Orthodontic treatment has traditionally evolved in a versatile intervention, with the aim of correcting malocclusion and improving functional obstacles that significantly affect the different dimensions of the patient's life. As dentistry change to a more towards patient aspects, understanding the widespread implications of orthodontic care has become increasingly important 1,2. Emotional and psychological welfare in patients undergoing orthodontic treatment is a necessary, but is often underexplored aspect. While the expected results usually improve confidence and satisfaction with the appearance, the process itself can sometimes occur with temporary emotional distress, discomfort or anxiety in early treatment stages or under visible appliance use3,4. The desire for a good and attractive smile is often not only in functional needs, but also in the pursit of self -confidence and social acceptance5. Orthodontic treatment, by addressing these problems, has the ability to increase emotional welfare and general quality of life6. These changes can temporarily affect how individuals consider themselves and how they are assessed by others, sometimes lead to feelings of self -awareness or embarrassment. In addition, long treatment periods require considerable patience, adaptability and flexibility, which can test the emotional endurance of a patient7. Conversely, the treatment process itself may also introduce temporary social discomfort. The visibility of braces, speech alterations, or dietary restrictions can lead to self-consciousness, especially in settings that demand frequent verbal communication or public interaction8,9. This underscores the importance of understanding not just the end result, but also how the journey through orthodontic treatment shapes the patient’s social experiences and self-perception in real time. Despite the significance of these social and interpersonal factors, they are often underrepresented in clinical evaluations of orthodontic outcomes10. There is a growing need for comprehensive studies that measure how orthodontic interventions affect patients social lives and their self esteem11. A comprehensive understanding of how orthodontic therapy influences emotional well-being and social behaviour will provide valuable insights for improving patient care, enhancing satisfaction, and optimizing overall treatment impact12

Study Design and Setting This study was designed as a cross-sectional, questionnaire-based survey aimed at evaluating the multifaceted impact of orthodontic treatment on patients' lives. The study was conducted over a period of six months in the orthodontic department of a tertiary care dental teaching hospital. Ethical clearance was obtained from the Institutional Ethics Committee prior to the commencement of the study. Study Population and Sampling The study population included patients who were currently undergoing fixed orthodontic treatment or had completed treatment within the last 12 months. Inclusion criteria comprised individuals aged 15 years and above, who provided informed consent, and had completed at least six months of active treatment. Exclusion criteria included patients with craniofacial anomalies, those undergoing combined orthodontic-surgical treatment, or those with a known psychological disorder. A stratified random sampling technique was used to ensure representation across age groups, gender, and treatment stages. The target sample size was calculated based on a confidence level of 95% and a margin of error of 5%, resulting in a final sample of 400 participants. Data Collection Tool A structured, self-administered questionnaire was developed specifically for this study, based on previously validated tools with modifications suited to the current objectives. The questionnaire was divided into three sections: 1. Demographic Information – Age, gender, education level, treatment duration, and stage of treatment. 2. Emotional Well-being – Items assessed changes in self-esteem, confidence, anxiety, and mood fluctuations associated with orthodontic treatment. 3. Social Interaction – This section evaluated the influence of treatment on social participation, communication, peer perception, and public self-consciousness. Responses were recorded using a 5-point Likert scale ranging from "Strongly Disagree" to "Strongly Agree." Data Collection Procedure After obtaining informed consent, the questionnaire was distributed to participants in both female and male in paper and digital format (via Google Forms) based on their preference. Participants were assured of confidentiality and anonymity. Assistance was provided where necessary to ensure complete and unbiased responses. Statistical Analysis The collected data were coded and entered into Statistical Package for the Social Sciences (SPSS) version 25.0 for analysis. Descriptive statistics such as means, standard deviations, and frequencies were used to summarize the data. Inferential statistics including Chi-square tests to explore associations between demographic variables and patient-reported outcomes. A p-value of <0.05 was considered statistically significant.

Table 1 shows the emotional wellbeing, The responses regarding emotional wellbeing indicated that a notable proportion of participants experienced varying levels of self-consciousness about their dental appearance after beginning orthodontic treatment. Approximately 40.3% reported feeling self-conscious "sometimes," while 20% felt this "often." A smaller group (5.3%) admitted to feeling self-conscious "always," whereas 4.3% never experienced such feelings. The p-value (0.054) suggested a trend towards statistical significance. Mood assessment during treatment revealed that almost half (46%) of the participants maintained a "neutral" mood, while 30.5% described their mood as "somewhat negative." Only a minor percentage (2.3%) reported a "very positive" mood. The association between mood and treatment was statistically significant (p = 0.047). stress levels were also evaluated, where a significant portion (47.5%) "often" experienced stress, and 19.8% faced it "always." Only a negligible number (1.8%) reported "never" experiencing stress. The p-value (0.041) confirmed a statistically significant relationship. When satisfaction of treatment when orthodontist approaches about the emotions was measured, about one-third (33.5%) were "satisfied," and 14% were "very satisfied," while 18% were "dissatisfied." This parameter, however, did not reach statistical significance (p = 0.083). In terms of confidence , 43.5% felt a "significant" impact, and 20.5% felt it was "extreme," with a statistically significant p-value of 0.045, highlighting a meaningful psychological influence of orthodontic treatment. Table 2 shows the Social Interaction, Social behaviour changes due to orthodontic treatment showed that 42.3% "often" avoided social interactions, and 38.3% did so "sometimes." However, the p-value (0.073) did not indicate a significant relationship. When questioned about comfort while interacting with others about their braces or aligners, 41.3% reported feeling "neutral," while 36.3% felt "uncomfortable." This perception was not statistically significant (p = 0.094). Experiences of negative reactions from others were perceived "sometimes" by 43.3% and "often" by 23.3% of respondents. The p-value (0.046) indicated a statistically significant correlation. Confidence in approaching orthodontist had notably decreased for more than half (52.8%) of the participants ("somewhat less confident") and 24.8% ("much less confident"), with a significant p-value (0.039). Changes in willingness to engage in group activities varied, with 37.3% experiencing "slight willingness" and 34.5% showing "decreased willingness," although the association was not statistically significant (p = 0.062). TABLE 1: EMOTIONAL WELLBEING QUESTIONAIRRE OPTIONS FREQUENCY (N) PERCENTAGE (%) P-value How often do you feel self-conscious or embarrassed about the appearance of your teeth since starting orthodontic treatment? Never 17 4.3 0.054 Rarely 121 30.3 Sometimes 161 40.3 Often 80 20.0 Always 21 5.3 How would you rate your overall mood during your orthodontic treatment? Very Positive 9 2.3 0.047* Somewhat Positive 73 18.3 Neutral 184 46.0 Somewhat Negative 122 30.5 Very Negative 12 3.0 Do you experience increased stress or anxiety due to the discomfort or appearance of your braces or aligners? Never 7 1.8 0.041* Rarely 28 7.0 Sometimes 96 24.0 Often 190 47.5 Always 79 19.8 Would you find it helpful if orthodontist regularly discuss how treatment is affecting your social life? Very Satisfied 56 14.0 0.083 Satisfied 134 33.5 Neutral 124 31.0 Dissatisfied 72 18.0 Very Dissatisfied 14 3.5 Has your perception of your looks or confidence level changed since starting orthodontic treatment? No, it has not affected me 15 3.8 0.045* Slightly 44 11.0 Moderately 85 21.3 Significantly 174 43.5 Extremely 82 20.5 TABLE 2: SOCIAL INTERACTION QUESTIONAIRRE OPTIONS FREQUENCY (N) PERCENTAGE (%) P-value Has your orthodontic treatment caused you to avoid social situations or interactions (e.g., avoiding smiling, speaking, or attending social events)? If yes ,explain how . Never 10 2.5 0.073 Rarely 29 7.3 Sometimes 153 38.3 Often 169 42.3 Always 39 9.8 How comfortable do you feel interacting with others regarding your braces or aligners? Very Comfortable 2 .5 0.094 Comfortable 61 15.3 Neutral 165 41.3 Uncomfortable 145 36.3 Very Uncomfortable 27 6.8 Do you feel that others react negatively to your orthodontic treatment (e.g., comments or teasing)? Never 10 2.5 0.046* Rarely 104 26.0 Sometimes 173 43.3 Often 93 23.3 Always 20 5.0 Do you feel your orthodontist is approachable and supportive when you express emotional concerns? Much More Confident 3 .8 0.039* Somewhat More Confident 10 2.5 No Change 77 19.3 Somewhat Less Confident 211 52.8 Much Less Confident 99 24.8 After extraction in orthodontic treatment have noticed any change in your willingness to participate in group activities or social events since starting orthodontic treatment? Increased willingness 10 2.5 0.062 No change 57 14.3 Decreased willingness 138 34.5 Slight willingness 149 37.3 Moderate willingness 46 11.5

Orthodontic treatment extends beyond the correction of dental malocclusion; it significantly influences multiple facets of a patient's life, including emotional well-being, social interactions13. Beyond aligning teeth and enhancing facial aesthetics, orthodontic therapy often brings about profound changes in an individual’s psychological state & social experiences. Understanding these psychosocial dimensions is essential for providing holistic orthodontic care. For many, the decision to undergo treatment is influenced by concerns related to self-image, confidence, and societal perceptions of dental aesthetics. The emotional impact of orthodontic treatment is particularly notable, especially among adolescents and young adults. Many patients experience an initial decline in self-esteem due to visible appliances such as braces or aligners14. However, over time, as dental alignment improves, a corresponding enhancement in self-image and psychological confidence is often observed. Studies have shown that the perceived improvement in dental aesthetics can reduce social anxiety and increase willingness to engage in public or professional settings. Emotional responses can also vary based on the duration of treatment, discomfort, and individual coping mechanisms15,16. Many patients, especially adolescents and young adults, experience self-consciousness or embarrassment due to crooked or misaligned teeth. This can lead to reduced confidence and reluctance to smile or speak freely When treatment begins, patients may feel self-conscious about wearing visible orthodontic appliances (e.g., metal braces). Some may worry about how others perceive them, which can temporarily lower self-esteem, particularly in social settings like school or work. Most patients adapt to the appliances within weeks or months. As they begin to see early improvements, their confidence often grows despite the temporary inconvenience Initial periods of adjustment often involve discomfort or pain, which may hinder concentration and productivity, particularly in academic or workplace environments17,18. Moreover, the time commitment required for regular orthodontic appointments may disrupt schedules, adding to the treatment burden. Social relationships are another area where orthodontic treatment exerts considerable influence19,20. While some individuals may feel self-conscious about wearing braces or other appliances, especially in social gatherings, others adapt quickly and are motivated by the anticipated outcomes21. The visibility of appliances can sometimes lead to teasing or negative attention, especially among school-aged patients, affecting their willingness to interact socially. Conversely, post-treatment phases often witness a significant boost in self-confidence, fostering greater social engagement. When patients feel heard and understood, they are more likely to adhere to treatment plans and express concerns22. Braces can affect speech temporarily, and some individuals may avoid social interaction to hide perceived imperfections or avoid teasing. In some social groups, especially among teenagers, braces are common and socially accepted, which can reduce stigma. However, teasing or bullying can occur, particularly if orthodontic appliances are very noticeable or if hygiene is neglected. Social media can influence how patients perceive themselves. Positive portrayals of orthodontics (e.g., influencers sharing their “braces journey”) can provide encouragement, while unrealistic beauty standards may do the opposite. These dimensions shall provide valuable insights that go beyond mechanical success, helping practitioners enhance the overall patient experience and improve treatment strategies through empathetic and responsive care. Furthermore, the social dimension of a person’s life—such as interactions with peers, colleagues, or strangers—may be altered due to perceived or actual changes in speech, appearance, or confidence levels

Orthodontic treatment has far-reaching effects beyond dental correction. Emotional health and social experiences are intricately tied to the treatment process, underscoring the need for patient-centred orthodontic care. Strengthening the therapeutic alliance while addressing the psychosocial aspects of treatment, can lead to improved outcomes and enhanced patient satisfaction.

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