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 Table of Contents  
Year : 2015  |  Volume : 1  |  Issue : 2  |  Page : 52-55

Assessment of the Prevalence of Malocclusion and Felt Barriers for Correctional Orthodontic Care Among High School Students Aged 12-15 Years of Ambala District

1 Department of Preventive and Community Dentistry, J.C.D Dental College, Sirsa, India
2 Department of Periodontology, MMCDSR, Mullana, Haryana, India
3 Department of Preventive and Community Dentistry, MMCDSR, Mullana, Haryana, India

Date of Web Publication17-Dec-2015

Correspondence Address:
Shweta Aggarwal
House No. 24, Subhash Park, Model Town, Hisar, Haryana
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2393-8692.172025

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Introduction: Malocclusion is considered to be a public health problem and the prevalence of occlusal anomalies, the need and demand for orthodontic treatment should be ascertained within a given community. Aim: To assess the prevalence of malocclusion among 12-15 years old students. Materials and Methods: A multistage random sampling technique was used from various schools of Ambala district and data were collected using type III examination on a modified WHO oral health assessment form 1997. Result: Data was analyzed using the Chi-square test, Mann-Whitney test, post hoc and ANOVAs probability tests. The mean dental esthetic index were 26.2 for males and 25.7 for females. Conclusion: Prevalence of orthodontic need was high and needed intervention.

Keywords: Dental aesthetic index, malocclusion, orthodontic needs

How to cite this article:
Aggarwal S, Singal P, Veeresha K L. Assessment of the Prevalence of Malocclusion and Felt Barriers for Correctional Orthodontic Care Among High School Students Aged 12-15 Years of Ambala District. Indian J Oral Health Res 2015;1:52-5

How to cite this URL:
Aggarwal S, Singal P, Veeresha K L. Assessment of the Prevalence of Malocclusion and Felt Barriers for Correctional Orthodontic Care Among High School Students Aged 12-15 Years of Ambala District. Indian J Oral Health Res [serial online] 2015 [cited 2023 Mar 23];1:52-5. Available from: https://www.ijohr.org/text.asp?2015/1/2/52/172025

  Introduction Top

Health is a state of total effective physiologic and psychological functioning, which has both a relative and an absolute meaning. Oral health is an integral part of general health. Dento facial appearances that deviate from the social norms may have a negative impact on social, physiological and psychological functions. Malocclusion may lead to such deviations and if left untreated may lead to various health problems like difficulty in speech, difficulty in eating and swallowing, hampered esthetics and psychological distress.

At the same time, most of the malocclusions can be corrected if detected earlier by correctional methods. As malocclusion is considered to be public health problem. [1] The prevalence of occlusal anomalies, the need for orthodontic treatment should be ascertained with a given community, so that appropriate arrangements could be made for allocation of staff and financial resources.

Malocclusion may be detected at early years of life, but malocclusion occurring during mixed dentition period may sometime be transitional and hence do not give the true picture of the prevalence in the community. Hence, children aged 12-15 years are suitable for early detection of types and extent of malocclusion. [2],[3],[4] Interceptive and sometimes corrective treatment is recommended at this age group as all permanent teeth have erupted, and the maxillae will be in the active growth period. The present study is focused on determining the prevalence of malocclusion and the need for orthodontic treatment among 12-15 years school children of Ambala district, Haryana.

Aims and objective

  • To assess the prevalence of malocclusion and the need for orthodontic treatment among 12-15 years school children of Ambala district, Haryana
  • To assess knowledge and attitude of students, regarding malocclusion and also to assess the felt barriers for correctional orthodontic treatment.

  Materials and Methods Top

The present study was carried out in the district Ambala, which is comprised of three tehsils. In the beginning, an adequate sample size was estimated based on the results of the pilot study and previous studies. Before the start of the study, a list of all schools was obtained from the district education office. The study was done in the government schools. The total numbers of government high schools in Ambala were 86. The entire district was divided into six blocks, and a multi-stage random sampling technique was adopted for schools and from the selected schools a universal sample was taken.

Inclusion criteria

All children between 12 and 15 years were included. [2],[3],[4] This age group is included in the study because most of the malocclusion becomes fully visible by this age, and this is the age where it can be easily and effectively corrected by interceptive or corrective orthodontic treatment.

Exclusion criteria

  1. All children below and above the mentioned age
  2. Children already undergoing correctional orthodontic treatment.

The examiner was trained and calibrated for dental esthetic index (DAI) in the department by the department staff. Type III examination [5] was carried out in the school premises. The children were allowed to sit on a chair or stool as per availability. A table to place instruments was placed within easy reach of the examiner. Data were collected on a modified WHO oral health assessment form 1997. [6] The assessment of malocclusion was done according to DAI. DAI was proposed by Cons et al. as an objective index concentrating on the correlation between occlusal morphology and socio-psychological handicaps, in the year 1986. The DAI also tells us about the severity of malocclusion and the treatment needs. The scoring was done using a community periodontal probe. [6],[7]

The data obtained were analyzed using SPSS package version 10. Differences were tested for statistical significance by using the Chi-square test, Mann-Whitney test, post hoc test and ANOVA probability tests. P < 0.05 was considered as statistically significant and P < 0.001 was considered as highly significant.

  Result and Discussion Top

As DAI is a ten point index, each criterion was examined and assessed. [8],[9] In females, 64.1% (706) had no spacing, 26.2% (289) had one segment spacing, and 9.6% (106) had two segment spacing. In males, 62.4% (518) had no spacing, 23.1% (192) had one segment spacing, and 14.5% (120) had two segment spacing. Incisal segment spacing was highly significant between male and females (P = 0.003). This could be attributed to the jaw size discrepancy between the genders. Apart from this all the other parameters were nonsignificant.

Age and sex wise distribution of DAI scores and shows that in males DAI score was 26.2 and in females it was 25.7 which is not significant. In 12 years old, the mean DAI was 27.5, in 13 years old it was 26.5, in 14 years old 25.3 and in 15 years old 24.9 [Table 1]. The results were not significant.
Table 1: Age-wise distribution of mean DAI

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In the present study, the mean DAI was 25.95, which states that the majority of the population screened had a definite malocclusion. It is in correlation with study by Bernabé and Flores-Mir [10] with DAI score 28.8, Katoh et al. [11] study in Taiwan with DAI score 25.9 and Jenny et al. [8] with DAI score of 26.53. In a study done by Ansai et al. [7] the score was a little higher 30.5. This little difference in mean DAI score may be due to the reason that these studies were done in different countries that could be attributed to racial differences.

Males had a slightly higher DAI score (26.2) than females (25.7) in the present study [Table 2]. Similar results were obtained by Otuyemi et al., [12] with mean DAI score 22.61 ± 5.87 (males) and 22.1 ± 5.79 (females). Thus, the difference in DAI score was nonsignificant. Marques et al. [13] also concluded to have no significant difference between DAI scores of males and females.
Table 2: Sex wise distribution of mean DAI

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In the present study 53.6% of children did not require any treatment, 24.3% required elective treatment, in 12.4% the treatment was highly desirable and in 9.8% it was mandatory [Table 3]. Similar results were found by Marques et al., [13] Jenny and Cons [14] and Abdullah and Rock. [15] But contrary to these results Otuyemi and Noar [16] and Onyeaso [17] showed that the percentage of the population with handicapping malocclusion was quite high. The reason could be because it was a hospital based study and hence the majority of subjects were those who reported for orthodontic treatment and in the study by Onyeaso, [17] the study population was mentally challenged who generally have developmental anomalies and thus severe malocclusion.
Table 3: Distribution of subjects according to severity of malocclusion and the treatment needs

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Regarding the knowledge and attitude some questions were asked to the subjects. [18] 33.3% of males and 30.3% of females were conscious about their malocclusion and knew that their teeth were irregular. However, the fact that malocclusion affected their esthetics was known by 42.2% of males and 45.2% females.

The knowledge that a dentist can correct the irregular teeth was known by 68.4% males and 69.3% females. However, the motivation to get their teeth corrected was only in 59.4% males and 58.5% females.

Only 40% of males and 33% females knew about the dental college in the vicinity. Even if they knew about the college, only 37.5% males and 30.9% females knew that orthodontic correctional treatment is also available at this college. The knowledge of parents about the orthodontic treatment was negligible as only 20.7% of boys said that their parents know about the treatment and 25% girls said the same. 31.1% (258) of males and 31.2% (344) females said that the cause for not coming for correctional care was lack of finances. 9.5% (79) of males and 10.4% (114) of females said that the barrier perceived was that they could not come for treatment during the school hours as the school timing unfortunately coincided with the college timing.

  Conclusion Top

There is a high prevalence of orthodontic need among 12-15 years high school students according to DAI. There is a considerable amount of deficiency of knowledge and awareness among students and parents about correctional orthodontic treatment. The major barrier perceived through my study about orthodontic care was lack of knowledge, understanding and awareness regarding existing irregularity of teeth, lack of awareness regarding existing dental health care facility in the nearby vicinity, lack of perception of the parents regarding their children's irregular teeth and lack of finances.

  Recommendation Top

  1. There is a need for school health education program for creating awareness and knowledge about general health, oral health and self-assessment of irregular teeth and correctional facilities available
  2. Strategies should be thought of rendering preventive and correctional orthodontic treatment for the economically weaker section of the students who are studying in government schools.

  References Top

Darker HL. Handicapping labial lingual deviations: A proposed index for public health purposes. Am J Orthod 1960;46:295-305.  Back to cited text no. 1
Esa R, Razak IA, Allister JH. Epidemiology of malocclusion and orthodontic treatment need of 12-13-year-old Malaysian schoolchildren. Community Dent Health 2001;18:31-6.  Back to cited text no. 2
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.  Back to cited text no. 3
Mahesh Kumar P, Joseph T, Varma RB, Jayanthi M. Oral health status of 5 years and 12 years school going children in Chennai city - An epidemiological study. J Indian Soc Pedod Prev Dent 2005;23:17-22.  Back to cited text no. 4
Dunning JM. Principles of Dental Public Health. 3 rd ed. 1963.  Back to cited text no. 5
World Health Organization. Oral Health Surveys: Basic Methods. 4 th ed. Geneva: World Health Organization; 1997.  Back to cited text no. 6
Ansai T, Miyazaki H, Katoh Y, Yamashita Y, Takehara T, Jenny J, et al. Prevalence of malocclusion in high school students in Japan according to the dental aesthetic index. Community Dent Oral Epidemiol 1993;21:303-5.  Back to cited text no. 7
Jenny J, Cons NC, Kohout FJ, Jakobsen J. Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores. J Public Health Dent 1991;51:234-8.  Back to cited text no. 8
Otuyemi OD, Noar JH. Variability in recording and grading the need for orthodontic treatment using the handicapping malocclusion assessment record, occlusal index and dental aesthetic index. Community Dent Oral Epidemiol 1996;24:222-4.  Back to cited text no. 9
Bernabé E, Flores-Mir C. Orthodontic treatment need in Peruvian young adults evaluated through dental aesthetic index. Angle Orthod 2006;76:417-21.  Back to cited text no. 10
Katoh Y, Ansai T, Takehara T, Yamashita Y, Miyazaki H, Jenny J, et al. A comparison of DAI scores and characteristics of occlusal traits in three ethnic groups of Asian origin. Int Dent J 1998;48:405-11.  Back to cited text no. 11
Otuyemi OD, Ogunyinka A, Dosumu O, Cons NC, Jenny J. Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI). Int Dent J 1999;49:203-10.  Back to cited text no. 12
Marques CR, Couto GB, Orestes Cardoso S. Assessment of orthodontic treatment needs in Brazilian schoolchildren according to the dental aesthetic index (DAI). Community Dent Health 2007;24:145-8.  Back to cited text no. 13
Jenny J, Cons NC. Establishing malocclusion severity levels on the dental aesthetic index (DAI) scale. Aust Dent J 1996;41:43-6.  Back to cited text no. 14
Abdullah MS, Rock WP. Assessment of orthodontic treatment need in 5,112 Malaysian children using the IOTN and DAI indices. Community Dent Health 2001;18:242-8.  Back to cited text no. 15
Otuyemi OD, Noar JH. A comparison between DAI and SCAN in estimating orthodontic treatment need. Int Dent J 1996;46:35-40.  Back to cited text no. 16
Onyeaso CO. Orthodontic treatment need of mentally handicapped children in Ibadan, Nigeria, according to the dental aesthetic index. J Dent Child (Chic) 2003;70:159-63.  Back to cited text no. 17
Onyeaso CO, Aderinokun GA. The relationship between dental aesthetic index (DAI) and perceptions of aesthetics, function and speech amongst secondary school children in Ibadan, Nigeria. Int J Paediatr Dent 2003;13:336-41.  Back to cited text no. 18


  [Table 1], [Table 2], [Table 3]

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