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Immigrant background and orthodontic treatment need: Quantitative and qualitative studies in Swedish adolescents
Jönköping University, School of Health Science, HHJ, Dep. of Natural Science and Biomedicine. Jönköping University, School of Health Science, HHJ. Oral health.
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin.

Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics.

The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing.

The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

Place, publisher, year, edition, pages
Jönköping: Hälsohögskolan , 2010. , 83 p.
Series
Hälsohögskolans avhandlingsserie, ISSN 1654-3602 ; 10
Keyword [en]
Orthodontic treatment need, adolescents, immigrant background, self-perceived need, malocclusion, poor dental aesthetics, social norms
National Category
Dentistry
Identifiers
URN: urn:nbn:se:hj:diva-13141ISBN: 978-91-85835-09-6 (print)OAI: oai:DiVA.org:hj-13141DiVA: diva2:351756
Public defence
2010-09-10, Forum Humanum, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2013-04-08 Created: 2010-09-16 Last updated: 2013-04-08Bibliographically approved
List of papers
1. Self-perceived orthodontic treatment need and culturally related differences among adolescents in Sweden
Open this publication in new window or tab >>Self-perceived orthodontic treatment need and culturally related differences among adolescents in Sweden
2005 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 27, no 2, 140-147 p.Article in journal (Refereed) Published
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-10946 (URN)10.1093/ejo/cjh070 (DOI)15817620 (PubMedID)
Available from: 2009-12-01 Created: 2009-12-01 Last updated: 2017-12-12Bibliographically approved
2. Factors determining perceived orthodontic treatment need in adolescents of Swedish and immigrant background
Open this publication in new window or tab >>Factors determining perceived orthodontic treatment need in adolescents of Swedish and immigrant background
2009 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 31, no 1, 95-102 p.Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to evaluate the association between self-perceived orthodontic treatment need and malocclusion in 12 to 13-year-old-adolescents of Swedish and immigrant background. The sample consisted of 379 students, stratified according to geographic background: both parents born in A/Sweden (n = 269), B/Eastern Europe (n = 56), and C/the Middle East (n = 54). Registrations were based on a questionnaire, a clinical examination, radiographs, and patient records. Treatment need was classified according to the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN). Logistic regression analysis was used for comparison of the results.

National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-10943 (URN)10.1093/ejo/cjn069 (DOI)19028671 (PubMedID)
Available from: 2009-11-30 Created: 2009-11-30 Last updated: 2017-12-12Bibliographically approved
3. Malocclusion frequency in Swedish and immigrant adolescents: influence of origin on orthodontic treatment need
Open this publication in new window or tab >>Malocclusion frequency in Swedish and immigrant adolescents: influence of origin on orthodontic treatment need
2007 (English)In: European Journal of Orthodontics, ISSN 0141-5387, E-ISSN 1460-2210, Vol. 29, no 1, 79-87 p.Article in journal (Refereed) Published
Abstract [en]

Sweden has become increasingly multicultural, In the year 2000, almost 25 per cent of the child and adolescent population was of foreign origin. Such a major change in demographics may lead to altered orthodontic treatment need in the community, with implications for planning appropriate levels of orthodontic resources. The aim of this study was to compare the frequency of malocclusion and orthodontic treatment need in 12- and 13-year olds of Swedish and immigrant background. The subjects, n = 493, were stratified into four groups according to family origin: (A) subject and both parents born in Sweden, and subject or at least one parent born in (B) Eastern Europe, (C) Asia, or (D) other countries. Registrations were based on available radiographs, patient records, and a clinical examination. Normative treatment need was based on a number of variables. Treatment need was expressed according to the dental health component (DHC) and aesthetic component (AC) of the Index of Orthodontic Treatment Need (IOTN).

Group A exhibited the greatest space deficiencies and irregularities in the maxillary and mandibular anterior segments and also the greatest overjet. More primary molars had been extracted in groups B and C, with a positive correlation between early extraction of primary molars and retention of permanent successors. Self-assessed orthodontic treatment need, IOTN-AC, was highest in group A. For all four groups, the orthodontist's estimate of treatment need was significantly higher than the subjects' self-assessed need.

This study confirms that, despite the change in demographics, variations in frequencies of malocclusion and treatment need among children of different cultural background are only minor and the overall orthodontic treatment need remains unchanged.

National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-10945 (URN)10.1093/ejo/cjl054 (DOI)17290019 (PubMedID)
Available from: 2009-12-01 Created: 2009-12-01 Last updated: 2017-12-12Bibliographically approved
4. Self-perceived orthodontic treatment need and prevalence of malocclusion in 18- and 19-year-olds in Sweden with different geographic origin
Open this publication in new window or tab >>Self-perceived orthodontic treatment need and prevalence of malocclusion in 18- and 19-year-olds in Sweden with different geographic origin
2010 (Swedish)In: Swedish Dental Journal, ISSN 0347-9994, Vol. 34, no 2, 95-106 p.Article in journal (Refereed) Published
Abstract [en]

Orthodontic treatment need and demand in 19-year-olds in Sweden has not previously been analysed in relation to geographic origin. The aim of this follow-up study was to examine the prevalence of self-perceived treatment need, malocclusion, earlier orthodontic treatment, self-perceived dental aesthetics and prevalence of symptoms indicative oftemporomandibular disorders in 18-19 year-olds and to analyze any differences between native born and immigrants. Body esteem and psychological wellbeing were also evaluated. The subjects, n=316, were grouped according to family origin: Group A: both parents born in Sweden (98 girls, 80 boys); Group B:the subject or at least one parent born in Eastern /South Eastern Europe (24 girls, 26 boys) and Group C: Asia (44 girls, 44 boys). Two hundered and sixty-eight participants presented for clinical examination and answered the full questionnaire, and 48 who rejected clinical examination,were interviewed by telephone using selected questions from a questionnaire. The results show that adolescents of Asian origin had a higher self-perceived treatment need than adolescents of Swedish origin. There were negligible inter-group differences with respect to frequency of malocclusion. Forty-four per cent of all participants had previously undergone orthodontic treatment, significantly more Swedish than Asian subjects. Dissatisfaction with dental aesthetics was attributed primarily to tooth colour (38 per cent) and irregular anterior teeth (34 per cent). Adolescents of Asian origin had a higher frequency of headache than those of Eastern/South Eastern European origin. Compared to boys, girls had a higher self-perceived treatment need, a higher frequency of headache and TMD and were more concerned about body appearance. Psychological wellbeing was reduced in nearly one quarter of the participants, predominantly girls: girls of Asian origin had the highest frequency. No association was found between self-perceived orthodontic treatment need and psychological wellbeing.

National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-12987 (URN)20701218 (PubMedID)
Available from: 2010-08-31 Created: 2010-08-31 Last updated: 2017-12-12Bibliographically approved
5. A qualitative study of the influence of poor dental aesthetics on the lives of young adults
Open this publication in new window or tab >>A qualitative study of the influence of poor dental aesthetics on the lives of young adults
2010 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 68, no 1, 19-26 p.Article in journal (Refereed) Published
Abstract [en]

Objective: Although many countries offer some publicly funded orthodontic treatment for children, not all conditions receive treatment and some adolescents enter adulthood with persisting poor dental aesthetics or malocclusions. The aim of this study was to generate a theory highlighting the main concerns of young adults, either native-born or of immigrant background, with poor dental aesthetics and the measures they adopt to manage their condition in everyday life.

Material and methods: A qualitative method, classic grounded theory, was applied in order to generate a substantive theory highlighting the main concerns and managing mechanisms of 13 strategically selected 19- and 20-year-olds with poor dental aesthetics. Open interviews were conducted with each participant, the topics covering different aspects of social and dental conditions.

Results: A core category and three conceptual categories were generated. The core category was labelled "Being under the pressure of social norms" and was related to categories explaining three different ways in which these young adults handle their main concern: (1) avoiding showing their teeth; (2) minimizing the importance of appearance; and (3) seeking orthodontic treatment. The theory offers the potential for improved understanding of young adults who, despite poor dental aesthetics, are managing well with life, and also of those who have not adjusted well.

Conclusions: In early adolescence it may be problematic to make decisions about orthodontic treatment. Undisclosed dental fear can be an important barrier. Some of the young adults in the present study would probably benefit from treatment.

Keyword
Dental aesthetics, Importance of appearance, Orthodontic therapy in adolescence, Social norms
National Category
Dentistry
Identifiers
urn:nbn:se:hj:diva-11832 (URN)10.3109/00016350903281740 (DOI)
Available from: 2010-03-26 Created: 2010-03-26 Last updated: 2017-12-12Bibliographically approved

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