Sex Differences in Esthetic Treatment Needs of Adolescent Orthodontic Patients

There is an interesting difference in terms of orthodontic treatment needs compared to actual treatment uptake. Epidemiological studies disclose few sex differences in the frequency or severity of malocclusions. On the other hand, the majority of adolescent orthodontic patients are girls. This difference suggests that—psychosocially—girls (and their parents) are more concerned and place greater priority on occlusal esthetics than for boys. Objective: This study tested for sex differences in the severity of malocclusions in adolescents who actually entered orthodontic treatment rather than simply voicing a concern about their occlusion. Methods: Severity was gauged with the 10-grade esthetic component of the Index of Orthodontic Treatment Need (IOTN) scored on the pretreatment intraoral photographs (n = 562) in a university-based specialty program in the Midsouth United States. The samples of American black (n = 161) and American white (n = 401) adolescents were free of craniofacial defects. Intraobserver repeatability (kappa) was high (0.71). Nonparametric statistics were used for analysis. Results: There is a significant sex difference in white teenagers due to milder cases among the girls. No sex difference occurs in the sample of blacks, with both sexes having IOTN scores on a par with white males. The severity of malocclusion is independent of the age at start of treatment (within range of 12 to 19 years). Conclusions: We infer that greater subjective self-perceptions of occlusal issues account for the preponderance of white girls in the patient pool, though why the sex difference is not evident in American blacks is complex. We speculate that sex differences are larger in private practices, since there are fewer selection criteria for entering treatment. Supported by the University of Tennessee Alumni Endowment for Research.