title: Psychosocial impact of dental aesthetics in adolescence: validity and reliability of a questionnaire across age-groups.
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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Orthodontics, University Medical Center of the Johannes Gutenberg-University Mainz, Augustusplatz 2, 55131, Mainz, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Klages
authors.forename: Christina
authors.initials: C
authors.lastname: Erbe
authors.forename: Sandra Dinca
authors.initials: SD
authors.lastname: Sandru
authors.forename: Dan
authors.initials: D
authors.lastname: Brüllman
authors.forename: Heinrich
authors.initials: H
authors.lastname: Wehrbein
mesh_terms: D000293:Adolescent; D002648:Child; D003729:Dental Care; D004644:Emotions; D004955:Esthetics, Dental / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000523:psychology; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D012649:Self Concept; D012647:Self-Assessment; D011795:Surveys and Questionnaires / Q000592:standards*
references.citation: Br Dent J. 2012 Dec;213(11):E20
references.pmid: 23222358
references.citation: Med Oral Patol Oral Cir Bucal. 2013 Jan 01;18(1):e168-73
references.pmid: 23229257
references.citation: J Orofac Orthop. 1997 Feb;58(1):44-61
references.pmid: 9300838
references.citation: Eur J Orthod. 2000 Jun;22(3):307-15
references.pmid: 10920563
references.citation: Eur J Orthod. 1998 Feb;20(1):65-72
references.pmid: 9558766
references.citation: Eur J Orthod. 2007 Feb;29(1):79-87
references.pmid: 17290019
references.citation: Eur J Orthod. 2010 Aug;32(4):441-6
references.pmid: 20089570
references.citation: Am J Orthod Dentofacial Orthop. 2003 Dec;124(6):679-82
references.pmid: 14666081
references.citation: J Soc Psychol. 2006 Feb;146(1):15-30
references.pmid: 16480119
references.citation: Eur J Orthod. 1992 Dec;14(6):463-8
references.pmid: 1486932
references.citation: Am J Orthod Dentofacial Orthop. 1998 Dec;114(6):684-91
references.pmid: 9844209
references.citation: Stat Med. 2002 May 15;21(9):1331-5
references.pmid: 12111881
references.citation: J Adolesc. 1991 Mar;14(1):85-98
references.pmid: 2050868
references.citation: Am J Orthod Dentofacial Orthop. 1992 Sep;102(3):265-9
references.pmid: 1510052
references.citation: J Orofac Orthop. 1999;60(5):292-307
references.pmid: 10546413
references.citation: Health Qual Life Outcomes. 2005 May 16;3:34
references.pmid: 15904527
references.citation: Angle Orthod. 2011 May;81(3):540-5
references.pmid: 21261487
references.citation: Eur J Orthod. 2006 Apr;28(2):103-11
references.pmid: 16257989
references.citation: J Clin Epidemiol. 2006 Oct;59(10):1033-9
references.pmid: 16980142
references.citation: J Indian Prosthodont Soc. 2013 Dec;13(4):455-60
references.pmid: 24431775
references.citation: Eur J Orthod. 2011 Jun;33(3):270-5
references.pmid: 20713456
references.citation: J Adolesc. 1989 Jun;12(2):225-9
references.pmid: 2768603
references.citation: Community Dent Health. 1996 Sep;13(3):139-44
references.pmid: 8897736
references.citation: J Coll Physicians Surg Pak. 2008 Sep;18(9):559-64
references.pmid: 18803894
references.citation: Eur J Orthod. 2013 Jun;35(3):354-60
references.pmid: 22117023
references.citation: Am J Orthod Dentofacial Orthop. 2003 Feb;123(2):127-32
references.pmid: 12594417
references.citation: Angle Orthod. 2013 Jul;83(4):617-22
references.pmid: 23163832
references.citation: Eur J Orthod. 2001 Jun;23(3):315-23
references.pmid: 11471274
references.citation: Angle Orthod. 2009 Nov;79(6):1188-93
references.pmid: 19852614
references.citation: Int Orthod. 2012 Mar;10(1):96-109
references.pmid: 22269885
references.citation: Korean J Orthod. 2013 Aug;43(4):193-200
references.pmid: 24015389
references.citation: J Orofac Orthop. 2000;61(6):398-413
references.pmid: 11126015
references.citation: Eur J Orthod. 2005 Jun;27(3):296-301
references.pmid: 15947231
references.citation: Medicina (Kaunas). 2009;45(10):814-21
references.pmid: 19996669
references.citation: Health Qual Life Outcomes. 2006 Oct 11;4:79
references.pmid: 17034633
references.citation: Eur J Orthod. 2003 Feb;25(1):57-63
references.pmid: 12608724
references.citation: Angle Orthod. 2007 Jul;77(4):675-80
references.pmid: 17605485
references.citation: Med Care. 2006 Nov;44(11 Suppl 3):S78-94
references.pmid: 17060839
references.citation: Health Qual Life Outcomes. 2010 Aug 04;8:81
references.pmid: 20684767
references.citation: Orthod Fr. 2013 Dec;84(4):319-31
references.pmid: 24280547
references.citation: Am J Orthod Dentofacial Orthop. 2005 Oct;128(4):442-9
references.pmid: 16214625
references.citation: Eur J Public Health. 2007 Dec;17(6):637-41
references.pmid: 17400542