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IJCRR - 13(21), November, 2021

Pages: 105-111

Date of Publication: 09-Nov-2021


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Concern, Awareness and Decision Towards Different Orthodontic Treatment Modalities - An Questionnaire Survey

Author: Navin N., Prema A., Saravana Kumar S., Yamini J., Sushmitha R. Iyer

Category: Healthcare

Abstract:Aim: To describe and analyze the awareness, thoughts and values influencing patients decisions to undergo orthodontic treatment with the ultimate aim of getting a deeper insight into decision making and the need to undergo orthodontic treatment. Material and Methods: All outpatients of the orthodontic department were included in the study. The questionnaire was framed under three categories namely patients concerns for orthodontic treatment, patients knowledge or awareness of different orthodontic treatment modalities and patients preferences or decisions on various orthodontic appliances. Likert type scale for awareness was used to rate the awareness level. Participants were then asked to rank their most preferred orthodontic appliance option. Four listed options included (a. Metal bracket, b. Clear bracket, c. Lingual brackets and d. Clear aligners). Result: The factors affecting patient's concern for orthodontic treatment are as follows: pain and discomfort, the appearance of braces, cost, changes in diet pattern, being teased by friends, neighbours, peer group etc., long treatment duration, skip work on the day of review, transportation for monthly review, uneasiness during smiling and speech. The mean awareness scale shows Metal braces to be highly recognized, followed by clear braces and lingual appliances while growth modification reported least appraised. Conclusion: The dentist must educate patients on new technologies available in the market which would address patients concerns about orthodontic treatment. Awareness should be created among all population groups on other orthodontic treatment modalities in particular growth modifiers.

Keywords: Orthodontic Treatment, Concern, Awareness, Decision Making, Survey, Questionaire

Full Text:

INTRODUCTION

The modern era with emerging and enabling technologies have helped the orthodontic profession progress in various methods of treatment. The profession has seen transitions from traditional braces to self-ligating brackets, lingual braces, removable aligners, and much more advanced technology, which address patients concerns (in particular esthetic and comfort) and the need for a timely efficient care1,2.

Orthodontics deals with the diagnosis, prevention and correction of malocclusion. Malocclusion is not a disease itself, but rather a state of being different from societal norms, which may cause anxiety about one’s dentofacial appearance and functional problems3. Sari et al., 20054 have shown that high anxiety levels are seen in patients with malocclusion. The concern is a cognitive activity that accompanies anxiety about future events5.

Increased patient awareness on smile beauty and facial appearance are observed more frequently in daily clinical practice. In recent years there has been an increase in the number of patients-both adults and adolescents seeking orthodontic treatment in addition, patients' expectations on treatment outcomes continue to rise. A desire for more aesthetic materials has resulted in both smaller sized and 'tooth-coloured appliances.

Long treatment duration and non-aesthetic appearance of metal brackets are the main reasons discouraging adult patients to start orthodontic treatment6.  Another important aspect of choosing a specific appliance option is its cost. The cost of treatment was reported to hinder their ability to meet their demanded treatment and fulfil their needs, and it was rated to be the most significant barrier to receiving dental services.

Hence, it is important to identify factors that may influence patients’ treatment uptake decisions. It is also unknown whether patients’ aware of orthodontic advancement which may be related to their treatment demands. Therefore, this study aimed to describe and analyze the awareness, thoughts and values influencing patients decisions to undergo orthodontic treatment with the ultimate aim of getting a deeper insight into decision making and the need to undergo orthodontic treatment.

MATERIALS AND METHODS

A cross-sectional epidemiological survey was conducted in the department of orthodontics and dentofacial orthopaedics approved by the institutional ethical committee(678/IHEC/12-19). All the outpatients for orthodontic consultation during the period from March 2019 to 2020  were included in the study. The patient's details like age, gender and educational level were collected. Both Verbal and written information about the study was given to all subjects and written concern was obtained from all the participants. All the participants were asked about their decision to undergo orthodontic treatment and the answers were registered (a. Yes b. No c. Not yet decided) before proceeding with the study questionnaire.

Study Design

A prestructured questionnaire (Fig. 1) was given to random 300 patients (179 girls and 121 boys) aged 18-30 years satisfying the inclusion criteria.

Inclusion criteria

  1. Patients undergoing orthodontic consultation for the first time.

  2. Patients between 18-30years old.

  3. Patients with no history of orthodontic treatment.

  4. Patients with no siblings who previously underwent orthodontic treatment.

 The questionnaire was framed under three categories namely patients’ concern about orthodontic treatment, patients’ knowledge or awareness on different orthodontic treatment modalities and patients’ preference or decision on various orthodontic appliances. The concern for orthodontic treatment was gathered under the following 10 factors: 1. Pain and discomfort, 2. Change in food style, 3. The appearance of braces, 4. Transportation, 5. Being teased, 6. Cost,7. Avoiding smiling, 8. Long treatment duration,9. Speech problems, 10. Time off from work.

Ten orthodontic treatment options representing the major therapeutic modalities in daily practices to understand patients’ knowledge or awareness on different orthodontic treatment modalities were listed as 1. Space maintainer, 2. Arch Expander, 3. Growth modification devices, 4. Metal braces, 5. Clear braces(Ceramic), 6.Self Ligating Braces, 7. Lingual braces, 8.Clear Aligner, 9. Mini implant or Mini screw, 10.Combined orthodontics and surgical cases. Images for each orthodontic therapy was shown to patients like Nance holding appliance, Maxillary arch expander, Headgear, Twin block, Metal bracket, Ceramic bracket, Lingual bracket, Passive Self ligating bracket with opening a door, Clear aligner partially and completely inserted, a Mini implant placed for anterior retraction and a pre-and posttreatment extra-oral profile of a combined orthodontic and surgical case. Each image was re-sized to the same dimension with better quality images. A likert-type scale for awareness was used to rate the awareness level of each therapy. It has five categories as follows: (1) not at all aware, (2) slightly aware (3) somewhat aware, (4) moderately aware, and (5) extremely aware.

Participants were then asked to rank their most preferred orthodontic appliance option. Four listed options include (a.Metal bracket, b.Clear bracket, c.Lingual brackets and d.Clear aligners).

Statistical analysis

Statistical evaluation of the data was performed using the IBM SPSS statistics software. Chi-Squared test was used to detect statistically significant differences between Likert’s scale awareness means of the different ten orthodontic modalities with age, gender, level of education and between treatment decisions and Mean ranking of the selected four appliances were found and also a concern for orthodontic treatment according to age, sex and treatment demand was evaluated.

RESULTS

The distribution of patients according to sex, age and treatment decision is shown in table 1. Out of 300 participants, 47(15.67%) were postgraduates, 189(63%) were graduates, 59(19.67%) were educated to higher secondary level (Class 11-12), 5(1.67%) were educated to secondary level(Class 6-10) shown in Table 2. Around 236 participants(78.67%) agreed to undergo orthodontic treatment, whereas 33 participants(11%) do not want to undergo orthodontic treatment while 31participants(10.37%) had not yet decided whether to undergo orthodontic treatment.

Patients' concern for orthodontic treatment which was gathered under 10 factors mentioned are shown in figure 2. 89(29.67%) participants felt pain and discomfort as their major concern towards orthodontic treatment, 67(22.33%) participants worried about the appearance of braces,43(14.33%) participants felt cost as their major concern, 26(8.67%) participants were apprehensive about changes in diet pattern, 19(6.33%) participants expressed on being teased from friends, neighbour, peer group etc.,19(6.33%) participants felt that the time off from work on the day of the review was their concern, 15(5%) participants were disturbed about long treatment duration,8(2.67%) participants bothered about their transportation for monthly review, 7(2.33%) participants felt about uneasiness during smiling due to braces, 7(2.33%) participants were distressed that braces would affect their speech.

The mean awareness level of each appliance is shown in figure 3.  Metal braces(3.96/5)  was mostly recognized, similarly, clear braces and clear aligners were among the highly recognized with the mean awareness scale of about 3.18 and 2.92 out of 5 respectively followed by lingual bracket. while growth modification appliances(1.48/5) was as expected reported at least (table 3).

The mean ranking for each one of the four orthodontic appliances selected were shown in figure 4. The ceramic bracket was the most preferred treatment option(3.68/5) and the Lingual bracket was placed the least in the ranking(2.34/5)

In our study 72.7% of participants were inadequately aware and 27.3% of participants shows moderate awareness to different orthodontic treatment modalities..(Table 4)

Statistical differences between age and level of awareness were found. Participants with age group of 26-30years had more level of awareness when compared to the remaining age group(p=0.02).(Table 5). and there is a correlation between education and level of awareness with the postgraduates showing more awareness when compared to graduates, higher secondary, and secondary(p=0.000). No statistical differences were found between gender(p=0.193), treatment decision(p=0.366) and level of awareness.

Correlation was also found between concern and treatment decisions groups, the concern items  “ Appearances of braces” and “ change in food style” were related to the treatment demand group ( p = 0.01, and p = 0.043, respectively). The most frequent concern item among patients who had not yet decided whether to undergo treatment or not and patients who don’t want treatment is about “cost” and “pain and discomfort”  p = 0.002, p=0.005 respectively. There was no statistically significant difference in patients’ concerns about gender and age group (p > 0.05).

DISCUSSION

This survey among patients regarding orthodontic treatment proves to admit the fact that individual concern plays an important factor in making their decisions to undergo treatment. According to our results, future orthodontic patients had concerns mainly on “pain and discomfort”, “Appearances of braces”, “Cost”, and “Changes in food style”. These findings are similar to those studies by Bennett et al., 19977, Sayer and Newton et al., 20078 and Kazanci et al., 20169. In the present survey, postgraduates felt changes in food style as one of their concerns whereas most graduates and higher secondary and secondary participants felt cost as one of their concerns along with pain and appearance of braces. Almost 14.33% of participants had a concern about cost as hindering factor for them to undergo orthodontic treatment.  a participant who had cost as their concern would certainly accept orthodontic treatment if there is a government-employed health care policy. But in the developing countries where patients cannot avail of insurance policy for orthodontic treatment, the concern of cost factor by patients should be dealt with separately. However, the majority of patients would spare cost factor when compared to other factors like pain and appearance of braces.

In our study, 29.67% of participants felt pain as the main concern in orthodontic treatment. Pain and discomfort are one of the most common and problematic sequelae of orthodontic treatment.10-12 According to the literature, 70-95% of orthodontic patients experience pain during orthodontic treatment.13, 14 According to Banerjee et al., 201815, pain is one of the major reasons for patient non-compliance and is a primary reason for missing appointments. To resolve this problem sufficient patient-orthodontist communication about pain management during orthodontic treatment may reduce their fear of pain and discomfort during orthodontic treatment and improve their quality of life and as well their treatment cooperation and satisfaction.

The highest awareness score among orthodontic devices listed was metal brackets (3.96 out of 5) followed by clear braces, clear aligners, lingual brackets (3.18,2.92 and 2.78 out of 5). On the other hand space maintainer, arch expander and growth modification appliances like facemask, headgear, twin block displayed the lowest level of awareness(1.68, 1.66 and 1.48 out of 5). Mane et al., 201816, found that people in rural areas have lack awareness of various techniques and advances in orthodontic treatment. Our result was also similar to the survey by Bindayel et al., 201817 where the level of awareness of the stainless steel brackets is high and the least awareness level was found in headgear and functional appliances. A study by Sruthi et al., 201818 found that participants knowledge on functional and myofunctional appliances was less and more awareness has to be created. This highlights the lack of specific knowledge on different orthodontic treatment modalities. Therefore a campaign is required to raise public awareness and improve knowledge on different orthodontic treatment modalities. Since growth modification appliance can be rendered only to younger age group population, general population or paediatric as well adult population seeking dental treatment should be educated on growth, modification procedures which can circumvent surgical procedures in future.

In our study, 22.33% of participants felt the appearance of braces as their concern in orthodontic treatment. This concern was about esthetics which attributes to the major requirement for modern society, which caused an increased demand for aesthetic treatment.19 In our study, the clear(Ceramic) bracket was the most preferred treatment option(3.68 out of 5)followed by a clear aligner (3.24 out of 5) whereas lingual braces were the least preferred treatment option(2.34 out of 5). This result was also similar to the study by Rosvall et al., 200920 and Bindayel et al., 201821. But the result was in contrast to a study by Ziuchkovski et al., 200822, where they noticed clear aligner and lingual appliances were the most attractive treatment. The metal bracket which was commonly used in orthodontic practice were considered unattractive while ceramic bracket and orthodontic clear aligners were considered better aesthetic options. According to Feu D et al., 201223, socioeconomic status and age play a major role in the decision of aesthetic orthodontic options. Patients with high socioeconomic status and ages between 17 and 26 years are willing to receive aesthetic appliances irrespective of the cost.  It is important to include socioeconomic status as one of the factors affecting decision making, hence this study’s results cannot be indiscriminately applied to groups with socioeconomic differences and this was considered to be the drawback of this study.

CONCLUSION

  1. The mean awareness scale shows Metal braces to be highly recognized, followed by clear braces and lingual appliances while growth modification reported least appraised.

  2. The dentist has to educate patients on new technologies available in the market which would address patients concerns about orthodontic treatment. Awareness should be created among all population groups on other orthodontic treatment modalities in particular growth modifiers. which would intercept malocclusion at an earlier stage

  3. Futuristic application of orthodontic treatment should be towards prevention and interception of malocclusion. Hence awareness of preventive and interceptive orthodontics should be created among the general public.

Conflict of interest:  None

Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

Funding Agency:  nil (self-funding)

Authors contribution:

References:

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2. Berto PM, Lima CS, Lenza MA, Faber J. Esthetic effect of orthodontic appliances on a smiling face with and without a missing maxillary first premolar. Am J Orthod Dentofacial Orthop  2009 Apr 1;135(4):S55-60

3. Shaw WC, O'brien KD, Richmond S, Brook P. Quality control in orthodontics: risk/benefit considerations. Brit Dent J 1991 Jan;170(1):33-7.

 4. Sari Z, Uysal T, Karaman AI, Sargin N, Üre Ö. Does orthodontic treatment affect patients' and parents' anxiety levels?. Eur J Orthod 2005 Jan 1;27(2):155-9.

5. MacLeod AK, Williams JM, Bekerian DA. Worry is reasonable: the role of explanations in pessimism about future personal events. J Abnorm Psychol1991 Nov;100(4):478

.6.Khan RS, Horrocks EN. A study of adult orthodontic patients and their treatment. Brit J Orthod 1991 Aug 1;18(3):183-94.

7. Bennett ME, Michaels C, O'Brien K, Weyant R, Phillips C, Vig KD. Measuring beliefs about orthodontic treatment: a questionnaire approach. J Public Health Dent 1997 Dec;57(4):215-23.

8. Sayers MS, Newton JT. Patients’ expectations of orthodontic treatment: Part 2—findings from a questionnaire survey. J Orthod. 2007 Mar;34(1):25-35.

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13. Liu Z, McGrath C, Hägg U. Changes in oral health-related quality of life during fixed orthodontic appliance therapy: an 18-month prospective longitudinal study. Am J Orthod Dentofacial Orthop  2011 Feb 1;139(2):214-9.

14. Zhang M, McGrath C, Hägg U. Changes in oral health-related quality of life during fixed orthodontic appliance therapy. Am J Orthod Dentofacial Orthop  2008 Jan 1;133(1):25-9.

15. Banerjee S, Banerjee R, Shenoy U, Agarkar S, Bhattacharya S. Effect of orthodontic pain on quality of life of patients undergoing orthodontic treatment.  Indian J Dent Res 2018 Jan 1;29(1):4.

16. Mane PN, Patil SD, Kadam K, Ganiger CR, Pawar RL, Phaphe SA, Yusuf AR, Bapana PA. Evaluation of the awareness and knowledge of orthodontics and orthodontic treatment in patients visiting the School of Dental Sciences, Karad. J Oral Res Rev 2018 Jul 1;10(2):62.

17. Bindayel NA. Awareness of orthodontic modalities and preference of appliance and payment options in Saudi Arabia. Saudi J Oral Sci 2018 Jul 1;5(2):98.

18. Sruthi S. Knowledge and awareness about the importance of undergoing early orthodontic treatment, the importance of undergoing functional and my functional appliances, and acceptance among the public. Drug Invent. Today 2018 Sep 2;10.

19. Singh V, Hamdan A, Rock P. The perception of dental aesthetics and orthodontic treatment need by 10-to 11-year-old children. Eur J Orthod 2012 Oct 1;34(5):646-51.

.20. Rosvall MD, Fields HW, Ziuchkovski J, Rosenstiel SF, Johnston WM. Attractiveness, acceptability, and value of orthodontic appliances. Am J Orthod Dentofacial Orthop  2009 Mar 1;135(3):276-e1.

21. Ziuchkovski JP, Fields HW, Johnston WM, Lindsey DT. Assessment of perceived orthodontic appliance attractiveness. Am J Orthod Dentofacial Orthop  2008 Apr 1;133(4):S68-78.

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A Study by Juna Byun et al. entitled "Study on Difference in Coronavirus-19 Related Anxiety between Face-to-face and Non-face-to-face Classes among University Students in South Korea" is awarded Best Article for Vol 12 issue 16
A Study by Sudha Ramachandra & Vinay Chavan entitled "Enhanced-Hybrid-Age Layered Population Structure (E-Hybrid-ALPS): A Genetic Algorithm with Adaptive Crossover for Molecular Docking Studies of Drug Discovery Process" is awarded Best article for Vol 12 issue 15
A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
A study by Raunak Das entitled "Study of Cardiovascular Dysfunctions in Interstitial Lung Diseas epatients by Correlating the Levels of Serum NT PRO BNP and Microalbuminuria (Biomarkers of Cardiovascular Dysfunction) with Echocardiographic, Bronchoscopic and HighResolution Computed Tomography Findings of These ILD Patients" is awarded Best Article of Vol 12 issue 13 
A Study by Kannamani Ramasamy et al. entitled "COVID-19 Situation at Chennai City – Forecasting for the Better Pandemic Management" is awarded best article for  Vol 12 issue 12
A Study by Muhammet Lutfi SELCUK and Fatma entitled "Distinction of Gray and White Matter for Some Histological Staining Methods in New Zealand Rabbit's Brain" is awarded best article for  Vol 12 issue 11
A Study by Anamul Haq et al. entitled "Etiology of Abnormal Uterine Bleeding in Adolescents – Emphasis Upon Polycystic Ovarian Syndrome" is awarded best article for  Vol 12 issue 10
A Study by entitled "Estimation of Reference Interval of Serum Progesterone During Three Trimesters of Normal Pregnancy in a Tertiary Care Hospital of Kolkata" is awarded best article for  Vol 12 issue 09
A Study by Ilona Gracie De Souza & Pavan Kumar G. entitled "Effect of Releasing Myofascial Chain in Patients with Patellofemoral Pain Syndrome - A Randomized Clinical Trial" is awarded best article for  Vol 12 issue 08
A Study by Virendra Atam et. al. entitled "Clinical Profile and Short - Term Mortality Predictors in Acute Stroke with Emphasis on Stress Hyperglycemia and THRIVE Score : An Observational Study" is awarded best article for  Vol 12 issue 07
A Study by K. Krupashree et. al. entitled "Protective Effects of Picrorhizakurroa Against Fumonisin B1 Induced Hepatotoxicity in Mice" is awarded best article for issue Vol 10 issue 20
A study by Mithun K.P. et al "Larvicidal Activity of Crude Solanum Nigrum Leaf and Berries Extract Against Dengue Vector-Aedesaegypti" is awarded Best Article for Vol 10 issue 14 of IJCRR
A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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