|Year : 2013 | Volume
| Issue : 2 | Page : 87-90
Prevalence and determinant factors of malocclusion in population with special needs in South India
R Muppa, P Bhupathiraju, MK Duddu, A Dandempally, DL Karre
Department of Pedodontics and Preventive Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Chaitanyapuri, Hyderabad, Andhra Pradesh, India
|Date of Web Publication||26-Jul-2013|
Department of Pedodontics and Preventive Dentistry, Panineeya Institute of Dental Sciences and Research Centre, Kamala Nagar, Chaitanyapuri, Hyderabad 500 060, Andhra Pradesh
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: Malocclusion plays an important role in the overall oral health of an individual because it is associated with periodontal disease, temporomandibular disorders and may be complicated by an individual's disparity. Careful attention to malocclusion in children with special needs leads to a considerable improvement in the quality-of-life. The objective of the present study was to analyze the prevalence of malocclusion and its association with determinant factors in individuals with special needs in South India. Materials and Methods: A cross-sectional study was carried out that included 844 individuals with special needs and their mothers at eleven institutions in South India. Data were collected based on the questionnaire given to the mothers and dental examination carried out on the children. The nutritive and non-nutritive oral habits were obtained from the reports of the mothers. Clinical examination recorded the following: Class I, Class II, Class III, anterior crowding, anterior spacing, deep bite, open bite, and anterior cross bite. Statistical analyses of data were performed using Chi-square test. Results: Results at the end of the study revealed anterior crowding in 27.37% of the total sample size, deep bite in 20.5%, Class I in 14.34%, anterior spacing in 12.9%, Class II in 9.95%, Class III in 5.33%, anterior cross bite in 4.98% and open bite in 4.62%. Conclusion: The prevalence of malocclusion in individuals with special needs is associated with the type of disability and it is more in males than females. Mentally disabled individuals had higher frequencies of all types the malocclusion. Prevalence of anterior crowding was higher compared to other types of malocclusion followed by deep bite.
Keywords: Anterior crowding, malocclusion, special children
|How to cite this article:|
Muppa R, Bhupathiraju P, Duddu M K, Dandempally A, Karre D L. Prevalence and determinant factors of malocclusion in population with special needs in South India. J Indian Soc Pedod Prev Dent 2013;31:87-90
|How to cite this URL:|
Muppa R, Bhupathiraju P, Duddu M K, Dandempally A, Karre D L. Prevalence and determinant factors of malocclusion in population with special needs in South India. J Indian Soc Pedod Prev Dent [serial online] 2013 [cited 2020 Jan 18];31:87-90. Available from: http://www.jisppd.com/text.asp?2013/31/2/87/115701
| Introduction|| |
About 3% of all children across the world are "special." They arrive on earth with unique gifts but mainstream lives have little time for them and consider them a problem. Nelson and Stein coined the phrase children with special health-care needs (CSHCN). The 1998 maternal and child health bureau definition: "CSHCN are those who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally."  Asdaghi Mamaghani et al. 2008 stated that children with special needs normally undergo dental examination at an older age.  It is therefore fundamental that the care offered by health professionals is integral and multidisciplinary, especially in encouraging parents/guardians to seek dental care for younger children, when preventive procedures and education are still possible. Individuals with Down's syndrome and cerebral palsy are particularly prone to orofacial disorders. Risk factors for malocclusion can originate from physical, behavioral or disease mechanism. Children who have premature tooth loss, missing teeth or arch length and tooth discrepancy have a higher risk of malocclusion.  Behavioral risk factors for malocclusion include finger sucking habits and excessive mouth breathing. Finally, disease can increase the risk of malocclusion as demonstrated by the incidence of malocclusion in population with disabilities. To improve the oral health of these individuals, it is essential for public oral health-care services to incorporate intervention methods directed at the prevention and treatment of malocclusions. It is therefore necessary to understand the panorama of dental needs of children with disabilities in order to ensure care that can help this proportion of the population overcome their difficulties and improve both their development and quality of life. This study therefore aims to assess the prevalence and determinant factors of malocclusion in population with special health care needs.
| Materials and Methods|| |
The present study was conducted in Hyderabad and Rangareddy, north-east region of Andhra Pradesh, South India. The study population consisted of individuals with special health-care needs. Special schools in the twin cities were identified, among them eleven schools were approached and a consent letter was taken from each school.
The sample comprised of 844 subjects of both genders, aged 6-30 years. Information on gender, date of birth, socio-economic status was obtained from the questionnaire given to the parent or guardian. Clinical examination was performed under natural light, with the child in the knee to knee position. Occlusion was assessed through the manipulation of the jaws to obtain centric occlusion. The following malocclusions were diagnosed: Class I, Class II, Class III, anterior crowding, anterior spacing, open bite, deep bite, and anterior cross bite. After the dental examination, those who had treatment needs were educated along with parents. Data analysis was performed. Univariate and bivariate analysis were carried using Chi-square test.
| Results|| |
The overall sample comprised 844 individuals categorized in to 6 groups based on the medical condition. [Table 1] shows the percentage of individuals categorized under different age groups. It indicates that the percentage of adults was 62.3% high when compared to children, i.e., 37.6% in the whole sample. [Table 2] shows the distribution of respondents by malocclusion groups and gender. It indicates high percentage of male population (65%) were included than females (34.2%). [Table 3] and [Table 4] shows the distribution of respondents into six groups and malocclusions.
In the overall population when the eight malocclusion traits were compared, anterior crowding showed the highest incidence (27.37%) followed by deep bite (20.55%), Class I malocclusion (14.3%), anterior spacing (12.91%), Class II (9.95%), Class III (5.33%), anterior cross bite (4.98%) and the least incidence was seen with open bite (4.62%). Among the six groups, high incidence of Class I malocclusion (19.77%), anterior spacing (18.22%) and anterior cross bite (13.37%) was seen in Group 5 (hearing and speech defect). High number of individuals with anterior crowding (33.44%), deep bite (26.6%) and Class III (7.79%) was seen in Group 1.
(Mild Mental Retardation). High frequency of Class II (16%) was seen in Group 2 (Moderate Mental Retardation). In Group 4 (autism) high frequency of open bite was noted.
| Discussion|| |
Oral health and quality oral health-care contribute to holistic health, which should be a right than privilege.  That is why individuals with disabilities deserve the same opportunities for dental services as those who are healthy. When compared to normal children, the disabled subjects were not given enough dental care with respect to treatment needs. Systemic dysfunction in such individuals may predispose them to oral disease, which in turn may aggravate the systemic disease. It is therefore fundamental that the care offered by health professionals is integral and multidisciplinary, especially in encouraging parents/guardians to seek dental care for younger children, when preventive procedures and education are still possible.
Kaye et al., 2005 stated that malocclusion has a considerable impact on the lives of CSHCN, associated with problems in their daily activities, including discrimination due to their physical appearance and problems related to oral functions, such as swallowing and speech. 
The sample consisted of children and adults of different ages none had been treated with orthodontic measures, neither interceptive nor corrective measures. In studies of prevalence of malocclusion, the material should be obtained from a well-defined population, large enough and cover non-orthodontically treated children and adults of different ages. Thus, the present study satisfies these requirements as well. In this study, the prevalence of malocclusion in men and women showed a significant difference with a high percentage of males in the whole sample compared to females.
In our study, concerning the different malocclusion traits, anterior crowding was found to occur in 27.37% of the study population followed with deep bite 20.50%. Class I malocclusion, anterior spacing, and anterior cross bite occurred far more frequently in the hearing and speech defect group than in the other group of study population. The high frequencies of occlusal anomalies in the incisor section found in this study might be explained by functional anomalies of the tongue and the perioral muscles. Particular patterns of oral habits among the mentally retarded children may also play a role. 
Anterior crowding was observed as the common malocclusion trait among the whole sample. This may be a factor of significance, since crowding may result in an early establishment of proximal contacts, there by resulting in an increased risk for earlier initiation of proximal carious lesions. 
Group 6 (Cerebral palsy) individuals showed high prevalence of anterior crowding followed with anterior open bite (AOB). Greater chance of having an AOB may be explained by the fact that muscle incompetence impairs lip seal in individuals with cerebral palsy and leads to a systematic anterior posture of the tongue, facilitating the onset and maintenance of the habit of tongue interposition (Ortega et al., 2007). 
Orthodontic treatment of mentally retarded children has long been neglected. Admittedly it can be difficult to communicate with and obtain cooperation from these patients; but, the variation of the degree of mental retardation is extremely great. Kreiborg in 1981 stated that apart from the few patients with specific syndromes, for instance Crouzon syndrome, there are no biologic factors to contraindicate some treatment, not even within the Down's syndrome group. 
It is important that these children should be provided with dental care as soon as their medical condition has been diagnosed and pediatricians should be encouraged to make the appropriate referral and advice the parents on the importance of dental health. Nevertheless, when there is a need and a wish for orthodontic treatment and when the child is able to cooperate, treatment should be carried out. Even though, it may not be possible to obtain a perfect result, every possible effort should be made to help these patients to a better functioning dentition.
| Conclusion|| |
Oral health disparities between individuals with disabilities and general population are widely reported in literature and malocclusion is no exception. As the number of people living with disabilities grow so does need to explore the oral health status of such individual's increases. As pediatric dentists it is important to lay special interest in oral health-care needs of special children and promote healthy smiles.
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[Table 1], [Table 2], [Table 3], [Table 4]
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