15018752330
发表时间:2015-12-07 浏览次数:471次
Introduction
Human self-esteem is influenced by acceptable physical appearance,
including the condition of the teeth. Further, well-aligned teeth and a
pleasing smile reflect positively at all social levels, while irregular
or protruding teeth reflect negatively. The major desire for orthodontic
treatment is usually related to aesthetics, and to look attractive for
self-esteem. Altered dentofacial esthetics and malocclusion less
frequently compromise oral function but can influence a person's
self-esteem, emotional development, and social integration worldwide. [1],[2],[3]
Although dissatisfaction with dental appearance is broadly related to occlusal irregularities, [4],[5] there are differences in the recognition and evaluation of the dental features. [6],[7]
Studies revealed that people seem aware of their malocclusion trait,
but they do not perceive a need for treatment to the same extent as a
dentist or an orthodontics. [8],[9]
Facial features may be viewed differently in different races and what
is considered as pleasing in one race might not be so in another race. [10] The perception of beauty not only is an individual preference, but also might have cultural and ethnic biases. [11],[12],[13]
Cultural, social and psychological factors and personal perceptions
influence what an individual might consider to be physically attractive.
It has been seen that physical attractiveness plays a major role in
social interaction and influences the impression of an individual's
social skill. [14],[15]
It has also been suggested that age, gender, and socio-economic
background are factors playing a role in the self-perception of dental
appearance. [16],[17]
Dentofacial esthetics is an important motivational factor to seek
orthodontic treatment, therefore, an improvement in appearance should be
an essential treatment goal. Personal esthetic perceptions of the
dentofacial complex and the associated psychosocial need are directly
reflected in perceived need for orthodontic care. Treatment is,
therefore, often influenced more by demand rather than by need. [18]
In the past, orthodontic treatment need was evaluated from a strictly
professional viewpoint (normative need), but several studies have stated
that self-perceived dental appearance is also important in the decision
to seek orthodontic treatment. [19],[20],[21]
Although dissatisfaction with dental appearance is broadly related to
the severity of the occlusal irregularities, there are differences in
the recognition and evaluation of the dental features. [14],[22]
For this reason, professional opinions regarding evaluation of facial
esthetics may not coincide with the perceptions and expectations of
patients. [23],[24]
The aims of present study were to:
Assess self-perceived dental appearance among rural Indian population using aesthetic component (AC) of the index of orthodontic treatment need (IOTN) index
Determine if gender and age influence patient self-perception.
Methods
Ethical considerations
The study protocol was approved by
Institutional Ethical review committee of Sudha Rustagi College of
Dental Sciences and Research, Faridabad. Voluntary consent was obtained
from each participant before the study.
Study population
A
cross-sectional study was carried out to assess the perceived aesthetic
impact of malocclusion in 16-24 year-old subjects selected from the
rural population of Faridabad, Haryana, India. A pilot study was
conducted to assess the methodology and to estimate the sample size. A
sample size of 990 was calculated to be satisfactory. Older adolescents
and younger adults were selected since they are at an age when facial
aesthetics including those of teeth are of importance. A stratified
two-stage cluster sampling technique with villages as the primary
sampling unit was utilized. All subjects between 16 and 24 years old,
willing to participate and to give their consent, were selected.
Subjects with presence of mixed dentition, any structural abnormality in
the teeth concerned and those undergoing or with a history of any
orthodontic treatment were excluded. The study was conducted from July
to November 2013.
The perceived orthodontic treatment need was assessed using the AC of IOTN. [25]
All readings were recorded on a specially prepared form.
Calibration of examiner
A
single calibrated examiner performed all measurements. The
intra-examiner test was performed in the measurement of the IOTN-AC.
Reliable results were seen with κ = 0.82.
[TAG:2]Index of orthodontic treatment need-aesthetic component [26][/TAG:2]
Each subject was shown 10 colored photographs depicted in the AC of IOTN [Figure 1]
and was asked to choose the one with the closest resemblance to their
actual smile. This was done on memory recall basis, and the subjects
were not allowed to check their smile in the mirror. The score of the
chosen photograph was used to determine the perceived need for
orthodontic treatment. A definite need of treatment was represented by
photos 8-10, while borderline and no need for orthodontic treatment were
represented by photos by photos 5-7 and 1-4, respectively.
Statistical analysis
The data was analyzed using the SPSS
software (version 11.5) (SPSS Inc., Chicago, IL, USA). Bivariate
analyses using the Chi-square test (χ2 ) at 5% significance level were performed to test the influence of age and gender on perceived orthodontic treatment needs.
Results
[Table 1] shows the age-wise and gender-wise distribution of study population. A total of 528 males (53.33%) and 462 females (46.67%) were selected. Of these, 210 males (49.65%) and 213 females (50.45%) were in the age group of 16-18 years, whereas 318 males (56.08%) and 249 females (43.92%) were in the age group of 18 years old and above.
[Table 2] represents the distribution of the individual scores according to the IOTN-AC index. Maximum number of subjects (n = 165) reported a score of 3, followed by score 1 (n = 156). Score 10 was reported by least subjects (n = 24).
When the IOTN-AC scores are divided into three categories based on the
need for orthodontic treatment, maximum subjects were found to report
scores of 1-4 (60.9%), followed by scores 5-7 (27%) and scores 8-10
(12.1%).
[Table 3]
represents the gender-wise differences according to the IOTN-AC scores.
The differences were not found to be statistically significant in
relation to the perceived needs (P = 0.095).
[Table 4] summarizes the perceived orthodontic need IOTN-AC scores according to age groups. The age wise differences were found to be statistically significant in relation to the perceived needs (P < 0.001). Significantly greater proportion of the older adolescents (60%) showed perceived orthodontic treatment.
Discussion
The sample analyzed composed of older adolescents and younger adults
ranging in age between 16 and 24 years old. People of this age range
tend to be more socially aware and conscious about their appearance than
a comparatively younger school going population. Further, young people
tend to show less physiological wear, wasting diseases, and periodontal
diseases in their teeth which if present might affect the accuracy of
the method.
In this study, it appeared that the gender of the
patients did not influence the perception of their own dentition. The
female and male subjects of both age groups had a tendency to score
their dental appearance more favorably and allocate themselves toward
the more attractive end of the scale.
When self-perceived
orthodontic treatment need was evaluated by means of the AC of IOTN,
only 12.12% of the subjects self-scored as presenting a definite need
for orthodontic treatment. Consistent to some other studies, no
statistically significant differences were observed in perceived
orthodontic needs according to gender. [15],[18] However, these findings were not consistent to those of other studies. [24],[27],[28],[29],[30]
This is probably because subjects were from a rural area and had a
general lack of awareness of the presence of malocclusion. The race,
level of expectations (probably affected by their culture), and
socioeconomic status of each population might also contribute to this.
Statistically
significant differences were found for perceived needs according to
age. Significantly greater part of the older adolescents (60%)
self-scored as presenting a definite orthodontic treatment need compared
to younger adults. Similar findings were observed in a study conducted
by Alhaija et al.[30]
where significant differences were found when age groups were compared
for the perceived need for treatment. However, this is in contradiction
with some other studies [16],[24],[28],[29]
where significant differences were not seen. Adolescence is the time
when concern over appearance and facial attractiveness is developing,
which translates to an increased awareness of body image. Teenagers, in
particular have been found to attach great importance to an attractive
dental appearance. The differences between studies may result from
ethnic variation and the age range of the adolescents in this present
study. Ethnicity does have an effect on self-perceived need due to
differences in acceptable facial appearances and what is deemed as
acceptable occlusion by different ethnic groups. It would thus be useful
to validate the IOTN in different ethnic groups.
Disease does
not always negatively affect subjective perceptions of well-being, and
even when it does, its impact depends on expectations, preferences,
material, social and psychological resources and more importantly,
socially and culturally derived values. [9]
What is considered aesthetically pleasing in one culture will often not
match that which is thought of as aesthetically pleasing in another.
Thus, the lack of perceived need in the population evaluated might be
because this rural population probably does not have the same notions of
beauty as their British peers, where the index was developed. The level
of education may also be a factor influencing perceived treatment need
and demand. [18]
It is possible that subjects replied defensively and subconsciously
trying to allocate themselves to the attractive side in order to avoid
treatment. Alternatively since each picture shows the dentition only
from the front, it is possible that the patients could not differentiate
between some features of malocclusion as increased overjet and deep
bite and subsequently they could not score. It might be that patients
could not estimate the malocclusion and subsequently could not classify
the teeth in any of these grades. Further, it is likely that the IOTN is
not sensitive enough to account for all types of malocclusion as Class
III, open bite, cross bite and scissors bite. [29]
Epidemiological analysis of the prevalence of various oral health
problems has evidenced an enormous lack of data related to malocclusion.
This is due to the accumulated treatment needs of the problems of
caries and periodontal disease, an issue that is strongly correlated to
the current healthcare model as well as to the inequality in access to
healthcare services. Thus, those responsible for planning orthodontic
treatment in both the public and private sector should concern
themselves with the desires of the community as well as with the large
body of evidence that supports the importance of facial characteristics
in the lives of individuals.
In summary, further studies are
required to improve our understanding of self-perceived need for
orthodontic treatment, especially in developing countries where
different factors than those reported in North American and European
countries could be influencing the demand and delivery of orthodontic
care. It may even be necessary to use more than one index in an
epidemiological study to gather all the required information.
The
conclusions derived from this study are of considerable importance for
Indian policy makers in their work with planning and implementing public
oral health strategies for the rural population of this age group.
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