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Assessment of psychosocial impact of dental aesthetics and self perceived orthodontic treatment need in young adults.

Byline: ROZINA NAZIR AMJAD MAHMOOD and AYESHA ANWAR

Abstract

The aim of this study was to assess the psychosocial impact of dental aesthetics using the Psy- chosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ) and self-rated Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and individual attitude to own teeth and general appearance. The cross sectional study was conducted among the students of Margalla Institute of Health Sciences (MIHS) Rawalpindi with age ranging from 18-25 years. Students were asked to complete a Psychosocial Impact of Dental Aesthetic Questionnaire' (PIDAQ). Total of five variables

Dental self-confidence Social impact psychosocial impact Aesthetic concern and Patients Beliefs were evaluated by series of questions and Dental Aesthetics was assessed by using of IOTN Aesthetic Com- ponent. The Kruskal-Wallis test was applied to determine differences between the mean scores for all the subject groups (1 to 4+). Chi square test was performed for patient beliefs.

All the five variables showed significant correlation with perceived severity of malocclusion with p-value of less than 0.01. The association between self-rated IOTN-AC grading and psychosocial well-being was established signifying that the self-perceived aesthetics may be a significant factor in defining treatment need as the degree of malocclusion itself.

Key Words: Dental self-confidence social impact psychosocial impact aesthetic concern.

INTRODUCTION

People vary in the observation of their physical self. In finding out the possible benefits of orthodontic treatment for a person the association between physical appearance and awareness of an aesthetic divergence is important. In young adults even a slight deviation can be perceived important and the impact of malocclusion on a youth's quality of life might be profound.

As malocclusion particularly that existing in the anterior area is often evident it may provoke unpleas- ant social responses and a poor self-confidence.23 Any major deviations from the norm may result in feelings of lack of self-confidence related to appearance em

barrassment in social contacts and comparison of self with others considered to be superior' all of which may negatively upset the quality of life of the individual.14

Orthodontic treatment may be additionally often influenced by demand than by need.5 In the past need for orthodontic treatment was evaluated from a strictly expert viewpoint. However several studies have stated that self-perceived dental appearance is also important in the choice to pursue orthodontic care.6 Different scales such as the Index of Orthodontic Treatment Need (IOTN) the Index of Complexity Outcome and Need (ICON) and the Dental Aesthetic Index (DAI) were made as a scoring system for malocclusion and may be used to rule out likely patients.

The IOTN is a grading system that grades maloc- clusion established on occlusal characteristics for oral health and aesthetic deficiency. The Aesthetic Com- ponent (AC) of the IOTN has frequently been used to assess treatment need on aesthetic grounds assessed by dentists (operator-rated) or patients (self-rated).

However since it is an acknowledged fact that psychosocial concerns due to undesirable dental aes- thetics may be as severe or even more severe than the biological problems the indices at present in use have been complained as deficient in psychosocial factor.8

In this perspective differences in perceived need and attitude to dental appearance and orthodontic care between individual are rarely documented. Up till now there have been very few studies of the importance of these concerns for the delivery of dental care and mainly with respect to orthodontic treatment.

The present study has the objective to determine the psychological as well as social impact of dental aesthetics using the Psychosocial Impact of Dental Aes- thetics Questionnaire' (PIDAQ) and self-rated Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) and to investigate self-perceived need and attitude to fixed orthodontic treatment and attitude to own teeth and general appearance.

METHODOLOGY

The cross sectional study was conducted among the students of Margalla Institute of Health Sciences (MIHS) Rawalpindi with age ranging from 18-25 years. The reason for choosing these ages is that the respon- dents would be sufficiently grown-up to be able to state their own opinion. Study was approved by the ethical review committee of MIHS. A questionnaire was given to 159 students who met the inclusion criteria of being

18-25 years of age and having no previous history of orthodontic treatment. Students already undergoing orthodontic treatment and/or having craniofacial syn- dromes or anomalies were excluded from the study.

The Psychosocial Impact of Dental Aesthetics Questionnaire' (PIDAQ) used in this study consisted of questions pool from various previous researches exam- ining dental aesthetics and oral health-related quality of life questionnaires.78 Thirty items were clustered into five main Groups (I-IV); Dental self-confidence I Social impact II Psychosocial impact III Aesthetic concern IV were based on the four factors of Klages et al.8 and Group V Patient Beliefs included nine questions five questions incorporated as developed by Grzywacz7 and four more questions added concerning dental aesthetic impact on dental health career social success and ef- fect on general appearance. In order to avoid increased awareness of the patient to the factorial relevance of each question the names of the Groups were not stated on the relevant items in the questionnaire.

The questionnaire was self-administered by the students with the Likert scale being used to rate the replies on a scale ranging from 0 (total disagree- ment) to 4 (total agreement) for I-IV Groups. Group V

Patient beliefs' were answered according to options provided. Dental aesthetics was assessed using the IOTN Aesthetic Component (AC).9 The students were shown 10 black and white photographs of anterior teeth presenting varying degrees of malocclusion and were inquired to indicate which grade of photograph (1 to

10) they believed most closely appeared like their own dentition. No time limit was given to the students for the self-rating of AC. The IOTN-AC self-rating was then employed in grouping the students; respondents representing as particular IOTN-AC grade were re- garded as particular groups.

Statistical analyses was performed using SPSS for Windows (version 16.0). The Kruskal-Wallis test was applied for Variable I-IV to determine differences between the mean scores for all the subject groups (1 to 4+). Due to small of number of students rating themselves as grade 4 and higher they were pooled together. P-value equal to or less than 0.05 was taken as statistically significant. To evaluate the psychosocial impact of dental aesthetics on the emotional wellbeing of person the mean values were associated among the four subject groups for each of variables. Chi square test was performed for variable V and descriptive statistics were carried out for gender age.

RESULTS

The sample consisted of 159 adults with mean age of 20 years (SD2.4) and largely female comprising 140 (88%) and males were 19 (12%). The study group consisted of BDS students at Margalla College of Dentistry. Of the total sample 100 (62.9%) of students rated their dental appearance as IOTN-AC grade 1 (constituting Group 1) 22 (13.8%) placed themselves as IOTN-AC grade 2 (Group 2) 21(13.2%) rated them- selves as IOTN-AC grade 3 (Group 3) and 16(10.1%) of the students rated their dental aesthetics as IOTN-AC grade 4 to 10 (Group 4).

Dental self-confidence' was found to be highest for subjects rating themselves as IOTN-AC grade 1 and lowest for IOTN-AC grades 4. Social impact' was highest for individuals scoring themselves as IOTN-AC grades 4 and least for those evaluating their dental appearance as IOTN-AC grade 1. The mean scores for Psychological impact' was found to be of greatest for respondents who rated themselves as resembling

TABLE 1: MEAN SCORES BY COMPARING RESPONSES OF I-IV GROUPS WITH

###DIFFERENT IOTN-AC GRADING

###Variable###IOTN###P value

###1 n=100###2 n=22###3 n=21###4 n=16

1###Dental Self Confidence###90.30###74.84###64.19###43.47###.000

2###Social Impact###69.34###92.77###90.07###115.84###.000

3###Psychosocial Impact###75.06###80.30###90.26###96.97###.222

4###Aesthetic concern###72.64###88.23###77.95###117.38###.000

TABLE 2 : COMPARING `PATIENT BELIEFS WITH DIFFERENT IOTN-AC GRADING

###IOTN

###1 n (%)###2 n (%)###3 n (%)###4 n (%)###Total n (%)###P value

Do you think healthy and###Yes###98(98%)###22(100%)###21(100%)###15(93.8%)###156(98.1%)###.043

well-arranged teeth are im-

portant for your appearance###No###2(2.0%)###0(0%)###0(0%)###1(6.2%)###3(1.9%)

Do you think you should###Yes###28(28%)###11(50%)###11(52.4%)###8(50%)###58(36.5%)###.038

have orthodontic treatment

(Braces)###No###72(72%)###11(50%)###10(47.6%)###8(50%)###101(63.5%

Is there anything you would###Yes###64(64%)###18(81.8%) 14(66.7%)###14(93.3%)###110(69.6%###.061

like to change about your

teeth###No###36(36%)###4(18.2%)###7(33.3%)###1(6.7%)###48(30.4%)

Do you think straight and###Yes###89(89%)###20(90.9%)###20(95.2%###16(100%)###145(91.2%)###.040

beautiful teeth can promote

dental health###No###11(11%)###2(9.1%)###1(4.8%)###0(0%)###14(8.8%)

Do you think straight and###Yes###44(44%)###15(68.2%) 12(57.1%)###5(31.2%)###76(47.8%)###.080

beautiful teeth can promote

your career###No###56(56%)###7(31.8%)###9(42.9%)###11(68.8%)###83(52.2%)

Do you think straight and###Yes###52(52%)###12(54.5%) 10(47.6%)###4(25%)###78(49.1%)###.232

beautiful teeth can promote

social success###No###48 (48%) 10(45.5%) 11(52.4%)###12(75%)###81(50.9%)

Do you think straight and###Yes###87 (87%) 21(95.5%) 19(90.5%)###10(62.5%)###137(86.2%)###.039

beautiful teeth have signif

icant effect on your general###No###13 (13%)###1 (4.5%)###2 (9.5%)###6 (37.5%)###22 (13.8%)

appearance

IOTN-AC grade 4 and lowest in those rating them- selves as IOTN-AC grade 1. Aesthetic Concern' was determined to be highest in IOTN-AC grade 4 and being least for IOTN-AC grade 1 being significantly different amongst the groups(.000) as shown in Table 1.

Twenty eight percent of students perceived that they needed orthodontic treatment. There were signifi- cantly more girls than boys 84% and 16% respectively.

69.6% of respondents replied that they wanted to change something about their teeth out of which 31% wanted to change the color 30.2% wanted to change the arrangement and 8.4% wanted to change the size of their teeth. When they were asked that Do they believe that orthodontic treatment with braces is painful 70% replied with yes somewhat' or yes a lot'. Girls and boys were equally concerned about treatment related pain. Table 2 compares Patient beliefs V' in respondents with

different IOTN-AC grading summarizes the replies to the questions according to IOTN grading.

DISCUSSION

Assessment of psychosocial factors of malocclusion has been considered important part of orthodontic examination in adults recently previously only children usually were focused. Many studies have used IOTN-AC as a data collection tool only few have so far intended to find association between increasing grades of AC (signifies poor dental aesthetics) with decreasing psy- chosocial wellbeing. Our study revealed that subjects with less attractive dentition may be psychosocially deprived and have esthetic concern.

With respect to IOTN-AC grading it was found that most of the subjects placed themselves as IOTN-AC grade 1 followed by IOTN-AC grade 2 IOTN-AC grade 3 and minimum number of subjects placed themselves as IOTN-AC grade 4 or higher. Our results were similar to Klages et al8 who found out that greatest number of subjects evaluated themselves as IOTN-AC grade 1(33.5%) and 8.8% of subjects placed themselves as IOTN-AC grade 4 or higher. Another study by Khan M10 found out that majority of the respondents placed themselves as IOTN-AC grade 2 followed by IOTN- AC grade 1 IOTN-AC grade 3 and least number of respondents placed themselves as IOTN-AC grade 4 or higher. Similar finding were that of another study by Birkland et al in their study of orthodontic treatment need in young adults.11 Kerosou et al also showed the same distribution in their study with least number of respondents placing themselves in the great treatment need group based on self-rated IOTN-AC scores.12

These results indicate a comparatively lower ratio of individuals with higher degree of dental aesthetics impairment. For all the variables namely dental self-confidence social impact psychosocial impact and aesthetic concern the comparison clearly indicates that there is strong psychosocial impact of altered dental aesthetics.

The first factor Dental self-confidence' suggested a significant impact of dental aesthetics on the emotional state of an individual. The results of our study show that with decreasing self-confidence there is increased level of altered aesthetics as IOTN AC grades suggest and is perceived by the subjects themselves. Same are the results of the study by Klages et al which summa- rized that a lower grades of IOTN-AC show more well aligned set of dentition and this may be due to more favourable oral health status and a superior degree of contentment regarding dental attractiveness ensuing a better social concept.13

The second factor Social impact' comprises of matters referring to possible problems in social circum- stances due to personal awareness of a discouraging individual dental appearance. Our finding confirms the previous interpretations14 that individuals with maloc- clusions might be qualified as unfavourable personality characters by others and this may bother the self-concept and self efficacy of the affected subjects. Klages et al. have proved a direct effect of dental aesthetics on all

oral health-related quality of life scale values with a greater social appearance concern in individuals with poor dental aesthetics.i5 According to Onyeaso et al over 40% of respondents reported feeling less confi- dent as a result of their malocclusions with normal

activities constrained in some of the subjects including laughing in public meeting people and forming close relationships.15

The third factor the Psychological Impact' of dental aesthetics is collection of items dealing with a sense of inferiority and sadness when the affected subjects link themselves with persons with superior dental aesthetics. Onyeaso et al. have reported depres- sion associated to altered dental aesthetics in 27% of their individuals.15 The highly statistically significant group differences in this study show the relationship of weakening psychological well-being with progressively poor dental aesthetics. Klages et al. show results in parallel to ours with IOTN-AC grades 1 to 4 and above demonstrating an increasing trend of psychological effect along the IOTN-AC range.18

The fourth factor Aesthetic concern" includes ac- counts referring to dissatisfaction of one's own dental appearance when challenged by mirror photographic and/or video images. Self-perceived concern' assesses the individuals need for orthodontic attention and as the results show is found to be highest in individuals categorising themselves as IOTN-AC grade 4 and above. The relationship of a greater self-perceived treatment need with increasing severity of malocclusion has also been shown by Mandall et al. who determined that chil- dren who are teased about their teeth are more likely to take orthodontic treatment.16 Onyeaso et al. reported that 56.6% of their subjects reported for orthodontic treatment for aesthetic purposes.15

The Dental Self-confidence' Psychosocial impact' social impact' and aesthetic concern scales confirmed the strongest differences between the IOTN-AC groups under consideration these results are equivalent to those achieved by Klages et al. representing that all these variables are independent factors.18 Further confirmed by the findings of Cunningham et al. that social impact and aesthetic concern are different and independent psychosocial factors17 and that social and psychological effects of oral health are also independent.

Regarding fifth factor Patient Beliefs' 86.2% individuals judged that healthy and well-arranged teeth are important in facial appearance Grzywacz7 reported that 100% of 84 children aged 12 years judged that healthy and well-arranged teeth were important in facial appearance. Vander Geld et al found that facial appeal was correlated with character traits and self-confidence/self-esteem and highlighted the need for further study on the aesthetic aspects of the oral region.18

Phillips and Beal showed that in adolescents the positive feelings towards the dentofacial region is more important factor in one's self-concept than the severity or perceived severity of the malocclusion or the adolescent's perception of their malocclusion.19 There- fore the expected benefits of orthodontic treatment would include an enhancement of self-esteem and a reduction in social anxiety.i 36% of the subjects were willing to undergo orthodontic treatment fear of pain associated with fixed appliance therapy was greater among girls than boys. This is in agreement with other studies.20 The results from this study shows an inverse relation being perceived between the IOTN-AC grad- ing with psychosocial well-being. Thus the IOTN-AC may be considered an effective tool in assessing the psychosocial impact of dental aesthetics.

CONCLUSION

There was strong association between subjects perceiving the need for orthodontic treatment and their psychosocial wellbeing. It seems prudent to endorse the benefits of orthodontic treatment based on the need as assessed normatively by the orthodontist and subjectively as perceived by the patient. Although the AC is effective in determining the detrimental effects of altered dental aesthetics the recommendations for an index incorporating a psychometric scale for assess- ment of orthodontic-specific aspects of quality of life still stand strong.

REFERENCES

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Author:Rozina Nazir; Amjad Mahmood; Ayesha Anwar
Publication:Pakistan Oral and Dental Journal
Article Type:Report
Date:Jun 30, 2014
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