|Year : 2021 | Volume
| Issue : 1 | Page : 12-17
Early orthodontic treatment need among 6-9-year-old children of West Bengal
Sauvik Galui1, Shubhabrata Pal2
1 Senior Lecturer Dept. of Pedodontics, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
2 Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital, Kolkata, West Bengal, India
|Date of Submission||29-May-2020|
|Date of Decision||18-Sep-2020|
|Date of Acceptance||14-Oct-2020|
|Date of Web Publication||15-Feb-2021|
Department of Pedodontics and Preventive Dentistry, Dr. R Ahmed Dental College and Hospital Kolkata, West Bengal
Source of Support: None, Conflict of Interest: None
Background: Early orthodontic treatments (EOTs), which basically include interceptive and preventive orthodontic procedures, are relatively simple and cost-effective treatment approaches that target developing malocclusions during the mixed dentition period. The present study is aimed to assess the need for EOT among 6–9-year-old children of West Bengal that would benefit from preventive and interceptive orthodontic treatment to prevent or reduce the number of late/corrective orthodontic treatments, which can be complex, lengthy, and costly.
Materials and Methods: A total of 1129 children from different public and private primary schools of West Bengal were evaluated using index for preventive and interceptive orthodontic need (IPION). On the basis of IPION, the overall scores of children were distributed into three groups – no treatment need, moderate treatment need, and definite treatment need. According to dental development, children were divided into two groups – IPION-6 and IPION-9.
Results: Among 1129 children examined, 554 children (49.1%) came under the category of no treatment need, 174 children (15.4%) presented with moderate treatment need, and 401 children (35.5%) showed definite treatment need. The IPION groups had a significant effect on treatment need distribution (6 vs. 9, P = 0.010)); the IPION-9 scores were significantly higher than the IPION-6 scores.
Conclusion: The prevalence of preventive and interceptive orthodontic treatment need is unsatisfactorily high in children of West Bengal, which highlights the importance of including preventive and interceptive orthodontic treatment in local dental health-care programs.
Keywords: Early orthodontic treatment need, index for preventive and interceptive orthodontic need, prevalence, preventive and interceptive orthodontics, West Bengal
|How to cite this article:|
Galui S, Pal S. Early orthodontic treatment need among 6-9-year-old children of West Bengal. J Oral Res Rev 2021;13:12-7
| Introduction|| |
One of the most important domains in pediatric dentistry is monitoring the development of children's occlusions. The main purpose of a pedodontist is to prevent, to intercept any oral problems, which could cause the deflection of the development of the occlusion. Early orthodontic treatment (EOT), which includes preventive and interceptive orthodontic treatments in pediatric dentistry, is an ancillary treatment modality to monitor the well development of the children's occlusions. In a nutshell, it can be said that early orthodontic intervention corrects obvious problems, intercepts developing problems, and prevents obvious problems from becoming worse.
Preventive orthodontics can be conceptually defined as the prevention of potential interferences with occlusal development. Basically, it is the action taken to preserve the integrity of what appears to be normal at a specific time. These are the procedures that attempt to counter adverse environmental attacks or anything that would change the normal course of events, e.g.,
- Early correction of proximal caries that might change the arch length
- Early recognition and elimination of oral habits that might interfere with the normal development of the teeth and jaws
- Placing of a space maintainer to maintain proper space for the eruption of succedaneous teeth.
The American Association of Orthodontists' Council of Orthodontic Education defines interceptive orthodontics as “that phase of the science and art of orthodontics employed to recognize and eliminate potential irregularities and malpositions in the developing dentofacial complex.” These procedures are utilized to lessen or to eliminate the severity of developing malocclusion, e.g., serial extraction.
EOTs, which basically include interceptive and preventive orthodontic procedures, are relatively simple and cost effective treatment approaches that target developing malocclusions during the mixed dentition period. Pedodontists perceive these as useful ways to reduce the severity of malocclusions, improve a patient's self-image, eliminate detrimental habits, promote normal tooth eruption, and improve some growth patterns. Because of this, some have proposed their wider use as public health measures aimed at decreasing the burden of malocclusion in underserved populations and as a strategy for increasing access to EOT when resources are limited.
Despite having these advantages, the tendency to overlook EOT seems to result from the thought that a child's malocclusion can be more easily, quickly and definitively treated after development of the permanent dentition is complete. As a result, detection of EOT need and the preventive and interceptive orthodontic treatment procedures have not been taken into active consideration in public health dentistry.
Keeping all this in mind, the present study is aimed to assess the need for EOT among 6–9-year-old children of West Bengal that would benefit from preventive and interceptive orthodontic treatment to prevent or reduce the number of late/corrective orthodontic treatments, which can be complex, lengthy, and costly.
| Materials and Methods|| |
The present study was designed as observational, qualitative, and cross-sectional survey that was conducted among 6–9-year-old children from different public and private primary schools of West Bengal to determine the proportion of children that would benefit from preventive and interceptive orthodontic treatment to prevent or reduce the number of late or corrective orthodontic treatments, which can be complex, lengthy and costly.
Sample size have been calculated using the formula
, where P = (p1 + p2)/2, Q = 1 - P, and d is p1 - p2. Now assuming P < 0.05 to be significant and considering effect to be two sided, we get Za = 1.96; assuming power of study to be 90% we get Z1-β = 1.28. Taking p1 and p2 as the percentage of moderate + sever index for preventive and interceptive orthodontic need (IPION) score as 81% and 88% for age 6 and age 9, respectively, using the above formula, we get n = 458 in age 6 and age 9. However, depending upon the available patients, finally, we have taken over 500 sample size in both the groups.
Index for preventive and interceptive orthodontic need
It was important to have an index that examines and measures the features relevant to preventive an interceptive orthodontics, especially in countries where the emphasis is on primary health care. Such an index will give an indication of the need for early orthodontic intervention and will also identify those individuals with a greater need for treatment. (IPION 6 and IPION 9) developed by Coetzee and de Muelenaere specifically meant for children in the mixed dentition (Coetzee CE, 1999, Development of an IPIONs, MChD dissertation, University of Pretoria, Pretoria) identifies the actual need for EOT. Therefore, in this present study, IPION index was selected.
The IPION identifies children aged between 6 and 9 years, who would most likely benefit from early preventive and/or interceptive orthodontic treatment, allowing certain characteristics of the occlusion to be weighted more heavily than the others. The IPION leads to the calculation of an overall score, which is reflective of the child's amenability to being treated early. As different factors affect the development of malocclusion between 6 and 9 years of age, two indices were developed – the IPION 6 and IPION 9. Each index comprised five components: primary component, anterior component, posterior component, occlusion, and soft tissue. Although the two indices are based on the same principles, there are a few different factors that distinguish each of them.
A multistage sampling technique was adopted to select the children. The map of West Bengal was procured and divided into separate geographical zones. All children between the ages of 6 and 9 years attending at different public and private primary schools of West Bengal on the day of research visit were invited to participate in the study. Head of the institution of each school was informed about the study design and survey's aim and objectives. Schedule of the survey was done by sending prior letter of notification regarding the date and time of examination. The entire sample was divided into two groups, which were IPION 6 and IPION 9. Children were scored chair side by using (IPION 6 and IPION 9) developed by Coetzee specifically meant for children in the mixed dentition.
IPION 9 scoring sheets were used for any child whose permanent maxillary central incisors were visible upon examination, as this scoring sheet has more categories than the IPION 6 and therefore derives more information about a malocclusion.
The clinical examiners were calibrated prior to the study in order to control reliability. The presurvey calibration was performed in two series of clinical examinations on 50 children (which were excluded from the final sample) at a 3 weeks interval in order to establish intra-examiner reproducibility. The Kappa values on intra-and inter examiner consistency in the diagnosis of EOT need were found to be >0.82, deemed excellent. CPITN probe was used to measure the degree of over jet as described by the1997 WHO Basic Oral Health Survey Guidelines. A sufficient number of mouth mirrors, explorers, tweezers, kidney trays, were sterilized and kept for examination. Dental examination was conducted using individually wrapped and sterilized sets of plain mouth mirrors, community periodontal index probes and gauze pads. The examination was carried out with subjects seated on a chair as per WHO Criteria. In the Department, children were examined chair side maintaining proper protocols.
Analysis of data
All scores were multiplied by their weighting factors and added together to get an Overall Score for each subject. This information was organized into a Microsoft Excel Spreadsheet. After the data for the subjects was collected and organized, the subjects were organized into three categories: no treatment need (overall score of 0–5), moderate treatment need (overall score of 6–14) and definite treatment need (overall score of 15 or more).
Categorical variables are expressed as number of patients and percentage of patients and compared across the groups using Pearson's Chi-square test for independence of attributes/Fisher's exact test as appropriate.
Continuous variables are expressed as mean ± standard deviation and compared across the two groups using unpaired t-test.
The statistical software? SPSS version 20 IBM, Armonk, NY has been used for the analysis.
An alpha level of 5% has been taken, i.e., if any P < 0.05 it has been considered as significant.
| Results|| |
In the IPION 6 group, 532 children (47.1%) were examined; their ages ranged from 6 years to 7 years and 5 months. In the IPION 9 group, 597 children (52.9%) were examined; their ages ranged from 7 years and 3 months to 9 years. Among the IPION 6 group, 226 children were girls and 306 children were boys [Figure 1] and among the IPION 9 group, 208 children were girls and 389 children were boys [Figure 2].
The distribution of the three categories of treatment need based on the overall scores in the total sample was detected by calculating frequencies and percentages. To isolate the impact of caries, the weighted points accumulated for caries were subtracted from the overall scores for each child. Consequently, a modified distribution of the three categories of treatment need was obtained which was termed as modified IPION score.
Among 1129 children examined, 554 children (49.1%) came under the category of no treatment need, 174 children (15.4%) presented with moderate treatment need and 401 children (35.5%) showed definitetreatment need [Figure 3].
According to modified IPION scale, 590 children (52.3%) showed no treatment need, 246 children (21.8%) showed moderate treatment need and 293 children (26.0%) presented definite treatment need [Figure 4]. It was found that the frequency and percentage of definite treatment need according to modified IPION scale (26%) was much lower than that of the conventional IPION index (35.5%).
|Figure 4: Modified index for preventive and interceptive orthodontic need score|
Click here to view
In IPION 6 group, 165 children (31.02%) showed definite treatment need, 85 children (15.9%) showed moderate treatment need and 282 children (53.01%) presented with no treatment need [Figure 5]. In IPION 9 group, 236 children (39.53%) showed definite treatment need, 89 children (14.91%) showed moderate treatment need and 272 children (45.56%) presented with no treatment need [Figure 5]. Distribution of definite treatment need was much higher in IPION 9 group than IPION 6 group. Chi-square test showed statistically significant difference (P = 0.010) in EOT need between children with these different age groups.
| Discussion|| |
The present study results are in agreement with the study conducted by Zeltmann et al. in 2016. In their study, the need for orthodontic treatment was judged according to the 5 point scale of the Swedish National Board of Health and Welfare (1966). In 32% of the children, there was an urgent need for treatment (Grades 3 and 4). In a further 32% of children, treatment would be desirable (Grade 2). There was a little need for treatment (Grade 1) in 24% and no need (Grade 0) in 12%.
The results of Thilander et al. study, conducted in Bogota, Colombia were also in accordance with the present study results. In their study, little need for orthodontic treatment was found in 35% and moderate need in 30%. A great need was estimated in 20%, comprising children with pre normal occlusion, maxillary overjet, or overbite (>6 mm), posterior unilateral cross bite with midline deviation (>2 mm), severe crowding or spacing etc.
Tausche et al. in 2004 also put forth same opinion regarding EOT need. The proportion of children estimated using the dental health component of the index of orthodontic treatment need (IOTN) to have a great or very great treatment need (Grades 4 and 5) was 26.2%.
The study done by Onyeaso in Ibadan, Nigeria revealed that about 27% of the children had need for one form of preventive/interceptive orthodontic treatment or the other with some having multiple needs. This proportion also was very nearer to that of the present study.
Onyeaso Co did another study in 2004 to assess Orthodontic treatment need of Nigerian outpatients assessed with the Dental Aesthetic Index (DAI). Almost 30% of the children and young adults presenting for treatment had “no/little” need of orthodontic treatment, 20% had DAI scores between 26 and 30 indicating that treatment was “elective,” 15% had a “desirable” need for treatment, and 35% per cent had a “mandatory” need for treatment. These results were in agreement with the present study results.
In January 2004, Mugonzibwa et al. conducted a study to determine need for EOT among Tanzanian Bantu children in age Groups 3–5, 6–8, 9–11 and 15–16 years using IOTN. Aesthetic treatment need and Dental health component occurred in 5%–15% and 16%–36% respectively.
Karaiskos et al. conducted a study in 2005 for the assessment of preventive and interceptive orthodontic treatment needs of an inner city group of 6- and 9-year-old Canadian children. They used the same index (IPION) like the present study. They reported that a considerable proportion of children scored 5 or higher: 20.9% of children in the IPION-6 group and 37.1% in the IPION-9 group. These results were almost comparable to the present study results.
In Souames et al. study in France, 21% of the children presented an objective need for orthodontic treatment.
In 2016, Burhan and Nawaya conducted a study to assess preventive and interceptive orthodontic needs among Syrian children. According to IPION scores, only 15.4% showed no treatment need, 26.7% showed moderate treatment need and 57.9% showed definite treatment need, which were much higher than the present study results. According to modified IPION scores, 29.5% showed no treatment need, 33.5% showed moderate treatment need, and 37% showed definite treatment need which were still higher than the present study results. The IPION groups (aged 6 vs. 9) had a significant effect on treatment need distribution (P = 0.038); the IPION-9 scores were significantly higher than the IPION-6 scores, which was quite similar to the present study. These differences may be attributed to the fact that the IPION 9 was used for children with comparatively more advanced developmental stage. Additionally, the IPION 9 had more categories. Therefore, more scores were there, which may lead to a higher percentage of children in the moderate and definite need categories.
Prabhakar et al. found that 63.4% of the children in Chennai needed orthodontic treatment, which was almost double than that found in the present study. This difference could be explained by the fact that older children were tested in their study. In addition, they used different index for assessment.
| Conclusion|| |
Preventive and interceptive orthodontics are utilized to recognize and eliminate potential asymmetries and malposition in the developing dentofacial complex. These procedures are employed to lessen or to eliminate the severity of developing malocclusion. The early assessment of the child's malocclusions, followed by regular review, and treatment at the appropriate time can do much to reduce the need for future extensive orthodontic treatment. Undoubtedly, this can be achieved by awareness.
The salient findings of this study results are:
- A significant proportion of children between the ages of 6 and 9 years presented definite EOT need (35.5%) regardless of sex
- When caries and restorations were completely disregarded, the proportion of children showing definite EOT need was still remarkable (26.0%)
- In the IPION 6 group, 532 children (47.1%) were examined; their ages ranged from 6 years to 7 years and 5 months. In the IPION 9 group, 597 children (52.9%) were examined; their ages ranged from 7 years and 3 months to 9 years. Distribution of definite treatment need was much higher in IPION 9 group than IPION 6 group. The Chi-square test showed statistically significant difference (P = 0.010) in EOT need between children with these different age groups. This result proved that the treatment needs increase with the development of occlusion and time
- Sexual dimorphism was demonstrated for some occlusal features
- Oral habits and type of occlusion affected the distribution of scores in a significant manner
- Caries of primary molars, overjet >5.1 mm, anterior crossbite and posterior crossbite with functional shift, open bite were prevalent occlusal characteristics in the study population.
The findings of the present study highlight the importance of including preventive and interceptive orthodontic treatment in local dental health-care programs. It is obvious that planning aimed at providing necessary and more affordable dental care to children in urban and rural communities is necessary. The present study indicates the need for the implementation of a primary dental health care program regarding EOT for children in underserviced communities.
Owing to ethical considerations, radiographs could not be taken during the survey, and thus congenitally missing incisors, supernumerary teeth, and other dental anomalies could not be verified. Still, further research is required in this field for better understanding and prediction regarding EOT need so that it can be better utilized for the public self.
Ethical approvals were obtained from the Ethical Committee, Dr. R. Ahmed Dental College & Hospital Dated 30-08-2018 and The West Bengal University of Health Sciences approved the Study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]