Parental influence is the most important predictor of child’s orthodontic treatment demand in a preadolescent age


The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11–14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test–retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (β = 0.335, p = 0.002), parental influence (β = 0.221, p = 0.002), and malocclusion severity (β = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4–25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5–12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1–1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0–1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents’ cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

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  1. 1.

    Wheeler TT, McGorray SP, Yurkiewicz L, Keeling SD, King GJ. Orthodontic treatment demand and need in third and fourth grade school children. Am J Orthod Dentofacial Orthop. 1994;106:22–33.

    Article  Google Scholar 

  2. 2.

    Morris AS, Silk JS, Steinberg L, Myers SS, Robinson LR. The role of the family context in the development of emotion regulation. Soc Dev. 2007;16:361–88.

    Article  Google Scholar 

  3. 3.

    Samsonyanová L, Broukal Z. A systematic review of individual motivational factors in orthodontic treatment: facial attractiveness as the main motivational factor in orthodontic treatment. Int J Dent. 2014.

    Article  PubMed  PubMed Central  Google Scholar 

  4. 4.

    Tuncer C, Canigur Bavbek N, Balos Tuncer B, Ayhan Bani A, Çelik B. How do patients and parents decide for orthodontic treatment—effects of malocclusion, personal expectations, education and media. J Clin Pediatr Dent. 2015;39:392–9.

    Article  Google Scholar 

  5. 5.

    Marques LS, Pordeus IA, Ramos-Jorge ML, Filogônio CA, Filogônio CB, Pereira LJ, Paiva SM. Factors associated with the desire for orthodontic treatment among Brazilian adolescents and their parents. BMC Oral Health. 2009;9:34.

    Article  Google Scholar 

  6. 6.

    Mahajan M. Evaluation of different motivational factors for seeking orthodontic treatment: the patients’ and parents’ response. J Dent Allied Sci. 2018;7:55–9.

    Google Scholar 

  7. 7.

    Hassan AH, Hassan MH, Linjawi AI. Association of orthodontic treatment needs and oral health-related quality of life in Saudi children seeking orthodontic treatment. Patient Prefer Adherence. 2014;8:1571–9.

    Article  Google Scholar 

  8. 8.

    Spalj S, Slaj M, Varga S, Strujic M, Slaj M. Perception of orthodontic treatment need in children and adolescents. Eur J Orthod. 2010;32:387–94.

    Article  Google Scholar 

  9. 9.

    Abreu LG, Melgaço CA, Abreu MH, Lages EM, Paiva SM. Agreement between adolescents and parents/caregivers in rating the impact of malocclusion on adolescents’ quality of life. Angle Orthod. 2015;85:806–11.

    Article  Google Scholar 

  10. 10.

    The WHOQOL Group. The World Health Organization Quality of Life assessment (WHOQOL): position paper from the World Health Organization. Soc Sci Med. 1995;41:1403–9.

    Article  Google Scholar 

  11. 11.

    Jokovic A, Locker D, Guyatt G. Short forms of the Child Perceptions Questionnaire for 11–14-year-old children (CPQ11-14): development and initial evaluation. Health Qual Life Outcomes. 2006;4:4.

    Article  Google Scholar 

  12. 12.

    Scapini A, Feldens CA, Ardenghi TM, Kramer PF. Malocclusion impacts adolescents’ oral health-related quality of life. Angle Orthod. 2013;83:512–8.

    Article  Google Scholar 

  13. 13.

    Manjith CM, Karnam SK, Manglam S, Praveen MN, Mathur A. Oral Health-Related Quality of Life (OHQoL) among adolescents seeking orthodontic treatment. J Contemp Dent Pract. 2012;13:294–8.

    Article  Google Scholar 

  14. 14.

    Li W, Wang S, Zhang Y. Relationships among satisfaction, treatment motivation, and expectations in orthodontic patients: a prospective cohort study. Patient Prefer Adherence. 2016;10:443–7.

    PubMed  PubMed Central  Google Scholar 

  15. 15.

    Taghavi Bayat J, Huggare J, Mohlin B, Akrami N. Determinants of orthodontic treatment need and demand: a cross-sectional path model study. Eur J Orthod. 2017;39:85–91.

    Article  Google Scholar 

  16. 16.

    Puberty and adolescence. Medline Plus. United States National Library of Medicine. 2017. Accessed 16 Jun 2017.

  17. 17.

    Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol. 1993;46:1417–32.

    Article  Google Scholar 

  18. 18.

    Mokkink LB, Terwee CB, Patrick DL, Alonso J, Stratford PW, Knol DL, Bouter LM, de Vet HC. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19:539–49.

    Article  Google Scholar 

  19. 19.

    Rener-Sitar K, Petricevic N, Celebic A, Marion L. Psychometric properties of Croatian and Slovenian short form of oral health impact profile questionnaires. Croat Med J. 2008;49:536–44.

    Article  Google Scholar 

  20. 20.

    Lajnert V, Grzic R, Radica N, Snjaric D, Spalj S. Translation and validation of the croatian version of the oral impacts on daily performances (OIDP) scale. Vojnosanit Pregl. 2016;73:811–6.

    Article  Google Scholar 

  21. 21.

    Spalj S, Lajnert V, Ivankovic L. The psychosocial impact of dental aesthetics questionnaire—translation and cross-cultural validation in Croatia. Qual Life Res. 2014;23:1267–71.

    Article  Google Scholar 

  22. 22.

    Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. Eur J Orthod. 1989;11:309–20.

    Article  Google Scholar 

  23. 23.

    World Health Organization (WHO). Oral health surveys: basic methods. 4th ed. Geneva: WHO; 1997. p. 39–44.

    Google Scholar 

  24. 24.

    Zreaqat M, Hassan R, Ismail AR, Ismail NM, Aziz FA. Orthodontic treatment need and demand among 12 and 16 year-old school children in Malaysia. Oral Health Dent Manag. 2013;12:217–21.

    PubMed  Google Scholar 

  25. 25.

    Austin PC, Merlo J. Intermediate and advanced topics in multilevel logistic regression analysis. Stat Med. 2017;36:3257–77.

    Article  Google Scholar 

  26. 26.

    Juniper EF, Guyatt GH, Streiner DL, King DR. Clinical impact versus factor analysis for quality of life questionnaire construction. J Clin Epidemiol. 1997;50:233–8.

    Article  Google Scholar 

  27. 27.

    Foster Page LA, Thomson WM, Jokovic A, Locker D. Epidemiological evaluation of short-form versions of the Child Perception Questionnaire. Eur J Oral Sci. 2008;116:538–44.

    Article  Google Scholar 

  28. 28.

    Lau AW, Wong MC, Lam KF, McGrath C. Confirmatory factor analysis on the health domains of the Child Perceptions Questionnaire. Community Dent Oral Epidemiol. 2009;37:163–70.

    Article  Google Scholar 

  29. 29.

    Torres CS, Paiva SM, Vale MP, Pordeus IA, Ramos-Jorge ML, Oliveira AC, Allison PJ. Psychometric properties of the Brazilian version of the Child Perceptions Questionnaire (CPQ11-14)—short forms. Health Qual Life Outcomes. 2009;7:43.

    Article  Google Scholar 

  30. 30.

    Page LA, Thomson WM, Mohamed AR, Traebert J. Performance and cross-cultural comparison of the short-form version of the CPQ11-14 in New Zealand, Brunei and Brazil. Health Qual Life Outcomes. 2011;9:40.

    Article  Google Scholar 

  31. 31.

    Salinas-Martínez AM, Hernández-Elizondo RT, Núñez-Rocha GM, Ramos Peña EG. Psychometric properties of the Spanish version of the short-form Child Perceptions Questionnaire for 11–14-year-olds for assessing oral health needs of children. J Public Health Dent. 2014;74:168–74.

    Article  Google Scholar 

  32. 32.

    Xiao-Ting L, Tang Y, Huang XL, Wan H, Chen YX. Factors influencing subjective orthodontic treatment need and culture-related differences among Chinese natives and foreign inhabitants. Int J Oral Sci. 2010;2:149–57.

    Article  Google Scholar 

  33. 33.

    Bhardwaj VK, Veeresha KL, Sharma KR. Prevalence of malocclusion and orthodontic treatment needs among 16 and 17 year-old school-going children in Shimla city, Himachal Pradesh. Indian J Dent Res. 2011;22:556–60.

    Article  Google Scholar 

  34. 34.

    Shaw WC. Factors influencing the desire for orthodontic treatment. Eur J Orthod. 1981;3:151–62.

    Article  Google Scholar 

  35. 35.

    Birkeland K, Katle A, Løvgreen S, Bøe OE, Wisth PJ. Factors influencing the decision about orthodontic treatment. A longitudinal study among 11 and 15-year-olds and their parents. J Orofac Orthop. 1999;60:292–307.

    Article  Google Scholar 

  36. 36.

    Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies. Eur J Orthod. 2015;37:238–47.

    Article  Google Scholar 

  37. 37.

    Agou S, Locker D, Streiner DL, Tompson B. Impact of self-esteem on the oral-health-related quality of life of children with malocclusion. Am J Orthod Dentofacial Orthop. 2008;134:484–9.

    Article  Google Scholar 

  38. 38.

    Agou S, Locker D, Muirhead V, Tompson B, Streiner DL. Does psychological well-being influence oral-health-related quality of life reports in children receiving orthodontic treatment? Am J Orthod Dentofacial Orthop. 2011;139:369–77.

    Article  Google Scholar 

  39. 39.

    Aguilar-Díaz FC, Irigoyen-Camacho ME, Borges-Yáñez SA. Oral-health-related quality of life in schoolchildren in an endemic fluorosis area of Mexico. Qual Life Res. 2011;20:1699–706.

    Article  Google Scholar 

  40. 40.

    Tsakos G, Blair YI, Yusuf H, Wright W, Watt RG, Macpherson LM. Developing a new self-reported scale of oral health outcomes for 5-year-old children (SOHO-5). Health Qual Life Outcomes. 2012;10:62.

    Article  Google Scholar 

  41. 41.

    Pahel BT, Rozier RG, Slade GD. Parental perceptions of children’s oral health: the Early Childhood Oral Health Impact Scale (ECOHIS). Health Qual Life Outcomes. 2007;5:6.

    Article  Google Scholar 

  42. 42.

    Eiser C, Morse R. Can parents rate their child’s health-related quality of life? Results of a systematic review. Qual Life Res. 2001;10:347–57.

    Article  Google Scholar 

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The research was supported by the University of Rijeka Grant no. and Grant no. uniri-biomed-18-22.

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Correspondence to Martina Brumini.

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All procedures performed in this study were in accordance with the ethical standards of the authors’ institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

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Informed consent was obtained from the parents of all individual participants included in the study. Parental consent was superseded by the child’s dissent.

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Brumini, M., Slaj, M., Katic, V. et al. Parental influence is the most important predictor of child’s orthodontic treatment demand in a preadolescent age. Odontology 108, 109–116 (2020).

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  • Quality of life
  • Adolescent
  • Parents
  • Index of orthodontic treatment need
  • Reproducibility of results