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Objectives: The aim of this work was to evaluate associations of oral health-related quality of life (OHRQoL) with sociodemographic factors and with emotional state in adults after orthodontic treatment for anterior tooth alignment. Few studies have examined these specific associations in the past, one reason presumably being a lack of specific instruments., Patients and Methods: A total of 128 adult patients consecutively treated with multibracket appliances were contacted during the retention period. The response rate was 68 %. They were asked to complete both an emotional well-being test (Zerssen Mood Scale, Bf-S) and a 52-item orthodontic survey of OHRQoL, which we had developed based on the German version of the Oral Health Impact Profile (OHIP-G14)., Results: The study demonstrated a high association of self-perceived apperance with OHRQoL and a strong role of the teeth and mouth. Aside from a few exceptions, the patients' responses in the survey did not reveal any significant gender-specific or age-specific differences. By contrast, patients in lower-than-normal spirits were found to also respond with significantly less favorable ratings to the survey items dealing with self-perceived overall attractiveness, facial attractivenss, and course of treatment., Conclusion: Dental appearance has a psychosocial impact on private and job-related interactions, which can increase the motivation of those affected to seek treament. Our orthodontic OHRQoL survey proved to be informative and practical. Findings that were especially striking included the patients' high acceptance of the changes induced by treatment and their high willingness to recommend such treatment to other adults.

Objectives: To describe oral health-related quality-of-life (OHRQoL) and the impact of malocclusions or orthodontic treatment need in a cohort of children in Swedish dental care, using the Swedish version of the Child Perceptions Questionnaire-Impact Short Form (CPQ11-14-ISF:16)., Subjects and Methods: Two hundred and fifty-seven children (mean age = 11.5 years, SD = 0.8, range = 9.8-13.5 years) completed the CPQ11-14-ISF:16 in conjunction with a clinical examination. In addition to malocclusions and orthodontic treatment need (based on the Index of Orthodontic Treatment Need-Dental Health Component), possible confounders (caries, enamel defects, dental trauma, headache and socio-economic markers) were recorded. Children also rated their own dental fear on the Children's Fear Survey Schedule-Dental Sub-scale (CFSS-DS)., Results: The mean total CPQ11-14-ISF:16 score was 9.31. The logistic regression analyses revealed an impact of orthodontic treatment need on OHRQoL (CPQ), but no clear association between higher severity and higher impact on OHRQoL was seen. Dental fear and headache appeared to discriminate for poorer OHRQoL. No impact from caries, enamel defects, dental trauma, or socio-economic markers was revealed., Conclusions: This cohort of children reported good self-perceived OHRQoL. Effects on OHRQoL from malocclusions or orthodontic treatment need were limited and inconsistent. Dental fear and headache were found to be more distinct impact factors on OHRQoL than were malocclusions or orthodontic treatment need.

Evaluating risks is part of the day-to-day practice of all orthodontists. Most of the time we forget that healing a patient also requires an evaluation of what is called the psychological risk. Indeed, focusing on harmonisation matters, we tend to omit that patient's requests, especially aesthetic requests, may conceal psychological problems. Such a risk is even higher when it comes to orthodontic-surgical protocols, as the physical changes are more radical. We will discuss the specificities of aesthetical demand, its links with the social discourse and the way self-esteem and reflection in the mirror are closely intermingled. Should we forget to take into account the psychological dimension of any patient, this could be a breach of professional ethics. We will furthermore consider the means we have to recognize patients with a high psychological risk. It is not in our hands to help these patients psychologically. It is in the hands of a mental health specialist, whose adress and phone number we should know in order to refer our patients to him/her., (© EDP Sciences, SFODF, 2015.)

Purpose: The present qualitative study aimed to explore the subjective perceptions and values of young adults having undergone combined orthodontic and orthognathic surgical treatment to resolve their dentofacial deformity., Materials and Methods: Ten participants (5 women and 5 men; 20 to 25 yr of age) whose combined orthodontic and orthognathic surgical treatment had been terminated 1 to 3 years before undertaking the present study were selected. Open in-depth interviews, of approximately 30 minutes' duration, were digitally recorded and transcribed verbatim. The interviews were analyzed using procedures inherent to the grounded theory approach, a qualitative approach to collecting and analyzing data that aims to develop a theoretical proposition grounded in real-world observations., Results: A core category was identified describing the participants' satisfaction with treatment outcome despite the difficult experiences that they lived through during the orthodontic and orthognathic surgical treatment. In association to the core category, 6 other categories emerged: experiences shared by those already having undergone similar treatment; shock for family and close friends at the hospital; difficulty eating; pain caused by orthodontic treatment; fears caused by swelling and complications; and smiling with self-confidence., Conclusion: A better understanding of patients' views on combined orthodontic and orthognathic surgical treatment can assist health care professionals in properly counseling patients and their families and providing better patient-centered care., (Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to assess the agreement between Brazilian adolescents and their parents or caregivers regarding the adolescents' oral health-related quality of life during orthodontic treatment., Methods: The sample consisted of 102 adolescent-parent/caregiver pairs. Adolescents answered the short form of the child perceptions questionnaire, and the parents or caregivers answered the parental-caregiver perceptions questionnaire. These questionnaires have 14 items in common organized across 4 subscales: oral symptoms, functional limitations, emotional well-being, and social well-being. Agreement on the overall score and the subscales was determined using comparison and correlation analysis. The former was performed through comparison of the mean directional and absolute differences. The latter was analyzed using the intraclass correlation coefficient., Results: The mean directional difference was significant for the oral symptoms subscale, with parents' reports lower than adolescents' reports (P = 0.012). However, it was not significant for the other 3 subscales and the overall score (P >0.05). The mean absolute difference for the overall score was 5.15, representing 9.2% of the maximum possible score. The intraclass correlation coefficient was 0.66, indicating substantial agreement., Conclusions: There was agreement between adolescents and their parents or caregivers in rating adolescents' oral health-related quality of life during orthodontic treatment., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Background: The objectives of this study were to investigated changes in OHRQoL among patients with different classifications of malocclusion during comprehensive orthodontic treatment., Methods: Clinical data were collected from 81 patients (aged 15 to 24) who had undergone comprehensive orthodontic treatment. Participants were classified 3 groups: Class I (n = 35), II (n = 32) and III (n = 14) by Angle classification. OHRQoL was assessed using the Oral Health Impact Profile (OHIP-14). All subjects were examined and interviewed at baseline (T0), after alignment and leveling (T1), after correction of molar relationship and space closure (T2), after finishing (T3). Friedman 2-way analysis of variance (ANOVA) and Wilcoxon signed rank tests were used to compare the relative changes of OHRQoL among the different time points. A Bonferroni correction with P < 0.005 was used to declare significance., Results: Significant reductions were observed in all seven OHIP-14 domains of three groups except for social disability (P > 0.005) in class I and class II, Handicap in class II and class III (P > 0.005). Class I patients showed significant changes for psychological disability and psychological discomfort domain at T1, functional limitation, physical pain at T2. Class III patients showed a significant benefit in all domains except physical pain and functional limitation. Class II patients showed significant changes in the physical pain, functional disability, and physical disability domains at T1., Conclusions: The impact of comprehensive orthodontic treatment on patients' OHRQoL do not follow the same pattern among patients with different malocclusion. Class II patients benefits the most from the stage of space closure, while class I patients benefits the first stage (alignment and leveling) of treatment in psychological disability and psychological discomfort domains.

Introduction: Many psychological, social, and cultural factors influence parents' motivation to seek orthodontic care for their children. In this study, we used Q methodology to identify and categorize shared motives and determine whether cultural differences exist between Hispanic/Latino (H/L) and non-Hispanic/Latino, white (W) parents., Methods: The fundamental question posed to the parents was "Why do you want your child to have braces?" Q methodology involves 3 stages. (1) Interviews of H/L (n = 5) and W (n = 5) parents generated 35 statements that represented different motives to seek orthodontic care. (2) In the Q sort, 70 new parents (22 H/L, 48 W) ranked statements in order of relative importance using a forced distribution grid. (3) Factor analysis was performed separately for the H/L and W groups to uncover cultural differences., Results: Four motivational profiles were described for both the H/L and W parents based on the significant factors identified in each group. More H/L parents (18 of 22 parents) than W parents (22 of 48 parents) were characterized by 1 of their group's 4 profiles. Comparisons of the motivational profiles across the groups showed 4 global themes: well-timed treatment that prevents future dental problems, parental responsibility, perceived benefits, and perceived need instilled by the dentist., Conclusions: Four global themes captured the motives of most parents seeking orthodontic treatment for their children. Understanding these global themes can help clinicians frame their treatment discussions with parents., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: The purpose of this study was to investigate the effect of orthodontic treatment on oral health-related quality of life (OHRQoL) in groups of standard patients with severe malocclusions; cleft lip, cleft palate, or cleft lip and palate patients; and orthognathic surgery patients., Methods: The study sample consisted of 83 consecutive patients undergoing treatment at the orthodontic unit of Christchurch Hospital, Christchurch, New Zealand, divided into 3 groups: 30 adolescents with severe malocclusions; 24 adolescents with cleft lip, cleft palate, or cleft lip and palate; and 29 adults with severe skeletal discrepancies requiring both orthognathic surgery and orthodontic treatment. Each patient completed the Short Form of the Oral Health Impact Profile (OHIP-14) questionnaire before and after orthodontic treatment., Results: The baseline OHIP-14 subscale scores among the 3 study groups were significantly different, with the surgery patients having nearly twice the OHIP-14 scores of the other 2 groups for nearly half of the items (P <0.05). The surgery patients experienced the greatest reduction in OHIP-14 scores (ie, improvement in OHRQoL), with the largest effect sizes reported for the psychological discomfort (+2.73) and disability (+2.65) domains. The group with clefts experienced the smallest changes in OHIP-14 scores across all 7 domains (-0.03 to +0.63). After adjusting for age and sex, the surgical patients had a significantly greater reduction in pretreatment OHIP-14 scores than did the standard and the cleft patients (P <0.01)., Conclusions: The effect of orthodontic treatment on OHRQoL varies for different patient groups even after adjusting for age and sex. The greatest improvement in OHRQoL occurred in adults with a need for orthognathic surgery, whereas the least improvement seemed to occur in adolescents with cleft lip, cleft palate, or cleft lip and palate., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objective: To assess parents' and caregivers' view of the first twelve months of adolescents' orthodontic treatment with fixed appliances and to assess the evaluative properties of the Brazilian version of the Parental-Caregiver Perceptions Questionnaire (P-CPQ) in the orthodontic setting., Methods: Data from a sample of 96 parents and caregivers of adolescents undergoing orthodontic treatment with fixed appliances were collected by means of P-CPQ. Assessments were performed before banding and bracket bonding (T1) and 12 months after placement of fixed appliances (T2). Statistical analysis included Wilcoxon signed-rank test for the overall P-CPQ score and Bonferroni correction for P-CPQ subscales. The evaluative properties of the P-CPQ were assessed through responsiveness calculation and the minimally clinical important difference (MCID)., Results: Among the 96 participants, 76 were mothers of patients, 16 were fathers, and four were other family members. Adolescents' mean age was 11.49 ± 0.50 years. Most families earned equal to or less than three times the Brazilian monthly minimum wage. There was significant improvement in the emotional and social well-being subscales (p< 0.001), which contributed to improve patient's overall quality of life (p< 0.001). Reductions in scores were associated with clinically meaningful moderate changes in the overall score as well as in the emotional and social well-being subscales. The MCID was 6.16 for the P-CPQ overall score., Conclusion: Parents and caregivers reported significant improvement in the quality of life of adolescents undergoing orthodontic treatment with fixed appliances.

Objective: To compare the quality of life (QoL) of Class III patients between conventional three-stage method (CTM) and surgery-first approach (SFA) using Orthognathic QoL Questionnaire (OQLQ)., Materials and Methods: The subjects consisted of 26 Class III patients treated with nonextraction and two-jaw surgery. They were divided into CTM group (N = 15) and SFA group (N = 11). They retrospectively rated the OQLQ scores of 4 domains (social relationship, facial esthetics, function, and awareness of dentofacial deformity) using 0 to 4 scale at initial (T0), just before surgery (T1), 3 month after surgery (T2), and at debonding (T3). Mann-Whitney test and Wilcoxon signed-rank test were performed for statistical analysis., Results: After total OQLQ score of CTM group was deteriorated at T1 stage compared with T0 stage, it was improved at T2 and T3 stages (T0 = 53.9, T1 = 58.1, T2 = 23.5, and T3 = 11.6). Total OQLQ score of SFA group, however, was improved at T2 and T3 stages compared with T0 stage (T0 = 51.6, T2 =  3.1, and T3 = 11.4; T1 was omitted.). Orthognathic QoL Questionnaire scores and their amounts of change did not show any significant difference in each domain and at each stage between 2 groups (T0, T2, T3, ΔT2 - T0, ΔT3 - T2, ΔT3 - T0; all P > 0.05). Both groups showed large change in effect size (ES) of all domains with descending order during T3 - T0: facial esthetics, oral function, social relationship, and awareness of dentofacial deformity (CTM group: -3.97, -3.40, -2.23, -1.25; SFA group: -2.83, -2.33, -1.76, -1.73) CONCLUSIONS: SFA might have an advantage over CTM group in terms of no deterioration stage of OQLQ score.

Introduction: Medicaid is a needs-based program in the United States that subsidizes medical and dental care for minors. The purpose of this study was to test for compliance differences between self-pay and Medicaid-supported patients., Methods: Medicaid patient records (n = 88) were perused retrospectively for characteristics that distract from an orthodontist's workflow (missed appointments, broken brackets, treatment duration, and so on) and compared with a sample (n = 145) of self-pay patients from the same teaching clinic. Differences in treatment difficulty were adjusted by subject selection and statistically (analysis of covariance)., Results: Medicaid patients were younger (mean age, 14.1 vs 14.9 years) and significantly more likely to be dismissed from treatment (19% vs 4%), generally for noncompliance. Broken brackets and missed appointments were more common in the Medicaid sample. There was no difference in the number of appointments in those completing treatment, but treatment duration was significantly longer for the Medicaid patients who completed treatment (29 vs 25 months). Commute distance and estimated driving time were significantly shorter for the Medicaid-assisted group., Conclusions: Greater difficulty in managing Medicaid patients may partly explain why they are underserved. Prospective studies are needed to clarify the causes of the differences., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Introduction: Our objective was to identify factors associated with orthodontic treatment satisfaction of patients and their caregivers, when applicable., Methods: MEDLINE via Ovid, PubMed, EBM Reviews and EMBASE via OVIDSP, LILACS, Web of Science, and Google Scholar were searched electronically. Reference lists of included articles were also screened for potential relevant studies missed during the electronic searches. Studies evaluating the satisfaction levels of patients or caregivers after orthodontic treatment were considered. Methodologic quality of the included studies was assessed using a modified Newcastle-Ottawa scale., Results: Eighteen studies satisfied the inclusion criteria, representing 2891 patients and 464 parents. The risk of bias was moderate in 13 and low in 4 of the included articles. The studies used different questionnaires and timings to assess postorthodontic treatment satisfaction. Based on the available limited evidence, satisfaction was associated with perceived esthetic outcomes, psychological benefits, and quality of care. The latter was specifically linked to dentist-staff-patient interactions. Dissatisfaction was associated with treatment duration, pain levels and discomfort, and the use of retention appliances. When both assessments were available, the patient's and the parent's satisfaction levels were strongly correlated., Conclusions: Based on the limited available evidence with moderate risk of bias, we identified factors that appear to be more commonly associated with a high or low level of satisfaction. Consideration of these factors could be important for practitioners attempting to set realistic expectations of their patients and caregivers regarding orthodontic treatment outcomes., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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.

Objectives: To analyse the relationship between different dimensions of dental appearance impact and self-esteem in adult patients undergoing orthodontic treatment, with special attention to the possible mediating role of anxiety., Setting and Sample Population: A quasi-experimental design was used with a matched control group (without orthodontic treatment). In each group (experimental and control), there were 85 patients., Material and Methods: The impact of dental appearance was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). State anxiety was assessed with the State Anxiety Inventory (STAI-S) and self-esteem with Rosenberg's self-esteem scale., Results: In both groups (experimental and control), self-esteem correlates negatively, ranging between 0.26 and 0.43, with all dimensions of dental appearance impact (except for the positive dental self-confidence dimension, where all correlations were positive). Anxiety correlates positively, ranges between 0.35 and 0.44, with social impact, psychological impact and aesthetic concern, although it maintains no significant correlations with dental self-confidence. Nevertheless, in patients undergoing orthodontic treatment, anxiety plays a mediating role between dental impact dimensions and self-esteem, whilst for the control group anxiety only plays a mediator role between psychological impact and self-esteem., Conclusion: Anxiety plays a fundamental role in the effect of perceived dental impact on self-esteem in adult patients undergoing orthodontic treatment. These results have important practical implications for the design of bio-psycho-social intervention programs that contemplate cognitive-affective variables as an essential part of orthodontic treatment in adults., (© 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.)

Background: This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of self-esteem, and the possible connection with eating habits of adolescents under orthodontic treatment., Methods: Sixty-one adolescents, aged between 12 and 22 years (mean=15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire., Results: Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student's t-test and using Pearson's correlation analysis., Conclusion: Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.

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., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: To assess the impact of fixed orthodontic treatment on oral health related quality of life (OHRQoL) and self-esteem in adults., Subjects and Methods: A prospective study design was applied, within private practice. Sample size estimation revealed a minimum of 52 subjects, allowing for drop outs. All participants completed a set of validated questionnaires at baseline (T0), 1- (T1), 3- (T2), and 6-months (T3) and post-treatment (T4). These included the Rosenberg Self-esteem scale, the Oral Health Impact Profile (OHIP-14) and a socioeconomic status questionnaire. The Dental Health Component of the Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion severity., Results: Sixty-one subjects were recruited, with only one subject lost to follow-up. A statistically significant difference in OHRQoL scores was seen between: T0 and T1 (P = 0.001); T0 and T2 (P = 0.020). There was no statistical difference between T0 and T3 (P = 0.078) or T4 (P = 0.565), where OHRQoL improved to pre-treatment scores. A significant difference in self-esteem scores was observed between baseline and end of treatment (P = 0.002)., Conclusions: Undergoing fixed orthodontic therapy had a negative impact on the overall OHRQoL, during the first 3 months of treatment, which then improved to pre-treatment scores, whilst a significant increase was observed in self-esteem as a result of treatment., (© The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Objectives: To examine patients' and parents' perceptions and expectations from orthodontic treatment., Study Design: 491 patients (274 female, 217 male) aged 14-22 years, and 399 parents (245 female, 154 male) completed a questionnaire about preferences, needs and expectations about orthodontic treatment, and scored the present problem. Continuous variables were compared by Mann-Whitney U and Kruskal-Wallis tests, whereas Chi-square test was used for categorical variables., Results: Patients'(77.1%) and parents'(84.6%), decision about orthodontic treatments were influenced by suggestion of dentists. Patients who decided to attend to clinic by themselves were higher than parents (p=0.006). Dental aesthetics was the determinant factor for treatment demand for patients(61.0%) and parents(57.3%). Improvement in oral functions was more important for Class III patients than Class I patients (p=0.040). Adult patients/parents with higher education gave more importance to oral functions as well as dental aesthetics (p=0.031). There was no difference among Angle classifications regarding orthodontic problem scores. Parents found media sources valuable (p=0.018) but majority expected dentists for information about orthodontic treatments. Education degree of adult patients/parents effected this decision(p=0.002)., Conclusions: Desire to have better dental aesthetics was the primary motivating factor for all participants. Clinicians should consider concerns of Class III patients about oral functions during treatment planning.

Introduction: Our aim was to evaluate the factors that predict orthodontic treatment uptake among adults attending a specialist practice., Methods: A cross-sectional controlled design was adopted in a private practice setting. The test group included 62 adults seeking fixed orthodontic treatment. The controls were 52 parents of children undergoing orthodontics but who had not undergone treatment themselves. All subjects completed a set of validated questionnaires: the Rosenberg Self-Esteem Scale, the shortened version of the Oral Health Impact Profile, and the demographic and socioeconomic position characteristics. The Dental Health Component and the Aesthetic Component of the Index of Orthodontic Treatment Need were used to assess the severity of the malocclusions., Results: A 100% response rate was achieved. Subjects without a partner (P <0.001), with a high oral health impact (P <0.001), or with a need for orthodontic treatment (as assessed by the clinician or the subject using the Aesthetic Component of the Index of Orthodontic Treatment Need; P = 0.003 and P = 0.031, respectively) were more likely to have orthodontic treatment than were their counterparts with a partner (odds ratio [OR] = 20.8; 95% confidence interval [CI] = 4.63-93.25), with a low oral health impact (OR = 5.3; 95% CI = 2.36-11.88), or with no treatment need (OR = 3.6 and 4.4; 95% CI = 1.57-8.99 and 1.15-16.77, respectively). Self-esteem and demographic and socioeconomic position characteristics were not significantly associated with orthodontic treatment uptake (P >0.05)., Conclusions: The significance of age, marital status, and the shortened version of the Oral Health Impact Profile in predicting the uptake of orthodontic treatment among adults was demonstrated., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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.

Purpose: To evaluate the changes of Oral Health Related Quality of Life (OHRQoL) in patients after the placement of a fixed orthodontic appliance., Materials and Methods: This prospective study consisted of 148 adolescents (97 girls and 51 boys) between the ages of 14 and 17 who were patients of an orthodontic clinic. OHRQoL was assessed by a modified questionnaire that evaluated four domains: oral symptoms, functional limitations as well as emotional and social well-being in three time frames: before bonding and banding (T(0)), two months after initiating orthodontic treatment (T(1)) and six months after initiating orthodontic treatment (T(2)). The repeated measures test was used to compare the relative changes of OHRQoL among the different time frames., Results: There were no significant differences between the levels of OHRQoL and its domains for boys or girls at any time point. The overall level of OHRQoL decreased significantly at T(1) relative to T(0); however, the emotional well-being domain improved at T(1) in comparison to T(0). At T(2), the OHRQoL level increased significantly relative to T(0) in all domains., Conclusion: The patients' quality-of-life level decreased by initiating orthodontic treatment; however, during that period, emotional well-being increased. As orthodontic treatment progressed, the quality of life level increased.

Introduction: The consensus about the relationship between TMD and orthodontic treatment has gone from a cause and effect association between TMD and orthodontic treatment to the idea that there is no reliable evidence supporting this statement., Objective: To assess the beliefs, despite scientific evidence, of Brazilian orthodontists about the relationship between TMD and orthodontic treatment with regards to treatment, prevention and etiology of TMD., Methods: A survey about the relationship between TMD and orthodontic treatment was prepared and sent to Brazilian orthodontists by e-mail and social networks. Answers were treated by means of descriptive statistics and strong associations between variables were assessed by qui-square test., Results: The majority of orthodontists believe that orthodontic treatment not only is not the best treatment option for TMD, but also is not able to prevent TMD. Nevertheless, the majority of orthodontists believe that orthodontic treatment can cause TMD symptoms., Conclusion: This study suggests that orthodontists' beliefs about the relationship between orthodontic treatment and TMD are in accordance with scientific evidence only when referring to treatment and prevention of TMD. The majority of orthodontists believe that, despite scientific evidence, orthodontic treatment can cause TMD.

Introduction: Orthognathic patients appear to be increasingly using the Internet to obtain information about their proposed treatment. The aim of this study was to investigate the information that orthognathic patients share and discuss with peers away from the clinical environment to improve the provision of information for orthognathic patients., Methods: Posts made by persons in a large publicly accessible online orthognathic discussion forum were analyzed; 1912 randomly selected forum posts were evaluated using a qualitative analysis technique known as "thematic analysis" that involves coding the posts and collating them into meaningful and distinct themes., Results: The main themes identified were (1) reasons for undergoing orthognathic treatment, (2) presurgery and postsurgery treatment stages including orthodontics, (3) surgery including postsurgical complications and difficulties, (4) expected and actual end of treatment changes, and (5) seeking and sharing information., Conclusions: This study demonstrates that orthognathic patients look to the Internet to supplement information regarding their proposed treatment. This may suggest a possible gap in the provision of information by health care professionals. However, it is clear that patients use Internet forums to seek additional information, support, and reassurance from peers undergoing similar treatment. Therefore, there is a need for clinicians to ensure that patients have access and are guided to appropriate and relevant Internet resources., (Copyright © 2015 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

Objectives: Researchers have conducted extensive studies regarding dentoalveolar factors that affect anterior dental aesthetics; however, there is no consensus regarding how these factors affect orthodontic treatment decisions. Only a few studies have included multiple factors simultaneously. Therefore, the objective was to investigate if there are identifiable dentofacial and perioral aesthetic factors that bias laypeople towards discontinuing treatment after a phase I treatment with this fixed class II corrector., Methods: An analysis of photos and dental casts of 60 children (23 males, 37 females) having received phase I orthodontic treatment with the Xbow appliance was conducted. Variables considered were incisor height and width measurements, incisor proportions, incisor angulations, vertical lip thickness, gingival/incisal display, smile width per cent, diastema, midline deviation, smile arc, gender, and use of a 2×4. A principal component analysis and a logistic regression were used to determine which factors related to a patient's likelihood of receiving further orthodontic treatment., Results: Only the angulation of the right maxillary incisors was significantly related to a patient's likelihood (odds ratio 1.886 (1.004-3.466); P = 0.049) to proceed to phase II orthodontic treatment following phase I orthodontic treatment with the Xbow appliance. The odds of proceeding to phase II treatment were 86.6% greater with a one standard deviation increase in the angulation of the right central and lateral incisors. Other factors demonstrated trends but were not statistically significant., Limitations: Sample in subgroups was small, excluded smiles that did not expose the upper incisor crowns significantly, smiles in real life are observed three-dimensionally, other factors outside the aesthetic measurements were not considered in the analysis., Conclusions: In this sample, the angulation of the maxillary right incisors was the most significant factor influencing the decision to undergo an orthodontic phase II., (© The Author 2014. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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.)

Aim: To evaluate the effect of the first 12 months of orthodontic treatment on the quality of life of Brazilian adolescents and to examine the evaluative properties of the short form of the Child Perceptions Questionnaire (CPQ11-14)., Study Design and Methods: This study involved a sample of 101 adolescents undergoing orthodontic treatment with a fixed appliance. Participants were asked to answer the Brazilian version of the short form of the CPQ11-14 before treatment (T1) and 12 months after the placement of the fixed appliance (T2). Statistical analysis was carried out using the Wilcoxon signed-rank test and the Bonferroni correction for the overall score and the short form of the CPQ11-14 subscales. Responsiveness of the measure and the minimal clinically important difference (MCID) were also evaluated., Results and Statistics: Out of the 101 individuals originally admitted to this study, three were excluded due to cessation of treatment and failure to return the questionnaire, providing a response rate of 97.0%. Statistically, significant improvements were found in the overall score (P < 0.001) as well as in both emotional well-being (P < 0.001) and social well-being (P = 0.007) subscales. The reductions in score were associated with an effect of size showing moderate clinically meaningful changes in the overall score and in the functional limitations, emotional well-being and social well-being. The MCID was 3.35., Conclusion: The first 12 months of orthodontic treatment with a fixed appliance had a positive effect on the quality of life of western adolescents.

Objective: Harmony is one of the main objectives in surgical and orthodontic treatment and this harmony must be present in the smile, as well as in the face. The aim of the present study was to assess the perceptions of professionals and laypersons in relation to the harmony of the smile of patients with or without vertical maxillary alterations., Materials and Methods: Sixty observers (oral and maxillofacial surgeons, orthodontists and laypersons) reported the degree of harmony of six smiles using an objective questionnaire and the participants indicated if there was a need for corrective surgery or not. The classification of observers was recorded on a Likert scale from 1 to 5. Mixed regression was used to determine differences between the three groups., Results: Statistically significant differences were found only for the harmony of the smile between the oral and maxillofacial surgeons and laypersons, with laypersons being more critical when assessing the smile. There was no statistical difference between the other groups for the harmony of the smile or the indication of corrective surgery. The patterns of greater or lesser harmony determined by observers during the smile were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning., Conclusions: Laypersons had a tendency to be more critical in relation to facial harmony than surgeons, although no statistical differences were found in the other groups in relation to the harmony of the smile or indication for the corrective surgery. In addition, the patterns of greater or lesser harmony of the smile determined by the participants were similar to those found in the literature as the ideal standard in relation to vertical maxillary positioning. Overall, the present study demonstrates that adequate interaction between surgeons, orthodontists and laypersons is essential in order to achieve facial harmony with orthodontic and/or surgical treatment., Clinical Relevance: Opinion of specialists and laypersons about the smile in relation to the vertical positioning of the maxilla., (Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.)

Introduction: The selection of appropriate outcomes is a fundamental part of the design of clinical trials. Orthodontic treatment aims to improve a person's dentofacial appearance, and research outcomes should therefore reflect the perspectives of both clinicians and patients. In this study, we aimed to identify which outcomes were measured in recent orthodontic trials and to explore whether any relevant outcome domains were underrepresented., Methods: Five electronic databases were searched to identify all randomized controlled trials of orthodontic treatment interventions in children published in the last 5 years. Abstracts and eligible full-text articles were screened independently and in duplicate by 2 reviewers. Outcome measures were identified and categorized into 6 predetermined outcome domains., Results: The search identified 650 abstracts, of which 244 eligible articles were retrieved in full. One hundred thirty-three studies met the inclusion criteria and were included. Morphologic features of malocclusion were measured in 84 studies (63%); health resource utilization in 43 (32%); adverse effects of orthodontic treatment in 43 (32%); quality of life in 12 (9%); functional status in 10 (8%); and physical consequences of malocclusion in 3 (2%). There was no consistency in the outcomes selected among the trials to measure these domains., Conclusions: Most of the outcomes used in orthodontic research are concerned with measuring morphologic changes of treatment and do not reflect patient perspectives. Five of the 6 domains were infrequently evaluated, and outcomes were heterogenous. A core set of outcomes for clinical trials of orthodontic treatment interventions would help to overcome these issues., (Copyright © 2014 American Association of Orthodontists. Published by Elsevier Inc. All rights reserved.)

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.)

Background: Many patients with disability require orthodontic treatment (OT) to achieve adequate oral function and aesthetic appearance. The cooperation of disabled patients and of their parents is central to the success of OT, as treatment can involve ethical dilemmas. The aim of this study was to analyze the motivation, expectations and overall satisfaction with OT among parents of patients with disabilities., Methods: The parents of 60 disabled Spanish children with physical, mental and/or sensory impairment undergoing OT were surveyed on attitudes to OT and level of satisfaction with the outcomes. The survey consisted of 23 questions in 4 sections: attitude and adaptation, benefits, adverse effects, and level of satisfaction after completion of OT. A control group formed of the parents of 60 healthy children undergoing OT at the same institution were also surveyed., Results: Parents of disabled children undergoing OT showed a high level of motivation and they are willing to collaborate in oral hygiene procedures. Adaptation to the removable appliances was poorer in disabled children but adaptation to fixed appliances was excellent. OT can provide a marked improvement in quality of life, social relationships and oral functionality in disabled children., Conclusions: Among parents of disabled children undergoing OT, the perceived level of overall satisfaction was very high and expectations were often exceeded.

Objectives: The aim was to find out if children who have gone through orthodontic and invasive treatment have less dental fear than children who have experienced only invasive treatment or no treatment at all., Materials and Methods: The data consisted of 910 9- to 15-year-old children from Jyväskylä and Kuopio, Finland. A questionnaire was used that contained 11 dental fear-related questions and family member's dental fear and questions on oral health habits and family characteristics. Information on treatment procedures from three preceding years was collected from patient records. To study the association between dental fear and treatment experiences, analysis of variance, and multiple logistic regression analyses were performed., Results: Dental fear was found more often in children who had experiences of orthodontic treatment experiences and invasive treatment than in children with invasive treatment only or no treatment experiences at all., Limitations: Different orthodontic treatment experiences were not analysed individually, and the study was retrospective., Conclusion: Familiarization to dental treatment via orthodontic procedures does not necessarily decrease dental fear among children., (© The Author 2013. Published by Oxford University Press on behalf of the European Orthodontic Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

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.

Background: Although a great number of specific quality of life measures have been developed to analyze the impact of wearing fixed appliances, there is still a paucity of systematic appraisal of the consequences of orthodontics on quality of life. To assess the current evidence of the relationship between orthodontic treatment and quality of life., Methods: Four electronic databases were searched for articles concerning the impact of orthodontic treatment on quality of life published between January 1960 and December 2013. 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 204 reviewed articles, 11 met the inclusion criteria and used standardized health related quality of life and orthodontic assessment measures. The majority of studies (7/11) were conducted among child/adolescent populations. Eight 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 quality of life and orthodontic treatment 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 orthodontic treatment and quality of life. 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.

Objectives: As a continuation of a baseline study on oral health-related quality of life (OHRQoL) and the role of self-esteem (SE), the aim of this research is to investigate the changes in OHRQoL reports in children during orthodontic treatment and the influence of SE., Subjects and Methods: This longitudinal study comprised 109 children (50 boys and 59 girls) aged 11-16 years, all receiving orthodontic treatment. Questionnaires were administered at baseline and at follow-up (1 year after start of orthodontic treatment). OHRQoL was assessed by the child perception questionnaire (CPQ). The Dutch adaptation of the Harter's Self-Perception Profile for Adolescents was used to assess SE and the Index of Orthodontic Treatment Need defined the need for treatment. The questionnaires also included questions related to motivation for treatment. Spearman correlations, Wilcoxon signed rank tests and Mann-Whitney U-tests were performed., Results: A significant increase in total CPQ score was found during orthodontic treatment. This increase was also significant for the subdomains functional limitations, oral symptoms, and social well-being, whereas for the subdomain emotional well-being a non-significant decrease in CPQ score was found. Children with high SE at baseline showed significantly lower variability in OHRQoL measures at follow-up., Conclusions: OHRQoL deteriorates in children during orthodontic treatment. There is evidence that SE can be a protective factor in OHRQoL during orthodontic treatment.

Objectives: To examine the relationship between normative and self-perceived treatment need assessed by different measures, comprising two Oral Health-Related Quality of Life (OHRQoL) scales., Subjects and Methods: This cross-sectional observational study comprised 386 children aged 11-16 years registered for a first consultation at the Orthodontic Department of the University Hospitals of Leuven (Belgium). Normative treatment need was assessed by the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The children completed questionnaires comprising the Child Perceptions Questionnaire (CPQ₁₁₋₁₄) and the Oral Aesthetic Subjective Impact Scale (OASIS). They also scored the AC of IOTN themselves. Spearman correlations, Mann-Whitney U-tests and signed-rank tests, a Bland-Altman plot, and an intra-class correlation were used to analyze the data., Results: Significant, yet weak correlations (maximum ρ = 0.23 for the CPQ emotional well-being domain) were found between normative orthodontic treatment need (IOTN AC) and most of the OHRQoL measures. Similarly, between the IOTN AC scores of the expert and the IOTN AC ratings given by the child a significant correlation (ρ = 0.37, P < 0.0001) was found, but with very poor agreement (95 per cent limits of agreement -4.3, 5.1). For the DHC of IOTN, only a relation was found with the AC child (ρ = 0.20, P = 0.0001)., Conclusions: These results suggest that the commonly used IOTN as a clinical assessment tool for orthodontic treatment need should be reinforced by OHRQoL measures, like the OASIS, expressing patients' perceived treatment need.

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.

In this paper we propose to study the role of psychosocial variables in affect in adult patients undergoing orthodontic treatment, considering that affect is a key variable in treatment adherence. Seventy-four patients (average age 33,24 ± 10,56) with metal multibracket-fixed orthodontic treatment were included. Patients were assessed twice. The first stage, at the beginning of treatment, included assessment of dental impact (Psychosocial Impact of Dental Aesthetics Questionnaire), trait anxiety (State-Trait Anxiety Inventory), self-esteem (Rosenberg's self-esteem scale), and self-efficacy (General Self-efficacy Scale). In the second stage, 6 months later, positive and negative affect towards treatment was assessed using the Positive and Negative Affect Scale. Dental social impact differentiates between patients with high and low negative affect, while self-efficacy differentiates between patients with high and low positive affect. Trait anxiety and self-esteem differentiate between both types of affect (positive and negative). Trait anxiety and self-esteem (when trait anxiety weight is controlled) are significant predictor variables of affective balance. These results have important practical implications, because it seems essential to adopt a bio-psychosocial model incorporating assessment methods focusing on day-to-day changes in mood and well-being.

Aim: To survey patient and parent satisfaction with premolar transplantation and the associated orthodontic treatment., Method: A postal service evaluation questionnaire was used to survey patient and parent satisfaction for children who had completed treatment involving premolar transplantation and the associated orthodontics. Patients and parents each completed separate questionnaires. For some questions a Likert scale from 1 to 10 was used., Result: Questionnaires were sent to 41 patients and their parents who had premolar transplants and orthodontic treatment. Following repeat mailing of the questionnaires: 20 of the patient and 25 parent questionnaires were completed and returned. Patients and parents felt there was a large improvement in dental appearance (median scores 8 and 10) and were highly satisfied with the final appearance (median scores 8 and 9). Both groups felt that treatment transition between departments was very good (median scores 9 and 9). Patients experienced moderate discomfort during their premolar transplant surgery and during their orthodontic treatment (scores 6 and 5, respectively). Most patients and parents would recommend this type of treatment (92 and 88%, respectively)., Conclusion: Overall, patients and parents report high levels of satisfaction with all aspects of their premolar transplant and their associated orthodontic treatment.

The collaboration between an orthodontist and parents is essential to improve the effectiveness of orthodontic treatment of 6-9 years old children. The author suggests method for increasing motivation of parents and thus of children by using a diary of orthodontic patient as well as modified orthodontic appliance with vestibular basis to decrease treatment time.

Unlabelled: Internet-based social media sites have recently surged in popularity and are often used to share thoughts and seek support about health issues., Objectives: The aim of this study was to investigate how orthodontic patients use Internet-based social media sites to share their treatment-related experiences and attitudes towards braces. A secondary objective was to investigate whether an online or mobile application would be considered helpful in improving co-operation with the use of orthodontic appliances., Method: Patients visiting the orthodontic clinic at the University of Otago were asked to participate in a cross-sectional survey that sought details of their Internet-based social media use and their thoughts about the development of a reminder application., Results: The sample comprised 130 orthodontic patients, with a mean age of 17.2 (SD 6.9) and a nearly equal sex distribution (52.3% were female). Internet-based social media sites were used by 80.8%, with Facebook being the most popular. Some 13.3% of the sample had posted comments about braces on these social media sites. Only 6.7% had considered obtaining information about orthodontic treatment from Internet-based social media sites, with the majority (81%) preferring to seek this information directly from their orthodontist. Nearly two-thirds of those who had difficulty remembering to wear their orthodontic appliances reported that a reminder application on their phone would be beneficial., Conclusions: A large proportion of orthodontic patients use Internet-based social media sites, although only a few currently use them to post about treatment-related topics. Social media sites may provide a useful channel of communication for patients seeking support. Further research is needed to evaluate the use of phone reminder applications in orthodontics.

Objectives: This article describes the process of validity and reliability testing of a condition-specific quality-of-life measure for patients with hypodontia presenting for orthodontic treatment. The development of the instrument is described in a previous article., Setting and Sample Population: Royal Devon and Exeter NHS Foundation Trust & Musgrove Park Hospital, Taunton., Materials and Methods: The child perception questionnaire was used as a standard against which to test criterion validity. The Bland and Altman method was used to check agreement between the two questionnaires. Construct validity was tested using principal component analysis on the four sections of the questionnaire. Test-retest reliability was tested using intraclass correlation coefficient and Bland and Altman method. Cronbach's alpha was used to test internal consistency reliability., Results: Overall the questionnaire showed good reliability, criterion and construct validity. This together with previous evidence of good face and content validity suggests that the instrument may prove useful in clinical practice and further research., Conclusions: This study has demonstrated that the newly developed condition-specific quality-of-life questionnaire is both valid and reliable for use in young patients with hypodontia., (© 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.)

Introduction: Many variables affecting smile esthetics and attractiveness have been evaluated. However, the influence of the interaction of several variables is not as well known. Furthermore, patients and dental professionals might view smile esthetics differently. Therefore, the purpose of this research was to evaluate the influence of the smile arc in conjunction with the amount of maxillary gingival display on the perception of smile attractiveness by orthodontists, dentists, and laypersons., Methods: A frontal intraoral photograph of ideally aligned teeth was modified using image-processing software. Photos showing 7 smile arcs, from flat to vaulted, were obtained, and these were combined with photos showing 4 different amounts of maxillary gingival display. The attractiveness of the 28 images of different smiles was evaluated by 3 groups of raters (orthodontists, dentists, and laypersons), each consisting of 70 persons., Results: Both smile arc (P <0.05) and gingival display amount (P <0.001) had statistically significant influences on the perception of smile attractiveness. Smile attractiveness scores with reference to gingival display amount showed a statistically significant (P <0.001) difference between the rater groups. A significant (P <0.05) interaction between smile arc and gingival display amount was observed., Conclusions: Examining other components influencing the perception of smile attractiveness might help clinicians develop more satisfying treatment plans for their patients., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

Introduction: Despite the high prevalence of dental anxiety in children, there is little research examining anxiety before orthodontic procedures. This parallel-group randomized controlled trial assessed whether provision of additional multimedia information regarding the bond-up procedure affected anxiety in adolescent orthodontic patients. The effects of sex, ethnicity, and age were also investigated., Methods: Participants were recruited from the orthodontic department of the Eastman Dental Hospital, University College London Hospitals Foundation Trust, in the United Kingdom; all were 10 to 16 years of age, with no history of orthodontic treatment, and patient assent and parental consent were obtained. The participants were randomized into control (n = 45) and intervention (n = 45) groups using a random number table. Both groups were given verbal information regarding the bond-up procedure, and the intervention group was additionally given a DVD showing a bond-up. Anxiety was assessed in the department immediately before the bond-up using the State-Trait Anxiety Inventory for Children, with state anxiety as the primary outcome measure. The researchers were unaware of group allocations while enrolling patients, scoring questionnaires, and analyzing data., Results: A statistically significant difference was found between groups, with a difference in scores of 2 (95% confidence interval for the difference = 0.15 to 3.85). The median state anxiety was 32 in the control group (n = 42) and 30 in the intervention group (n = 43; P = 0.012). Sex, ethnicity, and age did not significantly affect anxiety. No harmful effects were noted., Conclusions: Additional information reduces anxiety levels, but other methods could be more cost-effective than the DVD. Sex, ethnicity, and age did not statistically affect the anxiety levels., (Copyright © 2013 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.)

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.

Statement of Problem: The perception of a pleasing smile may differ between the countries in Asia or may be converging on a more internationally pleasing one., Purpose: The aim of this study was to evaluate the influence of vertical positions of anterior teeth on smile esthetics as assessed by Japanese and Korean orthodontists as well as by orthodontic patients., Materials and Methods: A standard composite smile was constructed from different females' intraoral and extraoral photographs. Vertical positions of anterior teeth were modified digitally in 1-mm increments, from 5 mm upper lip coverage of the incisors to 5 mm gingival exposure. Using a visual analog scale, 41 Japanese orthodontists and 96 Japanese orthodontic patients, 25 Korean orthodontists, and 72 Korean orthodontic patients rated the attractiveness of 11 smiles with altered gingival displays., Results: Overall, the Japanese and Korean raters assigned similar esthetic scores between the corresponding groups. The male orthodontic patients assigned higher scores to the smiles with upper lip coverage of the teeth than the corresponding females did in both countries. The female patients assigned clinically significant higher scores to the smiles from 2 mm upper lip coverage of the teeth to 0 mm gingival exposure in both countries., Conclusions: In both countries, the orthodontists and the female patients shared the similar preference in the smile evaluation of vertical positions of anterior teeth, whereas the male orthodontic patients were more tolerant of upper lip coverage of the anterior teeth than the orthodontists and the female patients., Clinical Significance: This study proposes 0 mm to 2 mm of upper lip coverage of the teeth as a threshold of acceptability for esthetic smile evaluations in female orthodontic patients. For male orthodontic patients, the paper proposes negative gingival display as a threshold of acceptability for esthetic smile evaluations., (© 2013 Wiley Periodicals, Inc.)