Association of orthodontic treatment needs and oral health-related quality of life in Saudi children seeking orthodontic treatment

Associations between oral health impacts attributed to malocclusion and normative and self-perceived orthodontic treatment need in Turkish adolescent patients

BACKGROUND

In the socio-dental approach, the integration of normative oral health-related quality of life (OHRQoL) and behavioral propensity measures should be considered when assessing treatment needs and planning oral services. Therefore, this study aimed to evaluate the relationship between oral health impacts attributed to malocclusion and normative and self-perceived orthodontic treatment needs in adolescent patients and to determine the clinical, sociodemographic, and behavioral factors affecting their OHRQoL.

METHODS

This cross-sectional study was conducted using a convenience sample size of 105 adolescent patients aged 11-14 years who were referred to the Orthodontics Clinic in the Faculty of Dentistry, Istanbul. Data were collected using clinical examinations and a self-reported questionnaire, including the condition-specific Child Oral Impact on Daily Performances (CS-COIDP) attributed to malocclusion and sociodemographic, clinical, and behavioral factors. The index of complexity, outcome, and need (ICON), gingival index, and Decayed, Missing, Filled Teeth index was used to assess oral health status. Descriptive statistics and bivariate and multivariate regression analyses were used for the data analyses.

RESULTS

A total of 70 patients (66.7%) reported at least one impact. Furthermore, 47% of the adolescents had very difficult and difficult complexity grades. The most affected performances were "emotional (52.4%) and smiling (40%)". No significant differences were found in the total CS-COIDP scores according to caries experience; however, the gingival status was associated with the total OHRQoL. Lower tooth brushing frequency, increased malocclusion complexity, and subjective treatment need were the most important predictors of worse OHRQoL, accounting for 39.3% of the variance in the scores. ( R2 = 0.422; p < 0.001) CONCLUSIONS: Oral health professionals should consider oral behaviors, malocclusion complexity, and subjective treatment need when planning orthodontic treatment plans. Integrating ICON, CS-COIDP, and behavioral assessment will help identify adolescents who should be prioritized for treatment.

An epidemiological study on early orthodontic treatment need among eastern Saudi Arabian children in the mixed dentition stage

Estimation of early orthodontic treatment need among children is essential for planning orthodontic interventions in the mixed dentition stages thereby reducing the burden in a publicly funded healthcare system. The present study aimed to assess the early orthodontic treatment need among children with mixed dentition in the Eastern Saudi Arabia. A descriptive cross-sectional study was conducted among Saudi children visiting the outpatient clinics in a University dental setting, and data were collected based on Index for preventive and interceptive orthodontic need (IPION). Descriptive statistics, chi-square test and Fisher's exact test were used for data analysis with statistical significance set at p < 0.05. The category of 'no treatment need' accounted for 11.3% while 'moderate treatment need' and 'definite treatment need' categories accounted for 29.3% and 59.4% respectively. There was no statistical difference between males and females in the distribution of the three categories of treatment need (p = 0.513). This study demonstrated a very high need for early orthodontic treatment among Saudi children in the mixed dentition stage. Emphasis should be placed on increased awareness and benefits of seeking early orthodontic treatment involving preventive and interceptive procedures in the mixed dentition.

Does malocclusion affect ingestion: a systematic review

OBJECTIVES

The multifactorial aspect of malocclusions and their consequences on ingestion function is rarely described in the literature. The aims of this review are (i) to investigate the relationship between oral ingestion and malocclusion and (ii) to gather malocclusion tools that could help screen subjects at risk of malocclusion-related ingestion disorders.

MATERIAL AND METHODS

A systematic review was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocol (PRISMA-P 2015) guidelines. The analysis methods and inclusion criteria have been documented in a protocol published in the Prospective International Register of Systematic Reviews (PROSPERO) under the registration number CRD42023395840. The bibliographic search involved the PubMed®, Cochrane and PROSPERO databases.

RESULTS

A total of 29 articles published between 2007 and 2023 were retained by the search criteria for the qualitative synthesis. Twenty of the studies found that the severity of malocclusion has a negative impact on oral ingestion. This review highlights that malocclusion and ingestion impairments are associated but it is not possible to determine causality due to the observational approach of many of the studies.

CONCLUSION

Malocclusion has a negative impact on ingestion function. During orthodontic consultations, particular interest should be directed towards chewing, biting, and swallowing disorders, which can affect patients' nutritional status. This review offers arguments for designing further studies assessing the extent to which malocclusions may affect nutritional status.

CLINICAL RELEVANCE

Orthodontic treatment should focus on improving patients' ingestion.

Prevalence of malocclusion and orthodontic treatment needs among adolescents in Najran City, Saudi Arabia

AIM

To determine the prevalence of malocclusions and the need for orthodontic treatment in a sample of school-going adolescents in the Najran city, Kingdom of Saudi Arabia (KSA).

METHODOLOGY

This cross-sectional study was conducted among 1094 school-going Saudi male adolescents. The age range of the sampled adolescents was 13-18 years, and none of them had any history of orthodontic treatment. A survey chart related to malocclusion was designed and filled up after clinical examination by a single experienced and calibrated examiner. The need for orthodontic treatment was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULT

The present study's findings demonstrated 61.2% of the samples with Angle's Class I malocclusions, 27.5% with Class II, and 11.4% of samples with Class III malocclusion. A significant difference was observed between the different classes of malocclusion (P < 0.001). Most samples presented normal overjet, crossbite, and no reverse overjet, deep bite, or open bite. The number of samples with no treatment need was 573 (52.37%), with slight treatment in 185 (16.91%) samples, moderate treatment needs in 123 (11.24%) samples, and severe and extreme treatment needs were 109 (9.96%) and 104 (9.50%), respectively. A significant difference was observed between the samples with no or slight treatment need (grades 1 and 2), moderate need (grade 3), and definite treatment need (grades 4 and 5) (p < 0.001).

CONCLUSION

The prevalence of malocclusion and IOTNs among the sample of school-going adolescents in the Najran city was 47.63%. However, 9.63% of those samples required immediate attention for orthodontic treatment.

Do the oral health-related quality of life and the magnitude of its association with malocclusion differ by developmental stages of schoolchildren?

INTRODUCTION

As schoolchildren go through multiple developmental periods, their oral health-related quality of life (OHRQOL) level may change over time. It is important to understand the association between malocclusion and OHRQOL in treatment planning for schoolchildren. This study aimed to examine OHRQOL and its association with malocclusion among schoolchildren at different developmental stages.

METHODS

Data from a representative sample of 2010 Korean schoolchildren aged 7-17 years were analyzed. The participants completed a self-administered questionnaire, and their orthodontic treatment needs were assessed by a dentist. OHRQOL was measured using the Child Oral Health Impact Profile (COHIP). Higher COHIP scores indicate better OHRQOL.

RESULTS

The mean age of the sample was 11.9 ± 2.5 years, and slightly more boys (53.0%) were in the sample. The total COHIP score (P <0.001) and 4 subscale scores (P <0.01) were lower in older age groups. Compared with those who needed orthodontic treatment, children with no and borderline orthodontic treatment needs were 1.9 times (odds ratio [OR], 1.9; 95% confidence interval, 1.5-2.4) and 1.5 times (OR, 1.5; 95% confidence interval, 1.1-2.1) more likely to have a higher COHIP score, respectively. The degree of association varied across age groups: a larger effect was found in the oldest group (aged 15 years) (OR, 4.1) than in younger groups (ORs, 1.5-2.2).

CONCLUSIONS

OHRQOL and the magnitude of its association with malocclusion varied by age among schoolchildren, particularly in functional and social-emotional well-being. Given the variation, schoolchildren's developmental stages should be considered in treatment planning.

Oral-Health-Related Quality of Life (OHRQoL) and Anterior Open Bite in Adult Patients: A Case-Control Study

Oral-health-related quality of life (OHRQoL) is defined as the impact of oral health on activities of daily living. Malocclusions are a public health problem with a high prevalence. Different studies have concluded that malocclusions negatively affect OHRQoL in patients of all ages. The aim of this study was to analyze the influence of having an anterior open bite on the OHRQoL of adult patients. Materials and Methods: A case-control study (1:1) was carried out with a sample size of 80 adults at the University of Salamanca in 2021. The case group (n = 40) was made up of patients with an anterior open bite, and the control group (n = 40) contained patients without an anterior open bite. OHRQoL was assessed using the Oral Health Impact Profile-14 (OHIP-14) questionnaire. The influences of gender and age on the OHRQoL of the patients were also analyzed. Results: There were no significant differences in gender or age between the case and control groups. An anterior open bite was not found to influence the OHRQoL of adult patients. Age was not shown to significantly influence OHRQoL. Female patients with an anterior open bite had higher scores in the handicap domain of the OHIP-14 questionnaire compared with male patients (p < 0.05). Conclusions: Anterior open bite can influence the OHRQoL of orthodontic patients. Gender can be considered an influencing factor.

Descriptive epidemiology of dental malocclusion in Najran patients seeking orthodontic treatment

Background

Untreated malocclusion can lead to compromised aesthetic function, depression, and low self-esteem. The aim of this study was to evaluate dental malocclusion in Najran, Saudi Arabia as no data existed before.

Method

This was a retrospective study analyzing the casts of all patients in Najran, Kingdom of Saudi Arabia, seeking orthodontic management for malocclusion between 2017 and 2019.

Measurements

The consultant orthodontist is the single investigator involved in collecting the details of demographics followed by molar relationships, overjet, overbite, crowding and spacing using digital caliper on each dental cast. Data were analyzed using IBM SPSS Statistics for IOS Version 25 (Armonk, NY: IBM Corp.

Results

A total of 326 patients sought treatment for different types of malocclusion. There were 143 males and 183 females with an M:F ratio of 1:1.3. Age ranged from 6 to 55 years with a mean SD of 22.6 ± 8.98. The prevalence for Class I, II and III malocclusions at 95% CI was (0.76 (0.757, 0.774)), 0.251 (0.243, 0.260) and 0.529 (0.519, 0.539) respectively. Fifty-one (15.6%) patients had reversed overjet, 65 (19.9%) reduced overjet, and 86 (26.4%) increased overjet. One hundred and sixty-four (50.3%) cases of reduced overbite and 99 (30.4%) cases of deep overbite were also observed. Tooth size arch length discrepancy were noticed with crowding and spacing in 83 (26.4%) and 71 (21.8%) patients, respectively.

Conclusions

This study has shown the prevalence of Class I, Class II, and Class III malocclusion to be 72.7%, 11.6% and 15.6% respectively. Increased over jet and crowding was demonstrated in more patients, though it is not statistically significant.

Cross-cultural adaptation of oral health-related quality of life measures used to assess the impacts of malocclusion and dentofacial deformities in Saudi Arabia: A literature review

Since the World Health Organization broadened its definition of health, beyond biological boundaries, to include physical, emotional, and social wellbeing. Oral health-related quality of life (OHRQoL) became common outcome measure in clinical trials and epidemiological studies in Dentistry and Medicine. It is not surprising, therefore, to see quality of life as one of the programs of the Saudi 2030 vision. That said, it can be difficult to interpret the findings of OHRQoL research if the measures used were not appropriately adapted and validated in the population being studied. In this review article, the concept of cross-cultural adaptation of OHRQoL and its use in the Saudi context, as applied to orthodontic research, was discussed. An electronic search in PubMed and MEDLINE databases was conducted. A second search was conducted to locate methodological papers discussing cross-cultural adaptation and translations. Appraisal of relevant research was conducted to provide a better understanding of the process of adapting OHRQoL measures to assess the impact of malocclusion and dentofacial abnormalities on quality of life. This review pointed out important methodological concerns that warrant considerations during the translation and adaptation of OHRQoL measures.

Oral Health-Related Quality Of Life of Pre-School Children: Review and Perspectives for New Instruments

This study aimed to describe different approaches for the evaluation of the Oral health-related quality of life (OHRQoL) of preschool children and to discuss perspectives for future instruments. The OHRQoL is a concept that surpasses an exclusively clinical perception and includes functional, social, emotional, and environmental issues. The measure of OHRQoL represents a holistic approach for researchers and clinicians extending their visions beyond the mouth and understanding the entire context of the patient. Negative impacts of oral conditions on OHRQoL in childhood can reflect on health development, especially in a life stage marked by social and cognitive maturation. Instruments have been developed and cross-culturally adapted to evaluate the impact of oral conditions on the OHRQoL of preschool children and their families. Some features distinguish these instruments and influence their selection, such as: self- or proxy-report; generic- or specific-condition; long- or short-form, and less or more established used in literature. Moreover, theoretical framework, construct validation and availability should also be considered. Nine OHRQoL instruments for preschool children were included in the present literature review. They were created between 2003 and 2017 by developed countries in most cases. The shorter instrument has five items, and the larger has 31 items. Most of them are proxy-reported, generic-condition, and have been relatively well established in the literature. The diversity of instruments indicates the evolution of OHRQoL studies, but there are methodological issues still in need to be improved in future developments or cross-cultural adaptations, according to current psychometric evidence.

The Impact of Socio-Economic and Home Environmental Factors on Oral Health-Related Quality of Life Among Children Aged 11-14

Background and Objectives: Oral diseases are known to negatively impact physical, functional, and emotional well-being, and thus adversely affect quality of life. The aims of the study were (1) to assess the oral health-related quality of life (OHRQoL) and (2) to explore socio-demographic, -economic, and -environmental factors that are associated with OHRQoL among a sample of children aged 11–14 in Saudi Arabia. Materials and Methods: A cross-sectional design was used. The Child Perceptions Questionnaire (CPQ)—a self-administered, validated, and standardized questionnaire was used to collect data on OHRQoL in four domains: oral symptoms, functional limitations, and emotional and social well-being. In addition, data were collected on home environment, socioeconomic/demographic characteristics, and oral hygiene practices of participants and their parents or adult guardians. Univariate descriptive statistics, Spearman’s correlation, and Kruskal–Wallis H and Mann–Whitney tests were used. Data were analyzed using SPSS 23 Software. Significance was set at α = 0.05. Results: In total, 534 children participated in the study (91% response rate), of which 60% were females. Twenty percent of children described their oral health as “poor” and one in every four children reported that their oral health had at least some effect on their overall well-being. Children who were male, attending public schools, and living with both parents were more likely to report poor OHRQoL. Conclusions: A considerable proportion of children aged 11–14 could discern that their oral health had some effect on their overall well-being. The results identified potential predictors of OHRQoL. Disparities in OHRQoL exist among certain sub-populations. Active efforts and local interventions are necessary to improve OHRQoL.

Parental influence is the most important predictor of child's orthodontic treatment demand in a preadolescent age

The aim was to explore the predictive value of objective treatment need, impaired quality of life, and parental influence on orthodontic treatment demand in preadolescents and adolescents. A secondary goal was to validate 16-item Child Perceptions Questionnaire for the 11-14 year age group (CPQ11-14): item-impact and stepwise-regression short-forms. A convenience sample of 287 participants (55% female) was used for validation. Internal consistency, test-retest reliability, and convergent validity were evaluated. Predictors of treatment demand were explored in 197 orthodontic patients: 93 preadolescents (51% females), 104 adolescents (55% females). Hierarchical linear regression and multilevel logistic regression models were used to explore the predictive power of age, gender, objective treatment need, impaired quality of life and parental influence on treatment demand. CPQ11-14 regression short-form had acceptable psychometric properties. Significant linear predictors of treatment demand were impaired emotional well-being (EW) (β = 0.335, p = 0.002), parental influence (β = 0.221, p = 0.002), and malocclusion severity (β = 0.152, p = 0.025). In logistic regression, parental influence was revealed as the most important predictor of treatment demand in preadolescents, OR = 7.7 (95% confidence interval CI 2.4-25.1; p = 0.001); objective treatment need in adolescents, OR = 4.5 (95% CI 1.5-12.9; p = 0.006). The increase of impairment in EW by one scalar point increased treatment demand by 1.4 (95% CI 1.1-1.9; p = 0.017) in preadolescents; 1.3 (95% CI 1.0-1.7; p = 0.021) in adolescents. Greater parental agreement and motivation for treatment could result in higher preadolescents' cooperation. Orthodontic treatment in adolescents might be more effective with the patient-oriented approach.

Orthodontic treatment needs in Saudi young adults and manpower requirements

Objectives:

To evaluate orthodontic treatment needs using the index of orthodontic treatment need (IOTN) components and to estimate the required manpower in the city of Jeddah, Saudi Arabia.

Methods:

A cross-sectional study involving 670 participants (390 females and 280 males) collected between November 2016 and April 2017, whose ages ranged from 12-19 years from secondary and high school students. Treatment needs were estimated using the IOTN components, dental health component (DHC), and aesthetic component (AC).

Results:

The results according to the severity of malocclusion using IOTN-DHC found that 24.3% of the cases required severe/extreme need and 54.3% were in the no/slight need category. The most frequent types of malocclusion were crowding (48.8%) followed by increased overjet (21.8%), and spacing (16.1%). Using Pearson’s Chi-squared test, there was a statistically significant association (p<0.001) between IOTN-DHC and IOTN-AC; 51.2% of the sample was in agreement at the mild need category, indicating a strong correlation, with a coefficient of 0.687.

Conclusion:

According to the IOTN’s components, the present study showed that almost one-quarter of the sample had a severe/extreme need for orthodontic treatment. The most frequent type of malocclusion traits according to the severity was crowding followed by increased overjet and then spacing. The Ministry of Health must employ 90-110 orthodontists in Jeddah to meet the demands of the definite needs for orthodontics in adolescents.

The prevalence of malocclusion and the need for orthodontic treatment among adolescents in the northern border region of Saudi Arabia: an epidemiological study

Background

To assess the prevalence of malocclusion and orthodontic treatment need among adolescents using the dental health component (DHC) of the index of orthodontic treatment need (IOTN).

Methods

A descriptive cross-sectional study was conducted among 500 (mean age 16.25 ± 1.09) adolescents randomly selected from the northern border region of Saudi Arabia (KSA). The northern border region is sub-divided into three governorates: Ar’ar (186), Rafha (142) and Turayf (172). The data were recorded in questionnaires to assess the prevalence of malocclusion and estimate of DHC of the IOTN index.

Results

The most common malocclusions in order of prevalence were Angle’s Class I (52.8%), Angle’s Class II (31.8%), Angle’s Class III (15.4%), crowding (47.2%), excessive overjet (> 2 mm) (22.2%), reduced overjet (< 1 mm) (11.4%), excessive overbite (> 2 mm) (23.4%), reduced overbite (< 1 mm) (12.2%), anterior crossbite (4.8%), posterior crossbite (9.4%) and open bite (4.6%). The most common facial profiles determined in the sagittal plane, were the straight facial profile (49.2%), convex (42.6%) and concave (8.2%). The prevalence of Grade 1 and 2 DHC was 49.4%, Grade 3 was 29.6%, Grade 4 and 5 was 21%. The grades of DHC of IOTN index were as follows: 48.73% of males and 50.22% of females showed grades 1 and 2. Grade 3 was observed in 30.32% of males and 28.69% of females. Grades 4 and 5 were recorded in 20.93% of males and 21.07% of females.

Conclusions

The prevalence of malocclusion and orthodontic treatment need among the north border region of KSA is comparable with that of other regional studies.

Effect of anterior crowding or spacing on oral health-related quality of life: a cross-sectional study

INTRODUCTION

Oral health-related quality of life (OHRQoL) involves many aspects such as chewing ability, sleeping, social interactions, self-esteem, and satisfaction with life and oral health. The increasing research interest in OHRQoL began only after the shortcomings of previous approaches of treating symptoms only and neglecting the patient's self-perception were revealed.

PATIENTS AND METHODS

The current study design is a cross-sectional study of patients who attended King Abdulaziz University Dental Hospital (Jeddah, Saudi Arabia) and King Saud University Dental Hospital (Riyadh, Saudi Arabia). After obtaining their verbal consent, young adult and adult patients (mean age 25.19±7.29 years old) with anterior spacing or crowding were recruited to participate in the study. They filled the Arabic short version of the oral-health impact profile-14 questionnaire after a clinical evaluation of the severity of their spacing or crowding. Parameters of spacing/crowding severity assessment were as follows: <4, mild; 4-8, moderate; and >8, severe. Data were analyzed using the chi-square test in SPSS statistical package. The level of significance was set to <0.05.

RESULTS

The sample size of this study was 308 subjects. Findings indicated a statistically significant (p=0.001) association between anterior spacing malocclusion (ASM) with Q5 "self-consciousness", since 64.2% of patients with ASM reported being self-conscious. Results indicated a statistically significant association between educational level with anterior crowding malocclusion (ACM; p=0.02) and ASM (p=0.01) with Q3 "painful aching". Moreover, findings indicated a statistically significant association (p=0.04) between income and ACM with Q5 "self-consciousness". On the other hand, results showed no significant association between gender with either ACM or ASM.

CONCLUSION

This study sheds light on how anterior malocclusion (crowding or spacing) impacts OHRQoL negatively, especially heightening self-consciousness about their appearance. These effects should be addressed by the orthodontist during the course of treatment.

Psychosocial impact of dental esthetics regulates motivation to seek orthodontic treatment

INTRODUCTION

The aim of this study was to evaluate the psychosocial impact of dental esthetics for adults seeking orthodontic treatment.

METHODS

The Chinese version of the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ) was administered to 393 adults, aged 18 to 30 years. The participants were divided into 2 groups: an intervention group (received orthodontic treatment) and a control group (rejected orthodontic treatment). Baseline malocclusion severity was assessed using the Index of Orthodontic Treatment Need (IOTN).

RESULTS

The Wilcoxon signed rank test showed no statistically significant difference between the groups for the dental health component (DHC) of the IOTN (P = 0.134). Total and subscale PIDAQ scores of the intervention group were higher than those of the control group and differed significantly in each group among the 4 IOTN-DHC grades; self-confidence scores in the control group (F = 1.802; P >0.05) were the exception. Correlations between the PIDAQ scores and the IOTN-DHC grades were strong in each group. DHC grades, psychological impact, social impact, and aesthetic concern had significant impacts on patients accepting orthodontic treatment.

CONCLUSIONS

The psychosocial impact of dental esthetics played an important role in the decision-making process of adults seeking orthodontic treatment. Importantly, participants with low self-awareness of the potential psychosocial impact rejected orthodontic treatment, despite the need for severe normative treatment.

Comparison of oral health-related quality of life of patients treated by palatal expanders with patients treated by fixed orthodontic appliances

INTRODUCTION AND PURPOSE

Wearing orthodontic appliances may negatively affect a patient's oral health-related quality of life (OHRQoL) physiologically, psychologically, and socially. Few studies have assessed the effect of palatal expanders on OHRQoL. The aim of this study was to evaluate the impact of palatal expanders on OHRQoL and to compare it with that of fixed orthodontic appliances.

MATERIALS AND METHODS

All adolescent and adult orthodontic patients who were undergoing treatment with fixed appliances or palatal expanders between July 2015 and January 2016 in King Abdulaziz University Orthodontc Dental Clinics, were recruited (n=399). The OHRQoL of each participant was assessed using the shortened Arabic version of the Oral Health Impact Profile-14 questionnaire. OHRQoL was compared between users of fixed appliances and users of palatal expanders; it was also compared after stratifying the patients by gender. Chi-squared and Fisher's exact tests were used, as indicated.

RESULTS

Palatal expanders had significantly greater negative effects on chewing ability (P≤0.01) and pronunciation (P=0.048). However, fixed orthodontic appliances had significantly greater negative impacts on mouth aching (P=0.003), difficulty in relaxing (P=0.01), irritability (P=0.001), and embarrassment (P≤0.01).

CONCLUSION

Palatal expanders had a significantly greater negative impact on some aspects of OHRQoL when compared with fixed orthodontic appliances in adolescents and young adults.

Orthodontic treatment need among young Saudis attending public versus private dental practices in Riyadh

Objective

To assess and compare the severity of malocclusion and orthodontic treatment need among young Saudis receiving free treatment at public dental practices versus those paying for treatment at private practices.

Materials and methods

This retrospective study evaluated the records of 300 patients (179 females, 121 males; age 13–21 years) treated at orthodontic clinics from 2013 through 2015. The public sample was selected from orthodontic clinics at the College of Dentistry, King Saud University (KSU); the private sample was selected from five private orthodontic clinics in Riyadh, Saudi Arabia. The records were examined for the severity of malocclusion and for orthodontic treatment need using the Dental Health Component of the Index of Orthodontic Treatment Need. The prevalence of each occlusal discrepancy and the Dental Health Component grade were recorded. The severity of malocclusion and orthodontic treatment need were compared between practice types, age groups, and sexes with the chi-square test.

Results

Displacement, increased overjet, and Class II and III malocclusion were the most common orthodontic problems in this study. Patients attending public clinics at KSU generally had more severe malocclusion than the patients attending private clinics. Seventy-seven percent of orthodontically treated patients at KSU clinics were in great need of treatment, compared with 58.5% of patients treated at private clinics (P=0.003). Among the patients with great treatment need, approximately 62% of male patients and 70% of patients ≤16 years of age were treated at KSU clinics, compared with 38% and 48%, respectively, treated at private clinics (P<0.0001).

Conclusion

Young Saudis receiving free orthodontic treatment at public clinics at KSU had more severe malocclusion with greater need of orthodontic treatment than the patients paying for treatment at private clinics.