Agreement Between Patient's Chief Complaint and Clinician's Diagnosis in Orthodontic Patients: A Diagnostic Concordance Study

Aim: To evaluate the level of agreement between orthodontic patients’ chief complaints and clinicians’ objective diagnoses and to identify factors associated with diagnostic mismatch. Methods: This cross-sectional diagnostic study included 180 orthodontic patients presenting at King Talal Military Hospital, Princess Haya Military Hospital, and Prince Rashid Military Hospital between November and December 2025. Before examination, each patient recorded a single primary chief complaint (crowding, spacing, esthetics, bite problem, midline deviation, or other). A blinded orthodontist performed a standardized clinical assessment and documented the primary diagnosis using the same categories. Results: Crowding (37%), esthetics (21%), and spacing (17%) were the most frequent chief complaints. Most often crowding (29%) and bite problems (20%) were identified as clinician diagnoses. The cases of diagnostic mismatch were found in (34%) patients. Mismatch-related comparisons did not reveal any differences in the distribution of study sites, age, sex, previous treatment, or chief complaint (p>0.05). Clinician diagnosis was unusual (p=0.002) with a high percentage of bite problems in the mismatch group (34% vs 13%), and a low percentage of crowding (15% vs 37%). Conclusion: Crowding (29%) as well as bite problems (20%) were diagnosed the most by clinicians. The cases of diagnostic mismatch were found in 34% of patients. Also clinician diagnosis had a high percentage of bite problems in the mismatch group. However, a low percentage of crowding was reported in the same group.