The Open Dentistry Journal




ISSN: 1874-2106 ― Volume 13, 2019

Self-Perception of Malocclusion Among Nigerian Adolescents Using The Aesthetic Component of The IOTN



E.A Aikins*, 1, O.O daCosta2, C.O Onyeaso3, M.C Isiekwe2
1 Department of Child Dental Health, Dental Centre, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
2 Department of Child Dental Health, Dental School, College of Medicine, University of Lagos, Lagos, Nigeria
3 Department of Child Dental Health, Faculty of Dentistry, College of Health Sciences, University of Port Harcourt, Port Harcourt, Nigeria

Abstract

Introduction:

The practice of orthodontics is very young in South-South Nigeria and there is need for base line data for informed planning. This study was carried out to investigate the self-perception of malocclusion among Nigerian school children aged 12 to 18 years in order to compare their perception with that of an orthodontist and also to determine the influence of gender and age on self-perception.

Materials and Methodology:

A total of 612 randomly selected schoolchildren comprising 299 (48.9%) males and 313 (51.1%) females with a mean age of 15 + 2.0 years were included in the study, the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was the instrument used to measure the perception of malocclusion by both the school children and the orthodontist.

Results:

Majority of the students (82.5%) rated their teeth towards the more attractive end of the scale (Grades 1-4). Although self - perception was not found to be related to gender, older children (16-18 years) had an increased level of perception of need. Males and older children were found to be more in need of treatment by the orthodontist.

Conclusions:

A significant difference was found between the orthodontist’s rating and the students’ ratings of the attractiveness of their occlusions. Age and gender were not found to influence self- perceived orthodontic treatment need. Therefore, for effective orthodontic care, self- perception and not only professional assessment must be taken into consideration when formulating treatment plans to ensure patient satisfaction.

Keywords: Children, Malocclusion, Orthodontist’s perception, Self-perception.


Article Information


Identifiers and Pagination:

Year: 2012
Volume: 6
First Page: 61
Last Page: 66
Publisher Id: TODENTJ-6-61
DOI: 10.2174/1874210601206010061

Article History:

Received Date: 26/1/2012
Revision Received Date: 8/2/2012
Acceptance Date: 16/2/2012
Electronic publication date: 12/4/2012
Collection year: 2012

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© Aikins et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.


* Address correspondence to this author at the Department of Child Dental Health Dental Centre University of Port Harcourt Teaching Hospital Port Harcourt, Nigeria; Tel: +2348033131969; E-mail: elfledaaikins@yahoo.com




INTRODUCTION

Human self-esteem and self-confidence depend to a large degree on an acceptable physical appearance, well proportioned facial features, properly aligned teeth and a pleasing attractive smile [1 Albarakati SF. Self-perception of malocclusion of Saudi patients using the aesthetic component of the IOTN index Pak Oral Dent J 2007; 27: 45-51.]. However, the cosmetic impairment of a particular malocclusion is not readily measured because perceptions of malocclusions are highly subjective and perceived by individuals more qualitatively than quantitatively [2 Evans R, Shaw W. Preliminary evaluation of an illustrated scale for rating dental attractiveness Eur J Orthod 1987; 9: 314-8.]. Most occlusal indices define aesthetics and ultimately orthodontic treatment need from a clinicians point of view only (normative need) without considering patients’ social needs. But, perception of dental aesthetics by patients cannot be under estimated because they are the ones receiving treatment and need to gain satisfaction from improved aesthetics [3 Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63., 4 Yeh M, Koochek A, Vlaskalic V, Boyd R, Richmond S. The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech and orthodontic treatment need Am J Orthod Dentofacial Orthop 2000; 118: 421-8.]. In most people, the demand for orthodontic treatment is related to their desire to improve their appearance and their degree of attractiveness [3 Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63., 5 Onyeaso CO, Utomi IL, Ibekwe T. Emotional effects of malocclusion in Nigerian orthodontic patients J Contemp Dent Pract 2005; 6: 1-10.-12 Al-Hamlan N, Al-Shraim N. Factors that influence perceptions of orthodontic treatment need: literature review Saudi Dent J 2008; 3: 11-20.].

The Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) (Fig. 1), which is a scale of ten photographs of the occlusion of anterior teeth is a standardized method of assessing dental aesthetics [2 Evans R, Shaw W. Preliminary evaluation of an illustrated scale for rating dental attractiveness Eur J Orthod 1987; 9: 314-8.,13 Brook PH, Shaw WC. The development of an index of orthodontic treatment priority Eur J Orthod 1989; 11: 309- 20.]. Data concerning self-perception of malocclusion based on this index, are available for many populations with figures ranging from 8% to 38% [3 Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63., 6 Mugonzibwa EA, Kuijpers-Jagtman AM, Van't Hof MA, Kikwilu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children Am J Orthod Dentofacial Orthop 2004; 125: 426- 34.,14 Hamden M, Al-Omari IK, Al-Bitar ZB. Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents and dentists Eur J Orthod 2007; 29: 366-71.-24 Abdullah MSB, Rock WP. Perception of dental appearance using index of treatment need (aesthetic component) assessments Commun Dent Health 2002; 19: 161-5.]. However, no such data are available for Nigerian adolescents residing in Rivers State; a place where the practice of orthodontics is relatively new.

Fig. (1)

The AC of the IOTN (Brook and Shaw, 1989)

1-4 indicates no need.

5-7 indicates moderate need.

8-10 indicates definite need



Therefore, this study aimed at investigating the self-perception of malocclusion among Nigerian school children aged 12 to 18 years using the Aesthetic Component of IOTN, and to compare their perception with that of an orthodontist as well as to determine the influence of gender and age on self-perception.

MATERIALS AND METHODOLOGY

A total of 612 students aged 12 to 18 years were randomly selected from six (6) public schools in six (6) different Local Government Areas (Port Harcourt, Ikwerre, Omuma, Tai, Okrika and Asari – Toru) located across Rivers State, Nigeria. Ethical approval was sought and obtained from the Ethics Committee of the University of Port Harcourt Teaching Hospital. Informed verbal consent was obtained from each of the participants. The data was collected in the school compound during school hours under standardised lighting conditions, with the student seated and the teeth in centric occlusion.

A full intraoral examination was carried out using a wooden spatula and each student’s anterior teeth were assessed using the AC of the IOTN with grade 1 as the most attractive and grade 10 as the least attractive (Fig. 1). The grades of the AC which correspond to the numbers on the respective photographs, depicting the levels of treatment need are as follows:

  • AC Grades 1- 4: No need for orthodontic treatment.
  • AC Grade 5-7: Borderline / Moderate need for orthodontic treatment.
  • AC Grade 8-10: Definite need for orthodontic treatment.

The examination was carried out by one author (EAA) who had been previously calibrated in the use of the AC of the IOTN by a senior colleague (COO). None of the students had undergone any form of orthodontic treatment.

The students also assessed their own occlusions using the same scale (AC of the IOTN) and rated their occlusions according to the photograph which most closely matched the attractiveness of their own teeth.

INTRA EXAMINER RELIABILITY

Intra-examiner reliability was tested using Spearman Rank Correlation Coefficient. Sixty-two students were re-examined a month after their initial examination. A result of 0.94 was obtained, indicating excellent agreement.

STATISTICAL ANALYSES

The data was analyzed statistically using the SPSS statistical package (Statistical Package for the Social Sciences Version 17.0 for Windows 2009, SPSS, Inc., Chicago, Illinois). Descriptive statistics were used to describe the subjects’ perception of their dental aesthetics as compared to the normative assessment. T-test and chi-square statistics were used to analyse the data with statistical significance set at P<0.05. A matrix of Spearman Rank Order Correlation Coefficients was constructed for comparison of self-perceived dental aesthetics of the subjects with normative assessment. Logistic regression analysis was used to determine the influence of sex, age and self assessment of need by participants on professional assessment of need. Preliminary analyses were performed by using univariable models. Next, a multiple logistic regression analysis was then performed to remove the effects of age, sex and self-assessment of need which serve as the confounding factors to produce the adjusted odd’s ratios.

RESULTS

Table 1 shows the gender and age distribution of the sample comprising 299 (48.9%) males and 313 (51.1%) females with a mean age of 15 ± 2.0 years. The mean age for the males was 14.9 ± 1.9 years, whilst that for females was 15.0 ± 2.0.

Table 1

Distribution of the Participants According to Age and Gender




ORTHODONTIST PERCEPTION OF DENTAL AESTHETICS

Orthodontist rating revealed that 64.9% (397 students) had no need for treatment (grades 1–4), 17.5% (107 students) had a moderate need (grades 5–7) and 17.6% (108 students) had a definite aesthetic need (grades 8–10) for orthodontic treatment (Table 2).

Table 2

Gender Distribution of Self-Assessment and Professional (Orthodontist) Assessment of Dental Aesthetics of the Studied Population According to the Aesthetic Component of the Index of Orthodontic Treatment Need




ORTHODONTIST PERCEPTION COMPARED BY AGE AND GENDER

There were significant statistical differences between age, gender and the normative orthodontic need as assessed by the AC. Thirteen year-olds had the least orthodontic treatment need of 25% whilst 17 year-olds had the greatest need for treatment of 43.5%. Male students were statistically (p=0.00) found to have a greater need for treatment (41.5%) than female students (29.1%) (Table 3). A multivariate analysis revealed that as age increased by one unit, participants were 1.1 times more likely to have a professional need for treatment. Males were 1.76 times more likely to have professional need than females (Table 4).

Table 3

Relationship Between Age, Gender and Professional (Orthodontist) Assessment of Need According to the Aesthetic Component of the Index of Orthodontic Treatment Need




Table 4

Multivariable Logistic Regression to Examine the Predictors of Professional Assessment of Need




SELF PERCEPTION OF DENTAL AESTHETICS

However, when the students were asked to rate their own dental attractiveness, 505 (82.5%) scored their teeth as aesthetically acceptable (grades 1–4), 67 (10.9%) as moderate (grades 5–7) and 40 (6.5%) rated their teeth from grades 8 to 10 (Table 2).

SELF PERCEPTION COMPARED BY AGE AND GENDER

As depicted in Table 5, majority of the students in each age group rated their teeth towards the more attractive end of the scale. Though there was an increase in the proportion of older children (16 -18 years) rating their teeth in need of orthodontic treatment as compared with the younger schoolchildren, the difference was not statistically significant (p >0.05). There were almost equal numbers of male 55(18.4%) and female 52(16.7%) students rating themselves to be in need of orthodontic treatment. Hence, self perception is not statistically different between genders.

Table 5

Associations Between Age, Gender and Self-Assessment of Orthodontic Treatment Need According to the Aesthetic Component of the Index of Orthodontic Treatment Need




ASSOCIATIONS BETWEEN ORTHODONTIST PERCEPTION AND SELF-PERCEPTION

Using Pearson Correlation Coefficient, a weak but significant correlation was found between the orthodontist rating and the students’ self-perception (r = 0.24, P= 0.00). One hundred and eight students were rated by the orthodontist to have a definite aesthetic need for orthodontic treatment, out of which 22 also rated themselves likewise. Whilst 107 of the students were rated by the orthodontist as having a moderate need, only 16 were in agreement with this rating. Meanwhile, out of the 397 students assessed not to have a need, 351 of them rated themselves similarly (Table 6). The students who perceived themselves to have a need for treatment were 2.91 times more likely to have a professional need than those without a self-perceived need (Table 4).

Table 6

Associations Between Self-Assessment and Professional (Orthodontist) Assessment of Orthodontic Treatment Need According to the Aesthetic Component of the Index of Orthodontic Treatment Need




DISCUSSION

The perception that potential patients have of the need for orthodontic treatment cannot be ignored because it is these patients that gain satisfaction from improved aesthetics and even function [3 Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63., 4 Yeh M, Koochek A, Vlaskalic V, Boyd R, Richmond S. The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech and orthodontic treatment need Am J Orthod Dentofacial Orthop 2000; 118: 421-8., 10 Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents Am J Orthod Dentofacial Orthop 2005; 127: 700- 6.]. Thus, the knowledge of self- perception of malocclusion, assessment of orthodontic treatment need, (self-perceived as well as professional) and their comparisons for any given population are vital issues in modern orthodontic practice.

In Rivers State, Nigeria, where this study was carried out, the practice and teaching of orthodontics is relatively new. Thus, this cross-sectional study of self- perception of malocclusion in 612 randomly selected 12 – 18 year-old Nigerian secondary schoolchildren residing in Rivers State will provide valuable data for the adolescents residing in the State and allow for informed planning of orthodontic services.

Research has proven that most patients seek orthodontic treatment principally for aesthetic improvement [5 Onyeaso CO, Utomi IL, Ibekwe T. Emotional effects of malocclusion in Nigerian orthodontic patients J Contemp Dent Pract 2005; 6: 1-10., 25 Shaw WC. Factors influencing the desire for orthodontic treatment Eur J Orthod 1981; 3: 151-62.]. Teenagers, in particular have been found to attach great importance to an attractive dental appearance [3 Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63., 7 Onyeaso CO, Sanu OO. Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria Odontostomatol Trop 2005; 109: 39-48., 8 Onyeaso CO, Arowojolu MO. Perceived, desired and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents West Afr J Med 2003; 22: 5-9., 10 Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents Am J Orthod Dentofacial Orthop 2005; 127: 700- 6., 16 Flores-Mir C, Major PW, Salazar FR. Self-perceived orthodontic treatment need evaluated through 3 Scales in a university population J Orthod 2004; 31: 329-4., 26 Helm S, Petersen PE, Kreiborg S, Solow B. Effect of separate malocclusion traits on concern for dental appearance Commun Dent Oral Epidemiol 1986; 14: 217-0.] and have also been shown to have developed an oral perceptual awareness [27 Baldwin DC. Appearance and aesthetics in oral health Commun Dent Oral Epidemiol 1980; 8: 244-56., 28 Tulloch JFC, Shaw WC, Smith A. A comparison of attitudes towards orthodontic treatment in British and American communities Am J Orthod 1984; 85: 253-9.]. Adolescence is the time when concern over appearance and facial attractiveness is developing, which translates to an increased awareness of body image [6 Mugonzibwa EA, Kuijpers-Jagtman AM, Van't Hof MA, Kikwilu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children Am J Orthod Dentofacial Orthop 2004; 125: 426- 34.]. Thus, the self perception of malocclusion is an important parameter in treatment planning for adolescent populations.

In this study, using the AC, 17.5% of the students perceived a need for orthodontic treatment. This result is higher than that of a similar study carried out in South- Western Nigeria by Kolawole et al. [22 Kolawole KA, Otuyemi OD, Jeboda SO, Umweni AA. Awareness of malocclusion and desire for orthodontic treatment in 11-14 Year Old Nigerian schoolchildren and their parents Aust Orthod J 2008; 24: 21-5.] with treatment need of 8% in 11 – 14 year-olds and that obtained by Ngom et al. [29 Ngom PI, Diagne F, Dieye F, Diop-Ba K, Thiam F. Orthodontic treatment need and demand in Senegalese school children aged 12- 13 years Angle Orthod 2007; 2: 323-0.] in 12 to 13 year-olds in Senegal (13.9%). These differences may be as a result of ethnic variation and the wider age range of the adolescents in this present study. Ethnicity does have an effect on self-perceived need due to differences in acceptable facial appearances and what is deemed as acceptable occlusion by different ethnic groups, it would be useful to validate the IOTN in different ethnic groups. This figure (17.5%) is also higher than the subjective need found in the U.K. (6%) [30 Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O'Brien KA. Perceived aesthetic impact of malocclusion and oral self- perception in 14-15 year old Asian and Caucasian children in Greater Manchester Eur J Orthod 1999; 21: 175-83.], Jordan (9%) [19 Abu Alhajia ESJ, Al-Nimri KS, Al-Khateeb SN. Self-perception of malocclusion among Jordanian schoolchildren Eur J Orthod 2005; 27: 292-5.], Saudi Arabia (14.5%) [1 Albarakati SF. Self-perception of malocclusion of Saudi patients using the aesthetic component of the IOTN index Pak Oral Dent J 2007; 27: 45-51.], and Peru (12.8%) [31 Bernabe E, Flores-Mir C. Normative and self-perceived orthodontic treatment need of a Peruvian university population Head Face Med 2006; 2: 22.]. It is, however, comparable with 18.7% found in Saudi Arabia among 11-16 year-olds [20 Al-Sarheed M, Bedi R, Hunt NP. Orthodontic treatment need and self-perception of 11-16 year old Saudi Arabian children with sensory impairment attending special schools J Orthod 2003; 30: 39-44.] and 5.8% definite need obtained in Malaysia [24 Abdullah MSB, Rock WP. Perception of dental appearance using index of treatment need (aesthetic component) assessments Commun Dent Health 2002; 19: 161-5.] but much lower than 65% and 21.8% subjective need, respectively reported among visually and hearing impaired Saudi Arabian adolescents [20 Al-Sarheed M, Bedi R, Hunt NP. Orthodontic treatment need and self-perception of 11-16 year old Saudi Arabian children with sensory impairment attending special schools J Orthod 2003; 30: 39-44.].

In the present study, there were no significant age or gender differences in the participants’ self-perceived need for orthodontic treatment, and this is probably due to the subjects’ general lack of awareness of the presence of malocclusion. This finding is in agreement with a previous Nigerian study [8 Onyeaso CO, Arowojolu MO. Perceived, desired and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents West Afr J Med 2003; 22: 5-9.],where almost equal numbers of male (79.8%) and female (83.6%) participants respectively perceived a need for treatment (p>0.05) as well as other studies in U.K. [23 Burden DJ, Pine CM. Self-perception of malocclusion among adolescents Commun Dent Health 1995; 12: 89-92., 30 Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O'Brien KA. Perceived aesthetic impact of malocclusion and oral self- perception in 14-15 year old Asian and Caucasian children in Greater Manchester Eur J Orthod 1999; 21: 175-83.] Saudi Arabia [1 Albarakati SF. Self-perception of malocclusion of Saudi patients using the aesthetic component of the IOTN index Pak Oral Dent J 2007; 27: 45-51.] and U.S.A. [28 Tulloch JFC, Shaw WC, Smith A. A comparison of attitudes towards orthodontic treatment in British and American communities Am J Orthod 1984; 85: 253-9.] However, in other studies carried out in South-Western Nigeria [32 Otuyemi OD, Ugboko VI, Adekoya-Soforowa CA, Ndukwe KC. Unmet orthodontic treatment need in rural Nigerian adolescents Commun Dent Oral Epidemiol 1997; 25: 363-6.] and North Jordan [19 Abu Alhajia ESJ, Al-Nimri KS, Al-Khateeb SN. Self-perception of malocclusion among Jordanian schoolchildren Eur J Orthod 2005; 27: 292-5.], females and older school children tended to rate their dentition towards the more attractive end of the AC scale whereas in a Latvian study [33 Liepa A, Urtane I, Richmond S, Dunstan F. Orthodontic treatment need in Latvia Eur J Orthod 2003; 25: 279-84.], female children felt more in need of treatment than male children.

There were significant gender and age differences in the orthodontist’s assessment of treatment need, (p< 0.05). The increase of orthodontic treatment need with age seen in this study is probably due to the fact that untreated malocclusion worsens with age as the permanent occlusion becomes established [34 Onyeaso CO, BeGole EA. Associations between pretreatment age and treatment time with orthodontic treatment outcome: a comparison by means of two orthodontic indices Hell Orthod Rev 2008; 1: 8-20.]. When assessed professionally, male adolescents had a significantly greater need for treatment than females. This is consistent with the findings of Burden et al. [35 Burden DJ, Mitropoulos CM, Shaw WC. Residual orthodontic treatment need in a sample of 15 and 16 year-olds Br Dent J 1994; 176: 220-4.], but at variance with the findings by Onyeaso [36 Onyeaso CO. Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index Aust Orthod J 2004; 20: 19-23.] where more females were found to be in need of treatment than males. However, it must be noted that the finding by Onyeaso [36 Onyeaso CO. Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index Aust Orthod J 2004; 20: 19-23.] was in a demand population and more females sought orthodontic care in that Nigerian study. It also disagrees with the findings from other studies conducted in Nigeria [8 Onyeaso CO, Arowojolu MO. Perceived, desired and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents West Afr J Med 2003; 22: 5-9., 10 Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents Am J Orthod Dentofacial Orthop 2005; 127: 700- 6., 32 Otuyemi OD, Ugboko VI, Adekoya-Soforowa CA, Ndukwe KC. Unmet orthodontic treatment need in rural Nigerian adolescents Commun Dent Oral Epidemiol 1997; 25: 363-6., 37 Akpata ES, Jackson D. Overjet values in children and young adults in Lagos Commun Dent Oral Epidemiol 1979; 7: 174-6.], Tanzania [6 Mugonzibwa EA, Kuijpers-Jagtman AM, Van't Hof MA, Kikwilu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children Am J Orthod Dentofacial Orthop 2004; 125: 426- 34.], Senegal [29 Ngom PI, Diagne F, Dieye F, Diop-Ba K, Thiam F. Orthodontic treatment need and demand in Senegalese school children aged 12- 13 years Angle Orthod 2007; 2: 323-0.], France [38 Souames M, Bassigny F, Zenati N, Riordan PJ, Boy-Lefevre ML. Orthodontic treatment need in French schoolchildren: an epidemiological study using the index of orthodontic treatment need Eur J Orthod 2006; 28: 605-9.], Kuwait [18 Kerosuo H, Al Enezi S, Kerosuo E, Abdulkarim E. Association between normative and self-perceived orthodontic treatment need among Arab high school students Am J Orthod Dentofacial Orthop 2004; 125: 373-8.], Latvia [33 Liepa A, Urtane I, Richmond S, Dunstan F. Orthodontic treatment need in Latvia Eur J Orthod 2003; 25: 279-84.] and Iran [39 Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F. The relationship between the ICON index and aesthetic components of the IOTN index World J Orthod 2010; 11: 43-8.] where there were no gender or age differences. Although, our findings corroborate that of Burden et al. [35 Burden DJ, Mitropoulos CM, Shaw WC. Residual orthodontic treatment need in a sample of 15 and 16 year-olds Br Dent J 1994; 176: 220-4.], no adequate explanation can be made for this gender difference.

In this study, a weak but positive correlation between self - perceived and normative orthodontic treatment need according to the AC of the IOTN was obtained. This is comparable to that obtained in a study carried out on schoolchildren by Kolawole et al. [22 Kolawole KA, Otuyemi OD, Jeboda SO, Umweni AA. Awareness of malocclusion and desire for orthodontic treatment in 11-14 Year Old Nigerian schoolchildren and their parents Aust Orthod J 2008; 24: 21-5.] in Western Nigeria (r = 0.252, p=0.00) and Kerosuo et al. [18 Kerosuo H, Al Enezi S, Kerosuo E, Abdulkarim E. Association between normative and self-perceived orthodontic treatment need among Arab high school students Am J Orthod Dentofacial Orthop 2004; 125: 373-8.] (r = 0.209, p= 0.05) in Kuwait but lower than the figure obtained by Otuyemi et al. [32 Otuyemi OD, Ugboko VI, Adekoya-Soforowa CA, Ndukwe KC. Unmet orthodontic treatment need in rural Nigerian adolescents Commun Dent Oral Epidemiol 1997; 25: 363-6.] (r = 0.35) in a previous study also carried out much earlier in South-Western Nigeria.

CONCLUSIONS

A significant difference was found between the orthodontist’s rating and the students’ ratings of the attractiveness of their occlusions. Age and gender were not found to influence self- perceived orthodontic treatment need. Therefore, for effective orthodontic care, self- perception and not only professional assessment must be taken into consideration when formulating treatment plans to ensure patient satisfaction.

ACKNOWLEDGEMENT

None declared.

CONFLICTS OF INTEREST

None declared.

REFERENCES

[1] Albarakati SF. Self-perception of malocclusion of Saudi patients using the aesthetic component of the IOTN index Pak Oral Dent J 2007; 27: 45-51.
[2] Evans R, Shaw W. Preliminary evaluation of an illustrated scale for rating dental attractiveness Eur J Orthod 1987; 9: 314-8.
[3] Grzywacz I. The value of the aesthetic component of the index of orthodontic treatment need in the assessment of subjective orthodontic treatment need Eur J Orthod 2003; 25: 57-63.
[4] Yeh M, Koochek A, Vlaskalic V, Boyd R, Richmond S. The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech and orthodontic treatment need Am J Orthod Dentofacial Orthop 2000; 118: 421-8.
[5] Onyeaso CO, Utomi IL, Ibekwe T. Emotional effects of malocclusion in Nigerian orthodontic patients J Contemp Dent Pract 2005; 6: 1-10.
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[7] Onyeaso CO, Sanu OO. Psychosocial implications of malocclusion among 12-18 year old secondary school children in Ibadan, Nigeria Odontostomatol Trop 2005; 109: 39-48.
[8] Onyeaso CO, Arowojolu MO. Perceived, desired and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents West Afr J Med 2003; 22: 5-9.
[9] Bernabe E, Flores-Mir C. Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index Angle Orthod 2006; 76: 417-21.
[10] Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents Am J Orthod Dentofacial Orthop 2005; 127: 700- 6.
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[12] Al-Hamlan N, Al-Shraim N. Factors that influence perceptions of orthodontic treatment need: literature review Saudi Dent J 2008; 3: 11-20.
[13] Brook PH, Shaw WC. The development of an index of orthodontic treatment priority Eur J Orthod 1989; 11: 309- 20.
[14] Hamden M, Al-Omari IK, Al-Bitar ZB. Ranking dental aesthetics and thresholds of treatment need: a comparison between patients, parents and dentists Eur J Orthod 2007; 29: 366-71.
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[18] Kerosuo H, Al Enezi S, Kerosuo E, Abdulkarim E. Association between normative and self-perceived orthodontic treatment need among Arab high school students Am J Orthod Dentofacial Orthop 2004; 125: 373-8.
[19] Abu Alhajia ESJ, Al-Nimri KS, Al-Khateeb SN. Self-perception of malocclusion among Jordanian schoolchildren Eur J Orthod 2005; 27: 292-5.
[20] Al-Sarheed M, Bedi R, Hunt NP. Orthodontic treatment need and self-perception of 11-16 year old Saudi Arabian children with sensory impairment attending special schools J Orthod 2003; 30: 39-44.
[21] Abu Alhajia ESJ, Al-Nimri KS, Al-Khateeb SN. Orthodontic treatment need and demand in 12-14 year old North Jordanian schoolchildren Eur J Orthod 2004; 26: 261-3.
[22] Kolawole KA, Otuyemi OD, Jeboda SO, Umweni AA. Awareness of malocclusion and desire for orthodontic treatment in 11-14 Year Old Nigerian schoolchildren and their parents Aust Orthod J 2008; 24: 21-5.
[23] Burden DJ, Pine CM. Self-perception of malocclusion among adolescents Commun Dent Health 1995; 12: 89-92.
[24] Abdullah MSB, Rock WP. Perception of dental appearance using index of treatment need (aesthetic component) assessments Commun Dent Health 2002; 19: 161-5.
[25] Shaw WC. Factors influencing the desire for orthodontic treatment Eur J Orthod 1981; 3: 151-62.
[26] Helm S, Petersen PE, Kreiborg S, Solow B. Effect of separate malocclusion traits on concern for dental appearance Commun Dent Oral Epidemiol 1986; 14: 217-0.
[27] Baldwin DC. Appearance and aesthetics in oral health Commun Dent Oral Epidemiol 1980; 8: 244-56.
[28] Tulloch JFC, Shaw WC, Smith A. A comparison of attitudes towards orthodontic treatment in British and American communities Am J Orthod 1984; 85: 253-9.
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