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Article |
University of Alberta
Universidad Peruana Cayetano Heredia
Address for correspondence: Dr C. Flores-Mir, Faculty of Medicine and Dentistry Room 4051A, Dentistry/Pharmacy Center, University of Alberta, Edmonton, Alberta, Canada T6G 2N8. Email: carlosflores{at}ualberta.ca
Received September 29, 2003; accepted February 5, 2004
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Abstract |
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 Top Abstract IntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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Design: Cross-sectional survey.
Setting: University dental clinic, Lima, Peru, 2001.
Materials and methods: Questionnaires that gathered perceptions on dentofacial aesthetic perception and orthodontic treatment need were applied to a randomly selected sample (329) of first year university students (729). Subjects undergoing orthodontic treatment at the time of examination were excluded.
Main outcome measures: Aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN), Oral Aesthetics Subjective Index Scale (OASIS) and a visual analogue scale (VAS) were used.
Statistical analysis: Descriptive statistics, Spearman correlation test, Kruskall–Wallis test and Mann–Whitney U-test were used.
Results: For the AC, 87.5% were in the ‘without treatment need’ category, 10.6% in the ‘borderline need’ category and 1.8% in the ‘treatment need’ category. The mean AC score was 3.02 (±1.49). The mean OASIS score was 11.81 (±4.84), and the VAS score was 40.16 (±18.16). Correlations between the 3 self-assessment scales were moderate (AC-OASIS 0.416, AC-VAS 0.541 and OASIS-VAS 0.457). Gender or previous orthodontic treatment had no influence (p<0.05) on the scales.
Conclusions: Differences in the approaches used by each scale to evaluate the self-perception of the aesthetical arrangement of the front teeth may explain the moderate correlation values.
Key words: Self-perceived orthodontic treatment need, IOTN, OASIS, VAS, university students
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Introduction |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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Nevertheless, identification of a malocclusion by a dental health care professional is a primary factor in motivating an individual to seek orthodontic care.2 This decision can be modified by many important factors, such as a combination of consumer and provider aspirations.3 These were summarized by Shaw et al.2 as patient factors (appearance improvement, age, gender, environment influence and social class), and orthodontist factors (appreciation of the treatment need, access to services, cost of the treatment and treatment priority).
In another study, Fox et al. reported that adolescents gave a different importance to the appearance of their anterior teeth depending if they sought orthodontic treatment or not.4 Petersen and Dahlström found that dentists and orthodontists perceived orthodontic treatment needs differently to adolescents.5
There are only a few indices or scales that consider the self-perception of the evaluated person regarding their orthodontic treatment need. They are the Index of Orthodontic Treatment Need (IOTN),6 the Dental Aesthetic Index (DAI),7 the Orthodontic Aesthetic Subjective Impact Scale (OASIS),8 and the Index of Complexity Outcome and Need (ICON).9
The IOTN has two components that have been refined through time.6,10,11 These are the Dental Health component (DHC), which classifies the dental health need for treatment, and the Aesthetic component (AC), which classifies the aesthetics of the arrangement of the teeth.3,6,8,12
The IOTN measures the treatment need from a provider (normative) viewpoint and this does not always reflect the consumers’ view. This problem was addressed by Mandall et al. who attempted to develop a patient derived measure.8 In this study, they combined scores from a questionnaire and the child’s perceived AC score to construct an overall perceived oral aesthetic impact score. They found that subjects with greater clinical orthodontic treatment need usually perceived themselves as worse off than their peers with lower clinical treatment need. Interestingly, children from lower socioeconomic conditions reported higher OASIS scores, yet they were less likely to have received orthodontic treatment. Untreated children who desired orthodontic treatment had higher values in the AC of the IOTN and OASIS.
In summary, there are several approaches to evaluate orthodontic treatment need that have been derived from a provider viewpoint (IOTN) and a consumer viewpoint (OASIS). The present study was designed to evaluate any association between these measures and to investigate possible differences in the determined self-perceived need in a young adult population.
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Materials and methods |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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of 95% and a precision error of 3% based on an orthodontic treatment need of 15% (objective need of 28% and self-perceived need of 2% obtained from a pilot study). Health sciences or artistic career students and students in active orthodontic treatment were excluded. All subjects signed a voluntary informed consent form. A focus group of 10 university students were recruited to assist in structuring the scales used in this study into a clearly understandable format. All the selected students were asked to complete the questionnaires. The primary examiner (CF) was available to respond to subject questions during the questionnaire completion process.
The following structured orthodontic treatment need scales were completed for each subject:
—the subjects were asked to score their teeth with the Aesthetic component of the IOTN. —subjects were asked to answer 5 questions on a 7-point Likert scale about their perception of oral aesthetics; the possible final score ranged between 5 and 35 (Table 1) —subjects marked their aesthetic perception of the appearance of their own teeth on a 100 mm line. They were asked: ‘Rate your aesthetic perception of your teeth by putting a cross on the line between the two extremes where 0 is the worst aesthetics you could imagine and 100 the most ideal aesthetics you could imagine’.
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Results |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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For the AC, 87.5% (288) were in the ‘without treatment need’ category, 10.6% (35) in the ‘borderline treatment need’ category and 1.8% (6) in the ‘treatment need’ category. The mean AC score was 3.02 (±1.49). The mean OASIS score was 11.81 (±4.84); and the mean VAS score was 40.16 (±18.16).
The Kolmogorov-Smirnov test demonstrated that the sample did not come from a normally distributed population for any scale. Therefore, non-parametric statistical tests were used for comparison purposes.
Comparison of the mean OASIS and VAS scores according to the AC category showed a trend of higher OASIS scores and lower VAS scores for the subjects with more treatment need (Table 2). Scores were ranked and evaluated through non-parametric tests. The Kruskall–Wallis test showed that there were highly significant differences (p<0.001) between AC groups for OASIS and VAS. Groups were then compared by pairs. Differences were highly significant (p<0.001; Mann–Whitney U test for independent samples) for OASIS and VAS between the ‘without treatment need’ and the ‘borderline treatment need’ categories. No differences were found between the ‘without treatment need’ and the ‘treatment need’ categories, and between the ‘borderline treatment need’ and the ‘treatment need’ categories (Mann–Whitney U test for independent samples).
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No association (Mann–Whitney U test for independent samples) between the evaluated scales with gender or previous orthodontic treatment was found (p>0.05).
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Discussion |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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3,13–19
The self-perceived need for orthodontic treatment in this population, based on the AC, was less than found in studies that evaluated other populations and cultures.6,8,20–23 (Table 3) This difference may result from different cultural and socioeconomic factors, where relatively few of the present sample’s peers had undergone orthodontic treatment (13.01%).
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Given the difficulty well educated subjects had with the interpretation of the scale, poorly educated or young patients may experience even greater problems of interpretation. The other two scales used a different approach to evaluate the self-perceived need. The OASIS uses a Likert type questionnaire and the visual analog scale (VAS) uses a simple line with two marked extremes, both of which appear to be more easily understood by these subjects. Comparison of the mean OASIS and VAS scores according to the AC category showed a trend of higher OASIS scores and lower VAS scores for the subjects with greater treatment need.
Mandall et al.8 developed the OASIS to permit adolescents to self-determine the grade of concern about the arrangement of their anterior teeth. In their study, subjects with greater clinical orthodontic treatment need usually perceived themselves worse off than their peers with lower clinical treatment need. In that study, untreated children who desired orthodontic treatment had higher values simultaneously in the AC of the IOTN and OASIS. The AC is a specific evaluation of the self-perception of the appearance of their anterior teeth, whereas the OASIS asks several questions about the perceptions of others and themselves, as well as questions about their previous behavior related to the appearance of their teeth. Therefore, differences in the results may be expected.
According to the present results, the VAS seemed to be the most easily perceived need scale to be understood and used by these university students. It also presented the strongest correlation with the other two scales. Differences could also be explained by the different approaches utilized. The VAS scale is more related to the AC in the sense that it is also a general evaluation of the perception of the anterior teeth, but without the use of photographs as facilitator stimuli.
Gender and previous orthodontic treatment did not influence the results. Our results were contradictory when compared with some previous studies that had demonstrated that more females than males perceive an orthodontic treatment need under similar conditions.8,25–30 Some authors have reported the same gender bias in adults,30,31 but others disagree.23,32,33 The difference is probably cultural or socioeconomic.
Two studies16,34 reported that young European adults who had previously received orthodontic treatment had similar or higher perception of orthodontic treatment need than untreated subjects. Burgersdijk34 used questions regarding satisfaction with the alignment of the anterior teeth and previous orthodontic treatment, whereas Tuominen16 used questions regarding orthodontic treatment desire. They did not utilize the more widely accepted self-perception scales. Our results did support their findings, but cultural or socioeconomic differences could make direct comparisons questionable. Further research regarding the influence of previous orthodontic treatment and the self-perceived orthodontic need in Peruvian populations is underway.
In conclusion, application of indices for research purposes should take into account possible cultural or socioeconomic differences that may arise between different populations. It is important that studies identify if they are using a modification of the original IOTN. A comparison between studies using nonidentical indices may not be valid.
According to the present results the VAS is as valid as the AC or OASIS in discriminating orthodontic treatment need in this university population. Further research with the VAS as a tool to evaluate self-perceived orthodontic need is required.
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Conclusions |
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Contributors |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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References |
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TopAbstractIntroductionMaterials and methodsResultsDiscussionConclusionsContributorsReferences |
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2 Shaw WC, O’Brien KD, Richmond S. Quality control in orthodontics: factors influencing the receipt of orthodontic treatment. Br Dent J 1991; 170: 66–8.[Medline]
3 Stenvik A, Espeland L, Linge BO, Linge L. Lay attitudes to dental appearance and need for orthodontic treatment. Eur J Orthod 1997; 19: 271–7.
4 Fox D, Kay EJ, O’Brien K. A new method of measuring how much anterior tooth alignment means to adolescents. Eur J Orthod 2000; 22: 299–305.
5 Petersen B, Dahlstrom L. Perception of treatment need among orthodontic patients compared with professionals. Acta Odontol Scand 1998; 56: 299–302.[CrossRef][Medline]
6 Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. Eur J Orthod 1989; 11: 309–20.
7 Jenny J, Cons NC. Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment need and the Dental Aesthetic Index. Am J Orthod Dentofacial Orthop 1996; 110: 410–16.[CrossRef][Medline]
8 Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O’Brien KD. Perceived aesthetic impact of malocclusion and oral self-perceptions in 14–15-year-old Asian and Caucasian children in greater Manchester. Eur J Orthod 2000; 22: 175–83.
9 Daniels C, Richmond S. The development of the index of complexity, outcome and need (ICON). J Orthod 2000; 27: 149–62.
10 Shaw WC, Richmond S, O’Brien KD, Brook P, Stephens CD. Quality control in orthodontics: indices of treatment need and treatment standards. Br Dent J 1991; 170: 107–12.[Medline]
11 Richmond S, Shaw WC, Stephens CD, Webb WG, Roberts CT, Andrews M. Orthodontics in the general dental service of England and Wales: a critical assessment of standards. Br Dent J 1993; 174: 315–29.[CrossRef][Medline]
12 Lunn H, Richmond S, Mitropoulos C. The use of the index of orthodontic treatment need (IOTN) as a public health tool: a pilot study. Comm Dent Hlth 1993; 10: 111–21.
13 Albino JE, Cunat JJ, Fox RN, Lewis EA, Slakter MJ, Tedesco LA. Variables discriminating individuals who seek orthodontic treatment. J Dent Res 1981; 60: 1661–7.
14 Helm S, Petersen PE, Kreiborg S, Solow B. Effect of separate malocclusion traits on concern for dental appearance. Comm Dent Oral Epidemiol 1986; 14: 217–20.[CrossRef][Medline]
15 Kenealy P, Frude N, Shaw W. The effects of social class on the uptake of orthodontic treatment. Br J Orthod 1989; 16: 107–11.[Abstract]
16 Tuominen ML, Tuominen RJ, Nystrom ME. Subjective orthodontic treatment need and perceived dental appearance among young Finnish adults with and without previous orthodontic treatment. Comm Dent Hlth 1994; 11 : 29–33.
17 O’Brien K, McComb JL, Fox N, Wright J. Factors influencing the uptake of orthodontic treatment. Br J Orthod 1996; 23: 331–4.[Abstract]
18 Tung AW, Kiyak HA. Psychological influences on the timing of orthodontic treatment. Am J Orthod Dentofacial Orthop 1998; 113: 29–39.[CrossRef][Medline]
19 Tickle M, Kay EJ, Bearn D. Socio-economic status and orthodontic treatment need. Comm Dent Oral Epidemiol 1999; 27: 413–18.[Medline]
20 de Muelenaere KR, Coetzee CE, Ackerman A. The treatment need of a group of senior dental students as assessed by the IOTN and PAR indices. S Afr Dent J 1998; 53 : 185–91.
21 Birkeland K, Boe OE, Wisth PJ. Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by index of orthodontic treatment need. Am J Orthod Dentofacial Orthop 1996; 110: 197–205.[CrossRef][Medline]
22 Shue-Te Yeh M, Koochek AR, Vlaskalic V, Boyd R, Richmond S. The relationship of 2 professional occlusal indexes with patients’ perceptions of aesthetics, function, speech, and orthodontic treatment need. Am J Orthod Dentofacial Orthop 2000; 118: 421–8.[CrossRef][Medline]
23 Ucuncu N, Ertugay E. The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population. J Orthod 2001; 28: 45–52.
24 Burden DJ. The ranking of dental aesthetics. Br J Orthod 1995; 22: 259–61.[Abstract]
25 Bearn D, Wright J, Kay E, O’Brien K. Perceptions of orthodontic treatment need: receiver operating characteristic analysis. Comm Dent Oral Epidemiol 1996; 24 : 303–6.[CrossRef][Medline]
26 Tuominen ML, Nystrom M, Tuominen RJ. Subjective and objective orthodontic treatment need among orthodontically treated and untreated Finnish adolescents. Comm Dent Oral Epidemiol 1995; 23: 286–90.[CrossRef][Medline]
27 Ng’ang’a PM, Ohito F, Ogaard B, Valderhaug J. The prevalence of malocclusion in 13- to 15-year-old children in Nairobi, Kenya. Acta Odontol Scand 1996; 54: 126–30.[Medline]
28 Sheats RD, McGorray SP, Keeling SD, Wheeler TT, King GJ. Occlusal traits and perception of orthodontic need in eighth grade students. Angle Orthod 1998; 68: 107–14.[Medline]
29 Birkeland K, Katle A, Lovgreen S, Boe OE, Wisth PJ. Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents. J Orofac Orthop 1999; 60: 292–307.[CrossRef][Medline]
30 Kerosuo H, Kerosuo E, Niemi M, Simola H. The need for treatment and satisfaction with dental appearance among young Finnish adults with and without a history of orthodontic treatment. J Orofac Orthop 2000; 61: 330–40.[CrossRef][Medline]
31 Holmes A. The prevalence of orthodontic treatment need. Br J Orthod 1992; 19: 177–82.[Abstract]
32 Cross JF, Cross J. Age, sex, race, and perception of facial beauty. Devel Psychol 1971; 5: 433–9.
33 Espeland LV, Stenvik A. Perception of personal dental appearance in young adults: relationship between occlusion, awareness, and satisfaction. Am J Orthod Dentofac Orthop 1991; 100: 234–41.[Medline]
34 Burgersdijk R, Truin GJ, Frankenmolen F, Kalsbeek H, van’t Hof M, Mulder J. Malocclusion and orthodontic treatment need of 15–74-year-old Dutch adults. Comm Dent Oral Epidemiol 1991; 19: 64–7.[CrossRef][Medline]
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