Occlusal perceptions of children seeking orthodontic treatment: Impact of ethnicity and socioeconomic status

Introduction: With the growth of orthodontic intervention at younger ages and increased interest in improving dentofacial appearance among the general public, it is important to assess whether demand for treatment is uniform across ethnic and socioeconomic groups. Methods: This study compared 3 groups of children who varied by location, payment source, and ethnicity. The sample consisted of 150 children in the Bronx, NY, and 100 in Seattle, Wash, who were undergoing or anticipating orthodontic treatment in publicly funded dental clinics. Ethnic minorities comprised 69% and 92%, respectively, of these groups. The third group consisted of 84 children in Seattle, Anchorage (Alaska), and Chicago who had sought treatment by private practitioners; ethnic minorities comprised 22% of this group. Data were collected from children and parents or guardians by questionnaires. Results: Desire for treatment was higher among children in the publicly funded clinics and among black children than whites or Asian Americans. Children in publicly funded clinics rated themselves as having worse occlusions as determined by anterior crowding, overbite, overjet, diastema, and open bite. Children in the Bronx clinic accepted a wider range of occlusion as attractive. Stage of treatment affected judgments of attractiveness. Vicarious experience with orthodontics through parents or siblings made children more tolerant of dentofacial disharmony, with more favorable ratings of malocclusion in this group than among children who had no family experience with orthodontics. Hispanic and mixed-ethnicity children rated themselves more negatively on all dimensions. Conclusions: These results suggest that both socioeconomic status and ethnicity play roles in children's desire for treatment, self-assessed need, and judgments of esthetics. A clinician's sensitivity to such differences can improve patient cooperation with treatment.