Association Between Psychosocial Factors and the Need for Orthodontic Treatment Based on Self-Perception

Introduction: Smile esthetics play a central role in social interaction, self-esteem, and self-confidence, and may influence individuals' perception of orthodontic treatment need. Understanding how patients evaluate their own smile and how this perception relates to treatment demand is increasingly relevant for patient-centered orthodontic care. This study aimed to examine the associations between demographic factors, self-perception of smile esthetics, psychosocial behaviors, and perceived need for orthodontic treatment. Materials and Methods: A cross-sectional study was carried out using a questionnaire, yielding 303 valid responses. The questionnaire assessed demographic characteristics, satisfaction with smile appearance, smile-related avoidance behaviors, awareness of dental esthetics, and self-perceived orthodontic treatment need. Associations between variables were analyzed using Chi-square tests, Kendall's tau_b, Spearman's rho, and Cramer's V coefficients. Multinomial logistic regression was performed to identify factors associated with perceived treatment need. Results: Gender was significantly associated with satisfaction with smile appearance, concern about dental esthetics, and awareness of the importance of aligned teeth (p ≤ 0.001), with weak to moderate effect sizes. Age showed statistically significant but weak correlations with smile-related behaviors and perceived treatment need (|τ| ≈ 0.11-0.12; p < 0.05). Lower satisfaction with one's smile was moderately associated with a higher perceived need for orthodontic treatment (τb = -0.20; p < 0.001). Avoidance of smiling and covering the mouth while speaking were positively associated with perceived treatment need (p < 0.01). Discussions: Regression analysis confirmed that dissatisfaction with smile esthetics, smile-avoidance behaviors, and belief in the esthetic benefits of dental alignment were significant predictors of perceived orthodontic treatment need. Self-perception of smile esthetics and related psychosocial behaviors are significantly associated with individuals' perceived need for orthodontic treatment. Conclusions: These findings underscore the importance of incorporating patient-reported perceptions and psychosocial factors into orthodontic assessment and shared decision-making.