Are changes in malocclusion associated with adulthood psychosocial well-being?

Introduction

The purpose of this study was to investigate the longitudinal psychosocial effects of changes in malocclusion from adolescence to adulthood on oral health–related quality of life (OHRQOL), self-rated dental appearance, and overall life satisfaction.

Methods

The Dunedin Multidisciplinary Health and Development Study is a longitudinal birth cohort study of 1037 children born at Queen Mary Hospital, Dunedin, New Zealand, between April 1, 1972 and March 31, 1973. Data on their health and development, including dental examinations, has since been collected periodically. Malocclusion severity was measured using the Dental Aesthetic Index in participants aged 15 and 45 years (data collected at age 18 years was supplemented for data missing at age 15 years). Other data collected included clinically assessed oral health (dental caries and periodontal disease experience) and self-rated dental appearance, OHRQOL, life satisfaction, and personality traits.

Results

Malocclusion data were available for 868 participants in adolescence and 834 aged 45 years. For those with a severe handicapping malocclusion at 15 years old, 46.6% who received orthodontic treatment transitioned to a resolved (ie, mild-moderate) malocclusion when aged 45 years, whereas only 16.2% of those who did not receive orthodontic treatment made that transition. A transition to a worse malocclusion was associated with impacts on OHRQOL when aged 45 years in the subdomains of functional limitation, psychological discomfort, and physical disability as well as worse self-ratings of dental appearance, and these findings were held after adjusting for potential confounders. Malocclusion was not associated with overall life satisfaction.

Conclusions

Maintenance of acceptable occlusion after orthodontic treatment requires a strong emphasis on achieving and maintaining excellent dental health and avoiding chronic oral conditions such as dental caries and tooth loss. The long-term benefits of orthodontic treatment may diminish by midlife unless good dental health is maintained. Orthodontists have the responsibility to raise awareness among their patients on how to maintain good oral health after orthodontic treatment.