Does Treatment Setting Influence Perceptions of Malocclusion? A Comparative Study of Quality of Life, Psychosocial Impact, and Orthodontic Need

Background Malocclusion affects both functional and psychosocial aspects of oral health. While normative indices quantify treatment need, patient-reported measures reveal the quality-of-life implications. The treatment setting may influence these perceptions. Objectives To compare the difference in scores between patients attending a government (subsidized/free treatment) and private dental institution (paid treatment) regarding treatment need using the patient-reported measures such as the Malocclusion-Related Quality of Life Questionnaire (MRQoLQ) and the Psychosocial Impact of Dental Esthetics Questionnaire (PIDAQ), and the differences in the severity of malocclusion using the Peer Assessment Rating (PAR) index. Methods A multicenter cross-sectional comparative study was conducted among 242 patients (121 each from a Government Dental College (GDC)— Group 1 and a Private Dental College (PDC)— Group 2 , aged 12-25 years. Malocclusion severity was assessed using the PAR index, while patient-reported outcomes were measured with PIDAQ and the MRQoLQ. Independent t -tests and chi-square tests assessed intergroup differences, and Pearson’s correlation examined associations between PAR and quality of life measures. Results Mean PAR scores were comparable between Group 1 and Group 2 ( P > .05). However, PIDAQ and MRQoLQ scores were significantly higher among Group 2 patients ( P < .01), indicating greater psychosocial and esthetic concerns despite similar malocclusion severity. Correlation analysis revealed stronger associations between PAR and patient-reported outcome measures (PROMs) in Group 1 patients, whereas Group 2 patients demonstrated higher expectations independent of normative severity. Conclusion While clinical malocclusion severity was similar across groups, orthodontic-specific quality of life impact was greater among PDC patients, reflecting heightened esthetic expectations. A combined approach incorporating both normative indices and patient-reported measures is essential for the assessment of orthodontic treatment need.