Dental Health Component Grades Research Articles

The distribution of malocclusion using the index of orthodontic treatment needs at a university dental hospital in and around Pretoria, South Africa

: The study described the patterns of malocclusion traits and the orthodontic treatment needs at a Dental Hospital using the Index of Orthodontic Treatment Needs (IOTN), Dental Health Component (DHC). We evaluated 2079 pre-treatment study models and clinical records of orthodontic patients from the Department of Orthodontics waiting list. The assessment of malocclusion was measured according to the molar relationship using Angle's classification.The DHC was further used to assess the five malocclusion traits: - missing teeth, overjet, crossbite, displacement of contact point, and overbite, including open bite (MOCDO). The MOCDO score was calculated to determine the orthodontic treatment needed based on the DHC grades 1–5. The data was analysed using SPSS version 28 and the level of significance was set at p≤ 0.05.: The sample consisted of 59.3% (n=1232) females and 40.7% (n= 847) males. The mean age of the study sample was 14 years (SD±2.3) and ranged between 12 to 20 years. Angle's Class I malocclusion was found in 57.7% of the sample, followed by Class II (35.4%) and Class III (6.9%). The orthodontic treatment needs DHC grade were: 53% grade 4 (need for orthodontic treatment), 21% grade 5 (great need for orthodontic treatment), 17% grade 3 (borderline need for orthodontic treatment), 6% grade 2 (little need for orthodontic treatment), and 3% grade 1 (no orthodontic treatment need). A statistically significant difference was found in Angle Class I malocclusion and the DHC grades (p=0.001), as well as MOCDO variables and DHC grades (p=0.001).Angle's Class I malocclusion was the most predominant in our study sample compared to Class II and Class III malocclusions. The DHC of IOTN was successfully used to evaluate the severity of malocclusion with the majority of the sample in Grades 4 and 5, requiring mandatory orthodontic treatment. A high frequency of the occlusal traits included missing teeth, overjet, crossbite, displaced contacts and overbite. The results of our study showed that most patients on the orthodontic waiting list require mandatory orthodontic treatment. Therefore, it is recommended that DHC be used to place patients on the waiting list to prioritise orthodontic treatment.

Assessment of malocclusion and patients' need for orthodontic treatment.

Objective: To document the frequency of various classes of Angle’s malocclusion and its treatment need among children of both gender between 13-17 years age attending government high schools in Peshawar District. Study Design: Cross sectional study. Setting: Khyber Medical University Institute of Dentistry. Period: Jan 2020 to Nov 2021. Material & Methods: 900 patients of both genders between the ages of 13 and 17 were used in the current investigation. A performa was used to record malocclusions e.g. Angle's classification, overjet, overbite, open bite and cross bite. For various malocclusions, the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) index was reported. Results: We looked at 900 students between the ages of 13 and 17 whose guardians had signed a written consent form. Among the 900 students who were examined, 60% (540) were males, and 40% (360) were females. 175 individuals had normal dental health, 420 had class 1 malocclusions, 265 had class 2s, and 40 had class 3s. Overjet was excessive in 210 cases and reduced in 53. Overbite was excessive in 201 cases and reduced in 34. In 185, there was an open bite. The difference was significant (P < 0.05). In 489 cases, DHC grade I and II, 310 cases, grade III, and 101 cases, grade IV, and grade V. The difference was significant (P< 0.05). Conclusion: The most frequent malocclusion is class 1. DHC grades I and II were more frequently observed in patients. Malocclusion can be identified using the Dental Health Components (DHC) of the Index of Orthodontic Treatment Need (IOTN).

Comparative assessment of orthodontic and aesthetic outcomes after orthognathic surgery with clear aligner or fixed appliance therapy.

Clear aligner therapy has an aesthetic advantage over fixed appliance therapy. However, to our knowledge, no study has objectively compared patient orthodontic and aesthetic outcomes between clear aligner and fixed appliance therapies administered after orthognathic surgery (OGS). This study included patients with no history of congenital craniofacial deformities who underwent surgery-first OGS and received clear aligner or fixed appliance therapy. The patients' grades on the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need and scores on the Peer Assessment Rating (PAR) index were calculated before OGS (T0), after OGS (T1), and after orthodontic therapy (T2). This study included 33 patients (clear aligner therapy, 19; fixed appliance therapy, 14). No considerable between-group differences were noted in the DHC and AC grades at T0, T1, or T2. Furthermore, %reduction in the PAR index score was more significant in the clear aligner group (74.4%) than in the fixed appliance group (63.2%) from T0 to T1 (p = .035); however, no between-group differences were noted from T1 to T2 or from T0 to T2. Both groups exhibited substantially improved DHC grades, AC grades, and PAR index scores at T1 and T2. Patient outcomes were similar between the clear aligner and fixed appliance groups after orthodontic therapy. However, the former group exhibited more favorable immediate results after OGS than did the latter group. Thus, as an adjunct therapy for patients with malocclusion, clear aligner therapy may be more effective than fixed appliance therapy.

What impact do personality traits have on self-perception of dental aesthetics?

BackgroundMalocclusion has significant social, psychological and physical impacts on the quality of life. This study aimed to study psychosocial impact of dental aesthetics among students, and how it was modified by personality traits.MethodsChinese version of Eysenck Personality Questionnaire Short Scale of (EPQ-RSC) and Chinese version of Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) were used to investigate 555 undergraduate students, aged 18 to 24 years. The participants and investigators self-rated their own dental aesthetics using the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The malocclusion was assessed by two independent investigators using the Dental Health Component (DHC) of IOTN.ResultsNo statistically significant difference was found for gender (p = 0.829) nor for majors (p = 0.598) in the psychosocial impact of dental aesthetics. Total and subscale PIDAQ scores differed significantly among the 3 IOTN grades. PIDAQ scores strongly correlated with Eysenck personality. The dimensions of extraversion and neuroticism, and dental health component grades had significant impact on participants' psychosocial well-being of dental aesthetics.ConclusionsNeurotic people with high self-concerns perceived greater psychosocial impact. Outgoing people appear to be less affected psychosocially by dental aesthetics.

Epidemiology of orthodontic treatment need in southwestern Ethiopian children: a cross sectional study using the index of orthodontic treatment need

BackgroundThe planning of orthodontic treatment within a public health system requires information on the orthodontic treatment needs of the population. It is important to have epidemiological data to estimate the total need for orthodontic care in any region. The present study aimed to determine the orthodontic treatment need in 12 years old Southwestern Ethiopian children.MethodsThe institution-based cross-sectional study was conducted which involved 347 twelve years old school children randomly selected from seven different public schools in Jimma Town, Southwestern Ethiopia. A structured interview and clinical examination were used to assess the subjects. One examiner used Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) to estimate the treatment need. Descriptive statistics and chi-square tests were used for data analysis with statistical significance set at P < 0.05.ResultsAccording to the DHC of IOTN, almost half of the subjects in the sample were in moderate to the great need for orthodontic treatment. About 15% of the children had a great need for orthodontic treatment based on IOTN-AC. The most prevalent occlusal traits for defining the DHC categorization include increased Overjet (30.8%) and Crowding (23.3%). There was no statistical difference in the distribution of DHC grades and AC scored based on gender.ConclusionThis study revealed that the need for orthodontic treatment was high. The percentage of the need for orthodontic treatment is higher in comparison to most of the studies conducted in African regions. Therefore, publicly subsidized orthodontic treatment should be planned and provided to those who are in great need for orthodontic treatment. Besides, awareness about orthodontic treatment should also be considered.

Socioeconomic status and orthodontic treatment need based on the Dental Health Component

Background: The dental health component (DHC) is used to assess different malocclusions by evaluating the number of teeth, overjet, overbite and contact points of each tooth. This index is subjectively influenced by socioeconomic factors. Purpose: This study aimed to determine the overview of the socioeconomic status and orthodontic treatment need based on the DHC of State 15 Medan Junior High School students. Methods: This study represented a descriptive research featuring cross-sectional design. The subjects of this study consisted of 100 high school students. This study was conducted by making dental impressions and distributing questionnaires. Data analysis was conducted with SPSS 17.0 software using a descriptive statistical test and presented in a distribution and frequency table. Results: 89% of subjects demonstrated DHC levels of 1-2. 66.3% of subjects with parents of secondary education level had DHC grades 1-2, followed by 31.5% with parents of higher education level and 2.2% with parents of basic education level. The majority of subjects with DHC grades 1-2 had parents occupying class 2 jobs and the lowest number of students had parents holding class 4 jobs. The majority of the subjects with DHC grades 1-2 (77.5%) were of low income parents. Conclusion: The largest distribution of orthodontic treatment need based on DHC among students of State 15 Junior High School occurred at levels 1-2 which either required or did not require minor orthodontic treatment. The majority of the students with DHC grades 1-2 have parents of secondary education level, a class 2 job and a low monthly income.

Orthodontic treatment need in a group of 6–12-year-old children in Szczecin

ABSTRAKTWstęp: Celem pracy była ocena ortodontycznej potrzeby leczenia w populacji dzieci w Szczecinie oraz określenie możliwych czynników związanych z tą potrzebą.Materiały i metody: Badaniem objęto 532 dzieci nieleczonych ortodontycznie, podzielonych na dwie grupy: 279 6–8-latków i 253 9–12-latków. Ortodontyczną potrzebę leczenia oceniono za pomocą komponenty zdrowotnej (DHC) i komponenty estetycznej (AC) wskaźnika ortodontycznej potrzeby leczniczej. Wyniki poddano analizie za pomocą testu χ2. Analizę wieloczynnikowej regresji logistycznej przeprowadzono w celu ustalenia związku między potrzebą leczenia a zmiennymi niezależnymi.Wyniki: Pomiędzy grupami 6–8-latków i 9–12-latków zaobserwowano istotne statystycznie różnice na podstawie dwóch komponent wskaźnika (DHC ≥ 4 i/lub AC ≥ 8) w ocenie wyraźnej potrzeby leczenia (odpowiednio 14% i 20,6%; p = 0,044). Czynniki takie jak nieprawidłowości zębowe, II klasa Angle’a, zwiększony nagryz poziomy, zgryz krzyżowy, a także przemieszczenie punktów kontaktu były istotnie statystycznie związane z wyraźną potrzebą leczenia (DHC stopień 4 i 5).Wnioski: W badanej populacji ortodontyczna potrzeba leczenia była zbliżona lub mniejsza w porównaniu z innymi populacjami europejskimi. Większa potrzeba leczenia zaobserwowana w grupie 9–12-latków podkreśla znaczenie wczesnej diagnozy wad zgryzu oraz konieczności zgłaszania się pacjentów do leczenia we właściwym czasie.

Assessment of Malocclusion and Orthodontic Treatment Need Among Hearing and Speech Impaired Children

Aim: Children with special needs are prone to poor oral health due to their potential sensory, motor and intellectual disturbances. The purpose of this study was to evaluate type and severity of malocclusion and assess orthodontic treatment need in hearing and speech impaired children. Materials and Methods: Sixty-seven hearing and speech impaired children aged 7-14 years studying in special schools in Bhilai and Durg were included in this study. The Dental Health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) were recorded by one examiner. Data were analysed using student's t-test and chi-square test at a level of significance of .05. Results: According to AC, 61.2% children had no/little need, 35.8% had moderate need and 3% had great need of orthodontic treatment. According to DHC, 35.8% children had no/little treatment need, 43.3% had moderate need and 20.9% had great treatment need. Chi-square test showed a highly significant gender difference (P&lt;.001), according to gender based DHC grade. Also, a highly significant difference between patient's perception and orthodontist's opinion for both AC and DHC (P&lt;.001). Conclusion: The patient's perception and orthodontist's opinion differed for assessment of malocclusion of hearing and speech impaired children. There was a moderate need of orthodontic treatment in these children of Bhilai and Durg.

Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh.

ObjectiveTo assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices.Materials and methodsThis retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13–21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test.ResultsDisplacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001).ConclusionYoung Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.

Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment.

The aim of this study was to evaluate the psychosocial impact of dental esthetics for adults seeking orthodontic treatment. The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered to 393 adults, aged 18 to 30years. The participants were divided into 2 groups: an intervention group (received orthodontic treatment) and a control group (rejected orthodontic treatment). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need (IOTN). The Wilcoxon signed rank test showed no statistically significant difference between the groups for the dental health component (DHC) of the IOTN (P=0.134). Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTN-DHC grades; self-confidence scores in the control group (F=1.802; P>0.05) were the exception. Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group. DHC grades, psychological impact, social impact, and aesthetic concern had significant impacts on patients accepting orthodontic treatment. The psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment. Importantly, participants with low self-awareness of the potential psychosocial impact rejected orthodontic treatment, despite the need for severe normative treatment.

An analysis of residual orthodontic treatment need in municipal health centres.

The aim of this study was to analyse residual orthodontic treatment need in Finnish municipal health centres. A random sample of two age groups, 16- and 18-year-olds (n = 2212), from seven municipalities was invited for a clinical examination, and 1041 adolescents participated. Two calibrated orthodontists blindly examined the participants for residual treatment need, applying the Dental Health Component (DHC) and Aesthetic Component (AC) of the Index of Orthodontic Treatment Need. Self-perceived treatment need, satisfaction with occlusal function, and dental appearance were evaluated with a questionnaire. Differences between objective and self-perceived treatment need and between treated and untreated adolescents were analysed using the chi-square test. A total of 18.8 per cent of all adolescents had DHC grade 4 or 5 and/or AC category 8-10, indicating a definite need for treatment. In the analysis between treated and untreated adolescents, orthodontic treatment history or gender had no statistically significant association with the objectively defined need (P > 0.05). Self-perceived treatment need was reported by 9.6 per cent of adolescents. This need was more common among treated (13.9 per cent) than untreated (4.6 per cent) adolescents (P < 0.001). Among all adolescents, satisfaction with occlusal function was high, 91.3 per cent; 78.9 per cent of adolescents were satisfied with their dental appearance. The main reasons for dissatisfaction and self-perceived need were visible contact point displacements. The observed proportion of residual orthodontic treatment need is in line with earlier findings. The high satisfaction with occlusal function reflects the applied selection criteria; orthodontic treatment of displacements causing only aesthetic concern is not prioritized.

Why Jordanians Seek Orthodontic Treatment ? Demand and Real Need

Objectives: Patients seek orthodontic treatment mainly due to psychological reasons, to improve their own dental appearance and aesthetic picture. The purpose of the present study was to determine factors associated with demand for orthodontic treatment and how this relates to real treatment need in a sample of Jordanian patients. Methods: This descriptive study involved 427 internally motivated patients aged 15 years and above who sought Orthodontic treatment at two Royal Medical Services Dental Clinics. Dental health component grade of index of orthodontic treatment need along with patient's chief concerns were recorded, according to these concerns five groups were obtained. Results: Among patients who were seeking treatment only 36% showed a definit need (grades 4 and 5 by orthodontic treatment need) for orthodontic treatment. The desire to have a better dental appearance at the anterior dental area was the main reason (61%). Other factors that influenced patients in seeking orthodontic treatment were to treat functional impairments (14%), profile and extraoral concerns (6%), and smile related reasons (4%). A remaining 15% attributed their desires to rather unusual reasons. Conclusion: Demand for orthodontic treatment outweighs the real subjective need, Royal Medical Services should adopt a standardized index to prioritize patients need and plan resources accordingly. Upper and lower dental crowding and/or malalignment was considered a main factor in seeking orthodontic treatment, and finally health and dental care workers have duty for educating and raising the public dental awareness.

Orthodontic treatment need in a 12-year-old population in the Western Sahara

The aim of this study was to establish orthodontic treatment need according to the Dental Aesthetic Index (DAI) and Aesthetic Component (AC) and Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) and to determine its association with gender among Saharan schoolchildren. The study was carried out in accordance with World Health Organization (WHO) recommendations for oral health surveys at 12 years of age. The sample comprised 248 Sahrawi children (135 girls and 113 boys) living in refugee camps in Tindouf, Algeria. None of the children had previously received any orthodontic treatment. A chi-square test was used to analyse the IOTN results by gender, and a Student's t-test was employed for the DAI results. The mean DAI was 23.32 with a standard deviation of 6.05, 4 percent with a very severe and 9.2 per cent with severe malocclusion. Orthodontic treatment need was 16.1 and 2.0 percent, respectively, according to grades 4 and 5 of the IOTN DHC, 13.7 percent according to the IOTN AC, and 28.6 percent according to the modified IOTN (IOTN DHC grades 4-5 and/or IOTN AC grades 8-10). There were no statistically significant differences by gender. The orthodontic treatment need of Western Saharan schoolchildren is similar to that reported by many recent studies in European and in Sub-Saharan countries.

Retrospective Study to Determine the Change in Referral Pattern to St George's Hospital Orthodontic Department before and after the 2006 NHS Dental Contract Changes

The aim of this study was to determine the possible effects of the 2006 National Health Service General Dental Services contract changes on the referral pattern to the orthodontic department at St George's Hospital, South West London. This study was carried out on a retrospective basis. The notes of consecutive patients referred between 1st May and 30th September in 2005 and 2008 were assessed, and the patient's Index of Orthodontic Treatment Need (IOTN) and the source of referral noted. The total numbers of referrals increased from 260 in 2005 to 405 in 2008. The number of referrals from general dental practitioners decreased slightly from 165 to 156, as did the numbers of referrals from other sources, such as tertiary referrals. The number of referrals made by specialist practitioners increased from 41 in 2005 to 207 in 2008, representing an increase from 16% to 51% of overall referrals. Overall, the number of patients being referred with an IOTN dental health component grade of 5 increased from 27% to 55%. The increase in referrals from specialist practitioners may be partly due to the changes brought to the commissioning of orthodontic services for specialist practitioners. Overall, the number of cases being referred with IOTN grades 4 and 5 remains high at St George's Hospital, indicating that appropriate referrals are being made.

Orthodontic Treatment Need in Adolescent Kuwaitis: Prevalence, Severity and Manpower Requirements

Objective: Our purpose was to determine the orthodontic treatment need in adolescent Kuwaitis, adjusting for treatment experience and acquired need due to mesial migration or loss of the first molars, and to assess the orthodontic manpower requirements. Subjects and Methods: A population-based sample of 753 boys and 728 girls, representing about 7% of all 13- to 14-year-old Kuwaitis, was examined in a classroom setting. Orthodontic treatment need was graded according to the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Subjects with treatment experience were scored on initial study models. The DHC and AC grades were categorized in 3 groups and aggregated to 3 IOTN groups according to the highest DHC or AC group. Group 1 was labeled as ‘no need’, 2 as ‘moderate need’, and 3 as ‘definite need for orthodontic treatment’. Results: According to the IOTN, 31.1% of the subjects demonstrated a definite need and 40.2% no need for treatment. Excluding DHC group 3 categories attributed to mesial migration and/or loss of first molars, definite need was reduced to 23.9%. Definite treatment need was more prevalent when estimated according to the DHC than according to the AC, while moderate and no need were more prevalent according to the AC (p < 0.001). No gender differences were detected (p > 0.05). Conclusions: About 30% of adolescent Kuwaitis have definite need for orthodontic treatment. The prevalence may be reduced towards 25%, provided loss or mesial migration of the first molars can be prevented. About 50–60 orthodontists are needed to meet the severe need in adolescent Kuwaitis.

Prevalence of orthodontic treatment need in southern Italian schoolchildren

The present survey was performed to determine orthodontic treatment need in a large sample (n = 703) of 12-year-old schoolchildren from the southern part of Italy. The sample comprised 331 males (47 per cent) and 372 females (53 per cent), all orthodontically untreated. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. The prevalence rates for the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) as well as for occlusal features (Angle Class, overjet, overbite, crowding, posterior crossbite) were calculated for the total sample. The IOTN grades were statistically compared in the two genders using the chi-square test. The findings indicated that this southern Italian school population showed a rather low prevalence rate for objective need for treatment (grades 4 and 5; 27.3 per cent of the total sample). This prevalence rate is generally lower than those reported in northern and central European countries (Sweden, Germany, and UK) but slightly greater than those in France. No significant differences in the DHC grades of the IOTN were found between genders. Among the occlusal features diagnosed in the subjects examined, a high prevalence rate was found for crowding (45.9 per cent). Moreover, posterior crossbites and Class III malocclusions, which would presumably have benefited from early orthodontic intervention, were still present in 14.2 and 4.3 per cent of the students, respectively.

Normative and self-perceived orthodontic treatment need of a Peruvian university population

BackgroundPrevious studies on orthodontic treatment need in young adults have shown that up to 50% had malocclusions that needed orthodontic treatment. The aims of this study were to assess the normative and self-perceived need for orthodontic treatment using the Index of Orthodontic Treatment Need (IOTN) and to determine if the treatment need levels were influenced by sex, age and socio-economic status (SES) in a sample of Peruvian young adults.Methods281 first-year students (157 male and 124 female students) with a mean age of 18.1 +/- 1.6 years were randomly selected and evaluated through the Dental Health Component (DHC) and Aesthetic Component (AC) of the IOTN. Structured interview and clinical examination were used to assess the students. Descriptive statistics and Chi-square tests were used for data analysis with statistical significance set at P < 0.05.ResultsAn intra-examiner reliability of 0.89 was obtained (weighted Kappa). The percentage of students according to SES was 51.2%, 40.6% and 8.2% corresponding to low, medium and high SES respectively. The percentage of students with DHC grades 4–5 was 29.9% whereas the percentage of students with AC grades 8–10 was 1.8%. There were no significant differences in the distribution of normative and self-perceived orthodontic treatment need based on sex, age and SES comparisons.ConclusionNormative orthodontic treatment need was not matched by a similar level of self-perceived treatment need in these young adults. Sex, age and SES were non-significant factors associated with levels of treatment need.

The time-factor in orthodontics: What influences the duration of treatments in National Health Service practices?

Abstract – This study aimed to elucidate factors associated with duration of orthodontic treatment. Methods: Retrospective analysis of a systematic 2% sample of cases completed in National Health Service practices in England and Wales. Records were collected during 1991. Characteristics of practitioners, patients, malocclusions, treatment variables and outcomes were evaluated. Data were submitted to multivariate analysis, with Log10 Time in Treatment as the dependent variable. Results: Data were available for 1506 cases. The (geometric) mean time in treatment was 13 months. A model was found that explained 41% of the variance. Factors found to increase duration were fixed appliances, multiple stages in the treatments, premolar extractions, and correction of antero-posterior buccal occlusion. Age, buccal segment malocclusion, DHC (Dental Health Component of the Index of Orthodontic Treatment Need) grade 5 and orthodontically qualified practitioners were also associated with slightly longer treatments. Conclusions: Whilst briefer treatments may be attractive to purchasers, providers and recipients, it should be remembered that thorough treatment, and treatment of more complex malocclusions, tends to take longer. Economic pressures on practitioners to produce high turnovers of cases may be counterproductive in the quest for better outcomes.

The time‐factor in orthodontics: What influences the duration of treatments in National Health Service practices?

This study aimed to elucidate factors associated with duration of orthodontic treatment. Retrospective analysis of a systematic 2% sample of cases completed in National Health Service practices in England and Wales. Records were collected during 1991. Characteristics of practitioners, patients, malocclusions, treatment variables and outcomes were evaluated. Data were submitted to multivariate analysis, with Log10 Time in Treatment as the dependent variable. Data were available for 1506 cases. The (geometric) mean time in treatment was 13 months. A model was found that explained 41% of the variance. Factors found to increase duration were fixed appliances, multiple stages in the treatments, premolar extractions, and correction of antero-posterior buccal occlusion. Age, buccal segment malocclusion, DHC (Dental Health Component of the Index of Orthodontic Treatment Need) grade 5 and orthodontically qualified practitioners were also associated with slightly longer treatments. Whilst briefer treatments may be attractive to purchasers, providers and recipients, it should be remembered that thorough treatment, and treatment of more complex malocclusions, tends to take longer. Economic pressures on practitioners to produce high turnovers of cases may be counterproductive in the quest for better outcomes.

Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by Index of Orthodontic Treatment Need

The aims of the study were to compare the opinions of both the children and the parents with an orthodontist's assessment of treatment need, to investigate the children's self-esteem, and parents' opinion of treatment results. The study group of 359 children (51% girls, 49% boys, mean age 10.6 years) and their parents were asked about their opinions in separate questionnaires. The self-esteem of the children was measured by the global negative self-evaluation scale (GSE). An orthodontist assessed the children's dental casts with the Index of Orthodontic Treatment Need (IOTN). Allocated to the dental health component (DHC) of lOTN, 53.2% children had very great to moderate need and 46.8% had little to no need. No sex difference was noted. The children's own assessments of the aesthetic component (AC) of lOTN were closer to the attractive end of the scale than the orthodontist's ( p < 0.05). Desire for treatment was more frequent than dissatisfaction with children's occlusion ( p < 0.001). The patients' orthodontic concern correlated significantly with both DHC and AC grades ( p < 0.001). The children's GSE scores were not correlated to components of lOTN. For children with very great need, high self-esteem was related to orthodontic concern. The parents (90.8%) perceived dental esthetics to be equally important for girls and boys. Most parents (93.0%) thought the results of orthodontic treatment were good. The results indicate meaningful association between orthodontic concern and orthodontic treatment need assessed by lOTN. However, some patients with great need do not express orthodontic concern, whereas others with near ideal occlusion express concern. (Am J Orthod Dentofac Orthop 1996;110:197-205.)