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Prevalence
of malocclusion
in Italian
schoolchildren and
orthodontic treatment
need
abstrac
t
Aim The aim of the study was to estimate the prevalence
of malocclusion and the need for orthodontic treatment
in a sample of 3,017 Italian schoolchildren.
Materials and methods Study design: 1,375
males and 1,642 females, aged between 8 and 13
years, were visited in primary and secondary schools.
Signs of malocclusion were registered according to an
occlusal index by trained and calibrated operators. First
the prevalence of malocclusion was calculated in
accordance to a scale of need for orthodontic
treatment (R.O.M.A. index), which considers both
malocclusion signs and risk factors for worsening of
malocclusion without any treatment and
during
craniofacial development. Then the distribution of the
most frequent characteristics, signs and symptoms was
evaluated both within each risk grade and in the basic
sample.
Results The overall percentage of children
classified as 3, 4 and 5 grade accounted for 75.8% of
the sample. The percentage of children classified as 4
and 5 grade are similar to those found in other
European countries. The most frequent features found
are poor oral hygiene, caries and early loss of
deciduous teeth, deviation from full intercuspation,
increased overbite and overjet. Conclusion This
epidemiological research describes the current
orthodontic treatment need in Italy in children
with a late mixed dentition.
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Introduction
Occlusal indices are used to rank malocclusion and
identify the individuals in special need for orthodontic
treatment, on the grounds of the potential damages
malocclusion might cause [Taylor, 1993]. They are
introduced
to
minimise
the
subjective
component of diagnosis and assessment of the
malocclusion. Some indices are used also to assess
the outcome of orthodontic treatment [BorzabadiFarahani, 2011]. They have been used successfully
in many countries and have provided useful
information on treatment need and provision of
orthodontic
services
[Espeland et al., 1992;
Richmond, 1993; Richmond and Andrews,
1993; Birkeland et al., 1996].
In countries of Northern and Central Europe
(Switzerland,
England,
Germany,
France,
Belgium) a great number of surveys have been
produced [Josefsson et al., 2007; Chestnutt et al.,
2006; Tausche et al., 2004; Souames et al., 2006;
Willems et al., 2001; Grabowski et al., 2007], whereas
there are few studies about
the prevalence of
malocclusions and orthodontic treatment need in
Southern European countries [Perillo et al., 2010]. In
Italy, in the last decades, several studies have been
undertaken to report the oral health status in children
and adolescents [Angelillo et al., 1990-99], but very
few focused on assessment of the prevalence of
malocclusion and orthodontic treatment need
[Ciuffolo et al., 2005; Nobile et al., 2007]. Occlusal
indices have been criticised for not being easy to use,
as they require long time, complicated calculations and
qualified staff for data collection [Tang and Wei,
1993], lack of items about skeletal problems, and
seem appropriate in permanent dentition and in
examining patients whose growth
is
already
complete,
rather
than
across all age ranges.
However, in young patients orthodontic problems are
not
restricted to dental disorders, being often
accompanied by altered underlying skeletal
relationships and closely related to craniofacial growth
and development. That is why the age and stage of
development of the patient entail different degrees of
risk of malocclusion, accompanied by negative effects
on the masticatory function. The R.O.M.A. index (Risk
Of Malocclusion Assessment index) [Russo et al.,
1998] is a tool to assess treatment need in young
patients and has been previously validated [Grippaudo
et al., 2007]. Unlike other indices, the R.O.M.A. index
(Table 1) was specifically devised for use for young
patients, in an attempt to rate not only the dental
malocclusion, but also skeletal and functional aspects,
which in children are determinants of the orofacial
development.
The aim of this investigation, which follows an
earlier
study
performed on
420
children
[Grippaudo et al., 2007], is to use the R.O.M.A.
index to estimate the prevalence of malocclusion and
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GRADE 5
Systemic problems
Malformation syndromes
5a
Congenital malformations
5b
4c
4d
4e
4f
TMJ dysfunctions
4g
4j
4k
Scissor bite
4m
4n
4o
4p
4q
3k
3l
3n
3o
3p
3r
2h
2n
2o
2p
2s
2t
2u
Functional asymmetries
2v
Bad habits
Mouth breathing
2w
2x
GRADE 4
Systemic problems
Craniofacial problems
4h
4i
Dental problems
GRADE 3
Craniofacial problems
3h
Dental problems
GRADE 2
Craniofacial problems
Dental problems
Functional problems
GRADE 1
None of the problems listed above
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grippaudo C. et al.
AGE
NORTH
CENTER
SOUTH
487
16.14
153
156
178
547
18.13
225
147
175
10
495
16.41
192
135
168
11
579
19.19
224
138
217
12
490
16.24
185
138
167
13
419
13.89
147
129
143
TOT
3017
100
1126
843
1048
Results
The main index items found were poor oral hygiene
(2t), caries and early loss of deciduous teeth (3l),
deviation from full intercuspation (2u), increased
overbite (3r) and increased overjet which has an
overall prevalence of
33.1% considering all the items for overjet (4h, 3h,
2h) (Fig. 1). The prevalence of each item was calculated
for each grade index.
Grade 2
There was
a considerable frequency
problems relating to oral hygiene, bad habits
displacement in grade 2 of the index in addition
fair percentage of cases with increased overjet up
mm (Fig. 2). However these
problems
do
necessarily imply dentoskeletal disharmony.
Grade 3
The main problems for grade 3 (Fig. 3) were
displacement greater
than
2 mm (3o) and
overbite greater than 5 mm (3r). There was also a
high rate of caries with early loss of deciduous teeth
(3l), overjet up to 6 mm (3h), anterior or posterior
crossbite up to 2 mm (3n), Class III malocclusion
without reverse overjet (3k).
35
35
32.1%
32.1%
30
30
25
25
20.8%
13.5%
20
%
%
15
20.8%
19.2%
20
14.6%
15
13%
15.5%
13.5%
13.2%
12%
9.2%
10
10
6.6%
4.9%
2.6%
3.2%
2.4%
0
2h
2t
2u
3h
3l
3n
3r
4h
of
and
to a
to 3
not
2h
2n
2o
2p
2s
2t
2u
2v
2w
2x
316
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30
25.5%
25
19.2%
20
14.6%
15
13%
9.2%
10
7%
5
3.4%
0
3k
3h
3l
3n
3o
3p
3r
Grade 4
The most frequent occlusal problems for grade 4
(Fig.
4) were displacement greater than 4 mm (4o),
maxillary
hyperdevelopment/mandibular
hypodevelopment with overjet greater than 6 mm (4h)
and anterior or posterior crossbite greater than 2 mm
(4n), while the prevalence of Class III malocclusion with
reverse overjet was low (4k).
It is quite remarkable that 37.7% of the examined
children were classified as at moderate need,
as defined by grade 3 of the index (non-severe
alterations in dental and /or skeletal relationships,
which
persist and often worsen with growth).
Significantly, 37.8% of subjects fell within grade 4 of
the
index (great need), presenting greater
craniofacial skeletal malformations and occlusal
alterations, often in association with systemic or
growth disorders which likely worsen the prognosis
(Fig. 5). Only 0.3% of children is in grade 5
of treatment need
(extreme need) for the
presence of underlying systemic conditions or
congenital malformations. Therefore, the overall
percentage of children with moderate, great and
extreme degree of the index accounted for 75.8% of
the sample.
Discussion
The results of this study showed that 38.16% of the
examined children have extreme and great degree of
orthodontic treatment need and the percentage
rises to 75.8 when including also the grade 3
(moderate degree). These findings should be taken
into great account
in devising strategies to
improve patient service quality in public and private
settings and also in planning preventive measures.
Deep overbite and increased overjet showed high
frequency as well as displacement. Anterior and
posterior crossbite was frequently found in degrees
of risk moderate and great. Also in other studies
37.8%
n. 1141
37.7%
n. 1136
13.5%
n. 407
10.7%
n. 323
fig. 5
Distribution
of risk
grades in
the basic
sample.
0.3%
n. 10
PREVALENCE
AUTHORS
OF
ORTHODONTIC
TREATMENT
NEED
COUNTRY
32,7%
UK
33%
UK
35%
UK
39,5%
Sweden
21,6%
Italy
21,3%
France
21,8%
Spain
27,3%
Italy
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grippaudo C. et al.
Conclusion
Current epidemiological data are needed to
detect trends or determine changes in the prevalence
of malocclusion for proper screening and treatment
planning services in the country. The overall prevalence
of children in need of orthodontic treatment in Italy
evaluated with the R.O.M.A. index was 75.8%. We
believe that this result is important for the sample
size. Moreover the sample is equally balanced for age,
sex and geographical origin and it is representative of
Italian children. A prevalence of orthodontic treatment
need of 75.8% suggest the need to develop screening
programmes and appropriate levels of health care in
orthodontics. It is also important that 32.1% of the
sample has poor oral hygiene (2t) and
14.6% is affected
by caries with early loss of
deciduous teeth (3l). For these reasons it should be
intensified preventive and health care programmes in
pediatric dentistry and in orthodontics and raise
awareness among parents, pediatricians and general
practitioners.
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