Accepted Manuscript

Some Malocclusion Traits Significantly Reduce Quality of Life Among Adults

Mauro Henrique Nogueira Guimarães De Abreu

PII: S1532-3382(17)30189-6
DOI: 10.1016/j.jebdp.2017.06.007
Reference: YMED 1212

To appear in: The Journal of Evidence-Based Dental Practice

Please cite this article as: De Abreu MHNG, Some Malocclusion Traits Significantly Reduce
Quality of Life Among Adults, The Journal of Evidence-Based Dental Practice (2017), doi: 10.1016/
j.jebdp.2017.06.007.

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ARTICLE ANALYSIS & EVALUATION // ETIOLOGY/OTHER

SOME MALOCCLUSION TRAITS SIGNIFICANTLY REDUCE QUALITY OF LIFE AMONG ADULTS

PURPOSE/QUESTION: To assess the impact of malocclusion on the oral health−related quality of

life (OHQoL) among Finnish adults.

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ARTICLE TITLE AND BIBLIOGRAPHIC INFORMATION

Malocclusion traits and oral health-related quality of life in Finnish adults. Masood M, Suominen
AL, Pietila T, Lahti S. Community Dent Oral Epidemiol 2017; 45:178-88.

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SOURCE OF FUNDING:

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Finnish Dental Society Apollonia and the Finnish Dental Association.

TYPE OF STUDY/DESIGN:

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Cross-sectional study
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REVIEWER NAME and CONTACT INFORMATION:

MAURO HENRIQUE NOGUEIRA GUIMARÃES DE ABREU

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Department of Community and Preventive Dentistry

School of Dentistry – Universidade Federal de Minas Gerais

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Avenida Antônio Carlos, 6627 – Pampulha, Belo Horizonte, Minas Gerais, Brazil
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CEP 31270.901

maurohenriqueabreu@gmail.com
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KEY WORDS: Malocclusion; Health-related quality of life; Oral health

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SUMMARY

Subjects

This cross-sectional study included a representative sample of adults and elderly people in Finland.

Key Risk/Study Factor

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The exposure of interest was malocclusion traits (increased overjet, cross-bite/scissor-bite and
increased overbite/ open bite).

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Other covariates included dental caries, periodontal disease, use of prostheses, general health,
age, marital status, educational level, orthodontic treatment history, number of contacting pairs of
teeth.

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Main Outcome Measures

The main outcome measure was the oral health−related quality of life (OHRQoL), measured using

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the questionnaire OHIP-14. The OHIP-14 measures the frequency of occurrence of oral impacts in
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seven domains: functional limitation, physical pain, psychological discomfort, physical disability,
psychological disability, social disability and handicap.

Main Results
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Results of this survey demonstrated that those who have increased overjet showed a statistically
higher level of total OHIP-14 score, meaning poorer OHRQoL (adjusted rate ratio = 1.09;
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confidence interval [CI] 1.01; 1.16; P ≤ .05). There was no statistically significant difference in total
OHIP-14 scores, after adjustment for covariates, for cross-bite/scissor-bite, and also for increased
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overbite/open bite.

Different malocclusion traits are associated with different domains of OHIP-14. Increased overjet is
associated with poorer physical disability of the OHIP-14 (adjusted rate ratio = 1.56; [CI]; 1.11;
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2.19; P ≤ .05). Increased overbite/open bite showed significantly poorer psychological disability
(adjusted rate ratio = 1.26; [CI]; 1.01; 1.59; P ≤ .05). Cross-bite/scissor-bite was associated only
with the social disability domain. The presence of cross-bite/scissor-bite improves the social
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disability domain of OHIP-14 (adjusted rate ratio = 0.75; [CI]; 0.60; 0.95; P ≤ .05).
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Conclusions

The authors concluded that Finnish adults (over 30 years old) with increased overjet had
significantly poorer OHRQoL than people with normal overjet. Cross-bite/scissor-bite and
increased overbite/open bite were not significantly associated with OHRQoL.
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SORT SCORE
A B C NA
SORT, Strength of Recommendation Taxonomy

LEVEL OF EVIDENCE

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1 2 3

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COMMENTARY AND ANALYSIS

Malocclusion is a dental public health problem based on its prevalence and impact on patients’
quality of life. A recent systematic review has shown that malocclusions in children and
adolescents between age 8 and 18 years were associated with diminished OHRQoL.1 The
assessment of malocclusion in adults and elderly individuals is not an easy task, especially when
tooth loss and edentulism are considered prevalent.2 On the other hand, in the last decades a

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decline in tooth loss has been observed,3 along with an increased desire for orthodontic treatment
among adults.4 Therefore, it was possible to identify that the quality of life has improved for adults
without malocclusion/orthodontic treatment need compared to those who have these

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conditions.5

This study is a cross-sectional epidemiological study, based on a representative sample of Finnish

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adults and elderly persons that aimed to assess the impact of malocclusion on OHRQoL.6
Moreover, this is a rare assessment of the impact of malocclusion on OHRQoL, especially because
authors included older adults, as well.

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OHRQoL was measured using the questionnaire OHIP-14. The OHIP-14 is an instrument that
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measures the frequency of occurrence of oral impacts in seven domains: functional limitation,
physical pain, psychological discomfort, physical disability, psychological disability, social disability
and handicap.7 The authors also measured malocclusion traits (increased overjet, cross-
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bite/scissor-bite and increased overbite/ open bite) and some covariates, such as dental caries,
periodontal disease, use of prostheses, general health, age, marital status, educational level,
orthodontic treatment history and number of contacting pairs of teeth. Statistical analysis is also
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very well described.6

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The results of this survey demonstrate in the adjusted analysis that only the increased overjet had
a statistically significant, but minor impact on OHRQoL. Interestingly, different malocclusion traits
are associated with different domains of OHIP-14. Increased overjet is associated with poorer
physical disability of the OHIP-14. On the other hand, increased overbite/open bite showed
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significantly poorer psychological disability although this trait had no significant impact on total
OHRQoL. Curiously, the presence of cross-bite/scissor-bite improves the social disability domain.
So, the results suggest that the presence of these occlusal traits impacts on the OHRQoL of the
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adults and elderly. Moreover, these causal relationships are complex.

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The authors properly covered their main findings, but no discussion is presented about the
association between social disability and cross bite/scissor bite. It would be interesting to
understand why Finnish adults/elderly individuals with cross bite/scissor bite apparently are more
likely to have better social abilities. The evaluation of number of teeth lost8, other cut-off point for
dental caries,9 and periodontal disease10 and a subpopulation analysis could be interesting if
tested in a secondary analysis to confirm the validity of these associations.11

Overall, this representative cross-sectional study enhances our knowledge about the impact of
oral health problems on patients’ quality of life. These results help to suggest designs for
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longitudinal epidemiological studies in the future as the number of adults and elderly persons will
continue to increase and challenge the public health sector. The findings of this study enable the
clinicians to understand in which dimension malocclusion could impact an adult´s quality of life.
These results may also be useful for clinicians to plan orthodontic interventions in evidence based
style.

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