|Year : 2017 | Volume
| Issue : 2 | Page : 87-93
Are adults enough motivated for orthodontic treatment: A questionnaire study
Department of Orthodontics and Dentofacial Orthopedics, Himachal Pradesh Government Dental College, Shimla, Himachal Pradesh, India
|Date of Web Publication||28-Dec-2017|
Department of Orthodontics and Dentofacial Orthopedics, Himachal Pradesh Government Dental College, Shimla - 171 001, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Context: Facial esthetics is an important determinant of self and social perceptions. Increased awareness toward orthodontic treatment has led to increase in number of adults seeking orthodontic treatment to improve their facial appearance. Understanding of different factors associated with adult orthodontic treatment allows better assessment of the requirements and priorities of adults during the treatment.
Aims: The aim of this study was to assess different motivational factors which lead to adults seeking orthodontic treatment.
Settings and Design: The adult patients coming to orthodontic outpatient department were given a questionnaire before the start of the treatment.
Materials and Methods: A sample of 45 adult patients which included fifteen males and thirty females within the age group of 18–35 years was taken who had come for orthodontic treatment. These patients were asked to fill a questionnaire before the start of the treatment.
Statistical Analysis Used: Differences in response of patients toward treatment were also evaluated gender wise using t-test. The t- test was also used to determine the influence of the scores combined in each of the four subgroups in the questionnaire.
Results: On assessing different factors which motivated adults to seek orthodontic treatment, it was found that most of the patients realized the need for the orthodontic treatment in adult age only followed by the fact that adult patients were mostly unhappy about their dental appearance in perception of their smile before treatment which motivated them to seek treatment at this age.
Keywords: Adult orthodontics; determining factor; motivation
|How to cite this article:|
Mahajan M. Are adults enough motivated for orthodontic treatment: A questionnaire study. Indian J Multidiscip Dent 2017;7:87-93
| Introduction|| |
In recent decades, orthodontic treatment in adults has increased due to their awareness toward improvement in good oral health. The technological advancement in the field of orthodontics and increased access to information regarding benefits of orthodontic treatment to an individual has led to an increase in orthodontic treatment in adults. Orthodontic treatment leads to improvement in dentofacial esthetics, thereby improving the self-esteem of the patient. There are many reasons why adults seek orthodontic treatment such as esthetics, pain in temporomandibular joint (TMJ). Improvement in dentofacial esthetics is the major motivational factor for adults to seek orthodontic treatment. The adults were aware of certain types of malocclusions such as crowding, rotation, and proclination of teeth which also make them seek orthodontic treatment.
As we know that existence or nonexistence of malocclusion is an individual's perspective toward his appearance, thus making the choice of treatment elective. Orthodontic malocclusion is an esthetic inadequacy usually not causing pain or discomfort, hence patient seeks treatment only when motivated.
Adults present a different category of people with different experience, certain psychological inhibitions, and different expectations regarding their treatment. Adult orthodontic concept was shown by Pierre Fauchard in a book Le Chirurgien Dentiste in 1723. Younger adults have been found to be more aware of their occlusion, making them good patients who appreciate a good treatment plan and significance of goals to be achieved by the orthodontist.
Many adults do not timely undergo treatment due to lack of finances, lack of information regarding orthodontic treatment at a younger age as well as other factors such as long treatment time, discomfort with appliances, fear of pain, antiesthetic look of brackets, and no surety of result of treatment. The motivation to improve one's esthetics has a psychosocial reason which can be motivating enough to make adults seek treatment at this age. Seventy-five percent of adult patients are dissatisfied with their dental appearance and making it a prime motive for seeking treatment. Trulsson et al. said that different factors motivate the patients to undergo orthodontic treatment which makes it important for the orthodontist to understand the subjective motives of the patient to set realistic treatment goals. Hamdan similarly said that perceptions of orthodontic treatment need are multifactorial and are influenced by different factors. The motivational factors of the patient with respect to orthodontic treatment will affect cooperation during treatment, the prognosis of the case, and posttreatment satisfaction. Some other factors motivating adult patients are recommendation from a dentist, impacts of friends and family, and improvement in dental health. Adults with malocclusion and protruding teeth suffer prejudice and discrimination in different fields such as career opportunities, finding a better job, and working in offices  giving adults another reason for seeking orthodontic treatment in having the need for isolated dental movements required for prosthetic rehabilitation or periodontal improvement of the patient.
It is necessary to determine prior to treatment the motivations of adult patients to know their expectation from treatment. The aim of this study is to describe factors motivating adult patients for orthodontic treatment as well as to find the reasons as to why did they not undergo treatment at a younger age.
| Materials and Methods|| |
All the patients coming to the Department of Orthodontics, Himachal Pradesh Government Dental College, Shimla, for treatment between age of 18 and 35, with the mean age of 26.5 years, were considered for this study. The final sample size was of 45 patients, with number of males 15 and females 30. The inclusion criteria were adult patients coming to our department for treatment above or equal to the age of 18 years. They had different Class I or Class II malocclusion with malalignment of the upper and/or lower anterior segment with varying degrees of overjet and overbite. The exclusion criteria were any patient with cleft lip/palate, craniofacial syndromes, orthognathic need, any systemic disease, and periodontal disease.
A questionnaire was developed with 21 questions divided into four subgroups  [Appendix 1]. The patients were requested to complete the questionnaire before the start of the treatment, and the responses were recorded as simple yes or no. The Subgroup I had 6 questions evaluating the reason for adults seeking orthodontic treatment in this age. The Subgroup II had 5 questions which evaluated perceptions of adult patients regarding their smile before treatment. The Subgroup III had 5 questions which were designed to know the attitude of adult patients toward orthodontic treatment and the last Subgroup IV, which had 5 questions and assessed the determining factor for starting orthodontic treatment. The patients could give more than one option as the reason in all of the subgroups.
Statistical analysis was done with data transformed into tables and descriptive statistics was done. Differences in response of patient toward treatment were also evaluated gender wise using t- test. Statistical significance was determined at a 0.05 level. The t-test was also used to determine the influence of the scores combined in each of the four subgroups in the questionnaire.
| Results|| |
The sample consisted of 45 patients in the age group of 18 and 35 with the mean age of 26.5 years. The females were 30 in number (66.6%) and males were 15 in number (33.3%). Cross-tabulation was done to know the percentage and tests for significance indicated that the reasons for adults in seeking orthodontic treatment were in the following descending order as asked in Subgroup I questions [Table 1]. About 84.4% of patients realized the need for the orthodontic treatment only in adult age whereas 22.2% of them considered that the treatment was for only children and adolescents. Nearly 20% of adults were seeking orthodontic treatment at this age due to lack of prior finances, and the same percentage of patients were not aware till now that an orthodontist could solve their problem. Almost 17.8% of patients had some other reason for undergoing orthodontic treatment at an adult age, and lastly, only 15.6% of patients decided to go for this treatment after being indicated by their dentist. The patients could give more than one option as the reason in all of the subgroups.
|Table 1: Subgroup I: Reasons for seeking orthodontic treatment in adult age|
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In Subgroup II, when adult patients were asked to assess their smile or malocclusion before treatment, 71.1% of them said that they were unhappy about their dental appearance, with 24.4% and 22.2% of adults reporting that problems such as edentulous space and gingival diseases, respectively, made them seek for this treatment. Whereas 17.8% of the adults gave problems in speech and 8.9% of them reported with problem of mastication as the reason for seeking orthodontic treatment at this age [Table 2].
|Table 2: Subgroup II: Perception of patients regarding their smile before treatment|
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Subgroup III analyzed the factor which made the adults apprehensive about orthodontic treatment, and it was found that 73.3% of patients were concerned about long duration of the treatment whereas 48.9% of patients had fear of pain during the treatment as well as were cautious of unaesthetic appearance of the appliance. As many as 33.3% of them had certain doubts regarding efficiency of treatment and only 11.1% of adult patients said that none of the mentioned factors led them to seek orthodontic treatment at this age [Table 3].
Subgroup IV analyzed the determining factor for the adult to undergo orthodontic treatment. A large percentage of 80% of adult patients said that it was the viewpoint and support from family, spouse, and friends which became the deciding factor to be followed by 71.1% of adults who said that they were already motivated to receive the treatment. About 60% of adults sought this treatment after having a discussion with the orthodontist whereas 22.2% of them decided to go for the treatment at this age due to the orientation brought about by dentist to them, and the same percentage of adult patients had some other reason which was not mentioned [Table 4].
As perception toward treatment may differ, according to gender, the analysis was done separately for male and female sample [Table 5].
Chi-square test showed a statistical significant difference in question 4 of Subgroup I, indicating that the male sample sought the treatment more after being suggested by their dentist in comparison to the female sample and question 16 where it was found that more of males found none of the mentioned reasons to start the treatment in comparison to the females.
Gender wise all the responses to questions in a particular subgroup were also considered collectively [Table 6], and the result showed no statistical significant difference in response of male and female adult patients in any of the four subgroups [Table 7].
|Table 6: T-test showing gender-wise differences in combined responses in each subgroup|
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|Table 7: Result of t-test for gender-wise differences in combined responses in each subgroup|
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| Discussion|| |
Adult orthodontics is assuming a greater proportion of dental practice. The increased demand worldwide has made the orthodontists improve his understanding the perceptions of adult patients toward orthodontic treatment to improve the outcome of the treatment. This enables better planning and the carrying out of the treatment by improving the qualitative deficiencies of orthodontic treatment. The discussion is done under different headings for better understanding.
The adult patients accounted for many reasons for seeking orthodontic treatment at this age. Lack of prior finances accounted for only 20% of our sample which showed that as our study was done in government setup, the cost charges were not high and hence did not become a reason for not taking up this treatment earlier which is in contrast to a study where 31.5% of patients showed lack of financial means for not getting treatment earlier  along with another study which showed that as many as 51.4% patients discontinued the treatment due to high cost. Another study has shown that self-satisfaction with one's own appearance and high cost of treatment are two main reasons to discourage individuals from seeking treatment despite definite need. In our study, 20% of patients did not know until adulthood that orthodontic treatment could correct their malocclusion, and 22.2% of them considered that the treatment was for children and adolescents. The main motivational factor seen as in 84.4% of our sample was that the need for the treatment was realized only in adult age. This is all reflects a lack of strong dental school education in bringing about awareness of malocclusion at an early age, hence emphasizing the importance of school education in orthodontic treatment.
Pabari et al. reported that desire to improve the smile was the main motivational factor for orthodontic treatment. Literature also shows that physically attractive people have more advantage over not so attractive persons. There is also a connection between mental and physical health which makes dentofacial deformity, a cause of psychological illness. Many studies show that improvement in dental and facial esthetics is the main reason for seeking orthodontic treatment as it also improves self-esteem of an individual., Similar results are seen in our study where 71.1% of adult patients wanted orthodontic treatment due to bad esthetics.
It has been reported by Magalhães et al. that there is an association of malocclusion with reduction of masticator efficiency. Other studies have also reported that main motivational factor in patients to undergo orthodontic treatment was difficulty in biting and chewing as reported by 66.7% of patients. However, in our study, only 8.9% of patients reported with some occlusion deviation being the cause of seeking orthodontic treatment.
Different reasons can be associated with apprehensions of adult patients toward orthodontic treatment. The adult may be embarrassed to wear orthodontic appliance at this age which makes it difficult for orthodontist to handle the situation as reported in a study. The same was found in our study where 48.9% of patients also reported this awkwardness along with the same percentage of adult patients having fear of pain during the course of treatment. This is in accordance with another study which reported adults having an aversion to use fixed appliances in public, but it gradually reduced with time.
Length of treatment was also an important reason to consider before the start of the treatment for as many as 73.3% of adults in our study. This is in contrast to a study by de Souza et al. which reported that only 46.7% of patients were concerned with the duration of treatment time.
This subgroup analyzed the determining factor for an adult patient to start the treatment. Oliveira et al. showed that only 22% of patients decided to go for the treatment after discussing with orthodontist which is in contrast to our study which showed a large percentage of 60% of adult patients being influenced by the orthodontist. Many studies have reported that for successful outcome of orthodontic treatment, a good doctor–patient relationship is needed, as also reported in a study by de Souza et al. where 76.8% of patients thought of orthodontist as a professional committed to improve their oral health. Pabari et al. also reported that patients should be provided with accurate information regarding orthodontic treatment for the successful outcome of the treatment.
Oliveira et al. reported that 11.8% of patients decided to seek orthodontic treatment after discussion with their family members, friends, and/or spouse  whereas our study showed that as high as 80% of adults were influenced by their friends and family members which is in accordance to other studies reporting that adults are strongly influenced by behavior and thoughts of their friends.
Badran reported that patients who needed orthodontic treatment showed low self-esteem. Kiyak et al. concluded that if the orthodontist is aware of psychological aspect of the patient before treatment, it will enable him to have better patient compliance and more successful treatment outcome. Similarly, our study showed as high as 71.1% of adult patient sample already wanted to receive this treatment, showing how motivated they were.
The ratio of 2:1 of female:male in our study sample already shows that females give more importance to esthetics which is consistent with previous studies showing women having a greater motivation to undergo orthodontic treatment to improve their dentofacial esthetics and also in being more uninhibited on expressing their dissatisfaction about themselves. de Souza et al. also reported that for females, the main motivational factor was bad esthetics whereas, for males, it was pain in TMJ.
| Conclusion|| |
To be physically attractive dental, esthetics plays an important role irrespective of age of the patients. Understanding of different factors associated with adult orthodontic treatment allows better assessment of the requirements and priorities of adults during the treatment.
- On assessing different factors which motivated adults to seek orthodontic treatment, it was found that most of the patients realized the need for the orthodontic treatment in adult age only
- The adult patients thought that they were mostly unhappy about their dental appearance in perception of their smile before treatment which motivated them to seek treatment at this age
- Adults thought that the long duration of the treatment was the most bothering factor before deciding to start orthodontic treatment
- For a very large percentage of adult patients, it was the viewpoint as well as support from family, spouse, and/or friends which became the deciding factor for them to undergo orthodontic treatment
- Role of gender was not found significant in relation to motivation for adult patients for orthodontic treatment.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]