|Year : 2019 | Volume
| Issue : 2 | Page : 65-70
The prevalence of malocclusion among 10–12-year-old schoolchildren in Khammam district, Telangana: An epidemiological study
N Venugopal Reddy, M Ajay Reddy, Nadella Chandana, Toviti Karthik, V Daneswari, P Niharika
Department of Pedodontics and Preventive Dentistry, Mamata Dental College, Khammam, Telangana, India
|Date of Submission||14-Mar-2019|
|Date of Acceptance||12-Oct-2019|
|Date of Web Publication||29-Nov-2019|
Dr. N Venugopal Reddy
Department of Pedodontics and Preventive Dentistry, Mamata Dentalc College, Khammam, Telangana
Source of Support: None, Conflict of Interest: None
Aim: The study aimed to determine the prevalence of malocclusion among 10–12-year-old school-going children in Khammam district of Telangana state. Materials and Methods: A descriptive cross-sectional study was conducted among 2550 schoolchildren aged 10–12 years old in the Department of Pedodontics and Preventive Dentistry, Mamata Dental College and Hospital, Khammam, Telangana, India, to assess the prevalence of malocclusion. An oral examination was conducted by a single trained examiner using a mouth mirror and probe. Occlusal characteristics such as molar relation, overjet, overbite, open bite, crossbite, midline deviations, midline diastema, and rotation were recorded. The data were tabulated and analyzed using the Chi-square test. Results: The results revealed that the overall prevalence of malocclusion was 76.6%. Of this, 65.9% of the children had Angle's Class I malocclusion, 9.25% had Class II malocclusion, and 1.37% had Class III malocclusion. About 15.4% showed an increased overjet (>3 mm), 0.2% had reverse overjet, 43.6% had increased overbite (>3 mm), 2% had open bite, 14.01% had crossbite, 46.23% had deviation of midline, 2.07% had midline diastema, and 2.98% had rotated tooth. Conclusion: There is a high prevalence of malocclusion among schoolchildren in Khammam district of Telangana. Problems of a functional nature that arise from these morphological changes may become more complex skeletal problems in future with serious psychosocial consequences for the developing individual.
Keywords: Malocclusion, molar relationship, prevalence
|How to cite this article:|
Reddy N V, Reddy M A, Chandana N, Karthik T, Daneswari V, Niharika P. The prevalence of malocclusion among 10–12-year-old schoolchildren in Khammam district, Telangana: An epidemiological study. Int J Pedod Rehabil 2019;4:65-70
|How to cite this URL:|
Reddy N V, Reddy M A, Chandana N, Karthik T, Daneswari V, Niharika P. The prevalence of malocclusion among 10–12-year-old schoolchildren in Khammam district, Telangana: An epidemiological study. Int J Pedod Rehabil [serial online] 2019 [cited 2020 Aug 10];4:65-70. Available from: http://www.ijpedor.org/text.asp?2019/4/2/65/272065
| Introduction|| |
Balanced facial features are much more pleasing and appealing in the majority of races and sexes rather than irregular or protruding teeth which also give a reflection of negative status. Malocclusion greatly affects the psychological and social well-being of the children. Well-aligned teeth and a pleasing smile reflect positive status and well-being. Studies on the prevalence of malocclusion in public health provide important epidemiological data to assess the type and distribution of occlusal characteristics of a given population, its treatment need and priority, and the resources required to offer treatment in terms of work capacity, skills, ability, and materials to be employed.
The World Health Organization (WHO) criteria for oral health assessment were used to examine the oral status of children, and the age group between 10 and 12 years was selected to know the incidence and intercept developing malocclusions. In India, the prevalence of malocclusion varies from 20% to 43%. Many cross-sectional studies have been attempted previously to examine the malocclusion in different populations representing the Indian population. However, no studies have been reported in Khammam, Telangana state of India. Hence, the aim and objective of the present study were to determine the prevalence of malocclusion and associated variables such as overjet, overbite, open bite, crossbite, midline deviations, midline diastema, and rotation of teeth among 10–12-year-old school-going children in Khammam district of Telangana state.
| Materials and Methods|| |
The present descriptive cross-sectional study was conducted in the Department of Pedodontics and Preventive Dentistry, Mamata Dental College and Hospital, Khammam, Telangana, India, to assess the prevalence of malocclusion among 10–12-year-old schoolchildren for 11 months from June 2017 to April 2018. Permission from the district educational officer was obtained to get the necessary information, such as names of all schools in Khammam district, their addresses, and total number of students studying in each division in each school for the construction of a sample frame. Considering an average of 500 students from each school, six schools were randomly selected using the cluster sampling method. To make up the estimated sample size, a total of 2750 students were examined, among which 2550 children satisfied the inclusion criteria.
Ethical clearance was obtained from the Ethical Committee of Mamata Dental College. Permission from the school authorities and consent from the parents of children examined were obtained before the commencement of the study. The study was conducted as per the World Medical Association Helsinki Declaration.
The inclusion criteria include children who were present on the day of examination with the informed consent of their parents, children who had all the permanent first molars erupted, and children with no neurological or systemic diseases. The exclusion criteria include a previous history of orthodontic treatment, missing permanent molars, craniofacial anomalies, associated syndromes, parents and children who did not provide consent for clinical examination, and medically compromised child.
Oral examination was conducted by a single trained examiner using a mouth mirror and probe to avoid inter-examiner bias. The children were examined while seated on a chair with good natural light illumination during class hours in a predetermined order. Each child was examined using the WHO type III criteria for oral health assessment, and for every child, a registered chart related to malocclusion was designed which includes all variables where all the findings were recorded. All occlusal relationships were evaluated at a centric occlusion position which was achieved by asking the child to swallow and then to bite in his or her most posterior teeth. Class of malocclusion in Angle's system of classification and presence of variables such as overjet, overbite, open bite, crossbite, midline deviations, midline diastema, and tooth rotation were recorded. Children with Class I molar relationship, normal overjet and overbite, proper alignment, and no gross irregularities of the tooth were categorized in the normal occlusion group.
The data were tabulated and subjected to statistical analysis. The prevalence of malocclusion was represented in proportions. Differences in proportion among the group were analysed using the Chi-square test and data were analysed using IBM SPSS Statistics for Windows. Version 24.0. Armonk. NY: IBM Corp.
| Results|| |
In the present study, the prevalence of malocclusion was conducted among 2550 school-going children, aged 10–12 years old in Khammam district, Telangana, India. Of 10, 11 and 12 years groups, 54% were male and 45.9% were female, as shown in [Table 1]. Among the total children examined, the normal occlusion was found in 23.4% of the participants and 76.6% presented with malocclusion. Class I malocclusion was seen in 65.9%. Class II malocclusion was seen in 9.24%. Class III malocclusion was seen in 1.3% of the participants, as shown in [Table 2].
|Table 2: The classification of the participants based on Angle's classification|
Click here to view
Normal overjet (<3 mm) was seen in 84.2% of participants, increased overjet (>3 mm) was seen in 15% of participants, and reverse overjet was seen in 0.27% of participants, as shown in [Table 3]. To present the overbite, among the total children examined, normal overbite (<3 mm) was seen in 54% of the participants, increased overbite (>3 mm) was seen in 43.6%, and open bite was seen in 2% of the participants, as shown in [Table 4]. In open bite, skeletal open bite was 1.7% and dental open bite was 0.19%, as shown in [Table 5].
Among the total children examined for the prevalence of crossbite, complete anterior crossbite was seen in 0.2%, anterior single tooth crossbite was seen in 0.23%, unilateral complete posterior crossbite was seen among 0.03%, unilateral posterior single tooth crossbite was seen among 7.6%, and anterior and unilateral posterior crossbite was seen in 5.8% of participants, as shown in [Table 6]. In the examination of the midline with respect to the maxillary arch, midline deviation toward the right was seen among 17.2% of participants, midline deviation toward the left was seen among 28.9% of participants, as shown in [Table 7]. About 2.07% of children had midline diastema, as shown in [Table 8], and 2.9% had tooth rotations, as shown in [Table 9].
| Discussion|| |
The WHO (1987), had included malocclusion under the heading of handicapping dentofacial anomaly, defined as an anomaly which causes disfigurement or which impedes function and requiring treatment “if the disfigurement or functional defect was likely to be an obstacle to the patient's physical or emotional well-being.”
Although malocclusion is less prevalent than caries or periodontal disease, it has a great impact on psychological and social well-being of the child. It has been found to cause psychological and psychosocial problems, oral dysfunction, impaired esthetics, difficulty in mastication, swallowing, speech, periodontal disease, and mostly increased susceptibility to trauma.
In studies of the prevalence of malocclusion, the material should be obtained from a well-defined population, be large enough, and cover nonorthodontically treated children. Thus, the present sample satisfies these requirements well. As the prevalence of malocclusion in different studies varies according to the methods of assessment, racial differences, and the chronological age of the sample, the findings should be compared with caution.
As no studies were reported in Khammam, Telangana state of India, the present study was conducted among 2550 school-going children aged 10–12 years old in Khammam District of Telangana state to report the prevalence of malocclusion according to age and gender. The WHO recommends basic oral health surveys in five selected age groups (i.e., 5 years, 12 years, 15 years, 35–44 years, and 65–74 years) to estimate the magnitude of the problem and to plan interventional activities. This age group was preferred since most malocclusions are manifested at this time to its full extent.
Proffit (1986) suggested that mild-and-moderate degree of malalignment might be present even in the absence of habits or environmental factors. Angle postulated that “the first upper permanent molar, more than any other tooth or anatomical point gives a precise scientific basis for defining occlusal disharmony and occlusal anomalies.”
The prevalence of malocclusion in the present study was in accordance with Hemapriya et al. from Kancheepuram. When compared with the present study, a greater prevalence of malocclusion was reported by Goel et al. from Ludhiana which might be due to the fact that their sample collection was done by treatment priority index.
When compared with the present study, Kaur et al. in Karnataka reported a greater prevalence of malocclusion as their study comprises both urban and rural children in 1:2 ratio of age 13–17 years. They reported that urban population had twice the Class II sagittal occlusion and increased overjet as compared to rural population which contributed to its greater prevalence.
In the present study, Class I malocclusion was found to be the most predominant, which was in accordance with the studies done by Narayanan et al. from Kerala. When compared with the present study, Ajayi from Nigeria and Mtaya et al. from Tanzania reported greater prevalence of Class I malocclusion as it was the most predominant sagittal molar relationship among Nigerian and Tanzanian schoolchildren which was in accordance with African and African–American surveys., When compared with the present study, the greater prevalence of Class I malocclusion reported by Reddy et al. in Nalgonda was attributed to influence of predominance of Class I molar relationship in the first transitional stage in 6–10 years' age group.
The lower prevalence of Class I malocclusion, when compared with the present study, was reported by Muppa et al. as it consists of children with special health-care needs. They reported that premature tooth loss, missing teeth or arch length, and tooth discrepancy have a higher risk of malocclusion, and finally, disease can increase the risk of malocclusion as demonstrated by the incidence of malocclusion in population with disabilities.
Celikoglu et al. in Turkey and Vibhute et al. in Mumbai showed the lower prevalence of Class I malocclusion when compared with the present study as their studies were based on the examination of pretreatment records of orthodontic patients, though the most predominant molar relationship among Turkish and Indians was Class I malocclusion.,
Untreated proximal caries in primary molars or early loss of a second primary molar may lead to forward drift of the first permanent molar, promoting the change in the molar relationship. Thus, some of the children with an Angle Class II or Class III malocclusion recorded in the present investigation might indeed have a neutral skeletal relationship.
The prevalence of Class II malocclusion in the present study was in accordance with Narayanan et al. from Kerala. Reddy et al. and Phaphe et al. stated a greater prevalence of Class II malocclusion compared with the present study, though there were no geographical variations which signify racial predominance., The greater prevalence of Class II malocclusion when compared with the present study was reported by Abu Alhaija et al. from Jordan stated that, “ancestral background of the various populations may have an effect on the prevalence of Class II malocclusion.” Lower prevalence rate of Class II molar relation when compared with the present study reported by Mtaya et al. again signified the most predominant Class I molar relation seen among Tanzanian schoolchildren.
In the present study, the prevalence of Class III malocclusion was in accordance with Abu Alhaija et al. from Jordan and Phaphe et al. from Bagalkot, India., The greater prevalence when compared with the present study was reported by Vibhute et al., in Mumbai and Celikoglu et al. in Turkey, as already mentioned, they took pretreatment records of orthodontic patients to record malocclusion.,
Only true Class III molar relationship was recorded in this study. Functional anterior crossbite generally shows a Class III molar relationship in the centric position, but a Class I relationship in the retruded position and should, therefore, be diagnosed with a Class I malocclusion according to Angle. Negligence of such a differential diagnostic principle may explain variations in Class III prevalence given in the literature. However, a high incidence of anterior crossbite in Class I and in Class III malocclusion has been reported in Chinese and Indian schoolchildren, in the Chinese sample combined with crowding in the upper anterior region (50%), as a result of retrognathic maxillary growth.
In the present study, increased overjet was found to be 15.4%. Increased overjet, when compared with the present study found in Jordanian schoolchildren, was in concordance with that reported for the Colombians (Thilander et al., 2001) but much higher than that reported for the Swedish (Thilander and Myrberg, 1973), the Saudi (Al-Emran et al., 1990), the British (Hill, 1992), and the Kenyan schoolchildren (Ng'ang'a et al., 1996). Differences in the definition of increased overjet between the above studies may have contributed to the variations in the results reported for various populations. Although the sample size was less when compared with the present study, Ciuffolo et al. from Italy showed a greater prevalence of reverse overjet because of geographical variations.
Increased overbite found in the present study was similar to the findings of Narayanan et al. from Kerala, Celikoglu et al. from Turkey., Siddegowda and Rani in Karnataka showed a higher prevalence of overbite when compared with the present study as the sample size was large, and they used Ackerman -Proffit classification for registering malocclusion. Rwakatema et al. in Tanzania and Phaphe et al. in Bagalkot reported lower prevalence when compared with the present study as the sample size was small which signifies the importance of sample size and racial variations.,
The likelihood of being diagnosed with an open bite was almost two times more in children with dental caries than in children without caries. Reduced salivary flow in children with an anterior open bite and with a mouth-breathing habit may have enhanced susceptibility to dental caries (Thylstrup and Fejerskov, 1994).
Researchers during the occlusal development have reported that early decay and tooth loss, rotations, forward shift of the first molars, interferences, posterior crossbite, and mandibular shifts predispose an individual to the development of the temporomandibular joint disorders and increase the sensitivity of the skeletal muscle. Williamson and Lundquist reported that interfering dental contacts have significant effects on volumetric muscle activity. A significant relationship was detected between the posterior crossbite and joint sounds, clicking, and muscle tenderness. Muscle tenderness is more common in children with crossbite than in children without crossbite.
In the present study, complete anterior and posterior crossbite was not identified. Vibhute et al. from Maharashtra and Kumar et al. from Hyderabad reported the lower prevalence of crossbite when compared with the present study because of differences in sample size and geographical variations.,
As the studies regarding the prevalence of midline deviations were very less, the presence of midline deviations was evaluated. In the present study, midline deviation was seen in 46.23% of the participants. Deviation toward the right was seen in 17.25% of the participants. Deviation to the left was seen in 28.9% of the participants.
The higher prevalence of midline diastema, when compared with the present study, was shown by Ajayi from Nigeria. Ajayi indicated abnormal labial frenal attachment and dentoalveolar disproportion in Nigerian children. Onyeaso indicated that diastema is not regarded as a malocclusion among Nigerians but as a mark of natural beauty. Lower prevalence rate when compared with the present study reported by Narayanan et al. in Kerala was because of racial difference.
The prevalence of tooth rotations in the present study was in accordance with Kumar et al. from Hyderabad and Narayanan et al. from Kerala., When compared with the present study, the greater prevalence was reported by Vibhute et al. from Mumbai as they took pretreatment records of orthodontic patients to record malocclusion. The most commonly rotated teeth found in the present study were maxillary right lateral incisor followed by mandibular right lateral incisor.
In the era of evidence-based dentistry, the findings of the present study will not only help in identifying the most prevalent variables of malocclusion but also help in taking necessary preventive as well as early interceptive measures for the correction of malocclusion, thereby preventing future complex and complicated treatment protocols in the permanent dentition.
| Summary and Conclusion|| |
- Problems of a functional nature that arise from these morphological changes may become more complex skeletal problems in future with serious psychosocial consequences for the developing individual
- Finally to conclude the recordings of the present study will not only serves to pose malocclusion as a public problem but also serves as a first step for planning necessary preventive, interceptive measures and helps in early correction of the malocclusion, thus reducing its severity in the permanent dentition, therefore, creating awareness among people raising concern for dental appearance.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Kumar SO, Sultana T, Bharadwaj S, Kumar SS, Manoj GS. Assessment of malocclusion prevalence and different variables associated with it in children aged 10-12 years belonging to Hyderabad city, Telangana, India. Sch Acad J Biosci 2017;5:804-8.
Bittencourt MA, Machado AW. An overview of the prevalence of malocclusion in 6 to 10-year-old children in Brazil. Dent Press J Orthod 2010;15:113-22.
Narayanan RK, Jeseem MT, Kumar TA. Prevalence of malocclusion among 10-12-year-old schoolchildren in Kozhikode district, Kerala: An epidemiological study. Int J Clin Pediatr Dent 2016;9:50-5.
World Medical Association. World medical association declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ 2001;79:373-4.
Hassan R, Rahimah AK. Occlusion, malocclusion and method of measurements – An overview. Arch Orofac Sci 2007;2:3-9.
Mtaya M, Brudvik P, Astrøm AN. Prevalence of malocclusion and its relationship with socio-demographic factors, dental caries, and oral hygiene in 12- to 14-year-old Tanzanian schoolchildren. Eur J Orthod 2009;31:467-76.
Borzabadi-Farahani A, Borzabadi-Farahani A, Eslamipour F. Malocclusion and occlusal traits in an urban Iranian population. An epidemiological study of 11- to 14-year-old children. Eur J Orthod 2009;31:477-84.
Athuluru D, Reddy VC, Sudhir KM, Krishna Kumar R, Gomasani S, Nagarakanti S. An epidemiological data of oral health status and treatment needs of rural population of Nellore district, Andhra Pradesh, India. J Indian Assoc Public Health Dent 2016;14:281-6. [Full text]
Hemapriya S, Ingle NA, Chaly PE, Reddy VC. Prevalence of malocclusion and orthodontic treatment needs among 12 and 15 years old rural school children in Kancheepuram district. J Oral Health Comm Dent 2013;7:84-90.
Goel S, Singh A, Chaudhary G, Kalsi S, Sood A, Marria G. The relationship of malocclusion with periodontal status, dental caries, and sociodemographic factors in school children of Ludhiana. Indian J Dent Sci 2018;10:87-91. [Full text]
Kaur H, Pavithra US, Abraham R. Prevalence of malocclusion among adolescents in South Indian population. J Int Soc Prev Community Dent 2013;3:97-102.
Ajayi EO. Prevalence of malocclusion among school children in Benin city, Nigeria. J Med Biomed Res 2008;7:5-11.
Reddy ER, Manjula M, Sreelakshmi N, Rani ST, Aduri R, Patil BD. Prevalence of malocclusion among 6 to 10 year old Nalgonda school children. J Int Oral Health 2013;5:49-54.
Muppa R, Bhupathiraju P, Duddu MK, Dandempally A, Karre DL. Prevalence and determinant factors of malocclusion in population with special needs in South India. J Indian Soc Pedod Prev Dent 2013;31:87-90.
] [Full text]
Celikoglu M, Akpinar S, Yavuz I. The pattern of malocclusion in a sample of orthodontic patients from Turkey. Med Oral Patol Oral Cir Bucal 2010;15:e791-6.
Vibhute AH, Vibhute NA, Daule R. Prevalence of malocclusion characteristics and chief motivational factor for treatment in orthodontic patients from Maharashtra, India. J Orthod Res 2013;1:62-5. [Full text]
Phaphe S, Kallur R, Vaz A, Gajapurada J, Raddy S, Mattigatti S. To determine the prevalence rate of malocclusion among 12 to 14-year-old schoolchildren of urban Indian population (Bagalkot). J Contemp Dent Pract 2012;13:316-21.
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.
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.
Ciuffolo F, Manzoli L, D'Attilio M, Tecco S, Muratore F, Festa F. Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: A cross-sectional study. Eur J Orthod 2005;27:601-6.
Siddegowda R, Rani MS. A cross-sectional epidemiological survey on prevalence of malocclusion in government, aided and private school children of Karnataka. Univ J Public Health 2013;1:124-30.
Rwakatema DS, Nganga PM, Kemoli AM. Prevalence of malocclusion among 12-15-year-olds in Moshi, Tanzania, using Bjork's criteria. East Afr Med J 2006;83:372-9.
Bilgiç F, Gelgör İE. Prevalence of temporomandibular dysfunction and its association with malocclusion in children: An epidemiologic study. J Clin Pediatr Dent 2017;41:161-5.
Gelgör IE, Karaman AI, Ercan E. Prevalence of malocclusion among adolescents in central Anatolia. Eur J Dent 2007;1:125-31.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9]