The number of orthodontic treatments carried out has risen steadily. The reasons patients and parents seek treatment may well differ  from that of the professional who is likely to prioritise function and occlusion. There are systems that have been used to quantify the severity of malocclusions and orthodontic need in an objective manner one of the best known being the index of Orthodontic Treatment Need (IOTN). The aims of this review was assess the relation between self-perception of treatment need and orthodontic expertise, both based on validated registration methods.

A search of three databases (Cochrane Library, Medline & Scopus) was supplemented by searching the European Journal of Orthodontics and Angle Orthodontist.  Only studies that investigated both self-perception of orthodontic need by laypersons and assessment of orthodontic need by professionals were included. Studies were independently graded for quality.

22 studies were included, 15 conducted with children and adolescents and 7  with young adults.

The overall evidence level provided by the evaluated publications was rated as limited. A qualitative summary of the findings is presented with discussion of a range of methodological issues.

The authors concluded

the existing body of evidence indicated a highly variable association between self-perception of orthodontic treatment need and orthodontist’s assessment. Future controlled studies with well-defined samples and common assessment methodology will clarify further the relationship between perception of treatment need by laypersons and orthodontists and enhance international comparison and development of health care

Livas C,Delli K. Subjective and objective perception of orthodontic treatment need: a systematic review. Eur J Orthod. 2012 Jan 16.[Epub ahead of print]PubMed PMID: 22250076.

Comment

While this review is helpful  it is also going to be challenging to get widespread agreement between the professional and patient on the need for treatment. This will also vary from society to society and over time as perception on what is acceptable are constantly changing. Another issue not considered in this review is the impact of  access to care and funding for treatment  be it  individual/insurance/government.  For in some areas indices such as IOTN are used to  used to control access to care.