Why do adults want orthodontic treatment?

It seems that the demand for orthodontic treatment among adults is rising continually. The primary reasons behind this trend are the growing awareness of modern orthodontic procedures and the availability of less noticeable appliances than traditional metal fixed appliances.

Adults’ decision-making process and preference for orthodontic treatment methods are poorly understood. Understanding these factors can help develop personalised care and support adult patients in making informed treatment decisions. A recent qualitative study of adult orthodontic patients investigated these factors. 

This is an excellent, innovative research paper, and all orthodontists interested in patients’ views should read it.  It provides valuable insight into adult orthodontic treatment.

A team from London did this study. The AJO-DDO published the paper. It is open access, so we can all read it!

I want to declare a potential conflict as I have known Ama Johal for many years.

What did they ask?

They did this study, to.

‘Understand adult patients reasoning for undergoing orthodontic treatment, the determinant factors for selecting a particular appliance and their overall treatment experience”.

What did they do?

They did a cross-sectional qualitative study using the following stages

They approached eight specialist orthodontic practices in London and asked them to participate in the study. Four of these agreed.

The lead clinician of each practice was responsible for identifying potential participants who met the following inclusion criteria: They were adult patients undergoing orthodontic treatment, had already been receiving treatment for at least two months, and expressed willingness to participate in the study. Subsequently, the primary researcher contacted the patients and invited them to participate in the study.

The study team developed an open-ended topic guide to use in the interviews. They did the interviews remotely because of the COVID-19 pandemic.  

They recorded and transcribed the interviews and analysed them using framework methodology.

What did they find?

The authors interviewed 22 adult participants. Most were female (59%,) and the mean age of the sample was 38.9 (SD=11.7) years. Eight participants were treated with ceramic appliances, 8 had clear aligners, and 6 had lingual orthodontics.

They provided a large amount of information and relevant quotes in the paper. I thought that these were the most important points.

When they analysed the data, they found two main themes: psychosocial influence and dental health-related issues.

The psychosocial theme comprised self-image and perception, as well as social acceptance. 

The participants seemed worried about their physical appearance and overall self-confidence. They had a strong need to enhance their dental appearance, linked to their desire to smile naturally. The use of social media and their aspiration to feel good about themselves influenced this desire.

“The thing with social media is that you just constantly see photos of yourself, like with other people who have got straight teeth. It is like my teeth look ridiculous.”

When they considered dental health issues, they wanted to reduce potential harm to their teeth.

When examining the factors that influenced patients’ choice of orthodontic appliance, it became evident that discussions with peers and family members and their relationship with the orthodontist played a significant role. Additionally, the potential aesthetic appearance of the appliance was also a decisive influencing factor.

“I am a person who smiles a lot, so, if the visible braces were the only option, I would not have done it”.

Interestingly, the fixed appliance group mentioned their experience with eating difficulties as a factor in not selecting aligner treatment. Furthermore, some of them preferred fixed appliances to aligners because they felt that the fixed appliance was more effective.

“We were looking at train tracks; basically we were only looking at fixed appliances because all of the orthodontists had said to me “yeah, do not do Invisalign, it is not going to work for you…”.

When they looked at difficulties with the treatment, they reported pain, speech impairment, chewing difficulty and changes in diet.

“I felt vulnerable. In some situations I tried to speak and just felt really stupid. And also, with dating, people will judge it because having the brace is a more teenage thing”.

The overall conclusions were

“Psychological factors and health concerns were important factors influencing the decision to start treatment. Functional impairment and psychosocial impact were major impacts on their quality of life during treatment”.

What did I think?

This study was fascinating. It was refreshing to see research teams conducting further orthodontic qualitative research. This type of study might be unfamiliar to some readers of this blog. Initially, I was sceptical of qualitative methods because I didn’t fully understand the methodology and believed they provided us with obvious information. However, after being involved in a few of these studies, I’ve come to appreciate the valuable insights they provide.

I have found a helpful article on qualitative research by the UK National Health Service. I have used this to summarise the main advantages of this form of study.

• Participants can answer using their own words. This may result in them providing new views that we, as clinicians, have not considered.
• The methods are flexible, and the study can be adapted according to the responses that we receive.
• They are empowering for research participants as they are being listened to.
• We can use narratives to present research conclusions more personally.

The disadvantages are.

• They only provide information on how individuals think. But, they cannot tell us how many people in the population feel.
• We cannot use the findings to compare the effectiveness of interventions.

What can we get from this study?

As with all studies, we need to consider how we can use the information from this study.  The authors covered this nicely in their discussion, and I agree with their comments.  

This study provides valuable information, as it reflects the concerns and motivations of our patients to seek orthodontic care. Most notably, their concerns are related to their physical appearance and the use of visible appliances. Additionally, the study shows that all treatment options impact their quality of life, as they are concerned about functional and psychosocial factors. 

This information enables us to provide scientific and comprehensive information to our patients, ensuring they have fully informed consent before undergoing any treatment. Overall, this study is an excellent resource for enhancing our understanding of our patients’ needs and concerns.

It would be great to see more qualitative research done in other areas of orthodontics.