Adult Orthodontic Patients Report Lower Quality of Life With Worse Malocclusion

Objectives: The aim of this study is to evaluate the correlation between severity of malocclusion and self-perception of esthetics and oral health quality of life in adults.
Methods: This study was approved by the Boston University Medical Campus IRB. A cross-sectional study was carried out at Boston University School of Dental Medicine Orthodontic clinic and iSmiles, a private orthodontic office in California. Patients age 18 and older completed a survey consisting of oral health quality of life (OQOL) items and sociodemographic questions before starting orthodontic treatment. Orthodontic measurements were taken from patients' records to assess the severity of malocclusion using the Index of Orthodontic Treatment Need (IOTN).
Results: A total of 76 subjects participated, with a mean age of 33 years. The patients were from diverse ethnic and racial backgrounds (44% White, 24% Hispanic, 17% Asian, 10% African-Americans and 6% other race), and 57% were female. Results were analyzed based on severity of malocclusion—mild-moderate malocclusion (IOTN score 2 or 3—66% of sample) vs. severe malocclusion (IOTN score 4 or 5—34% of sample). There was a difference in the sample population between sites; subjects from iSmiles had significantly milder malocclusion and better esthetic scores than subjects at Boston University. Subjects with severe malocclusion reported significantly worse oral health on a 1-item instrument (p<0.001), and had worse overall OQOL in 2 scales (p<0.05). Patients with severe malocclusion also reported significantly worse OQOL related to the social domain (p<0.05) and reported significantly worse esthetics by the Esthetic Score of the IOTN (p<0.001).
Conclusions: Adult patients with severe malocclusions had a more negative self-perception related to esthetics and psychological aspects of oral health quality of life compared with patients with milder malocclusions.