Clinical status in adolescents: is its impact on oral health-related quality of life influenced by psychological characteristics?

The objective of this study was to examine, using structural equation modelling, the relationships among clinical characteristics (such as caries experience and malocclusion), oral health-related quality of life (OHRQoL), and psychological characteristics (mental health, self-esteem, somatisation, and social perception of body image) in adolescents in New Zealand. Adolescents were examined for malocclusion using the Dental Aesthetic Index (DAI) and for dental caries. Among the 353 (58.8%) 12- and 13-yr-old adolescents who took part in this cross-sectional study, the overall mean ± SD decayed, missing, or filled surfaces (DMFS) value was 1.6 ± 3.0, with slightly more than 50% of being caries-free; the mean ± SD DAI was 31.5 ± 7.6, with one-quarter of subjects having a 'handicapping' malocclusion. The structural equation modelling analysis showed that the structural model was a good fit to the data. As hypothesized, the DAI score significantly predicted OHRQoL. There was no direct relationship between caries experience (DMFS) and OHRQoL, but there was an indirect effect of DMFS on OHRQoL mediated through psychological characteristics. The amount of OHRQoL variance accounted for in the model was substantial, at 62%. It appears that investigating OHRQoL in adolescents is not straightforward; while malocclusion directly affects OHRQoL, the influence of dental caries experience is less direct.

Factors influencing adolescents' oral health-related quality of life (OHRQoL).

BACKGROUND: OHRQoL comprises an apparently complex array of biological and psychological aspects of oral health. AIM: To determine the relative contribution of sociodemographic, psychosocial, or clinical characteristics to OHRQoL in adolescents. DESIGN: A cross-sectional study of Dunedin adolescents was carried out. Each participant completed a self-administered questionnaire and underwent a clinical examination. Information collected included sociodemographic characteristics (sex, ethnicity, and household deprivation), psychosocial characteristics (self-esteem, psychological well-being, somatisation, and self-perception scores for body image), and clinical measures (DMFS and Dental Aesthetic Index). OHRQoL was measured using the 16-item impact short-form CPQ11₋14 questionnaire. Linear regression analyses used the CPQ11₋14 as the dependent variable, with independent variables entered in related groups. RESULTS: Three hundred and fifty-three children (48.4% females) took part, representing a 58.8% response rate. Linear regression modelling of the CPQ11₋14 score showed that sociodemographic characteristics were predictors, but the model's overall explanatory power was low (R(2) = 0.05). This increased slightly with inclusion of the clinical variables. When the psychosocial variables were added, however, the R(2) increased to 0.50; all psychosocial variables (except self-esteem) were strongly associated with the CPQ11₋14 score. Psychological well-being was the strongest predictor. CONCLUSION: Psychosocial characteristics are important contributors to OHRQoL in adolescents and appear to be more important than sociodemographic or clinical characteristics.

Psychological aspects of orthodontics in clinical practice. Part two: general psychosocial wellbeing.

Orthodontists tend to treat/see their patients on a systematic, recurrent basis, often during crucial stages of psychological development. Therefore, they have a pivotal role in identifying a number of psychological as well as of psychiatric disorders. Effective communication is crucial and unfortunately, it is often underestimated in a busy clinical practice. Aim of part two of this article it to review the role clinical orthodontics and the orthodontist-patient relationship have on the patients' psychosocial wellbeing, including effects on self-esteem, bullying and harassment by peers, and even several psychiatric disorders, such as anorexia/bulimia nervosa, and attention deficit hyperactivity disorders. Due to the complexity and importance of these issues, the orthodontist may play a dynamic role, not only in the management of dental malocclusions, but at times, as "psychologist" and a counselor to the patient.

Psychological aspects of orthodontics in clinical practice. Part one: treatment-specific variables.

The orthodontist-patient relationship may have a significant impact on treatment outcome and patient satisfaction, thus improving the overall quality of care. Effective communication is crucial and unfortunately, it is often underestimated in a busy clinical practice. Aim of part one of this article is to review the psychological aspects that are relevant to a number of treatment variables in clinical orthodontics, including compliance with treatment, oral hygiene, management of orthodontic pain and discomfort, and oral habits. Due to the complex nature of the psychology of orthodontic treatment, it is difficult to determine the extent of the influence that the orthodontist-patient relationship may have on these variables, with effective communication and an awareness of the psychological issues playing an important role in enhancing the orthodontist-patient relationship.