Journal of Orthodontics

ISSN: 1465-3125 (Print) 1465-3133 (Online) Journal homepage: http://www.tandfonline.com/loi/yjor20

The Impact of Malocclusion

Tim Newton

To cite this article: Tim Newton (2016) The Impact of Malocclusion, Journal of Orthodontics,
43:1, 1-2, DOI: 10.1080/14653125.2016.1143228

To link to this article: http://dx.doi.org/10.1080/14653125.2016.1143228

Published online: 09 May 2016.

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 FOCUS Journal of Orthodontics, Vol. 43, 2016, 1–2

The Impact of Malocclusion

Healthcare systems throughout the World face an unpre- Quality of Life (OHRQoL). Most of the current
cedented level of demand and ever-increasing costs. This measures of OHRQoL are based around the original
is most obvious in developed countries where health ser- WHO International Classification of Impairment, Dis-
vices are extensive and expensive. Yet healthcare is not ability and Health (World Health Organisation, 1976),
something we can do without – the idea that the health which identified several key concepts, including:
of the people should always be adopted as the supreme
law is attributed originally to Cicero, but over time has . Disease. Pathological entities diagnosed by means of
been adopted by philosophers, police services and clinical signs and symptoms.
London boroughs as a central tenet of public policy. I . Impairment. Anatomical loss, structural abnormality
mention it here as a starting point for our considerations or disturbance in chemical processes.
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in planning health services, since it speaks of the necessity . Functional limitation. Restriction in the functions nor-
of health. I believe that improving health is a good thing mally expected of the body.
in and of itself, quite aside from arguments about the . Pain and discomfort. Self-report pain and discomfort,
importance of a healthy workforce and the other benefits physical and psychological symptoms. These are not
of health for an economy (European Commission, 2005). directly observable.
However, given the increasing demands on health service . Disability. Limitations in, or lack of ability to perform,
funding, one logical response is to focus only on those the activities of daily living
treatments and interventions that can be demonstrated . Handicap. The disadvantage and deprivation experi-
to produce health benefits. As a result, providers of enced by individuals with impairments, functional
healthcare are faced with the challenge of demonstrating limitations, pain and discomfort or disabilities
empirically that not only are the interventions they because they cannot or do not conform to the expec-
provide effective in terms of the measures that they tations of their social group.
believe to be important, but also that they lead to demon-
strable improvements that are valued by patients. Ortho- Disease may lead to impairment; which, in turn may
dontists in the UK will be familiar with the pressure to lead to functional limitation, pain and discomfort. Ulti-
demonstrate their value in a publicly funded health mately, functional limitation may limit the ability of an
system. individual to perform activities of daily living, thus
So what do patients expect from a healthcare system? resulting in disability. To the extent that those activities
Ironically, I suspect that most expect that the treatment are expected by the social group to which the individual
given to them by their dentist, doctor or other healthcare belongs, this may result in handicap. The original model
provider is going to return them to health, or at the very has been updated, and renamed the International Classi-
least – make them healthier. But this does rather beg the fication of Functioning, Disability and Health, to
question of what ‘health’ is. The World Health Organiz- emphasise both that disability can occur at different
ation has a rather idealistic definition: ‘A complete state levels (the organ, the individual or within a social
of physical, mental and social well-being and not merely context) and that the impact of dysfunction is dependent
the absence of disease or infirmity’. While this celebrates on the context in which the individual lives (World
a 70th birthday this year (World Health Organisation, Health Organisation, 2001). So for example, malocclu-
1946) it still offers little practical guidance in terms of sion may conceivably result in disability in speaking or
thinking about the outcomes of healthcare. In the chewing (organ level), embarrassment (individual level)
absence of a simple definition of health many researchers or in terms of the judgements made about an individual
and policy developers have focused instead on modelling at a job interview (society level) (Pithon et al., 2014). Our
how poor health affects our life, and such models have expectations of the ‘Ideal smile’ are likely to be influ-
been the foundation of the development of measures of enced by the social context in which we live (Newton
Quality of Life and of course, Oral Health Related and Minhas, 2005).

© 2016 British Orthodontic Society DOI:10.1080/14653125.2016.1143228

 2 Focus FOCUS JO 2016

Orthodontists have previously sought to demonstrate for determining the level of impact experienced by indi-
the effect that their treatments have upon impairment, viduals with malocclusion and how treatment affects
through demonstrating changes in the measured aspects that impact. It is likely that this scale will be used
of occlusion – for example, Peer Assessment Rating widely to further inform our understanding of the value
(PAR) scores, overjet values etc. There have also been of orthodontic treatment.
attempts through the use of quality of life measures and
more specifically, OHRQoL measures to determine the Tim Newton
impact of malocclusion on such measures and even King’s College London
exploring the change in quality of life following treat- tim.newton@kcl.ac.uk
ment. William Shaw has argued comprehensively and
convincingly that the evidence does not support the effec-
tiveness of orthodontic treatment in the long term to
reduce pain and discomfort, enhance function or References
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remains that the measures we have previously used have Marshman Z. Development of the Malocclusion Impact Questionnaire
(MIQ) to measure the oral health-related quality of life of young people
not addressed the domains that are most pertinent to with malocclusion: Part 2 - cross-sectional validation. J Orthod 2016; 43:
orthodontic patients, and thus, have missed key aspects 14–23.
of the impact of malocclusion. It is the latter that the European Commission. The Contribution of Health to the Economy in the
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European Union. Luxembourg: Office for Official Publications of the

Malocclusion Impact Questionnaire (MIQ) described in European Communities. 2005. Available at: http://ec.europa.eu/health/ph_
this issue of the Journal seeks to quantify – how does a overview/Documents/health_economy_en.pdf
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clusion: Part 1 – qualitative inquiry. J Orthod 2016; 43: 7–13.
with malocclusion. It is derived from qualitative data Pithon MM, Nascimento CC, Barbosa GCG, Coqueiro RDS. Do dental esthetics
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Shaw WC. Uncertainty of Orthodontic Benefit and the Questionable Ethics of
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