Evaluation of severity and treatment need using Occlusal & IOTN indices in Coimbatore population

In this study two commonly used and conceptually different measures of indices were used in assessing the severity and treatment need on Coimbatore population. This study appears to be the first study to examine the impact of malocclusion and its treatment need on patients who reported to our Orthodontic department. 1. In our study, the Coimbatore population showed 17% requires no need of treatment, 30% requires moderate need of treatment and 53% requires greater need of treatment when DHC of IOTN was used. 2. On the other hand, the Aesthetic component showed 25.5% showed no need of treatment, 63.5% moderate level of treatment needed and the great need of treatment was about only 11%. 3. When OI was used, our study population showed 22%no need of treatment, 45% requires moderate need of treatment and the great need treatment was about 33%. 4. The study shows, the prevalence for severity of malocclusion was assessed and found to be equally distributed with no gender differences. 5. In the present study, the OI correlated better with objective assessment of IOTN -DHC and subjective opinion of IOTN-AC. Between DHC & AC of IOTN there was poor correlation. 6. We found poor correlation between objective and subjective assessment for both severity & treatment need with in DHC & AC of IOTN, indicating that the need for treatment differs from patients perspective. 7. The need for orthodontic treatment was higher and most of the samples were in the category of moderate to great treatment needed, which is almost equal to the percentage values found by Brook and Shaw and It would be useful to replicate this study in other settings to support or refute our present findings. To conclude, the present study done on Coimbatore population indicated a high prevalence of malocclusion in terms of severity & treatment need. The study also established a reliable base line data regarding prevalence, distribution and severity of malocclusion to meet the treatment needs in our population .In India with a vast ethnic and cultural heritage, where there is a wide range of prevalence of malocclusion, further epidemiological studies of this nature is needed to analyze the demand for orthodontic treatment

Malocclusion among adolescents : qualitative and quantitative studies of the impact on oral health and daily life

Though not considered pathological conditions, malocclusions and their impact have traditionally been assessed from a professional point of view. This could be due to their multifactorial aetiology and the great variation in their severity. Interceptive orthodontic treatments are undertaken during childhood often to reverse an unfavourable development, whereas corrective treatment is performed to adjust established deviations. Orthodontic treatment is, however, predominately optional and provided for the convenience of the individual. Therefore, it is important to involve the patients in the process of assessing treatment need. To do so, detailed knowledge ofpatient views of the condition and of its impact on their daily life are needed. In Sweden, dental health care is free-of-charge for children and adolescents. However, due to limited public resources, subsidized orthodontic care is only offered to those with the greatest need. Thus, treatment priority determination is critical. Current modes for assessing treatment need and decision priority are based on normative occlusal indices, which do not account for patient values. In addition, findings of systematic reviews that use generic instrument to evaluate the impact of malocclusion on Quality of Life are inconclusive. These shortcomings reveal the limitations of these approaches. Thus, the aims of this thesis were to (i) examine the effect of malocclusions on the everyday lives of adolescents, (ii) explore the relationship between professionally assessed treatment need and patient demand for treatment, and (iii) develop a condition-specific instrument that would help improve treatment need evaluations. The present thesis comprises three papers. Paper I was a qualitative investigation using grounded theory for data collection and analysis. It elucidated how malocclusions affect the daily lives of adolescents and how adolescents cope with malocclusion-related distress. Paper II was a cross-sectional, quantitative prediction study based on a subpopulation of Swedish adolescents and used survey and dental record data. In Paper II, path analysis explored the structural relationship between a set of self-assessed measures and treatment need and demand. Paper III was a methodological prediction study that used the same dataset as Paper II. Here, a prediction equation based on regression analysis was presented to test the validity of the measures in the newly developed Demand for Orthodontic Treatment Questionnaire (DOTQ). The overall findings were that internal and external factors repeatedly remind adolescents with malocclusion of their condition. Consequently, adolescents develop strategies, such as “hiding one’s teeth” and “striving for a cure”, to handle the negative feelings associated with the condition. Self-assessed demand for treatment was significantly correlated with professionally assessed treatment need. Further, the DOTQ measures are reliable and intercorrelated. It was demonstrated that self-assessed demand for treatment is a strong predictor of professionally assessed treatment need. Finally, cross-validation confirmed the predictive validity of the DOTQ. Thus, the DOTQ seems to be a promising instrument for predicting orthodontic treatment need. In clinical praxis, dental professionals who treat adolescents with malocclusions should be aware of various strategies that these patients use to deal with their condition, and which potentially lead to irrational behaviours. Patients often become frustrated when treatment need assessment becomes lengthy and delays treatment start. The perceived discrepancy between the professional focus on health aspects and the adolescent focus on aesthetics is unsatisfying in adolescent eyes. Thus, instruments able to evaluate patient perception would be helpful, and recommended, in assessments of orthodontic treatment need and treatment decision priority. Here, the DOTQ could become a useful consultation tool

Orthodontic status and treatment need of 12-year-old children in South Africa : an epidemiological study using the dental aesthetic index

The aim of this study was to evaluate the prevalence and severity of malocclusion and orthodontic treatment needs in a sample of 12-year-old South African school children using the Dental Aesthetic Index (DAI), and to assess the relationship between malocclusion and certain socio-demographic variables. The sample comprised 6142, 12-year-old children attending school in seven of the nine provinces of South Africa. For each subject the standard demographic information such as gender, population group, location type and employment status of the parents were collected, after which an intra-oral examination for occlusal status using the DAI was performed. The results showed that 47.7 per cent of the children in the sample presented with good occlusion or minor malocclusion, just over 52.1 per cent presented with identifiable malocclusion, a DAI score larger than 26. Of these, 21.2 per cent had definite malocclusion, 14.12 per cent had severe malocclusion and 16.89 per cent had very severe or handicapping malocclusion. Malocclusion as defined in this study was found to be significantly associated with the different provinces, the different population groups in South Africa, gender and dentition stage, but not with the location type or the employment status of parents. The results of the individual variables showed that anterior maxillary and mandibular irregularity occurred in more than 50 per cent of the sample. More than 40 per cent of the children examined showed signs of crowding. Spacing in the incisal segments occurred in almost 28 per cent of the sample and maxillary midline diastema was present in 16.66 per cent of the sample. At the age of 12 years, Black children, showed a higher prevalence of maxillary midline diastema, larger than 2mm, than their White, Coloured and Asian counterparts. A maxillary midline diastema, larger than 2mm, was more prevalent in 12-year-old females than in males. Thirty one per cent of the sample had an increased overjet larger than 3mm and a severe overjet of 6mm or more occurred in only 2.18 per cent of the sample. More Black 12-year-old children presented with an edge-to-edge anterior relationship and significantly less Black children had an increased overjet. Mandibular overjet affected only 10.43 per cent of the sample and was more prevalent in the late mixed dentition stage than in the early permanent dentition stage. Anterior openbite occurred in 7.7 per cent of the sample and ranged from 1mm to 8mm. Almost 44 per cent of the sample had a antero-posterior molar relation discrepancy. The results of this study indicated a high prevalence of malocclusion in 12-year-old South African children. The findings provide reliable base-line data regarding the prevalence, distribution and severity of malocclusion as well as useful epidemiological data on the orthodontic treatment needs of 12-year-old children in selected rural and urban areas in South Africa. The inclusion of occlusal traits as part of the index provided an opportunity to assess several occlusal characteristics in 12-year-old South African children, separately.Thesis (MChD (Orthodontics))--University of Pretoria, 2004.Orthodonticsunrestricte

The perceived and normative orthodontic treatment need of a group of South African children

Magister Scientiae Dentium - MSc(Dent)Introduction: Improvement of aesthetics is often the reason patients seek orthodontic treatment. The ability to accurately assess aesthetic treatment need from the viewpoint of the patient is necessary. The threshold for orthodontic treatment is not constant in all countries and no previous attempts to determine this threshold has been made in South Africa. By ensuring that patient’s perceptions of treatment need are incorporated into the index chosen to assess perceived need, accurate data can be obtained. Determining perceived need from the patient’s viewpoint is important, and understanding its relationship with perceived need according to the professional, as well as normative need can facilitate better patient communication and management of expectations. Aims: There were three main aims of this study. First, South African children’s perceptions of treatment need according to the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was assessed to determine if they were similar to those of the dentists who established the threshold, or if the threshold of the grading system should be altered to better suit laypeople’s opinions. Second, the newly established threshold could then be used to determine the perceived needs for orthodontic treatment, and compare them to the normative need of the population. Finally, factors that may influence the perceived needs of the patients such as gender, ethnicity and socio-economic position could be investigated. Methodology: A cross-sectional study on 317 children aged between 11 and 14 years was done. 43.8% were male and 56.2 % were female. The sample was chosen from five schools in the Lekwa District of Mpumalanga using a multi-stage sampling technique. The study population comprised of four groups based on ethnicity; Asian (3%), black (74%), coloured (6%) and white (17%). The socio-economic position (SEP) was determined by Principal Component Analysis of household assets. Societal perceived, subjective perceived and self-perceived needs were assessed using a questionnaire and the child-rated AC of the IOTN. An intra-oral examination was conducted using the AC of the IOTN to assess objective perceived need and the modified Dental Health Component (DHC) of the IOTN to assess normative treatment need. Results: Treatment threshold was determined to be grade 3 of the AC of the IOTN according to societal perceived need of the group of South African children, and was confirmed by self-perceived need. Subjective perceived need for treatment was assessed using the AC grade participants felt best reflected their aesthetic impairment, and was found to be 20.2%, compared to actual self-perceived need of 38.5%. The latter was deduced by comparing the child-rated AC (subjective perceived need) to their perception of treatment need of that grade (societal perceived need). The objective perceived need measured by the examiner-rated AC was 60%. Definite need for orthodontic treatment based on the modified DHC of the IOTN was 41.2%. No significant difference between societal perceived or self-perceived need and gender or socio-economic position was found. White children have lower societal perceived treatment need regarding others’ aesthetic impairment. Conclusion: The treatment threshold grade should be lowered to better represent the societal perceived and self-perceived need of the South African population. Normative need was higher than perceived needs from the patients’ point of view (subjective perceived and self-perceived need), but lower than the perceived need from the professional’s point of view (objective perceived need). Ethnicity was found to have an influence on societal perceived need

Orthodontic treatment need in children aged 12-14 years in Mombasa, Kenya

Magister Scientiae Dentium - MSc(Dent)A public orthodontic system generally is designed to prioritize patients so that those who have the greatest need receive treatment. The aim of this study was to compare the subjective perceptions of the occlusal appearance of 11 to 12 year-old schoolchildren of Nairobi with the modified Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN). The objectives were to assess the children's perception of their occlusal appearance, categorise the occlusal appearance using the AC scale, by both the children and researcher; and to compare the children's' perception and the AC of the IOTN. Satisfaction with appearance of teeth and occlusion as well as peer comparison was investigated. The treatment need and demand was assessed using the modified AC photographs of the IOTN. Altogether, 488 school children (249 girls and 239 boys) assessed their perception of the anterior teeth using a Verbal Descriptor Scale (VDS) and a Visual Analog Scale (VAS) questionnaire. The researcher examined the anterior teeth of the participants and categorised them using the AC of the IOTN. The following results were reported: about two-thirds of the respondents were satisfied with the appearance of their teeth, with the gender difference being statistically significant. About 35% were dissatisfied or very dissatisfied, but reasons for it varied. More than half of the respondents rated their teeth as better than those of their peers and three-quarters were satisfied with their occlusion, the two responses elicited no gender difference. Treatment need was assessed by use of the AC indicated that there was a moderate agreement between researcher and respondents’ in treatment need assessment. The researcher found 36.3% needed treatment against self-perceived need of 30.9%. One-third of the respondents determined by the researcher to 'need treatment', felt 'no need'. There was no statistical gender difference in perceived need for treatment. The selection of ranked photographs of the AC by both researcher and respondents demonstrated skewed distributions towards the 'low ranked' or attractive end of the ranking order irrespective of the state of occlusion. Statistical comparison of the two methods used, namely the VDS and VAS, indicated that the responses were significantly different. Therefore it is suggested that any treatment priority assessment should take perceptions of occlusal appearance. into consideration

Orthodontic treatment need and demand in the Upington area of the Northern Cape Province

Magister Scientiae Dentium - MSc(Dent)When considering a person's self-esteem, behavioural patterns and personal interactions, the one feature having the most impact is their physical appearance. In an ideal world, every person should have a fair opportunity to reach their full potential in life. Orthodontics can improve a person's quality of life by creating confident smiles and a functional occlusion (Sheiham, 1993). Uncorrected malocclusions can adversely affect one's speech, general health and self-esteem. Improving the general physiological implications malocclusions has on person, may make them more employable and more successful in relationships, creating an overall happier, healthier and more successful community. The more people are offered affordable orthodontic treatment, the more acceptable orthodontic treatment may become. Thus, the perceived benefits of Orthodontic treatment in a population group are Improvement of Oral Health and enhancement of psychosocial welfare. Accurate data on the prevalence, distribution and severity of malocclusion is needed by provincial oral health management. They also need accurate data of the orthodontic treatment need of the children in that specific area. This data is vital for the effective planning of the education, training and deployment of dental workers, as well as the resources and distribution thereof in specific, designated areas (Holtshousen, 1997; So & Tang, 1993). This study's focus was to estimate the prevalence of malocclusion amongst adolescents in Upington area in the Northern Cape, and to determine the need for orthodontic treatment in the area using the Index for Orthodontic Treatment Need (IOTN)

The Relationship Between Excessive Anterior Overlap And Dental Status

Aim: This study was designed to analyze the third National Health and Nutrition Examination Survery (NHANES III) database to determine whether excessive overlap of the anterior teeth was related to an increase in structural dental problems. Materials and Methods: The NHANES III database was procured from the National Center for Healthcare Statistics for the purpose of investigating whether a relationship exists between tooth condition and occlusal characteristics of horizontal and vertical overlap. The sample population was limited to those aged 18-50 to incorporate those people who had both Restoration and Tooth Condition Scores and Occlusal Characteristics. The subject set was statistically analyzed using SAS v9.2 software to demonstrate any possible relationships. Results: Our study reaffirmed the characteristics of naturally occurring occlusions. It was shown that 59.5% of the population has a horizontal overlap between 1-3mm, 56% of the population has a vertical overlap of 1-3mm, and 4.6% of the population has an open bite. It was also suggested that the majority of the population has a sound dentition with 83.61% of all teeth recorded being sound. The anterior relationship to tooth condition score comparison was also made for individual at-risk teeth. Teeth numbers 9 (maxillary left central incisor), 12 (maxillary left first premolar), and 14 (maxillary left first molar) were analyzed. The vast majority of teeth were again found to be sound, approximately 85% (tooth 9), 75% (tooth 12), and 71% (tooth 14). No association was found between overlap and tooth condition scores for any individual tooth. Conclusions: According to the NHANES III data file documentation currently available through the Center for Disease Control and Prevention, no relationship exists between the degree of anterior overlap and tooth condition. Due to large differences in the raw data found within this database when compared to previously published data, the reliability of the NHANES III database can be called into question

Necesidad de Tratamiento Ortodóntico en adolescentes de 12 a 17 años-Huancayo 2018

RESUMEN Introducción: El impacto que tienen las maloclusiones sobre los adolescentes puede influir en su desarrollo social haciéndolos vulnerables a la crítica de la población. El índice de estética dental (DAI) es útil en estudios epidemiológicos como un dispositivo de detección para priorizar el tratamiento de ortodoncia. El índice de necesidad de tratamiento ortodóntico (IOTN), registra la presencia y severidad de la maloclusión y la necesidad de tratamiento de los sujetos. Objetivo: determinar la necesidad de tratamiento ortodóntico en adolescentes de 12 a 17 años-Huancayo, 2018. Materiales y Métodos: Se realizó un estudio de tipo descriptivo se evaluó a 217 escolares entre 12 y 17 años de edad, los cuales fueron evaluados mediante un examen clínico intraoral utilizando el índice de estética dental (DAI) y el índice de necesidad de tratamiento ortodóntico (IOTN) componente estético. Los datos demográficos como género, edad y procedencia fueron recolectados caso a caso. Resultados: Se obtuvo como resultado para la necesidad ninguno o poco necesario para el sexo masculino fue 37.96% y para el sexo femenino 43.11%, para el ítem altamente deseable para las edades de 12 a 13 años fue 13.8%, de 14 a 15 años fue 19.1%, de 16 a 17 años fue 25%, de acuerdo a la procedencia. Se obtuvo que para la necesidad altamente deseable para la zona rural 16.31% y para la zona urbana 21.60% según edad Conclusiones: La necesidad de tratamiento es poco necesario para las edades de 12 a 13 años y la necesidad de tratamiento electivo es alto en la zona rural. Palabras claves: Necesidad de tratamiento, DAI, IOTN.Tesi

A Study of Factors Associated with Orthodontic Treatment Outcome

Objective measures of malocclusion have been developed in response to concerns over treatment standards and provision of unnecessary treatment, the rise in the level of clinical audit and the need for effective use of health resources. To determine which factors, including treatment need and severity of malocclusion measured by occlusal indices, have most influence on quality of result, improvement, and resource commitment in terms of treatment duration, case notes and pre- and post-treatment study casts of 161 cases treated within a dental hospital orthodontic department were examined and assessed. Differences were found between cases treated with full fixed appliances and other appliance types with regard to severity of malocclusion, extraction pattern, duration of treatment and number of appointments required to complete treatment. There was evidence that different criteria in appliance selection were in use for males and females. Stepwise multiple linear regression analysis identified the initial severity of malocclusion as being highly influential and predictive for fixed appliance therapy in all the outcomes under study. Other important information included whether or not the treatment plan had been altered through poor co-operation, whether a first permanent molar had been extracted, and whether or not an anterior crossbite had been present initially. Accurately predictive models were produced for improvement as measured by change in PAR score, but predictive models for post-treatment PAR and duration of treatment were less accurate

Nanomaterials for nanotheranostics : tuning their properties according to disease needs

Altres ajuts: this work was funded by the CERCA Program/Generalitat de Catalunya.Nanotheranostics is one of the biggest scientific breakthroughs in nanomedicine. Most of the currently available diagnosis and therapies are invasive, time-consuming, and associated with severe toxic side effects. Nanotheranostics, on the other hand, has the potential to bridge this gap by harnessing the capabilities of nanotechnology and nanomaterials for combined therapeutics and diagnostics with markedly enhanced efficacy. However, nanomaterial applications in nanotheranostics are still in its infancy. This is due to the fact that each disease has a particular microenvironment with well-defined characteristics, which promotes deeper selection criteria of nanomaterials to meet the disease needs. In this review, we have outlined how nanomaterials are designed and tailored for nanotheranostics of cancer and other diseases such as neurodegenerative, autoimmune (particularly on rheumatoid arthritis), and cardiovascular diseases. The penetrability and retention of a nanomaterial in the biological system, the therapeutic strategy used, and the imaging mode selected are some of the aspects discussed for each disease. The specific properties of the nanomaterials in terms of feasibility, physicochemical challenges, progress in clinical trials, its toxicity, and their future application on translational medicine are addressed. Our review meticulously and critically examines the applications of nanotheranostics with various nanomaterials, including graphene, across several diseases, offering a broader perspective of this emerging field