Smile economics: Measuring health utilities and orthodontic quality of life in malocclusion patients

Introduction: Malocclusion adversely affects oral function and psychosocial well-being. Utility-based approaches can quantify health preferences, yet their application in routine orthodontic patients remains insufficiently explored. Materials and Methods: The aim of this study was to assess the feasibility of the time trade-off (TTO) method for quantifying health utility values in adults with untreated malocclusions and to examine the association between TTO utilities and Orthognathic Quality of Life Questionnaire (OQLQ) scores. A pilot cross-sectional feasibility study was conducted on 30 adults with untreated malocclusion at a tertiary center in Delhi National Capital Region. Utility scores for current malocclusion and four hypothetical treatment scenarios were elicited using a structured TTO task. OQLQ scores were recorded across four domains. Descriptive statistics were used due to limited subgroup sizes. Results: The mean TTO utilities showed variability across age, gender, and malocclusion types but no meaningful statistical differences. OQLQ scores demonstrated greater psychosocial impact in Class II division 1 patients. Very small sample numbers in some subgroups (e.g., Class III : n = 1) precluded inferential comparisons. Conclusion: The TTO method is feasible and acceptable for use in adults seeking orthodontic care. Observed trends suggest higher perceived impact in Class II division 1 patients, but findings are exploratory only. Larger powered studies are required to validate subgroup differences.