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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Oral health-related quality of life of children seeking orthodontic treatment based on child oral health impact profile: A cross-sectional study</title><author><name sortKey="Thiruvenkadam, G" sort="Thiruvenkadam, G" uniqKey="Thiruvenkadam G" first="G." last="Thiruvenkadam">G. Thiruvenkadam</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Asokan, Sharath" sort="Asokan, Sharath" uniqKey="Asokan S" first="Sharath" last="Asokan">Sharath Asokan</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="John, J Baby" sort="John, J Baby" uniqKey="John J" first="J. Baby" last="John">J. Baby John</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Geetha Priya, P R" sort="Geetha Priya, P R" uniqKey="Geetha Priya P" first="P. R." last="Geetha Priya">P. R. Geetha Priya</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Prathiba, J" sort="Prathiba, J" uniqKey="Prathiba J" first="J." last="Prathiba">J. Prathiba</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">26321842</idno><idno type="pmc">4549994</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4549994</idno><idno type="RBID">PMC:4549994</idno><idno type="doi">10.4103/0976-237X.161899</idno><date when="2015">2015</date><idno type="wicri:Area/Pmc/Corpus">000271</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000271</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Oral health-related quality of life of children seeking orthodontic treatment based on child oral health impact profile: A cross-sectional study</title><author><name sortKey="Thiruvenkadam, G" sort="Thiruvenkadam, G" uniqKey="Thiruvenkadam G" first="G." last="Thiruvenkadam">G. Thiruvenkadam</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Asokan, Sharath" sort="Asokan, Sharath" uniqKey="Asokan S" first="Sharath" last="Asokan">Sharath Asokan</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="John, J Baby" sort="John, J Baby" uniqKey="John J" first="J. Baby" last="John">J. Baby John</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Geetha Priya, P R" sort="Geetha Priya, P R" uniqKey="Geetha Priya P" first="P. R." last="Geetha Priya">P. R. Geetha Priya</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author><author><name sortKey="Prathiba, J" sort="Prathiba, J" uniqKey="Prathiba J" first="J." last="Prathiba">J. Prathiba</name><affiliation><nlm:aff id="aff1"></nlm:aff></affiliation></author></analytic><series><title level="j">Contemporary Clinical Dentistry</title><idno type="ISSN">0976-237X</idno><idno type="eISSN">0976-2361</idno><imprint><date when="2015">2015</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec id="st1"><title>Aims:</title><p>The aim of this study was to assess oral health-related quality of life (OHRQoL) using short form (SF) of child oral health impact profile (COHIP) in children aged 11–15 years who sought orthodontic treatment. A comparison was done between these children and age-matched peers who never had or sought orthodontic treatment.</p></sec><sec id="st2"><title>Methodology:</title><p>This cross-sectional study included 227 children aged 11–15 years. A total of 110 participants had sought orthodontic treatment at KSR Institute of Dental Science and Research (orthodontic group) and 117 participants from a nearby school who had never undergone or sought orthodontic treatment (comparison group). OHRQoL was assessed with the SF of the COHIP, and malocclusion severity was assessed with the index of orthodontic treatment needs. Data presentation and statistical analysis were performed with the Statistical Package for the Social Sciences Software (Version 19, SPSS, Chicago, IL, USA). The Chi-square test and Fischer exact tests were used to analyze the qualitative data.</p></sec><sec id="st3"><title>Results:</title><p>Children with little to borderline treatment needs have a better quality of life when compared to children with definitive treatment needs (<italic>P</italic> = 0.049). No statistically significant difference in COHIP-SF scores was found between boys and girls (<italic>P</italic> > 1.000). In the orthodontic group, children with little to borderline treatment needs were 4.8 times (<italic>P</italic> = 0.037) more likely to report better OHRQoL when compared to children with definitive treatment needs.</p></sec><sec id="st4"><title>Conclusion:</title><p>Children who sought orthodontic treatment had lower quality of life scores than those who never had or never sought treatment.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Orley, J" uniqKey="Orley J">J Orley</name></author><author><name sortKey="Kuyken, W" uniqKey="Kuyken W">W Kuyken</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Allen, Pf" uniqKey="Allen P">PF Allen</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Nettleton, S" uniqKey="Nettleton S">S Nettleton</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Locker, D" uniqKey="Locker D">D 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Sheiham</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Zhang, M" uniqKey="Zhang M">M Zhang</name></author><author><name sortKey="Mcgrath, C" uniqKey="Mcgrath C">C McGrath</name></author><author><name sortKey="H Gg, U" uniqKey="H Gg U">U Hägg</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Sischo, L" uniqKey="Sischo L">L Sischo</name></author><author><name sortKey="Broder, Hl" uniqKey="Broder H">HL Broder</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Broder, Hl" uniqKey="Broder H">HL Broder</name></author><author><name sortKey="Wilson Genderson, M" uniqKey="Wilson Genderson M">M Wilson-Genderson</name></author><author><name sortKey="Sischo, L" uniqKey="Sischo L">L Sischo</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Piovesan, C" uniqKey="Piovesan C">C Piovesan</name></author><author><name sortKey="Padua, Mc" uniqKey="Padua M">MC 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Inglehart</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Pahel, Bt" uniqKey="Pahel B">BT Pahel</name></author><author><name sortKey="Rozier, Rg" uniqKey="Rozier R">RG Rozier</name></author><author><name sortKey="Slade, Gd" uniqKey="Slade G">GD Slade</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Jokovic, A" uniqKey="Jokovic A">A Jokovic</name></author><author><name sortKey="Locker, D" uniqKey="Locker D">D Locker</name></author><author><name sortKey="Tompson, B" uniqKey="Tompson B">B Tompson</name></author><author><name sortKey="Guyatt, G" uniqKey="Guyatt G">G Guyatt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Locker, D" uniqKey="Locker D">D Locker</name></author><author><name sortKey="Jokovic, A" uniqKey="Jokovic A">A Jokovic</name></author><author><name sortKey="Tompson, B" uniqKey="Tompson B">B 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Kiyak</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Calis, Em" uniqKey="Calis E">EM Calis</name></author><author><name sortKey="Geels, Lm" uniqKey="Geels L">LM Geels</name></author><author><name sortKey="Prahl Andersen, B" uniqKey="Prahl Andersen B">B Prahl-Andersen</name></author><author><name sortKey="Zentner, A" uniqKey="Zentner A">A Zentner</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Contemp Clin Dent</journal-id><journal-id journal-id-type="iso-abbrev">Contemp Clin Dent</journal-id><journal-id journal-id-type="publisher-id">CCD</journal-id><journal-title-group><journal-title>Contemporary Clinical Dentistry</journal-title></journal-title-group><issn pub-type="ppub">0976-237X</issn><issn pub-type="epub">0976-2361</issn><publisher><publisher-name>Medknow Publications & Media Pvt Ltd</publisher-name><publisher-loc>India</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">26321842</article-id><article-id pub-id-type="pmc">4549994</article-id><article-id pub-id-type="publisher-id">CCD-6-396</article-id><article-id pub-id-type="doi">10.4103/0976-237X.161899</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Article</subject></subj-group></article-categories><title-group><article-title>Oral health-related quality of life of children seeking orthodontic treatment based on child oral health impact profile: A cross-sectional study</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Thiruvenkadam</surname><given-names>G.</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Asokan</surname><given-names>Sharath</given-names></name><xref ref-type="aff" rid="aff1"></xref><xref ref-type="corresp" rid="cor1"></xref></contrib><contrib contrib-type="author"><name><surname>John</surname><given-names>J. Baby</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Geetha Priya</surname><given-names>P. R.</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib><contrib contrib-type="author"><name><surname>Prathiba</surname><given-names>J.</given-names></name><xref ref-type="aff" rid="aff1"></xref></contrib></contrib-group><aff id="aff1"><italic>Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode, Tamil Nadu, India</italic></aff><author-notes><corresp id="cor1"><bold>Correspondence:</bold> Dr. Sharath Asokan, Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research, Tiruchengode - 637 215, Tamil Nadu, India. E-mail: <email xlink:href="asokansharath@yahoo.com">asokansharath@yahoo.com</email></corresp></author-notes><pub-date pub-type="ppub"><season>Jul-Sep</season><year>2015</year></pub-date><volume>6</volume><issue>3</issue><fpage>396</fpage><lpage>400</lpage><permissions><copyright-statement>Copyright: © Contemporary Clinical Dentistry</copyright-statement><copyright-year>2015</copyright-year><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc-sa/3.0"><license-p>This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p></license></permissions><abstract><sec id="st1"><title>Aims:</title><p>The aim of this study was to assess oral health-related quality of life (OHRQoL) using short form (SF) of child oral health impact profile (COHIP) in children aged 11–15 years who sought orthodontic treatment. A comparison was done between these children and age-matched peers who never had or sought orthodontic treatment.</p></sec><sec id="st2"><title>Methodology:</title><p>This cross-sectional study included 227 children aged 11–15 years. A total of 110 participants had sought orthodontic treatment at KSR Institute of Dental Science and Research (orthodontic group) and 117 participants from a nearby school who had never undergone or sought orthodontic treatment (comparison group). OHRQoL was assessed with the SF of the COHIP, and malocclusion severity was assessed with the index of orthodontic treatment needs. Data presentation and statistical analysis were performed with the Statistical Package for the Social Sciences Software (Version 19, SPSS, Chicago, IL, USA). The Chi-square test and Fischer exact tests were used to analyze the qualitative data.</p></sec><sec id="st3"><title>Results:</title><p>Children with little to borderline treatment needs have a better quality of life when compared to children with definitive treatment needs (<italic>P</italic> = 0.049). No statistically significant difference in COHIP-SF scores was found between boys and girls (<italic>P</italic> > 1.000). In the orthodontic group, children with little to borderline treatment needs were 4.8 times (<italic>P</italic> = 0.037) more likely to report better OHRQoL when compared to children with definitive treatment needs.</p></sec><sec id="st4"><title>Conclusion:</title><p>Children who sought orthodontic treatment had lower quality of life scores than those who never had or never sought treatment.</p></sec></abstract><kwd-group><kwd>Child oral health impact profile-short form scale</kwd><kwd>oral health-related quality of life</kwd><kwd>index of orthodontic treatment need index</kwd></kwd-group></article-meta></front><body><sec sec-type="intro" id="sec1-1"><title>Introduction</title><p>The constitution of the World Health Organization defines quality of life (QoL) as individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns.[<xref rid="ref1" ref-type="bibr">1</xref>] Dealing only with the disease and not the other domains such as environmental, psychosocial, and cultural influences is one of the principal limitations of biomedical paradigm.[<xref rid="ref2" ref-type="bibr">2</xref>] In recent years, there has been a broad paradigm shift from medical model of health care to socioenvironmental model, which involves a change in aspects that constitute the health and the strategies necessary to construct it.[<xref rid="ref3" ref-type="bibr">3</xref>] Earlier, there was a tendency to treat oral cavity as an autonomous anatomical entity. This approach was challenged by socioenvironmental model of health care necessitating the understanding of physical and social environments as one of the major determinants of health status.[<xref rid="ref4" ref-type="bibr">4</xref>] As a result, an atomistic or reductionist way of thinking was replaced by a more holistic perspective, thereby enhancing the health outcomes and QoL of an individual.[<xref rid="ref5" ref-type="bibr">5</xref>]</p><p>Oral health related QoL (OHRQoL) is a rapidly emerging phenomenon, which has surfaced over the past two decades. Locker and Allen defined OHRQoL as “the impact of oral diseases and disorders on aspects of everyday life that a patient or person values, which are of sufficient magnitude, in terms of frequency, severity or duration to affect their experience, and perception of their life overall.”[<xref rid="ref6" ref-type="bibr">6</xref>] In other words, OHRQoL is “a multidimensional construct that reflects (among other things) people's comfort when eating, sleeping, and engaging in social interaction; their self-esteem; their satisfaction with respect to their oral health.”[<xref rid="ref7" ref-type="bibr">7</xref>] Various studies have demonstrated that oral diseases can have significant influences on the QoL of individuals.[<xref rid="ref8" ref-type="bibr">8</xref><xref rid="ref9" ref-type="bibr">9</xref><xref rid="ref10" ref-type="bibr">10</xref>] Although common oral diseases are not life-threatening, their outcomes may influence the overall well-being of the individuals. This has resulted in greater clinical focus on improving QoL as a major objective of dental care for conditions like orthodontic problems.[<xref rid="ref11" ref-type="bibr">11</xref>]</p><p>The impact of dental esthetics on social acceptance and self-concept dictates the need for evaluating OHRQoL among orthodontic patients. Zhang <italic>et al.</italic> have shown that patients with malocclusion can develop feelings of self-consciousness and shame about their dental condition or feel shy in social contexts.[<xref rid="ref12" ref-type="bibr">12</xref>] Nevertheless, a malocclusion can be perceived differently by the affected person, and a person's self-awareness of the malocclusion might not be related to its severity. A variety of index systems have been developed to measure OHRQoL. Among these, child oral health impact profile (COHIP) and its short form (SF) is the first children's questionnaire to incorporate positive and negative health impacts.[<xref rid="ref13" ref-type="bibr">13</xref>] With its five domains (oral health, functional well-being, social-emotional well-being, school environment, and self-image), the SF of COHIP is an established instrument for measuring OHRQoL in children and adolescents.[<xref rid="ref14" ref-type="bibr">14</xref>] The aim of this study was to assess OHRQoL using SF of COHIP in children aged 11–15 years who sought orthodontic treatment. A comparison was also done between these children and age-matched peers who were not seeking orthodontic treatment.</p></sec><sec sec-type="methods" id="sec1-2"><title>Methodology</title><p>This cross-sectional study was conducted in the Department of Pedodontics and Preventive Dentistry, KSR Institute of Dental Science and Research (KSRIDSR), Tiruchengode, Tamil Nadu, India from June 2014 to October 2014. The study protocol was approved by the Institutional Review Board and the ethical committee of KSRIDSR. Children with chronic medical conditions, craniofacial abnormalities, untreated severe dental caries, and poor periodontal health status were excluded from the study to prevent possible confounding bias as these conditions could influence their QoL.</p><p>Children in the age range of 11–15 years participated in the study. Totally, 115 children who sought orthodontic treatment at KSRIDSR constituted the orthodontic group. Informed consent was obtained from the parents who accompanied their children to the hospital. Only those children who had the consent to participate were included into this study. Five parents did not allow their children to participate in the study (4.3% loss), and hence the orthodontic group had a final sample size of 110 children. All the children in the orthodontic group belonged to private schools in and around Tiruchengode. After the inclusion of children into the orthodontic group, the participants in the comparison group were recruited. This group comprised of 125 age-matched children from a private school in Tiruchengode. The type of school can be used as an alternative indicator for socioeconomic status.[<xref rid="ref15" ref-type="bibr">15</xref>] Hence, matching based on age, place, and socioeconomic status was possible in this study. The purpose of the study was explained to the school authorities, and their approval was obtained. A consent form was sent to each parent along with a question, asking whether their children had already sought or undergone any kind of orthodontic treatment. Eight children were excluded as they already had undergone orthodontic treatment. Therefore, the comparison group consisted of 117 children (6.4% loss). Hence, the final study sample consisted of 227 children belonging to two groups: The orthodontic group (110) and the comparison group (117). This cross-sectional study carried out over a period of 4 months used a convenience sampling method. Care was taken to include a sample size similar to the study done by Feu <italic>et al.</italic>,[<xref rid="ref9" ref-type="bibr">9</xref>] as this sample size was sufficient to estimate the difference between the comparison group and the orthodontic group, with a power of 80% at a significance level of 0.05.</p><p>The OHRQoL of all these children (OHRQoL) was assessed by SF of COHIP-SF. It consists of 19 items (17 negative, 2 positive) forming five conceptually distinct domains. The questionnaire was designed to be completed in 10–15 min. Any difficulties faced by the child in understanding the questions were clarified by the primary investigator (PI). For the 2 positive items, ordinal responses were recorded as “never = 0,” “almost never = 1,” “sometimes = 2,” “fairly often = 3”, and “almost all of the time = 4.” Scoring for the 17 negatively worded items was reversed. Higher COHIP scores reflected more positive OHRQoL while lower scores reflected lower OHRQoL.</p><p>After completion of the questionnaires, children were clinically examined to assess malocclusion severity and orthodontic treatment needs using dental health component (DHC) of the index of orthodontic treatment need (IOTN). The malocclusion severity was based on the evaluation of five occlusal traits: Missing teeth, overjet, crossbite, displacements of contact points, and overbite. The most severe occlusal trait was identified for each person, and children were categorized according to it. The DHC of IOTN consists of five grades that have been grouped following validation into Grades 1 and 2 representing “slight or no need for treatment,” Grade 3 representing “borderline” cases, and Grades 4 and 5 representing those in “definitive need of orthodontic treatment.”</p><p>Students in the comparison group were examined in their school premises under natural light with adequate illumination (American Dental Association Type III examination). Clinical examination for all the children was done by the PI. To test intra-examiner agreement, 25 children were re-examined approximately 6 weeks later after their initial examination (10 from the comparison group and 15 from the orthodontic group).</p><p>Data presentation and statistical analysis were performed with the Statistical Package for the Social Sciences statistical package (Version 19, SPSS, Chicago, IL, USA). The Chi-square test and Fischer exact test were used to analyze the qualitative data. Significance level was set at 0.05. Kappa statistics was used to evaluate the consistency of intra-examiner reliability.</p><p>For COHIP-SF analysis, all the 19 ordinal responses were summed to produce an overall score that could range from 0 to 76, with higher score indicating better OHRQoL. In the statistical analysis, COHIP-SF scores were transformed into a dichotomous variable using a cut-off value, the median for the whole sample (<italic>n</italic> = 227). Scores higher than median value indicate better QoL, while lower scores indicate lower QoL. A score of sometimes, fairly often, and almost all of the time was used to indicate participants who had experienced at least some oral health impact. For the DHC scores (range, 1–5), subjects with scores >3 were considered to have an objective orthodontic treatment need. These determinations of orthodontic treatment needs were based on the cut-off points for index dichotomization of Mandall <italic>et al.</italic>[<xref rid="ref16" ref-type="bibr">16</xref>]</p></sec><sec sec-type="results" id="sec1-3"><title>Results</title><p>Intra-examiner reliability was very good (Kappa, 0.91), indicating substantial consistency in DHC assessment. The median value for the whole sample (<italic>n</italic> = 227) was 59. Thus, COHIP-SF scores higher than 59 were considered to reflect positive OHQoL and those lower than or equal to 59 indicated lower OHQoL. The mean age of the orthodontic group and comparison group were 12.99 ± 1.36 years and 13.01 ± 1.41, respectively (<italic>P</italic> = 0.91).</p><p><xref ref-type="table" rid="T1">Table 1</xref> shows the distribution of study sample, according to gender and treatment needs. <xref ref-type="table" rid="T2">Table 2</xref> shows the distribution of DHC component of IOTN in both the groups based on index dichotomization.</p><table-wrap id="T1" position="float"><label>Table 1</label><caption><p>Distribution of study sample according to gender and treatment needs</p></caption><graphic xlink:href="CCD-6-396-g001"></graphic></table-wrap><table-wrap id="T2" position="float"><label>Table 2</label><caption><p>Distribution of DHC component of IOTN in comparison and orthodontic group</p></caption><graphic xlink:href="CCD-6-396-g002"></graphic></table-wrap><p>Overall, children with little to borderline treatment needs have better QoL when compared to children with definitive treatment needs (odds ratio [OR] = 1.88, confidence interval [CI] = 1.03–3.43, <italic>P</italic> = 0.049). COHIP-SF scores were significantly higher in comparison group when compared to children who seek orthodontic treatment (OR = 1.99, CI = 1.17–3.38, <italic>P</italic> = 0.0117). However, no statistically significant difference in CHOIP-SF scores was found between boys and girls (OR = 1.03, CI = 0.609–1.72, <italic>P</italic> > 1.000) as shown in <xref ref-type="table" rid="T3">Table 3</xref>.</p><table-wrap id="T3" position="float"><label>Table 3</label><caption><p>Association between IOTN-DHC, groups, gender, and COHIP-SF scores</p></caption><graphic xlink:href="CCD-6-396-g003"></graphic></table-wrap><p>In the orthodontic treatment group, children with IOTN-DHC scores of 1–3 were 4.8 times (OR = 4.87, CI = 2.039–11.69, <italic>P</italic> = 0.037) more likely to report better OHRQoL when compared to children with definitive treatment needs (Scores 4–5). Even though girls reported better COHIP-SF scores than the boys, the difference was not statistically significant (OR = 1.03, CI = 0.478–2.22, <italic>P</italic> > 1.000) [<xref ref-type="table" rid="T4">Table 4</xref>]. Self-image, social-emotional well-being, and oral health well-being were the most negatively affected domains in both boys and girls. However, girls were comparatively more negatively affected than the boys [<xref ref-type="table" rid="T5">Table 5</xref>].</p><table-wrap id="T4" position="float"><label>Table 4</label><caption><p>Association between IOTN-DHC, gender and COHIP-SF scores within the orthodontic group</p></caption><graphic xlink:href="CCD-6-396-g004"></graphic></table-wrap><table-wrap id="T5" position="float"><label>Table 5</label><caption><p>Impact percentage of boys and girls in the orthodontic group on the specific domains of COHIP-SF</p></caption><graphic xlink:href="CCD-6-396-g005"></graphic></table-wrap></sec><sec sec-type="discussion" id="sec1-4"><title>Discussion</title><p>OHRQoL is a multidimensional phenomenon that records an individual's well-being and perceptions. It can play an important role in understanding subjective evaluations. The subjective evaluation of an individual in healthcare decision-making process leads to a change in dynamics of clinical practice and health outcomes.[<xref rid="ref17" ref-type="bibr">17</xref>] OHRQoL instruments may be used in clinical practice as they reflect “a better understanding of treatment needs and outcomes from the patient's perspective.”[<xref rid="ref18" ref-type="bibr">18</xref>]</p><p>This cross-sectional study was done to assess the relationship between OHRQoL and orthodontic treatment needs in adolescents with reliable and valid instruments: The COHIP-SF and the DHC of IOTN. Various other instruments are available to measure the QoL in children. Michigan OHRQoL[<xref rid="ref19" ref-type="bibr">19</xref>] and the early childhood oral health impact score[<xref rid="ref20" ref-type="bibr">20</xref>] are targeted for preschool children. The child perceptions questionnaire (CPQ) was the first instrument created for school-aged children. It has been validated for children 8–10 years (CPQ<sub>8-10</sub>)[<xref rid="ref21" ref-type="bibr">21</xref>] and 11–14 years (CPQ<sub>11-14</sub>).[<xref rid="ref22" ref-type="bibr">22</xref>] In 2011, the pediatric OHRQoL was created and had been validated for use in preschool, school-aged, and preteen children.[<xref rid="ref23" ref-type="bibr">23</xref>] None of these instruments includes positive and negative items to assess the QoL. As both are needed to encompass all aspects of well-being, the COHIP scale was introduced.</p><p>The original COHIP, developed by Broder <italic>et al.</italic> in 2007, consists of 34 items (28 negative, 6 positive).[<xref rid="ref24" ref-type="bibr">24</xref>] Later in 2012, a SF of COHIP was developed, which contains 19 items (17 negative, 2 positive). Reliability and validity testing verified that the COHIP-SF had good psychometric properties and can be used as a stable instrument to measure OHRQoL across school-aged pediatric populations.[<xref rid="ref14" ref-type="bibr">14</xref>] Even though COHIP-SF is suitable for ages between 8 and 15 years, children in the age range of 11–15 years were selected for this study, as they are capable of abstract thinking, reckoning about timing of past events, and correlating them with their experiences.[<xref rid="ref25" ref-type="bibr">25</xref>]</p><p>The IOTN was described by Brook and Shaw and modified by Richmond (1990).[<xref rid="ref26" ref-type="bibr">26</xref>] It consists of two components, DHC and esthetic component and is known to provide reliable and practical results. In various populations, malocclusion was examined using the IOTN, and the reproducibility of IOTN has been proven.[<xref rid="ref27" ref-type="bibr">27</xref><xref rid="ref28" ref-type="bibr">28</xref>] However, the major disadvantage of this index is risk of insensitivity and its inability to map the minor irregularities about which a patient is deeply concerned.[<xref rid="ref29" ref-type="bibr">29</xref>] Only DHC of IOTN was used in this study to ascertain the need for orthodontic treatment.</p><p>Similar to the previous literature, more girls sought dental treatment than boys during the recruitment period of this study.[<xref rid="ref30" ref-type="bibr">30</xref><xref rid="ref31" ref-type="bibr">31</xref>] It was not surprising to find that those children who sought orthodontic treatment had more negative OHRQoL impacts since these conditions may cause discomfiture at school and other social situations.[<xref rid="ref32" ref-type="bibr">32</xref>] In this study, orthodontic treatment needs had almost similar impact on the OHRQoL of both males and females. This is in concordance with the study done by Feu <italic>et al.</italic>[<xref rid="ref9" ref-type="bibr">9</xref>] and in contrast to the studies done by Tung and Kiyak[<xref rid="ref33" ref-type="bibr">33</xref>] and Oliveira and Sheiham[<xref rid="ref11" ref-type="bibr">11</xref>] who demonstrated that children with definitive treatment need had no overall health impact. A study done by Calis <italic>et al.</italic> demonstrated that boys scored significantly lower (higher impact) on the subscales “oral symptoms” and “emotional well-being” than girls.[<xref rid="ref34" ref-type="bibr">34</xref>] However, in this study, impact was higher in girls than boys. The domains that were more negatively affected were in the order of self-image, social-emotional well-being, and oral well-being. Their greatest impact was at the psychosocial level. Feu <italic>et al.</italic> have shown that the individual personality behavior probably has an impact on OHQOL and making negative impacts might not be dependent on malocclusion severity.[<xref rid="ref9" ref-type="bibr">9</xref>]</p><p>Esthetics and appearance assume paramount importance during adolescence. Children who seek orthodontic treatment are concerned of improving their appearance and social acceptance. Apart from improving oral function, health, and esthetics, it is important to enhance self-esteem and QoL of an individual through orthodontic treatment.[<xref rid="ref33" ref-type="bibr">33</xref>] The OHRQoL questionnaire, as a part of treatment planning, could help to identify the individuals’ perceptions and thereby enhance their satisfaction to the treatment outcome.</p></sec><sec sec-type="conclusion" id="sec1-5"><title>Conclusion</title><p>Within the limitations of this cross-sectional study, it could be demonstrated that children who sought orthodontic treatment had lower QoL than those who had never sought treatment. 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