Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil

Silveira, Marise Fagundes; Freire, Rafael Silveira; Nepomuceno, Marcela Oliveira; Martins, Andrea Maria Eleutério de Barros Lima; Marcopito, Luiz Francisco

doi:10.1590/S1518-8787.2016050005861

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Original Articles • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050005861 copy

Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To identify the factors associated with severity of malocclusion in a population of adolescents.

METHODS

In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion.

RESULTS

We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health.

CONCLUSIONS

Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this segment of the population, particularly among those of lower socioeconomic status.

Adolescent; Malocclusion, epidemiology; Risk Factors; Socioeconomic Factors; Self Concept; Cross-Sectional Studies

Variable	n^a	%^b
Demographic characteristic
Sex
Male	367	47.3
Female	396	52.7
Self-reported skin color
Non-white	554	73.1
White	209	26.9
Marital status
Single	729	94.7
Married or stable union	34	5.3
Socioeconomic condition
Level of education (years of schooling)
> 8	595	77.2
≤ 8	168	22.8
Attending school
No	185	26.1
Yes	578	73.9
Monthly per capita incomec
≤ R$200.00	374	58.7
> R$200.00	309	41.3
Household crowding
More than one person per room	122	18.5
Up to one person per room	641	81.5
Use of dental services
Use of dental services
Never	46	6.1
Has used	717	93.9
Type of dental service
Never used	46	6.1
Public or charity	366	48.0
Private, health plan or insurance	351	45.9
Time since last dentist appointment
Never seen a dentist	46	6.1
One year or more	333	43.7
Less than one year	384	50.2
Sees dentist regularly
No	575	75.4
Yes	188	24.6
Health-related behavior
Tooth-brushing frequency
2< 3 times/day	217	28.9
≥ 3 times/day	545	71.1
Use of dental floss
No	426	58.8
Yes	336	41.2
Use of topical fluoride
No	509	60.7
Yes	253	39.3
Harmful oral habits
Yes	302	41.2
No	457	58.8
Smoking
Yes	40	5.1
No	723	94.9
Alcohol consumption
Yes	146	18.8
No	617	81.2
Physical activity
Rarely or never	260	31.8
Occasionally	160	20.0
Always or frequently	343	48.2
Oral health subjective condition
Self-perceived oral health
Negative	257	34.4
Positive	505	65.6
Self-perceived chewing
Negative	162	22.0
Positive	600	78.0
Self-perceived appearance of teeth or gums
Negative	250	35.4
Positive	513	64.6
Self-perceived speech due to teeth or gums
Negative	92	14.0
Positive	671	86.0
Self-perceived relationship affected by oral health
Affects	128	17.5
Does not affect	621	82.5

Variable	n^a	%	IC95%^b
Severity of malocclusion
Absence of malocclusion or slight malocclusion	510	69.5	63.3–75.9
Defined malocclusion	134	17.8	13.4–23.0
Severe malocclusion	56	6.2	4.2–8.5
Very severe malocclusion	49	6.4	4.6–8.6
Occlusal condition			%^b
Number of missing teeth in superior dental arch
None	748		98.5
One or more	13		1.5
Number of missing teeth in inferior dental arch
None	755		99.3
One or more	6		0.7
Alignment in anterior segment
None	460		58.2
One segment	195		26.6
Two segments	106		15.2
Spacing in anterior segment
None	618		80.8
One segment	119		16.7
Two segments	24		2.5
Midline diastema
No	613		80.5
Yes	146		19.5
Anterior superior irregularity
< 2 mm	567		77.4
≥ 2 mm	194		22.6
Anterior inferior irregularity
< 2 mm	569		75.2
≥ 2 mm	192		24.8
Maxillary overjet
< 4 mm	603		80.4
≥ 4 mm	158		19.6
Mandibular overjet
< 4 mm	759		99.6
≥ 4 mm	3		0.4
Anterior openbite
< 2 mm	728		95.8
≥ 2 mm	33		4.2
Molar relationship
Normal	407		56.3
Half cusp	247		32.1
One cusp	97		11.6

Variable	Severity of malocclusion

	Absent or slight		Defined		Severe		Very severe		Total	OR_r	95%CI	p*

	n	%	n	%	n	%	n	%	n
Demographic characteristics and socioeconomic condition
Self-reported skin color
Non-white	355	67.2	102	18.4	47	7.2	40	7.2	544	1.7	1.2–2.4	0.004
White	155	77.3	32	15.7	9	2.9	9	4.1	205	1.0	-	-
Level of education
> 8 years of schooling	409	71.7	97	16.8	42	5.5	34	5.9	582	0.7	0.5–1.0	0.069
≤ 8 years of schooling	101	64.1	37	20.5	14	7.7	15	7.8	167	1.0	-	-
Per capita income
≤ R$200.00	224	62.7	74	20.7	38	7.9	30	8.7	366	1.7	1.1–2.7	0.028
> R$200.00	218	74.0	48	15.3	18	5.5	19	5.2	303	1.0	-	-
Household crowding
> 1 person/room	70	60.3	26	20.0	11	8.8	11	10.9	118	1.8	1.1–2.9	0.027
≤ 1 person/room	440	72.1	108	17.2	45	5.4	38	5.3	631	1.0	-	-
Use of dental services and health-related behavior
Time since last dentist appointment
Never seen a dentist	31	67.1	7	12.1	1	1.5	6	19.2	45	1.6	0.72–3.4	0.250
One year or more	214	67.6	57	17.0	32	8.1	24	7.4	327	1.3	1.0–1.8	0.066
Less than one year	265	72.3	70	19.0	23	4.8	19	3.9	377	1.0	-	-
Harmful oral habits
Present	180	62.2	64	20.2	31	8.9	22	8.7	297	1.9	1.2–3.1	0.009
Absent	329	75.5	68	15.8	25	4.0	27	4.7	449	1.0	-	-
Oral health subjective condition
Self-perceived oral health
Negative	157	63.9	43	17.0	25	7.9	25	11.1	250	1.7	1.1–2.5	0.015
Positive	352	73.0	91	18.0	31	5.1	24	3.9	498	1.0	-	-
Self-perceived appearance of teeth or gums
Negative	133	59.2	54	22.0	27	8.8	26	10.0	240	2.2	1.3–3.6	0.003
Positive	377	75.7	79	15.4	29	4.5	22	4.4	507	1.0	-	-
Self-perceived relationship affected by oral health
Affects	75	58.2	26	22.2	10	6.9	17	12.7	128	2.0	1.5–2.6	0.000
Does not affect	435	72.5	108	16.7	46	5.8	32	5.0	621	1.0	-	-

Variable	Raw analysis			Adjusted analysis

	OR_r	95%CI	p	OR_a	95%CI	p
Demographic characteristics and socioeconomic condition
Self-reported skin color
Non-white	1.7	1.2–2.4	0.004	1.5	1.1–2.2	0.041
White	1.0	-	-	1.0	-	-
Monthly per capita income
Up to R$200.00	1.7	1.1–2.7	0.028	1.5	1.2–2.4	0.040
Over R$200.00	1.0	-	-	1.0	-	-
Use of dental services and behavior
Harmful oral habits
Yes	1.9	1.2–3.1	0.009	1.7	1.1–2.9	0.039
No	1.0	-	-	1.0	-	-
Oral health subjective condition
Self-perceived appearance of teeth or gums
Negative	2.2	1.3–3.6	0.003	1.8	1.1–3.1	0.026
Positive	1.0	-	-	1.0	-	-
Self-perceived relationship affected by oral health
Affects	2.0	1.5–2.6	< 0.001	1.4	1.1–2.1	0.047
Does not affect	1.0	-	-	1.0	-	-

Faculdade de Saúde Pública da Universidade de São Paulo Avenida Dr. Arnaldo, 715, 01246-904 São Paulo SP Brazil, Tel./Fax: +55 11 3061-7985 - São Paulo - SP - Brazil
E-mail: revsp@usp.br

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[1] Correspondence: Marise Fagundes Silveira. Rua 3, 259 Barcelona Parque 39401-825 Montes Claros, MG, Brasil. E-mail: ciaestatistica@yahoo.com.br