- Email: [email protected]
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects
Original Article
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects Archana Jatania, bds mds*, Shivalinga BM, bds mds** *Postgraduate Student, **Professor and In charge of PG Studies, Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, Mysore, Karnataka, India.
Abstract Facial esthetics has been suggested as one of the most important variables in terms of an individual’s own self-esteem and social acceptance. With a growing trend toward a beautiful face, and a perfect smile the profession of dentistry has become a challenge. The knowledge and attitude of the people have changed toward the field of dentistry. There have been lots of studies conducted on the attitude of the patients toward dentistry. The present study was conducted to evaluate and compare the attitude, knowledge, and the practices among a group of treated and untreated patients. A questionnaire consisting of 20 questions regarding the knowledge, attitude toward treatment and orthodontist, and oral hygiene practices was prepared and 200 subjects (100 treated and 100 untreated) were asked to complete it. Previously treated subjects were found to have a significantly more positive attitude toward treatment, had a better knowledge regarding treatment, and followed better oral hygiene practices. Keywords: Attitude, facial esthetics, knowledge, practices
INTRODUCTION Facial esthetics has been suggested as one of the most important variables in terms of an individual’s own self-esteem and social acceptance.1 With a growing trend toward a beautiful face and a perfect smile, the profession of orthodontics has become a challenge. Orthodontists have a special interest in beauty and esthetics. Wahl wrote, “Now it appears that facial esthetics is again in the forefront as we realize why patients come to us in the first place.”2 Most orthodontic patients are children or adolescents. In consequence their guardians are likely to play an important role in initiating treatment and supporting compliance. Baldwin3 reviewed literature on appearance and esthetics in oral health. He suggested there was some evidence that parents occasionally sought to solve problems on their own selfconcept by identifying with their children, orthodontically. According to a study conducted in the USA, orthodontic
Correspondence: Dr. Archana Jatania, Postgraduate Student, Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, Mysore, Karnataka, India. E-mail: [email protected] Received: 09.07.2011 Accepted: 05.09.2011 © 2011 Indian Journal of Dentistry. Published by Elsevier Ltd.
treatment is regarded as a status symbol, available on demand to a privileged section of the community. It has also been reported that parents who are former orthodontic patients are more likely to approve of orthodontic care and to perceive a need for it in their child.4 A general problem in orthodontics is that patients can interrupt their treatment. An orthodontist plays a very vital role in maintaining compliance by encouraging the patient, giving positive feedback, and communicating with the patient.5,6 Studies have suggested that patients’ satisfaction with their orthodontist is a primary determinant of whether they seek preventive and treatment-related orthodontic care. People who are dissatisfied with the interpersonal aspects of their dentists’ treatment tend to avoid care and jeopardize their dental health.7 Knowledge of the elements of care that affect patient regard may help orthodontists enhance their relationships with patients and thus, improve their own well-being. It is also important that the profession frequently monitor patients’ attitudes toward their treatment and themselves. Enhanced understanding of patients’ perceptions can help practicing orthodontists gain a better understanding of public perceptions of themselves and of their profession. It is hypothesized that orthodontically treated subjects have a more positive attitude toward treatment partly by the fact 81
Jatania and Shivalinga
that orthodontist induce in their patients a zeal not only to co-operate during treatment but also to maintain their oral hygiene status. So, the aims of the present study are to evaluate and compare the knowledge, attitude, and practices of untreated and treated orthodontic subjects which will help us in understanding certain aspects of public and patients perception of treatment.
MATERIALS AND METHOD Subjects As one of the aims of the study was to compare the effect of orthodontic experience on subjects’ attitudes toward orthodontics, it was necessary to select a large group of relatively young subjects with and without orthodontic experience but with similar other relevant characteristics. The difference in gender was not considered in the study. In total, 200 subjects (100 treated and 100 untreated) participated in the study. The subjects selected were MBBS students in the age group of 20–23 years. Questionnaire A questionnaire was prepared based on the dental attitude, practices, and the knowledge of the subjects. The questionnaire consisted of 20 questions—6 questions pertaining to the subjects’ knowledge about orthodontic treatment and braces, 11 questions pertaining to the attitude of the subjects toward the orthodontist and toward the treatment, and 3 questions pertaining to oral hygiene practices followed by the subjects. Items could be answered on a 5-point scale (1—completely agree and 5—completely disagree). Statistical Analysis Using Statistical Package for the Social Sciences (SPSS) version 10, the scale and item characteristics of the questionnaire were determined. Positive questions were scored on a scale of 5–1 while negative question were scored on a scale of 1–5. Items formulated positively were rescored, so that a high score indicated a positive attitude toward orthodontics. As recommended by Bonferroni, in order to reduce the type 1 error rate, for every individual t-test the critical significance level was adjusted to 0.01. A one-tailed sign test was used to establish whether either group differed in their general attitude toward orthodontics.
RESULTS The reliability of the questionnaire for both, treated and untreated subjects, was satisfactory (Cronbach’s α value = 0.81 and 0.75, respectively). 82
For 14 items, previously treated subjects scored more positively: in 6, the difference reached significance (p <0.01). For 6 items, the untreated subjects scored higher and 2 of which reached a significant value (p <0.01). A one-tailed sign test revealed a significant difference between untreated and previously treated subjects (p = 0.010) and the Student’s t-test for the total scores was also significant. All the questions pertaining to the oral hygiene practices were found to have a higher score in the treated subjects and one of which reached a significant value (p <0.01). Subjects who had undergone treatment were more concerned about their oral hygiene practices and the use of mouthwash (mean score for treated subjects 2.5 ± 0.5 and for untreated subjects 2.3 ± 0.3). The questions pertaining to knowledge—most of the questions showed more knowledge in the treated subjects but the difference was not statistically significant (p >0.01). Questions pertaining to attitude—there was a higher score for the subjects who had already undergone treatment with 5 questions having significant values (p <0.01). Regular visits to the orthodontists, maintaining the appointments, problems faced during treatment, following the instructions of the orthodontists, and the use of retainers were all better managed by the treated subjects. Experiences with the treatment result, appliances, the orthodontist, treatment duration, follow-up appointments, and compliance were significantly correlated with a subject’s general attitude toward orthodontics. The results of the multiple regression analysis confirmed these correlations (Table 1). Table 2 shows the correlations between the sum scores on the different subscales with general attitude toward orthodontics.
DISCUSSION The hypothesis that previously treated subjects had a more positive attitude toward orthodontist and orthodontic treatment than the untreated subjects is confirmed in the present study. In an earlier study conducted in Netherlands, it was seen that the treated orthodontic subjects had a more positive attitude toward treatment and it was concluded that age, not gender, was considered an important criteria for co-operation.8 Table 1 Regression analysis. General attitude toward orthodontics
Experiences with
Treatment result Braces Orthodontist Treatment duration Follow-up appointments Compliance Oral hygiene Diet
b
p
0.14 0.02 0.36 0.10 0.23 0.13 −0.04 0.09
<0.01*
0.08 <0.01*
0.10 <0.01*
0.03 0.45 0.08
*p <0.01 (Statistically significant).
© Indian Journal of Dentistry 2011/Volume 2/Issue 3
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects
QUESTIONNAIRE Age: __________ years 1. Braces cause a lot of problem. Completely agree 䊐 Agree 䊐
Neutral 䊐
2. When you wear braces you need to adjust to your dietary habits. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
Disagree 䊐
Completely disagree 䊐
3. Orthodontists often say that you have to wear your braces more often than is necessary. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
4. It is no problem visiting the orthodontist regularly. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
5. It is necessary to brush your teeth more often when you are wearing braces. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
6. It is nice to wear braces. Completely agree 䊐
Agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
8. Recommendations of orthodontist are often easy to follow. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
9. The duration of orthodontic treatment is 2 years or more. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
10. People wearing braces do not look good. Agree 䊐 Completely agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
11. It is no use visiting an orthodontist time and again. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
12. Other people see immediately whether you are wearing braces or not. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
13. Orthodontists are generally nice. Completely agree 䊐 Agree 䊐
Completely disagree 䊐
7. Orthodontic treatment has often no use at all. Completely agree 䊐 Agree 䊐
Neutral 䊐
Disagree 䊐
14. It is not a problem at all when you stop treatment as soon as your teeth became straight. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
15. You are not supposed to have certain food and drinks when undergoing orthodontic treatment. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐 Completely disagree 䊐 16. The use of mouth rinse is necessary. Completely agree 䊐 Agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
17. It is difficult to recall appointments with the orthodontist. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
18. Orthodontist takes very little time with their patients. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
19. It does not matter if you wear braces for less time as recommended by the orthodontist. Agree 䊐 Neutral 䊐 Disagree 䊐 Completely agree 䊐
Completely disagree 䊐
20. People who have had orthodontic treatment often have pretty teeth. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
© Indian Journal of Dentistry 2011/Volume 2/Issue 3
83
Jatania and Shivalinga Table 2 Correlations between sum scores of previously treated subjects on different subscales and their general attitude toward orthodontics. Experiences with
Treatment result Braces Orthodontist Treatment duration Follow-up appointments Compliance Oral hygiene Diet General attitude
Treatment result
1.00 0.25* 0.40* 0.29* 0.14 0.25* 0.11 0.01 0.35*
Braces
Orthodontist
Duration
1.00 0.46* 0.42 0.40* 0.35* −0.11 −0.13 0.36*
1.00 0.56* 0.46 0.36* 0.07 −0.11 0.59*
1.00 0.42* 0.33* 0.05 −0.02 0.47*
Follow-up appointments
1.00 0.49* −0.01 −0.04 0.53*
Compliance
1.00 0.25* 0.11 0.47*
Oral hygiene
1.00 0.23* 0.08
Diet
1.00 0.05
General attitude
1.00
*p <0.01 (2-tailed).
The co-operative orthodontic patient has been described in many studies that identified the patient by demographic and personal characteristics, such as age, sex, social class, personality type, and severity of malocclusion. Since the sex of the patient is one of the easiest attribute variables to assess, it is frequently reported although it may not be the central question of the study. Of 8 studies relating gender to various aspects of orthodontic co-operation, 3 reported girls to be more co-operative than boys and 5 found no difference between the sexes.9–11 Age was found to be a significant predictor of the subject’s general attitude toward orthodontics. Although previous studies8 have shown that age does play a role in the levels of co-operation in the present study, a group of young adults with high levels of education was included to obtain a homogenous sample with respect to age and educational background, which is known to have a substantial influence on oral-health attitudes and behavior.12 Higher socio-economic groups tend to co-operate more than lower socio-economic groups. This may be due to differences in values of facial esthetics. For example, higher socioeconomic groups may believe that malocclusion and the associated facial disharmony might have a social influence and could hinder their chances of obtaining jobs, running for public office, or succeeding in their social relationships.13 However, Dorsey and Korabik14 found that lower middle class patients considered orthodontic treatment to be more important than the upper middle class patients. In this study, the subjects included were all of similar socio-economic status so the factor of socio-economic status was not taken into consideration. Patients with previous history of orthodontic treatment showed better oral hygiene practices partly because of the special efforts and skills required for adequate oral hygiene during fixed appliance treatment. With professional instruction and monitoring, improvement of oral-hygiene practices was seen.15 The attitudes of previously treated subjects toward orthodontics in general were predicted by the way they perceived their relationship with their orthodontist, attitude toward braces, and follow-up appointments. The oral hygiene practices followed by the group of subjects who had undergone 84
an orthodontic treatment were better than the subjects who had not undergone treatment partly because of the constant reinforcement of the oral hygiene practices by the orthodontist. The results of this study indicate that the general attitude, knowledge, and practices of the subjects toward orthodontics are not predicted by any specific factor of treatment but a combination of various factors like the treatment result (esthetics), positive reinforcement by the orthodontist, and an improvement in occlusion. The different attitudes toward orthodontics of previously treated subjects compared with untreated subjects, at least partially, can be explained by cognitive dissonance. It has been suggested that patients, who, after prolonged orthodontic treatment report that they are satisfied with treatment results, do so because they feel the need to justify what they have gone through. Although the subjects were fairly similar according to demographic characteristics, the treated subjects in the study had a fairly good occlusion.
CONCLUSION Whether the present findings will generalize beyond the current study population will have to be answered in a follow-up investigation. Furthermore, as the type of orthodontic treatment, the age of the patients, and the gender differences were not taken into account in the present study, it is recommended that in future studies they have to be analyzed more specifically.
CONFLICT OF INTEREST None.
REFERENCES 1. Sari Z, Uysal T, Karaman AI, Sargin N, Ure O. Does orthodontic treatment affect patients’ and parents’ anxiety levels? Eur J Orthod 2005; 27:155–9. 2. Wahl N. Orthodontics in 3 millenia. Chapter 1: antiquity to the mid19th century. Am J Orthod Dentofacial Orthop 2005;127:255–9. 3. Baldwin DC. Appearance and aesthetics in oral health. Community Dentistry and Oral Epidemiology 1980;8:244–56. © Indian Journal of Dentistry 2011/Volume 2/Issue 3
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects 4. Pietilä T, Pietilä I. Parents’ views on their own child’s dentition compared with an orthodontist’s assessment. Eur J Orthod 1994;16: 309–16. 5. Mehra T, Nanda RS, Sinha PK. Orthodontists’ assessment and management of patient compliance. Angle Orthod 1998;68:115–22. 6. Nanda RS, Kierl MJ. Prediction of cooperation of orthodontic treatment. Am J Orthod Dentofacial Orthop 1992;102:15–21. 7. DiMatteo MR, McBride CA, Shugars DA, O’Neil EH. Public attitudes toward dentists: a US household survey. J Am Dent Assoc 1995;126: 1563–70. 8. Bos A, Hoogstraten J, Prahl-Andersen B. Attitudes toward orthodontic treatment: a comparison of treated and untreated subjects. Eur J Orthod 2005;27:148–54. 9. Clemmer EJ, Hayes EW. Patient cooperation in wearing orthodontic headgear. Am J Orthod 1979;75:517–24.
© Indian Journal of Dentistry 2011/Volume 2/Issue 3
10. Allan TK, Hodgson EW. The use of personality measurements as a determinant of patient cooperation in an orthodontic practice. Am J Orthod 1968;54:433–9. 11. Swetlik WP. A behavioral evaluation of patient cooperation in the use of extraoral elastic and coil spring traction devices. Am J Orthod 1978;74:687. 12. Eklund S, Burt BA. Tooth loss, dental caries and quality of life: a public health perspective. In: Oral Health-related Quality of Life Inglehart M, Bagramian RA, eds. Chicago: Quintessence 2002:65–78. 13. Graber TM, Swain BF. In: Orthodontics: Current Principles and Techniques St. Louis: CV Mosby 1985:20. 14. Dorsey J, Korabik K. Social and psychological motivations for orthodontic treatment. Am J Orthod 1977;72:460. 15. Klages U, Bruckner A, Guld Y, Zentner A. Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults. Am J Orthod Dentofacial Orthop 2005;128:442–9.
85
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects Archana Jatania, bds mds*, Shivalinga BM, bds mds** *Postgraduate Student, **Professor and In charge of PG Studies, Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, Mysore, Karnataka, India.
Abstract Facial esthetics has been suggested as one of the most important variables in terms of an individual’s own self-esteem and social acceptance. With a growing trend toward a beautiful face, and a perfect smile the profession of dentistry has become a challenge. The knowledge and attitude of the people have changed toward the field of dentistry. There have been lots of studies conducted on the attitude of the patients toward dentistry. The present study was conducted to evaluate and compare the attitude, knowledge, and the practices among a group of treated and untreated patients. A questionnaire consisting of 20 questions regarding the knowledge, attitude toward treatment and orthodontist, and oral hygiene practices was prepared and 200 subjects (100 treated and 100 untreated) were asked to complete it. Previously treated subjects were found to have a significantly more positive attitude toward treatment, had a better knowledge regarding treatment, and followed better oral hygiene practices. Keywords: Attitude, facial esthetics, knowledge, practices
INTRODUCTION Facial esthetics has been suggested as one of the most important variables in terms of an individual’s own self-esteem and social acceptance.1 With a growing trend toward a beautiful face and a perfect smile, the profession of orthodontics has become a challenge. Orthodontists have a special interest in beauty and esthetics. Wahl wrote, “Now it appears that facial esthetics is again in the forefront as we realize why patients come to us in the first place.”2 Most orthodontic patients are children or adolescents. In consequence their guardians are likely to play an important role in initiating treatment and supporting compliance. Baldwin3 reviewed literature on appearance and esthetics in oral health. He suggested there was some evidence that parents occasionally sought to solve problems on their own selfconcept by identifying with their children, orthodontically. According to a study conducted in the USA, orthodontic
Correspondence: Dr. Archana Jatania, Postgraduate Student, Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, Mysore, Karnataka, India. E-mail: [email protected] Received: 09.07.2011 Accepted: 05.09.2011 © 2011 Indian Journal of Dentistry. Published by Elsevier Ltd.
treatment is regarded as a status symbol, available on demand to a privileged section of the community. It has also been reported that parents who are former orthodontic patients are more likely to approve of orthodontic care and to perceive a need for it in their child.4 A general problem in orthodontics is that patients can interrupt their treatment. An orthodontist plays a very vital role in maintaining compliance by encouraging the patient, giving positive feedback, and communicating with the patient.5,6 Studies have suggested that patients’ satisfaction with their orthodontist is a primary determinant of whether they seek preventive and treatment-related orthodontic care. People who are dissatisfied with the interpersonal aspects of their dentists’ treatment tend to avoid care and jeopardize their dental health.7 Knowledge of the elements of care that affect patient regard may help orthodontists enhance their relationships with patients and thus, improve their own well-being. It is also important that the profession frequently monitor patients’ attitudes toward their treatment and themselves. Enhanced understanding of patients’ perceptions can help practicing orthodontists gain a better understanding of public perceptions of themselves and of their profession. It is hypothesized that orthodontically treated subjects have a more positive attitude toward treatment partly by the fact 81
Jatania and Shivalinga
that orthodontist induce in their patients a zeal not only to co-operate during treatment but also to maintain their oral hygiene status. So, the aims of the present study are to evaluate and compare the knowledge, attitude, and practices of untreated and treated orthodontic subjects which will help us in understanding certain aspects of public and patients perception of treatment.
MATERIALS AND METHOD Subjects As one of the aims of the study was to compare the effect of orthodontic experience on subjects’ attitudes toward orthodontics, it was necessary to select a large group of relatively young subjects with and without orthodontic experience but with similar other relevant characteristics. The difference in gender was not considered in the study. In total, 200 subjects (100 treated and 100 untreated) participated in the study. The subjects selected were MBBS students in the age group of 20–23 years. Questionnaire A questionnaire was prepared based on the dental attitude, practices, and the knowledge of the subjects. The questionnaire consisted of 20 questions—6 questions pertaining to the subjects’ knowledge about orthodontic treatment and braces, 11 questions pertaining to the attitude of the subjects toward the orthodontist and toward the treatment, and 3 questions pertaining to oral hygiene practices followed by the subjects. Items could be answered on a 5-point scale (1—completely agree and 5—completely disagree). Statistical Analysis Using Statistical Package for the Social Sciences (SPSS) version 10, the scale and item characteristics of the questionnaire were determined. Positive questions were scored on a scale of 5–1 while negative question were scored on a scale of 1–5. Items formulated positively were rescored, so that a high score indicated a positive attitude toward orthodontics. As recommended by Bonferroni, in order to reduce the type 1 error rate, for every individual t-test the critical significance level was adjusted to 0.01. A one-tailed sign test was used to establish whether either group differed in their general attitude toward orthodontics.
RESULTS The reliability of the questionnaire for both, treated and untreated subjects, was satisfactory (Cronbach’s α value = 0.81 and 0.75, respectively). 82
For 14 items, previously treated subjects scored more positively: in 6, the difference reached significance (p <0.01). For 6 items, the untreated subjects scored higher and 2 of which reached a significant value (p <0.01). A one-tailed sign test revealed a significant difference between untreated and previously treated subjects (p = 0.010) and the Student’s t-test for the total scores was also significant. All the questions pertaining to the oral hygiene practices were found to have a higher score in the treated subjects and one of which reached a significant value (p <0.01). Subjects who had undergone treatment were more concerned about their oral hygiene practices and the use of mouthwash (mean score for treated subjects 2.5 ± 0.5 and for untreated subjects 2.3 ± 0.3). The questions pertaining to knowledge—most of the questions showed more knowledge in the treated subjects but the difference was not statistically significant (p >0.01). Questions pertaining to attitude—there was a higher score for the subjects who had already undergone treatment with 5 questions having significant values (p <0.01). Regular visits to the orthodontists, maintaining the appointments, problems faced during treatment, following the instructions of the orthodontists, and the use of retainers were all better managed by the treated subjects. Experiences with the treatment result, appliances, the orthodontist, treatment duration, follow-up appointments, and compliance were significantly correlated with a subject’s general attitude toward orthodontics. The results of the multiple regression analysis confirmed these correlations (Table 1). Table 2 shows the correlations between the sum scores on the different subscales with general attitude toward orthodontics.
DISCUSSION The hypothesis that previously treated subjects had a more positive attitude toward orthodontist and orthodontic treatment than the untreated subjects is confirmed in the present study. In an earlier study conducted in Netherlands, it was seen that the treated orthodontic subjects had a more positive attitude toward treatment and it was concluded that age, not gender, was considered an important criteria for co-operation.8 Table 1 Regression analysis. General attitude toward orthodontics
Experiences with
Treatment result Braces Orthodontist Treatment duration Follow-up appointments Compliance Oral hygiene Diet
b
p
0.14 0.02 0.36 0.10 0.23 0.13 −0.04 0.09
<0.01*
0.08 <0.01*
0.10 <0.01*
0.03 0.45 0.08
*p <0.01 (Statistically significant).
© Indian Journal of Dentistry 2011/Volume 2/Issue 3
Comparison of knowledge, attitude and practices of untreated and treated orthodontic subjects
QUESTIONNAIRE Age: __________ years 1. Braces cause a lot of problem. Completely agree 䊐 Agree 䊐
Neutral 䊐
2. When you wear braces you need to adjust to your dietary habits. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
Disagree 䊐
Completely disagree 䊐
3. Orthodontists often say that you have to wear your braces more often than is necessary. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
4. It is no problem visiting the orthodontist regularly. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
5. It is necessary to brush your teeth more often when you are wearing braces. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
6. It is nice to wear braces. Completely agree 䊐
Agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
8. Recommendations of orthodontist are often easy to follow. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
9. The duration of orthodontic treatment is 2 years or more. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
10. People wearing braces do not look good. Agree 䊐 Completely agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
11. It is no use visiting an orthodontist time and again. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
12. Other people see immediately whether you are wearing braces or not. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
13. Orthodontists are generally nice. Completely agree 䊐 Agree 䊐
Completely disagree 䊐
7. Orthodontic treatment has often no use at all. Completely agree 䊐 Agree 䊐
Neutral 䊐
Disagree 䊐
14. It is not a problem at all when you stop treatment as soon as your teeth became straight. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
15. You are not supposed to have certain food and drinks when undergoing orthodontic treatment. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐 Completely disagree 䊐 16. The use of mouth rinse is necessary. Completely agree 䊐 Agree 䊐
Neutral 䊐
Disagree 䊐
Completely disagree 䊐
17. It is difficult to recall appointments with the orthodontist. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
18. Orthodontist takes very little time with their patients. Completely agree 䊐 Agree 䊐 Neutral 䊐
Disagree 䊐
Completely disagree 䊐
19. It does not matter if you wear braces for less time as recommended by the orthodontist. Agree 䊐 Neutral 䊐 Disagree 䊐 Completely agree 䊐
Completely disagree 䊐
20. People who have had orthodontic treatment often have pretty teeth. Completely agree 䊐 Agree 䊐 Neutral 䊐 Disagree 䊐
Completely disagree 䊐
© Indian Journal of Dentistry 2011/Volume 2/Issue 3
83
Jatania and Shivalinga Table 2 Correlations between sum scores of previously treated subjects on different subscales and their general attitude toward orthodontics. Experiences with
Treatment result Braces Orthodontist Treatment duration Follow-up appointments Compliance Oral hygiene Diet General attitude
Treatment result
1.00 0.25* 0.40* 0.29* 0.14 0.25* 0.11 0.01 0.35*
Braces
Orthodontist
Duration
1.00 0.46* 0.42 0.40* 0.35* −0.11 −0.13 0.36*
1.00 0.56* 0.46 0.36* 0.07 −0.11 0.59*
1.00 0.42* 0.33* 0.05 −0.02 0.47*
Follow-up appointments
1.00 0.49* −0.01 −0.04 0.53*
Compliance
1.00 0.25* 0.11 0.47*
Oral hygiene
1.00 0.23* 0.08
Diet
1.00 0.05
General attitude
1.00
*p <0.01 (2-tailed).
The co-operative orthodontic patient has been described in many studies that identified the patient by demographic and personal characteristics, such as age, sex, social class, personality type, and severity of malocclusion. Since the sex of the patient is one of the easiest attribute variables to assess, it is frequently reported although it may not be the central question of the study. Of 8 studies relating gender to various aspects of orthodontic co-operation, 3 reported girls to be more co-operative than boys and 5 found no difference between the sexes.9–11 Age was found to be a significant predictor of the subject’s general attitude toward orthodontics. Although previous studies8 have shown that age does play a role in the levels of co-operation in the present study, a group of young adults with high levels of education was included to obtain a homogenous sample with respect to age and educational background, which is known to have a substantial influence on oral-health attitudes and behavior.12 Higher socio-economic groups tend to co-operate more than lower socio-economic groups. This may be due to differences in values of facial esthetics. For example, higher socioeconomic groups may believe that malocclusion and the associated facial disharmony might have a social influence and could hinder their chances of obtaining jobs, running for public office, or succeeding in their social relationships.13 However, Dorsey and Korabik14 found that lower middle class patients considered orthodontic treatment to be more important than the upper middle class patients. In this study, the subjects included were all of similar socio-economic status so the factor of socio-economic status was not taken into consideration. Patients with previous history of orthodontic treatment showed better oral hygiene practices partly because of the special efforts and skills required for adequate oral hygiene during fixed appliance treatment. With professional instruction and monitoring, improvement of oral-hygiene practices was seen.15 The attitudes of previously treated subjects toward orthodontics in general were predicted by the way they perceived their relationship with their orthodontist, attitude toward braces, and follow-up appointments. The oral hygiene practices followed by the group of subjects who had undergone 84
an orthodontic treatment were better than the subjects who had not undergone treatment partly because of the constant reinforcement of the oral hygiene practices by the orthodontist. The results of this study indicate that the general attitude, knowledge, and practices of the subjects toward orthodontics are not predicted by any specific factor of treatment but a combination of various factors like the treatment result (esthetics), positive reinforcement by the orthodontist, and an improvement in occlusion. The different attitudes toward orthodontics of previously treated subjects compared with untreated subjects, at least partially, can be explained by cognitive dissonance. It has been suggested that patients, who, after prolonged orthodontic treatment report that they are satisfied with treatment results, do so because they feel the need to justify what they have gone through. Although the subjects were fairly similar according to demographic characteristics, the treated subjects in the study had a fairly good occlusion.
CONCLUSION Whether the present findings will generalize beyond the current study population will have to be answered in a follow-up investigation. Furthermore, as the type of orthodontic treatment, the age of the patients, and the gender differences were not taken into account in the present study, it is recommended that in future studies they have to be analyzed more specifically.
CONFLICT OF INTEREST None.
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10. Allan TK, Hodgson EW. The use of personality measurements as a determinant of patient cooperation in an orthodontic practice. Am J Orthod 1968;54:433–9. 11. Swetlik WP. A behavioral evaluation of patient cooperation in the use of extraoral elastic and coil spring traction devices. Am J Orthod 1978;74:687. 12. Eklund S, Burt BA. Tooth loss, dental caries and quality of life: a public health perspective. In: Oral Health-related Quality of Life Inglehart M, Bagramian RA, eds. Chicago: Quintessence 2002:65–78. 13. Graber TM, Swain BF. In: Orthodontics: Current Principles and Techniques St. Louis: CV Mosby 1985:20. 14. Dorsey J, Korabik K. Social and psychological motivations for orthodontic treatment. Am J Orthod 1977;72:460. 15. Klages U, Bruckner A, Guld Y, Zentner A. Dental esthetics, orthodontic treatment, and oral-health attitudes in young adults. Am J Orthod Dentofacial Orthop 2005;128:442–9.
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