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Factors influencing the decision about orthodontic treatment

A longitudinal study among 11-and 15-year-olds and their parents

Faktoren, die die Entscheidung über eine kieferorthopädische Behandlung beeinflussen

Eine Longitudinalstudie unter elf-und 15jährigen Patienten und ihren Eltern

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Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2.

A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered.

Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2.

The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need.

Zusammenfassung

Ziel dieser Studie war es, unter elf (T1) und 15 (T2) Jahre alten Kindern und deren Eltern die Einstellung gegenüber einer kieferorthopädischen Behandlung zu beurteilen, um eine Verteilung der Überweisungsraten und des Behandlungsbeginns darzustellen, die anhand eines Behandlungsbedarfsindexes zum Zeitpunkt T1 beurteilt wurden, und um die Faktoren zu erläutern, die eine Entscheidung für eine kieferorthopädische Behandlung im Zeitraum von T1 bis T2 beeinflussen.

Eine Gruppe von 359 Kindern und deren Eltern beantworteten getrennte Fragebögen zum Zeitpunkt T1, 293 Familien antworteten in einer Folgestudie vier Jahre später. An der klinischen Untersuchung nahmen 224 Kinder teil, dabei waren Kinder mit aktiver Behandlung ausgeschlossen. Die Untersuchungsmodelle wurden mit dem “Index of Orthodontic Treatment Need” (IOTN) beurteilt. Die mittlere Überweisungsrate lag bei 56% mit einer Variationsbreite von 40% bis 71% für die verschiedenen Zahnkliniken. Zum Zeitpunkt T2 hatten etwa 44% der Kinder die Behandlung bereits abgeschlossen oder unterzogen sich noch einer kieferorthopädischen Behandlung. Es wurden keine signifikanten Unterschiede in bezug auf das Geschlecht bei den überwiesenen und behandelten Kindern entdeckt.

Die Ästhetik war der am häufigsten genannte Grund für eine kieferorthopädische Versorgung. Im darauffolgenden Zeitraum sank in der unbehandelten Gruppe der Wunsch nach einer Behandlung. Die logistische Regressionsanalyse hat DHC-(Dental Health Component-)Grade als sicheren Vorhersagefaktor für einen Behandlungsbeginn ausgewählt, gefolgt von der Besorgnis der Eltern und ihrer Einstellung zu festsitzenden Apparaturen, während das Bewußtsein gegenüber einer kieferorthopädischen Behandlung, das die Elfjährigen selbst hatten, weniger signifikant war. Kinder der unbehandelten Gruppe mit später Entscheidung für eine Behandlung (zum Zeitpunkt T2) konnten am besten bei Veränderungen der “Aesthetic Component” (AC) des IOTN im Zeitraum von T1 bis T2 eingeschätzt werden.

Die Ergebnisse zeigen, daß Zahnärzte eine Schlüsselrolle bei der Bestimmung des kieferorthopädischen Behandlungsbedarfs spielen. Hohe Überweisungsraten halten das Risiko gering, einem Patienten die Behandlung vorzuenthalten. Dabei könnte der Behandlungswunsch vom Kieferorthopäden gelenkt sein. Der individuelle Unterschied bezüglich der Einstellung und des Behandlungswunsches beeinflußt jedoch den Behandlungsbeginn auch bei den Kindern, die einen großen Behandlungsbedarf haben.

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Authors and Affiliations

  1. Department of Orthodontics and Facial Orthopedics, University of Bergen, Årstadveien 17, N-5009, Bergen

    Kari Birkeland, Astrid Katle, Stina Løvgreen, Olav E. Bøe & Per Johan Wisth

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  1. Kari Birkeland
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  2. Astrid Katle
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  3. Stina Løvgreen
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  4. Olav E. Bøe
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  5. Per Johan Wisth
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Correspondence to Kari Birkeland.

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Translation of manuscript into German: Dr. E. Hösl and Dr. P. Rettig.

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Birkeland, K., Katle, A., Løvgreen, S. et al. Factors influencing the decision about orthodontic treatment. J Orofac Orthop/Fortschr Kieferorthop 60, 292–307 (1999). https://doi.org/10.1007/BF01301243

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  • DOI: https://doi.org/10.1007/BF01301243

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