Discomfort associated with fixed orthodontic appliances:
               determinant factors and influence on quality of life

Marques, Leandro Silva; Paiva, Saul Martins; Vieira-Andrade, Raquel Gonçalves; Pereira, Luciano José; Ramos-Jorge, Maria Letícia

doi:10.1590/2176-9451.19.3.102-107.oar

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Articles • Dental Press J. Orthod. 19 (3) • May-Jun 2014 • https://doi.org/10.1590/2176-9451.19.3.102-107.oar copy

Discomfort associated with fixed orthodontic appliances: determinant factors and influence on quality of life

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

To investigate the determinant factors of discomfort attributed to the use of fixed orthodontic appliance and the effect on the quality of life of adolescents.

MATERIAL AND METHODS :

Two hundred and seventy-two individuals aged between 9 and 18 years old, enrolled in public and private schools and undergoing orthodontic treatment with fixed appliance participated in this cross-sectional study. The participants were randomly selected from a sample comprising 62,496 individuals of the same age group. Data was collected by means of questionnaires and an interview. Discomfort intensity and bio-psychosocial variables were assessed using the Oral Impact on Daily Performance questionnaire. Self-esteem was determined using the Global Negative Self-Evaluation questionnaire. Statistical analysis involved the chi-square test and both simple and multiple Poisson regression analyses.

RESULTS:

Although most individuals did not present discomfort, there was a prevalence of 15.9% of impact on individuals' daily life exclusively due to the use of fixed orthodontic appliance . Age [PR: 3.2 (95% CI: 1.2-8.5)], speech impairment [PR: 2.2 (95% CI: 1.1-4.6)], poor oral hygiene [PR: 2.4 (95% CI: 1.2-4.8)] and tooth mobility [PR: 3.9 (95% CI: 1.8-8.1)] remained independently associated with a greater prevalence of discomfort (P ≤ 0.05).

CONCLUSIONS:

Discomfort associated with the use of fixed orthodontic appliances exerted a negative influence on the quality of life of the adolescents comprising the present study. The determinants of this association were age, poor oral hygiene, speech impairment and tooth mobility.

Adolescent; Orthodontics; Quality of life

Discomfort – use of orthodontic appliance
	Absent n (%)	Present n (%)	p
Age
9 to 14 years	110 (95.7)	5 (4.3)	< 0.001^C
15 to 18 years	119 (80.4)	29 (19.6)	< 0.001^C
Sex
Male	83 (84.7)	15 (15.3)	0.294^C
Female	155 (89.1)	19 (10.9)	0.294^C
Difficulty in eating
No	156 (93.4)	11 (6.6)	< 0.001^C
Yes	82 (78.1)	23 (21.9)	< 0.001^C
Speech impairment
No	148 (92.5)	12 (7.5)	0.003^C
Yes	90 (80.4)	22 (19.6)	0.003^C
Poor oral hygiene
No	159 (93.0)	12 (7.0)	< 0.001^C
Yes	79 (78.2)	22 (21.8)	< 0.001^C
Difficulty in showing the teeth
No	185 (87.3)	27 (12.7)	0.825^C
Yes	53 (88.3)	7 (11.7)	0.825^C
Difficulty in sleeping
No	182 (88.3)	24 (11.7)	0.454^C
Yes	56 (84.8)	10 (15.2)	0.454^C
Difficulty in maintaining a stable emotional state
No	201 (87.0)	30 (13.0)	0.564^C
Yes	37 (90.2)	4 (9.8)	0.564^C
Difficulty in performing school tasks
No	198 (85.7)	33 (14.3)	0.035^C
Yes	40 (97.6)	1 (2.4)	0.035^C
Difficulty to get along with friends
No	217 (86.8)	33 (13.2)	0.330^F
Yes	21 (95.5)	1 (4.5)	0.330^F

Discomfort – use of orthodontic appliance
	Absent n (%)	Present %)	p
Pain
No	171 (85.5)	29 (14.5)	0.096^C
Yes	67 (93.1)	5 (6.9)
Missing tooth
No	230 (87.5)	33 (12.5)	1.000^F
Yes	8 (88.9)	1 (11.1)	1.000^F
Tooth mobility
No	228 (90.8)	23 (9.2)	< 0.001^F
Yes	10 (47.6)	11 (52.4)	< 0.001^F
Position of teeth
No	224 (88.2)	30 (11.8)	0.257^F
Yes	14 (77.8)	4 (22.2)	0.257^F
Shape/size of teeth
No	228 (87.4)	33 (12.6)	1.000^F
Yes	10 (90.9)	1 (9.1)	1.000^F
Deformity of mouth/face
No	236 (88.1)	32 (11.9)	0.078^F
Yes	2 (50.0)	2 (50.0)	0.078^F
Blisters
No	182 (87.1)	27 (12.9)	0.704^C
Yes	56 (88.9)	7 (11.1)	0.704^C
Sensation of dry mouth
No	220 (86.6)	34 (13.4)	0.141^F
Yes	18 (100)	0	0.141^F
Halitosis
No	226 (90.8)	23 (9.2)	< 0.001^C
Yes	12 (52.2)	11 (47.8)	< 0.001^C
Impaired taste
No	235 (89.7)	27 (103)	< 0.001^F
Yes	3 (30)	7 (70)	< 0.001^F
Halitosis
No	226 (89.7)	26 (10.3)	0.001^F
Yes	12 (60.0)	8 (40.0)	0.001^F
Gingival bleeding
No	220 (92.1)	19 (7.9)	< 0.001^F
Yes	18 (54.5)	15 (45.5)	< 0.001^F
Gingival recession
No	235 (87.4)	34 (12.6)	1.000^F
Yes	3 (100)	0	1.000^F
Difficulty opening the mouth
No	237 (87.5)	34 (12.6)	1.000^F
Yes	1 (100.0)	0	1.000^F
Self-esteem (n=271)
High	215 (88.5)	28 (11.5)	0.137^F
Low	22 (78.6)	6 (21.4)	0.137^F

	Unadjusted Rate ratio			Adjusted Rate ratio
	PR	(CI 95%)	p*	PR	(CI 95%)	p**
Age (n = 263)
9 to 14 years	1.0	(1.8; 11.7)	0.002	1.0	(1.2; 8.5)	0.020
15 to 28 years	4.5	(1.8; 11.7)	0.002	3.2	(1.2; 8.5)	0.020
Difficulty in eating
No	1.0	(1.6; 6.7)	0.001
Yes	3.3	(1.6; 6.7)	0.001
Speech impairment
No	1.0	(1.2-4.9)	0.012	1.0	(1.1; 4.6)	0.032
Yes	2.4	(1.2-4.9)	0.012	2.2	(1.1; 4.6)	0.032
Poor oral hygiene
No	1.0	(1.6; 6.4)	0.001	1.0	(1.2; 4.8)	0.018
Yes	3.2	(1.6; 6.4)	0.001	2.4	(1.2; 4.8)	0.018
Difficulty in performing school tasks
No	1.0	(0.0; 1.2)	0.074
Yes	0.2	(0.0; 1.2)	0.074
Pain
No	1.0	(0.2; 1.3)	0.143
Yes	0.5	(0.2; 1.3)	0.143
Tooth mobility
No	1.0	(2.7; 11.3)	< 0.001	1.0	(1.8; 8.1)	< 0.001
Yes	5.5	(2.7; 11.3)	< 0.001	3.9	(1.8; 8.1)	< 0.001
Halitosis
No	1.0	(2.4; 10.2)	< 0.001
Yes	4.9	(2.4; 10.2)	< 0.001
Impaired taste
No	1.0	(1.8; 8.7)	0.001
Yes	3.9	(1.8; 8.7)	0.001
Gingival bleeding
No	1.0	(2.8; 10.8)	< 0.001
Yes	5.5	(2.8; 10.8)	< 0.001
Deformity of mouth/face
No	1.0	(0.9; 16.8)	0.056
Yes	4.0	(0.9; 16.8)	0.056
Self-esteem (n=271)
High	1.0	(0.7; 4.3)	0.195
Low	1.8	(0.7; 4.3)	0.195

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