|Year : 2019 | Volume
| Issue : 2 | Page : 86-91
Prevalence of malocclusion among female schoolchildren aged 12-15 years: Saudi Arabia
Ameera Al Qahtani1, Navin Anand Ingle2, Mansour K Assery3, Sultan S AIshamrani4
1 Department of Dental Public Health, Riyadh Elm University, Riyadh, Saudi Arabia
2 Program Director of Dental Public Health, Riyadh, Saudi Arabia
3 Vice Rectorate of Post Graduate Studies and Scientific Research, Riyadh Elm University, Riyadh, Saudi Arabia
4 Department of Restorative, Riyadh Elm University, Riyadh, Saudi Arabia
|Date of Web Publication||29-Apr-2019|
Ameera Al Qahtani
Department of Dental Public Health, Riyadh Elm University, Riyadh
Source of Support: None, Conflict of Interest: None
Aim: The aim of the study is to assess the prevalence of malocclusion and orthodontic treatment needs among 12–15-year-old female schoolchildren of Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional descriptive survey was conducted among 500 female students aged 12–15 years. The prevalence of malocclusion and orthodontic treatment needs was assessed using occlusal traits based on the FDI/World Health Organization objective method. General information on demographic data was also recorded. Descriptive statistics was done to check discrepancies and consistencies. Results: Malocclusion and orthodontic treatment need were reported in this study. Twenty-three percent of participants had 2 mm and more diastema. The majority of participants had Class 1 relation with molar, incisor, and canine. Around 18.8% of participants had over 1/3 overlap, 12.9% had anterior open bite, and 11.9% had posterior over bite (unilateral and bilateral). Posterior crossbite on the right and left sides was present in 19.6% and 16.1% of participants, respectively. Scissor bite on the right and left sides was present in 11.5% and 12.8% of participants, respectively. Around 8.4% of participants had maxillary overjet over 4 mm. Reverse overjet was present in 14.8% of participants. Conclusions: There is a prevalence of malocclusion among the age group of 12–15 years in the KSA. This study can be used as a standard to implement school-based oral health awareness programs which are needed in the KSA.
Keywords: Malocclusion, orthodontic need, schoolchildren
|How to cite this article:|
Al Qahtani A, Ingle NA, Assery MK, AIshamrani SS. Prevalence of malocclusion among female schoolchildren aged 12-15 years: Saudi Arabia. J Int Oral Health 2019;11:86-91
|How to cite this URL:|
Al Qahtani A, Ingle NA, Assery MK, AIshamrani SS. Prevalence of malocclusion among female schoolchildren aged 12-15 years: Saudi Arabia. J Int Oral Health [serial online] 2019 [cited 2019 Dec 6];11:86-91. Available from: http://www.jioh.org/text.asp?2019/11/2/86/257362
| Introduction|| |
Dental malocclusion is present in all societies, but its prevalence varies in different parts of the world among various populations. Ethnic, genetic, and environmental factors lead to development of malocclusion.
Identifying occlusal problems and the need for treatment can help determine the appropriate awareness plans, preventive and interceptive treatment, and task force needed in orthodontics.
According to the World Health Organization (WHO), the main oral diseases should be subjected to periodic epidemiological surveys in malocclusion. It is the second most common dental disorder in children and young adults next to dental caries.
Malocclusion is “any deviation from normal occlusion of teeth.” The teeth are in abnormal position in relation to the basal bone of the alveolar process, to the adjacent teeth, and to the opposing teeth. There are many methods available to classify occlusion, both quantitatively and qualitatively, whereby qualitative variables define only the presence or absence of a trait. Angle's method is the most popular qualitative epidemiological tool used for assessing malocclusion; hence, we have adopted the Angle's method of classification, which not only describes malocclusion but also divided into further classes, which is practical and easier to use. According to Angle, “occlusion is the normal relation of the occlusal inclined planes of the teeth when the jaws are closed.” Malocclusion is considered to be a dental public health problem. The interest and awareness in dental health have increased considerably over the last few years.
The prevalence of malocclusion during the mixed dentition period in Saudi children was reported. Despite the amount of literature on the subject, no study, to the best of our knowledge, was done across a significant geographically and ethnically identical Saudi female children in Central Region (Riyadh city); however, one study in the Saudi Arabia population, “Prevalence of Malocclusion and Need for Orthodontic Treatment in Saudi Arabia,” was reported.
The purpose of this study was to determine the prevalence of malocclusion among 12–15-year-old female schoolchildren in Riyadh City.
| Materials and Methods|| |
A cross-sectional descriptive study was conducted among 12–15-year-old schoolchildren of Riyadh City, Saudi Arabia. A group of 500 Saudi female schoolchildren, representing those age ranged between 12 and 15 years, were selected randomly from governmental and private schools. For the study, these schools were categorized into five sections according to the geographical location of different parts in Riyadh City. These were Central (two schools), Eastern (two schools), Western (two schools), Northern (two schools), and Southern (two schools). A full clinical examination was carried out in the school premises using a dental examination kit.
A multistage stratified random sampling technique was used in selecting the schools. All intermediate schools in each governorate were listed and allocated numbers. Inclusion criteria were parents and child are originally from Saudi, child's age between 12 and 15 years, child born and lived in the included area, and healthy children. Exclusion criteria were uncooperative children, children or parents refuse to participate in the study, children with incomplete examination, current oral health of a child that contraindicates examining his/her acute dental pain or abscess, oral mucosal diseases, and craniofacial anomalies (clefts and syndromes), who are undergoing or had a history of orthodontic treatment, extracted of permanent teeth, and impaction and delayed eruption permanent teeth in children.
Ethical approval was officially obtained from the Scientific and Ethics Committee, Riyadh Colleges of Dentistry and Pharmacy. After approval, Riyadh Colleges of Dentistry and Pharmacy sent official letters to the relevant authorities (Ministry of Education and others) to justify the purpose and importance of conducting the study, to explain the safety of the procedures, to confirm the confidentiality of data collected, and to confirm that the participation is voluntary. Parents of the targeted children were contacted officially through signed letters, in which the study purpose, procedures, data confidentiality, and voluntary participation were stated and explained simply. Blank area in these letters to be filled by the parents agreement and signs. Similarly, targeted children, whose parents provided consent, were verbally informed about the study purpose and procedures. Any child need dental treatment were referred to the Faculty of Dentistry, Riyadh Colleges of Dentistry and Pharmacy for treatment.
Information in the study forms were transferred into a spreadsheet and were subsequently entered into the SPSS software version 18 (PASW Statistics for Windows, SPSS Inc, Chicago). Descriptive statistics were generated to check discrepancies and consistencies in the overall data.
| Results|| |
- General and personal information
A total of 500 female children aged between 12 and 15 years were examined.
- Occlusal traits based on the FDI/WHO objective method:
a. Dental discrepancies
[Table 1] and [Table 2] show dental discrepancies in permanent and deciduous teeth. In both permanent and deciduous teeth, maxilla had more dental discrepancies than mandible. In permanent teeth, the second molar was the most affected tooth; and in deciduous teeth, the canine was most affected.
b. Space discrepancies
1. Maxillary diastema
Near one-fourth (23%) of participants had 2 mm and more diastema [Table 3]. Overall, crowding/spacing was higher in maxilla (33.2%) than mandible (29.7%). Of the 33.2% in maxilla, 26.3% had <2 mm and 6.9% had 2 mm and more spacing/crowding. Of the 29.7% in mandible, 24.4% had <2 mm and 5.3% had 2 mm and more spacing/crowding [Figure 1].
c. Anteroposterior occlusal relationship
The distribution of molar relationship (right and left), incisor relationship, and canine relationship (right and left) is shown in [Figure 2], [Figure 3], [Figure 4], respectively. The majority of participants had Class I molar, canine, and incisor relationship.
- Molar relationship
- Incisor relationship
- Canine relationship.
d. Vertical occlusion relationship
2. Anterior openbite
3. Posterior openbite.
Around 18.8% of participants had over 1/3 overlap [Figure 5], 12.9% had anterior open bite [Figure 6], and 11.9% had posterior overbite (unilateral and bilateral) [Figure 7].
e. Transversal occlusion relationship
Posterior crossbite on the right and left sides was present in 19.6% and 16.1% of participants, respectively. Scissor bite on the right and left sides was present in 11.5% and 12.8% of participants, respectively [Table 4]. Around 8.4% of participants had maxillary overjet over 4 mm [Figure 8].
- Posterior crossbite and scissor bite
- Overjet and crossbite.
- Maxillary overjet
- Reverse overjet
- Anterior crossbite.
Reverse overjet was present in 14.8% of the participants [Figure 9]. Distribution of anterior crossbite is shown in [Figure 10]. The majority of participants had no crossbite, followed by 10.2% having crossbite in one tooth and 6.9% in two teeth.
Only 8.7% of participants had good oral hygiene, 44.1% fair, and 47.2% bad [Figure 11]. Distribution of frequency of toothbrush is shown in [Figure 12]. Near half (47.2%) of participants brushed once daily, followed by 32.4% twice and 13.2% never brushed.
| Discussion|| |
Various studies have been reported in different countries describing the prevalence of malocclusion among different age groups and sex.,, Few studies have been conducted across the Kingdom of Saudi Arabia with different inclusion criteria., The present study includes only females of age group 12–15 years. The simplest method to record malocclusion has been adapted in this study by the determination of the total frequency of malocclusion and the need for orthodontic treatment.
In the present study, dental discrepancies were found in both mandible and maxilla, with the permanent and deciduous teeth of the maxilla having more dental discrepancies than mandible. In permanent teeth, the second molar was the most affected tooth; among deciduous teeth, canine was most affected. This can be compared to a study conducted in India in 2013, which reported that, among the dental anomalies, 10.5% of the study population had one or more missing anterior teeth either in maxilla or in mandible. This finding can also be related to finding of previous studies.,,
In the present study, it was observed that 73.8% of participants had Angle's Class I occlusion, 21.5% had Class II occlusion, and 4.8% had Class III occlusion. The study showed the higher prevalence of Angle's Class I occlusion and lower prevalence of Angle's Class III occlusion. This finding supports that the most prevalent malocclusion was Angle's Class I, followed by Angle's Class II, whereas the least prevalent malocclusion was Class III. This result can be compared to a study conducted in Riyadh in 2015 among 12–16-year-old schoolchildren, which found that 60.11% and 54.13% of Saudis presented Class I molar and canine malocclusions, respectively. There was a low prevalence of Class II and Class III molar and canine malocclusions.
Moreover, earlier studies conducted in the Kingdom of Saudi Arabia had findings similar to the present study, reporting that the most common type of malocclusion in the Saudi population was Class I followed by Class II division 1 and Class III., Another study conducted in 2009 in Tanzania showed that the majority (93.6%) of children showed a Class I molar relationship. Class II and Class III malocclusions were registered in 4.4% and 2% of participants, respectively. This is also in comparison to the present study. A study conducted in Nigeria in 2004 reported that 50% of participants had Class I malocclusions, 14% had Class II malocclusions, and 12% had Class III malocclusions. These findings are similar to the present study.
The prevalence of reduced overjet in this study of 0–4 mm was seen among 91.6%, 5–8 mm overjet was seen among 6.4%, and increased overjet of more than 8 mm was reported among 2% of participants. The findings are in comparison to a study in India, which reported that 64.1% of participants had normal overjet (<3 mm) and 23.2% had an increased overjet (>3 mm). Reverse overjet was found among 14.8% of participants in this study, which was higher than a previous study, which reported a small percentage (4.2%). Another study reported 24.7% increased overjet in 13–15-year-old Jordanian schoolchildren, which was also close to the findings in the present study.
This study found 23% of participants with 2 mm and more diastema. A study conducted in Karachi in 2014 reported similar findings, with the prevalence of diastema found to be 21.4%. In the present study, crowding/spacing was higher in maxilla with 33.2% than mandible with 29.7%. Around 26.3% of participants had <2 mm and 6.9% had 2 mm and more spacing/crowding in the maxilla and 24.4% had <2 mm and 5.3% had 2 mm and more spacing/crowding in the mandible. A study conducted in India in 2015 reported that the prevalence of moderate spacing was more in maxilla than mandible, which was found in accordance with our study.
This study found that the majority of participants had no crossbite, 10.2% crossbite was found in one tooth, and 6.9% in two teeth. This was similar to a study in Nairaobi where anterior crossbite was found in a small percentage of 6.2% children. In the present study, it was recorded that 11.9% of participants had posterior over bite (unilateral and bilateral) and 12.9% had anterior open bite (unilateral and bilateral). A recent study conducted reported that over bite was found to be 25.5%, which was almost similar to the present study. However, the prevalence of open bite was found to be 0.68%, which was much lower than the present study.
In the present study, it was found that only 8.7% of participants had good oral hygiene, 44.1% fair, and 47.2% bad. Only 47.2% of participants brushed once daily, followed by 32.4% twice and 13.2% never brushed. In a study in India, in 2013, it was found that 64% of participants (12 years of age) brushed once a day. This finding is different from the present study. The frequency of brushing decreased dental caries prevalence and severity of gum diseases. The difference in practice may be due to more awareness of dental hygiene among the school students.
| Conclusions|| |
It can be stated that this result confirms that there is a prevalence of malocclusion among the age group of 12–15 years old in the KSA. This study having included only female schoolchildren in this age range sets it apart from most of the studies conducted worldwide on this topic where usually both the male and female schoolchildren are included. The results obtained in this study can be used as a standard to implement school-based oral health awareness programs which are needed in the KSA.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9], [Figure 10], [Figure 11], [Figure 12]
[Table 1], [Table 2], [Table 3], [Table 4]