Malocclusion: review finds that it has an adverse effect on quality of life


Malocclusion is common and the majority of corrective orthodontic treatment is performed during adolescence. As this is a period during which appearance tends to become more importance it is considered that malocclusion may have a psychological and social impacts on the individual’s quality of life.

The aim of this review was to conduct a systematic review of quantitative studies for evidence regarding the influence of malocclusions on oral health-related quality of life (OHRQOL) in children and adolescents.


Searches were conducted in Medline. Embase. PSYCHinfo, CINHAL, and the Cochrane Library. Studies in health child or adolescent population with non-syndromic problems and no previous orthodontic treatment were considered where self-assessed OHRQOL estimated using validated questionnaire instruments. Three independent reviewers selected studies and Quality of evidence was classified according to GRADE guidelines as high, moderate, or low.


  • 6 studies were included. All were cross-sectional
  • 4 were considered to be of high quality and 2 moderate quality.
  • OHRQOL was evaluated with
    • The Child Perception Questionnaire (CPQ11-14 or 8–10) in 4 studies
    • Oral Health Impact profile (OHIP-14) in 1 study
    • Oral Impact on Daily Performance (OIDP) in 1 study
  • 4 studies reported that severe malocclusions, predominantly anterior crowding had a negative impact on OHRQOL.
  • 2 studies stated that increased orthodontic treatment need had a negative impact on OHRQOL.
  • 2 studies revealed that malocclusions predominantly affected the dimensions of emotional wellbeing and social wellbeing.


The authors concluded

The scientific evidence was considered strong since four studies with high level of quality reported that malocclusions in the aesthetic zone have negative effects on OHRQOL, predominantly in the dimensions of emotional and social wellbeing.


Earlier this week (Dental Elf -22nd Sept 2014) we considered a review that looked at whether malocclusion and orthodontic treatment improved quality of life. This review has searched more databases than that review but a narrower focus, on malocclusion only and possibly using stricter inclusion criteria, has resulted in only 6 higher quality studies were included.  A 2009 review by Liu et al noted by the reviewers considered the impact of malocclusion and orthodontic treatment on OHRQOL. They were of the opinion that the evidence for the association between malocclusion and orthodontic treatment need was moderate. Interestingly none of the studies included in the Liu review are included in this current review and all 6 of the studies included in this review were published after the Liu review.


Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies. Eur J Orthod. 2014 Sep 11. pii: cju046. [Epub ahead of print] Review. PubMed PMID: 25214504.

Dental Elf – 22nd Sept- 2014 – Orthodontic treatment: Does it improve quality of life for patients?

Liu Z, McGrath C, Hägg U. The impact of malocclusion/orthodontic treatment need on the quality of life. A systematic review. Angle Orthod. 2009 May;79(3):585-91. doi: 10.2319/042108-224.1. Review. PubMed PMID: 19413386.

Dental Elf 12th Jun-2014 – Review suggests a modest quality of life benefit from orthodontic treatment

GRADE Working Group


Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+