Download Evaluation of Malocclusion Pattern and Dentofacial Characteristics

10.5005/jp-journals-10021-1181
ORIGINAL ARTICLE
Oommen Nainan et al
Evaluation of Malocclusion Pattern and
Dentofacial Characteristics in Orthodontically
Referred Urban Indians
1
Oommen Nainan, 2Sukhbir Singh Chopra, 3Rajat Mitra, 4Dashrath R Basannar
ABSTRACT
Introduction: With the observed increase in number of Indian patients seeking orthodontic treatment, a number of investigators have reported on
the prevalence of malocclusion and need for orthodontic treatment.
Aim: The aim of this study was to analyze the pattern of malocclusion and dentofacial characteristics among the patient population, who were
presented for orthodontic treatment at a tertiary care dental establishment, providing free treatment.
Materials and methods: All patients aged 7 years and above who visited the Division of Orthodontics and Dentofacial Orthopedics, of a tertiary
care dental establishment for orthodontic consultation and orthodontic patients presently undergoing orthodontic treatment, were included in the
study. Pretreatment orthodontic records of a total of 688 patients were obtained.
Statistical analysis: Descriptive statistics were calculated to find the means and standard deviations. Chi-square tests were used to determine
the possible gender differences and to find the association between the skeletal and Angle’s Classes. The dental health component (DHC) of the
index of orthodontic treatment need (IOTN) was determined to obtain an idea of the distribution of the IOTN grades.
Results and conclusion: Prevalence of malocclusion was found to be 86.5% with Angle’s Class I malocclusion being more prevalent as
compared to the other types of malocclusion. Increased overjet in 81.5% of subjects was the major occlusal finding. This study has tried to
highlight a number of factors which play an important role in making the decision to start orthodontic treatment and may provide a base line data
for planning orthodontic services to policy makers and orthodontists with implications on the provision of care and the use of limited resources.
Keywords: Pattern of malocclusion, Dentofacial characteristics, Angle’s classification, Orthodontic services.
How to cite this article: Nainan O, Chopra SS, Mitra R, Basannar DR. Evaluation of Malocclusion Pattern and Dentofacial Characteristics in
Orthodontically Referred Urban Indians. J Ind Orthod Soc 2013;47(4):328-334.
INTRODUCTION
The demand for orthodontic treatment is increasing in most
countries,1 Well-aligned teeth not only contribute to the health
of the oral cavity and stomatognathic system, but also influence
the personality of an individual. Malocclusion compromises
the health of oral tissues and also can lead to psychological
and social problems. A systematic and well organized dental
1
Surgeon Lieutenant Commander, 2Colonel, Associate Professor
Colonel, 4Scientist E
1
Graded Specialist, Department of Orthodontics and Dentofacial
Orthopedics, Naval Institute of Dental Sciences, INHS Asvini Campus
Colaba, Mumbai, Maharashtra, India
2
Department of Orthodontics and Dentofacial Orthopedics, Department
of Dental Sugery, Armed Forces Medical College, Pune, Maharashtra
India
3
Commanding Officer, Department of Orthodontics, 3 Corps Dental Unit
C/O 99 APO, India
4
Department of Community Medicine, Armed Forces Medical College
Pune, Maharashtra, India
3
Corresponding Author: Oommen Nainan, Surgeon Lieutenant
Commander, Graded Specialist, Department of Orthodontics and
Dentofacial Orthopedics, Naval Institute of Dental Sciences, INHS Asvini
Campus, Colaba, Mumbai, Maharashtra, India, Phone: +91-9869860710
e-mail: [email protected]
Received on: 30/12/11
Accepted after Revision: 7/4/12
328
care program for any target population in a community requires
some basic information, such as the prevalence of the
condition. While numerous features can describe the
occlusion and position of teeth, difficulties in the definition
of criteria and the standardization of examiners have made
reliable assessments of dentofacial characteristics difficult.2
A possible solution is breaking ‘tooth position’ down into
discrete characteristics like crowding/spacing, molar
relationship, individual tooth malpositions and using indices
of occlusion.3
A large number of studies on the prevalence of malocclusion in different ethnic groups have been investigated;
including Caucasian,4 Italian,5 non-Hispanic black,6 nonHispanic white,7 Amerindian1 and Nigerian.8 The prevalence
of malocclusion has been reported to vary from 11 to
93%.2,9,10 Although many studies have been reported on
prevalence of malocclusion in different populations, a review
of literature shows that only few studies have evaluated
malocclusions in the referred population so as to plan and
develop the treatment modalities based upon the pattern of
the malocclusion and their frequencies of occurrences.11-13
The assessment of the severity of the malocclusion in
relation to orthodontic treatment need would be important to
policy makers and orthodontists with implications on the
provision of care and the use of limited resources.14 It will
JIOS
Evaluation of Malocclusion Pattern and Dentofacial Characteristics in Orthodontically Referred Urban Indians
also facilitate in assessing the appropriate resources required,
such as manpower, skill, time, facilities and materials.
As there is a lack of statistical data on malocclusions in
this particular geographical area, this study was conducted in
the city of Pune, a cosmopolitan city in Western India. The
aim of this study was to analyze the pattern of malocclusion
and dentofacial characteristics among the patient population,
who presented for orthodontic treatment at the Division of
Orthodontics at a tertiary care dental establishment. The
objective of the study was to provide quantitative information
regarding the pattern of malocclusion and dentofacial
characteristics in a sample of urban Indian orthodontic patients
and to find the frequencies of Angle’s Classes and other
dentofacial characteristics along with the gender differences,
if any.
MATERIALS AND METHODS
This cross-sectional study included orthodontic patients
presently undergoing treatment and those who visited the
Division of Orthodontics at a tertiary care dental establishment
of a government teaching institution providing free treatment.
All patients who met the following inclusion criteria were
included: (i) All patients who visited for consultation during
the period from July to Dec 2010, (ii) age—07 years and above,
(iii) orthodontic patients with complete pretreatment records
and undergoing orthodontic treatment. Subjects with history
of orthodontic treatment or reconstructive/orthognathic
surgery or those with a history of craniofacial deformity or a
syndrome or a history of pharyngeal surgery were excluded
from analysis. Also patients with incomplete records were
excluded. Data collection was based on written case records,
dental study models, cephalometric radiographs and orthodontic photographs of those patients presently undergoing
treatment and clinical examination and cephalometric
radiographs of those patients presenting for treatment.
Based on the above selection criteria, pretreatment
orthodontic records of 688 patients were obtained and used
for the study. This sample of 688 records of orthodontic
patients included 419 females and 269 males with a mean age
of 12.6 ± 2.8 years. Data was collected from the patients after
taking due consent from the patients/guardians. An orthodontic
assessment of occlusion and dentofacial characteristics was
carried out in all subjects by a single investigator. The
individual traits of malocclusion and dentofacial characteristics, including sagittal molar relationship, posterior
crossbite, overjet, overbite, crowding and spacing of upper
and lower arches, habits, temporomandibular joint problems,
centric occlusion and centric relation discrepancy, facial type,
facial profile and facial asymmetry were assessed in this mixed
sample of Indian orthodontic patients. The measurements on
study models were made with a digital caliper to the nearest
millimeter. Findings were classified as per following criteria:
Sagittal molar relationship was classified as Class I,
Class II Division 1, Class II Division 2 and Class III. All
occlusal relationships were evaluated at a centric occlusion
position which was achieved by asking the subject to swallow
and then to bite on his or her teeth. Children with Class I molar
relationship, minimal overbite and overjet, proper alignment
and minimal crowding were classified as normal. Patients that
deviated from the Class I relationship (including crowding,
spacing, rotation and abnormal overjet and overbite) were
categorized as Class I malocclusion.15 Therefore, the Class I
normal category was limited to patients with ideal or near ideal
occlusions. Patients with a different Angle classification of
occlusion on each side were categorized into a single class
based on the predominant pattern of occlusion and/or canine
relationship. The incisor classification was described on the
basis of British Standard Classification of Incisor
relationship.16 Posterior crossbite was evaluated assessing
transversal relationship of the upper and lower premolar and
molar teeth.
Overjet, the distance between the edge of the upper central
incisor and the labial surface of the lower central incisor, was
measured in millimeters. The overjet between 1.1 and 3 mm
were considered normal, greater than 3 mm was considered
increased, and less than 1 mm was taken as edge-to-edge. The
term negative overjet was used if both the left and right
maxillary central incisors were in palatal occlusion.1,8,10
Overbite, the perpendicular distance from the edge of the
central lower incisor to the upper central incisor edge, was
measured in millimeters and considered as normal between
0 and 3 mm. Greater than 3 mm was considered as deep bite,
less than 0 mm as open bite.1,8,10,17 Surplus space in the upper
and lower dental arches exceeding 2 mm was considered as
spacing.10,17 Crowding of upper and lower arches was measured
in millimeters and considered as no crowding between 0 and
2 mm, mild crowding between 2.1 and 4.0 mm, moderate
crowding between 4.1 and 7.0 mm and severe crowding more
than 7 mm.10,17 Also, the chief complaint, habits, temporomandibular joint (TMJ) problems, centric occlusion and
centric relation (CO/CR) discrepancy, facial type, facial
profile and any facial asymmetry (frontal facial asymmetry,
nose deviation and/or chin deviation) were taken into
consideration.
The Dental Health Component of the index of orthodontic
treatment need (IOTN) was determined based on the study
casts to obtain an idea of the distribution of the IOTN grades
within this orthodontic population.18
The radiographs were examined by two investigators. To
check for the diagnostic reproducibility of interreliability of
the two examiners, 10% of the radiographs were examined in
random order, daily for 3 consecutive days assigned by them.
Examination of results with the Wilcoxon matched-pairs
signed rank test showed no statistically significant differences
between the two observers, indicating diagnostic reproducibility. In addition, 10% of the remaining radiographs were
selected at random and reevaluated twice by the same examiner
6 weeks after the first evaluation. Intraexaminer reproducibility
was found to be 95 and 90% respectively.
The Journal of Indian Orthodontic Society, October-December 2013;47(4):328-334
329
Oommen Nainan et al
Calculation of descriptive statistics was done to estimate
the means and standard deviations. Chi-square tests were used
after cross tabulations of dentofacial characteristics with
Angle’s Classes to evaluate for TMJ problem, facial type,
asymmetry, facial profile, CO/CR discrepancy, crowding,
spacing, overjet, overbite and crossbite. Chi-square tests were
also used to determine the possible gender differences and to
find the association and Cramer’s V for correlation between
the skeletal and Angle’s classes. The p-value less than or equal
to 0.05 was considered statistically significant. The data were
analyzed using the statistical package for social sciences
software (SPSS version 10.0) and Excel 2007.
RESULTS
Since, no special patient-referral system exists in India, it was
found that about 85% of the patients/parents took the initiative
themselves for seeking consultation at this department. The
proportion of males to females in the overall sample was 1:1.5.
Out of 688 patients, 419 (60.9%) were females. Ages of
the patients ranged from 9 years and 1 month to 26 years and
6 months with mean age of 12 years and 6 months. The age
distribution of patients is shown in Figure 1. The chief
complaints in majority of the patients were ‘forward placed
upper front teeth’ and ‘crooked and malaligned teeth’ as
described in Figure 2.
The study showed that 86.5% of the subjects surveyed had
malocclusion. Since, the results indicated no statistically
significant differences of dentofacial characteristics between
the genders, the data collected were pooled to determine
frequencies. The distribution of the malocclusions according
to Angle’s and incisor classification is presented in Table 1.
The prevalence of Class I, Class II Division 1, Class II Division
2 and Class III malocclusions was 49.9, 43.3, 2.7 and 4.1
respectively. Angle’s Class I (49.9%) and incisor Class I
(53.3%) were typical features of the sample while the
prevalence of Angle’s Class II Division 2 malocclusion (2.7%)
and Class III malocclusion was the least (4.1%).
A total of 8.7% of patients presented with some types of
habits with the most common being thumb sucking (4.2%).
Prevalence of oral habits in the total population is shown in
Figure 3. The major occlusal finding was an increased overjet
in 561 (81.5%) of all patients examined with the maximum
prevalence of mild overjet (34.7%) between 2 and 3 mm.
Normal overjet was found in 127 (18.5%) subjects. The
prevalence of the reverse/negative overjet was found to be
2.6%. Increased overbite was recorded in 75.7% of the
patients. The prevalence of open bite was 6.7%. Crossbite was
observed in 97 (14.1%) of the subjects examined (Table 2).
Fig. 1: Age distribution of patients
Fig. 2: Chief complaints of the patients. Others: Lower jaw/teeth forward
(12), noneruption of upper canine/s (11), TMJ pain (11), lower lip touches
the upper gums (10), reverse bite (10), prominent upper canine (10),
rabbit teeth (9), out of alignment lower canine (6), lack of incisor show (5)
Fig. 3: Prevalence of oral habits
Table 1: Distribution of sample by Angle’s and incisor classification
Angle’s classification
Class I
Class II division 1
Class II division 2
Class III
330
n = 688 (n%)
343 (49.9)
298 (43.3)
19 (2.7)
28 (4.1)
Incisor classification
n = 688 (n%)
Class I
Class II division 1
Class II division 2
Class III
367 (53.3)
274 (39.9)
19 (2.7)
28 (4.1)
JIOS
Evaluation of Malocclusion Pattern and Dentofacial Characteristics in Orthodontically Referred Urban Indians
When it was unilateral, it was more commonly found on the
right than left side.
Most patients had orthognathic (49.4%) and normodivergent profiles (82.4%). The hypodivergent (6.0% of the
sample) and retrognathic profile (47.7% of the sample) mainly
existed in Class II patients, i.e. 12 and 69.7% respectively (Table
3). In this study, it was found that 526, i.e. 76.4% subjects had a
crowding of 1 mm or more in the upper and lower dental arches.
Increased spacing in the upper and lower dental arches was
detected in 162 (23.5%) subjects. Increased spacing in maxillary
arch was found in Class II malocclusion group. (Table 2).
Midline diastema was observed in 83 (12.1%) of the patients.
Statistically significant associations were observed
between facial profile sagittal (p < 0.01), facial profile vertical
(p < 0.01), spacing in maxilla (F2 = 13.1, df = 3, p = 0.004),
overjet (F2 = 220.99, df = 4, p = 0.000001), overbite (F2 =
123.01, df = 6, p = 0.000001) and Angle’s classes (Tables 2
and 3).
Statistically significant association was observed between
Angle’s and skeletal classes (F 2 = 208.27, df = 4,
p = 0.000001) whereas weak correlation was observed
between the two (Cramer’s V = 0.389, p < 0.0001) (Table 4).
In the present study, a clear need for orthodontic treatment
was found in 67% of the cases, according to the Dental Health
Table 2: Cross tabulations of occlusal characteristics with Angle's classes
Occlusal characteristics
Class I
343 (49.9%) (n%)
Class II
317 (46.0%) (n%)
Class III
28 (4.1%) (n%)
Total
688 (n%)
0 (0)
7 (25)
7 (25)
0
14 (50)
29 (4.2)
106 (15.4)
203 (29.5)
188 (27.3)
526 (76.4)
Crowding (mm)
0-1 normal
2-3 mild
4-6 moderate
>7 severe
Total
14 (4.1)
51 (14.9)
107 (31.1)
96 (28.0)
268 (78.1)
15 (4.7)
48 (15.1)
89 (28.1)
92 (29.0)
244 (76.9)
Spacing (mm)
0-1 normal
2-3 mild
4-6 moderate
> 7 severe
Total
7 (2.1)
32 (9.3)
30 (8.8)
6 (1.7)
75 (21.9)
5 (1.6)
42 (13.3)
24 (7.6)
2 (0.6)
73 (23.1)
2 (7.1)
7 (25)
5 (17.9)
0
14 (50)
14 (2.1)
81 (11.8)
59 (8.5)
8 (1.2)
162 (23.6)
Overjet (mm)
1-2 normal
3-4 mild
5-6 moderate
> 7 severe
Reverse
93 (27.1)
176 (51.3)
54 (15.8)
11 (3.2)
9 (2.6)
23 (7.3)
55 (17.4)
101 (31.8)
136 (42.9)
2 (0.6)
11 (39.3)
7 (25)
3 (10.7)
0
7 (25)
127 (18.5)
238 (34.7)
158 (22.8)
147 (21.4)
18 (2.6)
Overbite (mm)
0-2 normal
3-4 moderate
5-7 severe
> 7 extreme
Reverse
Open bite
107 (31.2)
163 (47.5)
34 (9.9)
17 (5.0)
0
22 (6.4)
53 (16.7)
107 (33.8)
85 (26.8)
53 (16.7)
0
19 (6.0)
7 (25)
6 (21.4)
3 (10.7)
0
7 (25)
5 (17.9)
167 (24.3)
276 (40.1)
122 (17.7)
70 (10.2)
7 (1.0)
46 (6.7)
37 (10.8)
54 (17.3)
6 (21.4)
97 (14.1)
Crossbite
Table 3: Cross tabulations of dentofacial characteristics with Angle’s classes
Dentofacial characteristics
Class I
343 (49.9%) (n%)
TMJ
Facial asymmetry
Pain or clicking
Facial profile—sagittal
Facial profile—vertical
Class II
317 (46.0%) (n%)
Class III
28 (4.1%) (n%)
Total
688 (n%)
2 (0.6)
7 (2.1)
17 (5.4)
27 (8.5)
8 (28.6)
6 (21.4)
27 (3.9)
40 (5.8)
Orthognathic
Retrognathic
Prognathic
231 (67.3)
105 (30.6)
7 (2.1)
94 (29.7)
221 (69.7)
2 (0.6)
15 (53.6)
2 (7.1)
11 (39.3)
340 (49.4)
328 (47.7)
20 (2.9)
Normodivergent
Hyperdivergent
Hypodivergent
283 (82.5)
57 (16.6)
3 (0.9)
266 (83.9)
13 (4.1)
38 (12.0)
18 (64.3)
10 (35.7)
0
567 (82.4)
80 (11.6)
41 (6.0)
11 (3.2)
17 (5.4)
3 (10.7)
31 (4.5)
CO/CR discrepancy
Table 4: Cross tabulation of Angle’s and skeletal classes
Skeletal classes
Skeletal Class I
Skeletal Class II
Skeletal Class III
Angle’s classes
Total (n = 688) (n%)
Class I (n%)
Class II (n%)
Class III (n%)
213 (62.1)
115 (33.5)
15 (4.4)
88 (27.8)
229 (72.2)
0
15 (53.6)
2 (7.1)
11 (39.3)
The Journal of Indian Orthodontic Society, October-December 2013;47(4):328-334
316 (45.9)
346 (50.3)
26 (3.8)
331
Oommen Nainan et al
Component (DHC) of the IOTN. Based on the analysis of the
688 study casts, a mean DHC grade of 3.8 was calculated.
DISCUSSION
Clinical evidence suggests that there is an increase in the
demand for orthodontic treatment in India. Studies have
indicated that the prevalence of malocclusion in India varies
from 20 to 43%.19 National surveys carried out in India have
shown that the children aged 12 and 15 years are the most
important population subgroups for estimating the prevalence
of malocclusion, since it is at this age that the clinical
diagnosis of the type and extent of malocclusion is best made
and active treatment recommended which can lead to successful outcomes.20 Many variables (including age differences of
the study populations, examiner subjectivity, specific
objectives and differing sample sizes) complicate efforts to
understand and appreciate the differences recorded in patterns
of malocclusion between ethnic groups.1,21
This was a prospective epidemiological survey carried out
at the orthodontic department of a tertiary care dental
establishment. A number of variables for evaluating the pattern
of malocclusion in a hospital setup have been incorporated
for the first time in an Indian study. The population of this
study is similar to that found in other surveys of orthodontic
patients in terms of gender distribution, prevalence of molar
relationship and need for orthodontic treatment.11-13 The
orthodontic population itself might be a very useful population
for specific orthodontic treatment-related analysis, as has been
previously reported.22 However, in view of the biased nature
of the sample, the data of this orthodontic population cannot
be extrapolated to the whole of the Indian population.
Specifically, these populations are expected to have a greater
prevalence of malocclusions. However, data such as these can
act as a pointer to the prevalence of these malocclusions and
dentofacial characteristics in the population.
Qualitative and quantitative methods may be used for
recording and measuring malocclusion while an occlusal index
quantifies the severity or the extent to which a malocclusion
deviates from the normal or ideal.16,23 Angle’s classification
of malocclusion with or without modifications is probably
the most universally accepted system that is reliable and
repeatable, among the qualitative methods of recording
malocclusion.24 Angle’s classification has been used in this
study since it is a fairly easy and rather accurate way of trying
to categorize malocclusions and is globally used in dental
profession notwithstanding the fact that it has been the topic
of many discussions in the literature.24,25 Since, the prevalence
of different types of malocclusions may show great variability
even in a population of the same origin,26 the selection criteria
for individual traits for malocclusion used in this study was
collected from the studies published in different geological
regions and contemporary populations.1,5,8,21
Age range of 10 to 15 years showed highest frequency of
malocclusion than other groups, among which females
332
(60.9%) seeking orthodontic treatment were approximately
twice than the males. This could be related to the increased
parental concern or higher self-consciousness for esthetics
in younger age group. Increased response of the females when
compared to males could be because of higher esthetic concern
of girls than boys and also due to social or matrimonial reasons.
The high percentage of urban patients seeking orthodontic
consultation can be attributed to the heightened media
awareness made available through newspapers, TV, radio and
oral health awareness programs.
In the present study, class I malocclusion was found to be
the most prevalent occlusal pattern and constituted the major
proportion of malocclusion, which is in agreement with other
studies.27,28 No studies exist in the Indian literature regarding
evaluation of the pattern of malocclusion in a hospital setup.
However, a study carried out among school children in Delhi,
which was one of the largest in terms of sample size, reported
that malocclusion was present in 36.6% of the total sample
with mild malocclusion comprising 16.9% of the sample and
those with moderate to severe malocclusion being 19.6%.29
A study carried out in Mumbai observed the prevalence of
malocclusion in the sample as Class I (68%), Class II Division
I (28%), Class II Division 2 (2.4%) and Class III (0.8%).30 In
the present study, the occurrence of Class III malocclusion
was found to be the least, similar to that reported in previous
studies. The differences between the prevalence of
malocclusions might be related to the material and racial
differences.1,31 However, international literature has reported
Class II malocclusion as more frequent than Class I and III
malocclusion in Asians.32
The results showed an increased overjet in 81.5% of the
subjects as a major occlusal finding, with an increased
frequency and severity in Class II patients. This trend in overjet
values is in agreement with the earliest surveys of orthodontic
population.8,11,33
Increased overbite was recorded in 75.7% of the patients.
A deep bite was more frequent than an anterior open bite and
was often associated with a Class II malocclusion. The
prevalence of subjects who presented with > 1 mm of anterior
open bite was 6.7%, in accordance with previous studies.34
Posterior crossbite was registered in 14.1% of the subjects
which is within the global reported range between 8 and 16%.
The great majority were unilateral and often associated with
forced guidance and mandibular midline deviation. One
explanation for the high rates of crossbite in the present study
might be due to the evaluation of subjects accepted for
orthodontic treatment and due to the material difference. In
this study, a total of 8.7% of patients were presented with
some types of habits with the most common being thumb
sucking (4.2%). The relative prevalence of oral habits in
school-going children in India has been reported to be as low
as 3% in rural children of Ambala (North India) to as high as
25.5% in Delhi and 29.7% in Mangalore (South India).28,35,36
The reasons for these inconsistent values of the previous
reports might be attributed to different methods used for
JIOS
Evaluation of Malocclusion Pattern and Dentofacial Characteristics in Orthodontically Referred Urban Indians
assessment of oral habits, different populations examined, ages
and socioeconomic status of the population involved. Our
findings do not agree with the observations of previous studies
that tongue thrusting and mouth breathing were the commonest
habits in an Indian population. Differences may be a result of
variation in clinical recording of a tongue thrust habit, which
may vary according to the experience and calibration of the
clinician/survey personnel. It was observed in this study that
mouth breathing and lip biting were the least common oral
habits with prevalence of 0.7 and 1.3% respectively.
The prevalence of maxillary midline diastema (12.1%), in
the present study, was very close to that reported in an earlier
study (9.86%).37 The results of the study showed that most
patients had orthognathic (49.4%) and normodivergent
profiles (82.4%). Class III patients showed a predominantly
hyperdivergent profile while the hypodivergent, retrognathic
profile mainly existed in Class II patients. This agrees with
previous reports that the hypodivergent pattern was dominant
in Class II and III malocclusions.38 The statistically significant
correlation observed between Angle’s and skeletal classes
(Cramer’s V = 0.389, p < 0.0001) indicates that although
Angle’s classification of malocclusion is based on
anteroposterior relationship of the maxillary and mandibular
first molars during maximum intercuspation, it can also be
utilized for clinically evaluating skeletal sagittal relationship.
In the present study, the need for orthodontic treatment
was estimated according to the Dental Health Component
(DHC) of the IOTN. As far as treatment, no treatment need or
borderline cases (IOTN grades 1-3) were found in 33% of the
cases, whereas need for treatment (IOTN grades 4-5) was noted
in 67% of the malocclusions. As far as the need of treatment
in different populations and cultures, there are usually several
levels of treatment need based on socio-economic and/or
ethnic differences. Thus, orthodontic treatment need should
be understood as a relative concept and, when expressed as a
single figure, is not easily comparable between different
cultures.
This study has tried to highlight a number of factors which
play an important role in making the decision to start
orthodontic treatment. This decision is based on certain
aspects of the malocclusion. According to the present study,
the following characteristics are positively correlated with
the decision to start orthodontic treatment: The major occlusal
finding was an increased overjet followed by crowded
anteriors, protruded maxillary incisors, anterior deep overbite,
anterior and posterior crossbite, midline deviation in upper
and lower jaw and retrognathic facial profile in descending
order. Though statistically significant association was observed
between Angle’s and skeletal classes, weak correlation was
observed between the two.
This study for the first time has incorporated a number of
variables while evaluating pattern of malocclusion in a hospital
setup. Differences in malocclusion characteristics, both within
India and between India and other countries, would be expected
because of differences in racial and ethnic composition.
Results cannot be representative of the whole of the Indian
population and thus there is expected to be a varying degree
of prevalence of malocclusion features and dentofacial
characteristics. The epidemiological data on the prevalence
of malocclusion is an important determinant in planning
appropriate levels of orthodontic services and further studies
are required to provide accurate estimates of the orthodontic
treatment need in Indian population. The overall prevalence
rate of malocclusion in the present group of subjects was high.
This data can provide a base for planning the preventive
strategies in eradicating the contributory factors and thus
reduce the occurrence of malocclusion traits, further
contributing in the rise of national level of oral health.
CONCLUSION
From this hospital-based study, the following conclusions have
been drawn:
1. Most of the urban Indian patients who requested clinical
consultation regarding their malocclusion belong to an age
group ranging from 9 to 26 years.
2. Prevalence of malocclusion was found to be 86.5%.
3. Angle’s Class I malocclusion was more prevalent as
compared to the other types of malocclusion.
4. There was no statistically significant gender difference
among the subjects studied.
5. Out of the entire dentoalveolar problems studied, increased
overjet was found to be the most common feature.
6. Angle’s classification of malocclusion can also be utilized
for clinically evaluating skeletal sagittal relationship.
7. Need for treatment (IOTN grades 4-5) was noted in 67%
of the malocclusions.
Identifying occlusal problems, their incidence and the need
for treatment can help to determine the appropriate treatment
plan and manpower needed in orthodontics. The prevalence
of malocclusion is high, a reason to continue training
professionals to care for those patients in need of treatment.
A nationwide survey with well-distributed sample size
considering different ethnic groups of India is recommended
for planning orthodontic services for the people of India.
REFERENCES
1. Thilander B, Pena L, Infante C, Parada SS, de Mayorga C.
Prevalence of malocclusion and orthodontic treatment need in
children and adolescents in Bogota, Colombia. An epidemiological
study related to different stages of dental development. Eur J
Orthod 2001;23:153-67.
2. Williams G, Bruyne DI, Verdonck A, Fieuws S, Carels C.
Prevalence of dentofacial characteristics in a Belgian orthodontic
population. Clin Oral Invest 2001;5:220-26.
3. Van Kirk LE. Assessment of malocclusion in population groups.
Am J Public Health 1959;49:1157-63.
4. Kerosuo H. Occlusion in the primary and early mixed dentitions
in a group of Tanzanian and Finnish children. ASDC J Dent Child
1990;57:293-98.
5. Ciuffolo F, Manzoli L, D’Attilio M, Tecco S, Muratore F, Festa F,
et al. Prevalence and distribution by gender of occlusal
characteristics in a sample of Italian secondary school students:
A cross-sectional study. Eur J Orthod 2005;27:601-06.
The Journal of Indian Orthodontic Society, October-December 2013;47(4):328-334
333
Oommen Nainan et al
6. Otuyemi OD, Ogunyinka A, Dosumu O, Cons NC, Jenny J.
Malocclusion and orthodontic treatment need of secondary school
students in Nigeria according to the dental aesthetic index (DAI).
Int Dent J 1999;49:203-10.
7. Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of
selected occlusal characteristics in the US population, 1988-1991.
J Dent Res 1996;75:706-13.
8. Onyeaso CO. Prevalence of malocclusion among adolescents in
Ibadan, Nigeria. Am J Orthod Dentofacial Orthop 2004;126:
604-07.
9. Vig KW, Fields HW. Facial growth and management of
orthodontic problems. Pediatr Clin North Am 2000;47:1085-123.
10. Gelgör IE, Karaman AI, Ercan E. Prevalence of malocclusion
among adolescents in central anatolia. Eur J Dent 2007;1:125-31.
11. Jones BW. Malocclusion and facial types in a group of Saudi
Arabian patients referred for orthodontic treatment: A preliminary
study. Br J Orthod 1987;14:143-46.
12. Rose JS. A thousand cases: A survey. Br J Orthod 1974;1:45-54.
13. Yang WS. The study on the orthodontic patients who visited
Department of Orthodontics, Seoul National University Hospital.
Taehan Chikkwa Uisa Hyophoe Chi 1990;28:811-21.
14. Shaw WC, Richmond S, O’Brien KD, Brook P, Stephens CD.
Quality control in orthodontics: Indices of treatment need and
treatment standards. Br Dent J 1991;170:107-12.
15. Angle E. Classification of malocclusion. Dental Cosmos
1899;41:248-64.
16. Tang EL, Wei SH. Recording and measuring malocclusion: A
review of the literature. Am J Orthod Dentofacial Orthop
1993;103:344-51.
17. Sidlauskas A, Lopatiene K. The prevalence of malocclusion among
7-15-year-old Lithuanian schoolchildren. Medicina (Kaunas)
2009;45:147-52.
18. Brook PH, Shaw WC. The development of an index of orthodontic
treatment priority. Eur J Orthod 1989;11:309-20.
19. Sureshbabu AM, Chandu GN, Shafiulla MD. Prevalence of
malocclusion and orthodontic treatment needs among 13-15-year
old school going children of Davangere city, Karnataka, India. J
Indian Assoc Public Health Dent 2005;6:32-35.
20. National oral health survey and fluoride mapping 2002-2003. Dental
Council of India, New Delhi, India; 2004.
21. Silva RG, Kang DS. Prevalence of malocclusion among Latino
adolescents. Am J Orthod Dentofacial Orthop 2001;119:313-15.
22. Al Yami EA, Kuijpers-Jagtman AM, van’t Hof MA. Orthodontic
treatment need prior to treatment and 5 years postretention.
Community Dent Oral Epidemiol 1998;26:421-27.
334
23. Keski-Nisula K, Lehto R, Lusa V, Keski-Nisula L, Varrela J.
Occurrence of malocclusion and need of orthodontic treatment in
early mixed dentition. Am J Orthod Dentofacial Orthop
2003;124:631-38.
24. Brin I, Weinberger T, Ben-Choirin E. Classification of occlusion
reconsidered. Eur J Orthod 2000;22:169-74.
25. Du SQ, Rinchuse DJ, Zullo TG. Reliability of three methods of
occlusion classification. Am J Orthod Dentofacial Orthop
1998;113:463-70.
26. Sayin MO, Türkkahraman H. Malocclusion and crowding in an
orthodontically referred Turkish population. Angle Orthod 2004;74:
635-39.
27. Das UM, Venkatsubramanian, Reddy D. Prevelance of
malocclusion among school children in Bangalore, India. Int J Clin
Ped Dent 2008;1(1):10-12.
28. Guaba K, Ashima G, Tewari A, Utreja A. Prevalence of
malocclusion and abnormal oral habits in North Indian rural
children. J Indian Soc Pedod Prev Dent 1998;16:26-30.
29. Kharbanda OP, Sidhu SS, Sundaram KR, Shukla DK. Prevalence
of malocclusion and its traits in Delhi children. J Indian Orthodontic
Soc 1995; 26(3):98-103.
30. Shaikh HS. Frequency of various types of malocclusion. J Indian
Acad Dent 1960; 3: 43-55.
31. Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion
and orthodontic treatment need in the United States: Estimates
from the NHANES III survey. Int J Adult Orthodon Orthognath
Surg 1998;13: 97-106.
32. Soh J, Sandham A, Chan YH. Malocclusion severity in Asian
men in relation to malocclusion type and orthodontic treatment
need. Am J Orthod Dentofacial Orthop 2005;128: 648–52.
33. Harrison RL, Davis DW. Dental malocclusion in native children
of British Columbia, Canada. Community Dent Oral Epidemiol
1996;24: 217-21.
34. Hill PA. The prevalence and severity of malocclusion and the
need for orthodontic treatment in 9,12 and 15 years old Glasgow
school children. Br J Orthod 1992;19:87-96.
35. Kharbanda OP, Sidhu SS, Sundaram KR, Shukla DK. Oral habits
in school going children of Delhi: A prevalence study. J Indian
Soc Pedo Prev Dent 2003;21(3):120-24.
36. Shetty SR, Munshi AK. Oral habits in Children - a prevalence
study. J Indian Soc Pedo Prev Dent 1998;16:61-66.
37. Nainani JT, Relan S. Prevalence of malocclusion in school children
of Nagpur rural region—an epidemiological study. JIDA 2011;
5(8):865-67.
38. Siriwat PP, Jarabak JR. Malocclusion and facial morphology—is
there a relationship? An epidemiologic study. Angle Orthod 1985;
55:127-38.