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Objective: To evaluate whether orthodontic treatment in adults requiring oral rehabilitation is effective for increasing patients' self-esteem and quality of life (QoL). Materials and methods: The sample consisted of 102 adult patients (77 women and 25 men) aged between 18 and 66 years (mean, 35.1 years) requiring oral rehabilitation and orthodontic treatment simultaneously. Rosenberg's Self-Esteem (RSE) Scale and a questionnaire about QoL based on the Oral Health Impact Profile (OHIP-14) were used to determine self-esteem and QoL scores retrospectively. Questionnaires were carried out in two stages, T1 (start of treatment) and T2 (6 months after). To compare score changes between T1 and T2, the data obtained from the RSE Scale were evaluated with paired t tests, and data from the quality-of-life questionnaire were assessed by applying descriptive statistics. Results: The results showed a statistically significant increase in self-esteem (P < .001) and a great improvement on patients' QoL. Conclusions: Orthodontic treatment causes a significant increase in self-esteem and QoL, providing psychological benefits for adult patients in need of oral rehabilitation.
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Original Article
Impact of orthodontic treatment on self-esteem and quality of life
of adult patients requiring oral rehabilitation
Vanessa de Couto Nascimento
a
; Ana Cla´udia de Castro Ferreira Conti
b
; Maurı
´cio de Almeida
Cardoso
b
; Danilo Pinelli Valarelli
b
; Renata Rodrigues de Almeida-Pedrin
b
ABSTRACT
Objective: To evaluate whether orthodontic treatment in adults requiring oral rehabilitation is
effective for increasing patients’ self-esteem and quality of life (QoL).
Materials and Methods: The sample consisted of 102 adult patients (77 women and 25 men)
aged between 18 and 66 years (mean, 35.1 years) requiring oral rehabilitation and orthodontic
treatment simultaneously. Rosenberg’s Self-Esteem (RSE) Scale and a questionnaire about QoL
based on the Oral Health Impact Profile (OHIP-14) were used to determine self-esteem and QoL
scores retrospectively. Questionnaires were carried out in two stages, T1 (start of treatment) and
T2 (6 months after). To compare score changes between T1 and T2, the data obtained from the
RSE Scale were evaluated with paired ttests, and data from the quality-of-life questionnaire were
assessed by applying descriptive statistics.
Results: The results showed a statistically significant increase in self-esteem (P,.001) and
a great improvement on patients’ QoL.
Conclusions: Orthodontic treatment causes a significant increase in self-esteem and QoL,
providing psychological benefits for adult patients in need of oral rehabilitation. (Angle Orthod.
2016;88:1–7.)
KEY WORDS: Adult; Self-esteem; Orthodontics; Quality of life; Oral rehabilitation
INTRODUCTION
There is an increasingly tendency nowadays for adult
patients to seek orthodontic treatment,
1–12
especially
those needing oral rehabilitation. Esthetics are important
in people’s lives, and facial appearance has a profound
influence on personal attractiveness and self-esteem
because it affects health and reverberates in social,
affective, and professional relationships.
2–4,6,10,12–18
Adult treatment demands an interdisciplinary ap-
proach,
1,2,4,7
since periodontal disease increases with
age,
5
and tooth and bone loss cause migration of
teeth and malocclusion. Periodontology prevents tissue
damage, and orthodontics improves tooth position,
promotes hygiene conditions and improves bone in-
sertion.
1,5
Thus, it is evident that an interdisciplinary
interaction plays an important role in patients’ quality of
life and self-esteem, especially in oral rehabilita-
tion.
1,2,4,7,11,19
Severe malocclusion involving the anterior teeth
exerts both emotionally and psychosocially negative
effects on patients’ lives.
3,9,13,15
In addition, their
perception of the malocclusion is often different from
that of the orthodontist. It is common that patients
present with high levels of concern for visible problems,
but tolerate a less noticeable but more severe
problem.
6,15,17,20
Considering treatment time as one of
the main concerns of adult patients, solving patients’
complains with an individualized approach, limiting the
treatment to a functional correction and therefore
reducing treatment time, should be the focus of
orthodontic treatment.
1,2,4,6,9,10,20
Some studies
3,4,6,8,11–23
performed to collect evidence
about the psychosocial profile of people seeking
orthodontic treatment suggest that dentofacial prob-
lems can affect peoples’ well-being. The gap in the
literature concerning this subject, as this treatment
may affect patients in need of rehabilitation because it
a
MSc Student, Department of Orthodontics, Institute of
Dentistry, Sagrado Corac¸a˜ o University, Bauru, SP, Brazil.
b
Professor, Department of Orthodontics, Institute of Dentistry,
Sagrado Corac¸a˜ o University, Bauru, SP, Brazil.
Corresponding author: Dr Vanessa de Couto Nascimento,
Department of Orthodontics, Institute of Dentistry, 10-50 Irma˜
Arminda Street, Cep: 17.011-160, Bauru-SP, Brazil
(e-mail: vanessacouto3009@gmail.com)
Accepted: December 2015. Submitted: July 2015.
Published Online: February 22, 2016
G2016 by The EH Angle Education and Research Foundation,
Inc.
DOI: 10.2319/072215-496.1 1 Angle Orthodontist, Vol 88, No 4, 2016
usually has its esthetic and compromised function,
stimulated the development of this study.
The objective of this study was to determine whether
orthodontic treatment in adults requiring oral rehabil-
itation is effective in enhancing patients’ self-esteem
and quality of life.
MATERIALS AND METHODS
This cross-sectional and prospective study was
based on patients’ answers to questions on assisted
self-report forms. The ethics-in-research committee of
Sagrado Corac¸a˜ o University approved all procedures
in this study.
Samples were selected from an orthodontic post-
graduate program, a specialization course, and a pri-
vate practice. Inclusion criteria were patients with
a minimum age of 18 presenting with malocclusion
requiring oral rehabilitation associated with orthodontic
treatment. Patients with craniofacial syndromes, neu-
rological or psychiatric disorders, or a history of
previous orthognathic surgery were excluded.
The sample size was calculated by adopting
a variation of dichotomous answers from T1 to T2,
with a minimum mean difference to be detected of 20
(percentage points), a significance level of 5%, and
power of 80%. Sample-size calculation required
a minimum of 97 patients.
Initially, 130 patients with fixed appliances presenting
with malocclusions caused by dental losses and
agenesis in T1 were selected for the study. Three patients
refused to participate in the study and 25 patients did
not answer the questionnaires in T2, thus were
excluded from the sample. The final sample consisted
of 102 adult patients: 77 women (75.5%) and 25 men
(24.5%) between 18 and 66 years of age (Table 1).
Patients agreed to participate in this research by
signing a written informed consent, and after a brief
explanation of the questionnaires, completed Rosen-
berg’s Self-Esteem (RSE) Scale and The Oral Health
Impact Profile-14 (OHIP-14) questionnaire. Both ques-
tionnaires were applied during two stages: T1—early
orthodontic treatment (1–3 months of treatment) and
T2—after leveling and alignment phase (minimum of
8 months of treatment); the minimum interval from T1
to T2 was 6 months.
To evaluate self-esteem, the RSE questionnaire
(Figure 1) had been previously validated and adapted
to patients’ conditions.
24
This scale comprises
10 questions; 5 are related to positive opinions and
5 to negative opinions, being interspersed to increase
reliability of the questionnaire. For each question, a
Likert Scale, consisting of four points (strongly agree,
agree, disagree, strongly disagree), was applied in
order to provide adequate weight to the responses.
Scores range from 0 to 3, where zero represents the
highest level of self-esteem and 3 the lowest (Table 2);
the lower the scores, the higher the patients’ self-
esteem. This method proved to be a reliable method to
measure self-esteem not only in the general population
but also in orthodontic patients.
15
The applied questionnaire for quality of life assess-
ment (Figures 2 and 3) was an adapted version of the
OHIP-14.
25
Modifications were made so that it would be
more effective in measuring the quality of life related
to orthodontic treatment. Thus, it was composed of
14 questions that were applied in T1 and T2 and 3 more
added to the T2 stage to answer any doubts of the
orthodontists regarding discomfort from the appliance
and satisfaction with the treatment outcomes, which
need no comparison. Another modification was di-
rected to the response scheme, whereas the gradation
system would not be sensitive to a two-stage modality.
Finally, for better adaptation of this questionnaire, the
researcher was advised by a psychologist with expe-
rience in this research protocol.
Statistical analysis was performed using Statistica
software version 12 (StatSoft Inc, Tulsa, Okla). Paired
ttests were used to compare the score changes from
T1 to T2 in the RSE questionnaire. Descriptive
statistics were used to assess the QoL-questionnaire
scores. The results are described in the tables, using
absolute frequency (n) and relative frequency (%), in
addition to the mean and standard deviation parame-
ters. The significance level was 5% (P,.05).
RESULTS
Results of the RSE questionnaire demonstrated a sta-
tistically significant improvement in self-esteem level from
T1 to T2 (Table 3). In total, 70.6% of patients showed self-
esteem improvement, 12.7% were unaltered, and self-
esteem worsened in only 16.7% (Table 4).
Table 1. Sample Distribution Regarding Age (Years)
Mean SD Minimum Maximum
T1 34.8 12.7 18 65
T2 35.1 12.8 18 66
Table 2. Calculation of Rosenberg’s Self-Esteem Scale Scores
Answers Scores
Questions 1, 3, 4, 7, & 10
Strongly agree 0
Agree 1
Disagree 2
Strongly disagree 3
Questions 2, 5, 6, 8, & 9
Strongly agree 3
Agree 2
Disagree 1
Strongly disagree 0
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Results of the QoL questionnaire were similar to
those of the RSE Scale and demonstrated an
increased QoL level. Only for those patients who had
answered yes in T1, questions 1 to 6 were separated
and applied again in T2 (Table 5). Among the patients
who had trouble speaking (question 1), 85% reported
an improvement. One hundred percent of the patients
who had alignment problems (question 2) and 76% of
those who had bruxism (question 3) also reported
improvement. Considering the patients who had
suffered from headaches (question 4), 71.8% reported
improvement as well. In addition, 86.5% of the patients
who felt uncomfortable when eating (question 5) and
80% of those presenting with impaired mastication
(question 6) reported improvement (Table 5).
Concerns related to oral hygiene (question 7)
increased from 78.4% to 98%. The percentage of
Figure 1. Rosenberg’s Self-Esteem Scale.
Table 4. Frequency of Sample Score Variation in RSE
Questionnaire: Improved (Scores Decreased From T1 to T2) or
Worsened (Scores Increased From T1 to T2)
Variation in RSE N %
Improved 72 70.6
Maintained 13 12.7
Worsened 17 16.7
Total 102 100.0
Table 3. Paired TTests Comparing the Average Score in T1 and
T2 for Rosenberg’s Self-Esteem (RSE) Scale Questionnaire
Score
T1 T2
Dif. PMean SD Mean SD
RSE 7.72 4.11 5.41 3.54 22.30 ,.001*
* Statistically significant difference (P,.05).
IMPACT OF ORTHODONTIC TREATMENT ON ADULT PATIENTS 3
Angle Orthodontist, Vol 88, No 4, 2016
patients satisfied with their faces (question 8) in-
creased from 38.2% to 77.5%. In addition, the number
satisfied with their smiles (question 9) increased from
14.7% to 97.1%. Specific issues related to self-esteem
increased from 56.9% to 97.1% and regarding self-
confidence from 60.8% to 96.1% (questions 10 and 11,
respectively).
Only for those patients who had responded no in T1
did we separate questions 12 to 14 and apply them
again in T2 (Table 6). Among those who had problems
with social acceptance (question 12), 81.8% reported
an improvement in this issue and, similarly, 80% of
those who reported difficulties in social relationships
and emotional well-being (question 13) demonstrated
a noticeable improvement. When asked whether
people liked their smile (question 14), 96.8% reported
improvement; only 3.2% did not know about other
people’s opinion, and there were no reports of disliking
their smiles (Table 6).
When patients were asked if they would undergo
treatment again, 96.1% said yes; no, 1%; and 2.9%
could not decide. It was interesting to note that 100%
of patients recommended the treatment to adult
patients. Finally, 35.3% of the patients reported
considerable discomfort while using the appliances
(Table 7).
DISCUSSION
The increase in demand for orthodontic treatment in
adults is justified, especially by the increasing pre-
ventive perspective of modern dentistry, esthetic
appeal of society, longevity, increased access to
information, technological advances of orthodontics,
and psychosocial variations.
1,2,4,6–19,22
Moreover, the
perception of malocclusion differs between profes-
sionals and patients.
23
Some people with severe
malocclusion do not report a negative impact, while
others with mild irregularities cited major impacts on
Figure 2. QoL questionnaire at T1 (orthodontic treatment beginning).
Table 5. Quality of Life Questionnaire Descriptive Statistics on T2 (Patients Who Answered Yes on Questions 1 to 6 in T1)
Improvement From T1 to T2:
T2
Yes, % No, % Do Not Know, %
1. Difficulties when speaking (n 527) 85.2 14.8 0.0
2. Teeth alignment problems (n 596) 100.0 0.0 0.0
3. Bruxism (n 525) 76.0 20.0 4.0
4. Headaches (n 539) 71.8 20.5 7.7
5. Discomfort when eating (n 537) 86.5 13.5 0.0
6. Impaired mastication (n 55) 80.0 20.0 0.0
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their QoL.
20
Esthetic reasons alone justify treatment,
not only because it almost always results in a better
patient self-image,
23
but also because patients value
esthetic and psychological benefits more than func-
tional and dental health improvements.
13,16
Women are more concerned with beauty and have
a better perception of treatment need as well as
esthetic results.
1,4,9,11,12,14,22
This fact explains why,
even in random samples such as in our study, there
is a prevalence of females.
4,6,9,11,14,18,21,22,26
Figure 3. QoL questionnaire at T2 (after leveling and alignment phase).
Table 6. Quality of Life Questionnaire Descriptive Statistics on T2 (Patients Who Answered No on Questions 12 to 14 in T1)
Improvement From T1 to T2
T2
Yes, % No, % Do Not Know, %
12. Good social acceptance (n 511) 81.8 18.2 0.0
13. Emotional well-being, good relationship with friends and others (n 55) 80.0 20.0 0.0
14. Do the people surrounding you (work partners, relatives, friends) like your smile? (n 531) 96.8 0.0 3.2
IMPACT OF ORTHODONTIC TREATMENT ON ADULT PATIENTS 5
Angle Orthodontist, Vol 88, No 4, 2016
In this study, it was found, by assessing the RSE
questionnaire, that 70.6% of patients showed improve-
ment in self-esteem, 12.7% were unaltered, and self-
esteem worsened only in 16.7%. Therefore, there was
a statistically significant difference in the self-esteem
level of individuals, which improved from 7.72 at T1 to
5.41 at T2 (P,.001). At the end of treatment, this
trend should increase even more, since patients
posttreatment usually have higher self-esteem than
during treatment or pretreatment.
22
Another cross-
sectional study assessed the effect of improvement
after therapy in the long-term (6 months to 10 years)
and stated that these benefits seem to be long-
lasting.
20
In order to assess more clearly the impact of
treatment on a patient’s QoL, only for those patients
who had answered yes in T1, we separated questions
1 to 6 and applied them again in T2. The patients
whose answers were positive are considered the focus
of this study. Among the 26.5% of patients who had
trouble speaking, 85.2% reported an improvement. All
patients who had alignment problems (94.1%) and
76% of those who had bruxism (24.5%) also reported
improvements. Considering the patients who had
suffered from headaches (38.2%), 71.8% reported
improvement as well. In addition, 86.5% of the patients
who felt uncomfortable when eating (36.3%) and 80%
of the patients who presented with impaired mastica-
tion (4.9%) reported improvement. At the end of
treatment, the percentage of patients who reported
improvement in masticating would probably increase,
as reported in another study.
14
Health and body care are also considered quality-
of-life issues. This could justify the increasing concern
in oral hygiene from 78.4% to 98% of sample patients.
The number of patients satisfied with their faces
increased considerably, from 38.2% to 77.5%. Even
though orthodontic treatment not always privileges the
face, this great improvement seems to be related to
the better QoL reported by patients. Furthermore, the
number of patients satisfied with their own smile
increased, from 14.7% to 97.1%.
Regarding the specific issues of self-esteem and
self-confidence, there was also a significant improve-
ment with increased percentage of 56.9% to 97.1% for
self-esteem and from 60.8% to 96.1% for self-
confidence. These results show that self-esteem,
social well-being, and QoL are closely related.
11,15
Since the perception of facial appearance can affect
health, social behavior, and happiness of the in-
dividual, it is safe to say that people with well-balanced
smiles are considered more intelligent and have
a greater chance of being employed.
6,17
In order to
observe more clearly the impact of these character-
istics, we considered only patients who said no in T1 to
questions 12 to 14 in the QoL questionnaire to be the
focus of this research, because others have reported
positive aspects. Of the 10.8% who originally said they
did not have good social acceptance, 81.8% reported
improvement; of the 4.9% who said they did not have
a good relationship with people, 80% reported im-
provement in their relationships.
When patients were asked about others’ perception
of their smile, 96.8% reported improvement, only 3.2%
reported not knowing people’s opinions, and no patient
reported others’ not liking his or her smile.
Several patients reported that they usually sought
information about orthodontic treatment from other
patients, which emphasized the latter’s important role
in adult patient referrals.
22
In another survey, 100% of
patients would undergo treatment again if necessary
and, based on their personal experience, would
encourage other adults to undergo treatment as well.
11
In this study, the results were similar, wherein 96.1% of
the patients said they would undergo orthodontic
treatment again if necessary, 1% would not, and
2.9% could not provide this information. It is notewor-
thy that all patients would recommend the treatment to
other adults with similar problems. Thus, orthodontists
should target this group, which is able to refer new
patients for treatment.
The patients’ chief complaint during orthodontic
treatment was oral pain,
11,12,14
especially in the first 3
months, generating a negative impact on the overall
QoL, then improving subsequently, although a signifi-
cant improvement in self-esteem was reported.
6
This
information is useful in motivating patients during the
adjustment period and encouraging them to finish
treatment, considering that their expectations will
probably be fulfilled.
6
Corroborating those authors,
35.3% of patients in this study felt uncomfortable while
using the appliances. The responses suggest that
esthetic improvement generates a significant increase
in QoL of adult patients,
4,20
corroborating a systematic
review stating that there is a modest association
between malocclusion, orthodontic treatment need,
and QoL.
16
Table 7. Orthodontic Treatment Perception After Leveling and Alignment Phase
Question Yes, % No, % Do Not Know, %
Would you undergo treatment again if necessary? 96.1 1.0 2.9
Would you recommend orthodontic treatment for other adults with the same problems? 100.0
Did you feel very uncomfortable when using the appliances? 35.3 64.7
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Even considering the significant sample size, these
results should be analyzed with caution because the
sample was selected in a specific area of the country.
Therefore, it is important to conduct future studies
involving more patients from different areas in de-
veloping countries such as Brazil.
Among the important features of this study were the
significant sample size, the collection of data from
a postgraduate program and a private practice, the
assistance of a single researcher, a sample comprising
only patients needing rehabilitation, and a QoL ques-
tionnaire specifically adapted for orthodontic patients.
Moreover, the large variation in patients’ ages (43
young adults at 18–30 years, 55 adults at 31–59 years,
and 4 adults aged over 60), made this study reliable
because it covered all age groups.
CONCLUSIONS
NOrthodontic treatment causes a significant increase
in patients’ self-esteem and QoL.
NThe psychological benefits for adult patients in need
of oral rehabilitation may occur because of the
motivation obtained by the improved occlusion and
smile esthetics.
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... Since a flawless appearance is today associated with better social and professional opportunities and increased self-confidence, more and more adults place high expectations on the abilities of orthodontists [4][5][6]. The treatment of this patient group in particular is proving to be highly demanding, often requiring interdisciplinary cooperation with periodontists, restorative dentists, implantologists, and maxillofacial surgeons. ...
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Objectives The aim of this systematic review was to examine the literature on aggressive and chronic periodontitis and orthodontics to clarify the therapy-relevant aspects of orthodontic treatment with altered biomechanics in periodontally compromised dentition. Materials and methods Literature searches were conducted in the electronic databases “PubMed” and “DIMDI” using the keywords “aggressive periodontitis AND ortho*,” “aggressive periodontitis AND orthodontics,” “chronic periodontitis AND ortho*,” and “chronic periodontitis AND orthodontics” for the publication period from January 1990 to July 2022. In addition, a manual search was carried out in the selected trade journals “Community Dental Health,” “European Journal of Oral Sciences,” and “Parodontologie.” Human clinical trials were included, whereas animal experimental studies, case reports, and reviews were generally excluded. The appropriate studies were selected, and the relevant data was tabulated according to different parameters, regarding the study design, the study structure, and the conduct of the study. Results A total of 1067 articles were found in the preliminary electronic search. The manual search and review of all related bibliographies resulted in an additional 1591 hits. After the first screening, 43 articles were classified as potentially relevant and reviewed in their original form. After the suitability test, 5 studies with a total of 366 participants were included in the final evaluation. These included one randomized controlled trial and four low-evidence intervention studies. The studies were conducted in two university hospitals and three private practices. All participants underwent scaling and root plaining and periodontal surgery before the orthodontic treatment started. Mean probing pocket depth reduction before and after the interdisciplinary treatment was analyzed in all the included studies; mean difference in clinical attachment level in four of the studies was also included. All participants were enrolled in a continuous recall system. In all studies, orthodontic therapy in periodontally compromised patients improved function and esthetics, resulting in lower probing depths and clinical attachment gains. Conclusions Orthodontic treatment can be used for patients with reduced periodontal support to stabilize clinical findings and improve function and esthetics. The prerequisite for this is a profound knowledge of altered biomechanics and an adapted interdisciplinary treatment approach. Due to the large heterogeneity of the included studies and their limited methodological quality, the results obtained in this review must be considered critically. Further randomized controlled long-term studies with comparable study designs are necessary to obtain reliable and reproducible treatment results. Clinical relevance Patients with periodontal impairment can be successfully treated with orthodontics as part of interdisciplinary therapy. Orthodontic treatment has no negative impact on the periodontium; if minimal, controlled forces are used under non-inflammatory conditions.
... It is widely acknowledged that orthodontic treatment of malocclusions improves self-esteem and emotional and social well-being, enhancing the quality of life in children, adolescents, 36 and adults. 37 However, treatments using premolar extractions might result in a reduced possibility to enhance the width and perimeter of the upper arch, causing instead its shortening and narrowing. 38,39 Premolar extractions can also change the inclination and position of the dental guidance, which may have an influence on the kinematics of mandibular movements at large. ...
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Objectives The practice of premolar extraction in orthodontics is controversial for its potential detrimental effects on the stomatognathic system. However, the ways in which premolar extraction affects mandibular function are still poorly understood. The purpose of this study was to assess the influence of premolar extraction on mandibular kinematics by evaluating axiographic tracings. Materials and Methods Forty-five orthodontically treated patients with premolar teeth extraction were compared with 45 paired untreated controls, selected for the absence of malocclusions. Systematic three-dimensional axiographic recordings of the mandibular movements were performed for protrusive–retrusive movements and speech. The transversal deviations and length of the movements were recorded for both sides along with the rotation angle during speech. Statistical Analysis Differences between the axiographic variables were analyzed via the permutation test and Wilcoxon rank-sum test. Linear regression was performed to test whether axiographic parameters were predictive of group affiliation. Dot plots were used to explore the distribution of each of the axiographic outcomes, and isometric principal component analysis to assess the differences between the cumulative effects of premolar extraction on jaw motion. Results The mandibular lateral translation in protrusion–retrusion and speech, the amount of rotation as well as the length of mandibular movements during speech were significantly higher in the treated subjects than in the controls, while retral stability did not differ. The linear regression yielded significant results for the mandibular lateral translation in protrusion–retrusion. The isometric principal component analysis showed higher values of the axiographic variables for 11 out of 45 individuals in the study sample compared with the control group. Conclusions Premolar extraction altered mandibular kinematics in at least 25% of the cases within our sample, and the transversal discrepancy between protrusive and retrusive tracings was even predictive of group affiliation. These results support the notion that the routine practice of premolar extraction as part of the orthodontic treatment should be discouraged. It is compelling to perform further studies to assess whether a disrupted kinematics of the mandible is associated to temporomandibular disorders.
... [15][16][17][18][19] However, self-esteem has not been the subject of research as often as the QoL, especially concerning oral health. While Chin and Chan [20] reported that participants with higher self-esteem had better clinical oral health status, de Couto Nascimento et al. [21] reported that dental treatment enhanced patients' self-esteem. ...
Article
Aim: The aim of this study is to assess the effect of periodontal disease on self-esteem and oral health-related quality of life (OHRQoL) in women. Materials and methods: A cross-sectional study was conducted among 522 women (mean age - 38.92 ± 14.3 years). Oral hygiene status, plaque level, gingival inflammation, probing depth, and periodontal status were assessed. The self-esteem was assessed using a Rosenberg Self-esteem Scale, and the OHRQoL was measured using a 14-item oral health impact profile (OHIP-14) questionnaire. Results: Younger, employed women with higher income had significantly better OHRQoL and self-esteem. Women with healthy periodontium had better OHRQoL. Probing depth and community periodontal index scores were found to have a significant positive correlation with most of the sub-scale items and total OHIP-14 score in women with low self-esteem. Women with good OHRQoL and normal self-esteem were seen to be maintaining significantly better oral hygiene. No such statistically significant difference was observed in women with low self-esteem. Multiple regression analysis for the prediction of OHIP-14 score indicated that the best model included probing depth as the only statistically significant predictor (P = 0.002). Conclusion: Periodontal disease has a significant negative impact on self-esteem and OHRQoL in women.
... impairment, higher susceptibility to traumatic dental injuries, periodontal disease, and dental caries (Navabi et al., 2012;Thomson & Broder, 2018). Thus, the demand for fixed orthodontic treatment has recently increased, particularly among the adult population, to overcome such problems (de Couto Nascimento et al., 2016;Gao et al., 2021;Johal et al., 2015). Elimination of psychosocial problems has been mentioned as the main reason behind the increased demand for orthodontic treatment (Gatto et al., 2019). ...
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Objective: The eating problems and changes in the diet and dietary intake of patients under orthodontic treatment are of great importance, and the available studies on this topic are mostly qualitative. Thus, this study aimed to assess the oral health-related quality of life (OHRQoL) and the eating-related quality of life (ERQoL) of patients under fixed orthodontic treatment. Materials and methods: This prospective study evaluated 105 patients (65 males, 40 females) with a mean age of 26 ± 1.1 years, who required fixed orthodontic treatment. All participants filled out the Oral Health Impact Profile-14 (OHIP-14) questionnaire before treatment (T0), and at 1 (T1), 3 (T2), and 6 (T3) months after treatment, and the ERQoL questionnaire at 1 (T1), 3 (T2), and 6 (T3) months after treatment. Data were analyzed using repeated measures analysis of variance with Greenhouse-Geisser and Huynh-Feldt corrections and Bonferroni test for pairwise comparisons (α = .05). Results: The OHIP-14 total score increased at T1 and decreased at T2 and T3, with significant differences between all four time points (p < .001). The ERQoL total score decreased over time, and significant differences were noted between all three time points (p < .001). No significant difference existed in OHRQoL or ERQoL with regard to gender at any time point (p > .05). Conclusion: The reduction in OHRQoL due to fixed orthodontic treatment was temporary and improved over time. The eating problems also decreased with time.
... While experiencing a reduction of facial self-perception, patients generally develop higher levels of anxiety, depression, and social isolation [4,5]. It is of great significance for orthodontists to take these psychological problems into account because patients with high levels of psychological distress might tend to overrate the pain they have experienced, exhibit more negative emotions, be averse to follow-up treatment, and be dissatisfied with the treatment effects [1,6,7]. Therefore, evaluation of patients' psychological status can enable orthodontists to identify potential problems and avoid medical disputes at an early stage [8]. ...
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Purpose: To explore the relationship between craniomaxillofacial features and psychological distress among adult pretreatment orthodontic patients. Methods: A group of 190 patients (95 males and 95 females) was included. Questionnaires including the Kessler psychological distress scale (K10) were sent to patients, and cephalograms were collected. Patients were divided into two groups according to K10 score: psychological distress group (score ≥ 20) and no psychological distress group (score < 20). Nineteen hard tissue and thirteen soft tissue parameters were traced on cephalograms to characterize the craniomaxillofacial features. Results: There was no significant difference in gender or age distribution between the two groups. Male patients with psychological distress showed statistically significantly larger anterior facial height (AFH) (126.62 mm vs. 120.97 mm), upper lip length (25.11 mm vs. 23.26 mm), and smaller overbite (1.21 mm vs. 2.75 mm) than patients without psychological distress. Male patients with hyperdivergent pattern and open bite were more likely to have psychological distress. None of the parameters showed statistical differences across groups in females. Frankfort-mandibular plane angle (r = 0.235), Bjork's sum (r = 0.311), AFH (r = 0.322), overbite (r = -0.238), AFH/posterior facial height (r = 0.251), and upper anterior facial height (UAFH)/lower anterior facial height (LAFH) (r = -0.230) were correlated with K10 score in males. After adjusting gender and age, the AFH (B = 0.147) and UAFH/LAFH (B = -14.923) were significantly related with the K10 score. Conclusion: Psychological distress was mainly correlated with hyperdivergent pattern, open bite, and larger lower anterior facial height proportion in pretreatment orthodontic patients. Orthodontists should be aware of the possible underlying psychological distress in patients with specific craniomaxillofacial features. Clinical assessment of psychological distress may need to take into account gender differences in patients.
... Orthodontic treatment offers several benefits, such as improvement in facial esthetics; oral functional efficiency; and an overall enhancement of individuals' self-esteem, selfconfidence, and work performance. 1 Beyond the discomfort caused by brackets, arch wires, and auxiliary springs, mild to moderate pain is also experienced after separators are placed and after every activation. 2 Patients are instructed to avoid or reduce consumption of hard, sticky, and fibrous foods to avoid breakage of the appliance and prevent dental caries, and for ease of maintenance of better oral hygiene. As a result of these protocols, both parents and patients complain about food restrictions and are apprehensive about weight loss during orthodontic treatment, thus potentially affecting patient compliance. ...
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Objectives During orthodontic treatment, patients are often apprehensive about reduced food intake and loss of body weight. Body mass index (BMI) assessment is an inexpensive, easy method for screening and studying changes in weight categories. This research aimed to determine whether long-term changes in BMI, self-esteem, and food habits occur in patients during the first year of orthodontic treatment. Methods BMI was calculated for 120 patients undergoing orthodontic treatment. Data were collected at baseline, and after the end of the first, second, third, sixth, and twelfth months. Rosenberg's self-esteem scale was used for scoring self-esteem. The Food Habit Assessment Scale was used to study changes in eating habits. Statistical analysis was performed with repeated measures ANOVA followed by Tukey HSD post-hoc test for BMI scores and Kruskal–Wallis test followed by Dunn's multiple comparison post-hoc tests for the Rosenberg scale and food habits questionnaire. Results At the end of 12 months, 43.4% of patients had a decrease in BMI, 45.8% had a mild to moderate increase in BMI, and 10.8% of patients maintained their BMI levels. The changes were not statistically significant. Self-esteem changes were statistically significant for both genders. Changes in food habits were also significant. Conclusion BMI decreased for the first 3 months and gradually recovered by the end of the first year of treatment. Self-esteem scores showed a significant improvement in both genders. Patients reverted to pre-treatment food habits by the end of the year.
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Kanama bozukluğu olan erişkinlerde ve çocuklarda ağız bakımı, genel sağlığı etkileyen en önemli faktörlerden biridir. Bu bireylerde; kanama diyatezinin varlığı ve enfeksiyona direncin azalması nedeniyle ortodontik tedavi sırasında dikkat edilmesi gereken prosedürler hayati rol oynamaktadır. Ortodontik tedavi ihtiyacı olan ve kanama bozukluğu bulunan hastalarla ilgili alınması gereken önlemler ve tedavi sırasında hekimi kısıtlayan durumlarla ilgili mevcut bir protokol bulunmamaktadır. 1 Bu derlemenin amacı; kanama bozukluğu olan ve ortodontik tedavi ihtiyacı bulunan bireylere klinik yaklaşım ile ilgili bir rehber oluşturmaktır. HEMOSTAZ MEKANİZMASI Kan hücreleri kemik iliğindeki yapım evresinden, retiküloendotelyal sistemde fagosite edildiği ana kadar, endotel ile kaplı alanlarda hareket ederler. Bu durum damarın açık kalmasını ve kan akımının devamını sağlar. Damarda kanın akışı bazı fizik prensiplerine dayanmaktadır. Damarın büyüklüğüne göre değişmekle beraber, damarın ortasında kan akım hızı yüksek iken, damarın duvarına doğru yavaşlar. Kandaki hücrelerin büyüklüğü farklıdır ve büyüklük ile hız arasında bir ilişki vardır. Damarın orta tabakasında en hızlı bir biçimde, en büyük kan hücreleri olan lökositler hareket ederler, yanlarda eritrositler yer alır. Damar duvarına en yakın bölgede, en yavaş seyreden, en küçük hücrelerden oluşan tabakayı trombositler oluşturur. 2-4 Damarların içi endotel adı verilen tek katlı bir yassı epitel ile örtülüdür. Endotel, da-marın duvarında bulunan lifsel proteinlerin kan hücreleriyle temasını engelleyen önemli ÖZET Pıhtılaşma sürecinin tam olarak gerçekleşmemesi olayına genel olarak 'kanama bozukluğu' denilmektedir. Kanama bozukluğu olan erişkinlerde ve çocuklarda ağız sağlığının korunması genel sağlığı etkileyen en önemli faktörlerden biridir. Bu derlemenin amacı, konjenital ve edinsel kanama bozukluğu olan hastalarda ortodontik tedavi yaklaşımları hakkında bilgi vermektir. Anahtar Kelimeler: Ortodonti; kanama bozuklukları; hemofili; lösemi; lenfoma ABS TRACT Bleeding disorder' is a condition that affects and distrupts the coagulation mechanism. Providing oral care in adults and children with bleeding disorders is one of the most important factors affecting overall health. The aim of this review is to summarize the current literature about orthodontic treatment approaches in patients with congenital and acquired bleeding disorders.
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A mordida aberta anterior (MAA) é definida como a presença de mordida aberta anterior, onde as bordas incisais dos dentes anteriores superiores e inferiores não se tocam. Diferentemente da MAA em dentadura decídua ou mista, o tratamento na dentadura permanente tem se mostrado como um grande desafio, uma vez que a finalidade consiste em melhorar as relações dentárias estéticas, funcionais e manter as relações faciais. Com isso, este trabalho tem o objetivo de descrever passo a passo o tratamento ortodôntico compensatório da MAA através de um caso clínico, cujo tratamento foi finalizado após 33 meses, com a correção da relação oclusal.
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The article reviews the ageing changes of the midfacial and maxillary bones, the mandible, the overlaying soft tissues and the smile, and presents clinical guidelines aiming to rejuvenate older faces by means of orthodontic therapy. With regard to the ageing changes, the maxillary skeleton appears to rotate clockwise inferior to the orbit and becomes retrusive, and as a general pattern the midface contracts and deteriorates with age. Resorption below the mental foramen, reduction in alveolar height, loss of bone at the chin region, and relative increase in size and shape are signs of an aged mandible. Epidermal thinning and decrease in collagen in combination with the effect of gravity and various external factors contribute to the ageing of the skin. Atrophy of the superficial and deep fat, changes in ligamentous tissues and changes in muscle structure, position and tone, all contribute to the stigmata of the aged face. In the article, two late adulthood orthodontic cases are discussed as examples, and general guidelines for orthodontic management of the older face aiming at reversing the ‘shrinkage’ of the tissues by restoring the facial shape and tightening the soft tissue mask are described. The possible mechanisms explaining the changes observed on the faces of the clinical cases are also discussed. A properly planned and executed orthodontic intervention reversing changes from the inside-out before embarking on cosmetic surgery might have a synergistic effect multiplying the benefits for adult patients.
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Background: Orthodontists should be aware of the potential ramifications of certain medications that may affect the cellular and molecular biology of orthodontic tooth movement (OTM). Aim: The purpose of this study was to examine orthodontists' knowledge and understanding of the effects of numerous popular medications on OTM in Saudi Arabia. Materials and method: In this cross-sectional study, a structured, close-ended, and self-administered online questionnaire was sent to the orthodontists registered with the Saudi Commission for Health Specialties and were practicing in Saudi Arabia. The questionnaire consisted of 24 items under the sections of Demographic and practice characteristics, medical history and medication awareness, and knowledge of the effect of medication on orthodontic tooth movement. A total of 138 orthodontists responded to the questionnaire. The data obtained from the participants were analyzed by applying descriptive statistics, Mann-Whitney and Kruskal-Wallis tests. Results: The total mean knowledge of medication in the study sample was 2.99±1.32. A large percentage of study participants were knowledgeable about the effect of Paracetamol (90%), NSAIDs (81.9%), and Bisphosphonate (71.0%) medication on OTM. On the contrary, the effects of prednisolone, losartan, propranolol, and statins family were known only for less than 20% of the sample. Comparison of mean medication knowledge of OTM across studied demographic variables did not yield any statistically significant difference (p>0.05). Conclusion: The Saudi orthodontists who participated in this study lacked knowledge regarding the effects of common medications on OTM.
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To identify appropriate dimensional items in objective diagnostic analysis for attractiveness of frontal posed smile in Japanese female patients by comparing with the result of human judgments. Photographs of frontal posed smiles of 100 Japanese females after orthodontic treatment were evaluated by 20 dental students (10 males and 10 females) using a visual analogue scale (VAS). The photographs were ranked based on the VAS evaluations and the 25 photographs with the highest evaluations were selected as group A, and the 25 photos with the lowest evaluations were designated group B. Then 12 dimensional items of objective analysis selected from a literature review were measured. Means and standard deviations for measurements of the dimensional items were compared between the groups using the unpaired t-test with a significance level of P < .05. Mean values were significantly smaller in group A than in group B for interlabial gap, intervermilion distance, maxillary gingival display, maximum incisor exposure, and lower lip to incisor (P < .05). Significant differences were observed only in the vertical dimension, not in the transverse dimension. Five of the 12 objective diagnostic items were correlated with human judgments of the attractiveness of frontal posed smile in Japanese females after orthodontic treatment.
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Objective: To evaluate the effect of dental crowding and lip protrusion on self-esteem and quality of life (QOL) in female orthodontic patients with Class I malocclusion. Materials and methods: The study sample consisted of 201 patients (mean age 22.6 ± 3.0 years) who sought orthodontic treatment. All the patients were evaluated before treatment in terms of their degree of dental crowding and lip protrusion. Rosenberg's Self-Esteem Scale and the Orthognathic Quality of Life Questionnaire (OQLQ) were used to determine self-esteem and QOL and to evaluate whether these values were related to malocclusion severity. Results: The results indicated that severe crowding and severe protrusion can result in lower self-esteem and poorer QOL (P < .05) than mild crowding and protrusion in Class I malocclusion. In the oral function component of the OQLQ, the severity of protrusion did not have significant effect. Conclusions: In Class I malocclusion, patients with mild crowding or protrusion had significantly better self-esteem and QOL scores than severe crowding or protrusion patients.
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Objectives: To assess the impact of fixed orthodontic treatment on oral health related quality of life (OHRQoL) and self-esteem in adults. Subjects and methods: A prospective study design was applied, within private practice. Sample size estimation revealed a minimum of 52 subjects, allowing for drop outs. All participants completed a set of validated questionnaires at baseline (T0), 1- (T1), 3- (T2), and 6-months (T3) and post-treatment (T4). These included the Rosenberg Self-esteem scale, the Oral Health Impact Profile (OHIP-14) and a socioeconomic status questionnaire. The Dental Health Component of the Index of Orthodontic Treatment Need (IOTN) was used to assess malocclusion severity. Results: Sixty-one subjects were recruited, with only one subject lost to follow-up. A statistically significant difference in OHRQoL scores was seen between: T0 and T1 (P = 0.001); T0 and T2 (P = 0.020). There was no statistical difference between T0 and T3 (P = 0.078) or T4 (P = 0.565), where OHRQoL improved to pre-treatment scores. A significant difference in self-esteem scores was observed between baseline and end of treatment (P = 0.002). Conclusions: Undergoing fixed orthodontic therapy had a negative impact on the overall OHRQoL, during the first 3 months of treatment, which then improved to pre-treatment scores, whilst a significant increase was observed in self-esteem as a result of treatment.
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AIM: The purpose of this article was to determine the main reasons that motivate adult patients to seek for orthodontic treatment. METHODS: The sample comprised 70 adult individuals (44 females and 26 males) that were asked to answer a questionnaire with a list of possible complaints. Descriptive statistics were obtained. RESULTS AND CONCLUSIONS: The findings showed that esthetics related to malpositioning of the upper incisors is the reason mostly associated to the search for orthodontic treatment. Only a few patients (7% of the sample) indicated skeletal discrepancies as reason for treatment. Symptoms of TMJ appeared as the second reason.
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To compare changes related to self-esteem and appearance satisfaction between pre and postsurgical phases in patients undergoing orthognathic surgery and to assess the quality of life and psychosocial changes of these patients six months after surgery. A longitudinal observational qualitative study was performed. The sample comprised 15 patients with dentofacial deformities who underwent orthognathic surgery. One questionnaire and two forms were answered during pre and postoperative phases. The results showed that 13.3% of patients demonstrated self-esteem improvement, especially in relation to appearance satisfaction. Improvements were also noted in social, occupational and family relationships. With regard to the assessment of quality of life, according to the World Health Organization questionnaire, the lowest improvement averages corresponded to environmental control. Orthognathic surgery brings along many emotional changes that should be considered before and after surgery, since the patients' psychological state may be favorable and/or unfavorable during recovery, influencing their quality of life, self-esteem and appearance satisfaction.
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The length of time that it takes an orthodontist to treat adult patients varies widely. The aim of this study was to investigate how different variables influence treatment time. Seventy clinical case reports of successfully treated adult patients were examined. The patients were selected from 4,723 records held by three experienced orthodontists. The influence exerted by the following variables on treatment time was assessed: age, sex, facial pattern, severity of malocclusion (measured by the PAR index), sagittal relationship of canines, type of brackets (ceramic or metal), tooth extractions, missed appointments and orthodontic appliance issues/breakages, the latter being the dependent variable. Assessment was performed by multiple linear regression analysis, followed by the stepwise method with p < 0.05. The number of times a patient missed their appointment (no-show) (R2 = 14.4%, p < 0.0001) and the number of appliance issues/breakages (R2 = 29.71%, p = 0.0037) significantly affected variability in treatment time, and these two variables together can predict 43.75% (R2 total) of the overall variability in treatment time. Other factors, such as canine relationship at the beginning of treatment, bracket type (metal or ceramic), tooth extractions, age at start of treatment, severity of the initial malocclusion, sex and facial pattern had no significant bearing on treatment time. The duration of orthodontic treatment in adults, when performed by experienced orthodontists, is mainly influenced by factors related to patient compliance. However, several factors which were not included in this study may contribute to variability in orthodontic treatment time.
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The high demand for orthodontic treatment, evidenced over the last few decades, has been justified mainly by the greater importance given to facial esthetics, influencing individual's self esteem. However, the professional frequently does not meet all the patient's expectations, for not establishing good communication and not knowing about the critical points during orthodontic treatment. The aim of this study was to elucidate patients' desires and doubts regarding orthodontic treatment, by means of a survey applied to 60 adult patients. The analysis of results revealed that most individuals (38.3%) noticed treatment success after its conclusion. Occlusion deviation was pointed out by 66.7% as the main reason for seeking treatment, and esthetics ranked as second (with 48.3%). Treatment time was considered within the prediction by 46.7% of the interviewees and the results were judged as very good by 43.3%. The social relations of most participants were not affected by treatment (73.3%). Also, 58.3% of the interviewees reported pain as the main complaint and 53.3% found it difficult to use dental floss. Most participants saw the orthodontist as a professional who was concerned about their health (76.7%), and believed that he/she was more able to treat them (96.6%) when compared with the general practitioner. The orthodontist/patient relationship enables an understanding of the expectations regarding orthodontic treatment, resulting in greater motivation and cooperation, leading to a successful outcome.
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Introduction Our objective was to determine whether dental esthetics have any influence on finding a new job. Methods Ten patients with orthodontic treatment needs for various types of malocclusions were selected. Smiling facial photographs of all patients were obtained and digitally altered (orthodontic correction of teeth). After the images were obtained, 2 different questionnaires were prepared (survey groups A and B) with the photographs without alteration (showing malocclusion) and altered (with orthodontic correction). Subjects appeared in one questionnaire (survey group) with an ideal smile and also in the other (survey group) with a nonideal smile. The images were evaluated by 100 persons responsible for hiring staff for commercial companies. In each survey group, 4 questions were asked regarding the individuals' likelihood of being hired, honesty, intelligence, and efficiency at work. Analysis of variance for repeated measures was used to determine the differences in the evaluations of patients with ideal and nonideal dental esthetics for the 4 characteristics evaluated. The level of significance adopted was 5%. Results The photographs of persons with ideal dental esthetics were, on average, evaluated as superior with respect to intelligence and likelihood of being hired than were the photographs of the same subjects with nonideal dental esthetics. For the characteristics of honesty and efficiency, no significant differences were observed in the evaluations between those with ideal and nonideal smiles (P <0.05). Conclusions Persons with ideal smiles are considered more intelligent and have a greater chance of finding a job when compared with persons with nonideal smiles.
Article
Background: Among child and adolescent patients, persistent but untreated malocclusions may or may not have psychological and social impacts on the individual's quality of life. Objectives: To gain knowledge of malocclusions and its impact on oral health-related quality of life (OHRQOL), we conducted a systematic review of quantitative studies for evidence regarding the influence of malocclusions on OHRQOL in children and adolescents. Materials and methods: Five databases (MEDLINE via PubMed, EMBASE, Psychinfo, CINAHL, and the Cochrane Library) were searched using specified indexing terms. The following inclusion criteria were used: child or adolescent study population; healthy study participants without syndromes such as cleft lip/palate or severe illness; no previous or ongoing orthodontic treatment among participants; a focus on malocclusions and quality of life; controlled or subgrouped according to malocclusions/no malocclusions; malocclusions and/or orthodontic treatment need assessed by professionals using standardized measures; self-assessed OHRQOL estimated using validated questionnaire instruments; full-text articles written in English or Scandinavian languages. Quality of evidence was classified according to GRADE guidelines as high, moderate, or low. Results: The search produced 1142 titles and abstracts. Based on pre-established criteria, the full-text versions of 70 articles were obtained, 22 of which satisfied the inclusion criteria. After data extraction and interpretation, six publications were deemed eligible for full inclusion. All six were of cross-sectional design, and the quality of evidence was high in four cases and moderate in the remaining two. The four studies with a high level of quality reported that anterior malocclusion had a negative impact on OHRQOL, and the two with a moderate level of quality reported that increased orthodontic treatment need had a negative impact on OHRQOL. Conclusion: The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.
Article
Objective: To investigate the association between satisfaction with dental esthetics and quality of life, and esthetics satisfaction in relation to esthetic evaluations of three panel groups. Materials and methods: Fifty-two patients (36 women, 16 men; age 18-61 years) with severe malocclusion were treated in Oulu University Hospital. Of these, 38 and 14 patients underwent orthodontic/surgical treatment and orthodontic treatment, respectively. A questionnaire and dental photographs were collected before and after treatment. The 14-item Oral Health Impact Profile (OHIP-14) was used to measure oral health-related quality of life. Satisfaction with dental esthetics was evaluated using the Visual Analogue Scale. Dental photographs were presented to three panel groups: 30 laypersons, 30 dental students, and 10 orthodontists, who rated the photographs using the Aesthetic Component of the Index of Orthodontic Treatment Need. Results: Oral health-related quality of life (OHIP-14 severity score) and esthetic satisfaction (according to the Visual Analogue Scale) improved after the treatment (P < .001). The most unsatisfied patients reported oral effects more often both before and after treatment. Changes in oral health-related quality of life components of severity, psychological discomfort, and psychological disability correlated positively with the changes in esthetic satisfaction. Orthodontists graded the situation before treatment as worse and the outcome as better than the laypersons; the level of grading by dental students fell between these two groups. Conclusion: Improvement in esthetic satisfaction due to the treatment of severe malocclusion improves oral health-related quality of life, particularly by decreasing psychological discomfort and psychological disability.