{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T13:13:11Z","timestamp":1790341991055,"version":"4.1.0"},"reference-count":29,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T00:00:00Z","timestamp":1770595200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Introduction: Smile esthetics play a central role in social interaction, self-esteem, and self-confidence, and may influence individuals\u2019 perception of orthodontic treatment need. Understanding how patients evaluate their own smile and how this perception relates to treatment demand is increasingly relevant for patient-centered orthodontic care. This study aimed to examine the associations between demographic factors, self-perception of smile esthetics, psychosocial behaviors, and perceived need for orthodontic treatment. Materials and Methods: A cross-sectional study was carried out using a questionnaire, yielding 303 valid responses. The questionnaire assessed demographic characteristics, satisfaction with smile appearance, smile-related avoidance behaviors, awareness of dental esthetics, and self-perceived orthodontic treatment need. Associations between variables were analyzed using Chi-square tests, Kendall\u2019s tau_b, Spearman\u2019s rho, and Cramer\u2019s V coefficients. Multinomial logistic regression was performed to identify factors associated with perceived treatment need. Results: Gender was significantly associated with satisfaction with smile appearance, concern about dental esthetics, and awareness of the importance of aligned teeth (p \u2264 0.001), with weak to moderate effect sizes. Age showed statistically significant but weak correlations with smile-related behaviors and perceived treatment need (|\u03c4| \u2248 0.11\u20130.12; p &lt; 0.05). Lower satisfaction with one\u2019s smile was moderately associated with a higher perceived need for orthodontic treatment (\u03c4b = \u22120.20; p &lt; 0.001). Avoidance of smiling and covering the mouth while speaking were positively associated with perceived treatment need (p &lt; 0.01). Discussions: Regression analysis confirmed that dissatisfaction with smile esthetics, smile-avoidance behaviors, and belief in the esthetic benefits of dental alignment were significant predictors of perceived orthodontic treatment need. Self-perception of smile esthetics and related psychosocial behaviors are significantly associated with individuals\u2019 perceived need for orthodontic treatment. Conclusions: These findings underscore the importance of incorporating patient-reported perceptions and psychosocial factors into orthodontic assessment and shared decision-making.<\/jats:p>","DOI":"10.3390\/jcm15041347","type":"journal-article","created":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:15:54Z","timestamp":1770624954000},"page":"1347","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association Between Psychosocial Factors and the Need for Orthodontic Treatment Based on Self-Perception"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1295-566X","authenticated-orcid":false,"given":"Olimpia","family":"Bunta","sequence":"first","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Diana","family":"Petca","sequence":"additional","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriela Ofelia","family":"Chiciudean","sequence":"additional","affiliation":[{"name":"Economic Sciences, Faculty of Horticulture and Business in Rural Development, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Sancraian","sequence":"additional","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel Ioan","family":"Chiciudean","sequence":"additional","affiliation":[{"name":"Economic Sciences, Faculty of Horticulture and Business in Rural Development, University of Agricultural Sciences and Veterinary Medicine, 400372 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dana","family":"Festila","sequence":"additional","affiliation":[{"name":"Orthodontics Department, Faculty of Dental Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40510-023-00456-5","article-title":"The effect of orthodontic treatment on smile attractiveness: A systematic review","volume":"24","author":"Coppola","year":"2023","journal-title":"Prog. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1146\/annurev-psych-010418-103145","article-title":"Non verbal communication","volume":"70","author":"Hall","year":"2019","journal-title":"Annu. Rev. Psychol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/S0022-3913(84)80097-9","article-title":"Some esthetic factors in a smile","volume":"51","author":"Tjan","year":"1984","journal-title":"J. Prosthet. Dent."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"89","DOI":"10.2147\/CCIDE.S189708","article-title":"Clinical effectiveness of orthodontic treatment on smile esthetics: A systematic review","volume":"11","author":"Christou","year":"2019","journal-title":"Clin. Cosmet. Investig. Dent."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s40510-022-00399-3","article-title":"The influence of malocclusion on social aspects in adults: Study via eye tracking technology and questionnaire","volume":"23","author":"Gasparello","year":"2022","journal-title":"Prog. Orthod."},{"key":"ref_6","first-page":"759","article-title":"Smile attractiveness. Self-perception and influence on personality","volume":"77","author":"Oosterveld","year":"2007","journal-title":"Angle Orthod."},{"key":"ref_7","first-page":"120","article-title":"Impact of severity of malocclusion and self-perceived smile and dental aesthetics on self-esteem among adolescents","volume":"11","author":"Akpasa","year":"2022","journal-title":"J. World Fed. Orthod."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"8364","DOI":"10.1038\/s41598-019-44655-9","article-title":"Subjectivity and complexity of facial attractiveness","volume":"9","author":"Amico","year":"2019","journal-title":"Sci. Rep."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"592","DOI":"10.1111\/j.1467-9280.2006.01750.x","article-title":"First impressions: Making up your mind after a 100-ms exposure to a face","volume":"17","author":"Willis","year":"2006","journal-title":"Psychol. Sci."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"713","DOI":"10.1055\/s-0042-1753452","article-title":"Psychosocial impact of malocclusion and self-perceived orthodontic treatment need among young adult dental patients","volume":"17","author":"Aldweesh","year":"2023","journal-title":"Eur. J. Dent."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"507","DOI":"10.1093\/ejo\/26.5.507","article-title":"Dental aesthetics, self-awareness and oral health-related quality of life in young adults","volume":"26","author":"Klages","year":"2004","journal-title":"Eur. J. Orthod."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"61","DOI":"10.4103\/jorr.jorr_68_21","article-title":"Psychological and social impact of malocclusion in children and young adults\u2014A review","volume":"15","author":"Georgina","year":"2023","journal-title":"J. Oral Res. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1093\/ejo\/cjr088","article-title":"Impact of self-esteem on the relationship between orthodontic treatment need and oral health related quality of life in 11- to 16-year-old children","volume":"34","author":"Lambrechts","year":"2012","journal-title":"Eur. J. Orthod."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1111\/cdoe.12299","article-title":"The association of subjective orthodontic treatment need with oral health-related quality of life","volume":"45","author":"Kragt","year":"2017","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"839","DOI":"10.2319\/072215-496.1","article-title":"Impact of orthodontic treatment on self-esteem and quality of life of adult patients requiring oral rehabilitation","volume":"86","year":"2016","journal-title":"Angle Orthod."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1093\/ejo\/cju047","article-title":"The impact of orthodontic treatment on quality of life and self-esteem in adult patients","volume":"37","author":"Johal","year":"2015","journal-title":"Eur. J. Orthod."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.jad.2008.03.014","article-title":"Validation of a brief measure of anxiety-related severity and imparement: The overall anxiety severity and imparement scale (OASIS)","volume":"112","author":"Norman","year":"2009","journal-title":"J. Affect. Disord."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"44","DOI":"10.11607\/ijp.3603","article-title":"Development of a maltese version of oral health-associated questionnaires: OHIP-14, GONAI and the Denture Datisfaction Questionnaire","volume":"27","author":"Santucci","year":"2014","journal-title":"Int. J. Prosthodont."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"36","DOI":"10.1016\/j.ajodo.2024.02.009","article-title":"Adult orthodontics, motivations for treatment, choice, and impact of appliance: A quantitative study","volume":"166","author":"Johal","year":"2024","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1111\/jerd.12906","article-title":"The influence of age and gender on perception of orofacial esthetics among laypersons in Switzerland","volume":"34","author":"Zaugg","year":"2022","journal-title":"J. Esthet. Restor. Dent."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Gao, X., Zhing, J., Li, H., Pei, Y., Li, X., Zhang, S., Yue, Y., and Xiong, X. (2023). The relationship between perfectionism, self-perception of orofacial appearance, and mental health in college students. Front. Public. Health, 11.","DOI":"10.3389\/fpubh.2023.1154413"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Hurrelmann, K. (1989). Human Development and Health, Springer. [1st ed.].","DOI":"10.1007\/978-3-642-74328-3"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1136\/jech.50.4.391","article-title":"Quality of life assessement in children: A review of conceptual and methodological issues in multidimensional health status measures","volume":"50","author":"Pal","year":"1996","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"151","DOI":"10.1111\/j.1600-0528.1993.tb00741.x","article-title":"Concern for dental appearance among Norwegian young adults in region with low uptake of orthodontic treatment","volume":"21","author":"Espeland","year":"1993","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_25","first-page":"249","article-title":"The orthodontic condition and treatment status of a sample of 14-year-old children in north Derbyshire","volume":"6","author":"Roberts","year":"1989","journal-title":"Community Dent. Health"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"199","DOI":"10.1093\/ejo\/17.3.199","article-title":"The influence of social class, gender, and peers on the uptake of orthodontic treatment","volume":"17","author":"Burden","year":"1995","journal-title":"Eur. J. Orthod."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Celikel, A.D.G., Cifter, M., Tagrikulu, B., and Peker, K. (2024). Associations between oral health impacts attributed to malicclusion and normative and self-perceived orthodontic treatment need in Turkish adolescent patients. BMC Oral Health, 24.","DOI":"10.1186\/s12903-024-05019-6"},{"key":"ref_28","first-page":"272","article-title":"Orthodontic treatment demand- differences between urban and rural areas","volume":"15","author":"Bergstom","year":"1998","journal-title":"Community Dent. Health"},{"key":"ref_29","first-page":"565","article-title":"Subjective need and orthodontic treatment experience in a Middle East country providing free orthodontic services: A questionnaire survey","volume":"72","author":"Kerosuo","year":"2002","journal-title":"Angle Orthod."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1347\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,9]],"date-time":"2026-02-09T08:44:27Z","timestamp":1770626667000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/4\/1347"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,9]]},"references-count":29,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["jcm15041347"],"URL":"https:\/\/doi.org\/10.3390\/jcm15041347","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,9]]}}}