Prevalence of Malocclusion and Orthodontic Treatment Needs in Primary and Mixed Dentition Using Baby Roma Index and Index of Orthodontic Treatment Needs

INTRODUCTION

Malocclusion is associated with a large degree of subjectivity and distortion regarding how treatment need is perceived. Many studies show that there is an association between malocclusion or orthodontic treatment needs and poor health-related quality of life. ¹ Many developing countries including India are struggling to eradicate medical and dental diseases. The main reason behind this is an inadequate implementation of preventive oral healthcare programs, which need a sound base of epidemiological data. Epidemiological studies on occlusion and malocclusion not only help in orthodontic treatment planning and evaluation of dental services but also offer a valid research tool for ascertaining the role of distinct environmental and genetic factors in the etiology of malocclusion. Indices of orthodontic treatment are used in screenings and epidemiological studies to identify the priority of treatment. ²

According to the studies conducted by Proffit et al., ³ Kelly and Harvey, ⁴ Mills, ⁵ it is found out that prevalence of malocclusion varies from country to country and among different ages and sex groups. Several studies illustrating that there are state-wise variations on the prevalence, Dhar et al. in 2007 in Rajasthan found out the prevalence of malocclusion 66.7%. Pruthi et al. observed a 53% prevalence of malocclusion in the state of Himachal Pradesh. In Uttar Pradesh state, Agarwal et al. in 2015 found 34.09% had malocclusion in his prevalence study. ⁶ Indices are being used globally in the field of medicine and dentistry to classify the disease conditions, to understand the etiology, risk, prognosis, and treatment outcome, to determine prevalence and incidence of disease/conditions. Early orthodontic treatments are particularly effective and desirable when the correction of skeletal malocclusions in young children is required since more stable results are achievable with subsequent increased parental satisfaction (King; ⁷ Kluemper; ⁸ Musich ⁹ ).

Orthodontic therapies in primary dentition contribute to oral health and avoid patients with more complicated treatments in permanent dentition (SIOI). ⁹ Thus, the present study was done to determine the prevalence of malocclusion and orthodontic treatment needs in children of East Lucknow city.

The objectives of this study are:

• To determine the prevalence of malocclusion in 3–12 years old children of east Lucknow city.
• To evaluate the orthodontic risk and treatment needs in 3–6 years old children by Baby ROMA index and in 7–12 years old children by the Index of Orthodontic Treatment Needs (IOTN).
• To evaluate intra-examiner reproducibility of Baby-ROMA Index and IOTN for assessment of the risk of malocclusion in 3–12 years old children

MATERIALS AND METHODS

The present study was conducted in the Department of Pedodontics and Preventive Dentistry, Babu Banarasi Das College of Dental Sciences; Lucknow after it was thoroughly reviewed and approved by the Institutional Ethical Committee. The nursery and primary schools of East Lucknow were included in the study to investigate the prevalence of malocclusion and their orthodontic treatment needs.

RESULTS

DISCUSSION

The epidemiological studies on occlusion and malocclusion not only help in orthodontic treatment planning but also offer a valid research tool for ascertaining the operation and depth of distinct environmental and genetic factors in the etiology of malocclusion. Extensive multicentric studies are required to obtain countrywide representative data. A more practical and feasible alternative is to develop a regional database and compilation of such databases may provide an understanding of the national scenario. ¹⁰ This study was conducted as a part of a dental health program in schools of East Lucknow city.

After statistical analysis, 69% of children aged between 3 and 6 years and 71% of children aged between 7 and 12 years were found with malocclusion. Our results were similar to the study done by Arnrup and Bondemark ¹¹ in which they obtained a 71.4% prevalence of malocclusion in 7–15 years old children.

A higher prevalence of malocclusion was reported by Boeck et al. ¹² where they found an 80.29% prevalence of malocclusion in Araraquara children aged between 5 and 12 years old. However, Holmes ¹³ reported a lower prevalence of 32% of malocclusion in a survey done on 12-year-old Sheffield school children and Crowther et al. ¹⁴ obtained 31.3% malocclusion in 10-year-old New Zealand school children which were comparatively lower than our study results. In the age group of 3- to 6-year-old, females had more prevalence of malocclusion (78.1%) than males (60.6%) which was statistically significant (0.007; p %3C; 0.05) and as per the findings of Hamdan, ¹⁵ Birkeland et al., ¹⁶ and Baeshen. ¹⁷

Ideally, the process of identifying and assessing the severity of malocclusion within national healthcare services should require a simple and reliable method. Several indices on occlusal parameters are used to assess the priority of orthodontic care. After a thorough examination and review of indices IOTN index for mixed dentition and the Baby ROMA index for primary dentition were selected for assessment of the prevalence of malocclusion and their orthodontic treatment needs in children of East Lucknow city.

IOTN is considered as a gold standard and a reliable index for assessment of malocclusion Ovsenik et al. ¹⁸ but it has a limitation of its applicability to the primary dentition. The ROMA index (Risk of Malocclusion Assessment Index) was developed by Russo et al., ¹⁹ which was set up for mixed and permanent dentitions in growing patients and evaluates skeletal and functional aspects of malocclusion. The ROMA index was validated by Grippaudo et al. ²⁰ and tested on a large sample of Italian children aged 9–13 years. Therefore, an index that assesses the need for orthodontic treatment in the primary dentition. When a wide variety of skeletal, dental, and functional factors, if unobserved could adversely influence occlusion and craniofacial growth, it is needed. Grippaudo et al. ²¹ authors have modified the ROMA Index and targeted the age of primary dentition (Baby-ROMA Index). The passage from primary to early mixed dentition is susceptible to changes that can often be caused by a variety of factors and may interfere with normal occlusion.

Keski-Nisula et al. ²² conducted a longitudinal study that indicates that malocclusion observed in primary dentition can fairly predict the malocclusion developing in mixed and/or permanent dentition. Franchi et al. ²³ and Masucci et al. ²⁴ have stated that earlier the treatment is carried out have greater chances of success, which are the results of skeletal changes rather than dental compensations with increased long-term stability.

Tschill et al., ²⁵ Kurol (2000), ²⁶ Viazis, ²⁷ Kurol (2006), Ngan (2006), and Proffit (2006) ²⁸ considered that the ideal time for a treatment is in the late-mixed dentition stage because the dentoalveolar and skeletal maturity starts in this phase, while other authors Thilander et al., Farnik et al., ²⁹ Trottman and Elsbach, ³⁰ Tschill et al., and Thilander et al. ³¹ concluded that early orthodontic treatments would be beneficial and desirable, especially to reduce skeletal and dental discrepancies and correct habits, dysfunction and malocclusion in their early stages.

In the present study, the most frequent malocclusions detected in the children aged 3–6 years were with caries and early loss of deciduous teeth (37.7%), hypodontia of more than 2 teeth (23.9%), and hypodontia of fewer than 2 teeth (5.8%). In the present study, the most common finding detected in the age group between 7 and 12 years old were crowding, displacement, presence of supernumerary teeth, retained deciduous teeth, and any pathological lesions 26.8%, 19% of children with extensive hypodontia with restorative implications, and 12% of children with posterior lingual crossbite with no functional occlusal contact.

Helm ³² reported that there was a high prevalence of crowding, rotation, tipping, and malformation (32%) which was a common finding in the age group of 6–7 years old children. The prevalence of posterior lingual crossbite was the third most common finding around 12% in the present study. In the present study, around 1.4% of the participants showed mouth breathing, and the 4.3% reported other deleterious oral habits. Brin et al. ³³ and Vázquez-Nava et al. ³⁴ stated that bad habits, such as persistent dummy or fingers sucking, can cause alterations of the occlusion and oral breathing associated with respiratory obstructions may cause alterations to the physiological patterns of the craniofacial growth. Kharbanda et al. ³⁵ concluded from their study that 4.3% had a habit of mouth breathing, tongue thrusting 4.9%, and thumb sucking 8.7%. Sahin et al. (2016) ³⁶ stated that 60% of malocclusions came under the category of treatment need.

In the present study, for the intra-examiner reliability of the Baby Roma Index, there was a high intraobserver agreement and the p value was found to be significant (0.0001). The intra-examiner observer agreement of the IOTN Index was also high and had a significant p value (0.0001). Ovsenik, Borzabadi, ¹ and Bhagyalaskshmi et al. ³⁷ have validated the IOTN index. Thus, the IOTN index is highly reproducible. Results obtained from statistical analysis suggested that the present study is by the formalized hypothesis. This hypothesis states that the prevalence of malocclusion in 3–6 years was 69% and in 7–12 years was 71% in the children of East Lucknow city. The present study also provided an insight into the patterns of complete skeletal, dental, craniofacial, and systemic problems in primary and mixed dentition in the East Lucknow region. Furthermore, we need more studies on the prevalence of malocclusion to diagnose malocclusion at the earliest level.

CONCLUSION

Based on observations made during the course of the study and their analysis the following conclusions have been drawn:

• The prevalence of malocclusion in 3–6 years was 69% and in 7–12 years it was 71% in children.
• The prevalence of malocclusion was more in females in the 3–6 years old age group 78.1% and the value was statistically significant (0.007; p < 0.05).
• The most common finding in primary dentition by using Baby ROMA index is Caries and early loss of deciduous teeth (37.7%), followed by hypodontia with %3E;2 teeth (23.9%). The sequentially most common finding in mixed dentition by using the IOTN index were impeded eruption of teeth (apart from 3rd molars) (26.8%) and hypodontia (19%).
• In the age group of 3 to 6 years; 49.2% of children were in the category of immediate treatment need and treatment need (grades IV and V) and 50.8% of children were in the category of little or no treatment need (grades II and III).
• In the age group of 7–12 years old; 75.4% of children were in the category of immediate treatment need and treatment need (grades IV and V) and 24.6% of children were in the category of little or no treatment need (grades II and III).

Ethical approval for the study was taken from the Institutes Ethical Committee. Patient consent was taken before the study.

CONSENT FOR PUBLICATION

All authors give consent for the publication of the article.

AUTHORS’ CONTRIBUTIONS

Alok Singh and Monika Rathore carried out the research work in gathering the articles for the study, thought of the concept, and drafted the manuscript. Somya Govil, Vinay Umale, and Rohit Kulshrestha participated in structuring the research, defined the intellectual content, and performed the quality check. Tushar Kolhe, Alok Singh, and Monika Rathore conceived of the study and participated in its design, coordination and helped to draft the final manuscript. Somya Govil, Vinay Umale, Rohit Kulshrestha, and Tushar Kolhe were part of the manuscript preparation, editing, and reviewing. All the authors read and approved the final manuscript.

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