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ORAL SELF PERCEPTION OF ESTHETICS AMONG DENTAL STUDENTS * Dr.BASWARAJ M.D.S. ,Dr. JAYASUDHA B M.D.S#., Dr.KUMARSWAMY K. M . M.D.S.$, Dr. PADMINI M N M.D.S.$, Dr. CHANDRALEKHA B .M.D.S.$ ABSTRACT : BACKGROUND -The relationship between physical appearance and perception of an esthetic deviation, and the impact of such deviation on self-esteem and body image are important issues in determining the benefits from orthodontic treatment.Studies in social psychology indicate that physical attractiveness plays a major role in social interactions and influence the impression of an individual’s social skill. AIM - To know the knowledge and attitude towards orthodontic treatment and compare perceived aesthetic impact of malocclusion among dental students from first year BDS to Final year, house surgeons and variables influencing to perceive orthodontic treatment. MATERIAL &METHODS- The subjects for the study were 230 dental students of Government Dental College, Bangalore, Karnataka. The entire subject group consisted of 93 males and 137 females of I, II, III, IV B.D.S. students and house-surgeons aged between 17 to 23 years. Each class room of the subjects were visited and the data was collected by asking the student to fill the lengthy questionnaire form. An analysis of Variance (ANOVA) was done between the five class groups to test for statistical difference on Mean variable scores for each group. Categorical variables were evaluated with a Chi-square analysis. As mentioned above the subject pool was divided by sex for purpose of analysis. RESULTS - 75 percent of the students were aware of their dental aesthetics, 17 percent were not aware and 8 percent did not have knowledge about aesthetics at all. 97 percent of females had very good knowledge about dental aesthetics compared to 93 percent of males.75 percent of the females were satisfied with the attractiveness of their teeth while the male percentage was only 69. House surgeons had more positive attitude with the least among the first year students. Among satisfaction, I year students and House-surgeons were very much satisfied. III year students were least satisfied. CONCLUSION – The dental students had very good knowledge about the orthodontic treatment and had positive attitude towards orthodontic treatment. Dental attractiveness being the most influencing variable to perceive orthodontic treatment. Females had very good knowledge, satisfaction and positive attitude compared to the males regarding dental aesthetics and treatment. House surgeons were much more aware, very much satisfied and had a more positive attitude which was decreasing towards I year students. Key Words : Dental Students, Self Evaluation, Satisfaction,Dental Aesthetics *Reader, Department of Orthodontics, PDUDC,Solapur, India # Reader,Department of Pedodontics, PDUDC,Solapur, India Department of Orthodontics, Government Dental College & Research Centre, Bangalore. $ INTRODUCTION: Orthodontic treatment is often carried out to improve the patient’s dental appearance, hence the individual’s attitude to his or her own malocclusion is an important factor in determining treatment need. The main factors influencing the decision for treatment are aesthetic improvement and psychological aspect. Measuring and recording the prevalence of mal-occlusion and treatment need in a population is useful for the planning of orthodontic services. In addition, knowledge about the attitude of patients to malocclusion is becoming increasingly important in orthodontics. Without a satisfactory estimate of the need and demand for treatment, it is difficult to develop and organize a meaningful orthodontic services.The orthodontist routinely evaluates his patients and prescribes treatment plans in order to satisfy the often stated goals of 1) Good dental function 2) Stability of teeth and jaw position, and 3) Dental esthetics. While the first two considerations have been researched and are continually discussed in all the specialties of dentistry, the last aspect dental esthetics has escaped research attention. The lack of research material in this area is due not to a lack of interest in the subject but to the difficulty of measuring exactly what “Dental esthetics” actually means. There are quantifiable determinants of good dental function and stability but how does one measure esthetics? Esthetics is judgmental commodity, and the assumed variability in individual judgements (beauty is in the eye of the beholder) makes it difficult to make generalized statements. The aim of this study is to find out the perception of dental appearance among dental students. The aim of this study was to find out the perception of self evaluation and satisfaction of dental appearance among dental students. MATERIAL &METHODS: The subjects for the study were 230 dental students of Government Dental College Bangalore, Karnataka. The entire subject group consisted of 93 males and 137 females of I, II, III, IV B.D.S. students and house-surgeons, aged between 17 and 23 years. The data for this study were collected visiting to the class-rooms of subjects, they were required to complete a lengthy questionnaire form. Embodied in the questionnaire were questions on self-evaluation of their teeth as well as self-satisfaction with their teeth. The test items formulated to assess the subjects were 1. Ability to recognise the presence or absence of mal-occlusion. 2. Knowledge to perceive the impact of mal-occlusion among various classes and sexes. 3. Their opinion about orthodontic treatment. These questions had been divided into three groups. 1. Q 1 -- 3 is to know about the awareness about their dentition. 2. Q 4 -- 13 is to know about their self-satisfaction . 3. Q 14 – 17 is to know about their attitude towards orthodontic treatment. Each question had three possible answers, ranging from positive response to a negative response and these answers were given scores ranging 0-2, the highest score to the best and the lowest to the worst. Statistical evaluation of the data set was completed by grouping the answers to each of the questions into three categories: a negative response, an average response, and a positive or favorable response. An analysis of Variance (ANOVA) was then done between the five class groups to test for statistical difference on Mean variable scores for each group. Categorical variables were evaluated with a Chi-square analysis. As mentioned above the subject pool was divided by sex for purpose of analysis. RESULTS: Crosstab Count 40 SEX VAR00001 Total 1.00 2.00 3.00 4.00 5.00 1.00 22 23 32 27 33 137 Total 25 13 10 17 28 93 47 36 42 44 61 230 30 20 10 Count .00 SEX .00 0 1.00 1.00 Table I V AR00001 Dental Students Males Vs Females 2.00 3.00 Graph I 4.00 5.00 When subjects were asked about their awareness, more than 75 percent of the students were aware of their dental aesthetics, 17 percent were not aware and 8 percent did not have knowledge about aesthetics at all. 97 percent of females had very good knowledge about dental aesthetics compared to 93 percent of males. However the difference is statistically not significant. When asked about self-satisfaction with the attractiveness of their teeth, this indicated a fairly objective evaluation of their own dental malocclusion situation. 43 percent of the subjects were satisfied with the attractiveness of their teeth,39 percent of the subjects reported negative feeling towards their teeth, 17 percent of the subjects showed a strong positive feeling towards their teeth(Table-3 and Graph-3). Crosstab 60 Count VAR00001 1.00 2.00 3.00 4.00 5.00 Total III 2.00 28 24 24 30 48 154 50 3.00 12 5 8 6 7 38 Total 7 7 10 8 6 38 40 47 36 42 44 61 230 30 III 20 1.00 10 2.00 Count 1.00 0 3.00 1.00 Table III 2.00 3.00 4.00 5.00 Graph III V AR00001 75 percent of the females and 69 percent of males were satisfied with the attractiveness of their but there was no statistical significance found(Table-4 Crosstab and Graph-4). Count 50 1.00 VAR00001 Total 1.00 2.00 3.00 4.00 5.00 4 4 3 4 4 19 39 27 34 31 37 168 40 3.00 Total 4 5 5 9 19 42 47 36 42 44 60 229 30 20 IV 1.00 10 Count IV 2.00 2.00 0 3.00 1.00 Table IV V AR00001 2.00 3.00 4.00 5.00 Graph IV When asked about attitude towards orthodontic treatment, 44 percent had strong positive attitude,35 percent were satisfied with their attractiveness and 19 percent were not aware of it(Table-5 and Graph-5). Crosstab Count 40 1.00 VAR00001 1.00 2.00 3.00 4.00 5.00 Total 10 8 9 9 16 52 3.00 33 26 30 29 35 153 Total 4 2 3 6 9 24 30 47 36 42 44 60 229 20 V 10 1.00 Count V 2.00 2.00 0 3.00 1.00 Table V V AR00001 2.00 3.00 4.00 5.00 Graph V Among females there was almost even split between strongly positive(47 percent) and satisfactory (47 percent) attitude towards orthodontic treatment , there was no statistical significance found between males and females. The most influencing variable was that, the teeth affect the way their face looks, and this was considered to be the most influencing factor among all the classes. SATISFACTION Vs ATTITUDE When asked about how many students were un-satisfied about their dental attractiveness and had a positive attitude towards orthodontic treatment77 percent of subjects were un-satisfied of which 55 percent had a positive attitude towards orthodontic treatment. 38 percent of subjects were very much satisfied with the attractiveness of their teeth and 47 percent of these were having satisfied attitude. This is Crosstab highly statistically significant(Table-6 and Graph-6). Count 40 1.00 VAR00001 Total 1.00 2.00 3.00 4.00 5.00 9 3 8 6 6 32 25 21 23 20 37 126 3.00 Total 13 12 11 18 18 72 47 36 42 44 61 230 30 20 VI 10 1.00 Count VI 2.00 2.00 0 3.00 1.00 Table VI V AR00001 2.00 3.00 4.00 5.00 Graph VI When compared among different class groups about the knowledge of dental aesthetics ,House- surgeons were very much aware of it followed by final year students. However there was no statistical significance found among the various classes. First year students were not aware of dental aesthetics very much (Table-8 and Graph-8). Crosstab Count 50 VIII 1.00 2.00 3.00 4.00 5.00 Total 2.00 5 3 2 1 1 12 3.00 13 13 12 12 20 70 32.00 29 20 27 31 39 146 Total 1 1 47 36 42 44 60 229 40 30 V III 20 1.00 2.00 10 3.00 Count 1.00 VAR00001 0 32.00 1.00 Table VIII V AR00001 2.00 3.00 4.00 5.00 Graph VIII When asked among different class groups about satisfaction of dental aesthetics, House-surgeons were very much satisfied about their teeth followed by final years. All the class groups were happy with their attractiveness almost equally. However the House –surgeons and II years were not happy with their dental aesthetics. This Crosstab was not statistically significant (Table-9 and Graph-9). Count 60 1.00 VAR00001 Total 1.00 2.00 3.00 4.00 5.00 9 5 4 2 10 30 38 31 37 40 49 195 3.00 50 Total 1 2 2 5 47 36 42 44 61 230 40 30 IX 20 1.00 10 Count IX 2.00 2.00 0 3.00 1.00 Table IX V AR00001 2.00 3.00 4.00 5.00 Graph IX When the attitude towards orthodontic treatment was compared among different classes , house surgeons had more positive attitude while first year students showed the least. Among satisfaction, I year students and House-surgeons were very much satisfied. III year students were least satisfied. No statistical significance was found. DISCUSSION: During the course of dental surgery it was noticed that there were number of dental students with minor to moderate malocclusion who have not sought orthodontic treatment. This prompted us to study the motivation and psychological factors among the dental students. These dental students can reflect how much the general population is aware of orthodontic treatment. To study Dento-facial aesthetics and assess the patients thought regarding aesthetics, a long questionnaire was made having options with scores allotted to each answer. It had been hypothesized that increased experience with and availability of orthodontic service should be translated into differences in aesthetics rating and perception of treatment need(Tulloch et al.,1984). Similar results have been obtained in our present study where seventy-five percent of the dental students who were having knowledge about orthodontic treatment were aware of dental aesthetics. The decision making process that a person undertakes when judging his/her own dental aesthetic satisfaction may be broken down into several steps. First to know about the awareness about their own dentition, after this step second their self- satisfaction ,and finally their attitude toward orthodontic treatment. We may postulate that females had very good knowledge about dental aesthetics compared to the males. When asked about self- satisfaction of their teeth, the study indicates that the subjects did make fairly accurate self –evaluation of their own mal-occlusions. The unsatisfied subjects with their dental aesthetics had positive attitude towards orthodontic treatment. This is highly statistically significant(p < 0.01). The highly satisfied subjects with their dental aesthetics were aware of the attractiveness of their teeth. This is also highly statistically significant. The sex difference is probably due to the fact that the standards for acceptable facial form are more clearly delineated for females and thus deviations in dental form that adversely influence facial outline are more important to females than males.Similar results were obtained by Sumant Goel et al, 2002. The subjects who had malocclusion and did not report to the orthodontic clinic seems to believe that teeth do not affect their aesthetic value and this appeared to be more of an ignorance and that teeth does significantly affect facial appearance and lack of knowledge was the main factor that kept away from treatment. Heidi Kero Suo et al.,2002; According to their results access to free of cost orthodontic treatment was likely to affect the treatment rate, where as it did not seem to influence the self perceived need for treatment. Similar study conducted by Sven Helm et al., 1985:that certain malocclusions especially conspicuous occlusal and space anomalies , may adversely affect body image and self concept not only at adolescence but also in adulthood. It is in strongest association with study conducted by Kari Birkeland et al., 2000.that both children and parents rate pleasant aesthetics as an important factor for psycho-social well-being. In accordance with Mark J. Bentele et al., 2002.Index of Orthodontic Treatment Need(IOTN) is a promising teaching aid for improving educational outcomes for orthodontic referral wherein the dental students are able to diagnose malocclusion and make appropriate referrals of potential orthodontic patients. SUMMARY AND CONCLUSION: A group of dental students (93 males and 137 females),17-23 years of age were given a questionnaire containing questions which evaluated knowledge of their teeth, level of self-satisfaction, their attitude towards orthodontic treatment and the overall perception of dental appearance. From the study done it was found that the subjects had 1. Very good knowledge about the orthodontic treatment and had positive attitude towards orthodontic treatment. 2. The teeth affect the way their face looks, dental attractiveness the most influencing variable to perceive orthodontic treatment. 3. Females had very good knowledge, satisfaction and positive attitude compared to the males regarding dental aesthetics and treatment. 4. House surgeons were much more aware, very much satisfied and had a more positive attitude which was decreasing towards I year students. 5. The un-satisfied subjects had positive attitude towards orthodontic treatment. REFERENCES: 1.Mathew Shue-Te Yeh et al The Relationship of 2 professional occlusal indices with patients’ perceptions of esthetics, function, speech, and orthodontic treatment need. Am J Orthod 2000;118:421-8. 2.Mark J. Bentele et al Efficacy of training dental students in the index of orthodontic treatment need. Am J Orthod 2002 ;122:456-62. 3.N.A.Mandall et al Perceived aesthetic impact of malocclusion and oral selfperceptions in 14-15year old Asian and Caucasian children in Greater Manchester. Euro J Orthod 1999;21:175-83. 4.Orlagh Hunt et al The Aesthetic component of the Index of Orthodontic Treatment Need validated against lay opinion. Euro J Orthod 2002;24:53-59. 5.Robert S.Corruccini An Epidemiologic transition in dental occlusion in world populations. Am J Orthod 1984;11:419-26. 6.Sven Helm, Sven Kreiborg, and Beni Solow Psychosocial implications of malocclusion :A 15 year follow up study in 30 year old Danes. Am J Orthod 1985;2:110-18. 7.S.M. Cochrane et al Perception of facial appearance by orthodontists and the general public. J Clin Orthod 1997;3:164-68. 8.Stephen Richmond and Charles P.Daniels International comparisons of professional assessments in orthodontics: Part 1-Treatment need. Am J Orthod 1998;113:180-5. 9.Susan P . Mc gorray et al Evaluation of orthodontists’ perception of treatment need and the Peer Assessment Rating(PAR)Index. Angle Orthod 1999;69(4):325-33. 10.Seppo Jarvinen Indexes for orthodontic treatment need .Am J Orthod 2001;120:237-9. 11.Sumant Goel et al Orthodontic Treatment Need-An Orthodontist’s and patient’s perception. J Ind Orthod Society 2002;35:28-35. Correspondance Dr. BASWARAJ Reader, Department of orthodontics & Dentofacial Orthopedics PDUDC Solapur, India Email : [email protected]