|Year : 2017 | Volume
| Issue : 4 | Page : 348-353
Geographic information system and index of orthodontic treatment need: Tools to assess orthodontic treatment needs of 12-year-old children of Mysuru District
Bhagyalakshmi Avinash1, BM Shivalinga1, S Balasubramanian2, M Ravikumar3, Suma Shekar1, BR Chandrashekar4, BS Avinash5
1 Department of Orthodontics, JSS Dental College and Hospital, JSS University, Mysuru, Karnataka, India
2 Director, Research, JSS University, Mysuru, Karnataka, India
3 Department of Geoinformatics, JSS University, Mysuru, Karnataka, India
4 Department of Public Health Dentistry, JSS University, Mysuru, Karnataka, India
5 Department of Periodontology, JSS University, Mysuru, Karnataka, India
|Date of Web Publication||13-Dec-2017|
Dr. Bhagyalakshmi Avinash
Department of Orthodontics and Dentofacial Orthopedics, JSS Dental College and Hospital, JSS University, Sri Shivarathreeshwara Nagarar, Mysuru - 570 015, Karnataka
Source of Support: None, Conflict of Interest: None
Introduction: The various research studies conducted in India have shown the prevalence of malocclusion ranging from 20% to 55%. Aim: The aim of this study is to assess the orthodontic treatment need of school going children of Mysuru district and to assess the perceptive need of orthodontic treatment using mapping of malocclusion. Materials and Methods: A cross-sectional, descriptive survey was conducted among 12-year-old schoolgoing children of Mysuru district. The orthodontic need has been assessed with the Index of Orthodontic Treatment Need (IOTN), and the mapping of malocclusion has been done with the use ArcGIS software version 9.3. With SPSS Version 16, frequency, descriptive, cross-tabulations (Contingency table analysis), and Chi-square test have been applied. Results: Among 409 boys, 163 (39.9%) had a little need, whereas 125 (30.6%) had a moderate need and 121 (29.6%) had a definite need for orthodontic treatment. Among 436 girls, 190 (43.6%) had little, whereas 122 (28%) had moderate need and 124 (28.4%) had definite need for orthodontic treatment (P = 0.53). Moreover, the overall perceptive need for orthodontic treatment need was only 35.6%. Conclusion: The prevalence of malocclusion in the studied sample is 58.2%. There is a general lack of awareness regarding orthodontic treatment as assessed by esthetic component of IOTN index. This study also found that Geographic Information System is a valuable tool for mapping of malocclusion and thus must be considered for studies related to public health.
Keywords: Dental, esthetics, esthetics, malocclusion, needs assessment, oral health
|How to cite this article:|
Avinash B, Shivalinga B M, Balasubramanian S, Ravikumar M, Shekar S, Chandrashekar B R, Avinash B S. Geographic information system and index of orthodontic treatment need: Tools to assess orthodontic treatment needs of 12-year-old children of Mysuru District. J Indian Assoc Public Health Dent 2017;15:348-53
|How to cite this URL:|
Avinash B, Shivalinga B M, Balasubramanian S, Ravikumar M, Shekar S, Chandrashekar B R, Avinash B S. Geographic information system and index of orthodontic treatment need: Tools to assess orthodontic treatment needs of 12-year-old children of Mysuru District. J Indian Assoc Public Health Dent [serial online] 2017 [cited 2020 Jul 3];15:348-53. Available from: http://www.jiaphd.org/text.asp?2017/15/4/348/220711
| Introduction|| |
Malocclusion is a common oral finding. It is nothing but a misalignment or incorrect relation between the teeth of the two dental arches when they approach each other as the jaws close. As malocclusion is the most common oral health problem along with dental caries, gingivitis, and dental fluorosis, its assessment and aids to correct it is a public health concern. A severe form of malocclusion is known to cause disability and discomfort in oral functions, and its milder form is known to cause esthetic discomfort. Not only are these but malocclusion also makes a person social handicap by causing psychological disturbances., Hence, there is a need to address the problem globally.
Prevalence of malocclusion – Indian scenario
Various epidemiological studies have been done to study the malocclusion status. Following are some of the states, wherein the epidemiological data about malocclusion is available. According to the studies done in Himachal Pradesh, 53% of the sample had malocclusion. Studies on Rajasthan  reports 66.7%. Studies done by Muppa et al. on Andhra Pradesh population reveals 14.3% with Class I, 9.95% with Class II, and 5.33% with Class III. Kerala population showed 49.2%. Tamil Nadu  reports 62.5% malocclusion.
In North part of India, Delhi  reports 91.6% Class I, 4.6% Class II, and 3.4% Class III, Madhya Pradesh  14.4%, Haryana  55.3%, and Chattisgarh , showed 25% with severe malocclusion.
In Karnataka, the latest study reported 32.8% of malocclusion.
A brief note on geographic information system
A geographic information system (GIS) is a system which is designed to capture, store, manipulate, analyze, manage, and present spatial or geographical data. One of the major uses of GIS is its use as a community assessment tool. GIS helps to reveal the direct correlation between geographic location and health. GIS highlights community assets and displays spatial patterns. Maps produced from GIS data can be used to depict relationship and significant locations of interest within a community. GIS maps present user-friendly presentations, thereby helping the community-based organization understand community data to make evidence-based decisions for proper planning. GIS technology is a powerful aid for public health profession as it provides data which can be used to communicate important facts about the community. Furthermore, GIS ties health to where people live.
The objectives of the study were to assess the severity and awareness of malocclusion in 12-year-old schoolgoing children of Mysuru district and to map the normative and perceptive orthodontic treatment need through GIS software technology.
| Materials and Methods|| |
A cross-sectional descriptive survey was planned in the school children of 12-year-old in Mysuru district. Prior permission to conduct the survey was taken from the Deputy Director of Public Instructions (DDPI) and also from the concerned school authorities. The survey protocol was reviewed and approved by the Institutional Review Board. Informed consent and informed assent were obtained from the parents of the child and to the child, respectively.
Government school, private aided and unaided schools in the four taluks of Mysuru district were considered. The sample size was determined using sample size formula for the prevalence study. Considering the previous studies on Karnataka population, the prevalence rate was fixed at 40%, and relative precision was 0.12. The sample size obtained was 845 participants. Two-stage sampling was planned out. In the first stage of sampling, four taluks (out of 7 taluks) were selected using simple random sampling by lottery method (Mysuru, Nanjangud, Hunsur, and T. Narasipura). In the second stage, from each Taluk, 16 schools were selected randomly by lottery method (schools list provided by DDPI) to include 845 participants. In each school, children in the age group of 12 years were chosen using the class attendance register. Children of 12-year-old in the sampled schools were included, and children with the history of previous orthodontic treatment, rampant caries, and any other craniofacial anomalies and syndromes were excluded from this study.
The Dental Health Component (DHC) of the Modified Index of Orthodontic Treatment Need (IOTN) with grades varying from little/no need, moderate need, and definite need was used to assess the normative orthodontic treatment need. The esthetic component (AC) of the IOTN index was used to know the perceived orthodontic treatment need (awareness regarding orthodontic treatment).
A single orthodontist carried out the examination using Type III examination as recommended by the American Dental Association, which includes inspection using a mirror and a probe, done under good illumination was conducted. The examination was performed under natural light in the school premises using disposable gloves, mouth mirrors. A periodontal probe was used for millimeter measurement. Sufficient number of autoclaved instruments was carried to the examination site to avoid the interruption during the study. To ascertain the prevalence of malocclusion among schoolgoing children of Mysuru district with an objective to estimate the prevalence of malocclusion and to ascertain the IOTN index among the participants, we followed Brook and Shaw 1989 methodology and the same was adopted for participants (845 participants) in its modified version. For each of these two assessment tools, IOTN DHC and IOTN AC, patients were categorized into three groups as having little/no orthodontic treatment need (IOTN DHC: 1–2 and IOTN AC: 1–3), moderate orthodontic treatment need (IOTN DHC: 3 and IOTN AC: 4–6), and definite orthodontic treatment need (IOTN DHC: 4–5 and IOTN AC: 7–10).
Data were entered into SPSS Windows version 16. Frequency, descriptive, cross-tabulations (contingency table analysis), and Chi-square test were applied.
Geographic information system mapping
The baseline map was created for Mysuru district and taluks of Mysuru, Hunsur, Nanjangud, and T. Narsipura. The individual taluk maps and the district map were merged together to create the overall study area map. The information on normative orthodontic treatment need and perceptive orthodontic treatment need for each taluk and for Mysuru district was incorporated into the baseline map, and the maps depicting the differences in the normative orthodontic treatment need and perceptive orthodontic treatment need for each taluk and Mysuru district was created using ArcGIS software version 9.3.
| Results|| |
The malocclusion/IOTN classification reveals that among 409 boys, 163 (39.9%) had little need for orthodontic treatment, whereas 125 (30.6%) had a moderate need and 121 (29.6%) had a definite need for orthodontic treatment. Among 436 girls, 190 (43.6%) had little need for orthodontic treatment, whereas 122 (28%) had a moderate need and 124 (28.4%) had a definite need for the orthodontic treatment. There was no statistically significant difference with regard to orthodontic treatment need between boys and girls (P = 0.53) [Table 1]. Mapping for the prevalence has been shown in the [Map 1],[Map 2],[Map 3],[Map 4],[Map 5].
|Table 1: Orthodontic treatment need based on dental health components of index of orthodontic treatment need in relation to gender in four taluks of Mysuru district|
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Regarding the awareness about orthodontic treatment need in Mysuru district, among 409 boys, 252 (61.6%) had little need for orthodontic treatment while 108 (26.4%) had a moderate need and 49 (12%) had a definite need for orthodontic treatment. Among 436 girls, 292 (67%) had little need for orthodontic treatment while 82 (18.8%) had a moderate need and 62 (14.2%) had a definite need for orthodontic treatment. The gender distribution of participants with regard to ACs of IOTN was statistically significant (P = 0.03) with the higher definite need for orthodontic treatment among girls compared to boys. This was evident even when a separate comparison was made among participants from Nanjangud Taluk (P = 0.01) with no significant difference between the genders in Mysuru Taluk (P = 0.44), Hunsur Taluk (P = 0.77), and T. Narsipur Taluk (0.51) [Table 2]. Mapping for awareness has been shown in the [Map 6],[Map 7],[Map 8],[Map 9],[Map 10].
|Table 2: Orthodontic treatment need based on esthetic components of index of orthodontic treatment need in relation to gender in four taluks of Mysuru district|
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| Discussion|| |
The epidemiologic determination of a disease is the first step in public health endeavors. A review conducted on malocclusion studies in India revealed wide variation in the prevalence, which can be attributed to lack of uniformity in data collection and variations in the indices used for assessing the severity of malocclusion. The prevalence of malocclusion had been found to vary with the different population, race, and origin. Children of 12 years age have a good capacity to remember, retrieve, and apply information related to specific events and experience. The present study was planned and designed to assess the normative and perceived orthodontic treatment need of 12-year-old schoolgoing children in Mysuru district.
In the present study, 58.2% of the participants were in need of orthodontic treatment (moderate need 29.2% + definite need of 29%). A similar study in Travancore population  reported 53.3% in need of orthodontic treatment. However, studies done by Singh et al., Narayanan et al. showed 68.4% and 83.8% in need of orthodontic therapy. This difference could because the latter studies were done on the higher age range participants. Furthermore, since the latter studies are done on participants in Himachal Pradesh and Kerala, there might be racial differences.
On the contrary, studies were done on Japanese population, Iranian population, and American population  showed an even higher percentage of malocclusion. The greater percentages of malocclusion from these studies may be due to racial variations, different age of the sample, genetic predisposition, differences in lifestyle, and variation in growth and facial skeleton.
In the present study, boys had a higher need for orthodontic treatment (60.2%) as compared to girls (56.4%). However, this was not statistically significant (P = 0.53, [Table 2]). Similar results were obtained in the studies done by Otuyemi et al., Onyeasi et al., and Sanu et al., However, this contrasts the finding of Rashida et al. on Malaysian children, Naveen Kumar et al. on Davangere children. This difference could be due to variation in the dentofacial morphology for boys and girls globally. Furthermore, there were no statistically significant differences in relation to gender in each taluk.
Assessment of awareness about orthodontic treatment need is complex and difficult as self-assessment of perceptive orthodontic treatment need depends on the knowledge and understanding every child has within him/her. Only 35.6% (moderate need of 22.5%, the definite need of 13.1%) of the participants felt that they are in need of orthodontic treatment. This means that the participants prefer to get orthodontic treatment, not because of functional concerns or to prevent the loss of tissues within the oral cavity but because of the consequences of the esthetic impairment caused by malocclusion. The inconsistencies highlighted between the child's perception and normative needs in our study are supported by the findings of de Oliveira and Sheiham  and de Oliveira et al. The explanation for this could be that some children have remarkable levels of concerns for minor discrepancy, whereas others are more tolerant of major occlusal problems. The finding of this study is in accordance with the studies were done by Al-Sarheed et al., Kerosuo et al., Kok et al., and Ghijselings et al.,,,, but contrary to the study done by Onyeaso and BeGole  whose study found a higher percentage of perceptive need among their participants, that is, 81.7%. This difference might be because of the inclusion of wide age range of the participants (12–18 years). The study found that girls were more aware regarding orthodontic treatment and this was statistically significant. This is in accordance with the study done by Jung.
| Conclusion|| |
The prevalence of malocclusion in Mysuru district was 58.2%, and the awareness regarding the same was only 35.6%. We also found that GIS technology is a useful aid in the accurate location of the problem area. Through GIS technology, it is possible to localize the malocclusion, and thereby it helps identify the treatment needs based on the severity of the malocclusion.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases, malocclusion and fluorosis in school-going children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent 2007;25:103-5.
] [Full text]
Grimm S, Frazão P, Antunes JL, Castellanos RA, Narvai PC. Dental injury among Brazilian schoolchildren in the state of São Paulo. Dent Traumatol 2004;20:134-8.
Geiger AM. Malocclusion as an etiologic factor in periodontal disease: A retrospective essay. Am J Orthod Dentofacial Orthop 2001;120:112-5.
Pruthi N, Sogi GM, Fotedar S. Malocclusion and deleterious oral habits in a north Indian adolescent population: A correlational study. Eur J Gen Dent 2013;2:257-63. [Full text]
Trehan M, Chugh VK, Sharma S. Prevalence of malocclusion in Jaipur, India. Int J Clin Pediatr Dent 2009;2:23-5.
Muppa R, Bhupathiraju P, Duddu MK, Dandempally A, Karre DL. Prevalence and determinant factors of malocclusion in population with special needs in South India. J Indian Soc Pedod Prev Dent 2013;31:87-90.
] [Full text]
Jacob PP, Mathew CT. Occlusal pattern study of school children (12-15 years) of Trivandrum city. J Indian Orthod Soc 1969;41:271-4.
Radha Krishna G, Saritha V, Suryaprakash VN. A study to determine the prevalence of malocclusion in primary dentition in suburban population in Chennai. Orthod Cyber J 2013;5:1-58.
Kharbanda OP, Sidhu SS, Sundaram K, Shukla DK. Oral habits in school going children of Delhi: A prevalence study. J Indian Soc Pedod Prev Dent 2003;21:120-4.
Jalili VP, Sidhu SS, Kharhanda OP. Status of malocclusion in Tribal children of Mandu (central India). J Indian Orthod Soc 1993;24:41-6.
Singh A, Singh B, Kharhancda OP, Shukla DK, Goswami K, Gupta S. Malocclusion and its traits in rural school children from Haryana. J Indian Orthod Soc 1998;31:76-80.
Kumar DA, Rana KV, Chaturvedi SS, Anil A, Fating C, Makkad RS. Prevalence of malocclusion among children and adolescents residing in orphanages of Bilaspur, Chattishgarh, India. J Adv Oral Res 2012;3:121-8.
Raghavendra MS, Manoj S, Sridhar NS, Reddy H, Sunaina S, Agarwal A. Oral Habits in children of Rajnandgaon, Chhattisgarh, India – A prevalence study. Int J Public Health Dent 2013;4:16-21.
Roopa S, Rani MS. Assessment of malocclusion in school children of Karnataka state between the age groups of 10-12 years and 13-16 years. A cross-sectional descriptive survey. IOSR J Dent Med Sci 2013;11:6-12.
Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001;23:153-67.
Burden DJ, Pine CM, Burnside G. Modified IOTN: An orthodontic treatment need index for use in oral health surveys. Community Dent Oral Epidemiol 2001;29:220-5.
Roopesh R, Manoj KM, Sidharthan B, Manjusha KK. Evaluation of prevalence and severity of malocclusion in South Travancore population. J Int Oral Health 2015;7:94-7.
Singh S, Sharma A, Sandhu N, Mehta K. The prevalence of malocclusion and orthodontic treatment needs in school going children of Nalagarh, Himachal Pradesh, India. Indian J Dent Res 2016;27:317-22.
] [Full text]
Narayanan RK, Jeseem MT, Kumar TA. Prevalence of malocclusion among 10-12-year-old schoolchildren in Kozhikode District, Kerala: An epidemiological study. Int J Clin Pediatr Dent 2016;9:50-5.
Ansai T, Miyazaki H, Katoh Y, Yamashita Y, Takehara T, Jenny J, et al.
Prevalence of malocclusion in high school students in Japan according to the Dental Aesthetic Index. Community Dent Oral Epidemiol 1993;21:303-5.
Danaei SM, Amirrad F, Salehi P. Orthodontic treatment needs of 12-15-year-old students in Shiraz, Islamic Republic of Iran. East Mediterr Health J 2007;13:326-34.
Onyeaso CO, BeGole EA. Orthodontic treatment need in an accredited graduate orthodontic center in north america: A pilot study. J Contemp Dent Pract 2006;7:87-94.
Otuyemi OD, Ogunyinka A, Dosumu O, Cons NC, Jenny J. Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI). Int Dent J 1999;49:203-10.
Onyeaso CO, Sanu OO. Perception of personal dental appearance in Nigerian adolescents. Am J Orthod Dentofacial Orthop 2005;127:700-6.
Onyeaso CO. Orthodontic concern of parents compared with orthodontic treatment need assessed by Dental Aesthetic Index (DAI) in Ibadan, Nigeria. Odontostomatol Trop 2003;26:13-20.
Rashida E, Abdul Razak I, Allister JH. Epidemiology of malocclusion and orthodontic treatment need of 12-13 year old Malaysian school children. J Community Dent Oral Epidemiol 2001;18:31-6.
Naveen Kumar B, Mohapatra A, Ramesh N, Ravishankar TL. Prevalence of malocclusion and orthodontic treatment need among 12-15 years old school children in Davangere, Karnataka, India. Pak Oral Dent J 2010;30:181-5.
de Oliveira CM, Sheiham A. The relationship between normative orthodontic treatment need and oral health-related quality of life. Community Dent Oral Epidemiol 2003;31:426-36.
de Oliveira CM, Sheiham A, Tsakos G, O'Brien KD. Oral health-related quality of life and the IOTN index as predictors of children's perceived needs and acceptance for orthodontic treatment. Br Dent J 2008;204:1-5.
Al-Sarheed M, Bedi R, Hunt NP. Orthodontic treatment need and self-perception of 11-16-year-old Saudi Arabian children with a sensory impairment attending special schools. J Orthod 2003;30:39-44.
Kerosuo H, Al Enezi S, Kerosuo E, Abdulkarim E. Association between normative and self-perceived orthodontic treatment need among Arab high school students. Am J Orthod Dentofacial Orthop 2004;125:373-8.
Kok YV, Mageson P, Harradine NW, Sprod AJ. Comparing a quality of life measure and the Aesthetic Component of the Index of Orthodontic Treatment Need (IOTN) in assessing orthodontic treatment need and concern. J Orthod 2004;31:312-8.
Ghijselings I, Brosens V, Willems G, Fieuws S, Clijmans M, Lemiere J. Normative and self-perceived orthodontic treatment need in 11- to 16-year-old children. Eur J Orthod 2014;36:179-85.
Onyeaso CO, Arowojolu MO. Perceived, desired, and normatively determined orthodontic treatment needs among orthodontically untreated Nigerian adolescents. West Afr J Med 2003;22:5-9.
Jung MH. Quality of life and self-esteem of female orthognathic surgery patients. J Oral Maxillofac Surg 2016;74:1240.e1-7.
[Table 1], [Table 2]