Objective, subjective, and self-assessment of preadolescent orthodontic treatment need--a function of age, gender, and ethnic/racial background?

J Public Health Dent. 2009 Winter;69(1):9-17. doi: 10.1111/j.1752-7325.2008.00089.x.


Children from socioeconomically disadvantaged and/or underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment.

Objectives: To determine whether preadolescents' (a) objectively assessed orthodontic treatment need; (b) subjectively assessed orthodontic treatment need; and (c) self-perceptions of the psychologic aspects of their oral health-related quality of life and desire to have braces vary as a function of age, gender, ethnicity/race, and socioeconomic status (SES).

Methods: Data were collected from 1,566 preadolescents (age range: 8 to 11 years; 47.3 percent male/52.7 percent female; 55.7 percent African-American/39.7 percent White/2.9 percent Hispanic) in oral exams and in face to face interviews. Malocclusion was determined with the Index of Orthodontic Treatment Need.

Results: Children (17.2 percent) had definite treatment need, 33.7 percent were borderline, and 49.1 percent had little or no need. Objectively and subjectively assessed treatment need was not affected by the children's age or gender. However, girls were more critical of their smiles and wanted braces more than boys. The older the children were, the more critical they were and the more they wanted braces. African-American children and children in schools with higher percentages of children on free school lunches had less treatment need than White children and children in schools with lower percentages of students with free school lunches. While the provider-assessed treatment need was higher for White children than for Black children, Black children were less happy with their smiles than White children, and wanted braces more than White children. SES did not affect the children's self-perceptions.

Conclusions: Findings showed that substantial percentages of the preadolescents have an orthodontic treatment need. Orthodontic need and child self-perceptions varied as a function of the children's age, gender, ethnicity/race, and SES.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Black or African American / psychology
  • Black or African American / statistics & numerical data*
  • Child
  • Dental Health Services
  • Ethnicity / psychology
  • Ethnicity / statistics & numerical data
  • Female
  • Health Services Needs and Demand / statistics & numerical data*
  • Hispanic or Latino / psychology
  • Hispanic or Latino / statistics & numerical data*
  • Humans
  • Male
  • Malocclusion / diagnosis*
  • Malocclusion / ethnology
  • Malocclusion / psychology
  • Minority Groups / psychology
  • Minority Groups / statistics & numerical data*
  • Oral Health
  • Orthodontics, Corrective / statistics & numerical data*
  • Quality of Life / psychology
  • Self-Assessment
  • Sex Factors
  • Socioeconomic Factors
  • United States
  • Vulnerable Populations
  • White People / psychology
  • White People / statistics & numerical data