| Malocclusion affects not only individual's appearance and oral function,but also the negative influence of psychosocial well-being.People with better dental appearance have higher self-esteem and social identity,and oral related quality of life is relatively high.Orthodontic treatment can improve a person's appearance,oral function,psychosocial well-being and quality of life.Because of the rapid development of social economy and culture in China,more and more adult patients are now finding orthodontic treatment.According to social experience differences,there are differences in adults' thoughts,emotions and behavior,and these differences have effects on the individual's self awareness of dental aesthetic and the motivation of seeking orthodontic treatment,also have an impact on treatment goals and satisfaction.Therefore,orthodontists should be aware of physiological and psychosocial characteristics of adults seeking orthodontic treatment,correctly understand the psychological status of the patients,so as to make good use of the bio-psycho-social medical model,strengthening the doctor-patient communication,improve patient compliance and satisfaction,enhance the quality of treatment.At present,the research on the mental state of orthodontic patients is increasing,however,domestic scholars have very little research on the cognitive and motivation of orthodontic patients.We found some adult patients seeking orthodontic treatment were not just because of the appearance and function of teeth in clinic,different people had different cognition of maxillofacial problems of their own.Some people with slight malocclusion found seriously affects on the appearance and daily life and had strong desire to seek orthodontic treatment,which might be related to the personality characteristics of the individual,social role and living environment,and so on.The traditional questionnaire investigation based on the large sample,and professors often have to design the questionnaire which is under the doctor's point of view.The Q-methodology makes the subjects directly express their internal view,and the subjects is the variables and the statement is the sample,the core of investigation is subject's view,it strengthen the method quantitatively and qualitatively compared to traditional research method.This study is to explore the motivation and related psychological characteristics of adult patients with malocclusion.We use the Q-methodology and multiple psychological questionnaires to investigate the psychological characteristics of adult patients combined with clinical examination,to systematically assess the patient's treatment motivation,to investigate the psychological factors influencing motivation of seeking orthodontic treatment,and to find the relationship between personality characteristics and oral health related quality of life.The whole dissertation consists of three parts:Part 1:Use Q-methodology to assess motivation of adult patients seeking orthodontic treatment.The motivation of patients seeking orthodontic treatment can affect satisfaction,treatment outcomes,and adherence.Motivations of people seeking treatment differ in their severity of malocclusion,education,living environment and personality.In order to provide better humanistic care and service quality,the purpose of this study is to assess adult patients' orthodontic treatment motivation,and classify people according to their motivations,so as to provide personalized diagnosis and design for different types of patients.This study uses Q-methodology as a main method and four stages are conducted in this research:collecting Q-sample,selection of P-sample,Q-sorting and analysis.At first,subjective viewpoints were collected by interviewing patients and reviewing the relevant orthodontic literature.After identified repetition of viewpoints and eliminated duplications,this study got 35 items.45 adult patients with different demographics were recruited as the P-sample,and then placed their statements into theQ-methodology distribution column.Participants ranked a set of 35 statements from"agree most" to "disagree most".Finally,PQ Method Version 2.35 was used to analyze the data.According to analysis of the participants' Q-sorts results,participants were classified into four factors:factor 1,patients focused on self-confidence and their appearance;factor 2,patients concerned about the esthetics and function of teeth;factor 3,patients concerned about the situations of their teeth;factor 4,patients who are easily influenced by others.The others who had different views did not match any of the above four groups.The results showed that the motivations are complex when adult patients seek orthodontic treatment,and 80%adult patients fell into one of four typical factor groups.Part 2.Psychosocial impact of dental esthetics regulates motivationto seek orthodontic treatmentMany patients who need orthodontic treatment according to the Index of Orthodontic Treatment Need(IOTN)reject clinical treatment.It is possible that these patients believe that the benefits of orthodontic treatment are not balanced against their associated risks and costs,or perhaps they think that the psychosocial impact of malocclusion(particularly dental esthetics)is not severe.The purpose of this study was to investigate the self-perceptions of dental esthetics in adults who sought orthodontic treatment and thus to assess the role of the psychosocial impact of dental esthetics on treatment-seeking motivations.This study was designed as a prospective trial.404 adults patient in orthodontic department were recruited,aged 18 to 30 years..The participants were divided into 2 groups:an intervention group(received orthodontic treatment)and a control group(rejected orthodontic treatment).Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need(IOTN).The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire(PIDAQ)was used to evaluate the psychosocial impact of dental esthetics.SPSS software was used to observe intragroup and intergroup differences.The result did not show any statistical differences between the groups in relation to the IOTN-DHC grades.Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTNDHC grades;self-confidence scores in the control group(F=1.802;P>0.05)were the exception.Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group.DHC grades,psychological impact,social impact,and aesthetic concern had significant impacts on patients accepting orthodontic treatment.The results showed that the psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment.For participants who sought orthodontic treatment,the esthetic impairments were varied,the psychosocial impact of dental esthetics increased with the severity of the malocclusion,and the psychosocial impact of dental esthetics played an important role in their seeking process.However,even participants with severe normative treatment needs may reject orthodontic treatment if they have little self-awareness of the potential psychosocial impact of dental estheticsPart 3:Effect of personality on oral health-related quality of life in undergraduatesMalocclusion reduces oral health-related quality of life(OHRQoL),and the degree of reduction increases with the severity of misalignment.However,some patients with mild malocclusion unexpectedly suffer psychosocially.This phenomenon still has not been explained but may be attributable to psychological factors.Thus,the purpose of this study was to investigate the relationship between OHRQoL and personality traits by assessing young Chinese adults with no history of orthodontic treatment using OHIP combined with EPQ and how this is influenced by other variables.A total of 443 undergraduate students(171 males and 272 females)aged 17 to 24 years were selected and completed a two-section questionnaire:the Eysenck Personality Questionnaire Short Scale Chinese version and the Oral Health Impact Profile-14 Chinese version(OHIP-14).After finishing questionnaires,Malocclusion severity was assessed via clinical examination using the dental health component(DHC)and esthetic component of the Index of Orthodontic Treatment Need(IOTN).Statistical analysis was performed using SPSS 18.0.The differences in OHIP variables among the groups were examined by Mann-Whitney test.Correlations between OHIP scores and other variables were performed using Pearson and Spearman correlation tests.EPQ personality effects were analyzed by logistic regression analysis and predicted curves.Neither total nor subscale OHIP-14 scores were significantly different between majors.Sex was significantly correlated with the total or subscale OHIP-14,such as physical pain,psychological disability,and psychological discomfort.The total and subscale OHIP-14 dimensions were all closely correlated with neuroticism personality traits(P<0.001).Moreover,total and some domains of the OHIP-14 were correlated with psychoticism,including social disability,psychological disability,and handicap.Women had significantly higher OHIP-14 scores than men across groups,indicating that women were more affected by oral health and had lower OHRQoL than men,especially for the subjects with mild malocclusion.Moreover,the impact of malocclusion on OHRQoL in terms of limited function and psychosocial well-being increased with the severity of malocclusion in men.Logistic regression analysis showed that the risk of perceiving higher poor oral health was associated with neuroticism personality and gender,as female respondents had higher OHIP scores.No significant association was found between OHRQoL and other factors.This study systematically investigates adult patients' orthodontic treatment motivation,and classifies people according to their motivations.We find that the motivations of adult patients seeking orthodontic treatment are various,including aesthetic needs,functional needs and social psychological needs.Thus,we use PIDAQ to assess the role of the psychosocial impact of dental esthetics on treatment-seeking motivations,and find that the psychosocial impact of dental esthetics played an important role in patients' seeking process when the patients have similar malocclusion.Personality characteristics,as an intrinsic factor,may affect a person's OHRQoL comprehensively,and the neuroticism dimension is the most significant predictor. |
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