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Psychosocial impact of dental aesthetics in adolescence: validity and reliability of a questionnaire across age-groups

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Abstract

Background

Dental malocclusion is a highly prevalent health condition in adolescence. Patients seek treatment primarily for aesthetic reasons. Therapy benefits are regarded, in the first place, to be psychosocial in nature. Therefore, it is mandatory to consider the perspective of the patient in treatment planning and control using a dental-aesthetics-related quality of life measure. The objective of this study was to investigate whether the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) developed in adult samples including the subscales Dental Self-Confidence, Social Impact, Psychological Impact and Aesthetic Concern is also applicable in adolescents aged 11 years and above. The psychometric properties were examined across three age-groups (11–12, 13–14, 15–17 year olds) with respect to factorial invariance, internal consistency, temporal stability, discriminant validity and gender- or age-associated scale mean differences and item response bias.

Method

Participants were 1,112 adolescents recruited from 4 institutions: orthodontic and dental practices, schools, and youth clubs. They answered the 23 partially reformulated items of the PIDAQ. Subjective and dentist evaluations of dental occlusion were assessed using the Perception of Occlusion Scale and the Aesthetic Component of the Index of Orthodontic Treatment Need. Both indices were aggregated to one Malocclusion Index (MI-S and MI-D).

Results

The fit indices using confirmatory factor analyses suggested that the factor structure and factor loadings underlying the PIDAQ items were invariant across ages (comparative fit index = 0.91, root-mean-square error of approximation = 0.04). Internal consistency and temporal stability were adequate within the age-groupings (Alpha = 0.71–0.88; intra-class correlations = 0.82–0.96). Adolescents with severe compared to slight malocclusion according to both self-evaluation and dentist evaluation were found to differ in all PIDAQ subscales at a level of p < 0.001 for all ages. PIDAQ scale scores were not related to age and gender. On the item level, no evidence for gender or age bias has been found.

Conclusion

The PIDAQ demonstrates to have good psychometric properties in adolescents, independent of their age. The instrument can be applied in making clinical decisions and in the assessment of psychosocial outcomes of orthodontic therapy.

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Conflict of Interests

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Department of Orthodontics, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany

    Ulrich Klages, Christina Erbe, Sandra Dinca Sandru & Heinrich Wehrbein

  2. Department of Oral Surgery, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany

    Dan Brüllman

Authors
  1. Ulrich Klages
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  2. Christina Erbe
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  3. Sandra Dinca Sandru
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  4. Dan Brüllman
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  5. Heinrich Wehrbein
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Corresponding author

Correspondence to Christina Erbe.

Appendix

Appendix

Item entries of the PIDAQ youth form.

  1. 1.

    I don’t like my teeth when I look at myself in the mirror.

  2. 2.

    When I smile, I sometimes try not to reveal my teeth completely.

  3. 3.

    I sometimes envy friends whose teeth are more beautiful.

  4. 4.

    I am proud of my teeth.

  5. 5.

    If I don’t know someone well, I imagine what they might think about my teeth.

  6. 6.

    If I compare my own teeth with others‘, I may get upset.

  7. 7.

    I like showing my teeth when I smile.

  8. 8.

    I dislike seeing my teeth on pictures of me.

  9. 9.

    I sometimes fear others might tease me because of my teeth.

  10. 10.

    The look of my teeth sometimes makes me a bit unhappy.

  11. 11.

    I think that most of my friends have more beautiful teeth.

  12. 12.

    I am happy about seeing my teeth in the mirror.

  13. 13.

    I sometimes have the feeling that people are giving me funny looks when they see my teeth.

  14. 14.

    I occasionally feel a little self-conscious toward others because of my teeth.

  15. 15.

    I would sometimes like to put my hand in front of my mouth in order to hide my teeth.

  16. 16.

    I sometimes feel ashamed because of my tooth position.

  17. 17.

    Other people like my teeth.

  18. 18.

    I don’t like my teeth when I see myself in a video.

  19. 19.

    Stupid jokes about my teeth upset me, even if they are only said in fun.

  20. 20.

    I sometimes wish my teeth would look better.

  21. 21.

    I am content with the look of my teeth.

  22. 22.

    I sometimes fear that other boys (or girls) might think my teeth are ugly.

  23. 23.

    I like my tooth position.

See Table 9.

Table 9 Stanine reference values and raw scores referring to the total sample (N = 1,112)
Full size table

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Klages, U., Erbe, C., Sandru, S.D. et al. Psychosocial impact of dental aesthetics in adolescence: validity and reliability of a questionnaire across age-groups. Qual Life Res 24, 379–390 (2015). https://doi.org/10.1007/s11136-014-0767-8

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