Self-perceived Treatment Need Research Articles

Reliability and self-perception of semi-automatically assessed orthodontic treatment need in elderly patients undergoing supportive periodontal therapy – a cross-sectional study

ABSTRACT Purpose Patients with periodontitis, who currently make up a large proportion of the adult population, show high interest in orthodontic therapy. It is therefore important to recognize and assess orthodontic treatment need in these patients. The index of orthodontic treatment (IOTN) is an established tool to determine malocclusions clinically and digitally. Materials and methods A semi-automatic IOTN-assessment using OnyxCeph3TM was performed on patients undergoing supportive periodontal therapy (SPT). Intra- and inter-rater reliability were investigated using intra-class-coefficient (ICC). Self-perceived aesthetic by patients and perception by the investigator according to the aesthetic component (AC) were compared to both each other and normative need, measured by the dental health component (DHC). Periodontitis stage and grade and the possibility of an orthodontic treatment were determined. Results The mean age of the 64 included patients in this study was 62.1 years (SD ± 8.6; min-max 45–81) at the time of the examination. Self-related AC was different to the investigator’s assessment (ICC: = 0.474; 95%-CI: [0.262, 0.643]). Normative treatment need compared to self-perceived treatment need resulted in poor reliability (ICC: = 0.098; 95%-CI: [−0.071, 0.298]). Comparison of IOTN between investigators showed moderate reliability for AC (ICC: = 0.618; 95%-CI: [0.331, 0.799]) and an excellent reliability for DHC (ICC: = 0.932; 95%-CI: [0.863, 0.967]). AC Intra-rater reliability was considered good (ICC: = 0.796; 95%-CI: [0.613, 0.898]). Orthodontic treatment was possible in 48 of the 64 patients. Conclusion Semi-automated IOTN-assessment showed satisfying inter- and intra-rater reliability, but patients’ self-perceived dental aesthetics differed from the dentist’s assessment as well as from the normative treatment need.

Individual and Contextual Factors Associated with Adolescents' Self-Perceived Need for Treatment.

The present study aimed to investigate associations between the self-perceived dental treatment need and clinical factors, familial characteristics, and school context in adolescents. A cross-sectional study was conducted with a representative sample of 746 students aged 15 to 19 years in a medium-sized city in Brazil. Data collection involved the use of a sociodemographic questionnaire, an oral health questionnaire, and the Family Adaptability and Cohesion Scales (FACES III) instrument. Clinical examinations were performed by two trained and calibrated examiners (Kappa > 0.80) using the Nyvad criteria. A robust logistic regression analysis for complex samples was performed using a multilevel approach (α = 5%). The individual factors associated with the self-perceived treatment need were dental pain (OR = 1.08; 95% CI: 1.01-1.16), the loss of the first molars (OR = 1.09; 95% CI: 1.03-1.15), and disengaged family cohesion (OR = 1.15; 95% CI: 1.01-1.31). In terms of context, attending a public school was associated with the self-perceived treatment need (OR = 1.17; 95% CI: 1.02-1.33). Thus, the individual factors of toothache, tooth loss, and a disengaged family, as well as the school context, exerted an influence on the self-perceived treatment need.

Relationship between Gerotranscendence and Oral Health-Related Quality of Life among Elderly Population in Tertiary Care Hospital, Wardha, Maharashtra: A Cross-sectional Study

Introduction: Gerotranscendence represents a shift in metaperspective, transitioning from a materialistic and rational outlook to a more cosmic and transcendent one. This phase fosters resilience in older individuals, enabling them to overcome the challenges and despondency associated with ageing, thereby promoting a positive embrace of the ageing process. Remarkably, individuals with high levels of gerotranscendence, even in the presence of poor oral health, demonstrate the capacity to cope and adapt to their circumstances. This adaptive capability may contribute to an enhancement in their self-reported Oral Health-Related Quality of Life (OHRQoL). Aim: To evaluate the relationship between gerotranscendence and OHRQoL among the elderly population in the Vidarbha region. Materials and Methods: This cross-sectional study was conducted over a 6-month period from March 2023 to August 2023 in collaboration with the Department of Prosthodontics and the Department of Public Health Dentistry at the Datta Meghe Institute of Higher Education and Research, Wardha, Maharashtra on 350 participants. The study included volunteers aged ≥70 years, residing in homes or old age homes, and those visiting tertiary healthcare centers. Methodologically, data collection employed a self-made organised proforma. Oral examinations were conducted using Type III inspections with a mouth mirror. Gerotranscendence was assessed using the Gerotranscendence Scale Type 2 (GST2), which was validated and translated into Marathi. The Geriatric OHRQoL was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), also translated into Marathi. The study used Chi-square tests for categorical variables and Pearson’s and Spearman’s tests for correlation analyses. Results: The average gerotranscendence score was 23.45 (95% confidence interval [CI]: 22.96, 23.94), reflecting a mid-level of gerotranscendence, indicating that the gerotranscendence score was neither low nor high. According to Pearson’s and Spearman’s correlation tests, the gerotranscendence score was significantly positively correlated with age and self-perceived need for treatment. The mean GOHAI score was 40.16 (95% CI: 39.55, 40.76). A substantial positive association between the GOHAI and self-perceived need for treatment was found using Pearson’s and Spearman’s correlation tests. When comparing gerotranscendence and GOHAI, Pearson and Spearman correlation tests revealed a significant positive association (p<0.001). Conclusion: Gerotranscendence was significantly positively correlated with OHRQoL, independent of objective oral status. Despite having poor oral health, elderly individuals with high levels of gerotranscendence may be better able to handle and adapt to their circumstances, which could result in an improvement in self-reported OHRQoL.

A comparative examination of the role of need in the relationship between dental service use and socio-economic status across respondents with distinct needs using data from the Scottish Health Survey

BackgroundDisparities in oral health and distinct patterns in service use related to socio-economic status have been shown to exist in the United Kingdom. A number of studies have used the Andersen behavioural model to better understand the factors that influence utilization and thereby inform policies aimed at improving service uptake. As the nature of need may differ across distinct types of patients, however, so too may the distribution of enabling and pre-disposing factors and observed relationships between need, other factors and service use. In this study we compare samples with distinct self-assessed needs in terms of their characteristics and patterns of service use to compare application of the Andersen model to dental services among respondents to a population based survey.Materials and methodsData were taken from the Scottish Health Survey, for 2019. Data on service use, oral hygiene habits, perceived treatment need, and socio-demographic characteristics were extracted. Data were analysed using descriptive statistics, t-tests and ordered logistic regression analyses.ResultsTwo thousand one hundred forty-eight usable responses were obtained from the survey, 74.95% of the sample had visited the dentist less than a year ago, 11.82% between 1 year and up to 2 years ago, 7.12% between 2 and 5 years ago and 6.10% more than 5 years. Descriptive statistics, t-tests and ordered logistic regression analyses revealed distinct patterns of service use when the sample was partitioned based on perceived treatment need. Specifically those with self-assessed treatment need were older, more likely to smoke, be male and be less likely to have a degree than those who did not. While service use was positively related to age (predisposing) among those who did not have self-assessed treatment need, it was negatively related for those with perceived treatment need. Distinct patterns were also evident with respect to sugar exposure (need) and ease with which time off work could be organised (enabling).DiscussionThe study shows common and distinct patterns of service use related to enabling and predisposing factors across groups differentiated by self-perceived treatment need. If inequalities in health and healthcare use are to be addressed, it is important to understand their origins. Conflation of distinct types of need that may correlate with predisposing and enabling factors complicates this.ConclusionIn applying the Andersen model, it is important to take account of potential differences in the types of need expressed where possible to understand the role of other variables in service use.

Correlation between gerotranscendence and oral health-related quality of life among elderly population in Davanagere city: A cross-sectional survey.

To assess the relationship between oral health related quality of life (OHRQoL) and gerotranscendence among elderly subjects in Davangere city. Field Setting and cross-sectional survey design. Study involved a stratified sample of 400 elderly population aged 60 years and above. Data related to demographic details, systemic and oral health related factors, nutritional status, gerotranscendence level and geriatric oral health related quality of life of study participants was recorded using study proforma, Mini Nutritional Scale Assessment- Short form (MNA-SF) index, Gerotranscendence Scale Type 2 (GST2) questionnaire and GOHAI questionnaire respectively. Significance level was fixed at P < 0.05. Chi-square, Pearson's/Spearman's correlation and Multiple linear regression tests were used for analysis. Participants had good oral health related quality of life (mean GOHAI - 41.33±10.8) and moderate level of gerotranscendence (GST2- 19.5 ± 8.7). The gerotranscendence scores were significantly (P<0.05) negatively correlated with socioeconomic status (r = -0.19), education (r = -0.55), self-perceived oral health (r = -0.43), nutritional status (r = -0.64), GOHAI (r = -0.17), utilization of dental services (r = -0.26) and marital status (r = -0.39) and were significantly (P < 0.05) positively correlated with age (r = 0.77), systemic problems (r = 0.49), number of missing teeth (r = 0.57), self-perceived need for treatment (r = 0.24), and pan chewing (r = 0.62). Gerotranscendence was not a significant predictor of GOHAI (P = 0.43). Gerotranscendence was negatively correlated with oral health related quality of life among elderly population in Davanagere city.

A Cross-Sectional Evaluation of Self-Perceived Orthodontic Treatment Needs Amongst Tribal Adolescent With Remote Access to Orthodontic Treatment Using a Simplified Malocclusion Index

Background: Self-perceived orthodontic treatment need is strongly influenced by what is perceived to be the esthetic norm amongst a community, and reluctance toward treatment amongst adolescents with clinically ascertained malocclusion may often be due to readily remediable factors. Of particular interest is the prevalence of malocclusion amongst such communities as a probable indicator of the role of diet and genetics in establishing a predominant clinical phenotype that may also play a role in the construct of what is perceived as the esthetic norm amongst the community, thereby influencing the self-perceived need for treatment. Studies aimed at evaluating the association between self-perceived esthetics, and self-perceived treatment need have not been performed amongst a population with no prior exposure to orthodontic treatment Objectives: The purpose of this study was to evaluate the self-perceived orthodontic treatment need amongst the tribal adolescents belonging to regions with remote access to orthodontic treatment by way of a verbally assigned index and to also identify the reasons of reluctance toward treatment to better understand how to make orthodontic treatment readily accessible to such populations. Participants, Materials, and Methods: The agency areas of Paderu located at 18.0833°N 82.667°E and Parvathipuram located at 18°46'N 83°25'E are 2 revenue districts of Visakhapatnam and Vizianagaram, respectively, in the state of Andhra Pradesh, India, that are home to various tribal populations with remote access to orthodontic treatment. A total of 2,016 school-going tribal adolescents of the Paderu revenue division and 819 tribal adolescents of the Parvathipuram revenue division were examined to ascertain the prevalence of malocclusion. Necessary consent and permissions were obtained from the tribal authorities, the school authorities, parents, and the institutional ethical clearance committee. The screening was done utilizing natural daylight in compliance with infection prevention and control protocol. Clinical examination aimed at categorizing the observed occlusion into either ideal occlusion or one of the three classes of Angle’s class I, II, and III malocclusions. The Simplified Malocclusion Index For Layperson Evaluation (SMILE) was verbally assigned in the vernacular language while interacting with each child and the findings made note of for calculation of relevant scores related to their orthodontic awareness, self-esteem as related to self-perceived esthetics, and their self-perceived need for treatment. Reasons for reluctance to undergo treatment were noted down if expressed. An initial group of 31 adolescents categorized as presenting with clinical malocclusion were randomly picked up and assigned the SMILE index a second time to assess the reliability of the index by way of Cohen’s kappa statistic. Results: The initial test group of 31 individuals assigned the SMILE twice showed a Cohen’s kappa of 0.93 validating almost perfect intraoperator agreement. The SMILE index revealed that 80.95% of the adolescents of Paderu revenue division had orthodontic awareness and 79.51% had self-perceived esthetics but only 15.97% felt a need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 1,371] = 19.71, P &lt; .001). The Index assigned to the Parvathipuram division revealed that 77.04% had orthodontic awareness and 78.38 had self-perceived esthetics but only 6.95% felt the need for orthodontic treatment. Pearson’s Chi squared statistical analysis indicated a gender bias related to the self-perceived need for orthodontic treatment ( X 2 [1, N = 764] = 4.95, P = .02). Conclusion: The self-perceived need for orthodontic treatment is often based on the self-perceived esthetics of an individual or the self-esteem as influenced by the perceived esthetic norm of the community. Orthodontic treatment of adolescents with borderline malocclusion derangements requires careful ascertaining of the actual perceived need of the patient to enable the rendering of a justifiable orthodontic treatment with the complete trust of the young patient. This helps build community trust in regions where orthodontic treatment has not yet made in roads and may help ensure higher end of treatment satisfaction levels.

Hazardous drinking, alcohol use disorders, and need for treatment among Pacific Islander young adults.

Pacific Islander (PI) young adults are suspected to bear heavy risk for hazardous drinking, alcohol use disorders (AUD), and alcohol-related harms. Yet, PIs remain among the most understudied racial groups in the United States-creating a lack of empirical data documenting their alcohol use problems and treatment needs. The present study presents the first known data on PI young adults' hazardous drinking, possible AUDs, alcohol-related harms, and treatment needs. Survey data were collected from 156 community-dwelling PI young adults (40% women, age 18-30 years) in 2 large PI communities: Los Angeles County and Northwest Arkansas. We screened participants for alcohol, cigarette, and marijuana use, hazardous drinking, possible AUD, alcohol-related harms, and past-year need for mental health and substance use disorder (SUD) treatment. Logistic regressions examined whether experiencing possible AUD and alcohol-related harms were associated with past-year need for treatment. PI young adults reported 78% lifetime rate of alcohol use with 56% screening positive for hazardous drinking, 49% for any possible AUD, and 40% experiencing significant alcohol-related harm (e.g., health, finances). Yet, just 25% of participants reported past-year need for SUD treatment. Although having possible AUD was not associated with perceived SUD treatment need, experiencing any alcohol-related harm associated with 4.7-13.2 times greater adjusted odds for needing treatment. Therefore, despite having low self-perceived treatment need, PI young adults experience excessive burden of hazardous drinking and alcohol-related harms. Given the profound negative social and health effects of AUDs, culturally grounded interventions should be designed to reduce PI young adults' elevated rates of hazardous drinking and alcohol-related harms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Analysis of the perceived oral treatment need using Andersen's behavioural model.

The aim of this study was to investigate the influence of specific components of Andersen's behavioural model on adult individuals' perceived oral treatment need. A questionnaire was sent to a randomly selected sample of 9,690 individuals, 20 to 89 years old, living in Skåne, Sweden. The 58 questions, some with follow-up questions, were answered by 6,123 individuals; a 63% response rate. Selected for inclusion in the multivariate logistic regression analysis were those questions relating to Andersen's behavioural model, phase five. Responses to "How do you rate your oral treatment need today?" were used as a dependent variable. The 62 questions chosen as independent variables represented the components: individual characteristics, health behaviour and outcomes in the model. Of the independent variables, 24 were significant at the p< or =0.05 level. Low educational level, previously unmet perceived oral TREATMENT need, frequent visiting pattern, perception of worse oral health than one's peers, an external locus of control, and to have received information from one's dental caregiver about a need for oral treatment were all highly significant (p<0.001) variables correlating with high self-perceived oral treatment need. The Andersen behavioural model can be a useful theoretical tool for the study of perceived oral treatment need.

Self-perceived dental treatment need among adolescents: A hierarchical analysis.

The aim of the present study was to analyse the factors associated with self-perceived need for dental treatment among adolescents. A representative sample in the state of São Paulo, Brazil, comprising 5558 adolescents, was evaluated in 2015. The adolescents were selected by probabilistic sampling by conglomerates in two stages. The outcome evaluated was self-perceived treatment need measured via a validated questionnaire. Independent variables included sociodemographic factors, type, frequency and reason for last dental visit, and examination of oral conditions. Statistical analysis was based on the multiple hierarchical logistic regression model. Of the total sample, 3340 (62.6%) adolescents reported needing dental treatment. After fitting the model, the self-perceived need for treatment was associated with adolescents with family income of up to $1,500 BRL (OR 1.39; [95% CI=1.20-1.60]; P<.001), who sought dental services solely for curative treatment (OR 1.58; [95% CI=1.46-1.72]; P<.001), reported toothaches in the previous six months (OR 2.88; [95% CI=2.53-3.28]; P<.001), were dissatisfied with the appearance of their teeth and mouth (OR 5.94; [95% CI=5.03-7.01]; P<.001), had caries in the posterior teeth only (OR 3.04; [95% CI=2.77-3.33]; P<.001) or had caries in the anterior teeth (OR 4.75; [95% CI=4.05-5.56]; P<.001). The self-perceived need for dental treatment among Brazilian adolescents was associated with normative and subjective needs, and sociodemographic context factors. This finding provides important evidence for collective health planning.

Factors that influence the oral impact on daily performance of older people in Brazil: A cross-sectional population-based study.

To investigate factors that influence the oral health-related quality of life of older people (65years and over) in Brazil. Population-based studies should be conducted to support health-planning interventions. Data from the São Paulo State Survey on Oral Health (SBSP-2015), which consisted of 5951 individuals, were used. A theoretical-conceptual model was built based on the impact of family socio-economic characteristics, individual social-demographic features and self-perceived and clinical oral health status on the oral impact on daily performance (OIDP). Multivariate binary logistic regression analysis was conducted at 5% significance level. Statistically significant variables included within the adjusted logistic regression model entered the multiple correspondence analysis (MCA). Oral health impact on daily activities was observed in 34.6% of older people. Characteristics significantly related to impact on OIDP score were as follows: family income up to R$ 500 (OR=2.73), self-perceived treatment need (OR=1.33), self-perceived toothache (OR=1.52), self-perception of denture replacement need (OR=1.27), dissatisfaction (OR=1.50) or very dissatisfied (OR=2.57) with own oral health, partial lower denture use (OR=1.34) and needing partial lower dentures (OR=1.28). Increased number of people living in the same house (B=0.05, OR=1.06), number of bedrooms in the house (B=-0.10, OR=0.90), age (B=-0.03, OR=0.97) and number of teeth needing treatment (B=0.08, OR=1.08) contributed significantly to OIDP. Prevalence of OIDP of older people in the state of São Paulo was related to factors other than their clinical and self-perceived oral health status.

Diagnostic Validity of Self-Perceived Dental Caries in Indonesian Young Adolescents Aged 12-15 Years

Objective: To compare self-perceived information and clinically diagnosed dental caries status among Indonesian children aged 12–15 years. Material and Methods: In this cross-sectional study, a questionnaire was used to obtain self-perceived information. Clinical examinations were conducted to determine the mean number of decayed, missing or filled teeth (DMFT) and the presence of severely decayed teeth with visible pulpal involvement, ulceration caused by dislocated tooth fragments, fistula, and abscess (PUFA). The study included 494 children aged 12–15 years recruited from six junior high schools in Jakarta, Indonesia. The clinical examination results and responses to the self-perceived assessment questionnaire were compared to determine the sensitivity and specificity. Results: The proportions of children with dental caries and clinical consequences of untreated dental caries in this study were 69.4% and 17.6%, respectively, with mean DMFT and PUFA index scores of 2.4 and 0.2, respectively. For the DMFT index, the self-perceived need for oral treatment had the highest sensitivity (86%), while the dental pain had the highest specificity (89%). For the PUFA index, the self perceived oral health condition had the highest sensitivity (92%), while the self-perceived dental pain had the highest specificity (82%). However, none of the self-perceived variables had both high sensitivity and specificity. Conclusion: Self-perceived information obtained from the questionnaire can not properly evaluate the clinical status of dental caries.

Perceptions of dental treatment need in Australian-born and migrant populations.

The objective of this study was to investigate differences in self-perceived and dentist-determined treatment need in Australian-born and migrant residents of Australia. Participants in the National Survey of Adult Oral Health 2004-06 were categorized into six groups according to country of birth. Interview and examination data were used to analyze differences between self-perceived and the 'gold standard' examiner-determined treatment need, and to compare the accuracy of self-reporting according to country of birth. Self-reported treatment needs, defined as the need for a restoration and/or extraction, were cross-tabulated with clinically observed conditions and compared using a multivariable logistic regression model. Concordance between self-reported and clinically-determined treatment need differed significantly for migrants from Europe and the UK and Australian-born individuals. In the logistic regression model, stratification according to examiner-determined treatment need revealed significantly greater reporting of treatment need by Asian-born migrants than by the Australian-born reference group. The results of this study demonstrate that self-perceived treatment need was less than the examiner-determined findings in European and UK migrant groups and Australian-born individuals. Additionally, Asian migrants were more likely than Australian-born individuals to over-report treatment need for a filling and/or extraction.

Validity of self-perceived dental caries as a diagnostic test and associated factors in adults

This study aimed to analyze the validity of self-perceived dental caries and associated factors in a sample of 795 adults (35-44 years). The dependent variable was self-perceived dental caries, and the independent variables were combined in blocks. Three logistic models were performed: (1) all adults; (2) adults with a formal diagnosis of caries; and (3) adults without such caries. Self-perceived dental caries showed 77.7% sensitivity, 58% specificity, 65% accuracy, 52% positive predictive value, and 81% negative predictive value. In Model 1, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, formal diagnosis of caries, self-perceived need for treatment, toothache, and dissatisfaction with oral health and general health. In Model 2, self-perceived dental caries was associated with time of use of dental services, self-perceived need for treatment, and dissatisfaction with oral health and general health. In Model 3, self-perceived dental caries was associated with time of use of dental services, access to information, flossing, self-perceived need for treatment, and dissatisfaction with oral health. Self-perceived dental caries showed limited utility as a diagnostic method.

Impact of Malocclusion on the Quality of Life of Brazilian Adolescents: A Population-Based Study.

The objective of this study was to evaluate the impact of malocclusion on the quality of life (QOL) of adolescents in Brazil. We carried out a cross-sectional study in a sample population of 1015 schoolchildren aged 12 to 15 years from São Luís, Maranhão, Brazil. The explanatory variable was malocclusion, evaluated on the basis of the normative need or the adolescent’s self-perceived need for dental treatment. Normative need for dental treatment was determined by professional diagnosis, made on the basis of Angle’s classification, the Dental Aesthetic Index, and other morphological deviations (e.g., posterior crossbite, posterior open bite, and deep overbite). We analyzed the impact of malocclusion on the QOL using the Portuguese version of the Oral Health Impact Profile-14. Associations were estimated by using the prevalence ratio (PR) in Poisson regression analysis, with hierarchized modeling. An alpha of 5% was adopted as the criterion for statistical significance. The QOL of adolescents was impacted by malocclusion, classified by a normative need for treatment according to the Dental Aesthetic Index (PR = 1.27; 95% confidence interval [CI] = 1.03–1.56) or by the self-perceived need for treatment (PR = 2.54; 95% CI = 1.81–3.56). Certain sociodemographic variables, including the head of the family (PR = 1.52; 95% CI = 1.02–2.23), greater educational level of the head of the family (PR = 0.32; 95% CI = 0.17–0.61), and female sex (PR = 1.40; 95% CI = 1.05–1.89), had negative associations with QOL. We conclude that malocclusion has a negative impact on the QOL of adolescents, associated with socioeconomic conditions and the cosmetic effects of malocclusion.

Implications of less‐than‐perfect reliability of clinical parameters for the misclassification of periodontitis

This study aimed to evaluate and compare the misclassification of periodontitis using two operational protocols currently employed in research, as a result of intra-examiner less-than-perfect reliability of their formative clinical parameters. Full-mouth duplicate recordings (six sites per tooth) of probing depth (PD) and clinical attachment level (CAL) were obtained by a single examiner, 1 week apart, from 148 adults with self-perceived need for periodontal treatment. They were used to classify periodontitis subjects according to the protocols proposed by the 5th European Workshop in Periodontology (EWP5) and the collaboration between the US Centre for Diseases Control and Prevention and the American Academy of Periodontology (CDC-AAP). Hundred percent and 91.2% of the subjects were classified as periodontitis cases according to the EWP5 and CDC-AAP protocols, respectively. Test-retest agreement was observed in 95% and 85% of the classified subjects according to the EWP5 and CDC-AAP protocols, respectively. The difference was statistically significant (P < 0.01). Alignment of protocols, in terms of number of classification categories, resulted in a similar test-retest agreement of 95% using the EWP5 protocol for extensive periodontitis and 90% using the CDC-AAP protocol for severe periodontitis (P = 0.09). Misclassification was nondifferential when subjects were classified according either to the EWP5 or the aligned CDC-AAP protocols, while the reliability using the original CDC-AAP protocol depended on the extent of bleeding on probing, CAL ≥3 mm and PD ≥4 mm. This study suggests the EWP5 protocol is less error-prone than the CDC-AAP protocol in adult subjects with perceived need for periodontal treatment, as a result of intra-examiner less-than-perfect reliability of periodontal clinical parameters. Extensive or severe cases presented similar misclassification. Further studies using survey-like conditions are recommended to confirm these findings.

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.

Effect of socioeconomic status on normative and perceived orthodontic treatment need

To determine the influence of socioeconomic status (SES) on normative and perceived orthodontic treatment need, satisfaction with dental appearance, and regularity of dental attendance. The sample consisted of 550 adolescents (232 boys, 318 girls) aged 13 to 17 years who were categorized according to SES into three groups: low, middle, and high SES. Normative treatment need was assessed by using the Index of Orthodontic Treatment Need. Data were collected by clinical examination and face-to-face interview. The χ(2) test and logistic regression analysis were used for statistical analyses. Approximately 34.0% of the untreated subjects had a definite dental need for treatment and 24.5% had a moderate need; among those, 53.5% were of low SES (P = .017). One-third of the sample had a moderate to definite esthetic need, most of whom had a low SES (P = .009). Of the subjects who were dissatisfied with their dental appearance and reported a self-perceived need for treatment, around one-third had a low SES. Most subjects with low SES were irregular dental attenders (P < .001). Subjects of low SES, those who had a self-perceived need for treatment, and those who were dissatisfied with their dental appearance were more likely to have a definite normative esthetic need. Subjects of low SES exhibited greater normative and perceived treatment needs than subjects of higher SES. They were less satisfied with their dental appearance and visited a dentist less frequently.

Normative and self-perceived orthodontic treatment need in 11- to 16-year-old children

To examine the relationship between normative and self-perceived treatment need assessed by different measures, comprising two Oral Health-Related Quality of Life (OHRQoL) scales. This cross-sectional observational study comprised 386 children aged 11-16 years registered for a first consultation at the Orthodontic Department of the University Hospitals of Leuven (Belgium). Normative treatment need was assessed by the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The children completed questionnaires comprising the Child Perceptions Questionnaire (CPQ₁₁₋₁₄) and the Oral Aesthetic Subjective Impact Scale (OASIS). They also scored the AC of IOTN themselves. Spearman correlations, Mann-Whitney U-tests and signed-rank tests, a Bland-Altman plot, and an intra-class correlation were used to analyze the data. Significant, yet weak correlations (maximum ρ = 0.23 for the CPQ emotional well-being domain) were found between normative orthodontic treatment need (IOTN AC) and most of the OHRQoL measures. Similarly, between the IOTN AC scores of the expert and the IOTN AC ratings given by the child a significant correlation (ρ = 0.37, P < 0.0001) was found, but with very poor agreement (95 per cent limits of agreement -4.3, 5.1). For the DHC of IOTN, only a relation was found with the AC child (ρ = 0.20, P = 0.0001). These results suggest that the commonly used IOTN as a clinical assessment tool for orthodontic treatment need should be reinforced by OHRQoL measures, like the OASIS, expressing patients' perceived treatment need.

Assessing the oral health-related quality of life in Iranian adolescents: validity of the Persian version of the Child Oral Health Impact Profile (COHIP).

To evaluate the psychometric properties of an oral-health related quality of life (OHRQoL) instrument for application in the population of Iranian adolescents and to assess the discriminate and convergent validity and reliability of the Persian version of the Child Oral Health Impact Profile (COHIP) in a representative sample of this population. Using multistage stratified sampling, 597 schoolchildren aged from 13 to 18 years living in the city of Isfahan were recruited to complete the Persian COHIP questionnaire. They were also examined for dental caries and malocclusion by two trained, calibrated examiners. Overall COHIP scores ranged from 15 to 135 (mean ± SD: 103.6 ± 18). Sixty-six percent of the students experienced at least one frequent oral health-related impact over the past three months. The Cronbach alpha coefficient was 0.89 for the overall score. Discriminate validity was supported by the significant difference between COHIP scores in the caries-free group and the others (P = 0.01). In addition, the questionnaire was able to differentiate among the groups by various degrees of need for orthodontic treatment (P < 0.01). Convergent validity was confirmed by significant association between the quality of life scores, the self-perceived health and oral health ratings and the self-perceived treatment need (r = 0.36, 0.57, -0.40). The Persian COHIP demonstrated acceptable psychometric properties for the descriptive purposes. Some discrepancies observed between the clinical data and quality of life status were confirmed by the perceptual identity of such indices influenced by several overt and covert variables.

Dental treatment needs in the Canadian population: analysis of a nationwide cross-sectional survey.

BackgroundNationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed.MethodsA secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need.ResultsMost of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently.ConclusionsIt is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.