Importance of Psychosocial Impacts of Malocclusion in Determining Orthodontic Treatment Needs in Adolescents: A Rapid Systematic Literature Review

Background: Orthodontic treatment need indices, commonly used in clinical practice for rationing publicly funded orthodontic treatment, may neglect important psychosocial impacts experienced by patients. Objectives: This rapid systematic literature review summarises the evidence regarding the psychosocial impacts of malocclusion for determining adolescent orthodontic treatment needs from the patient perspective. The review has two objectives: 1) assess the evidence on psychosocial impacts of malocclusion in adolescents and 2) assess the evidence on measures of orthodontic treatment needs from a psychosocial perspective. Methods: Six electronic databases were searched for using two keyword search strategies. Out of 893 records yielded, 231 unique records were identified for objective 1 and 2 respectively. Twenty full-text records were deemed eligible for objective 1 and four full-text records were analysed for objective 2. The Critical Appraisal Skills Programme tools were used for quality assessment. Results: The quality of evidence of eligible studies was rated high for 20 papers, and moderate or low for the remaining four papers. Four key themes were identified, two pertaining to each objective: 1) Malocclusion has psychosocial impact on adolescents, 2) Several factors contribute to negative psychosocial impacts of malocclusion, 3) Identified orthodontic treatment needs assessment tools do not consider patients’ psychosocial perspectives, and 4) There is a need to combine clinicians’ and patients’ perspective in orthodontic practice. Conclusion: Psychosocial perspectives of malocclusion provide important insights into orthodontic treatment needs among adolescents. Its absence as a criterion for resource allocation by publicly funded oral healthcare should be considered to support value-based health care.