The Unmet Orthodontic Treatment Need of Adolescents and Influencing Factors for not Seeking Orthodontic Therapy

Stjepan Špalj, Martina Šlaj, Athanasios Athanasiou, Danijela Kalibović Govorko, Mladen Šlaj


The purpose of this study was to estimate unmet orthodontic treatment need of Croatian adolescents, compare normative and self-perceived need and investigate factors influencing the reason why untreated subjects with severe malocclusions have not been treated before. One thousand and forty-two non-orthodontically treated subjects in age groups of 12 and 18 years, from sixteen randomly selected public schools in Zagreb, Croatia were examined. The Dental Aesthetic Index (DAI), Standardized Continuum of Aesthetic Needs (SCAN) and a questionnaire concerning self-perceived orthodontic treatment need, perception of aesthetics, function, behaviours and socioeconomic status were used. Around one third of untreated adolescent population had an objective need, less than 20 percent had aesthetic need, and self-perceived need was reported in one third of population. Associations and agreements between objective, aesthetic and self-perceived need were weak (r=0.27-0.48; p<0.001 and κ in range from 0.05 (p>0.05) to 0.32 (p<0.05), respectively). Satisfaction with personal dental appearance and awareness of malocclusion were better related in persons with no treatment need or minor need (r=0.53–0.59) than in those with major need (r=0.31–0.40). Multivariate analyses confirmed that objective, aesthetic and self-perceived needs were better related between themselves than to socioeconomic status of subjects, function, activities of daily living and oral health-related behaviours. It appears that self-perceived treatment need has low role in predicting objective need, but relation between satisfaction and awareness of malocclusion could be one of basic factors in process of making decision to go for treatment and maybe could serve in predicting patient’s compliance.


malocclusion, prevalence, orthodontic treatment need, perception

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