Evaluation of Awareness of the Need for Orthodontic Treatment Across Different Age Groups in Adolescents and Young Adults

Background/Objectives: This study aimed to determine the awareness levels of individuals presenting to an orthodontic clinic regarding their orthodontic treatment needs and to identify the various factors contributing to the development of this awareness, particularly the developmental period. Methods: A total of 160 participants were divided into four equal age groups (n = 40 each): early adolescence, middle adolescence, late adolescence, and young adults. Participants’ subjective awareness of orthodontic treatment need was assessed using questionnaire items, the Index of Orthodontic Treatment Need-Aesthetic Component (IOTN-AC), and a Visual Analog Scale (VAS) for self-perceived dental aesthetics, while normative treatment need was evaluated by an expert orthodontist using the IOTN, DAI, and ICON. The primary outcome was aesthetic agreement, classified as underestimation, exact concordance, or overestimation according to the participant-minus-researcher raw IOTN-AC score difference. Sensitivity analyses allowed a ±1-point tolerance and included a pooled analysis of the two youngest age groups. Results: Researcher IOTN-AC scores correlated strongly with IOTN-DHC (ρ = 0.861; 95% CI 0.804–0.904), DAI (ρ = 0.755; 95% CI 0.664–0.827), and ICON (ρ = 0.860; 95% CI 0.802–0.903; all Holm-adjusted p < 0.001, n = 160), confirming construct alignment with normative treatment need. Subjective perception of dental irregularity and skeletal discrepancy increased significantly with age (p = 0.005 and p < 0.001). In the exploratory pooled model, the odds of underestimation rather than exact concordance were lower at 19–21 years (OR = 0.11; 95% CI 0.04–0.35) and 22–30 years (OR = 0.09; 95% CI 0.03–0.28) than at 12–18 years. The concordant perception group demonstrated higher self-referral and subjective awareness (p < 0.05). Nonetheless, these estimates remain susceptible to sparse-data bias. Conclusions: Personal awareness of morphological and skeletal discrepancies strengthens with age, with treatment-need underestimation diminishing significantly from age 19 onward in favor of concordant perception. However, conclusions specific to middle adolescence remain uncertain because exact concordance was sparse. While enhancing awareness at younger ages is hypothesized to facilitate timely intervention during active growth periods, longitudinal studies are warranted to evaluate the long-term clinical consequences of early awareness deficits on skeletal growth patterns and subsequent surgical requirements.