Orthodontic Treatment Demand in Iraqi 13 Year Olds - A National Survey

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1 Orthodontic Treatment Demand in Iraqi 13 Year Olds - A National Survey Dr. Akram Faisal Alhuwaizi B.D.S., M.Sc., Ph.D. Prof. Dr. Wael S. Al-Alousi B.D.S., M.Sc. Prof. Dr. Ausama A. Al-Mulla B.D.S., Dr.D.Sc. P.O.P. Department, College of Dentistry, University of Baghdad Abstract 7120 thirteen year old students taken from 6 governorates in Iraq were asked and clinically examined regarding history or present orthodontic. Orthodontic appliance was found in 1.2% of the sample, being significantly more in female and urban students and more in Baghdad and Ninevah. Extractions to improve appearance were found in 1.1% of the students, being insignificantly more in female and urban students and significantly more in Basrah, Baghdad and Diyala. Also, 0.9% reported that their was postponed by a dentist for a later time, being significantly more in female and urban students and more in Baghdad and Ninevah. This gives a total of 3.2% of the sample had some type of orthodontic or consultation. (J Coll Dentistry 2002; 13: 134-9) Introduction As growing public interest in oral health increases the demand for orthodontic, it is important and valuable to have epidemiologic data to estimate the total need and demand for orthodontic care services (Wheeler et al., 1994). The potential interest in orthodontic for an increasing proportion of children will undoubtedly affect the type of services provided, as well as organization and delivery systems in the future (Jenny, 1975). The orthodontic need and demand assessment is of interest for dental public health programs, clinical, screening for priority, resource planning, and third-party funding (Foster, 1979). Surveys on the prevalence of received orthodontic have been concentrated in the Scandinavian countries giving percentages ranging from 16% to 57%, whereas Ast et al. (1965) found that 9.6% of his American sample had undergone extractions or appliance. On the other hand, Ng ang a et al. (1996) found that 4% of Kenyan year olds were orthodontically treated as presented in table 1. Several studies have investigated the prevalence and severity of malocclusion for specific ethnic groups, age distribution, and country-specific populations; however fewer reports (Lindegard et al., 1971; Kelly et al., 1973; Myrberg and Thilander, 1973; Haynes, 1974; Gravely, 1990) specifically address the need and demand issues for the orthodontic of children. In planning orthodontic care, one should not only consider the prevalence of a disorder, but as importantly, the need for such care as expressed by specialists and the demand for shown by the patients and their parents (Lindegard et al., 1971). Prahl-Anderson (1978) found that 14% of parents who were aware of their child s malocclusion did not want orthodontic. In a study by Ingervall and Hedegård (1974), 60% of 18-year-old Swedish men were evaluated to have orthodontic need; however, only 4% were aware of the malocclusion and desired. Similarly, Myrberg and Thilander (1973) reported that, in a group of 7- to 13- year-old children who had very urgent or urgent need, as many as 52.2% declined orthodontic. Gravely (1990) compared two regional areas where the number of practicing orthodontists and levels were variable. He found that where levels were high, the unacceptability of appliance therapy was reduced, thereby increasing demand for. 134

2 Table 1: Reported prevalences of received orthodontic. Sample Treatment received Author Country Size Age % Comments Ast et al. (1965) America extractions or appliances 26 treated/extractions Helm (1968) Denmark appliances Ingervall & Hedegård (1974) Sweden appliances 19 treated/extractions Helm et al. (1975) Denmark appliances Bernhold & Lindqvist (1981) Sweden treated in various areas Rölling (1982) Denmark treated 8 treated/interceptive care Bäckström (1982) Sweden appliances Mohlin (1982) Sweden treated adult women Helm et al. (1984) Denmark treated or with request for Lindgren (1986) Sweden 639 < treated in various areas Salonen et al. (1992) Sweden Pietilä & Pietilä (1993) Finland treated Espeland et al. (1993a&b) Norway Tuominen et al. (1994a) Finland treated Tuominen et al. (1994b) Finland treated Spencer et al. (1995) Australia , Fixed appliance Bergström & Halling (1996) Sweden treated in various areas Ng'ang'a et al. (1996) Kenya treated treated low uptake area treated normal uptake area Materials and Method The study included 7176 thirteen year old students taken from 6 governorates (cities and environs) in Iraq selected to cover the whole country geographically (Baghdad the capital, Ninevah, Basrah, Diyala, Anbar and Najaf) according to a multi-stage stratified sampling technique. Details of the geographic distribution and sampling technique are given elsewhere (Alhuwaizi, 2002; Alhuwaizi et al., 2002). After isolating 56 invalid case sheets the current sample involved 7120 students (Table 2). The students were subjected to an interview and clinical examination to isolate them into five categories: 1. Those currently under orthodontic 2. Those with history of orthodontic 3. Those who have extracted one tooth or more to improve appearance 4. Those who have consulted a dentist and their was postponed until an older age. 5. Those with no orthodontic The data was statistically analyzed by Chi-square tests. For those contingency tables (2 by 2) Yate s correction was used. P values of less than 5% (p<0.05) were considered as significant. Results Distribution of the examined students according to history of orthodontic whether in the past, present or just extraction of permanent teeth to improve appearance are shown in tables 3 and 4 and figures 1 according to governorate, residency and gender. Eighty five students (1.2%) did or were doing orthodontic, being mostly from Baghdad (2.5%) and Ninevah (1.8%), and least from Basrah (0.3%) and Diyala (0.3%). This difference in governorates was 135

3 statistically significant (X 2 = , d.f.= 5, p<0.001). Females showed more orthodontic (1.7%) than males (0.7%) which was statistically significant in the urban students (X 2 = , d.f.= 1, p<0.001) and total sample (X 2 = , d.f.= 1, p<0.001); but was found to be statistically insignificant in the rural students (X 2 = 0.637, d.f.= 1, NS). Orthodontic was found to be significantly more in the urban students (2.0%) than rural students (0.4%) whether among the males (X 2 = 7.737, d.f.= 1, p<0.01), females (X 2 = , d.f.= 1, p<0.001) or total sample (X 2 = , d.f.= 1, p<0.001). Extractions to improve appearance were found in 78 students (1.1%), being mostly from Basrah (1.5%), Baghdad (1.3%) and Diyala (1.2%). This difference in governorates was statistically significant (X 2 = , d.f.= 5, p<0.001). Females showed a non-significant (1.2%) increase in extractions than males (1.0%) in the urban students (X 2 = 0.055, d.f.= 1, NS), rural students (X 2 = 0.110, d.f.= 1, NS) and total sample (X 2 = 0.265, d.f.= 1, NS). Orthodontic extractions were found to be insignificantly more in the urban students (1.2%) than rural students (1.0%) whether among the males (X 2 = 0.219, d.f.= 1, NS), females (X 2 = 0.135, d.f.= 1, NS) or total sample (X 2 = 0.497, d.f.= 1, NS). Those who reported that their was delayed to a later time by a dentist were 63 (0.9%), being mostly from Baghdad (2.1%) and Ninevah (1.1%). This difference in governorates was statistically significant (X 2 = , d.f.= 5, p<0.001). Females showed more delayed (1.3%) than males (0.5%) which was statistically significant in the urban students (X 2 = , d.f.= 1, p<0.001) and total sample (X 2 = , d.f.= 1, p<0.001); but was found to be statistically insignificant in the rural students (X 2 = 0.164, d.f.= 1, NS). Delayed was found to be significantly more in the urban students (1.6%) than rural students (0.2%) whether among the males (X 2 = 8.376, d.f.= 1, p<0.01), females (X 2 = , d.f.= 1, p<0.001) or total sample (X 2 = , d.f.= 1, p<0.001). Discussion Of the sample, 1.2% did or were doing orthodontic and 1.1% had undergone extractions to improve appearance; giving a total of 2.3% of the sample who have had some type of orthodontic. This percentage is very small when compared to studies carried out in European countries as Sweden, Denmark and Finland which showed that 27-45% of their samples have received some sort of orthodontic as displayed in table 1 (Helm, 1968; Helm et al., 1975; Bernhold and Lindqvist, 1981; Rölling, 1982; Pietilä and Pietilä, 1993). On the other hand, Helm (1968) found that 1% of his 1700 students sample was wearing orthodontic appliances, and this figure was close to ours. The scarcity of orthodontic may be explained by the small number of dentists in general and orthodontic specialists in specific in Iraq and the lack of a health insurance system concerned with orthodontic in Iraq. The students who did or were doing orthodontic were significantly mostly from Baghdad and Ninevah, and least in Basrah and Diyala; while those who had undergone extractions to improve appearance were significantly mostly from Basrah, Baghdad and Diyala. This may be because the majority of the orthodontic specialists reside in Baghdad and then Mosul while Basrah and Diyala at the time of the research had one orthodontist each making general practitioners favour extractions to improve appearance rather than to refer the patient to Baghdad. Urban females showed more orthodontic (appliances or extraction) than males in accordance with Tuominen et al. (1994b) which may be because females are more concerned with their appearance than males (Odah and Alhuwaizi, 1997). Orthodontic (appliances or extraction) was found to be more in the urban sample than the rural sample. This could be explained by the fact that all the orthodontic specialists in Iraq reside and practice in the large cities making it more difficult for rural students to obtain. 136

4 Table 2: Number and distribution of the sample (valid case sheets). Residency Gender Urban Rural Total Baghdad Karkh Rusafa Ninevah Males Females Total Males Females Total Males Females Total Basrah Diyala Anbar Najaf Total Table 3: Distribution of the examined students according to history of orthodontic by governorate. Baghdad Ninevah Basrah Diyala Anbar Najaf Total Done or doing orthodontic 52 (2.5%) 18 (1.8%) 1 (0.1%) 3 (0.3%) 6 (0.6%) 5 (0.5%) 85 (1.2%) Extracted teeth to improve appearance 26 (1.3%) 8 (0.8%) 15 (1.5%) 12 (1.2%) 8 (0.8%) 9 (0.9%) 78 (1.1%) Postponed by dentist (2.1%) (1.1%) (0.4%) (0.1%) (0.2%) (0.2%) (0.9%) No orthodontic (94.2%) (96.4%) (98.0%) (98.4%) (98.4%) (98.4%) (96.8%) Total Table 4: Distribution of the examined students according to history of orthodontic by residency and gender. Urban Rural Total M F T M F T M F T Done or doing orthodontic (1.1%) (2.8%) (2.0%) (0.3%) (0.5%) (0.4%) (0.7%) (1.7%) (1.2%) Extracted teeth to improve appearance (1.1%) (1.3%) (1.2%) (0.9%) (1.1%) (1.0%) (1.0%) (1.2%) (1.1%) Postponed by dentist (0.8%) (2.3%) (1.6%) (0.1%) (0.2%) (0.2%) (0.5%) (1.3%) (0.9%) No orthodontic (96.9%)(93.6%)(95.2%) (98.7%)(98.2%)(98.4%) (97.8%)(95.9%)(96.8%) Total

5 Baghdad Ninevah Basrah Diyala Anbar Najaf Done or doing Orthodontic Extracted teeth to improve appearance Postponed by dentist 0.0% 1.0% 2.0% 3.0% 4.0% 5.0% 6.0% Figure 1: Distribution of the examined students according to history of orthodontic by governorate. References Alhuwaizi AF. (2002): Occlusal features, perception of occl7usion, orthodontic need and demand among 13 year old Iraqi students (A national cross-sectional epidemiological study). Ph.D. Thesis, College of Dentistry, University of Baghdad. Alhuwaizi AF, Al-Mulla AA, Al-Alousi WS. (2002): The prevalence of malocclusion in Iraq (a national survey among 13 year olds). Part I: sampling and examination method. J Coll Dentistry; 13: Ast DB, Carlos I P, Cons NC. (1965): The prevalence and characteristics of malocclusion among senior high school students in upstate New York. Am J Orthod; 51: Bäckström A. (1982): Hur effektiv är landstingens tandregleringsvård? Tandläkartidningen; 74: Bergström K, Halling A. (1996): Orthodontic care provided by general practitioners and specialists in three Swedish counties with different orthodontic specialist resources. Swed Dent J; 20: Bernhold M, Lindqvist B. (1981): Orthodontic care in the Swedish Public Dental Service, County of Västerbotten. Swed Dent J; 5: Espeland LV, Stenvik A, Medin L. (1993a): Concern for dental appearance among young adults in a region with nonspecialist orthodontic. Eur J Orthod; 15: Espeland LV, Grönlund G, Stenvik A. (1993b): Concern for dental appearance among Norwegian young adults in region with low uptake of orthodontic. Community Dent Oral Epidemiol; 21: Foster TD. (1979): The public health interest in assessment for orthodontic. J Public Health Dent; 39(2): Gravely J. (1990): A study of need and demand for orthodontic in two contrasting National Health Service regions. Br J Orthod; 17(4): Haynes S. (1974): An epidemiologic study of the relationship between overbite in English children aged years. Comm Dent Oral Epidemiol; 2: Helm S. (1968): Malocclusion in Danish children with adolescent dentition: an epidemiologic study. Am J Orthod; 54: Helm S, Kreiborg S, Barlebo J. (1975): Estimates of orthodontic need in Danish schoolchildren. Community Dent Oral Epidemiol; 3: Helm S, Kreiborg S, Solow B. (1984): Senfolger af tandstillingsfejl. Tandlaegebladet; 88: Ingervall B, Hedegård B. (1974): Awareness of malocclusion and desire for orthodontic in 18-year-old 138

6 Swedish men. Acta Odontol Scand; 32: Jenny J. (1975): A social perspective on need and demand for orthodontic. Int Dent J; 25: Kelly JE, Sanchez M, van Kirk LE. (1973): An assessment of the occlusion of the teeth of children 6-11 years. Washington DC: National Center for Health Statistics. DHEW publication no. (HRA) (Vital and health statistics; 11(130): 1-49). Lindegard B, Lindegard L, Carlson M, Larsson S. (1971): Need and demand for orthodontic. Tandlaegebladet; 75(12): Lindgren G. (1986): Behov av ortodontibehandling i Åhus och Simrishamn. Tandläkartidningen; 78: Mohlin B. (1982): Need and demand for orthodontic in a group of women in Sweden. Eur J Orthod; 4: Myrberg N, Thilander B. (1973): Orthodontic need of in Swedish schoolchildren from objective and subjective aspects. Scand J Dent Res; 81: (81-4). Ng ang a PM, Ohito F, Ogaard B, Valderhaug J. (1996): The prevalence of malocclusion in 13- to 15-year-old children in Nairobi, Kenya. Acta Odontol Scand; 54(2): Odah FD, Alhuwaizi AF. (1997): The prevalence of functional disturbances of masticatory system in pre orthodontic patients. Iraqi Dent J; 20: 155. Pietilä T, Pietilä I. (1993): Adolescents concern for dental appearance in a medium sized Finnish community. Eur J Orthod; 15: 342 (Abstract). Prahl-Anderson B. (1978): The need for orthodontic. Angle Orthod; 48: 1-9. Rölling S. (1982): Orthodontic and socioeconomic status in Danish children aged years. Community Dent Oral Epidemiol; 10: Salonen L, Mohlin B, Götzlinger B, Helldén L. (1992): Need and demand for orthodontic in an adult Swedish population. Eur J Orthod; 14(5): Salzmann JA. (1967): Malocclusion severity assessment. Am J Orthod; 53: Spencer AJ, Allister JH, Brennan DS. (1995): Predictors of fixed orthodontic in 15-year-old adolescents in South Australia. Community Dent Oral Epidemiol; 23(6): Tuominen ML, Nyström M, Tuominen RJ. (1994a): Subjective orthodontic need among orthodontically treated and untreated Finnish adolescents. Community Dent Oral Epidemiol; 22: 1-5. Tuominen ML, Tuominen RJ, Nyström ME. (1994b): Subjective orthodontic need and perceived dental appearance among young Finnish adults with and without previous orthodontic. Community Dental Health; 11(1): Wheeler TT, McGorray SP, Yuriewicz L, Keeling SD, King GJ. (1994): Orthodontic demand and need in third and fourth grade schoolchildren. Am J Orthod Dentofac Orthop; 106: