Correlation Between Malocclusion Severity and Oral Health-related Quality of Life Using OHIP-14 and IOTN Among Patients Seeking Orthodontic Treatment: A Cross-sectional Observational Study

Abstract

Aim This research focuses on assessing oral health-related quality of life (OHRQoL) through the application of the Oral Health Impact Profile (OHIP)-14 and the Index of Orthodontic Treatment Need (IOTN). It specifically explored the link between clinician-assessed malocclusion severity and how adolescents and young adults seeking orthodontic treatment perceive their own dental health. Methods A cohort of 120 orthodontic outpatients (77 females and 43 males; age range: 15-30 years; mean age: 22.07 ± 4.71 years) was selected via consecutive convenience sampling. To capture both clinical and patient-centered perspectives, OHRQoL was assessed using the self-reported OHIP-14 and the AC-IOTN indices, whereas a single operator evaluated normative treatment needs using the Dental Health Component (DHC)-IOTN. Statistical distribution analysis with the Shapiro–Wilk test confirmed that the data were non-normally distributed (P < .05). Consequently, we utilized the non-parametric Mann–Whitney U test to compare differences between genders and Spearman’s rho (ρ) to explore correlation patterns. High examiner consistency on the DHC was verified by an almost perfect intra-rater Cohen’s kappa of 0.966. Results A majority of participants (74.16%) of the sample were clinically categorized as having a “Great Need” for treatment (DHC); clinical severity did not significantly correlate with quality of life (QoL) (P = .398). In contrast, the patient’s own aesthetic perception showed a significant but weak positive correlation with poorer OHRQoL (P = .030). Females reported significantly higher negative impacts on QoL (P = .012) and higher aesthetic concern (P = .014) than males, despite having statistically similar clinical severity (P = .590). The total median OHIP-14 score was 10.0 (interquartile ranges: 4.0-15.5). The results showed a weak correlation between AC and OHIP-14. Conclusion This study identifies a significant “clinical-perceptual gap,” demonstrating that patient-centered AC is a more reliable predictor of OHRQoL impact than objective clinical indices (DHC). Females in this demographic exhibit a heightened subjective awareness of malocclusion, experiencing a greater negative impact on their QoL than males for the same degree of clinical severity. These findings underscore the need to prioritize patient-reported outcomes when planning orthodontic services in public health settings.