|Year : 2014 | Volume
| Issue : 4 | Page : 273-278
A study of occurrence of malocclusion in 12 and 15 year age group of children in rural and backward areas of haryana, india
Dhanashree Damle, Vinay Dua, Rajat Mangla, Mannu Khanna
Department of Orthodontics and Dentofacial Orthopaedics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Haryana, India
|Date of Web Publication||17-Sep-2014|
Department of Orthodontics and Dentofacial Orthopaedics, Maharishi Markandeshwar College of Dental Sciences and Research, Mullana, Haryana
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: Objectives of the study were to determine the severity of malocclusion, orthodontic treatment needs and variation in malocclusion with respect to age and sex (gender) in 12 and 15 years age-group children in rural and backward areas of Haryana, India. Materials and Methods: A sample of 1322 school children (12 and 15 years of age) was selected randomly. Severity of malocclusion and orthodontic treatment needs were assessed according to dental aesthetic index (DAI) criteria (WHO). All the 10 components of DAI were assessed. Clinical examination was performed by single examiner. The data for each child was coded and analyzed by Statistical Package for Social Sciences (SPSS) version 13, Chi Square and Student t-tests. Results: 23.6% of the subjects had dental anomaly, ranging from mild to severe. Percentage of medium, high, and very high treatment needs in children was 15.1, 4.9, and 3.6% respectively. Conclusion: 76.4% children had little or no malocclusion and 23.6% children were in need of treatment which reveals that the infl uence of civilization has reached rural and backward areas.
Keywords: Malocclusion, school children, dental aesthetic index, orthodontic treatment needs
|How to cite this article:|
Damle D, Dua V, Mangla R, Khanna M. A study of occurrence of malocclusion in 12 and 15 year age group of children in rural and backward areas of haryana, india. J Indian Soc Pedod Prev Dent 2014;32:273-8
|How to cite this URL:|
Damle D, Dua V, Mangla R, Khanna M. A study of occurrence of malocclusion in 12 and 15 year age group of children in rural and backward areas of haryana, india. J Indian Soc Pedod Prev Dent [serial online] 2014 [cited 2019 Dec 9];32:273-8. Available from: http://www.jisppd.com/text.asp?2014/32/4/273/137622
| Introduction|| |
Face is the important component of an individual's physical appearance. A balanced face is the outcome of intricate proportion between the hard tissues, That is the craniofacial, skeletal, and dentoalveolar structures as well as soft tissue drape in function and at rest. Heterogeneous mixing of people from across the globe, the gene-environment interaction and the genetic mix up usually leads to the new look faces, in which, jaw size, dentition, and occlusion are significant components.  There are ethnic variations of the profile in different parts of India like the people from North, South, and North-East are of different ethnic stock and therefore, exhibit significant variations in face form. The concept of malocclusion therefore, is greatly influenced by the definition of normal occlusion and its range.The malocclusion can be defined as an occlusion having a malrelationship between the arches in any of the planes or in which there are anomalies in tooth position beyond the normal limits.  Malocclusion is closely related to an individual's social performance and well-being. Prevalence of malocclusion varies from country to country and also in different age-groups as well as gender. The prevalence of malocclusion in India varies between 20-43% as reported by many researchers. ,,, Earlier surveys in India were mainly focused on dental caries and periodontal disease while malocclusion received comparatively less attention. ,, In India, very few studies have been reported on prevalence of malocclusion and no study has been carried out in rural and backward area specifically with dental aesthetic index (DAI) criteria. DAI criteria are a relatively simple, reproducible and valid criteria developed by Cons NC, Jenny J, and Kohout FJ in 1986.  Therefore, the aim of the present study was to assess the severity of malocclusion, orthodontic variation, and treatment needs with respect to age and sex in the age-group of 12 and 15 years in rural and backward areas of Haryana, India.
| Materials and Methods|| |
The present study was conducted in one of the most backward and rural areas of Ambala district of Haryana, a northern state in India [Figure 1]. Ambala district has an area of 1568.85 sq. kms with total population of 10, 13,660. A cluster sample was selected from a list of schools obtained from Ambala District Board Development Office. A random and representative sample of 1322 children (679 males, 51.4% and 643 females, 48.6%) was selected from 8 different schools of Haryana. Out of 1322 children examined 664 were in the age-group of 12 years (50.2%) and remaining 658 were in 15 year age-group (49.8%). 12 years age-group was selected as it is generally the age at which children are in middle school. Therefore, in many countries it is the last age at which a reliable sample can be obtained. Also by this time, all the permanent teeth except third molars are erupted. The 15 years age-group is also important as the permanent teeth are exposed to the oral environment for 3-9 years. The assessment of dentofacial anomalies is often significant at this age. This age is also important to decide the treatment needs. The children who previously had any kind of orthodontic treatment were excluded from the study. Furthermore, children with clefts and with systemic diseases were also not included.
The ethical committee of Maharishi Markandeshwar University, Mullana, granted permission to conduct this study. The DAI criterion was selected as a measurement tool as all the 10 components can be measured. A proforma for recording of general information and dentofacial anomalies in relation to the oral health and relevant specifications was utilized as prescribed by WHO for oral health assessment 1997 proforma.
The individuals were examined under natural light and away from direct sunlight using
- mouth mirror
- CPI Probe.
To check the inter and intra examiner variability in determining the DAI components, 50 children were examined twice by the examiner who conducted the oral examination and the results were compiled and were confirmed that the assessment was proper. The data for each child was coded and analyzed by Statistical Package for Social Sciences (SPSS) version 13, Chi Square and Student t-tests [Figure 2].
|Figure 2: Malocclusion and treatment needs of the study population according to Dental Aesthetic Index|
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Calculation of Dental Aesthetic Index (DAI) Score
The regression equation adopted for calculating standard DAI scores was as follows: (missing visible teeth × 6) + (crowding) + (spacing) + (diastema × 3) + (largest anterior maxillary irregularity) + (largest anterior mandibular irregularity) + (anterior maxillary overjet × 2) + (anterior mandibular overjet × 4) + (vertical anterior openbite × 4) + (anterior - posterior molar relation × 3) + 13
The severity of malocclusion and treatment indications within a population was classified and interpreted on the basis of DAI scores as stated below:
Severity of Malocclusion - Treatment indication
- No abnormality or - No or slight treatment minor malocclusion
- Definite malocclusion - Elective treatment
- Severe malocclusion - Highly desirable treatment
- Very severe malocclusion - Mandatory treatment
| Results|| |
The results of the study revealed that 23.6% of the children had some form of dental anomaly, ranging from mild to severe. Percentage of orthodontic treatment need, that is medium, high, and very high was 15.1, 4.9, and 3.6% respectively according to DAI scale. Further division of the result revealed that 74.2% of 12 year old and 78.6% of 15 years old children had normal or minor malocclusion. Whereas 25.8% of 12 years and 21.4% of 15 years old children had malocclusion necessitating treatment needs. The prevalence of malocclusion in 12 years age children was 25% and in 15 years it was 22.3%. The P value > .05 revealed that the orthodontic treatment needs in 12 year old and 15 year old children was statistically insignificant. The prevalence of malocclusion in boys was 24.9% whereas in girls it was 22.2 % [Table 1]. According to DAI score,74.2% 12 year old children had normal or minor malocclusion accounting slight or no treatment need whereas in 15 year old children 78.6% required slight or no treatment [Table 2]. The difference in the treatment need in these two variables was insignificant (P value > .05).
|Table 1: Gender wise distribution of malocclusion and orthodontic treatment needs of children according to dental aesthetics index (DAI) score|
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|Table 2: Orthodontic treatment needs of children according to dental asthetics index (DAI) score|
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The component of the DAI index which was seen to be the most common was crowding, affecting 55.2% boys and 53.2% girls followed by anterior mandibular irregularity, anteroposterior molar relation and incisal spacing respectively [Table 3] and [Figure 3]. Mean DAI score in 12 year age-group was 22.97 and 22.31 in 15 year age-group with standard deviation (SD) of 8.8 and 7.6 respectively.
|Figure 3: Comparison of percentage distribution of DAI Components amongst males and females|
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|Table 3: Gender wise distribution of DAI components amongst boys and girls|
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| Discussion|| |
The development of the DAI index by Cons NC, Jenny J, and Kohout FJ in 1986 has gained wide acceptance the world over.  It is useful, standardized tool for those interested in research in epidemiology of malocclusion. In comparing the prevalence of malocclusion it must be taken into account that the present study is cross-sectional. The data in present study is methodologically secure with proper accuracy, reproducibility, and minimization of deviations. The findings of the present survey remain significant in providing the data on the orthodontic status of 12 and 15year-old children in rural of Haryana (India), and at the same time, reflecting the need for orthodontic treatment in this population.
The prevalence of malocclusion in 12 years age-group was 25.8% and 21.4% in 15 years group [Table 2]. There was no significant difference between the findings of present study and findings of the study conducted in National Oral Health Survey in which the prevalence of malocclusion was reported to be 27.4% in 12 year olds and 25.4% among 15-year-olds.  The findings are not concurrent with the findings of the study reported by Singh et al.,  in which the prevalence of malocclusion reported was 55.3% in 12-16 years age group and differ slightly with the result of the study conducted by Gauba et al.,  in which the prevalence of malocclusion reported was 29.2%. The findings of the present study differ vastly from the findings of the study conducted on South Indian population in a state of Karnataka by Shiva Kumar KM et al.,  in which they reported the prevalence of malocclusion to be 19.99%. In the present study 25.8% (12 year) and 21.5% (15 year) are in agreement with the results by Danaei et al.,  which reported the prevalence of malocclusion to be 29.9% in 12-15 years age-group.
Three percent of the study population in this study had one or more missing anterior teeth in either arch which was not in accordance with the study by Rao et al.,  which reported higher percentage of missing teeth.
In the present study 54.2% of the study population had incisal crowding. The results are in agreement with the studies by Otuyemi and Abidoye  as well as Thilander and Myrberg  , though Thilander et al., claimed that females had more crowding as compared to males which was not the case in the present study.
In the present study, incisal segment spacing either in one or both the arches were exhibited by 23.4% subjects. The prevalence observed by Otuyemi and Abidoye  , was higher than the present study. This difference may be attributed due to parafunctional habits, such as thumb sucking, mouth breathing and tongue thrusting, dento-alveolar discrepancies and jaw size discrepancies. Spacing between males and females was statistically significant (24% in males and 22.9% in females) in the present study. This is similar to the study conducted in Iran  and Columbia. 
Of the 1322 school children examined, 11.7% had midline diastema (≥1 mm). Female children exhibited fewer occurrences as compared to male children (10-13.4%). Singh et al., reported no sex difference in their study conducted in 1998. Like most communities except Nigeria the population studied in the present survey had more crowding discrepancies than spacing. In this study 25.2% of the subjects had > 1 mm of maxillary anterior irregularity. In contrast, higher percentage was reported by Otuyemi et al. 
A significant number of thechildren (16.7%) presented with overjet ≥4 mm. However, 72.5% of the children had normal (2 mm) overjet. Brunelle et al.,  reported lower prevalence of the maxillary overjet.
In the present study, 0.83% subjects recorded anterior mandibular overjet. The results are in agreement with Shiva Kumar et al.,  however, the study by Burden and Holmes  reported higher percentage of mandible overjet. This difference can be attributed to variation in growth and disproportion for the dentofacial alveolar width and genetic predisposition.
In the present study 0.37% subjects presented with vertical anterior open bite. Similar results were reported by Shiva Kumar et al.,  The difference can be attributed to variation in development and maturation of the arches and children may have different deleterious oral habit such as mouth breathing, tongue thrusting and dentoalveolar discrepancies of the jaws. In the present study 72.7% of the school children had normal anteroposterior molar relationship. 19% had half cusp deviation whereas 8.3% had full cusp deviation. The results are in agreement with findings of Otuyemi et al., and Suresh Babu et al. The usefulness of the study lies in the determination of the scale and severity of malocclusion with the use of DAI and therefore grading of treatment required for a population to be studied. The disadvantage of the study is its inability to assess the total occlusal characteristics, the condition of the dental, osseous and soft tissues, and the function of the stomatognathic system. Although the present study has demonstrated a great and urgent need for orthodontic treatment, oral hygiene aspects must be taken into consideration. Preventive programs and early treatment of caries are still the best means of reducing the high prevalence of malocclusion traits, especially crowding. The question of the orthodontic treatment need therefore remains irrelevant as long as dental health care is neglected.
This study conducted with an important malocclusion assessment criteria, that is DAI index recorded 76.4% prevalence of little or no malocclusion and 23.9% children were in need of treatment [Table 3]. It was also seen that malocclusion is not only a single entity but rather a collation of situations, each in itself constituting a problem. Further the study also suggested that more emphasis should be laid on proper preventive and interceptive orthodontic services to the affected group. Based on DAI grading the percentage with moderate, high and very high treatment needs were 15.1%, 4.9%, and 3.6% respectively. It is a known fact that the orthodontic treatment demand and selection criteria are not defined by the severity of the malocclusion alone and the actual treatment needs as there are other factors also involved. However the findings of the study could initiate intervention in the field of orthodontic care provision.
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[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3]