Nature and severity of dental malocclusion in children suffering from transfusion-dependent (-thalassemia major

Jeelani, Waqar; Sher, Uroosa; Ahmed, Maheen

doi:10.1590/2177-6709.25.6.26.e1-9.onl

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Dental Press Journal of Orthodontics

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online article* • Dental Press J. Orthod. 25 (06) • Nov-Dec 2020 • https://doi.org/10.1590/2177-6709.25.6.26.e1-9.onl copy

Nature and severity of dental malocclusion in children suffering from transfusion-dependent (-thalassemia major

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the prevalence and severity of malocclusion in children suffering from β-thalassemia and to assess orthodontic treatment need using Grainger’s Treatment Priority Index (TPI) and index of orthodontic treatment need (IOTN)-dental health component (DHC).

Methods:

A cross-sectional study was conducted on 200 transfusion-dependent children diagnosed with homozygous β-thalassemia and 200 healthy school children aged 11-17 years. The TPI and IOTN-DHC data was recorded for both groups. Total TPI score for each subject was calculated and graded according to malocclusion severity estimate (MSE). Independent sample t-test was used to compare mean TPI scores, overjet and overbite between thalassemic and healthy children. Chi-square test was used to compare the frequency of IOTN-DHC grades, Angle’s classification, and MSE grades between thalassemic and healthy children.

Results:

The most prevalent malocclusion was Class I in normal children (67.5%) and Class II in thalassemic children (59%). The mean overjet and overbite were significantly (p<0.001) greater in thalassemic children than in healthy children. Severe tooth displacements were 3.5 times greater in thalassemic children, compared to controls. A greater proportion of thalassemic children were in IOTN grades 3 and 4, compared to the controls (p<0.001). MSE grades 4 and 5 were significantly (p<0.001) more prevalent in thalassemic children, compared to the controls.

Conclusion:

There is a high prevalence of Angle’s Class II malocclusion in thalassemic children. Majority of these children are categorized in higher grades of IOTN-DHC and TPI-MSE, showing a great severity of malocclusion and high orthodontic treatment needs.

Keywords:
Thalassemia; Beta-thalassemia; Index of orthodontic treatment need; Malocclusion

			(6) Distocclusion					(7) Mesiocclusion
First Molar Relationship (choose the appropriate column)			2 sides full Class II	1 side half Class II 1 side full Class II	2 sides half Class II or 1 side full Class II	1 side half Class II	N E U T R A L	1 side half Class III	2 sides half Class III or 1 side full Class III	1 side half Class III 1 side full Class III	2 sides full Class III	W E I G H T	Type of Syndrome
Incisor Horizontal Relationship in mm
(1) Upper Overjet		>9	2.0	3.4	5.4	9.3	10+	9.3	5.4	3.4	2.0		Retrognathism
		9	1.4	2.5	4.0	6.9	10+	6.9	4.0	2.5	1.4
		8	1.0	1.8	2.8	4.8	8.0	4.8	2.8	1.8	1.0
		7	0.6	1.1	1.8	3.0	5.1	3.0	1.8	1.1	0.6
		6	0.4	0.6	1.0	1.7	2.9	1.7	1.0	0.6	0.4
		5	0.2	0.3	0.4	0.8	1.3	0.8	0.4	0.3	0.2
NORMAL (Counting 0)
(2) Lower Overjet		1	0.2	0.3	0.4	0.8	1.3	0.8	0.4	0.3	0.2		Prognathism
		0	0.4	0.6	1.0	1.7	2.9	1.7	1.0	0.6	0.4
		1	0.6	1.1	1.8	3.0	5.1	3.0	1.8	1.1	0.6
		2	1.0	1.8	2.8	4.8	8.0	4.8	2.8	1.8	1.0
		3	1.4	2.5	4.0	6.9	10+	6.9	4.0	2.5	1.4
		>3	2.0	3.4	5.4	9.3	10+	9.3	5.4	3.4	2.0
Incisor Vertical Relationship
(3) Overbite in relation to crown thirds		>3/3	2.9	3.8	4.8	6.2	8.0	6.2	4.8	3.8	2.9		Overbite
		3/3 to ⅔	1.5	2.0	2.4	3.2	4.1	3.2	2.4	2.0	1.5
		⅔ to ⅓	0.5	0.7	0.9	1.1	1.5	1.1	0.9	0.7	0.5
NORMAL (Counting 0)
(4) Open bite in mm		<2	1.5	2.0	2.4	3.2	4.1	3.2	2.4	2.0	1.5		Open bite
		2 to 4	2.9	3.8	4.8	6.2	8.0	6.2	4.8	3.8	2.9
		>4	4.9	6.3	7.9	10+	10+	10+	7.9	6.3	4.9
(10) Teeth displacement		No.
• Sum of teeth rotated 45^o or 2mm displaced • Sum of teeth rotated >45^o or >2mm displaced x2 • Total (0,1 without counting)		2	0.1	0.1	0.2	0.3	0.4	0.3	0.2	0.1	0.1		Distocclusion and/or posterior buccal crossbite May be: YES: - maxilla - expansion - Brodie syndrome NO: - maxilla - collapse - posterior crossbite
		3	0.2	0.3	0.4	0.7	1.1	0.7	0.4	0.3	0.2
		4	0.3	0.5	0.9	1.2	1.9	1.2	0.9	0.5	0.3
		5	0.5	0.8	1.2	1.9	3.0	1.9	1.2	0.8	0.5
		6	0.7	1.1	1.8	2.8	4.3	2.8	1.8	1.1	0.7
		7	1.0	1.5	2.4	3.9	5.9	3.9	2.4	1.5	1.0
		8	1.3	19	3.1	4.9	7.7	4.9	3.1	19	1.3
		9	1.7	2.5	4.1	6.2	9.7	6.2	4.1	2.5	1.7
		>9	2.0	3.0	4.9	7.7	10+	7.7	4.9	3.0	2.0
Constants			5.17		3.95	2.72	1.50	0.27	1.50	2.72	3.95	5.17
(8) Sum of teeth in posterior crossbite	Buccal upper posterior teeth	No.	0	1	2	3	4	5	6	7	8	More
	Buccal upper posterior teeth	Weight	0	0.1	0.6	1.3	2.2	3.5	5.0	6.9	9.0	10
	Lingual upper posterior teeth	No.	0	1	2	3	4	5	6	More
	Lingual upper posterior teeth	Weight	0	0.3	1.0	2.3	4.2	6.5	9.4	10
Score sum is the Treatment Priority Index (TPI)

Angle’s classification of molar relationship	Thalassemic children (n=200)	Healthy controls (n=200)	Total	p value
Class I	76	135	173	<0.001
Class II	118	49	108
Class III	6	16	19

	Thalassemic children n=200	Healthy controls n=200	Mean difference	p value
Overjet (mm)	4.17 ± 2.64	2.90 ± 2.31	1.27	<0.001*
Overbite (mm)	4.18 ± 2.88	3.14 ± 1.91	1.04	<0.001*
Teeth mildly displaced	4.37 ± 3.10	2.49 ± 2.05	1.88	<0.001**
Teeth severely displaced	2.09 ± 2.64	0.59 ± 0.95	1.50	<0.001**
Number of patients with buccal/lingual crossbite	20	8	6%	0.079**

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[1] Contact address: Waqar Jeelani Email: wjeelani@gmail.com