Quality of life and psychosocial outcomes after fixed orthodontic treatment: a 17-year observational cohort study

Background: There is little evidence to suggest that orthodontic treatment can prevent or reduce the likelihood of dental caries or of periodontal disease or dental trauma and temporomandibular disorders, but there is a modest association between the presence of malocclusion/orthodontic treatment need and quality of life. However, little is known of the long-term outcomes of orthodontic treatment. This study reports on the longitudinal follow-up of quality of life and psychosocial outcomes of orthodontic treatment among a cohort of adults who were examined as adolescents in 1988/1989. Materials and Methods: Children who were examined in 1988/1989 were invited to a follow-up in 2005/2006. Respondents completed a questionnaire, which collected information on quality of life, receipt of orthodontic treatment and psychosocial factors, and were invited for a clinical examination. Oral health conditions including occlusal status using the Dental Aesthetic Index were recorded. Analysis of variance and multiple linear regression were used to examine the relationship between the measured factors. Results: There was no statistically significant association between occlusal status at adolescence and quality of life at adulthood. Those individuals who had orthodontic treatment but did not need orthodontic treatment had higher self-esteem (23.1, SD 5.2) and were more satisfied with life (18.5, SD 3.7) than other treatment groups (self-esteem range, 20.0-22.7; life satisfaction range, 16.4-18.1), anova P < 0.01 and P < 0.05, respectively. Occlusal status at adulthood was significantly associated with quality of life, P < 0.01. Multivariate analyses showed a statistically significant association between occlusal status at adolescence ('Desirable treatment' beta = 0.70, P = 0.04) and adulthood ('Desirable treatment' beta = 1.66, P < 0.01) with quality of life. Orthodontic treatment was negatively associated with psychosocial factors (life satisfaction; fixed orthodontic treatment (FOT) beta = -0.91, P = 0.02 and self-esteem; FOT beta = -1.39, P < 0.01). Conclusions: Occlusal status appears to have limited association with quality of life and psychosocial factors. Receipt of fixed orthodontic treatment does not appear to be associated with oral health-related quality of life but appears to be negatively associated with self-esteem and satisfaction with life.