Patient response to the usage of orthodontic appliance in patients undergoing orthodontic treatment -A survey

Harini G1, Sumathi Felicita A*2, Bala Krishna R N3 1Saveetha dental college and hospitals, Saveetha institute of medical and technical sciences, Saveetha University, Chennai-600077, Tamil Nadu, India 2Department of orthodontics, Saveetha dental college and hospital, Saveetha institute of medical and technical science, Saveetha University, Chennai600077, Tamil Nadu, India 3Department of oral and maxillofacial surgery, Saveetha dental college and hospital, Saveetha institute of medical and technical science, Saveetha University, Chennai600077, Tamil Nadu, India


ABSTRACT
To evaluate the patient perception of orthodontic appliances and their experience during orthodontic treatment. Patient data archived in the institution's database were reviewed and data pertaining to patients undergoing orthodontic treatment was retrieved. 60 patients were identi ied randomly. A questionnaire was framed to record the patient's compliance to functional appliance therapy. The questionnaire survey was framed and sent to the patient by sharing the link of the survey planet that consists of necessary context. Chi-square, isher exact tests were used for data analysis through SPSS software. It was found that patients needed more time to the orthodontic appliance. 66% of patients had eating dif iculties, 63.3%. More than half of the patients encountered oral sores almost 57.7%. 64% of the patients using these appliances encountered breakage and displacement problems. A total of 54% of patients stated that they had dif iculty in keeping the appliances clean and maintaining proper oral hygiene Individuals undergoing orthodontic treatment had more dif iculty to perform routine activities. Care must be taken to overcome these dif iculties.

INTRODUCTION
Malocclusion is a common dental discrepancy that is the result of skeletal discrepancy such as prognathic maxilla, mandible, retrognathic maxilla, mandible or both (Namara and Namara, 2019). Orthodon-tic appliances need much patient cooperation (Profit et al., 2014). These appliances have their own advantages and disadvantages in regards to the oral hygiene and soft tissue irritation (Clark, 2014). These effects of orthodontic treatment on the skeletal (Sivamurthy and Sundari, 2016;Vikram, 2017;Kamisetty et al., 2015) and dental tissues have been heavily investigated (Viswanath et al., 2015;Kumar et al., 2011;Felicita, 2017a). Effective treatment with orthodontic appliances involves proper diagnosis (Rubika et al., 2015;Samantha et al., 2017;Krishnan and Pandian, 2015;Felicita, 2018) treatment planning and treatment mechanics (Felicita, 2017b;Kumar et al., 2011;Dinesh et al., 2013). The perception of the patient to these appliances have been evaluated to a certain extent (Dandajena, 2010). During orthodontic appliance treatment, patients may have pain and discomfort at various levels. It has been shown that these appliances can lead to oral mucosa pressure, soft tissue tension, oral constriction , toothache and pain (Celikoglu et al., 2016). They may lead to fatigue or alteration in function, respiratory disorder and may affect the appearance of the individual (Freeman, 2004). Informing the patients prior to treatment about the possible problems and discomfort throughout orthodontic appliance treatment is bene icial in order to enhance the appliance ef iciency and patient compliance (Nedeljkovic, 2011;Felicita et al., 2012). Gradually the patient cooperation can decrease due to the irritation caused by these appliances (Wieslander and Lagerström, 1979;Kannan et al., 2017).
Therefore the aim of the study was to conduct a survey with the purpose of evaluating the experience of the patient undergoing orthodontic appliance treatment.

MATERIALS AND METHODS
The patient's data was collected from the digital archives of our institution. All patients reporting to the orthodontic department between June 2019 to March 2020 were reviewed. All total of 60 patients underwent orthodontic treatment in a private dental college, Department of Orthodontics. The participants were informed about the aim of the survey and the link was shared to patient number. The online survey was prepared.
The survey questions were designed to be as simple as possible so that the participants could easily comprehend them. A total of 60 patients (mean age 23 years) participated in the study. The survey comprised 10 questions that covered issues, pain, speech problem, duration, satisfaction of the smile etc,. The survey was undertaken by patients who had already completed the orthodontic treatment. Closed ended questions with answers as yes or no were framed. The outcome was interpreted through frequency distribution using SPSS version 25.

RESULTS AND DISCUSSION
The adaptation period to orthodontic appliances was signi icant. Table 1 -shows the gender distribution of the patients undergoing orthodontic appliance treatment 55% were males and 45% were female (33 males and 27 females) (Figure 1). Table 2 shows the response to the survey with frequency distribution. There was dif iculty in speech in 66.7% of the patients undergoing orthodontic treatment. The eating problems occurred in 61.7% and they had dif iculty in deglutition. Toothache and jaw pain was also present in 63.3% of individuals. More than half of the patients encountered oral sores (57.7%). 64% of the patients using these appliances encountered breakage and displacement problems. A total of 54% patients stated that they had dif iculty in keeping the appliances clean and maintaining proper oral hygiene (Table 2).   phase of the treatment 85% of the study population were entirely satis ied with the treatment post operatively. Over 60% of the population encountered dif iculties in visiting the dentist at regular appointments and following the guidelines according to their orthodontist/dentist (Table 2). Association between the gender and their satisfaction of the smile showed that males are predominantly satis ied compared to females which was statistically signi icant (p value=0.030) (Figure 2). The association between gender of participants and the dif iculty in speech during treatment showed that the majority of the male participants ind dif iculty in talking during the phase of treatment when compared to females which was statistically signi icant (p value=0.023) (Figure 3).
In Figure 1, X-axis denotes the gender distribution and Y-axis denotes the number of patients. Higher number of males(brown) participated in the survey (55%). In Figure 2, X-Axis denotes the gender involved and Y-axis denotes the number of patients involved. Majority of the male participants are satisied in their smile (red) when compared to females. This difference was statistically signi icant. (Pearson's chi-square value-4.596, p value=0.030 -statistically signi icant) In Figure 3, X-axis denotes the gender of the patient and Y-axis denotes the number of patients involved. Majority of the male participants (Red) ind dificulty in talking during the phase of treatment when compared to females (female), statistically signi icant. (Pearson's chi-square value-5.071, p value=0.023 -statistically signi icant).
Since patients of different age groups may respond differently to orthodontic treatment only young adults were included. The main complaints resulting from the use of appliances were pain and dif iculty in speech. Increasing the number and the content of the questions may decrease the response rate causing misinterpretations. For this reason, a sur-vey of 10 questions was prepared and the patients were asked to evaluate their experiences in using the appliances.
In previous studies, the rationale for low patient cooperation has been reported as pain (28%) and dissatisfaction with the appearance. Likewise, Oliver and Knapman (1985); Jain et al. (2014); Viswanath et al. (2015) did not ind any difference in terms of pain. These indings match up with the outcomes of earlier studies that show that orthodontic appliances cause undesired consequences due to oral pressure. The pain encountered during the course of treatment is as mentioned in earlier studies (Gu, 2016). There was also increased breakage of the brackets in the ixed appliances when compared to the removable appliance. There was an increased number of urgent appointment requests reported due to displacement and breakage of the ixed appliances in comparison with previous studies (Gu, 2016;Ishaq et al., 2016). During social interactions, the mouth is one of the most attentionseeking features of the face, emphasizing the signi icance in the smile as a facial feature. Thus, the esthetic enhancement has become the growing reason for dental visits as it has a major role in social interactions. For an orthodontist to provide satisfactory smile corrections, knowledge of esthetics of the human face is necessary (Hata and Arai, 2016).

CONCLUSION
Based on this study, we conclude that 60% of patients had eating dif iculties, and encountered ulcerations and appliance breakage during the treatment and over 50% of patients had dif iculty in maintaining oral hygiene and frequent consultations to their dentist based on monthly reviews. Of all these dif iculties encountered over 85% of the patients are entirely satis ied with their change over smiles.