title: Qualitative evaluation of pretreatment patient concerns in orthodontics.
abstract: BACKGROUND
  A discrepancy exists between objective and subjective measures of orthodontic treatment need, highlighting the importance of patients' perceptions. Limited qualitative information is available regarding patients' perceptions and orthodontic concerns. For the first time, patient facial images and qualitative methodology were used to assess patients' orthodontic concerns, which are incorporated into and are important in treatment planning and consent.
  
  
  METHODS
  An interview-based, cross-sectional study of adolescent patients eligible to receive orthodontic treatment in a public dental hospital was conducted with 105 adolescents (42 boys, 63 girls) aged between 12 and 17 years. Each patient's face was video recorded, and 3 images were selected from each recording to assess the patient's orthodontic concerns. The initial chief concerns were compared with concerns articulated after the patients assessed their facial images. In addition, patient concerns were compared with occlusal features visible on smiling using the Dental Aesthetic Index and patient study casts.
  
  
  RESULTS
  For 37% of the adolescent patients, smiling images helped to identify additional concerns. For 87%, their smiling images helped them to describe their concerns in more detail. In addition, a few patients did not articulate any concern about features measurable on the Dental Aesthetic Index that were visible on smiling.
  
  
  CONCLUSIONS
  Showing adolescent patients images of their face and smile helped them to identify and better describe their concerns. Adolescents are not always overly concerned about visible and quantifiable malocclusion features. This might influence orthodontic treatment planning and consent.
authors.affiliation: Registrar, Department of Orthodontics, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Eugene
authors.initials: E
authors.lastname: Twigge
authors.affiliation: Senior lecturer, School of Psychology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Roberts
authors.affiliation: Associate professor, Australian Research Centre for Population Oral Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Jamieson
authors.affiliation: Professor, Begg Chair in Orthodontics, Department of Orthodontics, University of Adelaide, Adelaide, South Australia, Australia. Electronic address: craig.dreyer@adelaide.edu.au.
authors.forename: Craig W
authors.initials: CW
authors.lastname: Dreyer
authors.affiliation: Emeritus professor, Department of Orthodontics, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: Sampson
mesh_terms: D000293:Adolescent; D001294:Attitude to Health; D002648:Child; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000628:therapy*; D009971:Orthodontics, Corrective