Providers' Assessment of Malocclusion and Brazilian Children's Quality of Life

Objectives: to assess the malocclusion status of Brazilian children with the Index of Complexity, Outcome and Need (ICON) and the subjective aesthetic component of this index and determine the children's self perceived oral health-related quality of life (ohrqol). The relationship between provider assessments and child responses will be explored as well.

Methods: Data were collected from 214 children (age range 9-13 years) in elementary schools in rural Brazil. The children participated in oral health screenings and face to face interviews.

Results: 43% of the children had acceptable occlusion, 35% were borderline, and 22% were in need of orthodontic treatment. The providers' assessment of the children's aesthetic appearance showed that 50% were rated as aesthetic, 42.5% as borderline, and 7.5% were perceived as having poor esthetics. Substantial percentages of the children reported functional impairments (difficulty to chew: 23.6%; difficulty to bite hard food: 37.7%) and pain / discomfort (pain now: 9.2%; pain when eating sweet food: 23.1%; pain when chewing: 40.9%), while only 10.1% of the children did not think that they had a nice smile. The ICON score without the aesthetic component correlated with the providers' subjective assessments (r=.410; p<.001). For children under 10 years, no relationship between ohrqol and provider assessments were found. However, for the older children, the subjective assessments were correlated with the children's psychological ohrqol score (Spearman rho= -.168; p=.078).

Conclusions: While ICON weighted norms are available for the US and UK child populations, no such considerations have been made so far for other populations. The results of this study showed that the development of ICON weights for Brazilian children should be undertaken. Gaining a better understanding of cross cultural differences of providers' assessments of children's aesthetic appearance and well as of children's perceptions of their own ohrqol is a crucial task for the future.