The prevalence and severity of malocclusion and the need for orthodontic treatment in 9-, 12-, and 15-year-old Glasgow schoolchildren

Prevalence of condylar morphological changes in individuals with class II malocclusion

This observational, cross-sectional study with retrospective collection was aimed to evaluate the prevalence of morphological changes in mandibular condyles in individuals with class II malocclusion, classified according to different vertical growth patterns (brachyfacial, mesofacial, and dolichofacial), through cone beam computed tomography (CBCT). Seventy CBCT images (140 mandibular condyles) were selected from individuals without orthodontic treatment, of both sexes, aged between 25 and 50 years. No statistically significant differences were found between facial patterns; however, there was a higher relative prevalence of bone changes in dolichofacial individuals with flattening (62%), sclerosis (44%), and subchondral bone cyst (20%). Erosion and osteophytes prevailed in mesofacial (39%), and brachyfacial individuals (32%), respectively. Thus, there was no statistically significant difference in the prevalence of degenerative changes between the vertical skeletal patterns. Flattening was the most prevalent change, whereas subchondral bone cyst was the least prevalent among the three groups studied. The observational design of this study makes it possible to analyze image banks to verify the correlation of morphological changes in the temporomandibular joint in different facial patterns in patients with class II malocclusion. A limitation of the study is that clinical characteristics were not evaluated.

Socio-economic and gender dynamics influence on the parental decision-making process for children's orthodontic care - A study in Madinah, Saudi Arabia

OBJECTIVES

To investigate the socio-economic and personal factors that impact parental decisions regarding orthodontic treatment for their children in Madinah, Saudi Arabia.

MATERIALS AND METHODS

A digital self-administered questionnaire was employed to collect data from 414 parents, focusing on their motivations and barriers that influence their decision-making process regarding orthodontic treatment.

RESULTS

Income level was the most significant factor in orthodontic decisions. Parents with higher incomes were twice as likely to choose orthodontic treatment for esthetic reasons compared to parents with middle incomes. The main incentive for seeking treatment was getting advice from dental professionals, with 60% of participants rating it as the most important factor. 34.5% of respondents identified cost as the main barrier, with middle-income parents being 151% more inclined to perceive it as a significant barrier compared to high-income parents. Gender dynamics revealed that mothers exhibited 48.9% greater concern regarding treatment costs compared to fathers, whereas fathers placed 2.105 times more importance on the orthodontist's reputation than mothers.

CONCLUSION

Income levels, along with other socio-economic factors and gender dynamics, have a significant influence on parental decisions regarding orthodontic care. Personalized consultations that address these variations are crucial for improving communication between patients and practitioners and increasing the accessibility of treatment.

Epidemiology of Malocclusion and Assessment of Orthodontic Treatment Need for Nepalese Children

Objective. To evaluate the prevalence of malocclusion and orthodontic treatment needs among 12- to 15-year-old schoolchildren in eastern Nepal and compare the findings with those of other populations. Methods. Two thousand seventy-four children (1149 males and 925 females) aged between 12 and 15 years were evaluated. Their orthodontic treatment need was assessed using the Index of Orthodontic Treatment Needs (IOTN) (dental health component (DHC)). Angle's classes of malocclusion were also evaluated. Results. The prevalence of classes I, II, and III was 48.50%, 32.68%, and 4.32%, respectively. The IOTN showed that 21.59% had an extreme treatment need, 24.67% had severe treatment need, 24.07% had moderate treatment need, 14.7% had mild treatment need, and 15.02% had no treatment need. Conclusion. Class I malocclusion is the most common, while class III is the least prevalent in eastern Nepal. The majority of the children need orthodontic treatment.

Prevalence of malocclusion and orthodontic treatment needs among 12-15 years old school children of Udaipur, India

Objective:

The objective of the study is to assess the prevalence of malocclusion and orthodontic treatment needs among 12-15 years old school children of Udaipur, India.

Materials and Methods:

A cross-sectional descriptive survey was conducted among 887 subjects aged 12-15 years. The prevalence of malocclusion and orthodontic treatment needs was assessed using dental aesthetic index (World Health Organization, 1997). General information on demographic data was also recorded. Chi-square test, analysis of variance and Scheffe's test were employed for statistical analysis.

Results:

Malocclusion and orthodontic treatment need was reported among 33.3% of the study subjects. A significant age and gender difference depicting preponderance among younger age group and a male proclivity was experiential. A significant improvement in anterior crowding and largest anterior maxillary irregularity with age was documented. Males had a significantly higher prevalence of anterior crowding, midline diastema and largest anterior maxillary irregularity than females.

Conclusions:

The prevalence of malocclusion and orthodontic treatment needs among school children of Udaipur city, Rajasthan, India was found to be 33.3%. A significant age and gender difference was observed in prevalence of malocclusion, crowding and largest anterior maxillary irregularity. Midline diastema showed a significant gender difference. The baseline information outlined in the present study can be appropriately utilized for the future planning to meet the orthodontic treatment need among the population.

Prevalence of long face pattern in Brazilian individuals of different ethnic backgrounds

Objective:

The long face pattern is a facial deformity with increased anterior total facial height due to vertical excess of the lower facial third. Individuals with long face may present different degrees of severity in vertical excess, as well as malocclusions that are difficult to manage. The categorization of vertical excess is useful to determine the treatment prognosis. This survey assessed the distribution of ethnically different individuals with vertical excess according to three levels of severity and determined the prevalence of long face pattern.

Material and Methods:

The survey was comprised of 5,020 individuals of Brazilian ethnicity (2,480 females and 2,540 males) enrolled in middle schools in Bauru-SP, Brazil. The criterion for inclusion of individuals with vertically impaired facial relationships was based on lip incompetence, evaluated under natural light, in standing natural head position with the lips at rest. Once identified, the individuals were classified into three subtypes according to the severity: mild, moderate, and severe. Then the pooled sample was distributed according to ethnical background as White (Caucasoid), Black (African descent), Brown (mixed descent), Yellow (Asian descent) and Brazilian Indian (Brazilian native descent). The Chi-square (χ²⁾ test was used (p<0.05) to compare the frequency ratios of individuals with vertically impaired facial relationships in the total sample and among different ethnicities, according to the three levels of severity.

Results:

The severe subtype was rare, except in Black individuals (7.32%), who also presented the highest relative frequency (45.53%) of moderate subtype, followed by Brown individuals (43.40%). In the mild subtype, Yellow (68.08%) and White individuals (62.21%) showed similar and higher relative frequency values.

Conclusions:

Black individuals had greater prevalence of long face pattern, followed by Brown, White and Yellow individuals. The prevalence of long face pattern was 14.06% in which 13.39% and 0.68% belonged to moderate and severe subtypes, respectively.

Stability evaluation of occlusal changes obtained with Fränkel's Function Regulator-2

OBJECTIVE: To analyze the stability of occlusal changes promoted by the Frankel's Functional Regulator 2 (FR-2), in a mean period of 7.16 years post treatment. METHODS: Fifty-four pairs of models were evaluated, from 18 patients treated with FR-2. All patients had Class II, division 1 malocclusion, with initial mean age of 10.77 years and were treated with FR-2 for 18 months. The models were evaluated at the beginning of treatment (T1), at the end (T2) and after 7.16 years post treatment (T3). For occlusal evaluation, the treatment priority index (TPI) was applied on the three analyzed phases. The alterations that occurred between phases were verified with one another through paired Student's t test, with critical value of 0.05. RESULTS: A statistically significant reduction of TPI was verified, from the initial to the final phase of the treatment, reflecting the efficiency of treatment performed with FR-2, specially due to improvement in molar relation, overjet and overbite. Apart from this, the Class II correction remained stable over time. CONCLUSIONS: In this way, it is concluded that the FR-2 appliance showed to be efficient for the dental correction of Class II malocclusion, with stable occlusal results after 7.16 years post treatment.

Posteroanterior cephalometric norms for an adolescent Kuwaiti population

The aim of the study was to establish posteroanterior (PA) cephalometric norms for adolescent Kuwaitis of an age comparable with the start of comprehensive orthodontic treatment, and to compare these with similar normative data, considering a difference of 2.0 mm or degrees as clinically significant. Digital PA cephalograms of 159 13- to 14-year-old Kuwaitis (81 boys and 78 girls) with untreated ideal occlusions were evaluated. Anatomic landmarks were identified directly on digital computer images and linear and angular measurements were calculated electronically. Mean values (norms), standard deviations, and ranges were calculated for the parameters. Student's t-tests were employed to test for gender differences. The dental norms were clinically similar to those of Ricketts' analysis, but the ranges of the skeletal dental width and relationship measurements were clinically larger. Only the ranges of skeletal symmetry measurements were larger. Regarding the four dental to skeletal relationships, the norms were larger only for the molar to jaw relationship, while the ranges were larger for all. No gender differences were detected after Bonferroni adjustments. The findings suggest clinically significant racial differences in PA cephaolometric norms with minimal gender differences at adolescence. The ranges of the various parameters in adolescent subjects with natural development of an ideal occlusion are considerably larger than those suggested in Ricketts' analysis system.

Disparity in orthodontic utilization and treatment need among high school students

OBJECTIVES

The aim of this cross-sectional study was to assess the disparity in utilization of orthodontic services among high school students and to measure and characterize the extent of unmet treatment needs among untreated students at the time of examination.

METHODS

The sample consisted of 2,808 tenth grade students enrolled in different public and private high schools. All subjects completed a dental survey that included questions on demographic, dental health, and orthodontic services, and assessment of smile using the visual analog scale. A subsample of dental study casts that were available for 561 untreated subjects were scored using the Dental Aesthetic Index (DAI) to estimate unmet treatment need.

RESULTS

The orthodontic utilization rate was 37 percent. The odds of being orthodontically treated were 8.7 times greater among those with dental visits within the past year than among those without, and three times greater among Caucasians than among other ethnic groups. The DAI indicated that the unmet treatment need was 29 percent, with ethnic minority groups having 2.6 greater odds of needing treatment than Caucasians.

CONCLUSION

Minority groups and infrequent dental attenders may experience disparities in unmet orthodontic treatment need.

Posteroanterior cephalometric analysis of the parental craniofacial morphology in orofacial clefting

OBJECTIVE

To evaluate the parental craniofacial morphology in orofacial clefting (OFC).

DESIGN

Case-control posteroanterior cephalometric study.

SETTING

The Department of Orthodontics, University of Dundee Dental School, Scotland, United Kingdom.

PARTICIPANTS

Ninety-two parents from a completely ascertained sample of 286 Scottish babies with nonsyndromic OFC and 43 comparison group volunteers from the University of Dundee Dental School.

MAIN OUTCOMES AND MEASURES

A conventional cephalometric analysis was used to measure linear distances and their ratios, angles, and areas. Two-sample Student's t tests and a discriminant analysis were applied to the data, and the clinically important statistically significant variables were identified using an accepted protocol.

RESULTS

Sixty-four linear distances, 10 ratios, 52 angles, and 7 areas statistically significantly differed between the parental and comparison groups (p <.01). Of these, 62 linear distances (22%), 9 ratios (45%), 41 angles (41%), and 6 areas (24%) were clinically important. Asymmetry was a feature of the results. Canonical variates analysis correctly classified 91.3% of the parental group and 90.6% of the comparison group using a series of 36 variables.

CONCLUSIONS

The parental craniofacial morphology in OFC differs significantly from the noncleft population. A larger superolateral face and smaller central midface and, in particular, a clinically significantly smaller maxillary width, in conjunction with skeletal asymmetry, characterize the parents of Scottish children with OFC. These features may be of morphogenetic importance in the etiopathogenesis of OFC in this ethnic group.

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.

Factors influencing the decision about orthodontic treatment. A longitudinal study among 11- and 15-year-olds and their parents

The aims of the study were to evaluate the attitude towards orthodontic treatment among 11-(T1) and 15-year-old children (T2) and their parents, to present the distribution of referral rate and treatment uptake by a treatment need index assessed at T1 and to elucidate factors influencing the decision about orthodontic treatment in the period from T1 to T2. A group of 359 children and their parents answered separate questionnaires at T1, and 293 families responded to a follow-up study 4 years later. For the clinical examination, 224 children participated after exclusion of children in active treatment. The dental study casts were assessed by the Index of Orthodontic Treatment Need (IOTN). The mean referral rate was 56%, with a variation from 40% to 71% among different dental clinics. About 44% of the children had completed or were undergoing orthodontic treatment at T2. No significant sex differences among referred and treated children were discovered. Aesthetic motives were the most frequently reported subjective reason for orthodontic care. The untreated group expressed diminishing treatment desire in the follow-up period. The logistic regression analysis selected Dental Health Component (DHC) grades as a strong predictor for treatment uptake, followed by parents' concern and attitude to braces, while the 11-year-olds' own orthodontic concern was less significant. Children in the untreated group with late treatment decisions (T2) were best predicted by Aesthetic Component (AC) changes from T1 to T2. The results indicate that dentists play a key role in determining orthodontic treatment levels. High referral rates secured low risk of denying care to some patients. Treatment decision may be guided by the orthodontist. However, individual variation in attitude and desire influence treatment uptake even among children with great need.

Orthodontic treatment need prior to treatment and 5 years postretention

OBJECTIVES

To assess orthodontic treatment need prior to treatment and 5 years postretention in a large university sample.

METHODS

A random sample of 920 patients (400 male and 520 females) from the Department of Orthodontics and Oral Biology, University of Nijmegen, the Netherlands, were included in this study. Dental casts were evaluated using the Index of Orthodontic Treatment Need (IOTN) at the pretreatment (TP) and 5-year postretention stages (T5). The mean age at TP was 12.2+/-3.0 years and at T5 21.6+/-3.1 years. At TP and T5 the aesthetic component (AC) and the dental health component (DHC) were assessed. The difference between TP and T5 was compared for males and females and tested by the t-test. The changes in AC, DHC and treatment need categories were described at TP and at T5.

RESULTS

On the basis of combined AC and DHC treatment need categories, 83% of the patients fell into the "Definite need" category prior to treatment and 10% of the treated patients were categorised as having "Definite need" 5 years postretention. No significant differences were found between males and females for the change in AC and DHC between TP and T5.

CONCLUSIONS

The results indicate that the policy used in the department for patient selection gives priority to patients with a high treatment need. The results also provide a general impression of treatment outcome utilising the IOTN to analyse the change in the treatment need categories.

Cephalometric features in the parents of children with orofacial clefting

This nonrandomised retrospective case-comparison survey was based on the hypothesis that craniofacial morphometric features can be used to identify individuals at greater risk for having children with a cleft. The theory of aetiological heterogeneity suggests there may be differences according to gender and cleft type. From a completely ascertained sample of 286 children with cleft lip and/or palate born in the West of Scotland between 1 January 1980 and 31 December 1984, a sample of 83 parents of the children with non-syndromic clefts volunteered for lateral cephalometric examination. A comparison group was derived from the archives of Glasgow Dental Hospital. Multivariate statistical analyses were applied to identify which parental craniofacial parameters, if any, determine predisposition to orofacial clefting. Compared to the male comparison group, the fathers of children with CL(P) were shown to have reduced mandibular and symphyseal areas (P < 0.001), reduced maxillary area (P < 0.01) and a shorter palatal length (P < 0.01). The cranial base angle was more acute (P < 0.01) and the cross-sectional area of the cranium on lateral skull radiographs was significantly smaller (P < 0.001). However, the occipital subtenuce was larger in the fathers (P < 0.05). The craniofacial morphology in the mothers of children with CL(P) was characterized by a longer mandible (P = 0.011), an increase in the anterior facial height (P < 0.05) and greater facial length (P < 0.01). Anterior cranial base and the clivus length were also larger in the mothers (P < 0.05). The cranial parameters showed a similar trend to the paternal group with a reduced cranial area (P < 0.01) and an increase in the occipital subtenuce length (P < 0.001). Different cephalometric parameters distinguish fathers from a male comparison group and mothers from their female counterparts. An awareness of these parameters might be of value in the prediction of liability to clefting and may prove to be important in the quest for clues to the pathogenesis of both CP and CL(P).

Differentiation between cleft lip with or without cleft palate and isolated cleft palate using parental cephalometric parameters

OBJECTIVE

The purpose of this study was to identify and compare lateral cephalometric measurements in noncleft parents of children with cleft palate (CP) and cleft lip (CL), and cleft lip and palate (CLP). The hypothesis was that discriminant analysis would enable identification of morphometric features that predispose to orofacial clefting and that differ for CP, CL, and CLP and are unevenly distributed within parental pairs.

DESIGN

This was a prospective, parametric analysis.

SETTING

The study was conducted by the Department of Dental Health, University of Dundee, and the Department of Statistics, University of Glasgow, Scotland.

SUBJECTS

From a completely ascertained sample of 286 children with cleft lip and/or palate born in the West of Scotland between January 1, 1980, and December 31, 1984, a sample of 83 parents of children with non-syndromic clefts volunteered for lateral cephalometric examination.

METHODS

Thirty-seven cranial and 99 facial landmarks were identified and 37 linear, angular, and area parameters were used to describe the craniofacial skeleton. Analysis of variance was used for a three-way comparison of CL/CLP/CP, and stepwise discriminant analysis was used to determine which variables discriminate best between cleft lip with or without cleft palate [CL(P)] and isolated cleft palate (CP) parents.

RESULTS

There were no significant differences whatsoever in the craniofacial morphology between the parents of children with CL and CLP, but differences were found between the CL(P) and CP groups. The most significant of these were in mandibular length, ramus length, mandibular area, and cranial area. Mandibular ramus length alone discriminated between the two groups in 71.4% of CP and in 62.5% of CL(P) cases, while separate analysis of fathers and mothers showed that ramus length and cranial height together reliably distinguish between mothers in 75% of CP and 80% of CL(P) cases.

CONCLUSIONS

Previous studies suggests that unaffected parents with non-syndromic children with cleft lip and/or palate have differences in their craniofacial morphology when compared to the general population. This study indicates that these morphologic features differ for CP and CL(P).