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A Systematic Review of Individual Motivational Factors in Orthodontic Treatment - Facial Attractiveness as the Main Motivational Factor in Orthodontic Treatment

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A Systematic Review of Individual Motivational Factors in Orthodontic Treatment - Facial Attractiveness as the Main Motivational Factor in Orthodontic Treatment
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  Review Article  A Systematic Review of Individual MotivationalFactors in Orthodontic Treatment: Facial Attractiveness asthe Main Motivational Factor in Orthodontic Treatment Lusine Samsonyanová and Zdenek Broukal Institute of Clinical and Experimental Dental Medicine, 󰀱st Faculty of Medicine, Charles University in Prague,Karlovo N ´amˇest ´ı 󰀳󰀲, 󰀱󰀲󰀱 󰀰󰀱 Prague, Czech Republic Correspondence should be addressed to Lusine Samsonyanov ´a; ino@mysmile.czReceived 󰀲󰀷 November 󰀲󰀰󰀱󰀳; Revised 󰀲󰀱 January 󰀲󰀰󰀱󰀴; Accepted 󰀱󰀲 April 󰀲󰀰󰀱󰀴; Published 󰀲󰀰 May 󰀲󰀰󰀱󰀴Academic Editor: Carla EvansCopyright © 󰀲󰀰󰀱󰀴 L. Samsonyanov ´a and Z. Broukal. Tis is an open access article distributed under the Creative CommonsAttribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the srcinal work isproperly cited. Introduction.  Physical, mental, and social consequences o malocclusion may impact the quality o lie. Te aim o this review is todescribe main actors motivating parents or orthodontic treatment or their children.  Methods.  A systematic review study designwas used to identiy articles analyzing different motivational actors in orthodontic treatment appearing in Medline database,EMBASE, and Google Scholar. Te search terms used were teasing, motivating actors, orthodontics, malocclusion, quality o lie, smile attractiveness, and perception o malocclusion. Papers selected up to May 󰀲󰀰󰀱󰀳 included retrospective and prospectivelongitudinal studies, randomized control trials, cross-sectional studies, reviews, and meta-analyses.  Results.  󰀱󰀳 articles includedin this review identi󿬁ed aesthetics as the main motivational actor in orthodontic treatment. Children mention teeth crowding,large overbite, missing teeth, and largest maxillary anterior irregularities also as motivational actors. Parents want their childrento look nice and worry o being accused o neglecting parental duties.  Conclusions.  Dissatisaction with one’s appearance, dentistrecommendation, interest and worries o parents, and the impact o peers who wear braces rank among the main motivationactors o seeking orthodontic treatment. Understanding these actors allows better planning o resources and better assessment o the requirements and priorities o treatment. 1. Introduction Physical attractiveness affects human lie in various waysand to a signi󿬁cant extent. It has been proven that theace is a slightly stronger indicator o overall attractivenessthan the body [󰀱]. Attractive people are regarded as riendly,intelligent, interesting, more social, and much more positivepersonalities [󰀲–󰀴]. Irregularities in the position o the teeth and jaws have a signi󿬁cant impact on the attractivenessand aesthetics o the smile and on quality o lie. Teseirregularities can disrupt social interaction, interpersonalrelationships, and mental wellbeing and may lead to a eelingo ineriority [󰀵].Most orthodontic patients are children and adolescents[󰀶, 󰀷]. It is assumed that an irregular set o teeth and less aesthetic ace can negatively affect a child. Te child is thenthe target o jibes and is given nicknames and so orth [󰀳,󰀸]. Most parents seek specialised orthodontic care or theirchildren to improve their overall appearance. It is importantto identiy actors which directly motivate parents to bringtheir child in or orthodontic examination and as the casemaybe orthodontic treatment.Te aim o this paper is to give a systematic review o motivational actors or orthodontic treatment in chil-dren. Te authors think that understanding the actorswhich contribute towards seeking out orthodontic treatmentallow or better planning o resources and better assess-ment o the requirements and priorities o treatment. Tesecondary aim o this paper is also to give an overview abouttheacialattractivenessandsocialstereotyping,respec-tively, on the impact o acial attractiveness on quality o lie. Hindawi Publishing CorporationInternational Journal of Dentistry Volume 2014, Article ID 938274, 7 pageshttp://dx.doi.org/10.1155/2014/938274  󰀲 International Journal o Dentistry        I       d     e     n      t      i       󿬁     c     a      t      i     o     n       S     c     r     e     e     n      i     n     g      E       l      i     g      i       b      i       l      i      t     y      I     n     c       l     u       d     e       d Records identi󿬁edthrough the databasesearching( n = 997 )Additional recordsidenti󿬁ed through othersources (n = 9) Records afer duplicates removed (n = 314) Records screened( n = 314 )Records excluded( n = 119 )Full-text articlesassessed or eligibility ( n = 46 )Full-text articlesexcluded, with reasons( n = 35 )Studies included inqualitative synthesis( n = 11 ) F󰁩󰁧󰁵󰁲󰁥 󰀱: Methodology ollowed in the article selection process (adapted rom Moher et al. [󰀲󰀲]). 2. Materials and Methods A comprehensive electronic database search to identiy rel-evant publications was conducted, and the reerence listsin relevant articles were searched manually or additionalliterature.Weusedasystematicreviewstudydesign.Medlinedatabase, EMBASE, and Google Scholar were searched orarticles published. Searching papers included retrospectiveand prospective longitudinal studies, randomized controltrials, and cross-sectional studies to determine individualmotivationalactorsoparentsinorthodontictreatment.Telast electronic search was concluded in May 󰀲󰀰󰀱󰀳. We weresearching articles published in English.Te search strategy ocused on the ollowing terms:“teasing, motivation in orthodontic treatment, malocclusionand quality o lie, smile attractiveness, and smile aestheticperception.”Te initial search revealed 󰀹󰀹󰀷 articles that were oundusing the searching strategy and only the titles related toorthodontic treatment were selected. Te number o articlesreviewed in each phase to perorm this systematic review is presented in the PRISMA 󿬂ow diagram (Figure 󰀱). Tesecond stage o the search protocol was to retrieve the re-erencelistsotheselectedarticles,whichyielded󰀹additionalarticlesointerest.Aferexcluding󰀶󰀸󰀳duplicates,󰀳󰀱󰀴articlesremainedorreview.Inthe󿬁rstphaseselection,thescreeningo the articles by reading titles and abstracts was proceeding.Articles that were not eligible because o irrelevant aimsand were not directly related to this systematic review wereexcluded; thus, 󰀲󰀲󰀲 articles remained or urther reading. 󰀴󰀶articles were assessed or eligibility.Afer screening, all the 󰀱󰀱 articles were selected orqualitative synthesis. 3. Results 󰀱󰀱 articles were selected or systematic review (able 󰀱). Mainreason or children to undergo the orthodontic treatmentwas aesthetics. Crowding o the teeth and large overbite werereported as main motivational actors in study o ung andKiyak [󰀳]. In study o essarollo et al. [󰀹], dissatisaction with dental appearance in children and adolescents wasmissingteethandwhenlargestmaxillaryanteriorirregularity is present. Children also report that orthodontic treatmentcanimprovetheirqualityoliethatitcanbeeasiertogetajobthanks to orthodontic treatment, and that it is easier to 󿬁nda romantic partner [󰀱󰀰]. In the same study, children reportdiscrimination when smiling on the part o schoolmates.From 󰀷󰀷% responders in one article who reported teasing,  International Journal o Dentistry 󰀳 󰁡󰁢󰁬󰁥 󰀱: Publications related to motivational actors in orthodontic treatment used or systematic review analysis.Authors (year) Aim o the study Subjects Design o the study  Results and conclusions according to theauthorsWe¸drychowska-Szulcand Syry´nska (󰀲󰀰󰀱󰀰) [󰀱󰀲] o examine patientsand parentsmotivation inorthodontictreatment󰀶󰀷󰀴 children whoaged 󰀷–󰀱󰀸 years and󰀸󰀶 parents who aged󰀱󰀹–󰀴󰀲 yearsQuestionnaire Children:  main reason is or aesthetics;less than 󰀵% is in󿬂uence o their peers Parents:  󰀷󰀷% seek treatment due toirregular positioning o the teeth, 󰀵󰀴% o parents want their children to look nice,and 󰀶󰀴% ear o being accused that they neglected their parental duties. Numbero patients dissatis󿬁ed with theappearance o their teeth increased withage Females demonstrated more concernor appearance than malesOtuyemi and Kolawole(󰀲󰀰󰀰󰀵) [󰀶]Perception o orthodontictreatment need.Relationship o thenicknames to dentalappearance󰀵󰀰󰀶 randomly selected children Questionnaire󰀷󰀷% responders reported teasing; 󰀴.󰀷% o them reported teasing and nicknamesbecause o teeth (equal in boys and girls).Te authors conclude that dentalappearance may not be a signi󿬁cantcontributor to nicknamesMarques et al. (󰀲󰀰󰀰󰀹)[󰀱󰀰]o determine actorsassociated to thedesire or orthodontictreatment󰀴󰀰󰀳 subjects who aged󰀱󰀴–󰀱󰀸 years randomly selected rom apopulation o 󰀱󰀸󰀲, 󰀲󰀹󰀱school childrenstudentsQuestionnaire Children:  󰀷󰀸% expressed a desire toreceive orthodontic treatment; 󰀷󰀲% o them believed that orthodontic treatmentcould improve their quality o lie; 󰀴󰀱%easier to get a job; 󰀲󰀷% thought it wouldbe easier to 󿬁nd a romantic partner; 󰀱󰀲%discrimination when smiling on the parto schoolmates; 󰀲󰀲% status or trend Parents:  󰀷󰀲% considered it necessary ortheir child to wear an orthodonticappliance󰀶󰀹% reported that the children were notin treatment due to high costs involvedAnterior crowding ≥ 󰀲mmBennett et al. (󰀱󰀹󰀹󰀷) [󰀱󰀳]Te demand orchildren’s orthodonticcare󰀲󰀲󰀰 orthodontists and󰀲󰀲󰀰 parents Questionnaire Orthodontic treatment would enhanceoral health and enhance sel-esteemKilpel¨ainen et al. (󰀱󰀹󰀹󰀳)[󰀱󰀱]󰀳󰀱󰀳 parents wereasked to provideanswers instead o their childrenQuestionnaire󰀴󰀴% teasing because o teeth. Te reasonor interest in orthodontic treatmentmost requently selected was as ollows:󰀸󰀵% appearance o teeth, 󰀴󰀶% acialappearance, 󰀱󰀶% speech, and 󰀷󰀳%dentist’s advice. Parents o children withoverjet ≥ 󰀷mm are 󰀵.󰀵 times as likely toreport that their child had been teasedwhen compared to parents o childrenwith lesser overjetung and Kiyak (󰀱󰀹󰀹󰀸) [󰀳]Reasons ororthodontictreatment󰀷󰀵 children and theirparents Questionnaire Children:  crowding o the teeth (󰀵󰀶%),large overbite (󰀱󰀷.󰀳%) Parents:  󰀷󰀵% o parents were dissatis󿬁edwith the appearance o their children’steeth; 󰀵󰀴% o them wanted their children“to look pretty”Daniels et al. (󰀲󰀰󰀰󰀹) [󰀲󰀳]Orthodontictreatment motivationo patient and parents󰀲󰀲󰀷 patients o 󰀷–󰀱󰀶years old and theirparentsQuestionnaire󰀹󰀱.󰀶% o the parents and 󰀹󰀳.󰀴% o children rated aesthetic concerns as themost importantParents were signi󿬁cantly moremotivated or their child to haveorthodontic treatment than their children  󰀴 International Journal o Dentistry  󰁡󰁢󰁬󰁥 󰀱: Continued.Authors (year) Aim o the study Subjects Design o the study  Results and conclusions according to theauthorsPratelli et al. (󰀱󰀹󰀹󰀸) [󰀷]Parental perceptionand attitudes inorthodontictreatment󰀴󰀳󰀷 parents o 󰀹-year-old children QuestionnaireInterest on the part o the parentsParents who had been treated themselvesor who desired treatment or regretted notbeing treated or were dissatis󿬁ed withtheir own occlusion perceivedorthodontic need in their childMiner et al. (󰀲󰀰󰀰󰀷) [󰀲󰀴]Te perception o children’s pro󿬁les by mothers󰀲󰀴 patients and theirparentsComputer imagingprogramMothers’ perceptions are the primary motivating actors or seekingorthodontic treatmentessarollo et al. (󰀲󰀰󰀱󰀲)[󰀹]Dissatisaction withdental appearance󰀷󰀰󰀴 adolescents whoaged 󰀱󰀲-󰀱󰀳 years Questionnaire Missing teethLargest maxillary anterior irregularity Abdullah et al. (󰀲󰀰󰀰󰀱)[󰀲󰀵]Reasons or seekingorthodontictreatment󰀱󰀱󰀰 patients who aged󰀱󰀱–󰀳󰀰 years Questionnaire󰀶󰀵% the desire to have better dentalappearance󰀴󰀸% attain straight teeth󰀳% that it was dentist recommendation󰀵% mentioned that they have been teaseddue to their dental irregularities󰀷󰀵% elt that their con󿬁dence andsel-esteem would be increased i theirteeth were straightened󰀶󰀴% stated that their social lie would beimproved󰀴󰀳% believed that their careeropportunities would be brighter󰀲󰀰% improve dental health󰀲󰀰% enhance sel con󿬁dence only 󰀴.󰀷% o them reported teasing and nicknames becauseo teeth (equal in boys and girls). Te author conclude thatdental appearance may not be a signi󿬁cant contributor tonicknames [󰀶]. In the other article [󰀱󰀱], 󰀴󰀴% o parents report teasing o their children because o teeth. Parents o childrenwith overjet ≥ 󰀷mm are 󰀵.󰀵 times as likely to report that theirchild had been teased when compared to parents o childrenwith lesser overjet. Te same article reports, as other reasonsor interest in orthodontic treatment, 󰀸󰀵% appearance o teeth, 󰀴󰀶% acial appearance, 󰀱󰀶% speech, and 󰀷󰀳% dentist’sadvice.Parents also report, as the main motivational actor,aesthetics,preciselyirregularpositioningotheteeth.Parentswant their children to look nice. Another reason is the earo being accused that they neglected their parental duties[󰀳, 󰀱󰀲]. Tey consider anteriorcrowding ≥ 󰀲mm as thereasonor orthodontic treatment o their children [󰀱󰀰]. Parentsconsider that orthodontic treatment would enhance oralhealth and enhance sel-esteem [󰀱󰀳]. Kilpel¨ainen et al. [󰀱󰀱]report that 󰀸󰀵% o parents in their study, as a motivationalactor,considerappearanceoteeth;󰀴󰀶%othemreportacialappearance, and 󰀱󰀶% report speech. It is interesting in thisstudy that 󰀷󰀳% o respondents report that the dentist’s advicewas a motivational actor or their children treatment. 4. Literature Review and Discussion 󰀴.󰀱. Attractiveness of the Face.  Te main actor determiningattractiveness is a person’s ace. Better looking people areregardedasriendly,moreintelligent,muchmoreinteresting,and much more socially competent [󰀲, 󰀱󰀴]. Te reason why  people seek orthodontic consultation as a result o this istheir wish to improve their appearance. Te ideal o beauty is subject to certain ashion trends [󰀲]. Te orthodontisttries to ul󿬁l the patient’s expectations to straighten crookedteeth by ollowing speci󿬁c standard procedures and rules.Nevertheless, it is stated in the literature [󰀵] that somestandards do not correspond to that which the laymanperceives as beauty.Attractiveness is judged on the basis o social standards.In addition to this, the literature also points to the actthat people have a natural ability to distinguish betweenthe beautiul and the ugly. Numerous studies perormed by Proessor Langlois et al. [󰀱󰀵] show that even children pay greater attention to people with a more attractive ace thanpeople o less attractive appearance. Te connection betweenacial aesthetics, quality o lie, and motivational actors ortreatment is explained in Figure 󰀲. 󰀴.󰀲. Symmetry and Facial Attractiveness.  Many authors areconvinced that a perectly symmetrical ace has a de󿬁niteimpactotheattractivenessotheace.Inhisstudy,Cellerino[󰀱󰀶] came to the conclusion that symmetry may contributetowardsattractivenessbutthatitisnotadecisiveactorortheattractiveness o the ace. Other authors do not regard acialsymmetryasimportantbutclaimthatasymmetricalacesareperceived as less attractive [󰀱󰀶].

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