Reasons for seeking orthodontic treatment in Qassim region: a Pilot Study

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1 58 ORIGINAL ARTICLE Reasons for seeking orthodontic treatment in Qassim region: a Pilot Study Ahmed Al Fawzan th Year Student, College of Dentistry, Qassim University, Saudi Arabia Corresponding Author Ahmed Al Fawzan College of Dentistry, Qassim University, Saudi Arabia ahmadfou@hotmail.com Access this Article Online Quick Response Code Use the QR Code scanner to access this article online in our database Article Code: IDJSR 39 Introduction The objective of orthodontic treatment is to improve dental occlusion, which, could result in a good functioning and aesthetically pleasing dentition in harmony with the face (1).Many studies have shown that problems associated with malocclusion such as traumatic occlusion, temperomandibular joint pain, periodontal disease and caries might resolve after orthodontic therapy (2,3).Various reasons and factors, which influence patients in seeking orthodontic treatment, had been reported in a number of previously published studies (4,5).Social and psychological impact of malocclusion whether noticed by the patient himself or by other people such as low selfesteem, frequent teasing experiences and dissatisfaction to appearance may develop the desire for orthodontic treatment. Selfconcept, self-image, status, pride, discomfort and concern for future oral health care but few other reasons for a person to decide for orthodontic treatment (3).Parents and dentists are likely to play an important role in initiating and motivating patients for orthodontic treatment (6,7,8). Demographic background of a patient such as gender, age, socio-economic status, dental attendance frequency and familiarity of orthodontic appliance may also affect patient's perception orthodontic treatment (4,9). The aim of this pilot study was to determine the reasons and factors motivating patients to seek orthodontic treatment in Qassim region (Saudi Arabia). Abstract Perceived needs of patients should be taken into consideration before commencing orthodontic treatment to increase chances of mutually satisfying result for both the orthodontist and the patient. This pilot survey was conducted to determine the reasons and the factors which motivate patients to seek orthodontic treatment in Qassim region. A structured questionnaire was distributed to 5patients who were undergoing orthodontic treatment in 5 private clinics in 4 cities of Qassim region. 2 questionnaires were returned and analyzed. The desire to have a better appearance was cited by the majority of Materials and Methods patients as the main reason (86 %) for This pilot survey was conducted using a seeking orthodontic care.53% of the patients structured questionnaire (Figure 1). The sought the orthodontic care at their own questionnaire was already pre-tested and will. About 8% of the study subjects used in previous published studies (,11). expected that the orthodontic treatment will The structured questionnaire consisted of enhance their self-confidence and social two main parts. Part 1 consisted of five interaction. In conclusion, patients seek questions about patient's demographic data orthodontic treatment mainly to enhance including sex, age, social status, educational facial esthetics, self-confidence and social level and frequency of dental visits. Part 2 of acceptability. this questionnaire comprised of seven Key words: Orthodontic treatment, reasons. questions related to patient s dental

2 59 awareness, dental satisfaction, effects of dental anomalies, any teasing experience, person who noticed the presence of dental irregularities, main reasons for seeking orthodontic treatment and its expected outcomes. The questionnaire was distributed among 5 patients visiting 5 randomly selected private clinics out of a total number of 15 private clinics registered with the Ministry of Health in Burayda, Unayza, Al- Rass and Al-Badaye of Qassim region for orthodontic treatment from 1 st to 12 th January 12(Table I).2 filled questionnaires were returned giving a response rate of 98.5%. The data was analyzed using SPSS 16 program for descriptive statistics. Table I: No. of distributed & returned questionnaire in each clinic Clinic City No. of distributed questionnaires 1 Burayda Burayda 41 3 Unayza 41 4 Al-Rass Al- Badaye 41 No. of returned questionnaires Results A total of 2 completed questionnaires were included in the analysis. Results were analyzed for: 1. Demographic data of the patients. 2. The main reasons and factors which motivated patients to seek orthodontic treatment majority of the patients (52%) visited the dentists only when it was needed. Part 2- Reasons and motivating factors for seeking orthodontic treatment Most of patients (88%) were aware that they had dental irregularities (Table III).The majority of the patients ( %) assessed their dental appearance as bad. % of the patients mentioned that they had always been teased due to their dental irregularities. A significant percentage of patients (48%) stated that they themselves were the first ones to notice their dental anomalies while 35% of the respondents revealed that their dental problems were pointed out by their mothers. In case of only a few respondents (8%), dentists were the first ones who informed them about their dental anomalies. 48% of the study subjects sought orthodontic treatment at their will. Only 9% were referred by the dentists for orthodontic care (Figure 2). Most of the patients (82%) felt that their confidence would increase if their teeth were straightened, 79 %stated that their social life would be improved while 32 %believed that it would improve their career prospects (Figure 3). A great majority of patients (86%) considered the improvement of facial appearances the most important motivating factor for seeking orthodontic treatment. In case of 7% of respondent s treatment was sought to improve dental health, in 6% to enhance self-confidence and only in 1% to improve chewing and speech (Figure 4). Part 1- Patients Demographic data The majority of the patients who responded to the questionnaire (Table II) were females (53%) and adolescents aged years (67%).The mean age of the study subjects was 17 years. The proportions of unmarried people were 88% while 12% were married. Regarding the educational level of the patients, 3% were at primary school level, 15% at Intermediate school level, and 54% at secondary school level and27 % at university level. Only 14 % of the respondents visited their dentists regularly (every 6 months) and 34% reported to pay an annual visit while

3 Enhance Facial and dental Appearance Improve Dental Health Enhance Self-Confidence Improve Chewing And Speech *total response to all (no missing data)2. Table II: Demographic data of the study subjects (Part 1 - questions 1, 2, 3, 4, 5) DEMOGRAPHIC DATA NO.* % Gender Male Female 8 53 Age group 8-12 years years years > years Social status Unmarried Married % 55% career opportunities 79% 82% 13% 14% 7% 8% % social interaction confidence Educational level Primary 7 3 Frequency of dental attendance Intermediate Secondary 9 54 University when necessary only 4 52 once a year monthly *total response to all (no missing data) 2. Yes No Not Sure Figure 3: Areas of improvement expected by patients after orthodontic treatment (Part 2 - question 6) 16% 9% 53% 9% 13% % 7% 6% 1% Figure 2: person who suggested orthodontic treatment to 2 - question 5) the patient(part Table III: Factors motivating patients to seek orthodontic treatment (Part 2 - questions 1,2,3,4,5) FACTORS NO.* % Awareness of Yes dental anomalies No Assessment of Good own dental Average appearance Bad 122 Figure 4: The motivating factors for seeking orthodontic treatment (Part 2 - question 7) Teasing experience First person to notice patient's dental anomalies First person to suggest orthodontic treatment Always 2 Sometimes Never Self Mother 7 35 Father 6 3 Dentist 16 8 Other 13 6 The parents Relatives/friends 18 9 Self 8 53 Dentist 18 9 Others wearing appliances Discussion Some previous studies have shown the demand for orthodontic care to be

4 61 significantly higher in girls than that in boys (5,7). However the present study did not find any significant difference between males and females with regard to enhancement in the facial appearance as a reason for seeking orthodontic treatment. Ingervall & Hedegard (1974) found that awareness and desire to receive orthodontic treatment might vary with age (11). Shaw (1981) also stated that decrease in satisfaction with dental appearance is associated with increasing age (5).In the study under discussion, since the majority of patients were adolescents aged years, the high demand for enhancement in facial esthetics may be associated with the psychological changes experienced by teenagers. At this age adolescents are very much concerned about physical attractiveness to gain social acceptability. Therefore, the desire to have an improved facial appearance by orthodontic treatment was found to be high in the study group. Most of the patients in the present study reported to visit the dentists only when they were having some dental problem. This could be due to low dental awareness of the patients surveyed. It is interesting to note that Shaw (1981) in his study found that irregular routine dental attendance pattern was associated with more dissatisfaction with dental appearance thus leading to higher demand for orthodontic treatment (5).This may be the reason for having an almost equal proportion of regular and irregular dental attainders in the sample for the present study. In the present study most of the participants assessed their appearance as 'bad'. This may reflect their desire to improve their unaesthetic dental appearance via orthodontic treatment. This study found that most of the patients had been experiencing teasing by their fellow beings. This result agrees with the finding of the study by Shaw (5) who reported a high incidence of teasing experienced by the subjects in his sample. In relation to mirror viewing frequency, Shaw (5) found that the changing stage from a child to an adolescent would make an individual become more conscious of their appearance. His result is similar to the finding of the present survey where most patients themselves noticed their own dental anomalies for the first time. Dentists have been reported to be the largest source of referral for orthodontic treatment in the USA and the UK (6,3,12).On the contrary most of the patients surveyed in the study under discussion sought orthodontic treatment by themselves with only a few seeking treatment through the recommendation of dentists. The differences may be due to the irregular dental attendance pattern of Saudi patients. An improvement in social life and selfconfidence following orthodontic treatment was expected by most of the patients in the sample while an increase in career opportunities as a result of the treatment had been lower down the list of patients expectations. This may be due to the fact that most of the patients in this survey were adolescents, making it difficult for them to visualize the long term benefits of orthodontic treatment. This has also been a finding of some previous studies on adolescents showing that adolescents are mostly concerned about getting immediate gratification rather than looking for health gains in the long run (5). Positive changes in social life and self-confidence expected by the majority of respondents in the study as an outcome of orthodontic therapy has also been the finding of a study by Abdullah et al (1) that showed that the positive response to changes in career opportunities after orthodontic treatment was lower compared to social life and self-confidence (7). The results of the present study showed that improvement in facial and dental appearance was undoubtedly the most important motivating factor for seeking orthodontic treatment. This was consistent with the findings of Lew (1992) who also found the enhancement of dental appearance to be the most significant factor in seeking orthodontic care amongst a sample of Singaporean patients (4). Some other studies also reached the same conclusion (6,,13,15,16). Conclusions The study highlighted the need to consider patient s esthetic concerns in planning orthodontic treatment. The orthodontists have to maintain a balance between the perceived and normative orthodontic treatment needs in order to achieve a desirable outcome of orthodontic therapy.

5 62 Acknowledgements I would like to thank Prof. Abdelwahab Samaha, Professor of Pediatric Dentistry and Community dentistry, Qassim University, Saudi Arabia and Dr. Abdul Haleem Hameed, Assistant Professor, Community dentistry Qassim University, Saudi Arabia. References 1. R. Orthodontic in daily practice. Vienna, Hans Huber Publishers, Bern Stuttgatt 1961;pp. 64, Houston WJB, Stephens CD, Tulley WI. In a textbook of Orthodontics. 2nd Edition. Cambridge, Redwood Books 1993; pp Tayer BH, Burek MJ. A survey of adults' attitudes toward orthodontic therapy. Am J Orthod 1991; 79: Lew KK. Attitudes and perceptions of adults towards orthodontic treatment in an Asian community. Community Dent and Oral Epidemiol 1993; 21: Shaw WC. Factors influencing the desire for orthodontic treatment. Euro J Orthod 1981; 3: Gosney MBE. An investigation into some of the factors influencing the desire for orthodontic treatment. Br J Orthod 1986; 13: Abdullah A., Yassin Z., Zamzam N. Reasons for seeking orthodontic treatment: A pilot study. Annal Dent Univ Malaya 1;8: Bergstrom K, Halling A, Wilde B. Orthodontic care from the patients' perspective: Perceptions of 27- year olds. Euro J Orthod. 1998; : Jenkins PM., Feldman BS, Stirrups DR. The effect of social class and dental features on referrals for orthodontic advice and treatment. Br J Orthod 1984; Sheats RD, Gilbert GR, Wheeler TT, King GJ.Pilot study comparing parents' and third-grade schoolchildren's attitudes toward braces and perceived need for braces. Community Dent. of Oral Epidemiol 1995; 23: Ingervall B, Hedegard B. Awareness of malocclusion and desire of orthodontic treatment in 18-year old Swedish men. Acta Odontol Scand 1974; 32: Baldwin DC. Appearance and aesthetics in oral health. Community Dent and Oral Epidemiol 198; 8: Dorsey J, Korabik K. Social and psychological motivations for orthodontic treatment. Am J Orthod. 1977; 72: Breece GL, Nieberg LG. Motivations for adult orthodontic treatment. J Clin Orthod 1986; : Burden DJ. The influence of social class, genders and peers on the uptake of orthodontic treatment. Euro J Orthod. 1995; 17: Kilpelairen PV, Phillips C, Tullock JE Anterior tooth position and motivation for early treatment. Angle Orthod. 1993; 63:

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