An insight into aesthetic insecurity related to malocclusion amongst tribal adolescents and extent of orthodontic awareness

Introduction: Adolescence is a period of affirmation of certain beliefs, including those related to the perception of one's aesthetics as related to what is perceived to be the standard norm within a community. Certain aspects of clinically ascertained malocclusion by a practitioner may, in fact, be aspects not considered an issue by the adolescent. Of interest was the evaluation of aesthetic insecurity amongst a group of school-going tribal adolescents with no access to orthodontic treatment and hence no prior history of orthodontic treatments within the community. Materials and Methods: 2016 tribal adolescents belonging to the Revenue divisions of Paderu (Visakhapatnam), in the age group of 13–19 years, with normal growth and development, who had no nutritional deficiencies, metabolic disorders or craniofacial anomalies, were enrolled in this study. Necessary permissions and consent were obtained from the parents or guardians, the school and tribal authorities and the institutional ethical clearance committee. The orthodontic screening was performed under natural daylight in compliance with infection prevention protocol. The students were categorised into those with either ideal occlusion or Angle's Class I, II and III malocclusions. A 'simplified malocclusion index for layperson evaluation' (SMILE) index was verbally assigned in Telugu, the vernacular language, during the orthodontic screening interaction. Aesthetic insecurity noted amongst the responses was subjected to a Chi-square statistical analysis to determine gender bias. Results: Thirty-two per cent of the tribal adolescents screened at Paderu (Visakhapatnam) presented with ideal occlusion and sixty-eight per cent with malocclusion. The verbally assigned SMILE index revealed that 78.24% of the boys and 81.85% of the girls exhibited orthodontic awareness. The percentage distribution of aesthetic insecurity had the boys at 19.04% and the girls at 31.86%. The Chi-square statistical analysis of this data revealed a gender bias (X2 [1, N = 1371] =4.44, P = 0.034). Conclusion: Aesthetic insecurity negatively impacts the perceived oral health-related quality of life. The use of the SMILE index proposed by the authors in this study allows for a candid assessment of any such insecurity and an assessment of orthodontic awareness and perceived treatment needs without the individual feeling coerced. The study results reveal a good level of orthodontic awareness with a statically significant gender bias of aesthetic insecurity.