Hypodontia and its impact on a young person’s quality of life, esthetics, and self-esteem

Johal A, Huang Y, Toledano S. Hypodontia and its impact on a young person’s quality of life, esthetics, and self-esteem. Am J Orthod Dentofacial Orthop. 2022 Feb;161(2):220-227.


Hypodontia has been defined as the developmental absence of at least 1 permanent tooth (excluding wisdom teeth). With a reported prevalence of 3.5-6.5% in permanent dentition, it is considered the most common congenital dental anomaly. Hypodontia is classified based on severity: mild (1-2 missing teeth), moderate (3-5 missing teeth), and severe (>6 missing teeth).

The management of hypodontia can be challenging, particularly when taking account the social, psychological, and dental aspects of care. Hence, a multidisciplinary approach is essential to attain optimal aesthetic and functional outcomes.

Individuals with malocclusions are known to experience stigmatization; they are more susceptible to being bullied, have lower self-esteem, and are less accepted socially. Untreated malocclusion in teenagers may have lasting psychological and social impacts on their quality of life (QOL). However, despite the prevalence of hypodontia and the growing interest in QOL within the field of medicine and dentistry, few studies have explored its impact on QOL. Furthermore, the existing studies primarily utilized generic oral-health related QOL measures rather than specific questionnaires designed to comprehend the consequences of specific oral conditions on overall health and QOL. This research aimed to use both generic and condition-specific scales to evaluate the impact of hypodontia on a young person’s oral health-related quality of life, aesthetics, and self-esteem.


This prospective cross-sectional hospital-based study involved 97 participants with hypodontia aged 11-18 years. Before any planned treatment, participants were asked to complete the following questionnaires:

  • Child Perception Questionnaire (CPQ) with 37 questions across 4 domains: Oral symptoms, Functional limitations, Emotional well-being, and Social well-being
  • Bristol Condition-Specific Questionnaire for hypodontia (BCSQ) with themes including Treatment, Activities, Appearance, and Reaction of Other People
  • Child Health Questionnaire (CHQ)
  • Oral Aesthetic Subjective Impact Scale (OASIS)


A total of 323 teeth were missing (characteristics are shown in Fig 1);

  • 58 subjects showed mild (2 absent teeth)
  • 39 subjects showed moderate to severe (>2 absent teeth) hypodontia
  • 41 patients were missing anterior teeth – predominantly absent maxillary lateral incisors
  • 30 patients were missing posterior teeth – predominantly mandibular second premolars
  • 26 were missing both anterior and posterior teeth
  • The mean age 14.1 years in mild group and 13.7 years in moderate to severe hypodontia group
  • Ethnically, a significant proportion were White British (32%), followed by Pakistani, Indian and Bangladeshi (27% combined); other White (15%); Black British (14% each); and other (12%)
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Fig 1: Characteristics of the sample (n=97).

Significant differences were observed in the Child Perception Questionnaire and the Bristol Condition-Specific Questionnaire for Hypodontia between the two groups. This indicated a greater negative impact in the moderate to severe hypodontia group in terms of emotional and social well-being, treatment, appearance, and reaction of other people. No significant differences were noted in self-esteem or aesthetics.


Hypodontia in young individuals appears to have a detrimental psychosocial impact, both in terms of its presentation and planned care.

Research Summary Written By: Aisha Azlan, University of Manchester – BDS3

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