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RAJIV GANDHI UNIVERSITY OF
HEALTH SCIENCES.
BANGALORE, KARNATAKA.
MASTER OF DENTAL SURGERYPUBLIC HEALTH DENTISTRY 2013
A.E.C.S. MAARUTI COLLEGE OF DENTAL
SCIENCES AND RESEARCH CENTRE,
NO. 108, HULIMAVU TANK BUND ROAD,
KAMMANAHALLI,
BANGALORE-560076.
RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
KARNATAKA, BANGALORE
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1.
NAME OF THE
Dr. NEHA MITTAL,
CANDIDATE
A.E.C.S MAARUTI COLLEGE OF DENTAL SCIENCES
AND ADDRESS
AND RESEARCH CENTER,
No 108, TANK BUND ROAD, HULIMAVU, BANGALORE76
2.
3.
4.
NAME OF THE
A.E.C.S MAARUTI COLLEGE OF DENTAL SCIENCES,
INSTITUTION
108, TANK BUND ROAD, HULIMAVU, BANGALORE-76
COURSE OF STUDY AND
MASTER OF DENTAL SURGERY-PUBLIC HEALTH
SUBJECT
DENTISTRY.
DATE OF ADMISSION
27-07-2013
Malocclusion, perceived aesthetic impact of malocclusion
5.
TITLE OF THE TOPIC
and quality of life among young adults aged 18-22 years in
Bangalore city: A comparative study between dental and
non-dental students.
6.BRIEF RESUME OF THE INTENDED WORK:
6.1 NEED FOR THE STUDY
Malocclusion represents an important health problem worldwide. Malocclusion affects not
only oral function and appearance, but it also has economic, social, and psychological effect1.
Malocclusion can be considered as public health problem due to its high prevalence and
prevention/treatment possibilities. A number of studies have been demonstrated its impact on quality of
life and it has been considered the third highest oral health priority by the World Health Organization2.
Malocclusion has potential to influence self perceived appearance especially during this
phase of life when there is intense social and affective interaction. For young people physical
attractiveness is an important factor affecting social relationships3. Forty–one percent of the
adolescents considered it is easier to get a job if they wore orthodontic appliances 2. Aesthetic alteration
in the face can be self perceived and can affect quality of life3. Malocclusion can also impair quality of
life by affecting function, appearance, interpersonal relationships, socializing, self-esteem and
psychological well-being4. At least one oral impact on quality of life was reported by 88% of the
adolescents, and 98.3% of subjects showed some level of psychological impact of dental esthetics1.
Perception of dental appearance is rather complex. A variety of social, psychological and
personal factors influence the self perception of dental appearance and the decision to undergo
orthodontic treatment. These include gender, age, peer group norms, level of education, social class,
personality, attitude, culture, standards of reference and value systems5. Adolescents & adults tend to
be strongly concerned about their body image, and body image plays an important role in
psychological and social adjustment and educational success1. Individual with severe malocclusion
showed 88.0% higher prevalence[ prevalence ratio=1.88] of poor aesthetic self perception compared to
those who had minor malocclusion status3.
Perception can be subjective and is therefore liable to errors. These perception error have
been demonstrated in two directions, individual tend to either overestimate or underestimate the degree
of severity of their malocclusion. The demand for correction of malocclusion is therefore not equal
even those with the same severity of occlusal deviation. Self perceived treatment need has been judged
as the key to establishing treatment priority especially in public funded oral health care systems 5.
Reduced susceptibility to dental caries and trauma, periodontal disease and temporamandibular
disorders may be possible benefits of orthodontic treatment3. Patient perceptions are important
indicators of treatment needs and may complement conventional clinical measurements. Treatment
assessment requires the integration of multiple dimensions of health care, such as improvement in
quality of life and self image related to body satisfaction, effectiveness of intervention, and cost/benefit
assessments. The use of sociodental indicators allows individuals with the greatest need to be a priority
when financial resources are limited1.
6.2 REVIEW OF LITERATURE
1) NA Mandall et al conducted a study in school of Manchester, UK in 1999.A total of 434 Asian and
Caucasian children aged 14-15 years were considered for the study. It was a random stratification
sampling study. The aim was to evaluate the effect of ethnicity, social deprivation and normative
orthodontic treatment need on orthodontic aesthetic self perception, self perceived need for orthodontic
treatment and oral aesthetic impact of malocclusion .The influences of perceived oral aesthetic impact
of malocclusion on perceived need and wish for orthodontic treatment .Information was collected on
orthodontic self perception using Oral Aesthetic Subjective Impact Scale (OASIS). Normative
orthodontic treatment need was measured with the index of orthodontic treatment need (IOTN). T –test
were used for group comparison of oral aesthetic impact of malocclusion .The author concluded that
ethnicity and social deprivation were not important variables with respect to orthodontic aesthetic self
perception. Socially deprived children or those with high aesthetic need had a more negative perceived
aesthetic impact of their malocclusion8.
2) A study was conducted by Delcides F. de Paula et al in city of Golania, Goias Brazil in 2006. A
total of 301 adolescents of public school age range 13-20 years were considered for the study. It was a
cross sectional study. The aim was to test the hypothesis that several dimension of the self perceived
psychological impacts of dental esthetic are not associated with grades of malocclusion , oral health
related quality of life measures and body self image in adolescents. All children were examined and
data was collected through interview and clinical examination in which the dental aesthetic index(DAI)
was used for assessment of malocclusion and determination of orthodontic treatment needs. The short
form of oral health impact profile, the psychological impact of dental aesthetic questionnaire and the
body satisfaction scale were used to measure adolescent’s self perceived variables. The author
concluded that subjective self perception of dental esthetic in adolescents is influenced by occlusal
conditions, oral health related quality of life and self image1.
3) Leandro S Marques et al conducted a study in city of Belo Horizonte Brazil in 2007. A total of
403 school children aged 14-18 years were considered for the study .It was a cross sectional random
sampling study. The aim of study was to determine factors associated to the desire for orthodontic
treatment among Brazilian adolescents and their parents. All children were examined and data was
collected through interview and clinical examination in which self perception of dental aesthetic was
assessed using the Oral Aesthetic Subjective Impact Scale (OASIS) and Dental Aesthetic Index (DAI)
was used for clinical assessment. Statistical analysis involved the chi-square test as well as both simple
and multiple logistic regression analysis. The author concluded that upper anterior crowding > 2 mm
and parent’s perception of their child’s need for treatment were considered factors associate to the
desire for treatment2.
4)Nihal Hamamci et al conducted a study in Dicle university Diyarbakir Turkey in 2009. The sample
consist of 841 randomly selected university students aged 17-26 year were considered for the study
.the aim of this study was to investigate the relationships
between Turkish university student
awareness of malocclusion ,their satisfaction with their personal dental appearance and the severity of
their occlusal irregularities. A pretested questionnaire was used to assess the subjects awareness of
malocclusion and satisfaction with their personal dental appearance the actual severity of malocclusion
was determined using the Dental Aesthetic Index (DAI).Statistical analysis was carried out using chisquare for gender differences and spearman rank order correlation coefficients for awareness of
malocclusion, satisfaction with personal dental appearance and DAI scores. The author concluded that
age had significant effect on satisfaction and gender on DAI score variation. No significant gender
differences were found in relation to either the subject’s awareness or satisfaction6.
5) A study was conducted by Serene Adnan Badran in Amman Jordan in 2010. The study includes
385 subjects aged 14-16 years were randomly selected from 12 representative schools located in four
demographic areas of the city. The aims of this study were to evaluate the effect of normative treatment
need, perceived treatment need and the influence of self perceived need and aesthetic on self esteem.
Self esteem was measured using the Global Negative Self Evaluation Scale (GSE). The aesthetic and
Dental health component (AC and DHC) of index of orthodontic treatment need were used to assess
orthodontic treatment need. The author concluded that the use of IOTN especially AC correctly reflects
subjective treatment need and self perceived aesthetics. Student who had received orthodontic
treatment had higher self esteem than those who had not undergone treatment .dissatisfaction with
dental appearance is a strong predictors for low esteem7.
6) Dikson Claudino and JeferrsonTraebert conducted a cross sectional study in the city of Tubarao
in southern Brazilian state of Santa Catarina in 2012. A total of 138 Brazilian State of Santa Catarina in
2012. A total of 138 Brazilian army soldier’s aged 18-21 years were considered for the study. The aim
of this study was to estimate the prevalence of malocclusion, identify the most common types of
malocclusion and test the association between malocclusion and oral aesthetic self perception. Data on
malocclusion was collected through the Dental Aesthetic Index (DAI) according to WHO criteria. Data
on oral aesthetic self perception was collected through the Oral Aesthetic Subjective Impact Scale
(OASIS). The chi-square and fisher’s exact test were used to test for the relationship between poorer
oral aesthetic self perception and parents and soldier’s education, per capita income, history of caries in
all teeth and only on anterior teeth, dental trauma, previous orthodontic treatment and malocclusion.
The author concluded that a high prevalence of malocclusion was observed. The young adults who
were presenting severe malocclusion had a higher and independent prevalence of poorer oral aesthetic
self perception3.
6.3 AIM AND OBJECTIVES OF THE STUDY:
1) To estimate the prevalence of malocclusion among dental and non-dental students aged between
18-22 years.
2) To identify the most common type of malocclusion among study subjects using DAI.
3) To find out the association between type of malocclusion and its perceived oral esthetic impact on
quality of life among study participants.
4) To compare and find out the difference if exists in perceived oral esthetic impact of malocclusion
between dental and non-dental study subjects.
7. MATERIALS AND METHODS:
7.1 SOURCE OF DATA:
A total sample of
1000 dental and non-dental students aged 18-22 years of either gender
will be considered for the study. The study subjects will be randomly selected from colleges situated in
Bangalore city of 500 dental and 500 non-dental students of Karnataka state, India after obtaining prior
permission from the concerned Head of Institution and subjects who are to be examined for the study.
7.2 METHOD OF COLLECTION OF DATA / METHOD
A total of 1000 students of aged 18-22 years will be examined at the college premises. The
study subjects will be examined using a sterile mouth mirror and CPI probe. Dental Aesthetic Index
(DAI) will be used for assessment of malocclusion and Oral Aesthetic Subjective Impact Scale
(OASIS) will be used for assessment of perceived aesthetic impact of malocclusion.
All the examinations will be conducted by a single calibrated examiner and the data will
be recorded by a trained assistant accompanying the investigator.
INCLUSION CRITERIA
1) Dental and non-dental students aged 18-22 years (both male and female )
2) The eligible subjects who are not suffering from any acute infections in the oral cavity.
3) Subjects who fulfill the research criteria and ready to give the written consent to
participate will be considered for the study.
EXCLUSION CRITERIA
1) Subjects with any serious systemic and any psychological illness.
2) Subjects having dental fluorosis.
3) Subjects undergoing/undergone orthodontic treatment for the corrections of any kind of
malocclusion.
STUDY DESIGN
It is a cross sectional studies involving 1000 students 500 from dental and 500 from non-dental
students. A specially designed proforma will be used to collect information on demographic details.
STUDY DURATION
The duration for the study is estimated to be six months from the date of commencement till the
required sample is achieved.
SAMPLE TECHNIQUE: Simple Random Sampling.
SAMPLE SIZE
Sample size determination:
n = (Zα/2)2 *P*(1-P)*D / E2
n = number of participants
P = prevalence / proportion
D =design effect. This is taken as 1.
E = error
Zα/2 = confidence interval
If, p = 45% = 0.45
E = 10% P = 0.10 x 0.45 = 0.045
According to the above given formula, the values are:
n = (1.96)2 x 0.45 x (1- 0.45) x 1 = 475
(0.045)2
Considering non-response rate and sample loss due to attrition, minimum sample size needed would be
n=500 for each study area.
In the present study 1000 eligible subjects will be considered for inclusion in the
investigation.
Methodology:
The present study is a cross-sectional study conducted on a sample of 1000 dental and nondental students aged 18-22 years in Bangalore city, Karnataka state, India. 500 Students from each
study group will be examined in the study. The data will be collected from different colleges until the
desired sample is attained. Before the oral examination, written informed consent will be obtained.
Data on malocclusion will collected through the Dental Aesthetic Index (DAI) according to WHO
criteria.DAI assessment includes ten parameters of Dentofacial structure related to tooth positioning
and the relationship between maxillary and mandibular arches .
Initial calibration: A single examiner (N.M) will be calibrated to apply the required
indices for the present study by the research guide at the Dept of public health dentistry till the
required kappa value is obtained for the diagnostic summary.
A pilot study will be conducted on at least 50 eligible subjects to find out the feasibility and
application of methods used in the present study protocol.
The clinical examination will be carried out using WHO Type III method of oral
examination using a sterile mouth mirror and CPI probe under adequate natural day light and when
required a battery operated torch will be used (artificial illumination), with the patient seated upright on
the ordinary chair.
Data on perceived aesthetic impact of malocclusion will be collected through the Oral
Aesthetic Subjective Impact Scale (OASIS). It consists of five questions regarding concerns on self
perceived oral appearance to be answered in a seven point LIKERT –type rating scale. This item
questionnaire will be made available both in English and Kannada (local language).
All the data collected will be subjected to statistical analysis using appropriate statistical
application as described above.
Statistical analysis:
The data collected will be analyzed statistically using ratios, means and standard deviations.
Presentation of analyzed data is made using tables, graphs and other required figures.

Chi-square test and Fischer’s exact test will be used.

Any other suitable statistical methods if needed, at the time of data analysis will be
considered.
7.3 Does the study require any investigation or interventions to be conducted on patients or other
humans or animals? If so please describe briefly.
No, only WHO type III examination, using a mouth mirror and a CPI probe under adequate
light will be done.
7.4 Has the ethical clearance obtained from your institution in case of 7.3
Yes Ethical clearance has been obtained from the ethical committee of AECS Maaruti College of
Dental Sciences and Research Centre, Bangalore.(Ref.No.AECS/MDC/161/2013-2014).
8. LIST OF REFERENCES:
1) Delcides F.de paula, Nadia C.M. Santos, E´ rica T. da Silva, Maria de Fatima Nunes, Claudio R.
Leles. Psychosocial Impact of Dental Esthetics on Quality of Life in Adolescents. Angle Orthodontist
2009,Vol 79,No 6: 1188-1193.
2) Leandro S Marques, Isabela A Pordeus, Maria L Ramos-Jorge, Cid A Filogônio, Cintia B Filogônio,
Luciano J Pereira and Saul M Paiva . Factors associated with the desire for orthodontic treatment
among Brazilian adolescents and their parents. BMC Oral Health 2009, 9:34.
3) Dikson Claudino and Jefferson Traebert. Malocclusion, dental aesthetic self-perception and quality
of life in a 18 to 21 year-old population: a cross section study. BMC Oral Health 2013, 13:3.
4)Yaghma Masood, Mohd Masood, Nurul Nadiah Binti Zainul, Nurhuda Binti Abdul Alim Araby,Saba
Fouad Hussain and Tim Newton. Impact of malocclusion on oral health related quality of life in
young. people Health and Quality of Life Outcomes 2013, 11:25.
5) Kikelomo Adebanke Kolawole, Olusegun Oluseun Ayeni, Vivien Ijeoma Osiatuma . Evaluation of
self-perceived dental aesthetics and orthodontic treatment need among young adults. Arch Oral Res.
2012 May/Aug,8(2): 111-19.
.
6) Nihal Hamamci, Güvenç Ba ş aran and Ersin Uysal. Dental Aesthetic Index scores and perception
of personal dental appearance among Turkish university students. European Journal of Orthodontics
2009, 31:168–173.
7) Serene Adnan Badran. The effect of malocclusion and self-perceived aesthetics on the self-esteem of
a sample of Jordanian adolescents. European Journal of Orthodontics 2010,32:638–644.
8 ) N.A. Mandall, J.F.McCord, A.S.Blinkhorn, H.V.Wotthington and K.D. O’Brien. Percieved
aesthetic impact of malocclusion and oral self –perception in 14-15 year old Asian and Caucasian
children in Greater Manchester. European Journal of Orthodontics 1999,21:175-183
9. REMARKS OF THE The present research topic is clinically relevant and results of the
GUIDE
study would help to understand malocclusion, perceived aesthetic
impact of malocclusion among young adults.
10. NAME AND DESIGNATION OF (IN BLOCK LETTERS)
10.1 GUIDE:
10.2 SIGNATURE:
Dr. H. L. JAYAKUMAR.
PROFESSOR & HEAD OF THE DEPARTMENT,
DEPARTMENT OF PUBLIC HEALTH DENTISTRY,
A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES AND
RESEARCH CENTRE, BANGALORE-76.
10.3 HEAD OF THE
DEPARTMENT
10.4 SIGNATURE
11. REMARKS OF THE
PRINCIPAL
11.1 SIGNATURE OF
THE PRINCIPAL
Dr. H. L. JAYAKUMAR,
PROFESSOR & HEAD OF THE DEPARTMENT,
DEPARTMENT OF PUBLIC HEALTH DENTISTRY,
A.E.C.S. MAARUTI COLLEGE OF DENTAL SCIENCES AND
RESEARCH CENTRE, BANGALORE-76.