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 Table of Contents  
Year : 2023  |  Volume : 15  |  Issue : 1  |  Page : 61-64

Psychological and social impact of malocclusion in children and young adults – A review

Department of Epidemiology, The Tamil Nadu DR. MGR Medical University, Chennai, Tamil Nadu, India

Date of Submission02-Oct-2021
Date of Decision22-Jun-2022
Date of Acceptance11-Jul-2022
Date of Web Publication29-Dec-2022

Correspondence Address:
Aasini Maria Georgina
No 2/7, 4th Street, Kanniamman Nagar, Vanagaram, Chennai - 600 095, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jorr.jorr_68_21

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Malocclusion is a major oral health problem, which is prevalent among all age groups. Malocclusion affects speech and mastication and causes pain. In psychosocial health, it may impact an individual's self-esteem due to self-perceived appearance and peer's opinions. This article aims to assess the effect of malocclusion on psychological and social health (i.e., quality of life, [QoL]) in children and young adults by reviewing the literature. Studies found to be relevant were identified in PubMed, Cochrane, and Google Scholar. Studies with data on malocclusion, factors influencing the treatment, and QoL associated with oral health in children and adolescents were considered for this review. After carefully scrutinizing the study objective, a total of ten full-text articles were selected and reviewed. Researcher's found that dental problems such as anterior tooth trauma or missing malocclusion affect the esthetics and psychological behavior of adolescents. Malocclusion can be socially and psychologically stigmatizing for young adults.

Keywords: malocclusion, psychological impact, self-esteem

How to cite this article:
Georgina AM, Sundar JS, Srinivas G. Psychological and social impact of malocclusion in children and young adults – A review. J Oral Res Rev 2023;15:61-4

How to cite this URL:
Georgina AM, Sundar JS, Srinivas G. Psychological and social impact of malocclusion in children and young adults – A review. J Oral Res Rev [serial online] 2023 [cited 2023 May 31];15:61-4. Available from: https://www.jorr.org/text.asp?2023/15/1/61/365923

  Introduction Top

The physical appearance of an individual is considered important for human life as one intends to be acknowledged and valued by others. Oral and dental health appearances are an important aspect of one's general and mental health.[1] Malocclusion is not a disease but a deviation in the esthetics of what is considered normal in society (Jenny, 1975).[2] The dental aspect is vital for facial beauty; in today's society, facial beauty and appearance determine how people treat them. Being part of a social network entails the need to feel accepted.[3] Patients with untreated malocclusion may suffer from temporomandibular joint problems, and it can also cause problems in talking, chewing, smiling, and limited food choices.[4] The quality of life (QoL) associated with oral health implies good oral health with psychological and social well-being.[5] Hereby, this article review's the psychological and social impact of malocclusion.

  Types of Malocclusion Top

The two main types of malocclusions are inter-arch and intra-arch malocclusion.[6] Intra-arch malocclusion is variation in tooth location on an individual level that is one tooth is present in an abnormal position concerning an adjacent tooth.[6] Individual teeth malposition could present in an abnormal inclination, tipping, or displacements. Malocclusion can be present on the sagittal, vertical, or transverse planes of space.[6]

  Materials and Methods Top

The literature was reviewed from 2005 to 2020 using keywords: psychological impact, self-esteem, and malocclusion in children and young adults. Search engines such as PubMed Central, Google Scholar, and Cochrane were used by applying the Boolean operator “AND” or “OR” based on the exclusion criteria (articles in languages other than English) and the lack of standardized assessing tools. All the available full text in the English language was compiled and thoroughly studied, and ten full-text articles were selected and reviewed.

Inclusion criteria:

The study was limited to studies that met the following criteria.

  • Articles published in peer-reviewed journals
  • Found in electronic databases
  • The articles that used standardized measuring tools
  • Articles written only in English were considered for the review
  • Methods of statistical analysis used.

  Screening and Data Extraction Top

The search titles were entered and searched in Zotero software. The title of the studies was screened and selected first as per their relevance. Second, we read and screened the abstracts of all relevant titles. Third, screening of full-length texts and abstracts and included according to the inclusion criteria [Figure 1]. The data extraction was done, and information on publication, methodology, and outcomes was recorded.
Figure 1: Flowchart of the study selection process

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Figure 1 shows the selection process from screening to data extraction.

  Search Results Top

A list of 180 articles was obtained from the searches of electronic databases [Figure 1]. Based on the inclusion criteria, the studies are included. Ten full-length articles were identified and included to form the basis of the review. Among the ten included articles, nine articles used a community sample (sample size ranged from 200 to 2000) and two articles used a convenient clinical sample [Table 1]. The included articles described findings in the study population of children and adolescents. All the findings from cross-sectional studies indicate the association between QoL and malocclusion (irrespective of how it was assessed) (P < 0.05) [Figure 1] and [Table 1].
Table 1: Summary of studies: study design, sample, indices (n=10)

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Table 1 shows a list of studies selected for review of their study designs, sample size, sampling technique, indices used, statistical analysis, and outcome.

  Tools for Assessment of Malocclusion Top

The tools for assessing orthodontic treatment are the Dental Aesthetic Index,[7] the Psychosocial Impact of Dental Esthetics Questionnaire,[2],[3],[7] the Index of Orthodontic Need,[7] and Oral Health Impact Profile-14,[8] but these tools do not take under consideration the consequences of malocclusion on the individuals QoL. Oral health related quality of life (OHRQoL) assessment questionnaires were adapted to investigate the effect of malocclusion, it focuses on adults with periodontal disease, and tooth loss and has been broadened to include children and young adults.[9] OHRQoL is usually a multidimensional concept.[4] OHRQoL not only measures the treatment needs and impact of malocclusion but also provides data that helps the health-care worker to plan preventive measures and management services.[1] It is useful in evaluating the self-perceived image of individuals which is important for psychological growth.

  Psychosocial Impact of Malocclusion Top

The QoL associated with the oral health index “observes individuals” comfort in eating, sleeping, socialization, and satisfaction with their oral health.[5] Thus, it represents the effect of oral health on social and psychological aspects. The impact of malocclusion and QoL is based on several factors. Age is an important factor for the psychosocial impact on the malocclusion. In the adolescent period between the ages of 11–14 when children undergo major physical changes, their facial and dental esthetics play a substantial role in self-perceived appearance. The lack of a proportional and beautiful smile and being shamed for laughing by peers results in low self-esteem which can influence social interaction. Children in this age group showed a significant association between psychological impact and malocclusion in most of the studies. In contrast, there is no impact of malocclusion on psychological and social well-being in younger age groups as well as toddlers as they are unaware and less concerned about their dental esthetics. Thus, the older the children age more the association. The association is more evident in children aged between 11 and 18 years and young adults aged between 18 and 24 years though the impact is considerably small, concurs with Hurrelmann's (1989) claim that as people get older, they become more aware of how attractive their teeth are.[15],[16]

The children's gender is another important factor that influences one's self-esteem. Female students aged 16 years and above recorded higher psychological and social impact compared to male students in terms of dental esthetics.[8] Prominent malocclusion, the color of teeth, and disproportionate smiles raise esthetic concern in female students than male students,[8],[10] but in the case of anterior tooth missing or malaligned, both male and female students show higher psychological impact. Studies found that dental esthetics influences the social impact on individuals. Lower self-esteem contributes to lower self-confidence and depression resulting from a negative self-image. Self-esteem and perceived dental esthetics are strongly correlated. In addition, the studies showed that severe malocclusions have an effect on OHRQOL, primarily in the social and emotional aspects.[17],[18] No matter how minor a malocclusion is, it should never be disregarded because some people may be more sensitive to its psychological effects than others.

  Factors Influencing the Intention to Get Orthodontic Treatment Top

There is a strong correlation between adolescents' perceived dental appearance and the need for orthodontic care. The factors influencing the desire to get orthodontic care among children are age, gender, education of the parents, ethnicity, the severity of malocclusion, socioeconomic status, and peer opinion among the study population.[8],[10] An individual intention in improving dental esthetics is the main determining factor. Female students, and children from urban, reported a higher desire to get orthodontic treatment due to exposure to various treatment facilities, and children of highly educated parents and high socioeconomic status also showed a higher desire to get orthodontic treatment even if the malocclusion is mild.

  Conclusion Top

It can be concluded that malocclusion does have a psychological and social impact though it is considerably small, factors such as age, gender, ethnicity, and socioeconomic status influence the impact, comparatively, children with mild malocclusion do have high self-esteem.[15],[17],[18],[19],[20] Dental dissatisfaction and an individual's self-perceived appearance are a significant indicator of low self-esteem and psychological impact, respectively. Hence, it is vital to educate the children and their parents about the preventive measures for malocclusion.


The majority of studies presented in this article have a cross-sectional study design because data are collected at a specific time, causality cannot be established, and confounders (dental caries) were not considered. There are very few longitudinal studies involving preschool children which signify the actual effect of malocclusion on QoL related to oral health.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Kaur P, Singh S, Mathur A, Makkar DK, Aggarwal VP, Batra M, et al. Impact of dental disorders and its influence on self esteem levels among adolescents. J Clin Diagn Res 2017;11:ZC05-8.  Back to cited text no. 1
De Baets E, Lambrechts H, Lemiere J, Diya L, Willems G. Impact of self-esteem on the relationship between orthodontic treatment need and oral health-related quality of life in 11- to 16-year-old children. Eur J Orthod 2012;34:731-7.  Back to cited text no. 2
AlSagob EI, Alkeait F, Alhaimy L, Alqahtani M, Hebbal M, Ben Gassem AA. Impact of self-perceived dental esthetic on psycho-social well-being and dental self confidence: A cross-sectional study among female students in Riyadh city. Patient Prefer Adherence 2021;15:919-26.  Back to cited text no. 3
Kragt L, Dhamo B, Wolvius EB, Ongkosuwito EM. The impact of malocclusions on oral health-related quality of life in children – A systematic review and meta-analysis. Clin Oral Investig 2016;20:1881-94.  Back to cited text no. 4
Sischo L, Broder HL. Oral health-related quality of life: What, why, how, and future implications. J Dent Res 2011;90:1264-70.  Back to cited text no. 5
Nandakumar E, vignesh R, Ganapathy D. Malocclusion and its influence in the quality of life – A review. Drug Invent Today 2019;12:277-80.  Back to cited text no. 6
Dahong X, Xiangrong C, Ying L, Yusong L, Ying G, Yan S. Effect of incisor position on the self-perceived psychosocial impacts of malocclusion among Chinese young adults. Angle Orthod 2013;83:617-22.  Back to cited text no. 7
Ellakany P, Fouda SM, Alghamdi M, Bakhurji E. Factors affecting dental self-confidence and satisfaction with dental appearance among adolescents in Saudi Arabia: A cross sectional study. BMC Oral Health 2021;21:149.  Back to cited text no. 8
Abdul Majid ZS. Effects of malocclusion on oral health related quality of life (OHRQoL): A critical review. Eur Sci J 2015;11:1857-7881.  Back to cited text no. 9
Yi S, Zhang C, Ni C, Qian Y, Zhang J. Psychosocial impact of dental aesthetics and desire for orthodontic treatment among Chinese undergraduate students. Patient Prefer Adherence 2016;10:1037-42.  Back to cited text no. 10
Florián-Vargas K, Honores MJ, Bernabé E, Flores-Mir C. Self-esteem in adolescents with Angle Class I, II and III malocclusion in a Peruvian sample. Dental Press J Orthod 2016;21:59-64.  Back to cited text no. 11
Dawoodbhoy I, Delgado-Angulo EK, Bernabé E. Impact of malocclusion on the quality of life of Saudi children. Angle Orthod 2013;83:1043-8.  Back to cited text no. 12
de Paula Júnior DF, Santos NC, da Silva ET, Nunes MF, Leles CR. Psychosocial impact of dental esthetics on quality of life in adolescents. Angle Orthod 2009;79:1188-93.  Back to cited text no. 13
Badran SA. The effect of malocclusion and self-perceived aesthetics on the self-esteem of a sample of Jordanian adolescents. Eur J Orthod 2010;32:638-44.  Back to cited text no. 14
Abu Alhaija ES, Al-Nimri KS, Al-Khateeb SN. Self-perception of malocclusion among north Jordanian school children. Eur J Orthod 2005;27:292-5.  Back to cited text no. 15
Hurrelmann K. Human Development and Health. Berlin: Springer; 1989.  Back to cited text no. 16
Vieira-Andrade RG, de Paiva SM, Marques LS. Impact of malocclusions on quality of life from childhood to adulthood. In: Issues in Contemporary Orthodontics. london: Farid Bourzgui, IntechOpen; 2015. [Doi: 10.5772/59485].  Back to cited text no. 17
Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: A systematic review of quantitative studies. Eur J Orthod 2015;37:238-47.  Back to cited text no. 18
Mary AV, Mahendra J, John J, Moses J, Ebenezar AV, Kesavan R. Assessing quality of life using the oral health impact profile (OHIP-14) in subjects with and without orthodontic treatment need in Chennai, Tamil Nadu, India. J Clin Diagn Res 2017;11:ZC78-81.  Back to cited text no. 19
Zhang M, McGrath C, Hägg U. The impact of malocclusion and its treatment on quality of life: A literature review. Int J Paediatr Dent 2006;16:381-7.  Back to cited text no. 20


  [Figure 1]

  [Table 1]


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