Age matters in orthodontics: divergent motivations, perfectionism, and patient-clinician discord in treatment need assessment

Background Understanding age-related differences in the psychological aspects of orthodontic treatment is crucial for patient-centered care. This study compared treatment motivation, psychosocial impact, and perfectionism between child and adult patients. Methods In this cross-sectional study, 306 orthodontic patients (223 children, 83 adults) completed validated questionnaires assessing motivation, psychosocial impact (PIDAQ), and perfectionism (FMPS). Patient-perceived aesthetic need (IOTN-AC) and orthodontist-evaluated clinical need (IOTN-DHC) were recorded. Results Adults reported significantly higher total treatment motivation ( p = 0.021) and a markedly greater psychosocial impact of malocclusion (PIDAQ: 58 vs. 35, p < 0.001) than children, with higher scores in social, psychological, and aesthetic concern domains. Adults also showed stronger functional motivation ( p = 0.004), greater concern over mistakes ( p = 0.018), and lower parental expectations ( p = 0.029). A significant discrepancy existed between patient self-perceived need (IOTN-AC) and orthodontist assessment (IOTN-DHC) in both groups ( p < 0.001). Regression analysis showed that higher psychosocial impact (PIDAQ) was associated with female gender, older age, higher perfectionism, and greater self-perceived aesthetic need, but not with clinical need (IOTN-DHC). The total PIDAQ score was the only significant independent predictor of higher treatment motivation (β = 0.10, p = 0.002). Conclusion Adult orthodontic patients experience a greater psychosocial burden and distinct motivational drivers compared to children. Treatment motivation is primarily driven by psychosocial distress, not clinical severity, highlighting the need for clinicians to prioritize patient-reported outcomes and address perception gaps to deliver effective, patient-centered care.