Prime Factors Influencing the Reluctance Expressed Toward Orthodontic Treatment Among a Tribal Population with No Prior History of Orthodontic Treatments in the Community: A Cross-sectional Study

Abstract

Background Perceiving a need for orthodontic treatment is a heuristic process usually conditioned by the interplay between motivational factors and influencing factors in a community with orthodontic awareness and a history of already ongoing or completed orthodontic treatments. Using a verbally assigned index to elicit candid responses, the current study aimed at assessing reluctance toward orthodontic treatment in adolescents with clinically ascertained malocclusion in a community with no prior history of orthodontic treatment. Objectives Tribal adolescents from two regions with clinically ascertained malocclusion but no previous access to orthodontic treatment were evaluated for willingness or reluctance to undergo orthodontic treatment using a verbally assigned Simplified Malocclusion Index for Layperson Evaluation (SMILE index). Methods 2,835 tribal adolescents belonging to the tribal regions of Paderu and Parvathipuram in Andhra Pradesh were questioned to analyze factors related to reluctance toward orthodontic treatment in those with malocclusion. Necessary permission and consent were obtained from the institutional ethical clearance committee, tribal authorities, school authorities, and parents or guardians. Clinical screening employing appropriate infection prevention protocol under natural daylight was used to determine the presence of malocclusion. A verbally assigned SMILE index in the vernacular language of the students with malocclusion was used to record candid responses to analyze possible reluctance toward treatment. Specific reasons for reluctance to undergo treatment were documented and tabulated separately. Pearson chi-square statistical analysis of the data was performed to determine if there was any gender bias. Results At Paderu, of the 68% of the tribal adolescents presenting with malocclusion, the verbally assigned SMILE index revealed that 84.03% of the adolescents were reluctant. The chi-square statistical analysis of the data indicated a gender bias ( X 2 (1, N = 2,016) = 35.99, p < .0001). At Parvathipuram, of the 93% of the tribal adolescents presenting with malocclusion, the SMILE index assigned revealed that 93.05% of the adolescents were reluctant. The chi-square statistical analysis of the data indicated a gender bias ( X 2 (1, N = 819) = 6.42, p = .11). Conclusion The use of the SMILE index allows for a qualitative analysis of reluctance based on the candid subjective inputs from each individual. The study reveals a high degree of orthodontic awareness among the tribal adolescents, and any reluctance toward orthodontic treatment is mainly related to difficulty in access to treatment.