# Age matters in orthodontics: divergent motivations, perfectionism, and patient-clinician discord in treatment need assessment

## TL;DR

Adults undergoing orthodontic treatment have higher motivation and psychosocial concerns than children, with treatment motivation linked to perceived social and aesthetic issues rather than clinical need.

## Contribution

This study reveals that adult orthodontic patients are more influenced by psychosocial factors and perfectionism, and highlights the importance of patient-reported outcomes in treatment planning.

## Key findings

- Adults showed significantly higher treatment motivation and psychosocial impact of malocclusion compared to children.
- Patient-perceived aesthetic need diverged from clinician assessments in both age groups.
- Psychosocial distress, not clinical severity, was the main driver of treatment motivation in adults.

## Abstract

Understanding age-related differences in the psychological aspects of orthodontic treatment is crucial for patient-centered care. This study compared treatment motivation, psychosocial impact, and perfectionism between child and adult patients.

In this cross-sectional study, 306 orthodontic patients (223 children, 83 adults) completed validated questionnaires assessing motivation, psychosocial impact (PIDAQ), and perfectionism (FMPS). Patient-perceived aesthetic need (IOTN-AC) and orthodontist-evaluated clinical need (IOTN-DHC) were recorded.

Adults reported significantly higher total treatment motivation (p = 0.021) and a markedly greater psychosocial impact of malocclusion (PIDAQ: 58 vs. 35, p < 0.001) than children, with higher scores in social, psychological, and aesthetic concern domains. Adults also showed stronger functional motivation (p = 0.004), greater concern over mistakes (p = 0.018), and lower parental expectations (p = 0.029). A significant discrepancy existed between patient self-perceived need (IOTN-AC) and orthodontist assessment (IOTN-DHC) in both groups (p < 0.001). Regression analysis showed that higher psychosocial impact (PIDAQ) was associated with female gender, older age, higher perfectionism, and greater self-perceived aesthetic need, but not with clinical need (IOTN-DHC). The total PIDAQ score was the only significant independent predictor of higher treatment motivation (β = 0.10, p = 0.002).

Adult orthodontic patients experience a greater psychosocial burden and distinct motivational drivers compared to children. Treatment motivation is primarily driven by psychosocial distress, not clinical severity, highlighting the need for clinicians to prioritize patient-reported outcomes and address perception gaps to deliver effective, patient-centered care.