TY - JOUR
T1 - Agreement between orthodontist and patient perception using Index of Orthodontic Treatment Need
AU - Siddiqui, Tania Arshad
AU - Shaikh, Attiya
AU - Fida, Mubassar
N1 - Funding Information:
This research was funded by the University Research Council upon recommendation of Grant Review Committee at the Aga Khan University Hospital (URC Project ID 10GS030SUR). A clearance from the Ethics Review Committee at the Aga Khan University was obtained prior to the commencement of this research project (1831). A cross-sectional analytical study was conducted in the Dental Section, Department of Surgery, on patients from September 2011 to February 2012 prior to initiation of orthodontic treatment. The sample size for this study was 121 subjects (41 males and 80 females). The age range of the subjects was 16–25 years. The mean age of the total sample size was 19.50 ± 3.15 years. The mean age of the male subjects was 19.05 ± 3.09 years and for female subjects it was 19.75 ± 3.18 years. Patient self-perception was measured by having patients rate their condition based on the IOTN-AC scale. Interviews were not conducted to evaluate patient perceptions in this study. Patients were shown their pretreatment monochrome intra-oral frontal photographs in their follow-up appointment for banding and bonding, after the orthodontic records had been taken in the previous appointment. The intra-oral frontal photographs had been taken by the orthodontic residents at the Dental Clinic; the principal investigator edited them for uniformity in magnification, size and colour (from colour photographs to monochrome) using Microsoft Office Picture Manager® (Aga Khan University Hospital, Karachi, Pakistan). Printouts of the photographs were shown to the patients’ chair-side and were scored in accordance to the standard IOTN-AC ( Fig. 1 ). The orthodontist also scored the conditions, at chair-side, simultaneously with the patients. The patients were informed to announce when they were ready to score their conditions, so that both patient and orthodontist could simultaneously write down their scores on separate data forms. The IOTN-DHC was assessed by the orthodontist using the IOTN ruler ( Fig. 2 ) on pretreatment study cast models ( Fig. 3 ) to determine the highest numerical value for severity of malocclusion. The ruler was further interpreted on the Dental Health Scale ( Fig. 4 ) to identify the trait which increased the severity of malocclusion. The hierarchy of traits in order of decreasing severity includes: missing or unerupted teeth; overjet; crossbites; displaced contact points; and overbite ( Fig. 5 a–d). In order to rule out measurement error, and the measure intra- and inter-examiner reliability, 30 records were randomly selected for review by the principal investigator and by a second examiner. All the AC and DHC scores were recorded on a data collection form ( Fig. 6 ).
Publisher Copyright:
© 2014 King Saud University.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Objectives: The primary objective of the study was to assess the agreement between orthodontist and patient perception regarding the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) at pre-orthodontic treatment levels. The secondary objective was to determine how well the subjective assessment of malocclusion (IOTN-AC) correlated with the normative Dental Health Component of the IOTN (IOTN-DC). Materials and methods: A cross-sectional analytical study was conducted on patients between the ages of 16 and 25, presenting for initiation of orthodontic treatment with no history of prior orthodontic treatment. The mean age of the total sample population was 19.50. ±. 3.15. years. The mean age of the males was 19.05. ±. 3.09. years and for females it was 19.75. ±. 3.18. years. The sample consisted of 41 males and 80 females. Patients were shown their pretreatment monochrome intraoral frontal photographs to rate according to the IOTN-AC. Simultaneously, the orthodontist reviewed the photographs with each patient. The IOTN-DHC of pretreatment casts was also recorded by the orthodontist. The frequency of specific traits that had led to increased severity of malocclusion was also identified. All readings were recorded manually on a data collection form. The data were assessed using the chi-square test, Spearman's correlation and Cohen's kappa test. Intra- and inter-examiner reliability was assessed using Spearman's correlation. Results: A significant positive relationship (p<. 0.05) was observed between orthodontist and patient perception (r=. 0.516), orthodontist perception and the normative need (r=. 0.430), and between the patient perception and the normative need (r=. 0.252). A statistically significant level of agreement was observed between orthodontist and patient perception (kappa. =. 0.339, p≤. 0.001, 95% CI, 0.207-0.470) and between orthodontist perception and the normative need (kappa. =. 0.331, p≤. 0.001, 95% CI, 0.197-0.424). A weak and insignificant level of agreement was observed between patient perception and normative treatment need (kappa. =. 0.107, 95% CI, 0.02-0.187). Conclusions: Patient understanding of their treatment need or aesthetic classification may not always be as accurate as that of orthodontists. This may be a cause for concern when an orthodontist finds a certain condition to be severe, and a patient who does not agree may limit their treatment needs.
AB - Objectives: The primary objective of the study was to assess the agreement between orthodontist and patient perception regarding the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN-AC) at pre-orthodontic treatment levels. The secondary objective was to determine how well the subjective assessment of malocclusion (IOTN-AC) correlated with the normative Dental Health Component of the IOTN (IOTN-DC). Materials and methods: A cross-sectional analytical study was conducted on patients between the ages of 16 and 25, presenting for initiation of orthodontic treatment with no history of prior orthodontic treatment. The mean age of the total sample population was 19.50. ±. 3.15. years. The mean age of the males was 19.05. ±. 3.09. years and for females it was 19.75. ±. 3.18. years. The sample consisted of 41 males and 80 females. Patients were shown their pretreatment monochrome intraoral frontal photographs to rate according to the IOTN-AC. Simultaneously, the orthodontist reviewed the photographs with each patient. The IOTN-DHC of pretreatment casts was also recorded by the orthodontist. The frequency of specific traits that had led to increased severity of malocclusion was also identified. All readings were recorded manually on a data collection form. The data were assessed using the chi-square test, Spearman's correlation and Cohen's kappa test. Intra- and inter-examiner reliability was assessed using Spearman's correlation. Results: A significant positive relationship (p<. 0.05) was observed between orthodontist and patient perception (r=. 0.516), orthodontist perception and the normative need (r=. 0.430), and between the patient perception and the normative need (r=. 0.252). A statistically significant level of agreement was observed between orthodontist and patient perception (kappa. =. 0.339, p≤. 0.001, 95% CI, 0.207-0.470) and between orthodontist perception and the normative need (kappa. =. 0.331, p≤. 0.001, 95% CI, 0.197-0.424). A weak and insignificant level of agreement was observed between patient perception and normative treatment need (kappa. =. 0.107, 95% CI, 0.02-0.187). Conclusions: Patient understanding of their treatment need or aesthetic classification may not always be as accurate as that of orthodontists. This may be a cause for concern when an orthodontist finds a certain condition to be severe, and a patient who does not agree may limit their treatment needs.
KW - IOTN
KW - IOTN-AC
KW - IOTN-DHC
KW - Orthodontist perception
KW - Perception
KW - Self perception
UR - http://www.scopus.com/inward/record.url?scp=84908488138&partnerID=8YFLogxK
U2 - 10.1016/j.sdentj.2014.03.004
DO - 10.1016/j.sdentj.2014.03.004
M3 - Article
AN - SCOPUS:84908488138
SN - 1013-9052
VL - 26
SP - 156
EP - 165
JO - Saudi Dental Journal
JF - Saudi Dental Journal
IS - 4
ER -