|Year : 2020 | Volume
| Issue : 1 | Page : 6
Associations between malocclusion and self-esteem among Persian adolescent papulation
Navid Naseri, Tahereh Baherimoghadam, Farkhondeh Kavianirad, Maedeh Haem, Shahryar Nikmehr
Department of Orthodontic, School of Dentistry, Shiraz Branch, Islamic Azad University, Shiraz, Iran
|Date of Submission||26-Apr-2019|
|Date of Decision||25-Oct-2019|
|Date of Acceptance||02-Jul-2020|
|Date of Web Publication||15-Jul-2020|
Dr. Tahereh Baherimoghadam
Medical Building, Sattarkhan Avenue, Shiraz
Source of Support: None, Conflict of Interest: None
OBJECTIVES: To assess the effect of malocclusion on the self-esteem of adolescents.
MATERIALS AND METHODS: This cross-sectional study evaluated 496 student aged between 12 and 14 tears old living in Shiraz city. The level of self-esteem was determined using the Rosenberg self-esteem scale (RSES). To assess the degree of malocclusion, Index of Orthodontic Treatment Need- Dental Health Component (IOTN-DHC) was used. The Spearman's correlation coefficient was calculated to assess the correlation of malocclusion and self-esteem. The mean of IOTN-DHC and total score of RSES in different age groups were analyzed using the Kruskal–Wallis test. The mean IOTN-DHC and total score of RSES were compared between the two municipal districts and males and females using the Wilcoxon test and independent t-test, respectively.
RESULTS: A significant but weak correlation was noted between IOTN-DHC and self-esteem (r = 115/0, P = 04/0), while IOTN-DHC subscale: space shortage, dental missing, overjet, overbite, and crossbite had nonsignificant correlation with self-esteem. The socioeconomic status of adolescents significantly affected their self-esteem (P < 0.001).
CONCLUSIONS: Weakly significant correlation between mild malocclusion and dental self-esteem.
Keywords: Malocclusion, orthodontic treatment need, quality of life, self-esteem
|How to cite this article:|
Naseri N, Baherimoghadam T, Kavianirad F, Haem M, Nikmehr S. Associations between malocclusion and self-esteem among Persian adolescent papulation. J Orthodont Sci 2020;9:6
|How to cite this URL:|
Naseri N, Baherimoghadam T, Kavianirad F, Haem M, Nikmehr S. Associations between malocclusion and self-esteem among Persian adolescent papulation. J Orthodont Sci [serial online] 2020 [cited 2021 Jan 17];9:6. Available from: https://www.jorthodsci.org/text.asp?2020/9/1/6/289828
| Introduction|| |
At present, demand for orthodontic treatment has greatly increased to level and align teeth and subsequently improve dental and facial esthetics. Hassebrauck showed that a beautiful smile is the second most important facial component after the eyes that catches the eyes when assessing facial attractiveness. Although dental clinicians and orthodontists pay attention to all aspects of malocclusion in orthodontic treatment such as esthetics, occlusion, mastication, and speech, patients often seek orthodontic treatment aiming to improve their facial appearance. Evidence shows that physical appearance can affect the psychosocial status, especially in adolescents and young adults. Moreover, they may be subjected to bullying and mocking and in severe cases, isolation.
Teachers' perception of the attractiveness of students can affect their expectations and assessments of children. Those who are considered by their teachers, peers, and employers to be attractive are more likely to achieve a better position. Thus, attractive individuals often have positive social experiences. Although such relationships are well accepted, evidence regarding direct correlation of self-esteem and malocclusion or orthodontic treatment in different communities is scarce. Furthermore, it has been shown that self-esteem of adolescents does not change after orthodontic treatment compared to before treatment.
According to psychologists, the term self-esteem may have three different definitions: (I) the golden concept of self-esteem, which refers to one's feelings about himself, (II) individual assessment of one's capabilities, and (III) momentary feelings of an individual about himself. The present study focused on the golden concept of self-esteem.
The Rosenberg self-esteem scale (RSES) is extensively used for the assessment of self-esteem. It has been translated to at least 28 languages and used in several countries worldwide. This study aimed to assess the effect of malocclusion on the self-esteem of 12- to 14-year-old adolescents using RSES.
| Materials and Methods|| |
In this cross-sectional study, 496 students were selected among all 12- to 14-year-old male and female students in Shiraz city in 2017 by cluster sampling. First, the middle schools of Shiraz city were identified and then 4 schools from the 2nd (low to moderate socioeconomic status) and 3rd (high socioeconomic status) municipal districts were randomly chosen. Next, the list of 12- to 14-year olds in each school was obtained. Students who met the inclusion criteria were chosen by convenience sampling. Students with mental disability, those with maxillofacial syndromes, facial or palatal clefts, history of orthodontic treatment, and subjects under orthodontic treatment were excluded. Before participation, a written informed consent form from the participants' parents and an informed assent form from the adolescents were obtained.
The RSES was used to assess the self-esteem of student. This questionnaire has 10 four-point Likert scale questions. Five questions were positive and the remaining five were negative. Positive questions were scored 4 (strongly agree) to 1 (strongly disagree). Negative questions were scored 1 (strongly agree) to 4 (strongly disagree) [Table 1]. Thus, the total score ranged from 10 to 40. In most studies, the self-esteem index (SI) is used to assess the overall self-esteem. SI was calculated by dividing the total score (10 to 40) by 10 (number of questions). One week before the clinical examinations, RSES Questionnaires were sent to the schools and collected before the clinical examinations, so that the examiner would not know any information regarding students' self-esteem.
The Index of Orthodontic Treatment Need-Dental Health Component (IOTN-DHC) was used to determine the level of malocclusion and the need for orthodontic treatment. This index evaluates the missing teeth, overjet, overbite, crossbite, and crowding by taking into account their severity. The clinical examination of students was carried out by same orthodontist in a classroom with adequate lighting using a spotlight, a dental mirror, and a ruler. Intraexaminer reliabilities were assessed in 30 subjects (test-retest at a 1-week interval). Weighted Cohen kappa's values for IOTN-DHC indicated complete agreement (0.82).
Data were analyzed using SPSS version 19. The Kolmogorov–Smirnov test revealed that data were not normally distributed. Thus, the mean of IOTN-DHC and total score of RSES in different age groups were analyzed using the Kruskal–Wallis test. The mean IOTN-DHC and total score of RSES were compared between the two municipal districts and males and females using the Wilcoxon test and independent t-test, respectively. Considering the nonnormal distribution of data, the Spearman's correlation coefficient was used to assess the correlation between RSES questions and IOTN-DHC.
| Results|| |
Of 496 students participating in this study, 242 (48.8%) were males and 254 (51.2%) were females. Comparison of the mean IOTN-DHC subscales and SI among the 6th (12 ± 1/23 years old), 7th (13 ± 0/25 years old), and 8th (14 ± 0/86 years old) graders showed a significant difference in crossbite among different age groups (P = 0.01) [Table 2]. Comparison of the mean and standard deviation of IOTN-DHC subscales and SI of the two municipal districts revealed significant differences in dental missing (P < 0.001), crossbite (P < 0.001), crowding (P < 0.001) and SI score (P < 0.001) [Table 3]. A significant difference in dental missing (P = 0.01) and crossbite (P = 0.02) in the mean and standard deviation of IOTN-DHC subscales and SI score between male and female students were found [Table 4].
|Table 2: Mean and standard deviation of IOTN subscales and SI score in the 6th, 7th, and 8th graders|
Click here to view
|Table 3: Mean and standard deviation of IOTN subscales and SI score in students of the two municipal districts|
Click here to view
|Table 4: Mean and standard deviation of IOTN subscales and SI score in male and female students|
Click here to view
The Spearman's correlation coefficient can be interpreted as followed: 00–0.19 = very weak; 0.20–0.39 = weak; 0.40–0.59 = moderate; 0.60–0.79 = strong; 0.80–1.0 = very strong. The result of this study showed a significant but very weak correlation between questions 3 and 7 and SI score with a total score of IOTN-DHC [Table 5].
|Table 5: Spearman's correlation coefficient for the correlation of IOTN subscales, Rosenberg questions, and total score|
Click here to view
| Discussion|| |
A beautiful smile is the second most important facial characteristic in physical attractiveness. Evidence shows that malocclusion can negatively affect the psychosocial status and quality of life., Nonetheless, several other factors can also affect the psychological state of individuals including hair, skin, eyes, body shape, height, and financial status; thus, single-dimensional evaluation of psychological status can be limiting. The present study aimed to assess the effect of space shortage, dental missing, overjet, overbite, crossbite, and the need for orthodontic treatment on self-esteem of adolescents.
The RSES was used for the assessment of self-esteem in this study. RSES is among the most widely used tools for the assessment of self-esteem in social sciences. The popularity of RSES is partly due to its favorable psychometric properties, simplicity, and briefness. More importantly, RSES has been translated into many languages including Farsi.,
In this study, we used DHC of IOTN to determine the severity of malocclusion; the validity of this index has been reported in the literatures, and they showed IOTN-DHC is a valid tool for screening.,
Although a significant correlation has been previously reported between the severity of malocclusion and self-esteem,, the present study conducted on adolescents demonstrated a weakly significant correlation between IOTN-DHC and self-esteem. Several studies have evaluated the relationship between malocclusion and QoL through self-esteem in different societies, ethnics, and background.,,,,,,,,, Gavric et al. found a weak but significant correlation between the self-reported severity of malocclusion and dental self-esteem; since the mean IOTN-DHC score in that study was 2.45 ± 1.23, a weak correlation between dental self-esteem and IOTN-DHC can be due to low to moderate need for orthodontic treatment among the study population. Taylor et al. showed a poor correlation between malocclusion and OHRQoL.
Evidence shows that in only one-third of patients with severe malocclusion and scores 4 or 5 of IOTN, psychological status is significantly affected by malocclusion. Also, Kovalenko et al. showed that psychological problems are correlated directly with the severity of facial deformity. Nonetheless, patients who seek orthodontic treatment often have an IOTN-DHC score of <4. Due to enhanced public knowledge about orthodontic treatment and dental esthetics, even patients with mild malocclusion seek orthodontic treatment.
In the present study, none of the dental components of IOTN including space shortage, dental missing, overjet, overbite, and crossbite alone had any significant correlation with Rosenberg questions or SI. Some studies concluded that spacing of the anterior teeth had the most negative impact on self-esteem,,, while others showed that crowding had the same influence on self-esteem.,,, Also, negative impact of increased overjet on self-esteem have been reported.,,,, However, finding of the present study can be due to the fact that, in the present study, the severity of malocclusion for each of the IOTN subscales alone was low. Evidence shows that malocclusion detectable by the laypeople can decrease the quality of life. The National Center for Health Statistics of the United States has set a basic level for each of the subscales of malocclusion. For instance, space shortage by 3 mm is the basic requirement for dental crowding. Thus, malocclusion alone can affect self-esteem only when it is severe enough and has reached a certain level of severity.
The self-esteem of students in the two municipal districts was significantly different, although comparison of the mean and standard deviation of IOTN-DHC revealed nonsignificant differences. Students who studied in 2nd municipal districts with low to moderate socioeconomic status showed significant more missing, crowding, and crossbite and they also showed less SI score compared to students studied in 3rd municipal districts with high socioeconomic status, which indicates the effect of other factors such as socioeconomic status on self-esteem. Sfreddo et al. reported that adolescents from low socioeconomic background reported worse OHRQoL compared to those from high socioeconomic background. Eremie and Chikweru found that private school students demonstrated higher self-esteem than public school students.
A significant difference was noted between males and females in dental missing and crossbite. However, no significant difference was found between males and females in total IOTN-DHC and self-esteem in Iranian society. The result of the present study is in consistent with those studies which concluded that the psychosocial impact of malocclusion was similar between sex.,,
Self-esteem is a multifactorial phenomenon; the result of our study showed that it is affected more by other factors than malocclusion. This study had a cross-sectional design. Therefore, we attempted to search for inferences with regard to causal factors without establishing a temporal relationship; this can be considered as a limitation of this study.
| Conclusions|| |
- The study results showed a weakly significant correlation between malocclusion and self-esteem
- Students who studied in different municipal districts showed nonsignificant difference in IOTN-DHC score; however, students with low to moderate socioeconomic status showed less SI score compared to students with high socioeconomic status
- Nonsignificant difference was found between males and females in total IOTN-DHC and self-esteem.
Declaration of patient consent
The authors certify that they have obtained all appropriate participant consent forms. In the form, the parents have given their consent for their children images and other clinical information to be reported in the journal. The parents understand that their children names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Ackerman JL, Proffit WR, Sarver DM. The emerging soft tissue paradigm in orthodontic diagnosis and treatment planning. Clin Orthod Res 1999;2:49-52.
Hassebrauck M. The visual process method: A new method to study physical attractiveness. Evol Hum Behav 1998;19:111-23.
Klages U, Claus N, Wehrien H, Zenter A. Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod 2006;28:103-11.
Badran SA. The effect of malocclusion and self-perceived aesthetics on the self-esteem of a sample of Jordanian adolescents. Eur J Orthod 2010;32:638-44.
Jung MH. An evaluation of self-steam and quality of life in orthodontic patients: Effects of crowding and protrusion. Angle Orthod 2015;85:812-9.
Tuchtenhagon S, Bresolin CR, Tomazoni F, da Rosa GN, Del Fabro JP, Mendes FM, et al
. The influence of normative and subjective oral health status on schoolchildren's happiness. BMC Oral Health 2015;15:15-7.
Jung MH. Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent population. Am J Orthod Dentofacial Orthop 2010;138:160-6.
Gavric A, Mirceta D, Jakobovic M, Pavlic A, Zrinski MT, Spalj S. Craniodentofacial characteristics, dental esthetics-related quality of life, and self-esteem. Am J Orthod Dentofacial Orthop 2015;147:711-8.
Shaw WH, Richmond S, Kenealy PM, Kingdon A, Worthington H. A 20-year cohort study of health gain from orthodontic treatment: Psychological outcome. Am J Orthod Dentofacial Orthop 2007;132:146-57.
Brown JD, Dutton KE. From the tap down: Self-esteem and self-evaluation. Cogn Emot 2001;15:615-31.
Schmitt DP, Allik J. Simultaneous administration of the Rosenberg self-esteem scale in 53 nations: Exploring the universal and culture-specific features of global self-esteem. J PersSoc Psychol 2005;89:623-42.
Dalaie K, Behnaz M, Khodabakhshi Z, Hosseinpour S. Impact of malocclusion severity on oral health-related quality of life in an Iranian young adult population. Eur J Dent 2018;12:129-35.
] [Full text]
Guimarães SPA, Jorge KO, Fontes MJF, Ramos-Jorge ML, Araújo CTP, Ferreira EF, et al
. Impact of malocclusion on oral health-related quality of life among schoolchildren. Braz Oral Res 2018;32:e95.
Sinclair SJ, Blais MA, Gansler DA, Sandberg E, Bistis K, LoCicero A. Psychometric peroperties of the Rosenberg's Self-Esteem Scale: Overall and across demographic groups living within the United States. Eval Health Prof 2010;33:56-80.
Twenge JM, Campbell WK. Age and birth cohort differences in self-esteem: A cross-temporal meta-analysis. Per Soc Psychol Rev 2001;5:321-44.
Dawoodbhoy I, Delgado-Angulo EK, Bernabé E. Impact of malocclusion on the quality of life of Saudi children. Angle Orthod 2013;83:1043-8.
Hassan AH. Orthodontic treatment needs in the Western region of Saudi Arabia: A research report. Head Face Med 2006;2:2.
Trivedi K, Shyagali TR, Doshi J, Rajpara Y. Reliability of aesthetic component of IOTN in the assessment of subjective orthodontic treatment need. J Adv Dent Res 2011;2:59-65.
Frejman MW, Vargas IA, Rousing CK, Closs LQ. Dentofacial deformities are associated with lower degrees of self-esteem and higher impact on oral health-related quality of life: Results Forman observational study involving adults. J Oral Maxillofac Surg 2013;71:763-7.
Taibah SM, Al-Hummayani FM. Effect of malocclusion on the self-esteem of adolescents. J Orthod Sci 2017;6:123-8.
Kelly J, Harvey C. An Assessment of the Teeth of Youths 12-17 Years. DHEW publication no (HRA) 77-1644, Washington, DC: National Center for Health Statistics, USPHS; 1977.
Bellot-Arcís C, Montiel-Company JM, Almerich-Silla JM. Psychosocial impact of malocclusion in Spanish adolescents. Korean J Orthod 2013;43:193-200.
Naseri N, Baherimoghadam T, Rasooli R, Hamzeh M, Merikh F. Validity and reliability of the Persian version of the psychosocial impact of dental aesthetics questionnaire. Health Qual Life Outcomes 2019;17:126.
Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ. Effects of malocclusion and its treatment on the quality of life of adolescents. Am J Orthod Dentofacial Orthop 2009;136:382-92.
Herkrath APCQ, Vettore MV, de Queiroz AC, Alves PLN, Leite SDC, Pereira JV, et al
. Orthodontic treatment need, self-esteem, and oral health-related quality of life among 12-yr-old schoolchildren. Eur J Oral Sci 2019;127:254-60.
Gherunpong S, Tsakos G, Sheiham A. A socio-dental approach to assessing children's orthodontic needs. Eur J Orthod 2006;28:393-9.
Kovalenko A, Slabkovskaya A, Drobysheva N, Persin L, Drobyshev A, Maddalone M. The association between the psychological status and the severity of facial deformity in orthognathic patients. Angle Orthod 2012;82:396-402.
Feu D, de Oliveira BH, de Oliveira Almeida MA, Kiyak HA, Miguel JA. Oral health-related quality of life and orthodontic treatment seeking. Am J Orthod Dentofacial Orthop 2010;138:152-9.
Sardenberg F, Martins MT, Bendo CB, Pordeus IA, Paiva SM, Auad SM, et al
. Malocclusion and oral health-related quality of life in Brazilian school children. Angle Orthod 2013;83:83-9.
Bernabé E, Sheiham A, Tsakos G, Messias de Oliveira C. The impact of orthodontic treatment on the quality of life in adolescents: A case-control study Eur J Orthod 2008;30:515-20.
Tessarollo FR, Feldens CA, Closs LQ. The impact of malocclusion on adolescents' dissatisfaction with dental appearance and oral functions. Angle Orthod 2012;82:403-9.
Vedovello SA, Ambrosano GM, Pereira AC, Valdrighi HC, Filho MV, Meneghim Mde C. Association between malocclusion and the contextual factors of quality of life and socioeconomic status. Am J Orthod Dentofacial Orthop 2016;150:58-63.
Sfreddo CS, Moreira CHC, Nicolau B, Ortiz FR, Ardenghi TM. Socioeconomic inequalities in oral health-related quality of life in adolescents: A cohort study. Qual Life Res 2019;28:2491-500.
Eremie MD, Chikweru AE. Self-esteem among private and public secondary schools students in Rivers State: Implications for counseling. Arabian J Bus Manag Rev 2015;5:1-4.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]