Prevalence of Malocclusion Traits in Saudi Males Seeking Orthodontic Treatment in Najran in Saudi Arabia

INTRODUCTION

Malocclusion refers to any type of irregular contact between the upper and lower teeth. It can manifest as an overbite, open bite, under bite, or crossbite. Malocclusion can be defined as an occlusion in which there is a malrelationship between the arches in any of the planes or in which there are anomalies in tooth position, number, form, and developmental position of teeth beyond normal limits.¹

Facial appearance has a long lasting implication on an individual. Malocclusion is a highly prevalent dental deformity, which was shown to have several consequences: physical, economic, social, and psychological impacts.² An unacceptable dental appearance has often been associated with a negative effect on self-image, career advancement, and peer-group acceptance. The adolescents often get subjected to teasing and intimidation which produces a feeling of inferiority leading to an incompetent social and intellectual well-being.

Angle’s classification of malocclusion in 1890s was an important step in the development of orthodontics because it not only subdivided major types of malocclusion but also included the first clear and simple definition of normal occlusion in the natural dentition.³

The prevalence of malocclusion has increased in the past few years and is one of the most common dental problems today. It varies widely and these variations are difficult to explain. It may depend on differences in recording approaches, ethnic origin, social class, or age of the examined subjects.⁴ However, diagnostic criteria are the key factors determining the prevalence of malocclusion.⁵

Malocclusion also has a large impact on both individuals and society in terms of discomfort, quality of life, and social and functional limitations^6,7

The aim of this study was to determine the distribution of malocclusion traits based on Angle’s classification in adolescent and adult male patients seeking orthodontic treatment in faculty of dentistry in Najran, Saudi Arabia

MATERIALS AND METHODS

The sample consisted of 250 Saudi male patients in the age group of 12–35 years who visited faculty of Dentistry in Najran University for orthodontic treatment. The selected sample was divided into two age groups: Adolescents (patients belonging to the age group of 12–17 years) and adults (patients belonging to the age group of 18–35 years). Accordingly, the sample consisted of 151 adults and 99 adolescents. The objectives and benefits of the study were clearly mentioned to the patients, and a written form of informed consent was taken. For patients below the age of 18 years, consent was obtained from their parents or guardians.

The patients included in this study had not undergone previous orthodontic treatment. The assessment was performed independently by a single investigator so as to eliminate any inter-examiner variations. The patients were examined and classified into Class I, Class II, and Class III malocclusions according to Angle’s classification. They were also examined for overjet, overbite, open bite, crossbite, scissor’s bite, crowding, and spacing according to the method used by Bjork et al.⁸

RESULTS

This study consisted of 250 male patients. The age range in this study was 12–35 years. The study sample was divided into two age groups: age group of 12–17 years (adolescents) and age group of 18–35 (adults). Adults constituted 60.4% of the sample, while adolescents represented the remaining 39.6% (Fig. 1).

Table 1 shows that Angle Class I classification was found to be most prevalent (52.8%) followed by Class II (31.6%) and Class III (15.6%). The total number with Angle’s Class I malocclusion (N = 250), was distributed as 53.2% adults and 47% adolescents. This was not the case for Class II malocclusion where only 75.9% of adults and 24.1% adolescents showed it. On the contrary, 53.8% and 46.2% of the total number of Class III were adults and adolescents, respectively.

Among the adolescents, it was observed that Class I was the most prevalent followed by Class II and then Class III. The same pattern was observed in adults with Class I being the most prevalent followed by Class II and then Class III.

The percentage distribution of different malocclusion traits in adolescents and adults has been recorded in Table 2.

With regard to overjet, 42.8% and 33.3% of the adolescents exhibited moderate and severe overjet while 57.2% and 66.7% of the adults showed moderate and severe overjet, respectively.

Anterior crossbite was observed in only 53.3% of adults and 46.6% of adolescents. As for posterior crossbite, 69.4% of the adults and 30.6% of the adolescents showed unilateral crossbite. A vast majority of the adults 69.2% showed bilateral crossbite while only 30.8% adolescents showed it. Unilateral scissor bite was observed in 1.51% of the adults and 2.27% of the adolescents. However bilateral scissor bite was not observed both in adolescents and adults.

Table 2 shows that higher percentage of adults showed anterior crossbite and posterior crossbite (uni- and bilateral). Unilateral crossbite showed a higher percentage than bilateral type. In addition, unilateral scissor bite was more frequently observed in as compared to bilateral scissor bite, which was absent in both adolescents and adults.

Overbite: 57.1% adults and 42.9% adolescents exhibited edge-to-edge overbite. Moderate overbite was observed in 100% of the adolescents. In contrast, none of the adults showed moderate overbite. This was in contrast to severe overbite where a majority of the adults, 69.2% manifested severe overbite while only 30.8% of the adolescents exhibited it.

Anterior open bite was present in 52.4% of the adults and 47.6% of the adolescents. However, lateral open bite was more frequent in adolescents and 87.5% of adolescents showed it, whereas only 12.5% of the adults showed lateral crossbite.

With regard to crowding and spacing, adolescents showed 38.8% and 30.8% crowding in maxillary and mandibular arches, respectively. As for the adults, crowding was present in 61.2% and 69.2% of the maxillary and mandibular arches, respectively. In adults, higher percentage of mandibular spacing was seen (64%) than maxillary spacing (57.9%). This was reversed in adolescents where maxillary spacing was more prevalent (42.1%) than mandibular (36.0%).

DISCUSSION

The prevalence of malocclusion varies widely depending on the population, race, and age, and it is very important in determining and planning orthodontic treatment. The data collected in this study will help in understanding the distribution of the traits of malocclusion in the Saudi male population (Najran area) and establish a proper preventive and orthodontic treatment programs.

The sample used for this study consisted of adolescents and adults belonging to the age group of 12 to 35 years as these are the most frequent age group for those seeking orthodontic treatment. This is in similar to the studies by al-Emran et al.¹⁴ and Nashashibi et al.¹⁵

Angle’s classification has been used in this study as it is a universally accepted system that is reliable and repeatable and that minimizes examiner subjectivity.¹⁶ Distribution of different types of malocclusion may show great variability even in a population of same origin.¹⁷

This study revealed that Angle Class I malocclusion was considered the most prevalent type of malocclusion with 52.8% followed by Class II with 31.6% and Class III with 15.6% among the orthodontic patients examined. This was in agreement with the study conducted by Meer et al.,¹⁸ al Emran et al.,¹⁴ and Al-Balkhi and Zahrani¹⁹ who reported that the most common type of malocclusion was Class I, followed by Class II, and then Class III in the Saudi patients. Gudipaneni et al.²⁰ in a study conducted on Northern border region of Saudi Arabia also found that Angle Class I was the most prevalent malocclusion with 52.8% followed by Angle’s Class II (31.8%) and Angle’s Class III (15.4%). The results of this study are also in accordance with the research conducted by AlQarni et al.²¹ in Asser region of Saudi Arabia in which Class I malocclusion (75%) was found to be most common, followed by Angle’s Class II malocclusion (14%) and Angle’s Class III malocclusion (11%). Another study conducted in the population of Dammam city by Al-Shahrani et al.²² found that the Class I malocclusion was most prevalent (61.6%), followed by Class II (31.8%) which is similar to the findings of this study. When compared to other countries, Nigeria²³ reported 76.5% and Turkey²⁴ reported 74% cases of Angle’s Class I malocclusion in their population. In Pakistan,¹⁰ Angle’s Class II malocclusion (70.5%) was more prevalent amongst orthodontic patients. In urban Iranian population²⁵ and Jordanian school children,²⁶ Angle’s Class I malocclusion was found to be more prevalent by 41.8% and 55.3%, respectively. In a recent systematic review conducted by Alhammadi et al.,²⁷ the highest prevalence of Class I malocclusion was reported in the African population, whereas the Caucasians and Europe population showed the highest prevalence of Class II malocclusion.

The different types of malocclusion anomalies that were observed were overjet, crossbite, overbite, open bite, crowding, and spacing. Similar occlusal anomalies were observed in a study by Hosam Baeshen.²⁸

Among the different malocclusion traits which were observed, the most common anomaly was moderate overbite which was found to be 42.8% in adolescents and 66.7% in adults followed by lateral open bite which was found to be 87.5% in adolescents and 12.5% in adults. Gudipaneni et al.²⁰ reported excessive overbite in 23.4% and reduced overbite in 12.2% in Northern border region of Saudi Arabia. In the similar study, excessive overjet was found to be 22.2% and reduced overjet was found to be 11.4% of population. Albakri et al.²⁹ in a study conducted in Riyadh, Saudi Arabia, concluded that deep bite was found in 9.6% and open bite was present in 4% of the population. In the same study, the normal overjet was seen in 75.4%, slight increase in overjet was found in 15.2%, and severe increase in overjet was found in 6.6% of the population.

In this study, posterior crossbite was found to be more prevalent than anterior crossbite. Albakri et al.²⁹ reported 4.6% bilateral crossbite and 1.4% unilateral crossbite in the population of Riyadh, Saudi Arabia.

With regard to crowding, adolescents showed more crowding in the maxillary arch (38.8%) compared to mandibular arch (30.8%). In adults, the findings were opposite to that of adolescents. Mandibular crowding (69.2%) was more frequently present than maxillary crowding (61.2%) in adults. This can be attributed to large teeth, small jaw, or a combination of both. Gudipaneni et al.²⁰ reported crowding in 47.2% of patients in Northern border region of Saudi Arabia. AlQarni et al.²¹ reported crowding in 40% of patients in Asser region of Saudi Arabia. Albakri et al.²⁹ found 23.2% crowding in maxilla and 28% crowding in mandible in Riyadh, Saudi Arabia.

In this study, in adults, spacing was more prevalent in mandibular arch (64%) compared to maxillary arch (57.9%). In the adolescent group, it was observed that the space discrepancies were more common in the maxilla (42.1%) than in the mandible (36%). This finding can be associated to the hereditary factors in tooth size–arch length discrepancies. The findings of this study are in accordance with the study conducted by Albakri et al.²⁹ who reported maxillary spacing (11.6%) more frequently than mandibular spacing (8.8%) in the population of Riyadh, Saudi Arabia. On the contrary, al-Emran et al.¹⁴ reported higher frequency of spacing in the mandibular arch. This could be due to the differences in age and gender distribution in this study.

The current study achieved its objective by identifying the prevalence of various malocclusion traits in the adolescent and adult male population of Saudi Arabia. Limitations of the study lie in the fact that only male population were included in the study. Moreover, Saudi Arabia due to its ethnically mixed cosmopolitan population has mixed races. Hence, further large-scale studies involving more population are required to provide accurate malocclusion traits of Najran area in the Saudi population.

CONCLUSION

In this study, the prevalence of Angle’s Class I, Class II, and Class III malocclusions was found to be 52.8%, 31.6%, and 15.6%, respectively in the adolescent and adult males in Najran population. The most common anomaly was found to be moderate overbite followed by lateral open bite. Posterior crossbite was found to be more prevalent than anterior crossbite.

The epidemiological data of this study can help in understanding the prevalent traits of malocclusion pertaining to the population of adolescent and adult Saudi males in Najran. to formulate an appropriate preventive and orthodontic treatment measures. The authors recommend the utilization of these data in formulating an appropriate preventive and orthodontic treatment measures for the required population.

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