Int J Adolesc Med Health 2015; 27(3): 311–317
Salvatore Settineri, Amelia Rizzo, Angela Ottanà, Marco Liotta and Carmela Mento*
Dental aesthetics perception and eating behavior in adolescence Abstract Background: This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of selfesteem, and the possible connection with eating habits of adolescents under orthodontic treatment. Methods: Sixty-one adolescents, aged between 12 and 22 years (mean = 15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire. Results: Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student’s t-test and using Pearson’s correlation analysis. Conclusion: Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.
*Corresponding author: Carmela Mento, Department of Neurosciences, University of Messina, Consolare Valeria, 1, str., Messina 98100, Italy, Phone: +39-0902212978, E-mail: [email protected] Salvatore Settineri: Depatment of Human and Social Sciences, University of Messina, Messina, Italy Amelia Rizzo and Marco Liotta: Doctoral School of Psychological Sciences, University of Messina, Messina, Italy Angela Ottanà: Master School of Clinical Psychodiagnosys, University of Messina, Messina, Italy
Keywords: behaviors.
adolescence;
dental
aesthetics;
eating
DOI 10.1515/ijamh-2014-0031 Received June 2, 2014; accepted August 9, 2014; previously published online January 14, 2015
Introduction In adolescence, aesthetics often plays an important role in patients who decide to start orthodontic treatment. Attractiveness is essential to self-esteem and well-being of adolescents and dental aesthetics can promote beauty as well as both physical and psychological health (1, 2). Traditionally, the major goals of treatment were considered as oral health and proper dental functioning, recently however, similar importance has been ascribed to aesthetics and psychosocial impact (3). Furthermore, many studies underlined how during adolescence, a phase of life with intense social and affective interaction, the aesthetic alterations, especially in the face, can adversely affect quality of life (4–7). Adolescents are highly concerned about their body image, which plays an important role in both their psychological and social regulation. Self-perceived impact of dental aesthetics is influenced by both severity of malocclusion and body satisfaction (8) and individual attention to dental appearance is one of the main reasons of the increasing demand for orthodontic treatment (3). Some studies found that wearing braces is not only important for the improvement of oral health, but also has a significant impact on psychosocial aspects of patients’ lives (9). Malocclusions have an impact on quality of life, especially in terms of satisfaction with appearance (10). Patients with malocclusion have lower quality of life and higher anxiety, but improve their psychological status after the treatment (11). These benefits can promote their social skills (12) as individuals satisfied with their physical appearance tend to have a greater number of social interactions (13). Many studies showed how adolescents who had completed orthodontic treatment had a better oral healthrelated quality of life than those currently under treatment
Brought to you by | Kungliga Tekniska Högskolan Authenticated Download Date | 9/11/15 5:31 PM
312 Settineri et al.: Perception and eating behavior in adolescence or those who never had treatment: after treatment adolescents smile and show teeth without embarrassment (14). This data were confirmed by studies that have analyzed the relationship between oral health and quality of life focusing on the perception of patients (15, 16). Other works on adolescent behavior found that orthodontic treatment, as well as improving aesthetics, increases the search for independence and autonomy (17), as well as self-consciousness and self-confidence, both related to social appearance (18). A review of the literature provides some evidence to suggest that self-concept improves after orthodontic treatment (19). In addition, individuals who perceive themselves attractive, even for their teeth, have higher levels of self-esteem (20) and some authors have seen that the dissatisfaction with dental appearance had a strong predictive effect on self-esteem (21). The will of changing something in physical appearance increases with age and in adolescence the satisfaction for body image is strictly linked to self-esteem, as well as to weight and eating habits. Many studies showed both the importance of self-esteem in the etiology of eating disorders and the strong relationship between body dissatisfaction and self-esteem (22–24). Adolescents who find themselves overweight tend to have feelings of inferiority and inadequacy. In our society, adolescents take into high account aesthetic appearance, as it is considered a very important advantage to establish social relationships, and aim to have a good body image, obtained by correcting possible defects using, for example, orthodontic treatment or seeking thinness. The primary role is certainly played by self-esteem, as it may improve or worsen self-conception. High levels of selfesteem improves the psychosocial impact in adolescents with braces, who pay attention to body weight. However, if self-esteem is low in the same category of person, it can cause the appearance of poor eating habits, and thus, affect the psychological impact because it triggers feelings of inadequacy and inferiority due to the lack of social security. The search for aesthetic perfection could cause bad eating habits in adolescents with braces that have low self-esteem and this could have a negative psychological impact, especially on social relations. In this regard, we investigated the relationship between psychosocial impact, levels of self-esteem, and possible development of erroneous eating habits in adolescents under orthodontic treatment.
Methods Sixty-one adolescents, aged between 12 and 22 years (mean = 15.6; standard deviation = 2.8) including 25 males (41%) and 36 females (59%) participated in the study. All subjects were undergoing
orthodontic treatment (from 0 to 60 months: mean = 21.6 ± 13.6) at the Clinic of Orthodontics and Dentistry of the “G. Martino” University Hospital of Messina, Messina, Italy. Each subject, in the presence of the parents, was informed in advance about the contents and purpose of the research and adolescents were only tested if their parents signed informed consent. The socio-cultural level was medium-low, as one of the reasons of pointing to the clinic was the considerable reduction in costs, compared to private orthodontic treatment. As for the level of education among the respondents, most of them (n = 40; 65.6%) had middle school certificates, 10 (16.4%) had high school diplomas, and 11 (18%) had primary school certificates. The sample was divided in three age groups: 27 subjects were aged between 12 and 14 years (44.3%), 20 between 15 and 17 years (32.8%), and 14 between 18 and 22 years (23%). In addition, the adolescents were differentiated according to treatment duration: 38 subjects (62.3%) wore dental braces for more than 1 year and 23 (37.7%) for
Salvatore Settineri, Amelia Rizzo, Angela Ottanà, Marco Liotta and Carmela Mento*
Dental aesthetics perception and eating behavior in adolescence Abstract Background: This correlational study explored the psychosocial aspects related to eating behavior in different age samples of adolescents in treatment from 0 to 60 months at the Clinic of Orthodontics and Dentistry of Messina, Messina, Italy. The aim of the study was to investigate the relationship between psychosocial impact, levels of selfesteem, and the possible connection with eating habits of adolescents under orthodontic treatment. Methods: Sixty-one adolescents, aged between 12 and 22 years (mean = 15.6 ± 2.8) participated to the study. Each adolescents was interviewed with the Eating Attitudes Test, the Rosenberg Self Esteem Scale, and the Psychosocial Impact of Dental Aesthetics Questionnaire. Results: Data did not show a direct connection between eating disorder and dental aesthetics, nevertheless, adolescents under orthodontic treatment, especially in the earliest phase of wearing braces, showed peculiar eating habits and underwent a higher psychological impact of dental aesthetics. Eating behaviors are strictly linked to global self-esteem. The processing of the results was made through the Student’s t-test and using Pearson’s correlation analysis. Conclusion: Increased knowledge of the psychological aspects involved in orthodontic treatment compliance may have positive effects in the relationship between adolescent patients and orthodontists. More attention should be paid to aspects that are often underestimated in clinical practice, thus, influencing the outcome of treatment and patient satisfaction, not only in terms of dental health, but also of mental health.
*Corresponding author: Carmela Mento, Department of Neurosciences, University of Messina, Consolare Valeria, 1, str., Messina 98100, Italy, Phone: +39-0902212978, E-mail: [email protected] Salvatore Settineri: Depatment of Human and Social Sciences, University of Messina, Messina, Italy Amelia Rizzo and Marco Liotta: Doctoral School of Psychological Sciences, University of Messina, Messina, Italy Angela Ottanà: Master School of Clinical Psychodiagnosys, University of Messina, Messina, Italy
Keywords: behaviors.
adolescence;
dental
aesthetics;
eating
DOI 10.1515/ijamh-2014-0031 Received June 2, 2014; accepted August 9, 2014; previously published online January 14, 2015
Introduction In adolescence, aesthetics often plays an important role in patients who decide to start orthodontic treatment. Attractiveness is essential to self-esteem and well-being of adolescents and dental aesthetics can promote beauty as well as both physical and psychological health (1, 2). Traditionally, the major goals of treatment were considered as oral health and proper dental functioning, recently however, similar importance has been ascribed to aesthetics and psychosocial impact (3). Furthermore, many studies underlined how during adolescence, a phase of life with intense social and affective interaction, the aesthetic alterations, especially in the face, can adversely affect quality of life (4–7). Adolescents are highly concerned about their body image, which plays an important role in both their psychological and social regulation. Self-perceived impact of dental aesthetics is influenced by both severity of malocclusion and body satisfaction (8) and individual attention to dental appearance is one of the main reasons of the increasing demand for orthodontic treatment (3). Some studies found that wearing braces is not only important for the improvement of oral health, but also has a significant impact on psychosocial aspects of patients’ lives (9). Malocclusions have an impact on quality of life, especially in terms of satisfaction with appearance (10). Patients with malocclusion have lower quality of life and higher anxiety, but improve their psychological status after the treatment (11). These benefits can promote their social skills (12) as individuals satisfied with their physical appearance tend to have a greater number of social interactions (13). Many studies showed how adolescents who had completed orthodontic treatment had a better oral healthrelated quality of life than those currently under treatment
Brought to you by | Kungliga Tekniska Högskolan Authenticated Download Date | 9/11/15 5:31 PM
312 Settineri et al.: Perception and eating behavior in adolescence or those who never had treatment: after treatment adolescents smile and show teeth without embarrassment (14). This data were confirmed by studies that have analyzed the relationship between oral health and quality of life focusing on the perception of patients (15, 16). Other works on adolescent behavior found that orthodontic treatment, as well as improving aesthetics, increases the search for independence and autonomy (17), as well as self-consciousness and self-confidence, both related to social appearance (18). A review of the literature provides some evidence to suggest that self-concept improves after orthodontic treatment (19). In addition, individuals who perceive themselves attractive, even for their teeth, have higher levels of self-esteem (20) and some authors have seen that the dissatisfaction with dental appearance had a strong predictive effect on self-esteem (21). The will of changing something in physical appearance increases with age and in adolescence the satisfaction for body image is strictly linked to self-esteem, as well as to weight and eating habits. Many studies showed both the importance of self-esteem in the etiology of eating disorders and the strong relationship between body dissatisfaction and self-esteem (22–24). Adolescents who find themselves overweight tend to have feelings of inferiority and inadequacy. In our society, adolescents take into high account aesthetic appearance, as it is considered a very important advantage to establish social relationships, and aim to have a good body image, obtained by correcting possible defects using, for example, orthodontic treatment or seeking thinness. The primary role is certainly played by self-esteem, as it may improve or worsen self-conception. High levels of selfesteem improves the psychosocial impact in adolescents with braces, who pay attention to body weight. However, if self-esteem is low in the same category of person, it can cause the appearance of poor eating habits, and thus, affect the psychological impact because it triggers feelings of inadequacy and inferiority due to the lack of social security. The search for aesthetic perfection could cause bad eating habits in adolescents with braces that have low self-esteem and this could have a negative psychological impact, especially on social relations. In this regard, we investigated the relationship between psychosocial impact, levels of self-esteem, and possible development of erroneous eating habits in adolescents under orthodontic treatment.
Methods Sixty-one adolescents, aged between 12 and 22 years (mean = 15.6; standard deviation = 2.8) including 25 males (41%) and 36 females (59%) participated in the study. All subjects were undergoing
orthodontic treatment (from 0 to 60 months: mean = 21.6 ± 13.6) at the Clinic of Orthodontics and Dentistry of the “G. Martino” University Hospital of Messina, Messina, Italy. Each subject, in the presence of the parents, was informed in advance about the contents and purpose of the research and adolescents were only tested if their parents signed informed consent. The socio-cultural level was medium-low, as one of the reasons of pointing to the clinic was the considerable reduction in costs, compared to private orthodontic treatment. As for the level of education among the respondents, most of them (n = 40; 65.6%) had middle school certificates, 10 (16.4%) had high school diplomas, and 11 (18%) had primary school certificates. The sample was divided in three age groups: 27 subjects were aged between 12 and 14 years (44.3%), 20 between 15 and 17 years (32.8%), and 14 between 18 and 22 years (23%). In addition, the adolescents were differentiated according to treatment duration: 38 subjects (62.3%) wore dental braces for more than 1 year and 23 (37.7%) for
