REASONS FOR SEEKING ORTHODONTIC TREATMENT· A PILOT …

REASONS FOR SEEKING ORTHODONTIC TREATMENT·A PILOT STUDY .A.A.A. Abdullah, Z. Yassin, N. Zamzam. Reasons forseeking orthodontic treatment: A pilot study. Annal DentUniv Malaya 2001; 8: 13-19.

ABSTRACT

This pilot survey was conducted to determine the mainreason and the motivating factors which, influencepatients in seeking orthodontic treatment. 115 patientsaged 11-30 years old were taken from the orthodonticwaiting list at the Dental Faculty, University Malayadated December 1999 - May 2000. A structuredquestionnaire was designed and the survey of patientswas carried out using the telephone. The desire to havea better dental appearance was the main reason (65 %)given by patients who were seeking orthodontictreatment. The most important motivating factor thatinfluences patients in seeking orthodontic treatment wasto attain straight teeth (48 %). In conclusion, patientsseek orthodontic treatment mainly due to psychologicalreason, which is to improve dental appearance andaesthetic. Perceived needs of an orthodontic patientshould also be taken into consideration beforecommencing orthodontic treatment to increase chancesof mutually satisfying result for both the orthoqontist andpatient.

Key words: Orthodontic treatment, reasons, motivatingfactors.

INTRODUCTION

The objective for undergoing orthodontic treatment isto improve dental occlusion, which, could result in agood functioning and aesthetically pleasing dentition inharmony with the face (1). Many studies have shownthat problems associated with malocclusion such astraumatic occlusion, temporomandibular joint pain,periodontal disease or caries might resolve afterorthodontic therapy (2).

Various reasons and factors, which influence patientsin seeking orthodontic treatment, had been reported ina number of previously published studies (3-7). Socialpsychological impact to any malocclusion whethernoticed by the patient himself or by other people suchas low self-esteem, frequent teasing experiences anddissatisfaction to appearance may develop the desire fororthodontic treatment (6,7). Self-concept, self-image,status, pride, discomfort and concern for future oralhealth are but a few reasons for a person to decide fororthodontic treatment (3).

Parents and dentists are likely to play an importantrole in initiating and motivating patients in seeking fororthodontic treatment (4,5,8). Demographic backgroundof a patient such as gender, age, socio-economic status,

Original Article

A.A.A. Abdullah!, Z. Yassin2, N. Zamzam2

1Faculty of Dentistry,National University of Malaysia,50603 Kuala Lumpur

2Department of Children's Dentistry & Orthodontics,Faculty of Dentistry, University of Malaya,50603 Kuala Lumpur

Corresponding author - Zafarina Mohamed Yassin

dental attendance frequency and familiarity oforthodontic appliance may also affect patient'sperception to orthodontic treatment (4-7,9-11).

The aim of this pilot study was to determine thereasons and motivating factors, which stimulate orinfluence patients in seeking orthodontic treatment at theFaculty of Dentistry, University of Malaya (FDUM).

MATERIALS AND METHODS

The QuestionnaireThis pilot survey was conducted using a structured

questionnaire (Figure 1). Most of the questions in thisstudy were taken from previously published studies(4- 7).

The structured questionnaire consisted of two mainparts. Part 1 consisted of four questions on patient'sdemographic data, which are the sex, age, ethnic groupand dental attendance frequency. Ethnic considerationis important as this survey was done in a multi-racialcountry.

Part 2 of this questionnaire comprised ten questionsinvolving psychosocial aspect of patients including dentalawareness (4), dental satisfaction (5), effect of dental~nomalies (4), teasing experience (6), factors which maymfluence patients in seeking treatment, main reason forseeking treatment and expected social changes onceorthodontic therapy is completed (7).

The Subjects and SurveyOutpatients who attend FDUM for treatment will

normally be seen by a dental officer in-charge in thePrimary Care Unit (Bahagian Rawatan Utama - BRU)during their first visit. Patients who requested for, orconsidered to require orthodontic treatment have theirnames placed on the orthodontic screening waiting list.These patients will be seen by dental students or by thelecturers/orthodontists to determine the suitability fororthodontic treatment. Upon completion of the

14 Annals of Dentistry, University of Malaya, Vol. 8 2001

o (C) bila perlu sahajawhen necessary only

3. Bangsa: 0 Melayu 0 CinaEthnic: Malay Chinese

0 India 0 Lain-lainIndian Others

4. Kekerapan mengunjungi doktor gigi :Frequency in dental attendance

Bahagian 1 (Part 1)

1. Jantina: 0 Perempuan 0 LelakiGender: Female Male

2. Umur: 0 (A) 8 -12 tahun

Age: 0 (B) 13 - 19 tahun

0 (C) 20 - 30 tahun

0 (D) 31 - 40 tahun

0 (E) ~ 41 tahun

o (A) 6 bulan sekali6 monthly

o (B) 1 tahunonce yearly

Bahagian 2 (Part 2)

Sila nilai penampilan pergigian anda ?Please assess your own dental appearance?

Adakah anda mempunyai gigi yang tidak tersusun ?Do your teeth have any irregularities?

1.

2.

o Ya (yes) o Tidak (no)

- Interaksi sosial(social interaction)

- Keyakinan diri(confidence)

o ya (yes) 0 tidak (no)

o tidak pasti (not sure)



6. Pada pendapat anda, setelah gigi anda telah dibetulkan,bahagian manakah didalam hidup anda yang akanberubah?Do you think after your teeth have been straightened, whichfollowing area/areas of your life will be altered?

Pernahkah anda diejek disebabkan penampilan gigi anda?Have you ever been teased due to your dentalappearance?

Siapakah orang pertama yang perasan kewujudankeganjilan gigi anda ?

Who first noticed the presence of your dental anomalies?

o (A) selalu ( always)

o (B) kadang-kadang ( sometime)

o (C) tidak pernah ( never)

0 (A) mendapatkan gigi yang tersusun lurus(attain straight teeth)

0 (B) meningkatkan kecantikan muka(enhance facial appearance)

0 (C) meningkatkan kesihatan pergigian(improve dental health)

0 (D) memperbaiki pertuturan (improve speech)

0 (E) meningkatkan keyakinan diri( enhance self-confidence)

0 (F) memperbaiki pengunyahan( improve chewing)

o (A) orang lain juga memakai aplian(others were wearing an appliance)

o (B) doktor gigi anda mancadangkanya demikesihatan pergigian(Your dentist recommended it in the interest ofdental health)

o (C) untuk memperbaiki penampilan gigi anda(to improve appearance of teeth)

o (D) ibu mahu anda mendapatkan rawatan( your mother wants you to have treatment)

Yang manakah antara faktor berikut merupakan faktorpaling penting yang mendorong anda mendapatkanrawatan ortodontik?Which one of the following factors is the most importantfactor in seeking orthodontic treatment?

Di antara sebab-sebab berikut, yang manakah sebab yangpaling tepat menggambarkan sebab anda mendapatkanrawatan ?Which one of the following factors, most accuratelydescribe the reason for you in seeking treatment?

8.

7.

o (D) Doktor gigi (dentist)

o (E) Lain-lain' (others)



- Peluang kerjaya(career opportunities)

o (A) Sendiri (self)

o (B) Ibu (mother)

o (C) Bapa (father)

o (A) Baik (good)

o (B) Sederhana (average)

o (C) Buruk (bad)

Siapakah yang mencadangkan rawatan ortodontik kepadaanda ?Who suggested you orthodontic treatment?

o (A) kaum keluarga\ kawan-kawan (relatives/friends)

o (B) sendiri (self)

o (C) doktor gigi ( dentist)

4.

5.

3.

Figure 1: Structured questionnaire

Reasons for seeking orthodontic treatment 15

Table 2: Factors, which influence patients in seekingorthodontic treatment (Part 2 - questions 1,2,3,4,5)

orthodontic screening, the patients will then be referredto various groups of clinicians for appropriateorthodontic management.

Subjects for this survey were chosen from theorthodontic waiting list for the period of 15th December·1999 until 15th May 2000. This survey was carried outby a telephone interview and with the duration of eachcall being approximately 5 minutes. Out of 138 patientsin the waiting list, only 115 subjects could be contactedduring the survey period. No systematic effort was madeto stratify the subjects, as the total number was limited.Subjects were only included in this survey if they havenot undergone any kind of orthodontic treatment. Allthe subjects interviewed were highly cooperative, thus,making the response rate to 100 %.

The Pre-testA pre-test of the questionnaires was conducted prior

to the actual survey. The first five subjects who werecontacted had participated in the pre-testing of theoriginal questionnaires. These five subjects understoodall the questions.

FACTORS

Awareness ofdental anomalies

Assessment of owndental appearance

Teasing experience

First person to noticepatient's dentalanomalies

First person to suggestorthodontic treatment

PERCENTAGE(%)

Yes 99No 1

Good 10Average 68Bad 22

Always 5Sometimes 39Never 56

Self 46Mother 29Father 8Dentist 3Others 14

Family/Friends 61Self 30Dentist 9

RESULTS

Table 1: Demographic data of the subjects interviewed(Part 1 - questions 1,2,3,4)

A total of 110subjects aged between 11-30 years old wereincluded in the study. Results were analyseddescriptively for:

1. Demographic data of the patients .

2. The main reason and factors that influence patientsin seeking orthodontic treatment

Part 1- Demographic data of patientsThe majority of the patients interviewed (Table I)

were females (61 %) and adolescents aged between 13-19 years old (67%). Mean age of this sample was 17years old. The proportions of Malay and Chinesepatients were equal (38 %). Indians made up 21 % ofthe total while the rest were from other ethnic groups.

DEMOGRAPHIC DATA

Regarding patient's dental attendance frequency, only12 % of the respondents regularly visit their dentistsevery 6 months while majority of the patients (74%) visittheir dentists only when necessary.

Part 2- Reason & motivating factors which influencepatients in seeking orthodontic treatment

Almost all patients (99 %) were aware that they haddental irregularities (Table II). The majority of thepatients (68 %) assessed their dental appearance asaverage. Only 5 % of the patients mentioned that theyhad always been teased due to their dental irregularities.Majority of the patients (46 %) stated that theythemselves were the first to notice their dental anomalieswhile 29% of the respondents said that their motherswere the first to point out their dental problems. Onlya few (3 %) noted that it was their dentist who firstalerted the anomalies to them. Most of the respondents(61 %) sought orthodontic treatment followingsuggestions from their family and friends; dentistreferral constituted only 9% (Table II). Most of thepatients (75 %) felt that their confidence and self-esteemwould be increased if their teeth were straightened, 64 %stated that their social life would be improved while 43 %believed that their career opportunities and prospectwould be brighter (Figure 2). Most of the patients(65 %) stated that the main reason for seekingorthodontic treatment was to improve their own dentalappearance (Figure 3). Some of the patients (18%)actually followed their mothers' wishes in obtainingorthodontic treatment. Attaining straight teeth was citedthe most important motivating factor in almost half(48 %) of the respondents (Figure 4). Second in the listwas to improve dental health (20 %) and to enhance self-confidence (20 %).

3961

116722

383821

1214743

PERCENTAGE(%)

MalayChineseIndians

MaleFemale

8-12 years old13-19 years old20-30 years old

6 monthlyOnce yearlyWhen necessary onlyOthers

Ethnic group

Age group

Gender

Dentalattendancefrequency


80~ 70~ 60~ 50~ 40as 302 20rf. 10

o

75

Career opportunities Social life

I[J yes IIIno £:,I not sure ISelf -confidence

Figure 2: Areas of improvement expected by patients after orthodontic treatment (Part 2 - question 6)

•......... 70 65~~ 60Q.) 50OJ 40ro 18- 30 15cQ.) 20 2

..--------.u 10 -r----"-Q.) 00...

Others Suggested by To improve Mother'swearing an dentist dental requestappliance appearance

Figure 3: The main reason for seeking orthodontic treatment (Part 2 - question 7)

6050 - 48

~~ 40 -Q.)OJro 30- 20 20cQ.) 20u .~, TL~~-,"-Q.)

100... 20

Enhance Enhance Improve Improve Enhance self- Improvedental facial dental health speech confidence chewng

appearance appearance

Figure 4: The most important motivating factor in seeking orthodontic treatment (Part 2 - question 8)

DISCUSSION

Part 1 - Demographic data & Dental attendancefrequency

The subjects surveyed in this pilot study representa convenient sample of the patients that attend theFDUM seeking orthodontic treatment within a 5-monthperiod.

The majority of patients surveyed in our study were·females. The same result was also reported inpreviously published studies such as in SingaporeUniversity Hospital where almost 3: 1 majority of femalerespondents (7). These may be a reflection of the factthat standard of aesthetic and beauty is more appreciatedby females (6,7,12).

Ingervall & Hedegard (1974) stated that awarenessand desire to receive orthodontic treatment might varywith age (4). Shaw (1981) also stated that decrease insatisfaction with dental appearance is associated withincreasing age (6). However, in this study, the majorityof patients were adolescents aged between 13-19 yearsold. This may be because of the psychological changesin teenagers to become more socially acceptableespecially in physical attractiveness. Therefore, thedesire for orthodontic treatment to enhance attractivenessis higher in this age group.

Malay and Chinese are the two largest ethnic groupsin Malaysia, thus making them the majority of patientsseeking orthodontic treatment. Most of the patients inour study stated that they visit the dentists only whenthey have dental problems. This could be due to lowdental awareness of the patients surveyed. It isinteresting to note that Shaw (1981) in his study foundthat irregular dental attendance pattern was associatedwith more dissatisfaction thus leading to higher demandfor orthodontic treatment (6). Results from Shaw's studymay explain why most of the patients in our study whoattend dental clinic only when necessary, have a higherdemand for orthodontic treatment.

Part 2 - Dental awareness, psychological effect ofmalocclusion, sources of referral, motivating factor andmain reason for seeking orthodontic treatment.

Most of the participants assessed their appearanceas 'average'. This may reflect their desire to improvetheir unaesthetic dental appearance via orthodontictreatment. Regarding teasing experience, this currentstudy found that most of the patients had no teasingexperience. The result disagrees with the study by Shaw(6) in which he reported a high incidence of teasingexperience in his sample. Low dental awareness amongMalaysians may be one of the reasons why teasingexperience is low in the current study, as dentalanomalies may appear unnoticeable by other people. Inthe current study, we also included adults; therefore theymay not have any teasing experience or may haveforgotten about earlier experiences.

In relation to mirror viewing frequency, Shaw (6)stated that the changing stage from a child to anadolescent would make an individual become moreaware of their appearance. His result is similar with


that of our pilot survey where most patients themselveswere the first to notice their own dental anomalies whilemothers were second in place. However, some studiesshowed that parents were found to have noticed occlusaldefects in their children as frequent as dentists have(5,13). Our results differ from those studies possiblydue to parental influence, which may not operate directly(5).

Dentists have a large part to play in recommendingorthodontic treatment when indicated. However, in thiscurrent study, most of the patients surveyed soughtorthodontic treatment after having been prompted to doso by friends or family. Only a small percentage soughttreatment through recommendation of their dentists. Theresults of this current study differ from some previouslypublished studies (5,7,8,12). Most of the patientsattending Singapore University Hospital were self-referred (7) while dentists were the largest sources ofreferral for orthodontic treatment in USA and UnitedKingdom (5,8,12). The differences may be due to theirregular dental attendance pattern of Malaysian patientsthus making the rate of dentists referrals low (7).

Expected improvement in career opportunities,social life and self-confidence following orthodontictreatment were sought by most of the patients. Thepositive response to changes in career opportunities afterorthodontic treatment was lower compared to social lifeand self-confidence. This may be due to the age ofpatients surveyed. Most of the patients in this surveywere adolescents, making it hard for them to visualiseor to evaluate the possible contributions that orthodontictreatment can provide for their future career. Changesin social life and self-confidence can be evaluated readilyas patients may have experienced these changes.

Our results showed that attaining straight teeth toimprove dental appearance was undoubtedly the mostimportant motivating factor for seeking orthodontictreatment. This was consistent with the findings of Lew(1992) whereby enhancing dental appearance was quotedto be the most important motivating factor fororthodontic treatment amongst Singaporean patients (7).Most studies also demonstrated the same result (5,7,8).The desire to have better dental appearance was the mainreason why patients in this current study soughtorthodontic treatment. This result is in agreement withmost previously published studies (7,14,15).

CONCLUSIONS

Demographic and psychosocial factors are a few butimportant ones in leading patients to seek orthodontictreatment. Demographic factors such as age and sexcan be considered to have some influences on patients.Most patients seek orthodontic treatment because of apsychological reason, which is to improve their dentalappearance and to achieve better aesthetics.

The patient's motivation in seeking orthodontictreatment should be determined before the treatmentcommences to increase chances for a mutually satisfyingresult for both dentist/orthodontist and patient.


However, severity of occlusion as evaluated by thedentists may not correlate with the patients' perceptionof their dental appearance. We realised that it is alsoimportant to justify whether orthodontic treatment shouldbe subjected to any patients when the normative needsdo not correlate with the perceived needs of treatment.Therefore, decision in orthodontic intervention shouldbe exercised cautiously when only perceived needs aretaken into consideration without assessing the normativeneeds.

ImplicationThis pilot survey can be used as a guide in designing

a larger study to represent the Malaysian population.The sample size in this study was small, being aconvenient sample of patients listed in the orthodonticwaiting list in FDUM for a short period of 5 months.It is recommended that a related future study shouldencompass larger sample consisting of subjectsthroughout the country. Sufficient representation ofimportant strata within the Malaysian population suchas age, gender, socio-economic background and ethnicityshould be included so that a more meaningful outcomecan be achieved. As language was one of the barriersin communication during the interview, future studiesshould consider training interviewers to conduct thesurvey using four major languages in Malaysia.

Studies looking into the association betweendemographic data and psychosocial impact of dentalanomalies in order to specify the group of patients,which are in real need for orthodontic treatment shouldbe made. Therefore, waiting lists especially in theGovernment sectors could be shortened if only theidentified specific groups are treated.

We suggest that future studies should also look intothe association between the clinical severity of dentalanomalies that lead to real treatment demand (normativeneed) and the treatment demanded by patients (perceivedneed). This present pilot study may be an effort to beginto assess these factors whereby the usage of orthodonticindices such as IOTN may be advocated.

An interesting extension to this study is to do acomparison study on a random population who havedental anomalies and do not seek orthodontic treatmentand a specific group of patients who seek orthodontictreatment, in relation to demographic background as wellas their perceptions of dental appearance.

Limitations of this studyDue to the short time frame for the conduct of this

survey, only 110 patients could be included, thus theydo not represent the general population. Age range,which was between 11-30 years old, was too wide, thusmaking some of the questions difficult to be understoodby younger participants. Questions pertaining toperception of appearance were subjective and hence theresponse varied from one individual to another. Rankingtype of questions could not be posed during a telephonesurvey because it would be difficult for the participantsto remember all the options and rank them at the same

time. Difficulties in explaining questions via thetelephone were encountered especially when languagewas also a barrier to some participants who could notunderstand both English and Malay.

ACKNOWLEDGEMENTS

We would like to thank Dr. Tuti Ningseh for her adviceand suggestions on the design and analysis of this studyand Dr. M. Shafeeq for his kind assistance.

REFERENCES

1. Hotz R. Orthodontic in daily practice. Vienna,Hans Huber Publishers, Bern Stuttgatt 1961.

2. Houston WJB, Stephens CD, Tulley WI. Atextbook of Orthodontics. 2nd Edition. Cambridge,Redwood Books 1993; pp. 6-12.

3. Tayer BH, Burek MJ. A survey of adults' attitudestoward orthodontic therapy. Am J Orthod 1991; 79:305-315.

4. Ingervall B, Hedegard B. Awareness ofmalocclusion and desire of orthodontic treatment in18-year old Swedish men. Acta Odontol Scand1974; 32: 93-101.

5. Gosney MBE. An investigation into some of thefactors influencing the desire for orthodontictreatment. Br J Orthod 1986; 13: 87-94.

6. Shaw WC. Factors influencing the desire fororthodontic treatment. Euro J Orthod 1981; 3: 151-162.

7. Lew KK. Attitudes and perceptions of adultstowards orthodontic treatment in an Asiancommunity. Community Dent and Oral Epidemiol1993; 21: 31-35.

8. Breece GL, Nieberg LG. Motivations for adultorthodontic treatment. J Clin Orthod 1986; 20: 166-171.

9. Bergstrom K, Halling A, Wilde B. Orthodontic carefrom the patients' perspective: Perceptions of 27-year olds. Euro J Orthod 1998; 20: 319-329.

10. Burden DJ. The influence of social class, gendersand peers on the uptake of orthodontic treatment.Euro J Orthod 1995; 17: 199-203.

11. Jenkins PM., Feldman BS, Stirrups DR. The effectof social class and dental features on referrals fororthodontic advice and treatment. Br J Orthod1984; 185-188.

12. Baldwin DC. Appearance and aesthetics in oralhealth. Community Dent and Oral Epidemiol 1980;8: 244-256.

13. Kilpelairen PV, Phillips C, Tullock JE Anteriortooth position and motivation for early treatment.Angle Orthod 1993; 63: 171-174.


14. Dorsey J, Korabik K. Social and psychologicalmotivations for orthodontic treatment. Am J Orthod(Abstract) 1977; 72: 460.

15. Sheats RD, Gilbert GR, Wheeler TT, King GJ.Pilot study comparing parents' and third-gradeschoolchildren's attitudes toward braces andperceived need for braces. Community Dent of OralEpidemiol 1995; 23: 36-43.

Documents

REASONS FOR SEEKING ORTHODONTIC TREATMENT· A PILOT …