Quality of Life and Orthodontic Treatment – Patient Versus Provider Evaluations

Objectives: to explore (a) the degree to which adolescent orthodontic patients experience impairments of their quality of life as a result of orthodontic treatment, and to assess (b) whether patients' and orthodontists' perceptions of these oral health-related quality of life outcomes are consistent.

Methods: Data were collected from 115 orthodontic patients and their providers. Forty-three patients (37.4%) were male and 72 (62.6%) were female. The patients ranged in age from 10 to 19 years (mean=14.27 Years; SD=1.939). The patients and providers responded to self administered surveys. Chart review data were used to assess the orthodontic treatment characteristics.

Results: 56.5% of the patients agreed/strongly agreed with the statement that they had pain for a few days after orthodontic appointments; 20.9% indicated that they changed their diet because of pain caused by the treatment. The patients also reported that the pain affected their oral hygiene efforts negatively. When the patients and providers rated how much pain the patients had experienced during the last appointment (Five point scale: 1 = “not at all” to 5 = “very much”: 2.01 vs. 2.28; p=.042), immediately after the last appointment (1.93 vs. 2.34; p=.005), and one day (1.77 vs. 2.53; p<.001) and two days after the last appointment (1.57 vs. 2.19; p<.001), the dentists underestimated the patients' self reported pain. Cross-tabulations of provider and patient responses concerning the pain experienced at the current appointment showed significant inconsistencies (p=.002). In addition, providers underestimated the degree to which patients used pain medication.

Conclusion: These data showed that orthodontists might underestimate the degree to which orthodontic treatment affects their patients' quality of life. Given that pain is the most significant predictor of missing appointments and affects cooperation with oral hygiene recommendations, a lack of realization of these quality of life impacts could negatively affect treatment outcomes.