Exploring the Reasons for Seeking Orthodontic Treatment among the Patients Attended in Selected Private Settings

: Introduction: This study was conducted to explore the reasons and influential factors for seeking orthodontic treatment among the orthodontic patients. Methods: A total 126 patients were interviewed for the duration of four months with a semi structured questionnaire who attended at two private dental settings in Dhaka and Jeshore city. In depth interview was conducted with some patients and with their guardians to explore the influential factors for seeking orthodontic treatment. Results: The study result showed out of 126 patients majority 82.5% were female, the mean age of the patient was 17.9(±5.9) years with range 7-36 years. Social harassment like teasing or bullying experiences was the influential factor for seeking orthodontic treatment mentioned by majority orthodontic treatment seeker. Other influential factors noted as desire to have better facial or aesthetic appearance, better career opportunity. Conclusion: Present study concluded that patients seek orthodontic treatment mainly due to psychosocial reason like to get rid of social harassment, also to improve their dental appearance and aesthetic.

Introduction: This study was conducted to explore the reasons and influential factors for seeking orthodontic treatment among the orthodontic patients.Methods: A total 126 patients were interviewed for the duration of four months with a semi structured questionnaire who attended at two private dental settings in Dhaka and Jeshore city.In depth interview was conducted with some patients and with their guardians to explore the influential factors for seeking orthodontic treatment.Results: The study result showed out of 126 patients majority 82.5% were female, the mean age of the patient was 17.9(±5.9)years with range 7-36 years.Social harassment like teasing or bullying experiences was the influential factor for seeking orthodontic treatment mentioned by majority orthodontic treatment seeker.Other influential factors noted as desire to have better facial or aesthetic appearance, better career opportunity.Conclusion: Present study concluded that patients seek orthodontic treatment mainly due to psychosocial reason like to get rid of social harassment, also to improve their dental appearance and aesthetic.

INTRODUCTION:
Orthodontics is a special branch of dentistry which mainly deals with the correction of malaligned teeth, correction of occlusion, functional and aesthetic improvement of patients.Malocclusion or malaligned teeth can cause aesthetic and psychosocial problems in patients, which may be defined as an irregularity of teeth or malrelationship of dental arches beyond the accepted normal range. [1,2]Many studies showed that the problems associated with malocclusion such as traumatic occlusion, periodontal diseases, temporomandibular joint pain might resolve after orthodontic treatment. [3]The lifestyle of a person can adversely impacted by malocclusion due to its psychosocial as well as other functional disturbances like eating, talking and aesthetics. [4]arious reasons and factors may influence patients in seeking orthodontic treatment.[7] Therefore present study aimed to explore the influential factors for seeking orthodontic treatment among the orthodontic patients.

MATERIALS AND METHODS:
A mixed method study was conducted among 126 patients attended at two private dental settings in Dhaka and Jeshore city for the duration of four months from June 2021 to September 2021 with the objective to explore the influencing factors for seeking orthodontic treatment among them.Data were collected from these patients with a semi structured interview administered questionnaire prior taking verbal consent from them and from their guardians to participate in the study.The questionnaire consists two parts, first part includes the demographic information and the orthodontic information like spacing, crowding, open bite, over jet, over 15| P a g e Website: https://www.banglajol.info/index.php/UpDCJbite ect.examined and noted by orthodontist after clinical examination.The second part of the questionnaire focused on the influential factors for seeking orthodontic treatment.This part was the qualitative part of the research, where the orthodontic patients briefly mentioned about the reasons for seeking orthodontic treatment individually and they were encouraged to brief their emotion and thoughts about the subject matter.As the qualitative part of the research, in depth interview was conducted from the patients who were interested to participate in the discussion to explore their feelings, experiences, thoughts for seeking orthodontic treatment.The collected data were analyzed and the results were presented in frequency and percentages.

RESULTS:
Table 1  Figure 1 shows out of 126 patients more than half (55.6%) were diagnosed as Class I malocclusion; Class II Division I, Class II Division II and Class III were diagnosed in 30.1%, 9.5%, 4.8% patients respectively.

DISCUSSION:
Present study was conducted to explore the influential factors for seeking orthodontic treatment among the orthodontic patients.The study findings revealed that the mean age of orthodontic patients was 17.9 (±5.9) years with range 7-36 years, half of the patients belonged to 11-15 years age group.Similar findings were observed in the study Al-harbi et al. [8] , Sawai et al. [9] Another study conducted by Baheti et al. [10] reported that 60% of the study participants belonged to 13-20 years age group, which was close to current study result.According to American Academy of Orthodontics (AAO) the best phase of seeking orthodontic treatment is between 11 and 14 years, [11] which is visible in the current scenario that majority patients were seeking orthodontic treatment belonged to 11-15 years age group.Present study reported majority (82.5%) orthodontic patients were female, which was consistent with different studies like Al-harbi et al. [8] , Sharma [12]   , Alhaija et al. [13] and Sawai et al. [9] The probable reasons of female predominance as orthodontic patient could be female are more concern about aesthetic issues than male.But male predominance for seeking orthodontic treatment reported by Shah et al. [14] which was contrast with present study.More than half of the patients were student and belonged to upper socio economic status.Present study reported more than half (55.6%) patients pattern of malocclusion was Class I 16| P a g e Website: https://www.banglajol.info/index.php/UpDCJmalocclusion according to Angles classification, which was consistent with previous Bangladeshi studies by Rita et al. [15] , Rahman et al. [16] , where they reported Class I malocclusion is the most prevalent type of malocclusion among Bangladeshi population.Current study recorded some influential factors for seeking orthodontic treatment mentioned by the respondents covering the psychosocial aspect, personal aspect, aesthetic and functional aspect.It was noted that social harassment was the influential factor for seeking orthodontic treatment mentioned by majority (81.7%) orthodontic treatment seeker, other influential factors noted as improvement of facial / aesthetic appearance (77.0%), teasing or bullying experiences (76.1%), improvement of confidence level (49.2%), better career opportunities (37.3%).Considering the psychosocial aspect, aesthetic or functional aspect, personal aspect and other aspects present study revealed that social harassment, teasing or bullying experiences, marriage issues were the major influential factors for seeking orthodontic treatment mentioned by majority orthodontic treatment seeker.In depth interview was conducted with some orthodontic patients in front of their guardian, where they expressed their circumstances and opinion for seeking orthodontic treatment.From the in depth interview session it was noted that orthodontic patients faced challenges in the society in the form of bullying or teasing by the surrounding people due to their facial appearance and malaligned teeth.Aesthetic problem was the major concern among them than the functional problem.The desire to have a better facial appearance was an important reason for seeking orthodontic treatment.Expected improvement in career opportunities, improvement in social life and self-confidence were also major factors for seeking orthodontic treatment, rather it was observed that they were not so concern about the functional problems due to the malaligned teeth.

CONCLUSION:
Present study concluded that psychosocial factors are important ones in leading patients to seek orthodontic treatment.Demographic factor such as age, sex may have some influences on patients.But most of the patients seek orthodontic treatment because of psychosocial reasons like social harassment, teasing or bullying experiences, to have a better aesthetic appearance which can lead to a better social as well as professional life.Present study recommended that the patient's motivation in seeking orthodontic treatment should be determined before the treatment commences to increase the chances for a mutually satisfying result for both orthodontists and patients.

Figure 1 :
Figure 1 shows out of 126 patients more than half (55.6%) were diagnosed as Class I malocclusion; Class II Division I, Class II Division II and Class III were diagnosed in 30.1%, 9.5%, 4.8% patients respectively.Figure 1 : Malocclusion pattern of patients by Angle's and incisor classification, (n=126)

Table 1 : Socio demographic details of the patients (n=126)
shows half of the patients (50.8%) were in 11-15 years age group, majority (82.5%) orthodontic patients were female, majority (89.7%) patients were students, almost half (53.2%) patients belonged to upper socio economic status.