Use of Orthodontic Treatment Needs Indices for Oral Health Survey

DOI: 10.5455/msm.2016.28.138-140

Published online: 25/03/2016

Published print:04/2016

Received: 13 January 2016; Accepted: 05 March 2016 © 2016 Enita Nakas, Alisa Tiro, Lejla Redzepagic Vrazalica, Dzana Hadzihasanovic, and Vildana Dzemidzic This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/bync/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL PAPER

Mater Sociomed. 2016 Apr; 28(2): 138-140

USE OF ORTHODONTIC TREATMENT NEEDS INDICES FOR ORAL HEALTH SURVEY Enita Nakas1, Alisa Tiro1, Lejla Redzepagic Vrazalica1, Dzana Hadzihasanovic2, and Vildana Dzemidzic1 Department of Orthodontics, School of Dental Medicine, University of Sarajevo, Bosnia and Herzegovina Graduated Student of School of Dental Medicine, University of Sarajevo, Bosnia and Herzegovina

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Corresponding author: Enita Nakas, PhD, Department of Orthodontics, School of Dental Medicine, University of Sarajevo, Sarajevo, Bosnia and Herzegovina. Phone: ++387 33 442 733; E-mail: [email protected]; [email protected] ABSTRACT Aim: The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and to evaluate the most commonly used method among the dentists for orthodontic treatment in Sarajevo. Material and Methods: The sample consisted of 110 (31 female and 79 male)subjects older than 16 years with complete permanent dentition. Subjects were examined according to Occlusal Index (Angle classification of malocclusion, overjet, overbite, dental arch crowding and tooth rotation) and IOTN index. We conduct survey regarding which indexes are used in deciding on orthodontic treatment need, among primary health care and Orthodontist. Results: The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the survey that we conduct all primary health care doctors use Occlusal Index to decide need for orthodontic treatment, more than 95% of orthodontic specialist use Occlusal Index for treatment need estimation. Conclusion: When measuring and grading treatment needs we should rely on Index of orthodontic treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental, so that individuals with greatest treatment need can be assigned priority. Key words: IOTN, Occlusal Index, Orthodontic treatment, Treatment outcome.

1. INTRODUCTION

The objective assessment of malocclusion is important in documenting prevalence and severity of malocclusion in populations group. Many methods are developed for assessing the malocclusion (1, 2). Occlusal Index based on Angle classification is the is diagnostic index. Usually, it is used in evaluating the incidence of malocclusion in the particular population (2). However in everyday clinical praxis, most treatment decisions are based on orthodontic treatment need indices. Several indices have been developed to assess orthodontic treatment need in particular populations or communities. One of the most widely applied indices for assessment orthodontic treatment need is the Index of Orthodontic Treatment Need (IOTN) (3). The main reasons for orthodontic treatment are usually an improvement in facial or dental aesthetic (2). The benefits of orthodontic treatment is hard to justify if treatment is based on improvement in oral or dental health for the majority of orthodontic patients (4). Previously published study indicate an encouraging awareness of the psychosocial benefits of orthodontic treatment (5).

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Usually, the treatment success is based on orthodontic indices before and after treatment. For this purposes, most case presentation relies on Angle Occlusal Index before and after the treatment. This creates misconception regarding the use of indices mentioned above in clinical practice. The aim of our study is to compare the incidence of orthodontic malocclusion based on Occlusal Index (molar and canine relationships according to Angle classification; overjet, overbite, tooth rotation and crowding in the arch) and IOTN and to evaluate the most commonly used method among the dentists for orthodontic treatment need in Sarajevo.

2. MATERIALS AND METHODS

Subjects: The sample consisted of 110 (31 female and 79 male) subjects older than 16 years with complete permanent dentition. Subjects who were undergoing or had previously received orthodontic treatment were not included in this study. Methods: Clinical examinations of subjects were performed in ORIGINAL PAPER • Mater Sociomed. 2016 Apr; 28(2): 138-140

Use of Orthodontic Treatment Needs Indices for Oral Health Survey

the school classrooms, under daylight conditions. A mouth mirror and sliding caliper were used, without radiographs or study casts. The examination was carried out by two calibrated examiners who had been previously trained and calibrated in the utilization of the IOTN and Occlusal Index (molar and canine relationships according to Angle classification; overjet, overbite, tooth rotation and crowding in the arch). Subjects were examined according to Occlusal Index (molar and canine relationships according to Angle classification; overjet, overbite, tooth rotation and crowding in the arch) and IOTN index (the index of the need for orthodontic treatment). IOTN has two parts - Dental Health Component (DHC) and Aesthetic Component (AC), and each subject’s occlusion was assessed using both components. Dental Health Component (DHC) falls into five categories - grades: Grade 1 and Grade 2 represent ‘no/little need for orthodontic treatment’, Grade 3 ‘borderline need for treatment’ and Grade 4 and Grade 5 ‘severe/great need for treatment’. Within each category the different occlusal traits are included according to their severity - overjet, overbite, open bite, cross bite (anterior or posterior), displacement of teeth, and impeded eruption of teeth, Class II and Class III occlusion, clefts of the lip and/or palate and hypodontia. Aesthetic Component (AC) consists of a scale of ten color photographs showing different levels of dental attractiveness, with Grade 1 representing the most attractive and Grade 10 the least attractive dentitions. The validation panel judged Grades 1 - 4 represent ‘no/little need for treatment,’ Grades 5 - 7 ‘borderline need for treatment’ and Grades 8 - 10 represent ‘great need for treatment’ on aesthetic grounds. For Occlusal Index we assessed molar and canine relationships according to Angle classification; overjet, overbite, tooth rotation and crowding in the arch. Survey We conduct survey regarding which index is used in deciding on orthodontic treatment need, among primary health professional care and Orthodontist.

3. RESULTS

Statistical analyzes were undertaken using the Statistical Packages for Social Sciences (SPSS Inc. Chicago, Illinois; USA). Survey • We conduct the survey regarding which index is used in deciding on orthodontic treatment need. • Primary health care professionals 100% use Angle molar relationship, overjet, and overbite. • Orthodontist 97 % use Angle molar relationship, overjet, and overbite.

4. DISCUSSION

Orthodontic treatment, as integral part of oral health care programs need to be based on information of treatment needs. Most commonly used an index for this purposes is IOTN index (6, 7, 8). Based on the survey that we conduct all primary health care doctors use Angle classification based Occlusal Index to decide the need for orthodontic treatment, more than 95% of orthodontic specialist also use Angle index Mater Sociomed. 2016 Apr; 28(2): 138-140 • ORIGINAL PAPER

Category No need Little Need Mild Need Severe Need Great Need Total

Grade 1 2 3 4 5

n 38 47 21 2 2 110

% 34 43 19 2 2 100

Table 1. Distribution of Dental Health Component of IOTN Category No need

Mild Need

Great Need

Grade 1 2 3 4 5 6 7 8 9 10

Total

n 50 14 28 10 2 2 2 0 2 0 110

% 45 13 25 9 2 2 2 0 2 0 100

% 92

6

2 2

Table 2. Distribution of the Aesthetic Component of IOTN Sagittal relationships of the arches Class I Class ½ II Class II Class ½ III Class III Total

Canine n 63 31 5 8 3 110

% 57 28 5 7 3 100

First molar n 63 30 4 11 2 110

% 57 27 4 10 2 100

Table 3. Distribution of the sagittal relationships of Angle classification Malocclusion Present Not present Total

n 4 106 110

% 4 96 100

Table 4. Distribution of malocclusions based on Occlusal Index (molar and canine relationships according to Angle classification, overjet, overbite, tooth rotation and crowding in the arch).

for treatment need. The present study show differences between the presence of malocclusion and treatment need as assessed by these two used indices. Based on the Occlusal Index that we used in this study, the malocclusion is present in 96% respondents. Compared to DHC which showed that 56% of respondents need orthodontic treatment (43% have little need of treatment), and based on AC only 8% of respondents need orthodontic treatment. Dental Health Component (DHC) represents biological or anatomical aspect of treatment need on dental and functional grounds. Aesthetic Component (AC) represents treatment need based on social well-being of the person. The main reasons for orthodontic treatment are usually an improvement in facial or dental esthetic (9). When measuring and grading treatment needs, we should rely on Index of treatment need. At the population level problems that are functionally handicapping should be ranked first, while a single tooth problem or problems that minimally affect persons well being should be ranked

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Use of Orthodontic Treatment Needs Indices for Oral Health Survey

last. The national dental health policies are usually based on IOTN indexes in other to provide the health care to the one that needs it most. Based on the previously published need for orthodontic treatment among Bosnian schoolchildren according to DHC, 53.6% of subjects need orthodontic treatment (10). Study published by Shaw find that lack of orthodontic treatment when there was need did not lead to psychological difficulties in later life (11). So we can conclude that in such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental so that individuals with greatest treatment need can be assigned priority.

5. CONCLUSION

When measuring and grading treatment needs we should rely on Index of treatment need. In such high demand for orthodontic treatment need it is necessary to establish need for the orthodontic treatment as fundamental so that individuals with greatest treatment need can be assigned priority. • Acknowledgment: This work was part of Project supported by the Ministry of Health of Canton Sarajevo, Federation of Bosnia and Herzegovina, no. 01 – 37 – 7383/15.

REFERENCES

1.

So LL, Tang EL. A comparative study using the Occlusal Index and the Index of Orthodontic Treatment Need. Angle Orthod. 1993; 63(1): 57-64; discussion 65-6. 2. Borzabadi-Farahani A. An insight into four orthodontic treatment need indices, Progress in Orthodontics, 2011; 12(2): 132-42. 3. Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. Eur J Orthod. 1989 Aug;

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11(3): 309-20. Burden DJ. Oral Helath-Related Benefits of Orthodontic Treatment, Seminars in Orthodontics, 2007; 13(2): 76-80. 5. Hunt O, Hepper P, Johnston C, Stevenson M, Burden D. Professional perceptions of the benefits of orthodontic treatment. Eur J Orthod. 2001; 23(3): 315-23. 6. Souames M, Bassigny F, Zenati N, Riordan PJ, BoyLefevre ML. Orthodontic treatment need in French schoolchildren: an epidemiological study using the Index of Orthodontic Treatment Need. Eur J Orthod. 2006; 28(6): 605-9. 7. Nobile CG, Pavia M, Fortunato L, Angelillo IF. Prevalence and factors related to malocclusion and orthodontic treatment need in children and adolescents in Italy. Eur J Public Health. 2007; 17(6): 637-41. 8. Bilgic F, Gelgor IE, Celebi AA. Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations’ adolescents. Dental Press J Orthod. 2015; 20(6): 75-81. 9. Twigge E, Roberts RM, Jamieson L, Dreyer CW, Sampson WJ. The psycho-social impact of malocclusions and treatment expectations of adolescent orthodontic patients. Eur J Orthod. 2015; Dec 26.pii:cjv093. 10. Džemidžić, V, Tiro, A., Redžepagić-Vražalica, L, Nakaš, E. The Need for Orthodontic Treatment Among 12–14 Years Old Bosnian Schoolchildren. Acta Stomatologica Croatica, 2012; 46(2): 105-10. 11. Shaw WC, Richmond S, Kenealy PM, Kingdon A, Worthington H. A 20-year cohort study of health gain from orthodontic treatment: psychological outcome. Am J Orthod Dentofacial Orthop. 2007; 132(2): 146-57 4.

ORIGINAL PAPER • Mater Sociomed. 2016 Apr; 28(2): 138-140

USE OF ORTHODONTIC TREATMENT NEEDS INDICES FOR ORAL HEALTH SURVEY.

The aim of our study is to compare incidence of orthodontic malocclusion based on occlusal indices and Index of Orthodontic Treatment Need (IOTN), and...
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