Magister Scientiae Dentium - MSc(Dent) / In modern day dentistry, aesthetics forms an integral part of our social perception almost as much as functionality. Malocclusion has been brought to the forefront of developmental anomalies as it can affect mastication, speech as well as the appearance of the face. Furthermore, pre-pubertal and pubertal changes have compounded existing malocclusions in this growth period thus spiraling the need for orthodontic treatment. Therefore, it is essential to determine the normative and selfperceived need for orthodontic treatment in a population. The epidemiological data collected can be used to facilitate policy changes to manage malocclusion in Khomas, Namibia. Aim: The aim of this study was to determine the orthodontic treatment needs of a population of 12-15 year-old children attending a school in Khomas and to express it as percentages of those with subjective and objective orthodontic treatment need over the whole sample population. The objectives were to find associations between treatment needs and some demographic and socioeconomic factors.

Magister Scientiae Dentium - MSc(Dent) / Introduction: Improvement of aesthetics is often the reason patients seek orthodontic treatment. The ability to accurately assess aesthetic treatment need from the viewpoint of the patient is necessary. The threshold for orthodontic treatment is not constant in all countries and no previous attempts to determine this threshold has been made in South Africa. By ensuring that patient’s perceptions of treatment need are incorporated into the index chosen to assess perceived need, accurate data can be obtained. Determining perceived need from the patient’s viewpoint is important, and understanding its relationship with perceived need according to the professional, as well as normative need can facilitate better patient communication and management of expectations. Aims: There were three main aims of this study. First, South African children’s perceptions of treatment need according to the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was assessed to determine if they were similar to those of the dentists who established the threshold, or if the threshold of the grading system should be altered to better suit laypeople’s opinions. Second, the newly established threshold could then be used to determine the perceived needs for orthodontic treatment, and compare them to the normative need of the population. Finally, factors that may influence the perceived needs of the patients such as gender, ethnicity and socio-economic position could be investigated. Methodology: A cross-sectional study on 317 children aged between 11 and 14 years was done. 43.8% were male and 56.2 % were female. The sample was chosen from five schools in the Lekwa District of Mpumalanga using a multi-stage sampling technique. The study population comprised of four groups based on ethnicity; Asian (3%), black (74%), coloured (6%) and white (17%). The socio-economic position (SEP) was determined by Principal Component Analysis of household assets. Societal perceived, subjective perceived and self-perceived needs were assessed using a questionnaire and the child-rated AC of the IOTN. An intra-oral examination was conducted using the AC of the IOTN to assess objective perceived need and the modified Dental Health Component (DHC) of the IOTN to assess normative treatment need. Results: Treatment threshold was determined to be grade 3 of the AC of the IOTN according to societal perceived need of the group of South African children, and was confirmed by self-perceived need. Subjective perceived need for treatment was assessed using the AC grade participants felt best reflected their aesthetic impairment, and was found to be 20.2%, compared to actual self-perceived need of 38.5%. The latter was deduced by comparing the child-rated AC (subjective perceived need) to their perception of treatment need of that grade (societal perceived need). The objective perceived need measured by the examiner-rated AC was 60%. Definite need for orthodontic treatment based on the modified DHC of the IOTN was 41.2%. No significant difference between societal perceived or self-perceived need and gender or socio-economic position was found. White children have lower societal perceived treatment need regarding others’ aesthetic impairment. Conclusion: The treatment threshold grade should be lowered to better represent the societal perceived and self-perceived need of the South African population. Normative need was higher than perceived needs from the patients’ point of view (subjective perceived and self-perceived need), but lower than the perceived need from the professional’s point of view (objective perceived need). Ethnicity was found to have an influence on societal perceived need.

Magister Scientiae Dentium - MSc(Dent) / When considering a person's self-esteem, behavioural patterns and personal interactions, the one feature having the most impact is their physical appearance. In an ideal world, every person should have a fair opportunity to reach their full potential in life. Orthodontics can improve a person's quality of life by creating confident smiles and a functional occlusion (Sheiham, 1993). Uncorrected malocclusions can adversely affect one's speech, general health and self-esteem. Improving the general physiological implications malocclusions has on person, may make them more employable and more successful in relationships, creating an overall happier, healthier and more successful community. The more people are offered affordable orthodontic treatment, the more acceptable orthodontic treatment may become. Thus, the perceived benefits of Orthodontic treatment in a population group are Improvement of Oral Health and enhancement of psychosocial welfare. Accurate data on the prevalence, distribution and severity of malocclusion is needed by provincial oral health management. They also need accurate data of the orthodontic treatment need of the children in that specific area. This data is vital for the effective planning of the education, training and deployment of dental workers, as well as the resources and distribution thereof in specific, designated areas (Holtshousen, 1997; So & Tang, 1993). This study's focus was to estimate the prevalence of malocclusion amongst adolescents in Upington area in the Northern Cape, and to determine the need for orthodontic treatment in the area using the Index for Orthodontic Treatment Need (IOTN).

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O objetivo do presente estudo foi estimar a prevalÃncia da maloclusÃo e a necessidade de tratamento ortodÃntico em adolescentes de Fortaleza e graduÃ-la de acordo com sua severidade, a fim de estabelecer prioridades para o tratamento ortodÃntico e determinar quais os componentes da maloclusÃo que mais pesavam na determinaÃÃo desta circunstÃncia. Investigou-se ainda a associaÃÃo da maloclusÃo com idade, gÃnero, renda e escolaridade. A amostra consistiu de 419 adolescentes entre 14 e 19 anos de idade, selecionados aleatoriamente a partir de uma populaÃÃo de estudantes de uma escola pÃblica. Os critÃrios de graduaÃÃo da maloclusÃo e a avaliaÃÃo da necessidade de tratamento ortodÃntico dos sujeitos foram estabelecidos por um consenso de ortodontistas de Fortaleza. Os resultados mostraram que 95,4% dos sujeitos eram portadores de algum tipo de maloclusÃo, sendo que 60,6% do total possuia maloclusÃo grave com necessidade obrigatÃria de tratamento e 34,8% tinham-na moderada, com necessidade relativa de tratamento. Os fatores de maior interferÃncia no estabelecimento da maloclusÃo grave foram a relaÃÃo de molar maior do que meia cÃspide (30,3%), a mordida cruzada (25,7%) e a relaÃÃo de canino maior do que meia cÃspide (22,2%). NÃo houve associaÃÃo da maloclusÃo com as variÃveis sociodemogrÃficas, a nÃo ser especificamente da idade com o componente mordida cruzada (p<0,05), do gÃnero com o componente relaÃÃo de canino maior do que um meio (p<0,05) e da escolaridade da mÃe com o componente relaÃÃo de molar maior do que um meio (p<0,05). / The aim of the present study was to estimate the prevalence of malocclusion and orthodontic treatment need in adolescents of a public school of Fortaleza and grade it according to the severity, to establish priorities in the orthodontic treatment and to determine which components of malocclusion had higher importance in deterrminating malocclusion. Also, were investigated the association between malocclusion and age, gender, income and scholarship. A total of 419 teenagers, between 14 and 19 years old, selected randomly from a population of students of a public school were enrolled in this project. The criteria of graduation and the assessment of malocclusion components were established by a joint of Fortalezaâs orthodontists. The results show that 95,4% of the subjects had some malocclusion, 60,6% of the total had serious malocclusion with compulsory need of orthodontic treatment, and 34,84% had moderate and relative need of treatment. The components with more prevalence, were the molar relation higher than half cusp (30,3%), crossbite (25,7%) and the canine relation higher than a half cusp (22,2%). There wasnât association between malocclusion and social demographic variables except the relation between age and cross bite (p<0,05), gender and canine relation higher than half a cusp (p<0,05) and motherâs degree of education and molar relation higher than half a cusp (p<0,05).

Magister Scientiae Dentium - MSc(Dent) / A public orthodontic system generally is designed to prioritize patients so that those who have the greatest need receive treatment. The aim of this study was to compare the subjective perceptions of the occlusal appearance of 11 to 12 year-old schoolchildren of Nairobi with the modified Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN). The objectives were to assess the children's perception of their occlusal appearance, categorise the occlusal appearance using the AC scale, by both the children and researcher; and to compare the children's' perception and the AC of the IOTN. Satisfaction with appearance of teeth and occlusion as well as peer comparison was investigated. The treatment need and demand was assessed using the modified AC photographs of the IOTN. Altogether, 488 school children (249 girls and 239 boys) assessed their perception of the anterior teeth using a Verbal Descriptor Scale (VDS) and a Visual Analog Scale (VAS) questionnaire. The researcher examined the anterior teeth of the participants and categorised them using the AC of the IOTN. The following results were reported: about two-thirds of the respondents were satisfied with the appearance of their teeth, with the gender difference being statistically significant. About 35% were dissatisfied or very dissatisfied, but reasons for it varied. More than half of the respondents rated their teeth as better than those of their peers and three-quarters were satisfied with their occlusion, the two responses elicited no gender difference. Treatment need was assessed by use of the AC indicated that there was a moderate agreement between researcher and respondents’ in treatment need assessment. The researcher found 36.3% needed treatment against self-perceived need of 30.9%. One-third of the respondents determined by the researcher to 'need treatment', felt 'no need'. There was no statistical gender difference in perceived need for treatment. The selection of ranked photographs of the AC by both researcher and respondents demonstrated skewed distributions towards the 'low ranked' or attractive end of the ranking order irrespective of the state of occlusion. Statistical comparison of the two methods used, namely the VDS and VAS, indicated that the responses were significantly different. Therefore it is suggested that any treatment priority assessment should take perceptions of occlusal appearance. into consideration.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A mà oclusÃo à considerada um problema de saÃde pÃblica pois, alÃm de ser bastante prevalente, à capaz de causar importantes prejuÃzos estÃticos e/ou funcionais. Entretanto, os adultos raramente sÃo incluÃdos em programas ou aÃÃes de saÃde pÃblica que estudam problemas de oclusÃo dentÃria, apesar de estarem suceptÃveis Ãs consequÃncias destes distÃrbios da mesma maneira, ou com maior intensidade, que os mais jovens. AlÃm disso, na maior parte das pesquisas que buscam estimar a prevalÃncia da mà oclusÃo e a necessidade de tratamento ortodÃntico, observa-se a exclusÃo de pessoas jà tratadas ortodonticamente, pois se supÃe que elas apresentariam necessidade significativamente menor do que as que nunca foram tratadas. Assim, esta dissertaÃÃo, composta por dois artigos, teve como objetivos: verificar a prevalÃncia e a severidade das mÃs oclusÃes, alÃm de determinar a necessidade de tratamento ortodÃntico, em um grupo de adultos jovens e, em um segundo momento, investigar se existia diferenÃa entre indivÃduos com e sem tratamento prÃvio. Para isso, foi avaliada uma amostra composta por 241 indivÃduos, com idade entre 17 e 33 anos, regularmente matriculados no Curso de Odontologia da Universidade Federal do CearÃ. Os estudantes foram divididos em dois grupos (com e sem tratamento ortodÃntico prÃvio) e examinados de acordo com o Dental Aesthetic Index (DAI). No artigo 1, estudou-se a prevalÃncia e a severidade das mÃs oclusÃes, e tambÃm a necessidade de tratamento ortodÃntico, dos indivÃduos nÃo tratados. No artigo 2, estas mesmas variÃveis foram comparadas entre os grupos tratado e nÃo tratado. Os resultados do artigo 1 demonstraram que o desalinhamento mandibular anterior e o apinhamento dental foram as mÃs oclusÃes mais prevalentes com 94,6% e 91,9%, respectivamente. A mÃdia do escore do DAI foi 25,94 (IC 95% 25,07; 26,81). Pouco mais da metade dos estudantes (51,4%) foram classificados como sem necessidade de tratamento ortodÃntico, enquanto 15,3% da amostra apresentou mÃs oclusÃes severas ou muito severas, o que implica em necessidade de tratamento ortodÃntico altamente desejÃvel ou obrigatÃria. No segundo artigo, observou-se que, diferentemente dos problemas decorrentes da falta de espaÃo, os quais se mostraram menos prevalentes em estudantes tratados previamente (p<0,001), a maioria das mÃs oclusÃes nÃo foi diferente entre os dois grupos (p>0,05). O DAI mÃdio do grupo tratado foi 24,77 (IC 95% 24,03; 25,51) e o do grupo nÃo tratado foi 25,94 (IC 95% 25,07; 26,81). Pode-se concluir que as mÃs oclusÃes relacionadas à falta de espaÃo foram mais prevalentes, embora sem muita severidade. A necessidade de tratamento ortodÃntico nÃo apresentou diferenÃa estatisticamente significante entre estudantes tratados e nÃo tratados (p>0,05), apesar de a severidade da mà oclusÃo dos tratados ter sido menor (p<0,05). / The malocclusion is considered a problem of public health because, beyond being enough prevalent, it is capable to cause important aesthetic and/or functional damages. However, the adults rarely are enclosed in programs or action of public health that to study problems of dental occlusion, although to be susceptible to the consequences of these disturbances in the same way, or with bigger intensity, that the younger. Moreover, in the most part of the research which search to esteem the prevalence malocclusion and the orthodontic treatment need, it is observed the exclusion of orthodontic treated already people, therefore it supposes that they would present significantly lesser need than the ones that had been never treated. Thus, this dissertation, comprised by two manuscripts, had as objectives: to verify the prevalence and the severity of the malocclusions, beyond determining the orthodontic treatment need, in a group of young adults and, in a second moment, to investigate if to exist difference between individuals with and without orthodontic treatment. For this, it was evaluated a sample composed for 241 individuals, with 17-to-33-years old, regularly registered in the College of Dentistry of the Federal University of the CearÃ. The students were divided in two groups (with and without previous orthodontic treatment) and examined according with the Dental Aesthetic Index (DAI). In article 1, it was studied the prevalence and the severity of the malocclusions, and also the orthodontic treatment need, of the individuals untreated. In article 2, these same variables were compared between the treat and untreated groups. The results of the manuscript 1 demonstrated that the anterior irregularity on the mandible and the crowding were the most prevalent malocclusions with 94,6% and 91,9%, respectively. The mean DAI score was 25,94 (CI 95% 25,07; 26,81). Little more than the half of the students (51,4%) were classified as without orthodontic treatment need, while 15,3% of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. In the second article, it was observed that, differently of the problems deriving of lack of the space, which it showed lesser prevalent in previously students treated (p<0,001), the majority of the malocclusions was not different between the two groups (p>0,05). The mean DAI of the treated group was 24,77 (IC 95% 24,03; 25,51) and the untreated group was 25,94 (IC 95% 25,07; 26,81). It can be concluded that the malocclusions related with the lack of the space were the most prevalent, although without very severity. The orthodontic treatment need presented no difference statistically significant between treated and untreated students (p>0,05), in spite of the severity malocclusion of the ones treated had been lesser (p<0,05).

Abstract The aims of this study were to evaluate the treatment need of fixed bridges according to the distribution of pontics in dentition in different age groups, and to investigate the primary and late complications and survival of the conventional fixed metal ceramic prostheses, as well as patients' satisfaction with the prosthetic treatment. The whole material consisted of the patients treated with fixed metal ceramic prostheses by undergraduate students at the Institute of Dentistry during the years 1984 - 1996. There were altogether 772 patients, 460 women (60 %) and 312 men (40 %). Their mean age was 47 years (23 - 81 years). Altogether 944 single metal ceramic crowns and 543 fixed bridges (1374 abutments and 807 pontics) were prepared. It can be concluded that the fixed bridges are most often prepared to replace upper first premolars and lower first molars also in the future. The most usual primary complications related to fixed bridges occurred during preprosthetic endodontic treatment of abutment teeth and during the preparation of the root canals. Previous restoration of the prepared tooth does not have any marked effect on the prognosis of single crowns with dowels, although anatomically complicated upper lateral incisors and upper first premolars need special attention in the treatment planning. Patients were satisfied with aesthetics and function of the fixed metal ceramic prostheses. Late complications found in clinical examinations were few, and the survival rate for the fixed metal ceramic bridge prostheses was calculated to be 84 % after 10 years, long fixed bridges having a lower survival than the shorter ones. The treatment need for conventional fixed bridges seems to be highest among patients over 50 years of age in the future. Age does not influence the longevity of the fixed prostheses, but basic circumstances of the mouth, especially low secretion of saliva affected by diseases and/or medications and high scores of lactobacilli and streptococcus mutans of the saliva seem to decrease the survival.

Purpose: Most individuals do not perceive a need for substance use treatment despite meeting diagnostic criteria for substance use disorders and they are least likely to pursue treatment voluntarily. There are also those who perceive a need for treatment and yet do not pursue it. This study aimed to understand which factors increase the likelihood of perceiving a need for treatment for individuals who meet diagnostic criteria for substance use disorders in the hopes to better assist with more targeted efforts for gender-specific treatment recruitment and retention. Using Andersen and Newman’s (1973/2005) model of individual determinants of healthcare utilization, the central hypothesis of the study was that gender moderates the relationship between substance use problem severity and perceived treatment need, so that women with increasing problems due to their use of substances are more likely than men to perceive a need for treatment. Additional predisposing and enabling factors from Andersen and Newman’s (1973/2005) model were included in the study to understand their impact on perceived need. Method: The study was a secondary data analysis of the 2010 National Survey on Drug Use and Health (NSDUH) using logistic regression. The weighted sample consisted of a total 20,077,235 American household residents (The unweighted sample was 5,484 participants). Results of the logistic regression were verified using Relogit software for rare events logistic regression due to the rare event of perceived treatment need (King & Zeng, 2001a; 2001b). Results: The moderating effect of female gender was not found. Conversely, men were significantly more likely than women to perceive a need for treatment as substance use problem severity increased. The study also found that a number of factors such as race, ethnicity, socioeconomic status, age, marital status, education, co-occurring mental health disorders, and prior treatment history differently impacted the likelihood of perceiving a need for treatment among men and women. Conclusion: Perceived treatment need among individuals who meet criteria for substance use disorders is rare, but identifying factors associated with an increased likelihood of perceiving need for treatment can help the development of gender-appropriate outreach and recruitment for social work treatment, and public health messages.

Abstract Introduction: Early Orthodontic Treatment (EOT) has been extensively studied, but questions still remain regarding the prevalence of its need in the United States. Without information regarding the epidemiology of EOT need, it is difficult to make determinations as to its viability as a Medicaid service. The Index for Preventive and Interceptive Orthodontic Needs (IPION) developed by Coetzee is the only index specifically meant for children in the mixed dentition. The purpose of this study was to utilize the IPION to measure EOT need in two pediatric dental populations in Philadelphia. Methods: 87 children between the ages of 6 and 9 were screened using the IPION. Overall scores, demographic information, and prevalence of specific malocclusions were recorded and analyzed. Results: A substantial proportion of children fell into the definite treatment need category (60.92% ±5.2% when including restorations and caries in the score, 31.03%±5.0% when excluding restorations and caries from the score). Site of screenings, race and sex had no significant effects on prevalence of EOT need, while IPION rubric used (IPION6 versus IPION9) had marginally significant effects on the prevalence of EOT need. Conclusions: There is a significant proportion of children in Philadelphia pediatric dental populations who have unmet EOT needs. Patients, communities, Medicaid, orthodontists and residents could all benefit from treatment of these children if policy were changed to allow EOT to be covered by Medicaid in Pennsylvania. / Oral Biology