Orthodontic treatment priorities in the Danish Child Dental Health Services

Malocclusion and oral health-related quality of life among young Danish adults. Is there a difference between subjects who received orthodontic treatment during adolescence and subjects without treatment need? A cross-sectional study

OBJECTIVES

To evaluate and compare malocclusion traits and oral health-related quality of life (OHRQoL) between untreated young adults assessed to have no orthodontic treatment need during childhood, and young adults treated orthodontically during childhood. In addition, to investigate the relationship between malocclusion and OHRQoL.

MATERIALS AND METHODS

One hundred undergraduate students were screened for eligibility. Subjects had intraoral scans and completed OHIP-14 questionnaires. Angle molar relationship, overjet, overbite, arch length and width, Little's Irregularity Index (LII), Peer Assessment Rating (PAR) index and Dental Aesthetic Index (DAI) scores were assessed. Unpaired t-tests were used to compare outcomes between treated and untreated subjects. Multiple regression analyses were conducted to model the relationship between OHIP-14 and several prognostics simultaneously.

RESULTS

Ninety-six subjects were included (mean age ± SD = 23.7 ± 1.8 years): 41 treated and 55 untreated. The untreated subjects had significantly higher LII (p = .02), PAR (p = .01), DAI (p < .01) and overbite (p = .03). The treated subjects had significantly larger inter-canine and inter-premolar distances. No relationship was found between OHIP-14 and LII, PAR, DAI, age, gender and presence/absence of previous orthodontic treatment. However, the DAI score was significantly correlated with the OHIP-14 functional limitation domain.

CONCLUSIONS

Untreated subjects had significantly higher LII, PAR and DAI scores than the treated subjects. DAI score was significantly correlated with the OHIP-14 functional limitation domain.

Orthodontic treatment of a disto-occlusion with and favorable growth pattern

The variety of etiological factors contributing to the development of distal bite various form, as well as the structures that are affected by the disorders determine the deegre of complexity of the malocclusion itself, and thus the choice of therapeutic procedure by which it will be treated. An 11-year-old female patient was diagnosed with this type of malocclusion with a certain degree of presence of other irregularities. After a detailed diagnostic procedure, and determining the type of growth, we approach the therapeutic procedure in two phases. By applying the funcional therapy in the first phase, we correct the vertical growth type, and then in the second phase of therapy using a fixed technique we achieve harmonious intermaxillary relations, an adequate molar and canine Class I relationship as well, thus improving the aesthetics of the patient's face.

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics, function and speech amongst secondary school children in Ibadan, Nigeria

OBJECTIVE

The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients.

METHODS

An epidemiological survey of 614 secondary school students, 327 males (53.3%) and 287 females (46.7%) was carried out in Ibadan, Nigeria. Children aged 12-18 years (mean age, 14.9+/-2.9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5-point Likert scale.

RESULTS

Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r=0.174; P<0.01) and between biting/chewing and appearance of teeth (r=0.095; P<0.05). Statistically significant correlations were found between appearance of teeth and speech (r=0.148; P<0.01) and biting/chewing and speech. The last showed the strongest correlation (r=0.268; P<0.01).

CONCLUSION

The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.

Occlusal status in orthodontically treated and untreated adolescents

In order to evaluate the outcome of orthodontic care, all available 16-year-old adolescents (n = 138) living within the catchment area of one Finnish health center were invited for a clinical examination. A total of 126 adolescents participated, corresponding to 79% of the whole age cohort. Of these, 47% had been treated orthodontically, 2% were still wearing appliances, and 51% were untreated. In 80% of cases, a non-extraction treatment was carried out. All occlusions were evaluated using a recently developed occlusal morphology and functional index (OMFI) based on assessment of 6 morphological and 4 functional traits which are classified applying an acceptable-non-acceptable dichotomy. The occlusal status in untreated individuals was used as a second reference in comparisons between the treated and untreated occlusions. The morphological criteria for an acceptable occlusion were met by 42% of the participants and the functional criteria by 64%. Although the treated occlusions failed to meet the criteria of morphological acceptability more often than the untreated ones (73% vs 40%), the proportions of non-acceptable occlusions were fairly high among untreated occlusions. The main reasons for non-acceptability were the failure of the canine relationship, overbite, and protrusion movement to fulfill the criteria of acceptability. Only 19% of the adolescents had occlusions classified as acceptable, both morphologically and functionally. In the evaluated health center, the allocation of resources resulted in a high coverage of orthodontic care. However, our results indicate that the general occlusal status in the examined age cohort did not reach an optimal level.

The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech, and orthodontic treatment need

The aim of this study was to determine the relationship between patients' perceptions of orthodontic treatment need and need as determined with professionally derived indexes, namely the dental aesthetic index and the index of orthodontic treatment need. This study was undertaken at orthodontic offices in San Francisco, Calif. The pretreatment study casts of 50 consecutive patients, presenting for orthodontic treatment, were objectively assessed with these indexes by 2 examiners trained and calibrated in their use. Patients were asked to complete a questionnaire consisting of 4 questions addressing appearance, function, speech, and treatment need, using either a 5-point Likert scale or a yes/no response. The professionally derived indexes showed that statistically significant correlations existed between the aesthetic component and dental health component (r = 0.46; P <.01), the aesthetic component and dental aesthetic index (r = 0.54; P <.01), and the dental health component and dental aesthetic index (r = 0.46; P <.01). Statistically significant correlations were also found for subjective assessments between biting/chewing and speech (r = 0.31; P <.05), between speech and the aesthetic component (r = -0.39; P <. 01) and the dental aesthetic index (r = 0.34; P <.05), and between the aesthetic component and appearance (r = -0.28; P <.05). Logistic regression analysis after dichotomization (treatment/no treatment need) confirmed that the aesthetic component was the only statistically significant factor (odds ratio, 0.57; 95% confidence limits 0.34 to 0.97).

The HLD (CalMod) index and the index question

The malocclusion index problem arises because of the need to identify which patient's treatments will be paid for with tax dollars. Both the civilian (Medicaid) and military (Champus) programs in the United States require that "need" be demonstrated. Need is defined as "medically necessary handicapping malocclusion" in Medicaid parlance. It is defined by Champus as "seriously handicapping malocclusion." The responsible specialty organization (the AAO) first approved the Salzmann Index in 1969 for this purpose and then reversed course in 1985 and took a formal position against the use of any index. Dentistry has historically chosen a state of occlusal perfection as ideal and normal and declared that variation was not normal hence abnormal and thus malocclusion. This "ideal" composes from 1% to 2% of the population and fails all statistical standards. Many indexes have been proposed based on variations from this "ideal" and fail for that reason. They are not logical. The HLD (CalMod) Index is a lawsuit-driven modification of some 1960 suggestions by Dr. Harry L. Draker. It proposes to identify the worst looking malocclusions as handicapping and offers a cut-off point to identify them. In addition, the modification includes two situations known to be destructive to tissue and structures. As of Jan. 1, 1998, the California program has had 135,655 patients screened by qualified orthodontists using this index. Of that number, 49,537 patients have had study models made and screened by qualified orthodontists using the index. Two separate studies have been performed to examine results and to identify problems. Necessary changes have been made and guidelines produced. The index problem has proven to be very dynamic in application. The HLD (CalMod) Index has been successfully applied and tested in very large numbers. This article is published as a factual review of the situation regarding the index question and one solution in the United States.

Longitudinal evaluation of the Treatment Priority Index (TPI)

The Treatment Priority Index (TPI) is an epidemiologic tool used to rank malocclusions and assess the need for orthodontic treatment. The purpose of this study was to (1) evaluate the predictability of the TPI as an indicator of malocclusion severity, (2) evaluate the effect of orthodontic treatment on TPI values, and (3) compare the results with a national survey of American children aged 6 to 11 years and 12 to 17 years conducted by the United States Public Health Service. The TPI was recorded annually in a young student population of Juniata County, Pa., from 1975 to 1979, and later in 1985. The mean values of the TPI did not reflect the range of severity in the population. For this reason the Malocclusion Severity Scale (Burlington Growth Center) was used to identify four groups in 1985. Each group was tracked back to 1975. Further evaluation investigated the role of individual factors contributing to malocclusion over time (tooth displacement and occlusal factors). The conclusions are as follows: (1) the TPI is a valid epidemiologic indicator of malocclusion but does not predict the severity of individual malocclusions in the permanent dentition, (2) TPI values decrease with orthodontic treatment, and (3) the average TPI values for this population were higher than the national average between 6 and 11 years of age and slightly lower in late adolescence, but lie within a treatment-need range of slight to elective. A characterization of treatment need relative to malocclusion severity that is different from the available scale is suggested.

Relationship between malocclusion and maintenance of teeth

The relationship between the presence of malocclusion and maintenance of teeth in adulthood was studied in a randomly drawn sample of 499 35-44-yr-old Danes. Maintenance of teeth in the past was expressed through the number of teeth present, attachment level and information of regularity of dental visits. Maintenance at present was expressed as caries present, plaque and gingivitis. The relationship of these parameters to the presence of a malocclusion symptom was analyzed directly and the indirect influence was studied through the influence of a subjectively perceived malocclusion and its impact on satisfaction. It appeared that satisfaction was significantly related to maintenance of teeth and to a positive dental behavior. A perceived malocclusion was shown to have a negative influence on satisfaction and thus indirectly on maintenance. If a public orthodontic service is aiming at lifetime maintenance of teeth, malocclusions leading to dissatisfaction with teeth and a subjectively perceived need should be taken into consideration when ranking children with regard to treatment priority.

Epidemiology of malocclusion in Argentine children

As part of a nationwide oral health survey in Argentina, malocclusion traits and need of orthodontic treatment was assessed in 1554 schoolchildren aged 12-13 using the WHO-FDI basic method for recording occlusal traits. A frequency of 1.38% extracted permanent teeth was found, being higher in Amerindian than Caucasian children. Incisor diastema and crowding was significantly lower in Amerindians. Both maxillary overjet and overbite were significantly lower in Amerindian (2.9% and 3.8%) than in Caucasian children (9.9% and 8.1%) respectively (P less than 0.001). The frequency of distal molar relation was 10% and the mesial molar relation 5%. Of the children examined 76% had no need of orthodontic treatment. Treatment need in Amerindian group (18%) was significantly lower than in the Caucasian group (28%). Since there is an increasing public demand for the provision of orthodontic treatment in public dental services, careful planning based on feasibility studies is essential for the creation of appropriate solutions.

Orthodontic treatment-service studied retrospectively in a group of Danish children aged 15-16 years

In a group of adolescent children in 9th grade attending a municipal dental health service, a certain amount of orthodontic treatment has been performed. 27% of the children had completed, or were undergoing, orthodontic appliance therapy. 9% of the children had completed extraction therapy only. 4% were recorded as discontinued appliance treatments and 3% as discontinued after extraction of permanent teeth as the only treatment. 21% had no anomalies and no treatment and 36% had a malocclusion but no treatment carried out. The effect of the orthodontic service was studied on the group as a whole according to the frequency and pattern of change in four selected malocclusion symptoms and to the degree of personal satisfaction about dental appearance and any orthodontic appliances. The individuals most satisfied with the results from their orthodontic treatment were found in the three middle socioeconomic groups.

A 15-year follow-up study of 30-year-old Danes with regard to orthodontic treatment experience and perceived need for treatment in a region without organized orthodontic care

It was the aim to study orthodontic treatment experience and past and present perceived need for treatment in 30-year-old Danes who, at adolescence, had no access to organized orthodontic care. In order to identify the malocclusion traits which elicited treatment or need for treatment, the findings were related to the occurrence of various traits which had been registered in the same individuals 15 years earlier. From questionnaires (response rate 86%, n = 841) it appeared that 10% had received treatment and 20% perceived need for treatment either in childhood or at present. At adolescence, the subjects who had subsequently received treatment, displayed relatively high frequencies of ectopic eruption, anterior cross-bite, extreme maxillary overjet, deep bite, and crowding; among those who perceived need for treatment, extreme maxillary overjet, mandibular overjet and crowding were relatively prevalent.