|Year : 2019 | Volume
| Issue : 6 | Page : 384-387
Prevalence of malocclusal traits among 6–9-year-old male schoolchildren in Rass, Saudi Arabia
Zeyad A Alsughier
Department of Orthodontics and Pediatric dentistry, Pediatric dentistry division, College of Dentistry, Qassim University, Almulida, Qassim, Kingdom of Saudi Arabia
|Date of Web Publication||26-Nov-2019|
Dr. Zeyad A Alsughier
Department of Orthodontics and Pediatric Dentistry, Pediatric Dentistry Division, College of Dentistry, Qassim University, Almulida, Qassim.
Kingdom of Saudi Arabia
Source of Support: None, Conflict of Interest: None
Aims and Objectives: The aim of this study was to assess the prevalence of malocclusal traits among male schoolchildren aged 6–9 years in Rass, Saudi Arabia. Materials and Methods: A descriptive cross-sectional study was conducted among randomly selected 304 male children in Rass, Qassim Province, Saudi Arabia. The molar relationships were recorded using Angle’s classification system and other occlusal traits, such as overjet, overbite, and crossbite, based on the methods of Bjoerk et al. for registration of malocclusion in centric occlusion. Descriptive statistics were used to check occlusal discrepancies and a chi-squared test was used to compare the malocclusion prevalence in three different age groups. Results: The frequencies of Angle’s Class I, Class II, and Class III molar relationships were 81.91%, 11.18%, and 6.91%, respectively. A total of 85.86% cases had normal overjet, whereas 90.13% of cases had normal overbite. The most prevalent malocclusion of the participants was increased overjet in 9.21%, followed by deep bite in 5.92%, deficient overjet in 4.93%, posterior crossbite in 3.95%, anterior open bite in 3.95%, and an anterior crossbite in 2.96%. No statistically significant difference was found age wise. Conclusion: The most frequent findings among Saudi male schoolchildren in the early mixed dentition were Class I molar relationship, normal overbite, and normal overjet. The most prevalent malocclusion trait was increased overjet followed by deep bite. Therefore, it is important to take children for an early orthodontic assessment.
Keywords: Early mixed dentition, malocclusion, orthodontics, prevalence
|How to cite this article:|
Alsughier ZA. Prevalence of malocclusal traits among 6–9-year-old male schoolchildren in Rass, Saudi Arabia. J Int Oral Health 2019;11:384-7
|How to cite this URL:|
Alsughier ZA. Prevalence of malocclusal traits among 6–9-year-old male schoolchildren in Rass, Saudi Arabia. J Int Oral Health [serial online] 2019 [cited 2021 Jul 27];11:384-7. Available from: https://www.jioh.org/text.asp?2019/11/6/384/271783
| Introduction|| |
Malocclusion is considered to have an impact on oral health and esthetic appearance of teeth. It has been found that excessive overjet in children has a negative effect on their quality of life. In the early mixed dentition stage, children with specific malocclusal traits tend to have more problems related to teeth in the future. Early management of nonskeletal and skeletal orthodontic discrepancies in the primary and early mixed dentition is planned to avoid the development of pronounced discrepancies in the late mixed and permanent dentition aiming to reduce or even eliminate the need for late orthodontic management. Orthodontists vary in the application of early interceptive orthodontic measures for the removal of factors interfering with normal development and growth of both dental arches. There is still considerable controversy surrounding early versus late orthodontic interventions where some research shows the early treatment being effective and desirable, whereas others show the late treatment. Studies investigating the incidence of malocclusion in the primary and early mixed dentition achieve very divergent results. Thus, it is not easy to draw a scientific conclusion about the efficiency of early orthodontic intervention.
However, early orthodontic treatment has been found to have a significant effect on the child’s psychosocial and masticatory functions. Anterior crossbites that cause traumatic occlusion and damage to the lower incisors, posterior crossbites that affect function, and an anterior open bite that results in unesthetic appearance and masticatory dysfunction are some of the main occlusal anomalies that need early treatment. Furthermore, prevention of traumatic injuries to the maxillary incisor teeth of patients with severe Class II malocclusion division I is another reason for early orthodontic treatment.
Numerous research studies have been carried among different populations to assess the prevalence of malocclusion. The reported incidence in different populations varies from 39% to 93%, and these differences can be attributed to variations in ethnicity, age, gender, sample size, and registration method used. Some studies have been conducted on children in the early mixed dentition.,,,,,,,,
Despite this interest, no one as far as we know has studied the prevalence of malocclusion in the early mixed dentition in Saudi Arabia. Most epidemiological studies undertaken in Saudi Arabia have only focused on the prevalence of malocclusion in the permanent dentition stage among patients aged over 12 years.,,,, Therefore, this study was conducted to assess the prevalence of malocclusal traits among male schoolchildren aged 6–9 years in Rass, Saudi Arabia.
| Materials and Methods|| |
A descriptive cross-sectional study was conducted among male children in Rass, Qassim Province, Saudi Arabia from September 2018 to February 2019. The participants were selected from primary schools using a stratified cluster random sampling technique. Sixteen schools were randomly selected from 47 primary schools in Rass (three schools from north, three schools from south, three schools from east, three schools from west, and four schools from middle center of Rass). The total sample size was calculated as 304 students with 95% confidence interval based on the total number of students obtained from ministry of education records of the first three grades (n = 2870), and on the prevalence of malocclusion in a pilot study (P = 33%).
The required criteria for selecting participants included Saudi male children aged 6–9 years with fully erupted permanent molars in the early mixed dentition, who attended these schools and who were present on the days of the study with informed consent signed by their parents. The age details of children were obtained from the school record. Children in the primary dentition and with previous orthodontic treatment were excluded from the study.
Clinical examination was performed by a single trained examiner who is a pediatric dentist. Calibration was carried out before the beginning of study according to the Oral Health Survey: Basic Methods manual by World Health Organization by examining a preselected 25 children twice in a time interval of two days under supervision of two professors of Pediatric Dentistry Department, Qassim University. The kappa score was found to be above 0.87. Children were examined in the school by using a lead headlamp, mouth mirror, millimetric ruler, and tongue depressors. No dental radiography, study cast, or skeletal assessments were taken. Clinical examination of children for malocclusion was done over a period of six months with two school visits every week (about ten patients were examined in each visit).
Sagittal occlusal relationships were recorded using Angle’s classification system as Class I, II, or III, according to occlusal relationships of first molars and other occlusal traits, such as overjet, overbite, and crossbite, based on the methods of Bjoerk et al. for registration of malocclusion in centric occlusion. Overbite was recorded as normal, followed by deep bite (>2/3 of lower incisors were covered by upper incisors) and open bite as no overlap (based on incisors overlap relation in the vertical dimension). Overjet was recorded as normal (0–4mm), increased (>4mm), and deficient (<0mm), depending on the horizontal distance between the labial surface of the upper and lower incisors. Transverse anomalies included anterior crossbite (upper incisors occluded lingual to lower incisors) and posterior crossbite (two or more lower posterior teeth occluded buccal to their opposing teeth).
Data were analyzed and tabulated using Statistical Package for the Social Sciences software version 20.0 (IBM, Armonk, NY). The intra-examiner agreement was assessed using Cohen’s κ statistics. Descriptive statistics were calculated to check the prevalence of malocclusal traits and a chi-squared test was used to compare the malocclusion prevalence in three different age groups. A value of P < 0.05 was considered statistically significant.
| Results|| |
A total of 304 male children were examined. The age distribution of the participants included the following: 41.12% (6–7 years), 35.86% (7–8 years), and 23.03% (8–9 years) with the mean age of 6.98 ± 0.67 years [Table 1].
It was observed that Angle’s Class I molar relationship involved the highest percentage of the participants (81.91%), whereas Angle’s Class II and Class III relationships were found in 11.18% and 6.91% of the participants, respectively [Table 2].
|Table 2: Distribution of sagittal occlusal relationships among participants|
Click here to view
The study showed that 5.92% had deep bite, whereas 3.95% had anterior bite. The majority of children had normal bite. On the contrary, 85.86% had normal overjet, 9.21% had increased overjet, and 4.93% had deficient overjet. The majority of children had normal overjet. It was observed that 93.09% of the schoolchildren had no crossbite, 3.95% had posterior crossbite, and 2.96% had an anterior crossbite [Table 3]. The majority of the children had no crossbite.
No statistically significant difference was found among the three different malocclusion age groups [Table 4].
|Table 4: Comparison of malocclusion prevalence in three different age groups|
Click here to view
| Discussion|| |
In this study, the orthodontic assessment was performed for a small age group of children in the early mixed dentition. At this age group (6–9 years), the early permanent dentition is usually not established yet. Interceptive orthodontic treatment is very successful in improving the treated condition and in reducing the need for further treatment. In addition, emphasis on earlier timing of orthodontic treatment may have contributed to the stability of treatment outcomes in the long term.
When comparing the findings of prevalence of malocclusion in children in this survey with those of previous research, it must be considered to take studies with similar age and evaluation criteria.
In this study, 81.91% of the participants had Angle’s Class I molar relationship, 11.18% had Class II, and 6.91% had Class III. Angle’s Class I molar relationship was the most prevalent in this population followed by Class II, whereas Class III molar relationship was found to be the least frequent malocclusion. These findings are in agreement with those obtained previously among older children in the permanent dentition in Saudi Arabia. The results showed that the most prevalent form of malocclusion was Class I molar relationship followed by Class II and Class III., In the early mixed dentition, the values for Angle’s Class I molar relationship recorded in children vary between 87.0% in Tanzania and 80.1% in Turkey for Class II molar relationship between 8.3% in Turkey and 20.8% in Colombia and for Class III molar relationship between 5% in Sweden and 11.6% in Turkey. Our results correlated well with these reported values.
In the present study, it was found that 2.96% of the sample had an anterior crossbite, this has a number of similarities with a Germany study among nine years old children, whereas, earlier studies in Tanzania and Israel found slightly higher values, lesser values were observed in Sweden., The posterior crossbite value in this study was 3.95%, which was consistent with the previous Colombian results. We found lower values for posterior crossbite with respect to those reported in Israel, Sweden,, Australia, and Italy.
With respect to the vertical plane, the anterior open bite was observed in 3.95% of the subjects. This finding was lower than that found in Colombia and Sweden,, whereas the finding was higher than that found in Israel, Australia, and Italy. In this study, the deep bite was in 5.92% of the schoolchildren, which is high as compared to observation in Sweden, and low as compared to the same studies performed in Colombia, Germany, Australia, and Italy.
It was observed that 9.21% of children had increased overjet. This result was in agreement with that reported in Indian study among children aged 8–9 years. In contrast to earlier findings of higher values of increased overjet in Colombia, Sweden,, and Australia, we found lower values of increased overjet. The deficient overjet in this study was seen in 4.93% of the children, this is in good agreement with results recorded in Colombia, lower values were obtained in Australia, Germany and Italy. From the above, these variations in the results of the prevalence of malocclusion traits in the early mixed dentition can be explained by diverse in ethnic groups, criteria of registration, age group, and sample size.
In summary, the prevalence of Class I molar relationship was higher among male schoolchildren in the early mixed dentition in Rass, Saudi Arabia. The most frequent findings were normal overjet and overbite. The most prevalent malocclusion trait was increased overjet followed by deep bite. This study was limited to male schoolchildren in the early mixed dentition. Accordingly, a further research is recommended for both male and female subjects to assess the prevalence of malocclusion in the early mixed dentition and need for early orthodontic treatment.
Ethical policy and institutional review board statement
The survey was approved by the ethics committee of the College of Dentistry, Qassim University (Protocol no. ST/46/2018). All the procedures have been performed as per the ethical guidelines laid down by Declaration of Helsinki 2013.
Financial support and sponsorship
Conflict of interest
There are no conflicts of interest.
| References|| |
Dutra SR, Pretti H, Martins MT, Bendo CB, Vale MP. Impact of malocclusion on the quality of life of children aged 8 to 10 years. Dental Press J Orthod 2018;23:46-53.
Stenvik A, Espeland L, Berg RE. A 57-year follow-up of occlusal changes, oral health, and attitudes toward teeth. Am J Orthod Dentofacial Orthop 2011;139:S102-8.
Schopf P. Indication for and frequency of early orthodontic therapy or interceptive measures. J Orofac Orthop 2003;64:186-200.
Tausche E, Luck O, Harzer W. Prevalence of malocclusions in the early mixed dentition and orthodontic treatment need. Eur J Orthod 2004;26:237-44.
Kluemper GT, Beeman CS, Hicks EP. Early orthodontic treatment: What are the imperatives? J Am Dent Assoc 2000;131:613-20.
daCosta OO, Aikins EA, Isiekwe GI, Adediran VE. Malocclusion and early orthodontic treatment requirements in the mixed dentitions of a population of Nigerian children. J Orthod Sci 2016;5:81-6.
Artun J, Behbehani F, Al-Jame B, Kerosuo H. Incisor trauma in an adolescent Arab population: Prevalence, severity, and occlusal risk factors. Am J Orthod Dentofacial Orthop 2005;128:347-52.
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.
Mugonzibwa EA, Eskeli R, Kuijpers-Jagtman AM, Laine-Alava MT, van’t Hof MA. Occlusal characteristics during different emergence stages of the permanent dentition in Tanzanian Bantu and Finnish children. Eur J Orthod 2004;26:251-60.
Emine K, Lale T, Kahraman G. Distribution of sagittal occlusal relationships in different stages of dentition. Braz Oral Res 2015;29:1
Dimberg L, Lennartsson B, Söderfeldt B, Bondemark L. Malocclusions in children at 3 and 7 years of age: A longitudinal study. Eur J Orthod 2013;35:131-7.
Lux CJ, Dücker B, Pritsch M, Komposch G, Niekusch U. Occlusal status and prevalence of occlusal malocclusion traits among 9-year-old schoolchildren. Eur J Orthod 2009;31:294-9.
Shalish M, Gal A, Brin I, Zini A, Ben-Bassat Y. Prevalence of dental features that indicate a need for early orthodontic treatment. Eur J Orthod 2013;35:454-9.
Dimberg L, Lennartsson B, Arnrup K, Bondemark L. Prevalence and change of malocclusions from primary to early permanent dentition: A longitudinal study. Angle Orthod 2015;85:728-34.
Steinmassl O, Steinmassl PA, Schwarz A, Crismani A. Orthodontic treatment need of Austrian schoolchildren in the mixed dentition stage. Swiss Dent J 2017;127:122-8.
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.
Asiry MA, AlShahrani I. Prevalence of malocclusion among school children of southern Saudi Arabia. J Orthod Sci 2019;8:2.
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.
Mohammed Almalky N, Mohammad Elattar H. Prevalence of different types of malocclusion among school children in Makkah Governorate of Saudi Arabia. Int J Dentistry Oral Sci 2018;5:645
Baeshen H. The prevalence of major types of occlusal anomalies among Saudi middle school students. J Contemp Dent Pract 2017;18:142-6.
Bjoerk A, Krebs A, Solow B. A method for epidemiological registration of malocclusion. Acta Odontol Scand 1964;22:27-41.
Al Nimri K, Richardson A. Interceptive orthodontics in the real world of community dentistry. Int J Paediatr Dent 2000;10:99-108.
Kerosuo H, Heikinheimo K, Nyström M, Väkiparta M. Outcome and long-term stability of an early orthodontic treatment strategy in public health care. Eur J Orthod 2013;35:183-9.
Perrotta S, Bucci R, Simeon V, Martina S, Michelotti A, Valletta R. Prevalence of malocclusion, oral parafunctions and temporomandibular disorder-pain in Italian school children: An epidemiological study. J Oral Rehabil. 2019;46:611-6.
Disha P, Poornima P, Pai SM, Nagaveni NB, Roshan NM, Manoharan M. Malocclusion and dental caries experience among 8-9-year-old children in a city of South Indian region: A cross-sectional survey. J Educ Health Promot 2017;6:98.
[Table 1], [Table 2], [Table 3], [Table 4]