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Our study involved secondary analyses of the oral health-related quality of life data collected in the Iowa Fluoride Study at the 17-year time-point. Both adolescents and their parents filled out questionnaires related to the assessment of the OHRQoL of the adolescents. In addition, adolescents also underwent clinical examination to assess dental caries, dental fluorosis, orthodontic characteristics, and non-fluoride opacities. Dental casts were also made with the assent of the participants. These casts were later used to estimate the social acceptability of the participants' dental appearance and assess their malocclusion severity, using the Dental Aesthetic Index (Cons et al, 1978). This study assessed the relationships between the OHRQoL of Iowa adolescents and the presence of selected oral conditions, such as dental caries, dental fluorosis, and malocclusion.
Based on the multivariable analyses, dental caries and malocclusion severity (reflected by DAI score) were the two oral conditions that were found to be significantly associated with poorer OHRQoL in adolescents. In addition, the influence of sex on adolescents' perceptions of OHRQoL was found to be statistically significant in our study and being female was associated with poorer OHRQoL.
The findings of our study corroborate the results of other investigations that have demonstrated significant associations between: i) dental caries and OHRQoL (Arrow P, 2013; Barbosa et al, 2013; Bastos et al, 2012; Castro et al,2010; Do and Spencer, 2007; Martinis et al, 2012); ii) malocclusion and OHRQoL (Foster Page et al., 2005; Do and Spencer, 2007; Locker et al, 2007; Bernabe et al, 2008; Agou et al, 2008; O'Brien et al, 2006; Feu et al, 2010; Ukra et al, 2013); and iii) sex and OHRQoL (Foster Page et al, 2005; Calis et al, 2009; Bos et al, 2010; Barbosa et al, 2013; Ukra et al, 2013).
Thus, oral conditions such as dental caries and malocclusion can be a source of stress and can have a negative impact on the life of an individual and can impede their ability to succeed. Females tend to be more sensitive to the negative impact of oral health conditions. Thus, in order to better understand the impact of oral health conditions, subjective measures should be used in conjunction with normative measures or clinical measures of assessing oral health. This can help in better treatment planning, and better allocation of resources, as oral health perceptions can vary for different individuals.