Use of the sociodental approach in estimating orthodontic treatment needs in adolescent patients.

PURPOSE: The sociodental model integrates clinical assessment, perceived impacts of malocclusion on quality of life, and behavioural propensity when prioritising orthodontic treatment. This study compares the effect of using different instruments to measure impact-related need on the assessment of orthodontic treatment need based on the sociodental framework. MATERIALS AND METHODS: In this cross-sectional study, 206 Malaysian adolescents (age: 11-18 years) were screened in orthodontic clinics to identify those with normative need, oral impacts due to malocclusion, and having high and medium-to-high behavioural propensities. The Index of Orthodontic Treatment Need classified normative need. The Psychosocial Impact of Dental Aesthetics (PIDA) questionnaire and the Condition-Specific Child-Oral Impacts on Daily Performances (CS-OIDP) index measured oral impacts. Subjects' behavioural propensities for successful treatment outcome were based on the Basic Periodontal Examination and International Caries Detection and Assessment System. Data were analysed using the McNemar test. RESULTS: The response rate was 99.0%. Estimates of normative need (89.7%) were significantly reduced under the sociodental model by 65.7% (p < 0.0001) when impact-related need was measured using PIDA, and by 41.7% (p < 0.0001) when measured using CS-OIDP. The difference between the results of the two instruments in proportions of identified need for orthodontic treatment was 24.0% (p < 0.0001). CONCLUSION: For Malaysian adolescents, estimates of need for orthodontic treatment when assessed with the sociodental approach were substantially lower than normative clinical assessment and depended highly on the tools selected to assess the patient's impact-related need. Health policy makers should understand the implication of adopting one instrument or the other when estimating orthodontic treatment need.

Inequalities in orthodontic outcomes in England: treatment utilisation, subjective and normative need.

OBJECTIVE: To investigate inequalities in three aspects of access to orthodontic care: uptake of orthodontic treatment, normative need and subjective need in England. METHODS: We used data from two surveys in England: 12 and 15-year-olds from the 2013 Child Dental Health Survey (CDHS 2013) and 12-year-olds from the 2008/2009 NHS Dental Epidemiology Programme for England (NDEP 2008/2009). Summary variables representing orthodontic status were calculated. Two regression-based summary measures of inequalities were used to investigate the relationship between deprivation level and orthodontic outcomes: Slope and Relative indices of Inequality. RESULTS: There were significant absolute and relative inequalities in uptake of orthodontic treatment. The least deprived were 1.9 times more likely to have received orthodontic treatment compared to the most deprived in both surveys. Normative need was not associated with deprivation in either the analyses of CDHS 2013 (SII= 0.03, 95% CI: -0.04, 0.1; RII=1.06, 95% CI: 0.91, 1.24) or the NDEP 2007/2008 (SII= 0.03, 95% CI: -0.02, 0.07; RII=1.06, 95% CI: 0.96, 1.18). There was greater willingness to have teeth straightened in more deprived children from CDHS 2013 (SII=-0.09, 95% CI: -0.16, -0.03; RII=0.85, 95% CI: 0.75, 0.96) but not in NDEP 2007/2008 (SII=0.03, 95% CI: 0, 0.06; RII=1.07, 95% CI: 0.99, 1.15). CONCLUSIONS: Being deprived was associated with lower uptake of orthodontic treatment. Normative need was not related to deprivation. The association between deprivation and subjective need was only partly established, with poorer children showing a greater desire to have their teeth straightened in one survey.

Prevalence and factors related to malocclusion, normative and perceived orthodontic treatment need among children and adolescents in Bangladesh

ABSTRACT Objective: The purpose of the present study was to assess the prevalence of normative and perceived orthodontic treatment need in schoolchildren and adolescents, related risk factors, and children/parent's aesthetic perception, compared to orthodontist's opinion, in Dhaka city, Bangladesh. Methods: A random sample of 800 schoolchildren aging 11-15 years was selected from different schools in the city of Dhaka, Bangladesh. The Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) were assessed as normative treatment need. The Decayed, Missing, Filled Teeth (DMFT) index was used to record caries experience. Children were interviewed on the perception of orthodontic treatment need. Parents also completed a questionnaire on the perception of their child's orthodontic treatment need, assessed by AC/ IOTN. Results: According to the DHC/IOTN, only 24.7% were in the category of definite need (grade 4-5) for orthodontic treatment. A significant difference was found between the clinician/children and clinician/parents perceived AC score of IOTN (p= 0.0001). Multiple logistic regression showed children with a higher DMFT were significantly more likely to need orthodontic treatment, according to the DHC of IOTN. Conclusion: A low proportion of schoolchildren needs normative orthodontic treatment in the city of Dhaka, Bangladesh. Children with a higher DMFT score were significantly more likely to need orthodontic treatment, according to the DHC of IOTN.

RESUMO Objetivo: o objetivo do presente estudo foi avaliar a prevalência de necessidade real e percebida de tratamento ortodôntico em crianças e adolescentes em idade escolar, bem como de fatores de risco relacionados, e comparar a percepção estética das crianças e responsáveis com a percepção de ortodontistas na cidade de Dhaka, Bangladesh. Métodos: uma amostra aleatória composta por 800 crianças, com idades entre 11 e 15 anos, foi selecionada em diferentes escolas da cidade de Dhaka, Bangladesh. Para avaliação da necessidade real de tratamento, utilizou-se o Dental Health Component (DHC) e o Aesthetic Component (AC) do Index of Orthodontic Treatment Need (IOTN). O índice de Dentes Cariados, Perdidos e Obturados (CPO-D) foi usado para registrar a prevalência de cáries dentárias. As crianças foram entrevistadas sobre sua percepção da necessidade de tratamento ortodôntico, e os pais também responderam a um questionário sobre a percepção da necessidade de tratamento ortodôntico de seus filhos, avaliada pelo AC do IOTN. Resultados: de acordo com o DHC, apenas 24,7% das crianças foram alocadas na categoria de necessidade real (notas 4-5) de tratamento ortodôntico. As pontuações no AC foram significativamente diferentes entre os ortodontistas, as crianças e os responsáveis (p= 0,0001). A análise da regressão múltipla mostrou que as crianças com maiores pontuações no CPO-D tinham chance significativamente maior de precisar de tratamento ortodôntico, segundo o DHC. Conclusão: um número reduzido de crianças em idade escolar necessita realmente de tratamento ortodôntico em Dakha, Bangladesh. Além disso, as crianças com maior CPO-D apresentaram chance significativamente maior de precisar de tratamento ortodôntico, segundo o DHC.

Agreement and association between normative and subjective orthodontic treatment need using the Index of Orthodontic Treatment Need.

AIMS: To determine the association and level of agreement between young adults' perception of orthodontic treatment need (subjective need) and the orthodontists' assessment of treatment need (normative objective need). METHODOLOGY: For this study, 670 students [280 males and 390 females; mean age (standard deviation) of 15.32 (1.81) years] were selected from public and private schools from different demographic areas of Jeddah city, Saudi Arabia, and divided into two age groups (12-15 years) and (16-19 years). All the participants were examined, and the Index of Orthodontic Treatment Need (IOTN) components [dental health component (DHC) and aesthetic component (AC)] were recorded. RESULTS: Kappa statistics showed a statistically significant but fair agreement between clinician AC (CAC) and student AC (SAC) assessments in both age groups (k = 0.343 and 0.334, respectively; P < 0.001), whereas Spearman's correlation coefficient showed a statistically significant but moderate association (r = 0.487 and 0.517, respectively; P < 0.001). The degrees of agreement were 76.4% and 76.7% at the no-need and mild-need levels of treatment, respectively. There was a statistically significant but weak association between the subjective and normative needs (SAC and IOTN-DHC) in both age groups (r = 0.336 and 0.360, respectively; P < 0.001). However, the degrees of agreement were 58.9% and 61.5% at the no-need and mild-need levels of treatment, respectively. CONCLUSION: Significant but weak positive association was found between the normative and subjective orthodontic treatment needs, indicating a lack of understanding of the nature of malocclusion and its consequences. Thus, promoting further knowledge and awareness of malocclusion are indicated.

Self-perceived oral health, normative need, and dental services utilization among dentate adults in the United States: National Health and Nutrition Examination Survey (NHANES) 2011-2014.

OBJECTIVE: This study investigated the role of self-perceived oral health and normative need on dental services utilization by US adults aged ≥30 years from the 2011-2014 National Health and Nutrition Examination Survey (NHANES). METHODS: Data on 5,806 dentate adult NHANES participants were analyzed. Key independent variables were self-perceived oral health and normative need assessed by a dentist. The dependent variable was dental visit within the past 12 months. Select sociodemographic variables were adjusted for in logistic regression models using SAS survey procedures. RESULTS: Overall, 33.8 percent of adults did not have a dental visit in the past 12 months. About 26.9 percent reported they were unsatisfied with their oral health and 53.4 percent needed to seek care. Individuals unsatisfied with their oral health were less likely to have a dental visit in the past 12 months compared to those who were satisfied with their oral health (57 versus 25 percent). Overall, participants who were unsatisfied with their oral health received a recommendation to seek care. These participants had more normative needs and were less likely to have a dental visit in the past 12 months; however, this relationship varied by race/ethnicity. For Asian-Americans, there was no association between those unsatisfied with their oral health and dental visits. Also, there was no association across all race/ethnicities between number of teeth present and dental visits. CONCLUSION: Both self-perceived oral health and normative need are associated with dental utilization. Results will contribute to health policy discussions and program development that aim to improve oral health status in the United States.

Gaps in need, demand, and effective demand for dental care utilization among residents of Krishna district, Andhra Pradesh, India.

AIMS: To identify the relation between need, demand, and effective demand for dental services in Andhra Pradesh, India. MATERIALS AND METHODS: This is a cross-sectional study performed among populations residing in the rural and urban areas of Krishna district, Andhra Pradesh, India. Data were collected from 3102 individuals who were selected through multiphase random sampling. Data regarding self-perceived dental need, dental service utilization, and barriers for utilization were collected through s pretested questionnaire followed by type-III clinical examination to assess the normative need of the individuals. Chi-square test was used to compare independent and dependent variables, and further comparison was done with multivariate logistic regression analysis for significant variables. RESULTS: Less than half (40%) of the participants perceived a need for dental care. Among the people who perceived need for care, only 21.4% utilized dental care and 78.6% of them had unmet dental needs. The two main reasons for not seeking dental care was lack of money, i.e., unaffordable dental treatment (48%) and having the perception that they do not have any dental problem (19.4%). CONCLUSIONS: There is an enormous difference between normative need, demand, and actual utilization rates in dental care, and hindrances for effective demand need to be addressed to improve dental care delivery system.

Self-reported and clinically diagnosed dental needs among institutionalized adults in Vijayawada: A cross-sectional study.

BACKGROUND: Frail and functionally dependent elderly people, living in institutions, have difficulties in accessing dental care. Hence, the present study aims to determine the relationship between subjective need and the equivalent clinical findings in an attempt to understand the factors that contribute to individual's perception of the need for dental care among institutionalized adults in Vijayawada. MATERIALS AND METHODS: A cross-sectional study is conducted in all old age homes in Vijayawada. A total of 182 subjects were interviewed with a questionnaire consisting of demographic details, dental behavior (last visit, reason for the last visit), and self-rating of oral health and impact of oral problems, followed by the clinical examination for oral mucosal condition, dentition status and treatment needs, prosthetic status and treatment needs, and periodontal status by using World Health Organization proforma. RESULTS: Results showed that normative needs of subjects are significantly more than the self-perceived needs. Response of subjects regarding their present condition of mouth and teeth is 65.4% of subjects reported good and 0.5% reported poor, with respective to perceived oral symptoms 61.9% of subjects' complaints of hypersensitivity and 23.1% of subjects were having toothache and 80.5% subjects are having difficulty in eating. The overall prevalence of complete Edentulous and require complete denture was 12.1%, and 60.4% required partial denture. CONCLUSION: About half of the participants confirmed need for problem-oriented dental care. The main reason for the problems faced by the institutionalized people is due to lack of teeth which could be prevented by appropriate care.

Associations between perceived needs for dental treatment, oral health-related quality of life and oral diseases in school-aged Thai children.

OBJECTIVES: To assess perceived needs for dental treatment (PNDT), oral health-related quality of life (OHRQoL) and oral diseases in a Thai school-aged national representative sample. In addition, relationships between PNDT and various aspects of OHRQoL, different levels of oral diseases as well as sociodemographic characteristics were assessed. METHODS: Study sample was a subsample of Sixth Thailand National Oral Health Survey. Data were collected on 1063 12-year-olds and 811 15-year-olds through oral examinations, interviews on PNDT and OHRQoL, using Child-Oral Impacts on Daily Performances (Child-OIDP) or Oral Impacts on Daily Performances (OIDP) indices and questionnaires containing questions on sociodemographic information. RESULTS: Prevalence rates of PNDT were 60.4% in 12-year-olds and 67.6% in 15-year-olds. PNDT were highly associated with OHRQoL with significant odds ratios that increased incrementally by the intensity of oral impacts. Oral impacts on eating, emotional stability and smiling and those attributed specifically to dental caries, periodontal diseases, malocclusion and tooth discolouration were associated with PNDT. The chances of having PNDT increased by number of untreated decayed teeth. Periodontal disease was associated with PNDT only when occurring to a great extent. Boys and children in some regional rural areas were less likely than girls and those living in Bangkok to have PNDT. CONCLUSIONS: Perceived needs for dental treatment were common and highly associated with levels of oral impacts, specifically impacts on eating, emotional stability and smiling performances. PNDT were also related to number of untreated decayed teeth, a great extent of periodontal disease, sex and geographical region.

Orthodontic treatment need of children in Trinidad and Tobago / Necesidad de tratamiento ortodóntico de los niños en Trinidad y Tobago

OBJECTIVE: This prospective cross-sectional study was undertaken to determine the normative and perceived orthodontic treatment needs of children aged 11-12 years in a Caribbean country, Trinidad and Tobago. METHODS: One author, an experienced orthodontist, examined 367 children using the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) to assess the normative need. The same orthodontist administered the questionnaire to assess the patient's perceived needs using the Aesthetic Component (AC) of the IOTN and the Oral Aesthetic Subjective Impact Scale (OASIS). RESULTS: The DHC and the AC of the IOTN and the OASIS showed respectively that 61.4%, 2.5% and 0.6% of the children had definite need for orthodontic treatment. The female proportion of the sample was more than the target population but the perceived need and normative need for orthodontic treatment did not depend significantly (p < 0.05) on the gender or ethnicity of the subjects of this study. The perception of need for orthodontic treatment differed inversely from the normative need and this is seen to be significant (p < 0.05) when OASIS was used. CONCLUSIONS: Approximately three out of five children in Trinidad and Tobago have a great (or very great) need for orthodontic treatment for dental health reasons.

OBJETIVO: Este estudio prospectivo transversal fue emprendido con el objeto de determinar las necesidades del tratamiento ortodóntico normativo y percibido para niños de 11-12 años de edad en un país caribeño - Trinidad y Tobago. MÉTODOS: Un autor - ortodoncista experimentado - examinó a 367 niños usando el Componente de Salud Dental (DHC) del Índice de Necesidad del Tratamiento Ortodóntico (IOTN) para evaluar la necesidad normativa. El mismo ortodoncista aplicó la encuesta para evaluar las necesidades percibidas del paciente usando el Componente Estético (CA) del IOTN y Escala ortodóntica de impacto estético subjetivo (OASIS). RESULTADOS: El DHCy el CA del IOTNy el OASIS mostraron respectivamente que 61.4%, 2.5% y .6% de los ninos tenían una necesidad definida de tratamiento ortodóntico. La proporción de hembras de la muestra fue mayor que la población objetivo, pero la necesidad percibida y la necesidad normativa de tratamiento ortodóntico no dependia significativamente (p < 0.05) del género o etnicidad de los sujetos de este estudio. La percepción de la necesidad de tratamiento ortodóntico difería inversamente de la necesidad normativa y puede verse que es significativa (p < 0.05) cuando el OASIS fue usado. CONCLUSIONES: Aproximadamente tres de cada cinco ninos en Trinidad y Tobago tienen una necesidad grande (o muy grande) de tratamiento ortodóntico por razones de salud dental.