An epidemiological survey using the Treatment Priority Index (TPI)

Prevalence of malocclusion in Turkish children and adolescents: A systematic review and meta-analysis

OBJECTIVES

The aim of this article is to establish a comprehensive nationwide prevalence of malocclusion traits on the sagittal, vertical, and transverse planes of space in the Turkish population.

MATERIAL AND METHODS

A systematic search of PubMed, Scopus, and Web of Science was supplemented by manual searches of Google Scholar and the reference lists of included studies. Original Turkish health studies of any age were included. Strengthening the Reporting of Observational Studies in Epidemiology assessed study quality and bias (STROBE). Sagittal, vertical, and transverse malocclusion features were retrieved and gathered.

RESULTS

Eleven studies were selected from 434 titles. Two studies showed a high risk of bias, eight low and one moderate. Thirteen thousand two hundred seventy-one individuals were investigated from early childhood to late adulthood. Most studies were sampled from universities and dental (nonorthodontic) clinics. The pooled malocclusion prevalence was 56% for Class I (95% confidence interval (CI): 44-68%), 31% for Class II (CI: 6-42%), and 11% for Class III (CI: 21-37%). The other common types of malocclusions were crowding (41%, CI: 18-65%), overjet (34%, CI: 21-50%), negative overjet (13%, CI: 7-20%), and crossbite (11%, CI: 7-15%). Additionally, there was no significant difference in Class I (relative risk [RR] = 1.00, [0.96-1.05]), Class II ([RR] = 0.97, [0.92-1.03]), and Class III ([RR] = 1.08, [0.96-1.225]) malocclusion by gender.

CONCLUSIONS

This study showed Class I malocclusion has a high prevalence among the Turkish population followed by Class II and Class III malocclusions. In addition, crowding and overjet were the most prevalent malocclusions among Turkish individuals. There were no significant differences in the prevalence of malocclusions between males and females.

Are the Reasons Why Patients Are Referred for an Orthodontic Visit Correct?

Who does refer patients for an orthodontic consultation? Which are the main reasons for the referral? Does the visit of the orthodontic specialist confirm these reasons or reveal undiagnosed problems? Is there the risk that only evident dental problems are addressed, while craniofacial malformations remain underdiagnosed? This cross-sectional epidemiologic study aims to answer these questions, analysing the clinical data collected during the orthodontic visits of 500 Caucasian young patients referred to a public health structure of northern Italy. All patients were visited by the same expert specialist in orthodontics. Clinical data were collected, analysing both dental and skeletal features. The reasons for the referral of the visit were analysed and compared with the specialistic diagnoses. In our sample, dentists, relatives/friends and paediatricians were the major source of the referrals, followed by family doctors and other facial specialists. In most cases, the reasons for the referral were dental irregularities, but approximately 80% of dental irregularities were associated with undiagnosed facial dysmorphism. Skeletal facial anomalies need an early diagnosis to prevent the development of severe facial malformations that would require invasive and expensive treatments. These findings reveal poor diagnostic skills regarding skeletal anomalies in dentists and paediatricians and the need for better specific training.

The relation of severe malocclusion to patients' mental and behavioral disorders, growth, and speech problems

Background

Severe malocclusions appear in up to 20 per cent of the population. Many neuropsychiatric diseases are likely to have a neurodevelopmental, partially genetic background with their origins as early as fetal life. However, the possible relationship between neurodevelopmental disorders and severe malocclusions is unclear. The aim of this study was in a population-based setting (270 000 inhabitants) to investigate whether patients with severe malocclusions have more mental and behavioural disorders and growth or speech problems than controls without severe malocclusion.

Material and Methods

The study group consisted of patients from the Espoo Health Care Center, Finland, born in year 2000, who were retrospectively screened for their medical and dental records, including their possible mental and behavioural disorders (i.e. attention deficit hyperactivity disorder, Asperger’s syndrome, autism, mood disorder, or broadly defined behavioural abnormalities, learning problems, mental disorders, sleep disturbances, anxiety symptoms, depressive symptoms, and eating-related symptoms) and their need of orthodontic treatment according to the Treatment Priority Index (TPI). The study group consisted of a severe malocclusion group (n =1008; TPI 8–10) and a control group (n = 1068) with no severe malocclusion (TPI 0–7).

Results

Patients with severe mandibular retrognatia (P < 0.000), lip incompetence (P = 0.006), or neurodevelopmental disorders (mental and behavioural; P = 0.002) were found to have significantly more speech problems than the controls. The patients with severe malocclusions were leaner, that is, body mass index (kg/m²) <17, underweight; 17–25, normal weight; >25, overweight) than controls (P = 0.003), and underweight patients had a significant association with retrognathic maxilla (P < 0.000) compared to normal or overweight patients. No significant relationship between neurodevelopmental disorders and severe malocclusions, that is, retrognatia of maxilla, hypodontia, and severe dental crowding was observed.

Conclusion

Our results indicate that patients with severe mandibular retrognatia, lip incompetence, or neurodevelopmental disorders were found to have significantly more speech problems than controls. During orthodontic treatment of patients with severe malocclusion, special attention should be paid to patients with severe mandibular retrognatia, lip incompetence, and speech problems to detect signs of possible neurodevelopmental disorders and record if potential follow-up measures are in place.

Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents

Objective:

To determine the prevalence of malocclusion and orthodontic treatment need in a large sample of Central Anatolian adolescents and compare them with European-other nations' adolescents.

Methods:

The sample included 1125 boys and 1204 girls aged between 12 and 16 years with no previous orthodontic treatment history. Occlusal variables examined were molar relationship, overjet, overbite, crowding, midline diastema, posterior crossbite, and scissors bite. The dental health (DHC) and aesthetic components (AC) of the Index of Orthodontic Treatment Need (IOTN) were used as an assessment measure of the need for orthodontic treatment for the total sample.

Results:

The results indicated a high prevalence of Class I (34.9%) and Class II, Division 1 malocclusions (40.0%). Moreover, increased (18%) and reduced bites (14.%), and increased (25.1%) and reversed overjet (10.%) were present in the sample.

Conclusion:

Using the DHC of the IOTN, the proportion of subjects estimated to have great and very great treatment need (grades 4 and 5) was 28.%. However, only 16.7% of individuals were in need (grades 8-10) of orthodontic treatment according to the AC.

[What are the treatment needs in adults? An evaluation of 258 cases by the IOTN]

INTRODUCTION

The aim of this epidemiological study was to evaluate the need for orthodontic treatment in a sample of adults living in France.

MATERIALS AND METHODS

The indicator selected was the dental component, IOTN (index of orthodontic treatment need).

RESULTS

Among the 258 adults evaluated, 37% of patients had a strong need and 21% had a moderate need; 29% of those aged 35 and under were in strong need for treatment compared with 47% of those over 35 years, with the need for treatment increasing with age. The most frequent occlusal anomalies were dental migrations following an uncompensated tooth extraction (a situation that involved 22% of subjects). It was the only occlusal anomaly whose frequency increased significantly with age. Among patients with uncompensated tooth extraction, two thirds experienced dental migrations requiring orthodontic treatment.

DISCUSSION

Although the IOTN indicator is widely used in the literature, it is controversial since all the characteristics evaluated are liable to impact longevity and the functioning and esthetics of the dentition, thus excluding any other consideration. The need for treatment in adults in France would therefore appear to be greater than in adolescents and would seem to increase with age, mainly due to uncompensated dental extractions.

Prevalence of malocclusion and assessment of treatment needs in β-thalassemia major children

Background

The objective of this study is to evaluate the prevalence of malocclusion and treatment needs in transfusion dependent β-thalassemia major children.

Methods

One hundred transfusion dependent β-thalassemia major children visiting the Department of Pediatrics were selected randomly and evaluated for malocclusion with Angle’s classification and Dewey’s modification. The orthodontic treatment needs were also assessed using Grainger’s treatment priority index (TPI). The orthodontic treatment needs were compared to normal children.

Results

The assessment of treatment needs revealed a higher prevalence of handicapping and severely handicapping malocclusion in thalassemic children compared to normal children. The thalassemic patients were found to show significantly more Angle’s Class II malocclusion (55 % vs. 15.7 %) when compared to normal children.

Conclusions

The higher prevalence of Angle’s Class II malocclusion and definitive malocclusion in thalassemic children indicates the importance of preventive orthodontic procedures and efforts towards providing orthodontic treatment to these children.

The relationship of orthodontic treatment need with periodontal status, dental caries, and sociodemographic factors

The aim of this study was to determine the relationship of orthodontic malocclusion with periodontal status, dental caries, and sociodemographic status. Our study population consisted of a sample of 836 school children (384 male and 452 female, aged 11-14 years). Four experienced orthodontists and two experienced periodontists performed the clinical examinations. The Treatment Priority Index (TPI), Community Periodontal Index of Treatment Needs (CPITN), decayed, missing, filled teeth (DMFT) scores, and a questionnaire that surveyed socio-demographic status of students were used. Spearman's rank correlation coefficients were used to measure the association between variables. TPI scores showed that 36.4% of the students had normal occlusion, while 41.2% had slight, 15.7% had definite, 4% had severe, and 2.7% had very severe malocclusion. TPI values did not show any significant differences between pupils in different age, gender, socioeconomic status groups, and CPITN scores, whereas there was a significant relationship between TPI and DMFT scores. The orthodontic treatment need was not significantly correlated with CPITN or socio-demographic status; however, the correlation coefficient showed a significant relationship between TPI and DMFT scores.

Prevalence of orthodontic treatment need in southern Italian schoolchildren

The present survey was performed to determine orthodontic treatment need in a large sample (n = 703) of 12-year-old schoolchildren from the southern part of Italy. The sample comprised 331 males (47 per cent) and 372 females (53 per cent), all orthodontically untreated. Two examiners, who had been previously trained in the use of occlusal indices, screened all the schoolchildren. The prevalence rates for the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) as well as for occlusal features (Angle Class, overjet, overbite, crowding, posterior crossbite) were calculated for the total sample. The IOTN grades were statistically compared in the two genders using the chi-square test. The findings indicated that this southern Italian school population showed a rather low prevalence rate for objective need for treatment (grades 4 and 5; 27.3 per cent of the total sample). This prevalence rate is generally lower than those reported in northern and central European countries (Sweden, Germany, and UK) but slightly greater than those in France. No significant differences in the DHC grades of the IOTN were found between genders. Among the occlusal features diagnosed in the subjects examined, a high prevalence rate was found for crowding (45.9 per cent). Moreover, posterior crossbites and Class III malocclusions, which would presumably have benefited from early orthodontic intervention, were still present in 14.2 and 4.3 per cent of the students, respectively.

Malocclusion, psycho-social impacts and treatment need: A cross-sectional study of Tanzanian primary school-children

Background

studies on the relationship between children's malocclusion and its psycho-social impacts are so far largely unexplored in low-income countries. This study aimed to assess the prevalence of malocclusion, reported dental problems and dissatisfaction with dental appearance among primary school children in Tanzania. The relationship of dissatisfaction with socio-demographic characteristics, clinically defined malocclusion and psychosocial impacts of dental anomalies was investigated. Orthodontic treatment need was estimated using an integrated socio-dental approach.

Method

One thousand six hundred and one children (mean age 13 yr) attending primary schools in the districts of Kinondoni and Temeke completed face to face interviews and a full mouth clinical examination. The survey instrument was designed to measure a Kiswahili translated and culturally adapted Child Oral Impact on Daily Performance (Child-OIDP) frequency score, reported dental problems, dissatisfaction with dental appearance/function and socio-demographic characteristics.

Results

The prevalence of malocclusion varied from 0.9% (deep bite) to 22.5% (midline shift) with a total of 63.8% having at least one type of anomaly. Moderate proportions of children admitted dental problems; ranging from 7% (space position) to 20% (pain). The odds ratio of having problems with teeth position, spaces, pain and swallowing if having any malocclusion were, respectively 6.7, 3.9, 1.4 and 6.8. A total of 23.3% children were dissatisfied with dental appearance/function. Children dissatisfied with their dental appearance were less likely to be Temeke residents (OR = 0.5) and having parents of higher education (OR = 0.6) and more likely to reporting problem with teeth position (OR = 4.3) and having oral impacts (OR = 2.7). The socio-dental treatment need of 12% was five times lower than the normative need assessment of 63.8%.

Conclusion

Compared to the high prevalence of malocclusion, psycho social impacts and dissatisfaction with appearance/function was not frequent among Tanzanian schoolchildren. Subjects with malocclusion reported problems most frequently and malocclusion together with other psycho-social impact scores determined children's satisfaction with teeth appearance- and function.

Intra- and inter-examiner reliability of intraoral malocclusion assessment

Malocclusion assessment methods are based on measurements of study casts, which requires that impressions be taken. In addition to being costly and time consuming, this process can be unpleasant for children. Therefore, the aim of this study was to evaluate intra- and inter-examiner reliability of intraoral score measurements to determine malocclusion severity in the permanent dentition. The research was a part of a longitudinal study from which a cohort of 92 children (39 boys, 53 girls), with a mean age of 14.8 years (standard deviation = 0.18), were randomly selected and classified into severity grades based on total malocclusion score. Subsequently, 12 children were randomly selected for a reliability study to assess intra-examiner reliability of malocclusion trait measurements. Nine subjects gave informed consent to participate in the study. Quantitative registrations of space and occlusal anomalies were performed intraorally by five examiners, on two occasions with a 1-month interval between the two measurements. Intra- and inter-examiner reliability was determined using intraclass correlation coefficients (ICCs). Overall classification into severity grades, based on total malocclusion score, showed almost perfect intra-examiner reliability for all examiners (ICC = 0.97-0.99); inter-examiner ICC was almost perfect (0.97). Near perfect intra-examiner reliability was determined for eight occlusal trait measurements (ICC = 0.89-1.0); substantial reliability for midline deviation (ICC = 0.68), overbite (ICC = 0.78), but large variability for space condition assessment (ICC = 0.42-0.52). Inter-examiner reliability was almost perfect for the eight traits (ICC = 0.81-1.0); substantial reliability for midline deviation (ICC = 0.65), and axial tooth inclination (ICC = 0.75), but large variability for space condition assessment (ICC = 0.13-0.26). Intra- and inter-examiner malocclusion assessment, recorded and measured intraorally to determine malocclusion severity scores in 14-year old children, is reliable. It is therefore proposed as the method of choice to be used not only in epidemiological studies and screening but also in clinical orthodontic assessment.

Prevalência de maloclusão e sua associação com alterações funcionais do sistema estomatognático entre escolares

Esta pesquisa objetivou estimar a prevalência de maloclusões entre escolares com 12 anos de idade do Município de Camaragibe, Pernambuco, Brasil. As maloclusões foram estratificadas em função do grau de severidade, analisando-se, ainda, a sua associação com as alterações das seguintes funções: fonoarticulação, respiração e deglutição. A oclusão foi avaliada por intermédio do Treatment Priotiy Index (TPI) e as referidas funções por meio de critérios utilizados na rotina clínica fonoaudiológica por um único examinador calibrado (valores de kappa variáveis entre 0,64 e 1,00). Os escolares foram selecionados randomicamente em 11 escolas públicas. Dos 173 sorteados, 82,1% apresentaram maloclusão (IC95%: 76,4-87,8), sendo 38,2% consideradas manifestações menores de maloclusões; 20,8% maloclusões definidas; 13,3% maloclusões severas; e 9,8% maloclusões muito severas. Conclui-se que há uma alta demanda reprimida por tratamentos ortodônticos e que quanto maior a severidade das maloclusões maior é a possibilidade de associação com alterações funcionais, fato que deve ser levado em consideração no planejamento de serviços públicos destinados aos referidos agravos.

Evaluation of 3 occlusal indexes: Eismann index, Eismann-Farčnik index, and index of orthodontic treatment need

INTRODUCTION

The aim of this study was to compare the validity, reliability, and time needed to use the Eismann index, the Eismann-Farcnik (EF) index, and the index of orthodontic treatment need (IOTN).

METHODS

One hundred pretreatment study casts of adolescent patients in the permanent dentition period (mean age, 15.4 years; SD, 0.4 year; 53 girls, 47 boys) were used. Three examiners trained and calibrated in the use of the Eismann and EF indexes and the IOTN scored the casts using the 3 indexes. A panel of 10 orthodontists individually rated the same casts for degree of malocclusion severity. The mean rating of the panel on the severity of malocclusion was used as the gold standard for evaluating the validity of the 3 indexes. Furthermore, the agreement of the 3 indexes in assessing the severity of malocclusion was evaluated. Ten randomly selected casts were reevaluated for the reliability study. Each evaluation was timed and rounded off to the nearest half minute.

RESULTS

The intraclass correlation coefficient indicated excellent agreement of the EF index with the ratings of the orthodontists (0.819), good agreement for the Eismann index (0.742), and moderate agreement for the IOTN (0.597). Receiver operating characteristic curves were plotted for the 3 indexes. The diagnostic accuracy, as determined by the area under the curve, was found to be the best for the EF index, followed by the Eismann index and the IOTN. Intraexaminer and interexaminer reliability was high (>0.75) for all 3 indexes. The most time-consuming methods were the EF (27.10 minutes) and the Eismann (26.86 minutes) indexes; the IOTN (1.97 minutes) was the least time-consuming method.

CONCLUSIONS

All 3 indexes are valid and reliable methods for assessing malocclusion severity. The EF index is the most time-consuming method, but it had the best agreement with clinical orthodontic diagnosis.

Prevalence and factors related to malocclusion and orthodontic treatment need in children and adolescents in Italy

BACKGROUND

The purpose of this study was to determine prevalence of malocclusions, normative and perceived orthodontic treatment need and related risk factors in schoolchildren in Italy.

DESIGN

A random sample of 1000 11-15 years old children was selected from randomly selected schools in Catanzaro (Italy). Parents completed a questionnaire on sociodemographic, orthodontic history and perception of their child orthodontic treatment need. Children were interviewed on utilization of dental services, perception of orthodontic treatment need and use of orthodontic devices. The Decayed, Missing, Filled Teeth (DMFT) index and the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN) were assessed. The Aesthetic Component (AC) of IOTN was assessed by parents, children and dentist.

RESULTS

A total of 546 children participated in the study. Three hundred and twenty-five subjects (59.5%) were assigned a 4 or 5 IOTN score, thus requiring orthodontic treatment. Definite treatment need (AC score 8-10) was reported for 8.6% of subjects by the orthodontist, 5.4% by parents and 3.2% by children. Higher DMFT significantly predicted orthodontic treatment need according to IOTN. Perceived orthodontic treatment need was significantly predicted by orthodontic treatment need for crowding/spacing and overjet.

CONCLUSION

A high proportion of children needs normative orthodontic treatment and perceptions of orthodontic treatment do not overlap with normative need.

Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: a cross-sectional study

The aim of this study was to describe the prevalence and distribution, by gender, of occlusal traits in a sample of Italian students aged 11-14 years (mean 13 +/- 1 years). Using standardized and validated recording criteria, a single operator measured the overjet, overbite, open bite, anterior and posterior crossbites, crowding, coincidence of the upper and lower midlines, and diastema, in 810 secondary school students (53.6 per cent males). Chi-square, t-test statistics, and odds ratios (ORs) with 95 per cent confidence intervals (CI) were used to investigate the relationship between gender and malocclusion characteristic. Logistic regression was used to further analyse the independent association between gender and each outcome measure. Ninety-three per cent of the subjects showed at least one occlusal trait, with one or two anomalies recorded in 63 per cent of children. The prevalence of occlusal traits ranged from 1.1 (negative overjet) to 54 per cent (upper and lower midlines not coincident). Males were more likely than females to show both an increased overbite and an increased overjet, although the latter result was not confirmed by logistic regression (P = 0.05). Multivariate analysis showed a negative association between overbite and misalignment of the lower incisors and lack of coincidence of the upper and lower midlines, whereas subjects with an increased overbite were more likely to have an increased overjet (all P < 0.01). Further studies are required in order to further clarify these findings and to provide accurate estimates of the orthodontic treatment need in Italian adolescents.

A useful insight into 2 occlusal indexes: HLD(Md) and HLD(CalMod)

Maryland and California are among the states that have adopted the Handicapping Labiolingual Deviation (HLD) Index to determine eligibility for public funding of orthodontic treatment. As a result of several lawsuits against the state, California has developed and employed a modification of that index, called the HLD(CalMod) index. This study compared and contrasted the effects of analyzing prospective patients with the HLD(Md)-the HLD index as used in Maryland-and the HLD(CalMod) indexes. The specific aims of this study were to observe (1) the correlation between the 2 occlusal indexes in determining patients' eligibility for treatment with public funding, (2) the characteristics of patients eligible according to each index, and (3) the major contributing factors in assigning patients as eligible under each index. Initial study models of 313 patients from the orthodontic clinic at the University of Maryland were scored by both HLD(Md) and HLD(CalMod) indexes. According to the scores, the patients were divided into 2 groups-those with handicapping malocclusions and those without handicapping malocclusions. Scores from each index were analyzed by the Pearson product moment correlation. The Angle classification for each patient was also recorded with the HLD variables. The mean and the percentage of the total score for each variable were calculated. The following conclusions were obtained: (1) Of the 313 patients, 127 (41%) were approved for treatment by the HLD(Md) index, and 110 (35%) were approved for treatment by the HLD (CalMod) index.(2) The correlation between the 2 indexes (R = 0.78) was not very strong, indicating the power of the additional variables introduced in the HLD(CalMod) index. (3) The use of the HLD(CalMod) index directs more public funding toward patients with severe Class II malocclusions than does the HLD(Md) index.

The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population

The aim of this study is to assess the need for orthodontic treatment in a Turkish school population and a group of population referred for orthodontic treatment. The study groups were 250 school children, 11-14 years of age, and 250 patients, 11-14 years of age, referred to the department of orthodontics. The Index of Orthodontic Treatment Need (IOTN) was used by two examiner in order to estimate the treatment need. The differences between the IOTN values for the boys and girls were also not statistically significant in both groups. When the dental health component of IOTN is considered, 38.8 per cent of Turkish school population showed great need treatment, 24.0 per cent moderate need treatment and slight or no need was 37.2 per cent. On the other hand, the referred population represented an 83.2 per cent great need treatment, 12.0 per cent moderate need treatment, 4.8 per cent no need treatment according to the DHC. The AC of IOTN in school population resulted in 4.8 per cent great need, 4.8 per cent moderate need, 90.4 per cent no need. These percentage were 36.8 per cent great need, 17.6 per cent moderate need, 45.2 per cent no need in referred population. Grade 8 was 28.8 per cent out of the 36.8 per cent great need percentage in referred population. Therefore, it can be concluded that the ectopic canines were the driving factor for the referred population.