Prevalence of Malocclusion among 12 Years Old Palestinian Schoolchildren: Epidemiological Study رسالة ماجستير

Abstract

Background: The World Health Organization has recognized that malocclusion is handicapping anomalies in the dental arches and jaws that may need therapeutic intervention on the individual's aesthetics and emotional well-being. It is considered as one of the most frequently reported problems among children. Palestine has no clear registry or accurate data about the prevalence of malocclusion and its related factors. This study aims to evaluate and assess the extent of malocclusion and its related factors among school students aged 12- years in the West Bank. Methods: A cross-sectional study was done using morphological examination and a questionnaire among 1384 school children aged 12 years in the WB. Data were collected from 69 public schools distributed in the northern, central, and southern regions of the WB from February to April, 2022. A pilot study was carried out to test the inter-examiner reliability by the intra-class correlation coefficient (ICC) and Cronbach's alpha test. ICC showed a high degree of inter-examiner reliability (ICCs 0.872 or above), except for overjet ICCs 0.776 and posterior crossbite ICCs 0.670. All analyses were performed with the Statistical Package for Social Sciences version 23.0. A 2-sided α of <0.05 was considered statistically significant. Frequencies and percentages were calculated for all variables. Chi-square test and Fisher’s exact test were performed to examine the association of demographic indicators and bad oral habits with malocclusions types. Multinomial logistic regression was used to estimate the prevalence ratios of having class II or class III molar relationships according to the presence of dental anomalies, bad oral habits, and space conditions. Results: 1278 schoolchildren were included with a response rate of (92.7%). Of the sample; males represented (48.5%) whereas females represented (51.5%), and northern XIV regions (40.5%), central regions (26.3%), and southern regions (33.2%). While (18.2%) were from cities, and (18.2%) from countryside. Mouth breathing and lip biting were the most prevalent bad oral habits with approximately 40% of the participants, with no differences among gender. 85% of our participants examined had one or more types of occlusal anomalies ranging from mild to severe. The sagittal relationship of malocclusion revealed a prevalence of 65% Class I, 23% Class II, and 12% Class II. In addition to 36% decreased overjet < 2 mm. The vertical dimension rate was in 25% of the children with an openbite, whereas 28% had a deepbite (> 4 mm). Moreover, 29% of the children had a midline shift. Significant relation between gender and midline shift, diastema, and most dental anomalies; more frequent in males. Regarding region and Class I malocclusion, Anterior Openbite, anterior crossbite, midline shift, diastema, reduced overbite, and reduced overjet, significant relations were found. Anterior and posterior openbite, and retained deciduous teeth were significantly in relation with the geographical area. A statistically significant association identified between anterior crossbite and midline shift, and bad habits. The multinomial regression analysis of angle’s molar relationship and dental anomalies revealed the children who had more than one missing permanent teeth were more likely to report Class III (42.4% compared to Class I. while the probability of having an ectopic tooth was higher in Class II division 2 (58.4%) compare to Class I. Furthermore, the analysis of molar relationship and crowding revealed a probability of children without crowding in upper arch to be in Class III compare Class I decreased by 57%. Conclusion: This study reported a high prevalence of malocclusion among school students. Diverse and disparate occlusal traits are related to many demographic and behavioral factors. Therefore, a collaborative effort should be directed to obtain more XV monitoring and surveillance of malocclusion more frequently to prevent and control the exacerbation of the problem.