de Oliveira, Cesar Messias; (2001) A comparison of normative and oral health related quality of life measures to assess the outcomes of orthodontic treatment. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Despite the fact that demand for orthodontic treatment is mostly related to personal concern about appearance and other psychosocial factors, measures of need assessment and outcomes of orthodontic treatment place little emphasis on patients' perceptions of need and the difference that orthodontic care makes to their daily lives. While quality of life has become a relatively common outcome measure in medical research, similar research in dentistry is in its infancy. Traditionally, dental researchers have focused on hard clinician-driven outcome measures at the expense of more subjective patient-driven measures, such as perceived functional status and psychological well-being. The measurement of treatment need and outcome has been based predominantly upon traditional clinical measures because there has not been a systematic study of the association of quality of life and malocclusion. The aim of this study was therefore to assess how the teeth and mouth impact on the daily lives of adolescents and whether the impacts, as assessed by two well established oral health related quality of life measures, are affected by orthodontic treatment. Hypothesis: It was hypothesised that adolescents who had completed orthodontic treatment had less oral health related impacts on their daily life activities and were more satisfied with their dental appearance than those who never had orthodontic treatment. In addition, it was hypothesised that a commonly used orthodontic clinical measure of need is an adequate measure of perceived satisfaction with dental appearance and also how the mouth affects oral health related quality of life. Methods: The study was conducted in Bauru-SP, Brazil. A sample of 1675 schoolchildren between 15 to 16 years old, from 21 urban schools, were randomly selected and three groups were identified according to their orthodontic status: treated, currently under treatment and untreated. Adolescents were clinically examined for orthodontic treatment need using the Index of Orthodontic Treatment Need (IOTN). Data on adolescents' self-perceptions were collected through a self-complete questionnaire. A structured interview was used to assess adolescents' oral health related impacts. Two oral health related quality of life measures, which had previously been used on Brazilian schoolchildren, namely the Oral Impacts on Daily Performance (OIDP) and the shortened version of the Oral Health Impacts Profile (OHIP-14) were used. Bivariate analysis and multiple logistic regression were used in the data analysis. Findings: Oral health related impacts were prevalent in the adolescents studied. Adolescents who had completed orthodontic treatment were significantly more satisfied with their dental appearance than those who were currently under treatment or who never had treatment. There were also significantly less oral health impacts on daily life activities in adolescents who had completed orthodontic treatment compared to the other two groups. Another finding was that the clinical measure of orthodontic treatment need, the IOTN index, did not adequately measure adolescents' satisfaction with dental appearance and overall oral health impacts as measured by two oral health related quality of life measures. Also, there was discordance between IOTN need and overall oral health impacts. Many adolescents who had no othodontic treatment need had impacts and vice versa. In conclusion, adolescents who had completed orthodontic treatment were more satisfied with their dental appearance and had fewer oral health impacts than those who never had orthodontic treatment and those who were currently having treatment. Combining the dental health component of IOTN with either of the two oral health related quality of life measures (OIDP and OHIP-14) used in this study provided more information about adolescents' perceived satisfaction with their appearance than the IOTN alone. Therefore current methods of orthodontic need should be complemented by oral health related quality of life measures with valid psychometric properties, and measures of perceived need.

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