Differences in chief complaints based on the molar relationship: A quantitative text analysis of open-ended responses...

Understanding the chief complaints of patients is essential for effective communication and successful orthodontic treatment. Although previous studies have often used structured questionnaires, few have applied data-driven methods to unstructured free-text responses. Furthermore, how these complaints from distinct semantic structures based on molar classifications remains underexplored. This study aimed to examine these structural differences using correspondence and co-occurrence network analyses.

Patients who visited an academic dental hospital for an initial orthodontic evaluation between April 2011 and March 2024 were included. Data on chief complaints (free text), sex, age, skeletal classification, and molar classification were obtained from standardized diagnostic records. Chief complaints were analyzed structurally, retaining nouns and adjectives. We extracted the 60 most frequently used terms, followed by correspondence and co-occurrence network analyses.

In total, 2568 (35.4% male) patients were included. Their mean age was 22.0 years (range: 7-74 years). Anterior esthetic concerns were the most frequently reported chief complaints across all patients. However, correspondence and network analyses revealed distinct structural patterns according to molar classification. Class I patients mainly cited esthetic reasons. Class II patients were characterized by morphological and symptomatic concerns and referrals. Class III patients presented interrelated skeletal, functional, and psychological concerns, often involving an awareness of surgical necessity and mentions of being pointed out by others.

Although esthetic dissatisfaction is common, distinct complaint patterns exist based on molar classification. Recognizing these semantic structures facilitates shared decision-making and provides a foundation for developing patient-centered PROMs in orthodontic practice.