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Disease does not always negatively affect subjective 6. Abdullah MS, Rock WP. Assessment of orthodontic treatment need in 5,112
perceptions of well‑being, and even when it does, its impact Malaysian children using the IOTN and DAI indices. Community Dent Health
depends on expectations, preferences, material, social and 7. 2001;18:242‑8.
Abdullah MS, Rock WP. Perception of dental appearance using Index of
psychological resources and more importantly, socially and Treatment Need (Aesthetic Component) assessments. Community Dent
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culturally derived values. What is considered aesthetically Health 2002;19:161‑5.
pleasing in one culture will often not match that which is 8. Abu Alhaija ES, Al‑Nimri KS, Al‑Khateeb SN. Orthodontic treatment need
thought of as aesthetically pleasing in another. Thus, the and demand in 12‑14‑year‑old north Jordanian school children. Eur J Orthod
2004;26:261‑3.
lack of perceived need in the population evaluated might 9. Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O’Brien KD.
be because this rural population probably does not have Perceived aesthetic impact of malocclusion and oral self‑perceptions in
the same notions of beauty as their British peers, where the 14‑15‑year‑old Asian and Caucasian children in greater Manchester. Eur J
Orthod 2000;22:175‑83.
index was developed. The level of education may also be a 10. Marques LS, Pordeus IA, Ramos‑Jorge ML, Filogônio CA, Filogônio CB, Pereira LJ,
factor influencing perceived treatment need and demand. [18] Paiva SM. Factors associated with the desire for orthodontic treatment among
Brazilian adolescents and their parents. BMC Oral Health 2009;9:34.
It is possible that subjects replied defensively and 11. Farrow AL, Zarrinnia K, Azizi K. Bimaxillary protrusion in black
subconsciously trying to allocate themselves to the Americans – an esthetic evaluation and the treatment considerations. Am J
attractive side in order to avoid treatment. Alternatively Orthod Dentofacial Orthop 1993;104:240‑50.
since each picture shows the dentition only from the 12. Polk MS Jr, Farman AG, Yancey JA, Gholston LR, Johnson BE, Regennitter FJ.
front, it is possible that the patients could not differentiate Soft tissue profile: a survey of African‑American preference. Am J Orthod
Dentofacial Orthop 1995;108:90‑101.
between some features of malocclusion as increased overjet 13. Mantzikos T. Esthetic soft tissue profile preferences among the Japanese
and deep bite and subsequently they could not score. It population. Am J Orthod Dentofacial Orthop 1998;114:1‑7.
might be that patients could not estimate the malocclusion 14. Claudino D, Traebert J. Malocclusion, dental aesthetic self‑perception and
and subsequently could not classify the teeth in any quality of life in a 18 to 21 year‑old population: a cross section study. BMC
Oral Health 2013;13:3.
of these grades. Further, it is likely that the IOTN is not 15. Badran SA. The effect of malocclusion and self‑perceived aesthetics on the
sensitive enough to account for all types of malocclusion as self‑esteem of a sample of Jordanian adolescents. Eur J Orthod 2010;32:638‑44.
Class III, open bite, cross bite and scissors bite. [29] 16. Shaw WC. Factors influencing the desire for orthodontic treatment. Eur J
Orthod 1981;3:151‑62.
Epidemiological analysis of the prevalence of various oral 17. Hamamci N, Basaran G, Uysal E. Dental Aesthetic Index scores and
health problems has evidenced an enormous lack of data perception of personal dental appearance among Turkish university students.
Eur J Orthod 2009;31:168‑73.
related to malocclusion. This is due to the accumulated 18. Bernabé E, Flores‑Mir C. Normative and self‑perceived orthodontic
treatment needs of the problems of caries and periodontal treatment need of a Peruvian university population. Head Face Med 2006;2:22.
disease, an issue that is strongly correlated to the current 19. Espeland LV, Stenvik A. Perception of personal dental appearance in young
healthcare model as well as to the inequality in access to adults: relationship between occlusion, awareness, and satisfaction. Am J
healthcare services. Thus, those responsible for planning Orthod Dentofacial Orthop 1991;100:234‑41.
orthodontic treatment in both the public and private sector 20. Espeland LV, Stenvik A, Medin L. Concern for dental appearance among
young adults in a region with non‑specialist orthodontic treatment. Eur J
should concern themselves with the desires of the community Orthod 1993;15:17‑25.
as well as with the large body of evidence that supports the 21. Pietilä T, Pietilä I. Dental appearance and orthodontic services assessed
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on dental attractiveness. Angle Orthod 2004;74:63‑70.
especially in developing countries where different factors than 23. Albino JE, Lawrence SD, Tedesco LA. Psychological and social effects of
those reported in North American and European countries orthodontic treatment. J Behav Med 1994;17:81‑98.
could be influencing the demand and delivery of orthodontic 24. Abdullah MS, Rock WP. Perception of dental appearance using Index of Treatment
Need (Aesthetic Component) assessments. Community Dent Health 2002;19:161‑5.
care. It may even be necessary to use more than one index in 25. Tsakos G. Combining normative and psychosocial perceptions for assessing
an epidemiological study to gather all the required information. orthodontic treatment needs. J Dent Educ 2008;72:876‑85.
The conclusions derived from this study are of 26. Brook PH, Shaw WC. The development of an index of orthodontic treatment
priority. Eur J Orthod 1989;11:309‑20.
considerable importance for Indian policy makers in their 27. Onyeaso CO, Arowojolu MO. Perceived, desired, and normatively
work with planning and implementing public oral health determined orthodontic treatment needs among orthodontically untreated
strategies for the rural population of this age group. Nigerian adolescents. West Afr J Med 2003;22:5‑9.
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