were given a written information leaflet recalled less information on both occasions of testing. ANCOVA revealed that the three methods did not differ in the rate of forgetting of the material (F = 1.96, nonsignificant). Mind maps and acronyms convey a small but significant advantage in patient recall of information over written information leaflets.

Recent studies have shown that there is a distinct relationship between patient satisfaction and patient compliance in orthodontic treatment. The aim of this study was to investigate whether patient compliance, as noticed and recorded by the orthodontist during treatment, can be used as a determinant of patient's satisfaction in the long run. Documentation of 100 patients who completed active orthodontic treatment in the year 2000 at the Academic Centre of Dentistry Amsterdam was analyzed, and compliance scores for patients were computed. Three years after completion of active orthodontic treatment, a questionnaire about satisfaction was sent to all subjects. Items were divided over six subscales on the basis of item content. Compliance and satisfaction scores of both sexes were compared, and correlations between compliance and satisfaction were explored. Regression analyses were done to examine the predictive value of sex and compliance on patient satisfaction. No significant correlations between compliance and satisfaction scores were found. Sex, but not compliance, predicted the patient's satisfaction with the doctor-patient relationship and the situational aspects of the treatment. Compliance, as noticed and recorded by the orthodontist during treatment, is not a decisive determinant of patient satisfaction in the long run. Sex, however, is a predictor of patient satisfaction with regard to the doctor-patient relationship and the situational aspects of the orthodontic treatment.

Soft tissue analyses are basic tools in planning orthodontic treatment. However, the perception of a well-balanced Japanese facial profile has not yet been established, particularly with respect to changes in facial convexity. The purpose of this study was to assess and determine the range of antero-posterior (A-P) lip positions of the top three most favored, well-balanced profiles from a series of various facial silhouettes with changing facial convexity. The average profile was constructed from the profiles of 30 Japanese males and females with Class I occlusions. Changes in facial convexity were established by altering the A-P chin position by protruding or retruding the chin in increments of 5 degrees and 10 degrees from the average profile. A series of 11 profiles were developed from each of the four changes in facial convexity. The lips were then protruded or retruded in one-mm increments from the average profile. Forty orthodontists were asked to rate the top three most favored, well-balanced profiles. We found that the raters tended to prefer more retruded lip positions as facial convexity decreased, for both males and females. The raters also tended to prefer slightly more protruded lip positions as the facial convexity increased. Because chin position is inherent in each patient, others may equate a retrusive or protrusive chin with certain personalities, thus, it is important for orthodontists to take into account the balance between the lips and the chin.

The objective was to investigate the opinion of Tanzanian parents on dental attractiveness and to compare their opinion with that of their children. A prestructured questionnaire with 18 intraoral frontal photographs was given to 286 parents and their children aged 9-18 years. The photographs represented various types of occlusion traits, with the first 10 intraoral photographs representing grade 1-10 of the aesthetic component (AC) of the index of orthodontic treatment need, and the remaining eight photographs were added to represent malocclusions that are often seen in Tanzania. Basic statistical techniques were used to analyze the data. Photographs showing severe deviations were perceived by both children and parents as the most unattractive. The opinion was significantly correlated with children's age (P = .02) and sex (P < .0005), with older girls tending to dislike photographs showing severe deviations the most. The mean of the opinion for the photographs showing some spacing with overbite < or = 2 mm or open bite and overbite > 2 mm fell in the middle of the scale, with a tendency toward unattractiveness. Photographs matching 8-10 on the AC scale were perceived as the most unattractive, indicating what could be a lay person's priority when considering an orthodontic treatment policy in Tanzania.

The aims of this study were to explore orthodontic treatment experience, subjective need for treatment, and perceptions of teeth and dental appearance in relation to background factors such as funding system, area of living, age, gender, ethnicity, and socioeconomic status. The subjects were 1076 randomly selected second-year high school students from a rural (Jahra) and an urban (Capital) area of Kuwait, with a mean age of 15.1 years. Kuwaiti citizens constituted 79% of the sample, and the rest were of other Arab origins. The data were collected using a questionnaire. Orthodontic treatment rate was significantly higher for Kuwaitis (10%) than for non-Kuwaitis (2%). Among Kuwaiti subjects, urban area of living and female gender increased the odds of receiving orthodontic treatment. Subjective treatment need was 36%, with no difference between Kuwaiti and non-Kuwaiti subjects, but Kuwaitis in the rural area expressed subjective treatment need less often than those in the urban area. The results suggest that access to free-of-cost orthodontic treatment was likely to affect treatment rate, whereas it did not seem to influence the self-perceived need for treatment. Gender and area of living may be significant for the distribution of free-of-cost orthodontic treatment.

The aim of this study was to determine which factors correlate with easy and difficult treatments and to assess the use of the Index of Complexity, Outcome & Need (ICON) as an indicator for treatment difficulty. The study was conducted at 2 centers using a retrospective cross-sectional questionnaire-based design. The participants were specialist orthodontic practitioners in Dresden, Germany and Cardiff, UK. Sixteen specialist orthodontists participated. Each supplied 10 completed cases--5 they regarded as being easy and 5 as being difficult. The specialist orthodontists completed a questionnaire and stated up to 5 reasons why they considered the case easy or difficult. Two examiners were calibrated in the use of the ICON. Logistic regression analysis using a forward conditional systematic model with complexity of case (ie, easy or difficult) as the dependent variable demonstrated statistical significance of the following patient-related factors: pretreatment ICON score, number of appointments, and age. Chi-squared testing demonstrated statistical significance of the following factors: cooperation, extent of overbite, presence of dysfunction, extent of overjet, anchorage, angulation of teeth, presence of crossbite, center-line shift, nonextraction treatment, age at start of treatment, compliance during the course of treatment, oral hygiene level. This study indicates that the main distinguishing factors between easy and difficult cases appear to be pretreatment age, number of appointments, and pretreatment ICON score. However, the odds ratios were not sufficiently high for these factors to be strong predictors of difficulty.

In 1994, 1155 eight-grade students in Alachua County, Fla., were asked about self-perception of and level of concern for their occlusal status. Clinical assessments of orthodontic parameters were also recorded. Twenty-five percent of the students had a history of orthodontic treatment. Of the remaining students who had no history of orthodontic treatment, 74% reported satisfaction with the way their teeth looked, 64% expressed no perceived need for braces, and 57% were judged clinically to have optional or no orthodontic needs. Sex, soft tissue profile, overjet, anterior crowding, and molar classification were significantly associated with the perception of need for braces while race and overbite were not. Clinical judgment of orthodontic need differed significantly among levels of satisfaction with teeth. Eighth graders with no history of orthodontic treatment were generally satisfied with the appearance of their teeth and perceived less need for braces than clinicians.

Increased overjet has been associated with teasing, negative stereotyping, and low self-concept. Early treatment for children with Class II malocclusion is often recommended under the assumption that an improved dental appearance may benefit a child by increasing his or her social acceptance and hence self-concept. The self-concept of 208 patients, age 7 to 15 years and with increased overjet, was measured before treatment using the Piers-Harris self-concept scale; a subset of 87 of these children were measured again after 15 months of early growth modification. The mean self-concept score for these children was above the population norm, and there was no association between the child's score and the magnitude of his or her overjet or age. Although some significant associations were found between Class II malocclusion features and self-concept scores, the explained variation in self-concept scores was low (R2 from 5% to 8%). There was no change in the mean self-concept score of these children during early treatment, nor was there any association between reduction of Class II malocclusion features and improved self-concept. These findings suggest that children with Class II malocclusion do not generally present for treatment with low self-concept and, on average, self-concept does not improve during the brief period of early orthodontic treatment.