|Year : 2015 | Volume
| Issue : 2 | Page : 158-162
Expressed needs associated with orthodontic treatment in a private dental college, Mathura
Gaurav Agarwal1, Navin Anand Ingle1, Navpreet Kaur1, Pramod Yadav1, Ekta Ingle2, Zohra Charania3
1 Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura, Uttar Pradesh, India
2 Department of Oral Medicine and Radiology, Vasantdada Patil Dental College, Sangli, Maharashtra, India
3 Department of Public Health Dentistry, Guardian Dental College, Amarnath, Mumbai, Maharashtra, India
|Date of Web Publication||18-Jun-2015|
Department of Public Health Dentistry, K.D. Dental College and Hospital, Mathura, Uttar Pradesh
Source of Support: None, Conflict of Interest: None
Introduction: The primary goal for most of the patients who seek orthodontic treatment is a discernible improvement in some aspect of their dento-facial appearance. Orthodontic therapy makes people look better and feel better about themselves and perhaps influences their ability for social interaction. Hence, this study was conducted to assess expressed needs and barriers associated with orthodontic treatment. Objectives: To know main motivational factor behind seeking orthodontic treatment and to correlate these factors with other variables such as age, gender, and socioeconomic status. Materials and Methods: The study included 200 orthodontic patients between 12 and 25 years visiting a private dental college, Mathura during July 2014 to September 2014. Structured proforma consisting of closed ended questions was used for assessing social demographic characteristics, factors and the barriers, which were associated with orthodontic treatment. Statistical analysis was performed using SPSS version 22. Results: This study comprised of 120 females. Self-confidence (48%) was the main motivating for undergoing treatment among the subjects. Social interaction (44%) was the most common area of improvement expected by the patients after orthodontic treatment. Financial constraints were the main barrier for seeking treatment found among 30% patients. Conclusion: Patients seek orthodontic treatment mainly to enhance facial esthetics, self-confidence and social acceptability. The mismatch of need and desire for treatment is a problem for orthodontists.
Keywords: Barriers, expressed need, malocclusion, orthodontic therapy
|How to cite this article:|
Agarwal G, Ingle NA, Kaur N, Yadav P, Ingle E, Charania Z. Expressed needs associated with orthodontic treatment in a private dental college, Mathura. J Indian Assoc Public Health Dent 2015;13:158-62
|How to cite this URL:|
Agarwal G, Ingle NA, Kaur N, Yadav P, Ingle E, Charania Z. Expressed needs associated with orthodontic treatment in a private dental college, Mathura. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jan 18];13:158-62. Available from: http://www.jiaphd.org/text.asp?2015/13/2/158/159054
| Introduction|| |
Malocclusion is defined as an occlusion having mal-relationship between the arches in any of the planes or in which there are anomalies in tooth position beyond the normal limits. The reasons to develop malocclusion could be genetic or environmental and/or combination of both the factors along with various local factors such as adverse oral habits, premature extraction of deciduous teeth, tooth anomalies, form and developmental position of teeth can cause malocclusion.  Social psychological impact to any malocclusion, whether noticed by the patient himself or by other people such as low self-esteem, frequent teasing experiences and dissatisfaction to appearance, may develop the desire for orthodontic treatment. Self-concept, self-image, status, pride, discomfort and concern for future oral are but a few reasons for a person to decide for orthodontic treatment.  The benefits of undergoing orthodontic treatment are to the prevention of tissue damage and correction of the esthetic component, improve the physical function.  During orthodontic treatment patients speech is impaired, which can affect patients self-confidence. Orthodontic treatment often results in discomfort, which can irritate the patients and it may result in stress between orthodontist and patient. 
Furthermore, whereas epidemiological research has suggested that at least 70-75% of the population could benefit from orthodontic treatment for some form of occlusal mal-relations, such functional considerations are not necessarily linked to the need for treatment as it is perceived by patients. Rather, most individuals view orthodontics as a means for improving dental-facial appearance. Consequently, professional guidelines for assessing orthodontic treatment need usually incorporate some estimate of esthetic impairment. The rationale usually given for this inclusion is that esthetic impairment, through its potentially negative impact on self-esteem, or self-efficacy, could result in personal or social difficulties. 
Several orthodontic researches have revealed that an important motivation for orthodontic treatment is usually an improvement in dento-facial appearance.  The studies on the attitude of children and adolescents to malocclusion conducted in various researches especially among the Caucasians also revealed an increased concern for dental appearance and desire for orthodontic treatment.  The importance of the patient's perception of dental appearance and the need for orthodontic treatment cannot be over-emphasized as it is the patients who receive treatment and need to gain satisfaction from improved esthetics and function.[ 6] This study was conducted to assess expressed needs associated with orthodontic treatment in a private dental college with the objectives to know main motivational factor behind seeking orthodontic treatment and to correlate these factors with other variables like age, gender and socioeconomic status.
| Materials and methods|| |
The study was conducted among 200 orthodontic patients selected through random sampling aged between 12 and 25 years visiting a private dental college, Mathura for the treatment during the period of August 2014 to September 2014.
Ethical approval was obtained from the ethical committee, and informed consent was obtained from the patients and their parents. A pilot study was also done to check out whether the questions were understood by the patients and then necessary modifications were made. Questionnaire was made both in English and Hindi.
- Patients aged between 12 and 25 years
- Patients who visited with parents/guardians in a case under 15 years.
Data were collected on a proforma which consisted of 2 parts. In part 1 patient's demographic data, such as age, gender, religion, residence and socioeconomic status were collected. Socioeconomic status was collected according to Kuppuswamy's scale for 2012. Part 2 consisted of self-administered pretested questionnaire to assess the factors which may influence them in seeking treatment, psychological makeup of subjects of their own appearance, teasing experiences and the factors, which may influence them in seeking treatment and expected social changes after taking treatment. The procedure to answer the questionnaire was explained to them, and each one of them was given a sufficient amount of time to complete the form and completed forms were then collected.
Statistical analysis was performed using SPSS version 22 (IBM Technolgy) and the data which was collected was then analyzed to know the demographic characteristics of the population and the factors, which influence patients to undergo orthodontic treatment. Chi-square test was used to determine the association of demographic characteristics with the factors associated with treatment seeking. P < 0.05 was considered to be significant.
| Results|| |
The final sample size comprised of 200 patients aged between 12 and 25 years. [Table 1] shows the distribution of study subjects according to their demographic characteristics. Of whom 200 patients responded, 130 that is, 65% were males, 100 that is, 50% of the subjects were between 12 and 15 years of age group, 188 that is, 94% of the subjects were Hindus, 167 subjects, that is, 83.5% were resident of Mathura, 116 that is, 58% were of upper middle status.
[Table 2] shows expressed needs associated with orthodontic treatment. Majority of subjects, that is, 46% assessed their dental appearance as "average," 47% felt teasing experience "often;" 46.5% said they themselves noticed their dental anomaly, 55% said they themselves had gone for orthodontic treatment and were self-motivated, 43.5% said career opportunities will improve after taking orthodontic treatment, 36% said improvement of self-confidence was the main motivating factor and 35% said attainment of straight teeth was the second main motivating factor for taking orthodontic treatment, 16% said improvement of facial appearance was the main factor, and 13% said improvement of dental health is the main factor for seeking orthodontic treatment. 41% said financial constraints was the main barrier for taking orthodontic treatment, shortage of time was the second most common barrier, that is, 21%.
[Table 3] shows an association of different age groups with the first person to notice their dental anomaly. In the age group of 12-15 years and 21-25 years most of the patients 49% and 75% respectively noticed themselves their dental anomaly, whereas in age group of 16-20 years parents and dentist (32.4%) were the first person to notice their dental anomaly. Statistically significant difference was found between different age groups and the first person to notice their dental anomaly as P < 0.05.
[Table 4] shows an association of gender with an assessment of their dental appearance. In male group, most of the males (40%) assessed their dental appearance as average, similarly in females. most of the females (57.1%) assessed their dental appearance as average. Statistically, a significant difference was found between genders and assessment as P value obtained was <0.05.
|Table 4: Association of gender with assessment of their dental appearance|
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[Table 5] shows an association of socioeconomic status with the perception of irregularities. In upper group most of the patients (83.3%) thought that they have irregularity in their mouth, similar results were found in upper middle, middle and lower group where 80.2%, 94.5% and 81.8% respectively thought that they have irregularity in their mouth.
|Table 5: Association of socioeconomic status with perception of irregularities|
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[Table 6] shows association with age with teasing experience. In the age group of 12-15 years, most of the patients (48%) very often felt teasing experience, while in age group of 16-20 years and 21-25 years, most of the patients, that is, 51.5% and 46.9% often felt teasing experience.
| Discussion|| |
Most of the time the orthodontic treatment in adults results in improved self-image, which justifies its performance, even for purely esthetic reasons.  Social interaction is the main motivational factor in males, while in females main area of concentration is esthetics. When compared to childrens, adults are more dissatisfied with their dento-facial appearance. 
It is generally accepted that treatment priority mostly is given to the patients with malocclusion associated with a high risk of tissue damage, functional disturbances or psychological problems. The objective and subjective needs of orthodontic patients is different. Some authors found that specialists tend to recommend more treatment by 10-12% than lay persons. The others state that self-perceived scoring of malocclusion was higher than the normative measure of need. 
When children are being treated, however, it is appropriate to evaluate the parent's interest as well, since they may have different concerns compared to their children, which may thus influence the decision to undertake orthodontic treatment. 
In this study total of 200 subjects participated, male patients (65%) were comparatively higher in proportion compared to the female patients (35%), which is in accordance with the study conducted by Marques et al. 
The majority of the patients (43.5%) thought that their career opportunities will improve after undergoing orthodontic treatment. The majority (46%) assessed that their dental appearance is average while only 03.5% of patients assessed their dental appearance as very bad, which is in accordance with the study conducted by Abdullah et al. 
About 47% of subjects often felt teasing experience while there were no subjects (0%) that had not felt teasing experience. Similar results had been observed in the study conducted by Albino et al. 
About 46.5% of the subjects noticed themselves while in 2.5% of cases others noticed their dental anomaly, which is in line with the study conducted by Phillips and Beal  in which 49% of subjects noticed themselves.
In the present study, most of the subjects, that is, 55% were self-motivated towards orthodontic treatment while others had suggested only in 1% of cases. This result is in line with the study conducted by Sonde et al. 
The most important motivating factor for seeking orthodontic treatment was to improve self-confidence (36%) followed by to attain straight teeth (35%). This result is in line with the study conducted by Venkatesh and Pratiba  in which the most important motivating factor was to improve self-confidence (45%).
The most common barrier in seeking orthodontic treatment was financial constraints (41%) while 10.5 subjects thought that their problem will get corrected on its own. This result is in line with the study conducted by Sonde et al.  and in contrast to the study conducted by Rohit and Sumit  in which most common barrier was a shortage of time (45%).
In the age group of 12-15 years and 21-25 years most of the patients 49% and 75%, respectively noticed themselves their dental anomaly, whereas in age group of 16-20 years parents and dentist (32.4%) were the first person to notice their dental anomaly Statistically significant difference was found between different age groups and first person to notice their dental anomaly as P < 0.05, which is line with the study conducted by Sonde et al.  and in contrast with the study conducted by de Souza et al.  in which dentists were the first person to notice their dental anomaly.
Both male and female group assessed their dental appearance as average that is, 40% and 57.1% respectively. Statistically significant difference found between genders and assessment as P value obtained was <0.05, which is line with the study conducted by Dias and Gleiser. 
Most of the patients in all the socioeconomic groups, that is, upper, upper middle, middle and upper lower thought that they have irregularities in their mouth (83.3%, 80.2%, 94.5% and 81.8% respectively) which is line with the study conducted by Sonde et al. 
Most of the patients in both age groups of 16-20 years and 21-25 years often felt teasing experience, that is, 51.5% and 46.9% which is line with the study conducted by Rohit and Sumit. 
Limitations of this study are small sample size of the study-might has influenced the study results. Another limitation of the study is that the normative need of the patient is not assessed, and hospital-based samples were not collected. Hence, the results cannot be generalized to the whole population, for which further studies are recommended taking larger samples with other dental clinics and hospitals and comparison between patient undergoing orthodontic treatment and a random group can also be done.
| Conclusion|| |
Most subjects seek orthodontic treatment with a psychological aspect of improving their self-confidence and social interaction. The most common barrier in seeking orthodontic treatment was financial constraints. The orthodontist/patient relationship enables an understanding of the expectations regarding orthodontic treatment, resulting in greater motivation and cooperation, leading to a successful outcome. This study indicates that there is an increased awareness in the younger generation toward their dental appearance and esthetics.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]