Normative and self-perceived orthodontic treatment need in 11- to 16-year-old children

To examine the relationship between normative and self-perceived treatment need assessed by different measures, comprising two Oral Health-Related Quality of Life (OHRQoL) scales.

This cross-sectional observational study comprised 386 children aged 11-16 years registered for a first consultation at the Orthodontic Department of the University Hospitals of Leuven (Belgium). Normative treatment need was assessed by the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). The children completed questionnaires comprising the Child Perceptions Questionnaire (CPQ₁₁₋₁₄) and the Oral Aesthetic Subjective Impact Scale (OASIS). They also scored the AC of IOTN themselves. Spearman correlations, Mann-Whitney U-tests and signed-rank tests, a Bland-Altman plot, and an intra-class correlation were used to analyze the data.

Significant, yet weak correlations (maximum ρ = 0.23 for the CPQ emotional well-being domain) were found between normative orthodontic treatment need (IOTN AC) and most of the OHRQoL measures. Similarly, between the IOTN AC scores of the expert and the IOTN AC ratings given by the child a significant correlation (ρ = 0.37, P < 0.0001) was found, but with very poor agreement (95 per cent limits of agreement -4.3, 5.1). For the DHC of IOTN, only a relation was found with the AC child (ρ = 0.20, P = 0.0001).

These results suggest that the commonly used IOTN as a clinical assessment tool for orthodontic treatment need should be reinforced by OHRQoL measures, like the OASIS, expressing patients' perceived treatment need.