Influence of self-esteem on perceived orthodontic treatment need and oral health-related quality of life in children: The Generation R Study

Background: Self-esteem (SE) is suggested to influence the relationship between orthodontic treatment need and oral health-related quality of life (OHRQoL), but evidence lacks. The aim of the present study was to investigate SE in the relationship between subjective orthodontic need and OHRQoL in children. Methods: This cross-sectional study was embedded in the Generation R Study, a multi-ethnic population-based cohort. In total, 3796 10-year old children participated in the present study. OHRQoL, measured with the Child Oral Health Impact Profile-ortho, and subjective orthodontic need were assessed within parental questionnaires. SE was measured with a modified version of the Harter's self-perception profile rated by the children. The role of SE in the association between SOT and OHRQoL was evaluated with linear regression models. Furthermore, the difference in this association between children with high and low SE was investigated. Results: Higher subjective orthodontic need was associated with lower OHRQoL scores (borderline: ß [95% CI] =-0.55 [-0.77,-0.33]; definite:-1.65 [-1.87,-1.54]). Children with lower SE scores showed a stronger relationship between borderline and definite subjective orthodontic need with OHRQoL (ß [95% CI] =-0.56 [-0.81,-0.31] respectively-1.68 [-1.94,-1.42]) than children with higher SE scores did (ß [95% CI] =-0.51 [-0.97,-0.04] respectively-1.43 [-1.90,-0.95]). Conclusion: The relationship between subjective orthodontic need and OHRQoL is not based on the SE of children. However, SE modifies the relationship between subjective orthodontic need and OHRQoL. Work still needs to be done to find an explanation for the effect modification by SE in the relationship between subjective health perceptions and OHRQoL.