A longitudinal study of changes in psychosocial well-being during orthognathic treatment.

The aim was to evaluate changes in the psychosocial well-being of orthognathic surgery patients (n=22) during treatment and to compare results with those of adults not requiring orthognathic treatment (n=22). Patient data were collected before treatment (T0), after the first orthodontic examination (T1), three times during treatment (T2-T4), and 1 year after surgery (T5). In this article, only data corresponding to patient stage T5 are reported for the control subjects. Participants filled in a structured diary and the modified version of the Secord and Jourard body image questionnaire, the Orthognathic Quality of Life Questionnaire, the Rosenberg Self-Esteem Scale, and the Acceptance and Action Questionnaire II. Moreover, patients filled in the Symptom Checklist-90. After the placement of orthodontic appliances (T2), orthognathic quality of life, self-esteem, and psychological flexibility were lower and psychiatric symptoms increased. Improvements were observed from T2 to T5 in orthognathic quality of life, body image, self-esteem, psychological flexibility, and psychiatric symptoms. Treatment resulted in improvements from T0 to T5 in orthognathic quality of life, body image, and psychiatric symptoms. At T5, patient psychosocial well-being was comparable to or even better than that of control subjects. Orthognathic treatment seems to support psychological well-being, but the range of individual variation is wide.

Comparison of treatment costs and outcome in public orthodontic services in Finland.

The objectives of the study were to compare the costs and outcome of orthodontic treatment in eight municipal health centres in Finland. A random sample of the age groups of 16- and 18-year-olds (n = 1109) living in these municipalities was clinically examined by two calibrated orthodontists. The acceptability of the morphology and function of the occlusion were assessed with the Occlusal Morphology and Function Index (OMFI). The data concerning previous orthodontic treatment were collected from the patient records of all subjects (n = 608) who reported previous or ongoing orthodontic treatment or who could not recall if they had received orthodontic treatment. The health centres were grouped into an early and a late timing group according to the mean age of starting the treatment. The mean age for starting orthodontic treatment was 8.0 years (SD 1.9) in the early group and 10.7 years (SD 2.3) in the late group. The visit costs and the costs of orthodontic appliances without overheads comprised the operating costs. The cost-effectiveness of orthodontic services was measured by estimating how much each health centre had to have paid for one per cent unit of acceptable morphology and acceptable function of occlusion. The mean appliance costs were higher in the late timing group and the mean visit costs higher in the early timing group. The mean operating costs per case were €720 in the early and €649 in the late timing group. However, there was a great variation within both groups. The cost of one per cent unit of acceptable morphology was the same in the two timing groups, while the cost of one per cent unit of acceptable function was lower in the early timing group. The low operating costs as such did not totally explain the better cost-effectiveness of orthodontic care. Furthermore, the cost-effectiveness was not directly connected with the timing of treatment.

Orthodontic treatment practices in Finnish municipal health centres with differing timing of treatment.

The aim of this study was to compare orthodontic practices in eight Finnish municipal health centres selected on the basis of an earlier survey to represent early and late timing of treatment. The health centres were grouped according to the mean age of starting treatment; earlier versus later than 9 years of age. A random sample of 16 and 18 year olds (n = 2325) living in these municipalities were invited for a clinical examination, and 1109 adolescents participated. The participants reported on their previous or ongoing orthodontic treatment by means of a questionnaire. Data on orthodontic treatment received were collected from the dental files of the adolescents who reported a treatment history and for those who did not recall exactly whether or not they had received orthodontic treatment. Analysis of the non-respondents was made on the basis of their dental files. Differences between the features of orthodontic treatment in the early and late starting health centres were analysed using a two-tailed t-test. In the early group, 70 per cent, and in the late group 42 per cent, of adolescents had a history of orthodontic treatment. General dentists carried out 90 per cent of the treatment in the early group and specialists every third treatment in the late group. An early start resulted in more frequent visits (P = 0.004) and a longer treatment duration (P < 0.001), while later timing resulted in an increase in the number of appliances (P < 0.001).

Morphological, functional and aesthetic criteria of acceptable mature occlusion.

At present, there are no generally accepted criteria that could easily be applied to the evaluation of occlusal acceptability in clinical examinations at population level. The present study analyses the opinions of Finnish orthodontists and general practitioners on the characteristics required for acceptable occlusion in the full permanent dentition. A questionnaire was sent to all 37 health centres where at least one orthodontist was employed, 31 regionally comparable health centres without an orthodontist, 12 private orthodontists, and 13 orthodontists working at university dental clinics. Seventy-four orthodontists returned the questionnaire giving a response rate of 80 per cent. They were asked to give their views on the importance of morphology, function, long-term stability, and dental appearance as elements of acceptable occlusion. They were also encouraged to indicate other significant characteristics and requested to assess the relative significance of these features. In general, the respondents expressed the need to assess morphological, functional and aesthetic aspects of occlusion as a whole. Good function, rather than morphology, was considered to be the most important feature of an acceptable occlusion, with a relative significance of 40 per cent (range 20-90 per cent). According to the respondents, the acceptability of occlusion is determined not only by morphological features, but also by the functional status and long-term stability, as well as by the patient's opinion of the dental appearance.

Outlining the morphological characteristics of acceptable occlusion.

OBJECTIVES: The aim of this study was to outline the definitions of a morphologically acceptable occlusion in young adults that could be applied to assess the outcome and effectiveness of orthodontic treatment. The opinions of Finnish orthodontists and general practitioners were investigated for this purpose. METHODS: A semi-structured questionnaire was sent to all health centres where at least one orthodontist was employed (n=37), to health centres without any orthodontist (n=31), to private orthodontists working as consultants (n=12) and to orthodontists working at university dental clinics (n = 13). The criteria for moderate and little orthodontic treatment need in the Need of Orthodontic Treatment Index (NOTI) and the Index of Orthodontic Treatment Need (IOTN) were chosen to describe the basic characteristics of occlusal acceptability. RESULTS: The questionnaire was returned by 76 subjects (82%). The respondents' views on an acceptable occlusion in young adults were not totally in line with the chosen definitions. Only 16% of the respondents accepted the definitions of both indices as such; the criteria in NOTI were accepted by 25% and those in IOTN by 21% of the respondents. Functional considerations of the occlusion were the main reasons for the desire for further details in the description of an acceptable occlusion. Crossbites with a discrepancy between retruded contact position and intercuspal position were the least accepted anomalies. The opinions were statistically significantly associated with the level of the respondents' orthodontic education and their type of employment. CONCLUSIONS: We conclude that the selected definitions of NOTI and IOTN can serve as a basis for the characteristics of a morphologically acceptable occlusion in young Finnish adults, but measures of the functional aspects of occlusion must be added for studies on the outcome of orthodontic services.