|Year : 2020 | Volume
| Issue : 2 | Page : 129-134
The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study
Department of Preventive Dental Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
|Date of Submission||04-Aug-2019|
|Date of Acceptance||15-Oct-2019|
|Date of Web Publication||28-Mar-2020|
Dr. Fahad Alharbi
Department of Preventive Dental Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj 11942.
Source of Support: None, Conflict of Interest: None
Background: Malocclusion is one of the most prevalent dental problems. The prevalence of malocclusion differs globally among various populations. It is essential to estimate its prevalence in order to allocate proper resources for preventive strategies and intervention plans. Aim: This study aimed to evaluate the status of malocclusion among school children in Al Kharj city, Saudi Arabia. Materials and Methods: This is a cross-sectional study. A group of 680 school children in Al Kharj city, Saudi Arabia, aged 11–14 years participated in the study. The occlusal parameters recorded in this study were molars relationship, overbite, crowding, midline diastema, anterior open bite, anterior crossbite, and posterior crossbite, using gloves, light source, mouth mirror, and ruler. Results: A Class-I molars relationship was observed in 84.9% of the total sample, whereas Class-II and -III molars relationships were observed in 9% and 6.2%, respectively. Normal overbite was found in 87.1%. The most widespread orthodontic problem was crowding (40.3%), followed by midline diastema (29.6%). A posterior crossbite was found in 3.8% of the sample, whereas 11.76% had an anterior crossbite. Conclusion: Crowding has the highest level of frequency among orthodontic problems. Class I, normal overjet, and normal overbite were frequent findings among Saudi adolescents in Al Kharj city.
Keywords: Angle’s Classification, Malocclusion, Occlusal Traits
|How to cite this article:|
Alharbi F. The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study. J Int Oral Health 2020;12:129-34
|How to cite this URL:|
Alharbi F. The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study. J Int Oral Health [serial online] 2020 [cited 2020 May 28];12:129-34. Available from: http://www.jioh.org/text.asp?2020/12/2/129/281486
| Introduction|| |
Although orthodontic treatment is an elective treatment, it has been claimed that it provides benefits to the patient in four domains: a reduction in dental caries susceptibility, improved dental health, and reduced temporomandibular dysfunction (TMD) and traumatic dental injury. Nevertheless, these claims are not supported by evidence. The World Health Organization (WHO) stated that orthodontic treatment’s main benefit is the improved self-esteem of the patients and their greater quality of life. Nonetheless, many authors have ascertained the functional benefits of orthodontic treatment in terms of improving mastication in cases such as anterior open bite and enhancing the acceptability of better oral hygiene.
The prevalence of malocclusion varies among different investigations. Many factors contribute to this, including the time of the study, the geographic area, and the criteria used for the sample selection such as age and gender. For example, Profitt reported that 57–59% of the Americans had at least some degree of orthodontic treatment need, whereas in the UK the percent was 59.9% and 92% in Jordan. In Saudi Arabia, it was reported that 40%–62.4% of the population had some degree of orthodontic treatment need.,,
It is imperative, when planning large-scale health-care activities, to obtain an updated estimation of the prevalence of active diseases to enable policy makers to set priorities and allocate resources for prevention and early intervention if needed. Also, such information provides guidance on the need to train orthodontists to meet the public demand for orthodontic treatment.
The number of individuals who are seeking orthodontic treatment has risen in Saudi Arabia in the last two decades because of the increased knowledge of the benefits of orthodontic treatment in regards to self-esteem.,, Although some orthodontic treatment is provided by government-funded orthodontic departments, the vast majority is provided in the private sector., The mismatch between the demand for orthodontic treatment by the public and the capacity to provide the treatment free of charge by the governmental hospitals created a gap that is filled by private orthodontic clinics.
The aim of this study was to estimate the prevalence of malocclusion traits among the Saudi adolescents in Al Kharj city, Saudi Arabia, in order to provide an epidemiological reference for intervention and prevention of the occurrence of malocclusion.
| Materials and Methods|| |
This epidemiological cross-sectional study was undertaken in eight governmental schools in Al Kharj city which is located 80 km from Riyadh and has 376,325 habitants. The sample comprised 680 schoolchildren with a mean age of 12.3 years (standard deviation [SD] ± 1.0) ranging from 11 to 14 years of age. The study was conducted from January 2018 to April 2018 as a part of the dental awareness campaign performed by final-year undergraduate students.
The nature of the study is descriptive analysis. Stratification by age, gender, or socioeconomic status was not applied. Sample size was made by enrolling all the students in this study by a convenience sampling technique. Sample size calculation was performed assuming the prevalence of malocclusion to be 23% based on a previous study. In total, 500 subjects will be appropriate to detect statistically significant difference of 5% and 80% power for subgroup analysis.
All subjects were Arabic descendants and with no history of orthodontic treatment. The subjects who had developmental anomalies, such as ectodermal dysplasia, cleft lip or palate, and Down syndrome, were excluded from the study. Parents and guardians were notified about the activity by school administrations with the option of excluding their children data.
Method of examination and observational parameters
A dental examination was carried out after all of the infection control measures were undertaken and each case was examined using a pair of disposable gloves, a mask, and a disposable examination kit.
The data were collected by four experienced dentists from the College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia, who were fully trained and calibrated by an experienced orthodontist with a correlation of more than 0.7, which was considered acceptable.
The malocclusion traits in the dental examination were predefined and included the following: occlusal relationship, crowding, spacing and midline diastema, overjet, overbite and open bite, and crossbite, as shown in [Table 1].
| Statistical Analysis|| |
Data were recorded on a Microsoft Excel 2015 spreadsheet computer program (Microsoft, Redmond, WA). The Statistical Package for the Social Sciences software version 22.0 (SPSS, Chicago, IL) was used for the analysis. Descriptive statistics of the malocclusion traits were reported.
| Results|| |
A group of 680 male subjects met the inclusion criteria; the average age was 12.3 years (SD ± 1.0) with no withdrawals from the study. The overall distribution of the malocclusion traits is presented in [Table 2].
|Table 2: The distribution of different malocclusion traits in the sample of 680 schoolchildren|
Click here to view
According to the results, 84.9% of the students had a Class-I molars relationship, 9% a Class II, and only 6.2% a Class III [Figure 1]. Thirty percent of the schoolchildren had midline diastema and 40.3% had some degree of crowding. [Table 2] represents the distribution of midline diastema, in which 70% had no midline diastema, 29.6% had 1–2 mm midline diastema, and only 0.4% had a midline diastema between 2 and 3 mm. In total, 1.76% of the sample had an open bite. Normal overbite was found in 87.1% of the students and 13.53% showed an increased overbite. A posterior crossbite was found in 3.8% of the sample and 11.76% had an anterior crossbite. According to Index of treatment need –aesthetic component, 17.94% showed no need or a mild need for treatment [Figure 2], whereas 39.12% and 42.94% showed a moderate and severe need for treatment, respectively. [Table 2] shows the distribution of malocclusion traits in the 680 schoolchildren.
|Figure 1: The distribution of malocclusion in schoolchildren aged 11–14 in Al Kharj|
Click here to view
| Discussion|| |
This cross-sectional study is the first study to the best of the author’s knowledge to look at the prevalence of malocclusion traits in Al Kharj city. The study included participants aged 11–14 years in which the malocclusion during adolescence had a negative impact on psychological well-being and interpersonal relationships and associated with bullying and a lower level of self-esteem among teenagers., The findings of this study revealed an increase in the orthodontic treatment need; hence, it is necessary to offer information to the public policy makers who implement future plans to accommodate the demand for orthodontic treatment in terms of funding for orthodontic departments and training dental and orthodontic practitioners. Currently, most orthodontic treatment is provided by the private sector,, although funded treatment is provided by the public sector. The regulations regarding eligibility criteria for treatment in public funding orthodontic departments should be revised to ensure that these departments provide treatment to patients who need it the most.,,, Also, the introduction of fees for treatment in publically funded orthodontic departments, with exemptions for those who cannot afford them, might help to ensure the better allocation of financial and manpower resources.
The findings of this study show that a Class-I molars relationship is more prevalent than a Class-II and -III molars relationship. Similar figures were found in other cities in Saudi Arabia,[7-9],,[16-26] and other countries in the Middle East.,[27-29] Interestingly, the reported figures of malocclusion traits differed from those reported in this study and retrospective studies performed on dental models retrieved from academic orthodontic departments and hospital orthodontic departments. For example, Aldress reported that 57.47% of 602 dental casts of patients attending King Saud University in Riyadh had a Class-I molars relationship, whereas Aljundi and Riba reported that 23.33% in a sample of 510 dental models at the National Guard Hospital in Riyadh had Class-I molars relationship. However, 84.9% of the public schoolchildren in Al Kharj had a Class-I molars relationship. This variation could be explained by the fact that their samples were selected from patients seeking orthodontic treatment who are more inclined to have Class-II and -III molars relationships as compared with the general population.
Another finding in this study is that more than three-quarters of the selected sample of schoolchildren in Al Kharj showed a moderate-to-severe need for orthodontic treatment. That was more than what was reported in Jeddah, which may be because of the variation in the sample or because of examiner subjectivity.
As the results show, crowding was the most common orthodontic problem in the selected sample, in which 40.3% had some degree of crowding. In other cities, crowding was in a range between 26.6% and 74%.,,,,[21-23],, Also, midline diastema was found in a third of the current sample, which was similar to Albarakati and Al-Dlaigan’s finding in their investigation that included 1,825 schoolchildren in Riyadh aged 12–16 years. Similarly, anterior crossbite was found in 11.76% of the sample, whereas, in other cities, anterior crossbite ranged from 2.80% to 22.30%.,,,[18-21],,
Posterior crossbite was found in less than 4% in this study, whereas other studies performed in public schools in the other cities reported prevalence ranging from 3% in Jeddah to 21.4% in Makkah., Anterior open bite prevalence found in adolescents in Al Kharj was the least prevalent malocclusion trait (1.76%) in comparison with other studies, which reported prevalence ranging from 4% to 7.20%.,,,[18-21],,[Table 3] presents a comparison between the prevalence of malocclusion traits in Al Kharj and other cities in Saudi Arabia. The variation between the reported figures could be attributed to the true variation between the population, the variation in the methods of measurements, or examiner subjectivity.
|Table 3: The prevalence of malocclusion in different cities in Saudi Arabia (%)|
Click here to view
The findings of this study are limited by the sample size and recording methods used for malocclusion. Ideally, larger samples are needed to estimate more precise figures for the prevalence of malocclusion traits. Also, a more clear-cut stratification of the selected samples based on several factors such as gender, socioeconomic status, and age would be suggested to evaluate the influence of these factors on the extent to which different groups of people are concerned with their appearances. Similarly, using dental casts and radiographic records would provide more objective findings. Also, it would provide a more valid archive of the collected data on which future research and policy planning can build.
| Conclusion|| |
Class I has the highest percentage of the prevalence of malocclusion among Saudi adolescents in Al Kharj aged 11–14 years in comparison with Class II and Class III. Also, crowding is the most prevalent orthodontic problem. The presented information of this study can be used to plan future investigations in which larger samples are included in order to formulate preventive measures and to meet the orthodontic treatment need in Al Kharj city.
Data availability statement
Data set is available at the preventive Dental Sciences Department, the College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
Ethical policy and institutional review board statement
This study was approved by the College of Dentistry, Prince Sattam Bin Abdulaziz University Al Kharj, Saudi Arabia (academic year 2017–2018). The approval was obtained from the Ministry of Education via schools’ administrations.
The author would like to thank Drs. MG Inderjit, BS Rajashekhara, George Sam, and Narendra Varma for their support and advice in this project.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Burden DJ. Oral health-related benefits of orthodontic treatment. Semin Orthod 2007;13:76-80.
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 Orthod Orthognath Surg 1998;13:97-106.
Foster TD, Day AJ. A survey of malocclusion and the need for orthodontic treatment in a Shropshire school population. Br J Orthod 1974;1:73-8.
Abu Alhaija ES, Al-Khateeb SN, Al-Nimri KS. Prevalence of malocclusion in 13-15 year-old north Jordanian school children. Community Dent Health 2005;22:266-71.
Al‐Emran S, Wisth PJ, Böe OE. Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:253-5.
Haralur SB, Addas MK, Othman HI, Shah FK, El-Malki AI, Al-Qahtani MA. Prevalence of malocclusion, its association with occlusal interferences and temporomandibular disorders among the Saudi sub-population. Oral Health Dent Manag 2014;13:164-9.
Nashashibi I, Darwish SK, Khalifa El R. Prevalence of malocclusion and treatment needs in Riyadh (Saudi Arabia). Odontostomatol Trop 1983;6:209-14.
Alhummayani FM, Taibah SM. Orthodontic treatment needs in Saudi young adults and manpower requirements. Saudi Med J 2018;39:822-8.
Al-Jobair AM, Baidas LF, Al-Hamid AA, Al-Qahtani SG, Al-Najjar AT, Al-Kawari HM. Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh. Clin Cosmet Investig Dent 2016;8:121-9.
Hassan AH. Orthodontic treatment needs in the western region of Saudi Arabia: A research report. Head Face Med 2006; 2:2.
Gudipaneni RK, Aldahmeshi RF, Patil SR, Alam MK. The prevalence of malocclusion and the need for orthodontic treatment among adolescents in the northern border region of Saudi Arabia: an epidemiological study. BMC Oral Health 2018;18:16.
Shaw WC, Addy M, Ray C. Dental and social effects of malocclusion and effectiveness of orthodontic treatment: A review. Community Dent Oral Epidemiol 1980;8:36-45.
Cunningham SJ, Hunt NP. Quality of life and its importance in orthodontics. J Orthod 2001;28:152-8.
Bindayel NA. Awareness of orthodontic modalities and preference of appliance and payment options in Saudi Arabia. Saudi J Oral Sci 2018;5:98. [Full text]
Dawoodbhoy I, Delgado-Angulo EK, Bernabé E. Impact of malocclusion on the quality of life of Saudi children. Angle Orthod 2013;83:1043-8.
Al-Anezi SA, Harradine NW. Quantifying plaque during orthodontic treatment. Angle Orthod 2012;82:748-53.
Albakri FM, Ingle N, Assery MK. Prevalence of malocclusion among male school children in Riyadh city. Open Access Maced J Med Sci 2018;6:1296-9.
AlBarakati SF, Al-Dlaigan YH. Maxillary midline diastema among Saudi schoolchildren in Riyadh: Prevalence and some related etiological factors. Egypt Orthod J 2011;40:41-55.
Aldrees AM. Pattern of skeletal and dental malocclusions in Saudi orthodontic patients. Saudi Med J 2012;33:315-20.
AlQarni MA, Banihuwaiz AH, Alshehri FD, Alqarni AS, Alasmari DS. Evaluate the malocclusion in subjects reporting for orthodontic treatment among Saudi population in Asser Region. J Int Oral Health 2014;6:42-6.
Alshammari DS, IqbalMian R, Al Zubaidi S, Alshammari NS, Saud A, Alenezi SK, et al
. Prevalence of Malocclusion among the Saudi Population in Ha’il City of Saudi Arabia. Can J Dent 2019;1:1.
Asiry MA. Occlusal status among 12-16 year-old school children in Riyadh, Saudi Arabia. J Int Oral Health 2015;7:20-3.
Asiry MA, AlShahrani I. Prevalence of malocclusion among school children of southern Saudi Arabia. J Orthod Sci 2019;8:2.
Jundi AA, Riba H. Pattern of malocclusion in a sample of orthodontic patients from a hospital in the Kingdom of Saudi Arabia. Savant J Med Med Sci 2015;1:014-21.
Meer Z, Sadatullah S, Wahab MA, Mustafa AB, Odusanya SA, Razak PA. Prevalence of malocclusion and its common traits in Saudi males of Asser Region. J Dent Res Rev 2016;3:99. [Full text]
Mohammed Almalky N, Mohammad Elattar H. Prevalence of different types of malocclusion among school children in Makkah Governorate of Saudi Arabia. Int J Dent Oral Sci 2018;5:645-8.
Akbari M, Lankarani KB, Honarvar B, Tabrizi R, Mirhadi H, Moosazadeh M. Prevalence of malocclusion among Iranian children: A systematic review and meta-analysis. Dent Res J (Isfahan) 2016;13:387-95.
Behbehani F, Artun J, Al-Jame B, Kerosuo H. Prevalence and severity of malocclusion in adolescent Kuwaitis. Med Princ Pract 2005;14:390-5.
Bugaighis I, Karanth D. The prevalence of malocclusion in urban Libyan schoolchildren. J Orthod Sci 2013;2:1-6.
Haltiwanger LH, Blakey GH, Proffit WR. Who seeks surgical-orthodontic treatment: A current review. The International Journal of Adult Orthodontics and Orthognathic Surgery2000.
Fatani NH, Hammam MB, Hana’a Oraif ST, Taju W. & Bukhari O. Prevalence of malocclusion among schoolchildren in Makkah, Saudi Arabia. Open Access Macedonian Journal of Medical Sciences 2019;7:856.
[Figure 1], [Figure 2]
[Table 1], [Table 2], [Table 3]