Self-Perceived vs. Clinically Assessed Malocclusion in Adolescents: A Cross-Sectional Study

Background: Malocclusion can influence not only oral function, but also adolescents’ perception of dental appearance, psychosocial status, and oral health-related quality of life. The present cross-sectional study aimed to examine the association between the clinical severity of malocclusion and adolescents’ self-perception, as well as to assess the level of agreement between clinician and patient ratings of aesthetic impairment. Methods: The study included 160 consecutive adolescents aged 12 to 17 years who were referred for orthodontic evaluation. Malocclusion severity was determined using the Index of Orthodontic Treatment Need (IOTN), considering both the Dental Health Component (DHC) and the Aesthetic Component (AC). Patients’ perceptions of malocclusion severity, aesthetic concerns, and functional limitations were collected through numeric rating scales, while psychosocial impact was measured using the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Correlations were examined with Spearman’s coefficients, agreement between clinician- and self-rated AC scores was evaluated with weighted kappa statistics, and multivariable regression analyses were used to identify independent predictors of patient-reported outcomes. Results: Moderate positive correlations emerged between IOTN-DHC and self-perceived malocclusion severity (rho = 0.42, p < 0.001), and between clinician-rated IOTN-AC and self-perceived severity (rho = 0.47, p < 0.001). Associations were stronger for aesthetic and psychosocial measures than for functional complaints, with the highest correlation observed between clinician-rated IOTN-AC and perceived aesthetic impact (rho = 0.58, p < 0.001). Greater clinical severity was also associated with increased psychosocial burden, as reflected by higher PIDAQ total scores. Agreement between clinician and patient evaluations of aesthetic impairment was fair to moderate (weighted kappa = 0.34) but improved when AC scores were grouped into broader categories (weighted kappa = 0.46). Overall, adolescents tended to perceive their dental aesthetic impairment as more severe than did clinicians. In the multivariable models, clinician-rated IOTN-AC remained an independent predictor of perceived severity, aesthetic impact, and psychosocial burden. Conclusions: Clinical measures of malocclusion severity and adolescents’ self-perception were significantly related, although they reflected partly different aspects of orthodontic treatment need. Combining normative clinical indices with patient-reported outcomes may allow a more complete and patient-centred evaluation of malocclusion.