Skip to main content
SpringerLink
Log in

Association of overjet and overbite with esthetic impairments of oral health-related quality of life

Zusammenhang von Overjet und Overbite mit ästhetischen Beeinträchtigungen der mundgesundheitsbezogenen Lebensqualität

  • Original article
  • Published:
Journal of Orofacial Orthopedics / Fortschritte der Kieferorthopädie Aims and scope Submit manuscript

Abstract

Objective

Esthetics is an important part of quality of life and a frequent reason for orthodontic treatment demand. It was the aim of this study to investigate whether esthetic impairments, related to overjet and overbite, can be assessed with an established oral health-related quality of life instrument.

Materials and methods

Data from 1968 participants (age: 16–90 years; 69.8 % female) from three German surveys were analyzed. Esthetic impairments of oral health-related quality of life were measured with four questions of the Oral Health Impact profile (OHIP), which comprise esthetic aspects of oral health-related quality of life. Higher values represent greater esthetic impairment (sum score: 0–16). Overbite and overjet values were categorized (≤ − 1 mm, 0–1 mm, 2–3 mm, 4–5 mm, ≥ 6 mm). The specific impact of each category on esthetic impairment, in relation to the reference category (2–3 mm), was calculated in linear regression analyses. The type of relationship and the specific impact of overbite and overjet were evaluated in regression analyses with fractional polynomials.

Results

Overbite ranged from − 5 to 15 mm (mean: 3.2 mm) and overjet from − 7 to 19 mm (mean: 3.1 mm). Both an increase and a decrease in overjet, in relation to the reference category, resulted in more esthetic-related oral health-related quality of life impairments. However, in this model, only the effect for increased overjet was statistically significant (4–5 mm: + 0.4 OHIP points; ≥ 6 mm: + 0.9 OHIP points). In the regression analysis with fractional polynomials, both an increase and a decrease in overjet resulted in more esthetic impairments, characterized by a U-shaped relationship. No association could be verified for overbite.

Conclusion

A substantial increase or decrease of overjet from the reference values is associated with esthetic impairments of oral health-related quality of life, whereas the extent of overbite seems to have no impact on esthetics.

Zusammenfassung

Zielstellung

Ästhetik ist ein wichtiger Bestandteil der Lebensqualität und ein häufiger Grund für einen kieferorthopädischen Behandlungswunsch. Es sollte untersucht werden, ob mittels eines etablierten Instruments für mundgesundheitsbezogene Lebensqualität eine Beeinträchtigung der Ästhetik in Abhängigkeit vom Overbite und Overjet bei Erwachsenen nachgewiesen werden kann.

Material und Methoden

Ausgewertet werden konnten die Daten von 1968 Personen (Alter: 16–90 Jahre; 69,8 % Frauen) aus 3 Untersuchungen aus Deutschland. Die ästhetische Beeinträchtigung der mundgesundheitsbezogenen Lebensqualität wurde mit den 4 OHIP(Oral Health Impact Profile)-Fragen ermittelt, die ästhetische Aspekte der Lebensqualität erfassen; höhere OHIP-Werte stehen für eine stärker beeinträchtigte Ästhetik (Summenwert: 0–16). Overbite- und Overjet-Werte wurden kategorisiert (≤ − 1, 0–1, 2–3, 4–5, ≥ 6 mm). Der spezifische Einfluss der Kategorien in Bezug zum Referenzbereich (2–3 mm) auf die Ästhetik wurde in linearen Regressionsanalysen berechnet. Die Form des Zusammenhangs und der spezifische Einfluss von Overbite und Overjet wurden in Regressionsanalysen mit fraktionalen Polynomen ermittelt.

Ergebnisse

Der Overbite reichte von − 5 bis 15 mm (MW: 3,2 mm) und der Overjet von − 7 bis 19 mm (MW: 3,1 mm). Sowohl eine Vergrößerung als auch eine Verringerung des Overjets gegenüber dem Referenzbereich war mit einer Zunahme der ästhetischen Beeinträchtigungen verbunden, wobei nur der Effekt der Vergrößerung des Overjets in diesem Modell statistisch signifikant war (4–5 mm: + 0,4 OHIP-Punkte; ≥ 6 mm: + 0,9 OHIP-Punkte). In den Regressionsanalysen mit fraktionalen Polynomen war sowohl eine Vergrößerung als auch eine Verringerung des Overjets gegenüber dem Durchschnittswert im Sinne eines U-förmigen Zusammenhangs mit einer Zunahme der ästhetischen Beeinträchtigungen verbunden. Für den Overbite konnte kein Zusammenhang nachgewiesen werden.

Schlussfolgerung

Eine wesentliche Abweichung des Overjets vom Referenzbereich, sowohl in positiver als auch in negativer Richtung, steht im Zusammenhang mit einer ästhetischen Beeinträchtigung der mundgesundheitsbezogenen Lebensqualität; das Ausmaß des Overbites hingegen scheint keinen Einfluss zu haben.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

References

  1. Al Yami EA, Kuijpers-Jagtman AM, van’t Hof MA (1998) Assessment of dental and facial aesthetics in adolescents. Eur J Orthod 20:399–405

    Article  Google Scholar 

  2. Bernabé E, Flores-Mir C (2007) Influence of anterior occlusal characteristics on self-perceived dental appearance in young adults. Angle Orthod 77:831–836

    Article  PubMed  Google Scholar 

  3. Bland JM, Altman DG (1997) Cronbach’s alpha. BMJ 314:572

    Article  PubMed Central  PubMed  Google Scholar 

  4. Chang CA, Fields HW Jr, Beck FM et al (2011) Smile esthetics from patients’ perspectives for faces of varying attractiveness. Am J Orthod Dentofacial Orthop 140:e171–e180

    Article  PubMed  Google Scholar 

  5. Cohen J (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Earlbaum Associates, Hillsdale

  6. Cronbach LJ (1951) Coefficient alpha and the internal structure of tests. Psychometrika 16:297–334

    Article  Google Scholar 

  7. Souza RA de, Oliveira AF de, Pinheiro SM et al (2013) Expectations of orthodontic treatment in adults: the conduct in orthodontist/patient relationship. Dental Press J Orthod 18:88–94

    Article  PubMed  Google Scholar 

  8. Dworkin SF, LeResche L (1992) Research diagnostic criteria for temporomandibular disorders: review, criteria, examinations and specifications, critique. J Craniomandib Disord 6:301–355

    PubMed  Google Scholar 

  9. Fleiss JL, Levin B, Paik MC (2003) Statistical methods for rates and proportions. Wiley, Hoboken

  10. Flores-Mir C, Silva E, Barriga MI et al (2004) Lay person’s perception of smile aesthetics in dental and facial views. J Orthod 31:204–209 (discussion 201)

    Article  PubMed  Google Scholar 

  11. Foster Page LA, Thomson WM, Ukra A et al (2013) Factors influencing adolescents’ oral health-related quality of life (OHRQoL). Int J Paediatr Dent 23:415–423

    Google Scholar 

  12. Hamdan AM, Singh V, Rock WP (2012) Assessment of the relationship between perceptions of dental aesthetics and demand for orthodontic treatment in 10–11 year old school children in Birmingham, UK. Community Dent Health 29:124–128

    PubMed  Google Scholar 

  13. Hirsch C, John MT, Drangsholt MT et al (2005) Relationship between overbite/overjet and clicking or crepitus of the temporomandibular joint. J Orofac Pain 19:218–225

    PubMed  Google Scholar 

  14. Hönn M, Göz G (2007) The ideal of facial beauty: a review. J Orofac Orthop 68:6–16

    Article  PubMed  Google Scholar 

  15. Jacobson S, Lennartsson B (1996) Prevalence of malocclusion and awareness of dental appearance in young adults. Swed Dent J 20:113–120

    PubMed  Google Scholar 

  16. John MT, Hirsch C, Drangsholt MT et al (2002) Overbite and overjet are not related to self-report of temporomandibular disorder symptoms. J Dent Res 81:164–169

    Article  PubMed  Google Scholar 

  17. John MT, Hirsch C, Reiber T et al (2006) Translating the research diagnostic criteria for temporomandibular disorders into German: evaluation of content and process. J Orofac Pain 20:43–52

    PubMed  Google Scholar 

  18. John MT, Patrick DL, Slade GD (2002) The German version of the Oral Health Impact Profile—translation and psychometric properties. Eur J Oral Sci 110:425–433

    Article  PubMed  Google Scholar 

  19. John MT, Reissmann DR, Feuerstahler L et al (2014) Factor analyses of the Oral Health Impact Profile—overview and studied population. J Prosthodont Res 58:26–34

    Article  PubMed Central  PubMed  Google Scholar 

  20. John MT, Reissmann DR, Rener-Sitar K et al (2013) The factor structure of the Oral Health Impact Profile [Abstract]. J Dent Res 92A:2583

    Google Scholar 

  21. John MT, Reissmann DR, Szentpétery A et al (2009) An approach to define clinical significance in prosthodontics. J Prosthodont 18:455–460

    Article  PubMed  Google Scholar 

  22. Kilpeläinen PV, Phillips C, Tulloch JF (1993) Anterior tooth position and motivation for early treatment. Angle Orthod 63:171–174

    PubMed  Google Scholar 

  23. Klages U, Claus N, Wehrbein H et al (2006) Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod 28:103–111

    Article  PubMed  Google Scholar 

  24. Larsson P, John MT, Nilner K et al (2010) Reliability and validity of the Orofacial Esthetic Scale in prosthodontic patients. Int J Prosthodont 23:257–262

    PubMed  Google Scholar 

  25. LeResche L (2001) Epidemiology of orofacial pain. In: Lund JP, Lavigne GJ, Dubner R, Sessle BJ (eds) Orofacial pain. From basic science to clinical management. The transfer of knowledge in pain from research to education. Quintessence, Chicago, pp 15–25

  26. Locker D (1988) Measuring oral health: a conceptual framework. Community Dent Health 5:3–18

    PubMed  Google Scholar 

  27. Mandall NA, McCord JF, Blinkhorn AS et al (2000) Perceived aesthetic impact of malocclusion and oral self-perceptions in 14–15-year-old Asian and Caucasian children in greater Manchester. Eur J Orthod 22:175–183

    Article  PubMed  Google Scholar 

  28. Marques LS, Ramos-Jorge ML, Paiva SM et al (2006) Malocclusion: esthetic impact and quality of life among Brazilian schoolchildren. Am J Orthod Dentofacial Orthop 129:424–427

    Article  PubMed  Google Scholar 

  29. Mehl C, Kern M, Freitag-Wolf S et al (2009) Does the Oral Health Impact Profile questionnaire measure dental appearance? Int J Prosthodont 22:87–93

    PubMed  Google Scholar 

  30. Nagarajan S, Pushpanjali K (2010) The relationship of malocclusion as assessed by the Dental Aesthetic Index (DAI) with perceptions of aesthetics, function, speech and treatment needs among 14- to 15-year-old schoolchildren of Bangalore, India. Oral Health Prev Dent 8:221–228

    PubMed  Google Scholar 

  31. Naini FB, Donaldson AN, McDonald F et al (2012) Assessing the influence of lower facial profile convexity on perceived attractiveness in the orthognathic patient, clinician, and layperson. Oral Surg Oral Med Oral Pathol Oral Radiol 114:303–311

    Article  PubMed  Google Scholar 

  32. Norman GR, Sloan JA, Wyrwich KW (2003) Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 41:582–592

    PubMed  Google Scholar 

  33. Onyeaso CO, Aderinokun GA (2003) The relationship between dental aesthetic index (DAI) and perceptions of aesthetics, function and speech amongst secondary school children in Ibadan, Nigeria. Int J Paediatr Dent 13:336–341

    Article  PubMed  Google Scholar 

  34. Pallett PM, Link S, Lee K (2010) New “golden” ratios for facial beauty. Vision Res 50:149–154

    Article  PubMed Central  PubMed  Google Scholar 

  35. Patzer GL (1997) Improving self-esteem by improving physical attractiveness. J Esthet Dent 9:44–46

    Article  PubMed  Google Scholar 

  36. Reissmann DR, John MT, Schierz O et al (2007) Functional and psychosocial impact related to specific temporomandibular disorder diagnoses. J Dent 35:643–650

    Article  PubMed  Google Scholar 

  37. Reissmann DR, Krautz M, Schierz O et al (2008) Was ist klinisch relevant bei Vera¨nderungen der Mundgesundheit?—Ergebnisse der deutschen Kurzversion des Oral Health Impact Profiles (OHIP-G14). Dtsch Zahnärztl Z 63:668–680

    Google Scholar 

  38. Royston P, Sauerbrei W (2004) A new approach to modelling interactions between treatment and continuous covariates in clinical trials by using fractional polynomials. Stat Med 23:2509–2525

    Article  PubMed  Google Scholar 

  39. Seehra J, Fleming PS, Newton T et al (2011) Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life. J Orthod 38:247–256 (quiz 294)

    Article  PubMed  Google Scholar 

  40. Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86:420–428

    Article  PubMed  Google Scholar 

  41. Slade GD, Spencer AJ (1994) Development and evaluation of the Oral Health Impact Profile. Community Dent Health 11:3–11

    PubMed  Google Scholar 

  42. Tatarunaite E, Playle R, Hood K et al (2005) Facial attractiveness: a longitudinal study. Am J Orthod Dentofacial Orthop 127:676–682 (quiz 755)

    Article  PubMed  Google Scholar 

  43. Wong AH, Cheung CS, McGrath C (2007) Developing a short form of Oral Health Impact Profile (OHIP) for dental aesthetics: OHIP-aesthetic. Community Dent Oral Epidemiol 35:64–72

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We wish to thank the principal investigators for making available their study data, all dentists who performed the clinical examinations on the individuals covered here, and Ms. Annett Schrock (University of Leipzig) for her assistance in data management. Part of this research project was supported by the German Federal Ministry of Education and Research (BMBF; 01 EZ 1022), and Dr. Reissmann received funds from a research grant awarded by the German Research Foundation (DFG; RE 3289/2-1).

Danksagung

Wir danken den Studienleitern für die Bereitstellung der Daten, allen Zahnärztinnen und Zahnärzten, die die klinischen Untersuchungen der Studienteilnehmer durchgeführt haben und Frau Annett Schrock (Universität Leipzig) für ihre Hilfe beim Datenmanagement. Teile des dargestellten Forschungsprojekts wurden vom deutschen Bundesministerium für Bildung und Forschung (BMBF; 01 EZ 1022) gefördert. Dr. Reissmann wurde durch ein Stipendium der Deutschen Forschungsgemeinschaft (DFG; RE 3289/2-1) unterstützt.

Compliance with ethical guidelines

Conflict of interest. Ira Sierwald, Mike T. John, Oliver Schierz, Paul-Georg Jost-Brinkmann, and Daniel R. Reissmann state that there are no conflicts of interest.

All studies on humans described in the present manuscript were carried out with the approval of the responsible ethics committee and in accordance with national law and the Helsinki Declaration of 1975 (in its current, revised form). Informed consent was obtained from all patients included in studies.

Einhaltung ethischer Richtlinien

Interessenkonflikt. Ira Sierwald, Mike T. John, Oliver Schierz, Paul-Georg Jost-Brinkmann und Daniel R. Reissmann geben an, dass kein Interessenkonflikt besteht.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethik-Kommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

Author information

Authors and Affiliations

  1. Department of Orthodontics, Dentofacial Orthopedics and Pedodontics, Center for Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Assmannshauser Str. 4–6, 14197, Berlin, Germany

    I. Sierwald & P.-G. Jost-Brinkmann

  2. Department of Diagnostic and Biological Sciences, University of Minnesota, Minneapolis, MN, USA

    M.T. John & D.R. Reissmann

  3. Department of Prosthodontics and Materials Science, University of Leipzig, Leipzig, Germany

    O. Schierz

  4. Department of Prosthetic Dentistry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

    D.R. Reissmann

Authors
  1. I. Sierwald
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M.T. John
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. O. Schierz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. P.-G. Jost-Brinkmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D.R. Reissmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to I. Sierwald.

Additional information

Part of this study was presented at the 86th scientific meeting of the Deutsche Gesellschaft für Kieferorthopädie in 2013 in Saarbrücken, Germany, within the framework of a short contribution.

Teile dieser Untersuchung wurden auf der 86. Wissenschaftlichen Jahrestagung der Deutschen Gesellschaft für Kieferorthopädie 2013 in Saarbrücken im Rahmen eines Kurzvortrags präsentiert.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sierwald, I., John, M., Schierz, O. et al. Association of overjet and overbite with esthetic impairments of oral health-related quality of life. J Orofac Orthop 76, 405–420 (2015). https://doi.org/10.1007/s00056-015-0300-x

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00056-015-0300-x

Keywords

Schlüsselwörter

Search

Navigation