The relationship between malocclusion and oral health-related quality of life among adolescents: A systematic literature review and meta-analysis

Background: Malocclusion is a deviation from an anatomical norm that occurs in various populations. Evidence shows that it has physical and psychological implications as well as an influence on the patient's oral health-related quality of life (OHRQoL). Self-perception of oral health plays an important role in the understanding of malocclusion's influence on the quality of life. Malocclusion has been reported to impair a patient's function, appearance, interpersonal relationships and psychological well-being. Objectives: The aim of this study was to investigate whether adolescents aged between 11 and 18 years with malocclusion are at increased risk for having a high level of OHRQoL compared with those without malocclusion. Search methods: The Ovid Medline, Embase and Scopus databases were used to identify studies measuring the association between malocclusion and HRQoL. Selection criteria: Only cross-sectional studies were included, and the following inclusion criteria were used: subjects were systemically healthy; data were available for untreated malocclusion and OHRQoL; malocclusion was measured by Dental Aesthetic Index and Index of Orthodontic Treatment Needs; OHRQoL was assessed by Child Perception Questionnaire, Child Oral Health Impact Profile and Child Oral Health Impact Profile; and the paper was published in English. Data collection and analysis: Data were extracted by two independent reviewers. The Appraisal tool for Cross-Sectional Studies (AXIS) was used to establish the risk of bias, and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) evidence quality assessment tool was used to assess the impact of malocclusion on adolescents across studies. Results: The initial search yielded 530 papers. Eleven cross-sectional studies were included in the meta-analyses, and all data describing the relationship between malocclusion and OHRQoL were gathered via a structured questionnaire. Our results showed that malocclusion is linked to decreased OHRQoL in children and adolescents aged between 11 and 18 years in continuously analysed studies. However, in dichotomously analysed studies, it was shown that young people without malocclusion are linked to decreased OHRQoL. Conclusions: Adolescents with severe levels of malocclusion might have among the worst levels of OHRQoL.The effects of malocclusion on OHRQoL were influenced by the age of the adolescents as well as by their culture and environment. Registration: PROSPERO (CRD42020178657).