Miguel José Augusto M, Sales Helena X, Quintão Catia C, Oliveira Branca H, Feu Daniela
Dra Daniela Feu, Rio de Janeiro State University, Rio de Janeiro, RJ, Brazil.
J Orthod. 2010 Jun;37(2):100-6. doi: 10.1179/14653121042957.
To investigate the interrelationships between factors involved in orthodontic treatment seeking by children aged 12-15 years.
State funded orthodontic clinic at the Faculty of Dentistry of the Rio de Janeiro State University (UERJ), Rio de Janeiro, Brazil, and a nearby public school.
One hundred and ninety-four adolescents aged 12-15 years took part in the study; 92 had sought orthodontic treatment at UERJ (orthodontic group) and 102 were from a nearby public school and had never undergone or sought orthodontic treatment (comparison group). Each participant underwent a comprehensive oral examination, and both parent and child were questioned about who had initiated the orthodontic referral.
Normative need assessed with IOTN DHC; clinician and self-perceived aesthetic perception assessed with IOTN AC, previous caries experience was determined using the decayed, missing and filled teeth index (DMFT) and WHO diagnostic criteria. The 'Brazil Economic Classification Criteria' was used to classify the socioeconomic status. Intra-examiner repeatability and inter-examiner agreement were assessed with kappa statistics. Univariate and multiple logistic regression analyses were used to investigate the association between orthodontic treatment seeking (dependent variable) and the independent variables (i.e. aesthetic impairment, malocclusion severity, socioeconomic status, gender, age and DMFT).
Univariate analyses showed that self-perceived aesthetics (P<0.001), examiner-assessed aesthetics (P = 0.01) and treatment need (P<0.001), socioeconomic status (P<0.001) were significantly associated with orthodontic treatment seeking, but gender (P = 0.22) and DMFT (P = 0.41) were not. Multiple logistic regression analyses showed that poor self-perceived aesthetics (OR = 16.7; 95% CI: 4.17-61.9), more severe malocclusion (OR = 3.4; 95% CI 1.64-7.14) and better socioeconomic position (OR = 39.1; 95% CI: 5.47-280.54) significantly influenced the decision to seek orthodontic treatment.
Concern about dental appearance and the desire for treatment, together with normative orthodontic need, should be carefully assessed by dentists before referring patients to specialized orthodontic care in publicly-funded clinics. In a publicly-funded oral health care system, self-perceived orthodontic treatment need is the key to establishing treatment priority.
研究12至15岁儿童寻求正畸治疗相关因素之间的相互关系。
巴西里约热内卢州立大学（UERJ）牙科学院的公立正畸诊所及附近一所公立学校。
194名12至15岁青少年参与了本研究；其中92名在UERJ寻求过正畸治疗（正畸组），102名来自附近公立学校且从未接受或寻求过正畸治疗（对照组）。每位参与者均接受了全面的口腔检查，同时询问了家长和孩子是谁发起了正畸转诊。
使用IOTN DHC评估规范需求；使用IOTN AC评估临床医生和自我感知的美学认知，使用龋失补牙指数（DMFT）和世界卫生组织诊断标准确定既往龋病经历。采用“巴西经济分类标准”对社会经济地位进行分类。使用kappa统计量评估检查者内部重复性和检查者间一致性。采用单因素和多因素逻辑回归分析来研究寻求正畸治疗（因变量）与自变量（即美学损害、错 畸形严重程度、社会经济地位、性别、年龄和DMFT）之间的关联。
单因素分析显示，自我感知美学（P<0.001）、检查者评估美学（P = 0.01）和治疗需求（P<0.001）、社会经济地位（P<0.001）与寻求正畸治疗显著相关，但性别（P = 0.22）和DMFT（P = 0.41）与之无关。多因素逻辑回归分析显示，自我感知美学较差（OR = 16.7；95%CI：4.17 - 61.9）、错 畸形更严重（OR = 3.4；95%CI 1.64 - 7.14）和社会经济地位更好（OR = 39.1；95%CI：5.47 - 280.54）显著影响寻求正畸治疗的决定。
在将患者转诊至公立诊所接受专科正畸治疗之前，牙医应仔细评估患者对牙齿外观的关注、治疗意愿以及正畸规范需求。在公立口腔卫生保健系统中，自我感知的正畸治疗需求是确定治疗优先级的关键。
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