Commentary

This systematic review aimed to establish from existing evidence, the relationship between orthodontic treatment and oral health-related quality of life (OHRQoL). The review included studies comparing OHRQoL (using recognised measures of OHRQoL) in participants who were undergoing or had completed orthodontic treatment. Despite the high levels of provision of such treatment, only 11 studies were identified that met the inclusion criteria. Of these four were high quality cohort studies (Level 1B evidence), with the remainder being cross-sectional or case-control studies with lower levels of evidence. Four measures of OHRQoL had been used: Oral Health Impact Profile; Oral Impacts on Daily Performances index; The Child Perceptions Questionnaire; and The Oral Health-related Quality of Life in the UK measure. Due to differences in the measures used and follow-up protocol meta-analysis of the results was not possible. However, the majority of studies did find correlations with orthodontic treatment and improvement in OHRQoL. Interestingly, one longitudinal study found that participants reported an increase in OHRQoL scores (indicating increased impact) in the month following appliance insertion. These impacts were particularly increased within the first week, where increases in impacts associated with pain, psychological discomfort and physical disability were reported. This finding highlights the importance of informing patients that they may have some difficulties adapting to their appliance in the first few weeks. The inferences the authors drew from the reported correlation statistics and regression statistics was that the effects of orthodontic treatment on OHRQoL could be described as moderate.

This systematic review highlights some important issues in the measurement of OHRQoL. The majority (n=8) of the studies included in the review had participants aged 16 years and under, however, only three of those studies used a measure designed specifically for children. While the Child Perceptions Questionnaire is designed for 11- to 14-year-olds, its content and structure may be more appropriate for those aged under 16 than some of the measures developed with adult populations in mind. Additionally, as the measures used were designed to cover a range of oral conditions, it may be that they are not sensitive enough to pick up subtle changes associated with treatment specifically for malocclusion. The authors recommend that further high quality research, which takes into account potential confounding factors, is required to fully understand the effect of orthodontic treatment on OHRQoL. In particular the use of a malocclusion-specific measure of OHRQoL would be of benefit, not only to ensure changes related to malocclusion are identified, but also to provide a standardised measure of this construct.

Practice point

  • It would appear from the available evidence that orthodontic treatment has positive effects on OHRQoL following treatment. However, deterioration in some aspects may occur during the first week of treatment.

  • Further high quality research is required to confirm these findings using a standardised measure specifically designed to measure the impact of malocclusion.