Objectives: To investigate the interrelationships between factors involved in orthodontic treatment seeking by children aged 12-15 years.
Setting: State funded orthodontic clinic at the Faculty of Dentistry of the Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil, and a nearby public school.
Subjects and methods: One hundred and ninety-four adolescents aged 12-15 years took part in the study; 92 had sought orthodontic treatment at UERJ (orthodontic group) and 102 were from a nearby public school and had never undergone or sought orthodontic treatment (comparison group). Each participant underwent a comprehensive oral examination, and both parent and child were questioned about who had initiated the orthodontic referral.
Outcomes: Normative need assessed with IOTN DHC; clinician and self-perceived aesthetic perception assessed with IOTN AC, previous caries experience was determined using the decayed, missing and filled teeth index (DMFT) and WHO diagnostic criteria. The 'Brazil Economic Classification Criteria' was used to classify the socioeconomic status. Intra-examiner repeatability and inter-examiner agreement were assessed with kappa statistics. Univariate and multiple logistic regression analyses were used to investigate the association between orthodontic treatment seeking (dependent variable) and the independent variables (i.e. aesthetic impairment, malocclusion severity, socioeconomic status, gender, age and DMFT).
Results: Univariate analyses showed that self-perceived aesthetics (P<0.001), examiner-assessed aesthetics (P = 0.01) and treatment need (P<0.001), socioeconomic status (P<0.001) were significantly associated with orthodontic treatment seeking, but gender (P = 0.22) and DMFT (P = 0.41) were not. Multiple logistic regression analyses showed that poor self-perceived aesthetics (OR = 16.7; 95% CI: 4.17-61.9), more severe malocclusion (OR = 3.4; 95% CI 1.64-7.14) and better socioeconomic position (OR = 39.1; 95% CI: 5.47-280.54) significantly influenced the decision to seek orthodontic treatment.
Conclusions: Concern about dental appearance and the desire for treatment, together with normative orthodontic need, should be carefully assessed by dentists before referring patients to specialized orthodontic care in publicly-funded clinics. In a publicly-funded oral health care system, self-perceived orthodontic treatment need is the key to establishing treatment priority.