Perceptions and utilization of the Index of Orthodontic Treatment Need (IOTN) among final year dental students: a qualitative study

The Index of Orthodontic Treatment Need (IOTN) is widely used to assess malocclusion severity and prioritize orthodontic treatment. However, its perception and utilization among undergraduate dental students remain unclear. This qualitative study aimed to explore the perceptions and utilization of the IOTN among 13 final-year dental students at AIMST University, Malaysia. Participants were recruited using convenience sampling, and data were collected through semi-structured interviews conducted via Zoom. The interviews were transcribed verbatim and analysed using thematic analysis until data saturation was achieved. Five main themes emerged: subjectivity in perception of criteria, neglect of patients’ psychological well-being, time-consuming application, lack of training and exposure, and potential facilitators for improvement. Although the participants acknowledged the IOTN as a valuable standardized tool, its consistent application in clinical practice was perceived to be limited by variability in interpretation and practical constraints. These findings highlight the need for improved undergraduate training, greater standardization, and the incorporation of digital technologies to enhance the reliability and clinical applicability of the IOTN. Strengthening these aspects may better prepare future dental practitioners for effective orthodontic assessment and treatment prioritization. Future research should consider multi-centre studies involving both public and private universities to improve generalisability and to better understand variations in training exposure, curriculum structure, and clinical experience across institutions.