Agreement between orthodontist and patient perception using Index of Orthodontic Treatment Need

The primary objective of the study was to assess the agreement between orthodontist and patient perception regarding the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) at pre-orthodontic treatment levels. The secondary objective was to determine how well the subjective assessment of malocclusion (IOTN-AC) correlated with the normative Dental Health Component of the IOTN (IOTN-DC).

A cross-sectional analytical study was conducted on patients between the ages of 16 and 25, presenting for initiation of orthodontic treatment with no history of prior orthodontic treatment. The mean age of the total sample population was 19.50 ± 3.15 years. The mean age of the males was 19.05 ± 3.09 years and for females it was 19.75 ± 3.18 years. The sample consisted of 41 males and 80 females. Patients were shown their pretreatment monochrome intraoral frontal photographs to rate according to the IOTN-AC. Simultaneously, the orthodontist reviewed the photographs with each patient. The IOTN-DHC of pretreatment casts was also recorded by the orthodontist. The frequency of specific traits that had led to increased severity of malocclusion was also identified. All readings were recorded manually on a data collection form. The data were assessed using the chi-square test, Spearman's correlation and Cohen's kappa test. Intra- and inter-examiner reliability was assessed using Spearman's correlation.

A significant positive relationship (p < 0.05) was observed between orthodontist and patient perception (r = 0.516), orthodontist perception and the normative need (r = 0.430), and between the patient perception and the normative need (r = 0.252). A statistically significant level of agreement was observed between orthodontist and patient perception (kappa = 0.339, p ⩽ 0.001, 95% CI, 0.207-0.470) and between orthodontist perception and the normative need (kappa = 0.331, p ⩽ 0.001, 95% CI, 0.197-0.424). A weak and insignificant level of agreement was observed between patient perception and normative treatment need (kappa = 0.107, 95% CI, 0.02-0.187).

Patient understanding of their treatment need or aesthetic classification may not always be as accurate as that of orthodontists. This may be a cause for concern when an orthodontist finds a certain condition to be severe, and a patient who does not agree may limit their treatment needs.