Summary

Background/Objectives: A healthy mouth, teeth and gums, is an important part of good overall health. One of the pathologiesaffecting the oral cavity is dental malocclusions. Due to a lack or unequal distribution of oral health professionals amongst other reasons, most patients having malocclusions in Cameroon remain untreated. Orthodontic tooth positioner are orthodontic appliances formed as an arch-shaped body fitting within a patient’s mouth between the upper and lower arches.

Since this appliance is relatively new in our context, we conducted a descriptive study in order to access the perception of Cameroonian parents towards orthodontic tooth positioner.Materials/Methods: We carried out a descriptive qualitative study involving one-to-one, semi-structured, in-depth interviewswith parents/guardians of patients who were undergoing orthodontic treatment in the 2 main cities: Douala and Yaoundé.Results: There were 90 parent participants in this study, 47 mothers and 43 fathers.

The mean age of the parents was 41.3±8.3years old. The age range of their kids varied from 6 to 13 years old. A great majority of parents (96%) had never experienced an orthodontic treatment, 80% of parents were unhappy with the teeth position of their kids, 68% of patients were convinced that orthodontics is something good, 4% found the treatment affordable and 64% of parents reported that their kids do not always wear the orthodontic tooth positioner.

Conclusion: Information on the perception of orthodontic treatment can be used to influence decision making on the orthodontic services to be provided, human resource training needs, continuing education for oral health personnel and resource planning.

Keywords: Orthodontic Tooth Positioner; Dental Malocclusions; Perception

Introduction

A healthy mouth, teeth and gums, or oral health, is an important part of good overall health, well-being and quality of life. WHO defines oral health as “a state of being free from chronic mouth and facial pain, oral and throat cancer, oral infection and sores, periodontal (gum) disease, tooth decay, tooth loss, and otherdiseases and disorders that limit an individual’s capacity in biting, chewing, smiling, speaking, and psychosocial well-being ”[1].

An example of these pathologies includes dental malocclusions. It is defined as a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close. Crowded teeth, crossbite, overbite, underbite, and open bite are all considered as malocclusion [2]. Due to a lack or unequal distribution of oral health professionals, a lack of appropriate facilities, in Cameroon – no dedicated oral health budget, people incur significant out-of-pocket expenses to access orthodontic treatment, while most patients having malocclusions in Cameroon remain untreated [1].

To overcome these problems, orthodontic tooth positioner (OTP) will be increasingly used in Cameroon (Figure 1). They are orthodontic appliances formed as an arch shaped body of a (Silastic)resilient material fitting within a patient’s mouth between the upper and lower arches [3].

They are generally having a concave surface for bearing on the buccal and labial surfaces of the teeth of at least one arch and a convex surface adjacent to the lingual surface of the patient’s teeth. They are easy to fabricate, inexpensive, aesthetic, and comfortable, and thus have a high level of patient acceptance [4]. Clear thermoplastic appliances have been recommended for use as transitional retainers, finishing appliances [5-7] and even permanent retention [6,7]. Since this appliance is relatively new in our context, we conducted a descriptive study in order to access the perception of Cameroonian parents towards OTP.

Materials and Methods

Research approval and ethical clearance were obtained from the Institutional Committee for Ethics and Research of the Faculty of Medicine and Biomedical Sciences prior to commencing study recruitment. All participants completed written consent (Figure 2).

As described in the introduction, this was a descriptive qualitative study involving one-to-one, semi-structured, in-depth interviews with parents/guardians of patients who were undergoing orthodontic treatment in Douala and Yaoundé. Parents were included in the study if they had a child aged 6-13 years (inclusive) who had an orthodontic tooth positioner.

All of the patients were eligible for treatment, based on the Index of Orthodontic Treatment Need. Parents of children with craniofacial syndromes, malocclusions due to trauma or pathology, and those with significant restorative implications were excluded. Participants were selected using a voluntary response sampling technique based on age, gender, and ethnicity of the patient; the patient’s malocclusion; orthodontic history and knowledge of parents, orthodontic treatment need, attitude towards orthodontic appliance and attitude of the child during the treatment.

This technique ensured that participants were selected to represent key characteristics of interest to the study and enhanced the generalizability of the results, while acknowledging there is debate surrounding generalizability of qualitative data. All interviews were done using a questionnaire undertaken by two members of the research team in a private area away from the clinic.

The interviews followed a topic guide, which was developed specifically for this study and was updated as new topics arose during the interviews. In keeping with qualitative methodology, no sample size calculation and no statistical testing were undertaken.

Interviews were conducted until no new themes were arising, a point at which ‘theoretical saturation’ is sometimes said to have been achieved. It is important to note that qualitative samples are frequently small in size and this does not detract from the quality of the data obtained, an opinion needs to appear only once for it to be an important finding.

Interviews were digitally recorded and transcribed verbatim immediately afterwards. Data were then analyzed using a content thematic analysis using a framework approach and were undertaken by all three researchers to ensure consistency. Major themes and subthemes were identified and this classification was agreed by all members of the research team.