The perceived and normative orthodontic treatment need of a group of South African children
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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.