A clinically based review of patient and treatment characteristics in West Australian private orthodontic practices


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Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





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VOLUME 36 , ISSUE 1 (May 2020) > List of articles

A clinically based review of patient and treatment characteristics in West Australian private orthodontic practices

Raymond Lam / Simone Mustac / Mithran S. Goonewardene *

Citation Information : Australasian Orthodontic Journal. Volume 36, Issue 1, Pages 9-19, DOI: https://doi.org/10.21307/aoj-2020-002

License : (CC BY 4.0)

Published Online: 20-July-2021



Objective: To describe patient and treatment characteristics in West Australian private orthodontic practices.

Methods: A quantitative retrospective cross-sectional study of patient records from private practices in Western Australia was conducted. Permission was sought to access clinical records of 100 most recently-treated patients at each participating practice. A sample of 3,200 patients (response rate 84%) was collected, representing approximately one-third of practices in Western Australia, and simple descriptive statistics were applied to assess patient and treatment characteristics.

Results: The majority of patients were female (58.5%), adolescent and had private health insurance (75.6%). The most common patient complaint was crowding (37.6%) and aesthetics (21.3%). Data analysis indicated that 31% of patients were self-referred and a similar proportion did not have a specific complaint. Adult females had a higher interest in aesthetic options. Over half of the patients (56%) received first phase treatment, and non-extraction orthodontics accounted for 61.6% of cases. Full fixed appliances were the most commonly prescribed device (94%). The acceptance rate of orthognathic surgery, when offered, was approximately 30%.

Conclusion: Clinical data relating to actual patient presentations provide an invaluable insight into the realities of private practice. The eventual course of treatment is often determined by the patient’s tolerances and expectations as much as a clinical recommendation.

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1. Lew KK, Foong WC, Loh E. Malocclusion prevalence in an ethnic Chinese population. Aust Dent J 1993;38:442-9.

2. Myllärniemi S. Malocclusion in Finnish rural children An epidemiological study of different stages of dental development. Suom Hammaslaak Toim 1970;66:219-64.

3. Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001;23:153-67.

4. Lauweryns I, Carels C, Vlietinck R. The use of twins in dentofacial genetic research. Am J Orthod Dentofacial Orthop 1993;103:33-8.

5. Markovic MD. At the crossroads of oral facial genetics. Eur J Orthod 1992;14:469-81.

6. Mossey PA. The heritability of malocclusion: part 2. The influence of genetics in malocclusion. Br J Orthod 1999;26:195-203.

7. Johe RS, Steinhart T, Sado N, Greenberg B, Jing S. Intermaxillary tooth-size discrepancies in different sexes, malocclusion groups, and ethnicities. Am J Orthod Dentofacial Orthop 2010;138:599-607.

8. Soh J, Sandham A, Chan YH. Occlusal status in Asian male adults: prevalence and ethnic variation. Angle Orthod 2005;75:814-20.

9. Corruccini RS, Townsend GC, Richards LC, Brown T. Genetic and environmental determinants of dental occlusal variation in twins of different nationalities. Hum Biol 1990;62:353-67.

10. de Souza BS, Bichara LM, Guerreiro JF, Quintão CC, Normando D. Occlusal and facial features in Amazon indigenous: An insight into the role of genetics and environment in the etiology dental malocclusion. Arch Oral Biol 2015;60:1177-86.

11. Eguchi S, Townsend GC, Richards LC, Hughes T, Kasai K. Genetic contribution to dental arch size variation in Australian twins. Arch Oral Biol 2004;49:1015-24.

12. Kawala B, Antoszewska J, Necka A. Genetics or environment? A twin-method study of malocclusions. World J Orthod 2007;8:405- 10.

13. Olczak-Kowalczyk D, Krasuska-Sławińska E, Danko M, Popińska K, Banaś E, Gozdowski D et al. Does long term parenteral nutrition in children have an impact on malocclusion? Preliminary report. Dev Period Med 2014;18:241-6.

14. Ciochon RL, Nisbett RA, Corruccini RS. Dietary consistency and craniofacial development related to masticatory function in minipigs. J Craniofac Genet Dev Biol 1997;17:96-102.

15. Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O’Brien KD. Perceived aesthetic impact of malocclusion and oral self-perceptions in 14-15-year-old Asian and Caucasian children in greater Manchester. Eur J Orthod 2000;22:175-83.

16. Spalj S, Slaj M, Varga S, Strujic M, Slaj M. Perception of orthodontic treatment need in children and adolescents. Eur J Orthod 2010;32:387-94.

17. Proffit WR, Fields HW, Sarver DM. Contemporary Orthodontics. 4th edn. St Louis: Mosby, 2007.

18. Isiekwe GI, Sofola OO, Onigbogi OO, Utomi IL, Sanu OO, daCosta OO. Dental esthetics and oral health-related quality of life in young adults. Am J Orthod Dentofacial Orthop 2016;150:627- 36.

19. Liu Z, McGrath C, Hägg U. The impact of malocclusion/ orthodontic treatment need on the quality of life. A systematic review. Angle Orthod 2009;79:585-91.

20. Silvola AS, Varimo M, Tolvanen M, Rusanen J, Lahti S, Pirttiniemi P. Dental esthetics and quality of life in adults with severe malocclusion before and after treatment. Angle Orthod 2014;84:594-9.

21. Taylor KR, Kiyak A, Huang GJ, Greenlee GM, Jolley CJ, King GJ. Effects of malocclusion and its treatment on the quality of life of adolescents. Am J Orthod Dentofacial Orthop 2009;136:382-92.

22. Zhou Y, Wang Y, Wang X, Volière G, Hu R. The impact of orthodontic treatment on the quality of life a systematic review. BMC Oral Health 2014;14:66.

23. Albino JE, Lawrence SD, Tedesco LA. Psychological and social effects of orthodontic treatment. J Behav Med 1994;17:81-98.

24. Dann C 4th, Phillips C, Broder HL, Tulloch JF. Self-concept, Class II malocclusion, and early treatment. Angle Orthod 1995;65:411-6.

25. Tung AW, Kiyak HA. Psychological influences on the timing of orthodontic treatment. Am J Orthod Dentofacial Orthop 1998;113:29-39.

26. Drugan CS, Hamilton S, Naqvi H, Boyles JR. Inequality in uptake of orthodontic services. Br Dent J 2007;202:E15; discussion 326-7.

27. Foster Page LA, Thomson WM. Malocclusion and uptake of orthodontic treatment in Taranaki 12-13-year-olds. N Z Dent J 2005;101:98-105; quiz 111.

28. Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg 1998;13:97-106.

29. Healey DL, Gauld RD, Thomson WM. The socio-demographic and malocclusion characteristics of adolescents presenting for specialist orthodontic treatment in New Zealand practices. Aust Orthod J 2015;31:20-5.

30. Brown DF, Spencer AJ, Tolliday PD. Social and psychological factors associated with adolescents’ self-acceptance of occlusal condition. Community Dent Oral Epidemiol 1987;15:70-3.

31. Thomson WM. Orthodontic treatment outcomes in the long term: findings from a longitudinal study of New Zealanders. Angle Orthod 2002;72:449-55.

32. Reichmuth M, Greene KA, Orsini MG, Cisneros GJ, King GJ, Kiyak HA. Occlusal perceptions of children seeking orthodontic treatment: impact of ethnicity and socioeconomic status. Am J Orthod Dentofacial Orthop 2005;128:575-82.

33. Whitesides J, Pajewski NM, Bradley TG, Iacopino AM, Okunseri C. Socio-demographics of adult orthodontic visits in the United States. Am J Orthod Dentofacial Orthop 2008;133:489 e9-14.

34. Harris EF, Glassell BE. Sex differences in the uptake of orthodontic services among adolescents in the United States. Am J Orthod Dentofacial Orthop 2011;140:543-9.

35. Deli R, Macrì LA, Radico P, Pantanali F, Grieco DL, Gualano MR et al. Orthodontic treatment attitude versus orthodontic treatment need: differences by gender, age, socioeconomical status and geographical context. Community Dent Oral Epidemiol 2012;40 Suppl 1:71-6.

36. Badran SA, Al-Khateeb S. Factors influencing the uptake of orthodontic treatment. J Public Health Dent 2013;73:339-44.

37. Spencer AJ, Allister JH, Brennan DS. Predictors of fixed orthodontic treatment in 15-year-old adolescents in South Australia. Community Dent Oral Epidemiol 1995;23:350-5.

38. Baccetti T, Reyes BC, McNamara JA Jr. Gender differences in Class III malocclusion. Angle Orthod 2005;75:510-20.

39. El-Mangoury NH, Mostafa YA. Epidemiologic panorama of dental occlusion. Angle Orthod 1990;60:207-14.

40. Mills LF. Epidemiologic studies of occlusion. IV. The prevalence of malocclusion in a population of 1,455 school children. J Dent Res 1966;45:332-6.

41. Nobile CG, Pavia M, Fortunato L, Angelillo IF. Prevalence and factors related to malocclusion and orthodontic treatment need in children and adolescents in Italy. Eur J Public Health 2007;17:637- 41.

42. Chen MS, Hunter P. Oral health and quality of life in New Zealand: a social perspective. Soc Sci Med 1996;43:1213-22.

43. Alexander RG, Sinclair PM, Goates LJ. Differential diagnosis and treatment planning for the adult nonsurgical orthodontic patient. Am J Orthod 1986;89:95-112.

44. Barrer HG. The adult orthodontic patient. Am J Orthod 1977;72:617-40.

45. Pabari S, Moles DR, Cunningham SJ. Assessment of motivation and psychological characteristics of adult orthodontic patients. Am J Orthod Dentofacial Orthop 2011;140:e263-72.

46. Tayer BH, Burek MJ. A survey of adults’ attitudes toward orthodontic therapy. Am J Orthod 1981;79:305-15.

47. Kruger E, Tennant M. Accessing government subsidized specialist orthodontic services in Western Australia. Aust Dent J 2006;51:29- 32.

48. Gnanamanickam ES, Teusner DN, Arrow PG, Brennan DS. Dental insurance, service use and health outcomes in Australia: a systematic review. Aust Dent J 2018;63:4-13.

49. Teusner DN, Brennan DS, Spencer AJ. Dental insurance, attitudes to dental care, and dental visiting. J Public Health Dent 2013;73:103- 11.

50. Brierley CA, DiBiase A, Sandler PJ. Early Class II treatment. Aust Dent J 2017;62 Suppl 1:4-10.

51. Proffit WR. The timing of early treatment: an overview. Am J Orthod Dentofacial Orthop 2006;129(4 Suppl):S47-9.

52. Russell JI, Pearson AI, Bowden DE, Wright J, O’Brien KD. The consultant orthodontic service--1996 survey. Br Dent J 1999;187:149-53.

53. Yang EY, Kiyak HA. Orthodontic treatment timing: a survey of orthodontists. Am J Orthod Dentofacial Orthop 1998;113:96-103.

54. Dental Board Australia. Registrant data. Melbourne: Australian Health Practioner Regulation Agency; 2017.

55. Cooke J, Wang HL. Canine impactions: incidence and management. Int J Periodontics Restorative Dent 2006;26:483-91.

56. Dachi SF, Howell FV. A survey of 3, 874 routine full-month radiographs. II. A study of impacted teeth. Oral Surg Oral Med Oral Pathol 1961;14:1165-9.

57. Ericson S, Kurol J. Radiographic assessment of maxillary canine eruption in children with clinical signs of eruption disturbance. Eur J Orthod 1986;8:133-40.

58. Grover PS, Lorton L. The incidence of unerupted permanent teeth and related clinical cases. Oral Surg Oral Med Oral Pathol 1985;59:420-5.

59. Kuftinec MM, Shapira Y. The impacted maxillary canine: I. Review of concepts. ASDC J Dent Child 1995;62:317-24.

60. Thilander B, Jakobsson SO. Local factors in impaction of maxillary canines. Acta Odontol Scand 1968;26:145-68.

61. Tin-Oo MM, Saddki N, Hassan N. Factors influencing patient satisfaction with dental appearance and treatments they desire to improve aesthetics. BMC Oral Health 2011;11:6.

62. Arrow P, Brennan D, Spencer AJ. Quality of life and psychosocial outcomes after fixed orthodontic treatment: a 17-year observational cohort study. Community Dent Oral Epidemiol 2011;39:505-14.

63. Arrow P, Brennan DS, Spencer J. Social acceptability of dental appearance and benefits of fixed orthodontic treatment: a 17-year observational cohort study. J Public Health Dent 2012;72:135-42.

64. Kenealy PM, Kingdon A, Richmond S, Shaw WC. The Cardiff dental study: a 20-year critical evaluation of the psychological health gain from orthodontic treatment. Br J Health Psychol 2007;12(Pt 1):17-49.

65. Shaw WC, Richmond S, Kenealy PM, Kingdon A, Worthington H. A 20-year cohort study of health gain from orthodontic treatment: psychological outcome. Am J Orthod Dentofacial Orthop 2007;132:146-57.

66. Australian Bureau of Statistics. Census of Population and Housing: Australia Revealed, 2016. Canberra: Australian Govt; 2016.

67. Amarasena N, Kapellas K, Brown A, Skilton MR, Maple-Brown LJ, Bartold MP et al. Psychological distress and self-rated oral health among a convenience sample of Indigenous Australians. J Public Health Dent 2015;75:126-33.

68. Brennan DS, Roberts-Thomson KF, Spencer AJ. Oral health of Indigenous adult public dental patients in Australia. Aust Dent J 2007;52:322-8.

69. Schuch HS, Haag DG, Kapellas K, Arantes R, Peres MA, Thomson WM et al. The magnitude of Indigenous and non-Indigenous oral health inequalities in Brazil, New Zealand and Australia. Community Dent Oral Epidemiol 2017;45:434-41.

70. Teusner DN, Brennan DS, Spencer AJ. Associations between level of private dental insurance cover and favourable dental visiting by household income. Aust Dent J 2015;60:479-89.

71. Gábris K, Márton S, Madléna M. Prevalence of malocclusions in Hungarian adolescents. Eur J Orthod 2006;28:467-70.

72. Thilander B, Myrberg N. The prevalence of malocclusion in Swedish schoolchildren. Scand J Dent Res 1973;81:12-21.

73. Lux CJ, Dücker B, Pritsch M, Komposch G, Niekusch U. Occlusal status and prevalence of occlusal malocclusion traits among 9-yearold schoolchildren. Eur J Orthod 2009;31:294-9.

74. Gungor K, Taner L, Kaygisiz E. Prevalence of Posterior Crossbite for Orthodontic Treatment Timing. J Clin Pediatr Dent 2016;40:422-4.

75. Woon KC, Thong YL, Abdul Kadir R. Permanent dentition occlusion in Chinese, Indian and Malay groups in Malaysia. Aust Orthod J 1989;11:45-8.

76. Ng CS, Wong WK, Hagg U. Orthodontic treatment of anterior open bite. Int J Paediatr Dent 2008;18:78-83.

77. Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school going children of Delhi: a prevalence study. J Indian Soc Pedod Prev Dent 2003;21:120-4.

78. Quashie-Williams R, daCosta OO, Isiekwe MC. Oral habits, prevalence and effects on occlusion of 4-15 year old school children in Lagos, Nigeria. Niger Postgrad Med J 2010;17:113-7.

79. Shetty SR, Munshi AK. Oral habits in children--a prevalence study. J Indian Soc Pedod Prev Dent 1998;16:61-6.

80. Wahl N. Orthodontics in 3 millennia. Chapter 12: Two controversies: early treatment and occlusion. Am J Orthod Dentofacial Orthop 2006;130:799-804.

81. Australian Research Centre for Population Oral Health. Dental specialists in Australia. Aust Dent J 2010;55:96-100.

82. Gurbuxani A, Kruger E, Tennant M. Geographic redistribution of practice location of graduate dentists: a six-year retrospective analysis (2004-2009). Aust Dent J 2012;57:85-9.