The Psychosocial Impact Of Malocclusion: A Cross Sectional Study

Abstract

Introduction Malocclusion refers to the morphological deviation from ideal facial and occlusal relations and functioning. Patients who suffer from malocclusion experience effects that are described entirely in terms of psychological concerns. Thus, studying the social and psychological effects of malocclusion is primordial to understand its consequences on people’s life. Aims 1. Determine the occurrence of oral health and psychosocial impacts of malocclusion among Lebanese orthodontic adolescents; 2. Evaluate the relationship of the psychosocial profile of patients seeking orthodontic treatment namely self-esteem, oral health related quality of life and self-perceived esthetics with the severity of malocclusion; 3. Assess the influence of gender and motivation for treatment on this relationship among adolescents; 4. Evaluate which malocclusion component (dental, skeletal or facial) best correlates with the psycho-social profile of patients. Design The prospective cross-sectional study targeted the understanding of the impact of malocclusion on the psychosocial profile of patients seeking orthodontic treatment. Accordingly, patients seeking treatment were asked to fill questionnaires regarding their self-esteem, oral health related quality of life and self-perceived esthetics. Malocclusion was measured through different occlusal indices, cephalometric measurements and intra and extra-oral pictures assessments taken at the start of orthodontic treatment. Methods The study included a representative sample of 102 adolescents (mean age 13.54 ±2.1 years, 53.9% female subjects). Different occlusal indices (DAI, IOTN, ICON, PAR) were used for assessment of malocclusion along with cephalometric, facial and smile measurements. The short form of the Child Oral Health Impact Profile (COHIP), the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and the Rosenberg Self-Esteem scale (RSES) were used to measure adolescents’ self-perceived variables. Results Subjective self-perception of dental esthetics and OHRQoL in adolescents are influenced by the different components of malocclusion by order of smile characteristics(r=0.41), dental components (r=0.35) and facial characteristics (r=0.18). Gender does not influence this association; however self-motivated patients have higher psychosocial impacts compared to patients whose parents are motivated for treatment. Also, older adolescents are more affected by the psychological burden of malocclusion compared to younger adolescents. Among all the studied occlusal indices, AC is the best index to check the psychosocial impact of malocclusion due to its high sensitivity to changes in OHRQoL scores, in addition to the fact that it is the fastest index to be recorded. Patients with low self-esteem are more psychologically sensitive to the esthetic effects of malocclusion and show poorer OHRQoL. Conclusion Malocclusion has a psychological impact on adolescents and this impact increases with the severity of malocclusion. Patients with increased severity of malocclusion have a decreased OHRQoL and are psychologically disadvantaged compared to patients with minor or no malocclusions. Hence, the psychosocial effects of malocclusion should never be underestimated no matter how small. Depending on the individual’s character, some may be more susceptible than others to psychological distress that results from malocclusion and its consequences such as teasing and bullying; Therefire, the impact on their psychological health might be great.