Orthodontic Treatment Needs in the Western Region of Saudi Arabia : a research report

Transcription

1 Orthodontic Treatment Needs in the Western Region of Saudi Arabia : a research report Ali H. Hassan 1 1 P.O. Box 80209, Jeddah Preventive Dental Sciences Department, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia address: AHH: aliresearch@gawab.com - 1 -

2 Abstract Background Evaluation of self perceived and actual need for orthodontic treatment helps in planning orthodontic services and estimating the required resources and man power. In the present study the perceptive need as evaluated by patients and the actual need to orthodontic treatment, as assessed by orthodontists, were evaluated at two types of dental practices in the city of Jeddah using the Index of Orthodontic Treatment Need (IOTN) Methods A total of 743 adult subjects seeking orthodontic treatment at two different practices in Jeddah city; King Abdulaziz University, Faculty of Dentistry (KAAU) (Free treatment) and two private dental polyclinics (PDP) (Paid treatment) were examined for orthodontic treatment need using the dental health component (DHC) of the IOTN. The self-perceived need for orthodontic treatment was also determined using the aesthetic component (AC) of the IOTN. The IOTN score and the incidence of each variable were calculated statistically. AC and DHC categories were also compared between the two groups using the Z test. In addition, a correlation was measured between the grades of AC and DHC Results The results revealed that among the 743 patients studied, 60.6% expressed no or slight need for treatment, 23.3% expressed moderate to borderline need and only16.1% thought they needed orthodontic treatment. Comparing these estimates to professional judgments, only 15.2% conformed to little or no need for treatment, - 2 -

3 13.2% were assessed as in borderline need and 71.6% were assessed as in need for treatment. Pearson s correlation proved a weak correlation (t = 0.27) between the two components. Comparing the EC and the DHC between the KAAU group and PDP group showed significant differences between the two groups (p<0.05). Conclusion A Patient's perception to orthodontic treatment does not always correlate with professional assessment. The IOTN should be used as a screening tool in orthodontic clinics for better services especially, in health centers that provide free treatment - 3 -

4 Background Facial and dental esthetics is the main motive for people seeking orthodontic treatment [1]. In Saudi Arabia, governmental sectors provide free orthodontic treatment for people, which has generated long waiting lists of patients that extend for two to four years. Evaluation of self perceived and actual need for orthodontic treatment as well as other factors affecting these needs such as personal, sociodemographic, and psychosocial factors help in planning orthodontic services and estimating the required resources and man power. Moreover, unnecessary referrals by general practitioners and lengthy waiting lists for orthodontic consultation can be eliminated [2]. It may also predict a patient's readiness to co-operate and show his or her interest and motivation toward the orthodontic treatment, thus driving the greatest benefit [3] through increasing a patient s awareness by conducting educational programs in schools and in the media based on actual patient's psychosocial factors and hence overcoming obstacles and barriers in seeking treatment. Perceptive or self assessed need to dental care is reported to be associated with certain signs and symptoms [4], socio-demographic factors and satisfaction with previous dental treatment [5, 6]. A number of studies have shown controversial results regarding a patient s perceptional awareness of orthodontic treatment need as compared to their actual orthodontic need [8-10]. It seems that normative or actual need as assessed by dental professionals may not be linked to a patient s perceptions unless the condition has progressed sufficiently to be symptomatic [7]. Several indices were used to evaluate malocclusion, such as the IOTN. The IOTN is a scoring system for malocclusion, developed by Brook & Shaw (1989) [11]. It comprises two independent components; the DHC, which is a five grade index that records the dental - 4 -

5 health need for orthodontic treatment, and the AC that records the esthetic need for orthodontic treatment using a ten grade standardized ranking scale of colored photographs showing different levels of dental attractiveness [2,7,8]. The IOTN has been used extensively in the literature to evaluate actual and perceptive treatment needs [9-23]. The objectives of the present study were to assess the perceptive and actual treatment need for orthodontic treatment among subjects seeking orthodontic treatment in the Jeddah area using the IOTN and to compare those subjects attending a governmental dental clinic (KAAU), with those attending a PDP utilizing the IOTN. Methods The sample consisted of 743 subjects seeking orthodontic treatment at two different practices; KAAU (N= 489) and two PDPs in the Jeddah area (N=254), ranging in age between 17 and 24 years. All subjects were of Arabic descendants and with no history of orthodontic treatment. The treatment at KAAU is free of charge while the treatment at PDPs is expensive and costs about 15,000 SR. All subjects enrolled in the study signed a consent form. Each subject was examined for orthodontic treatment need using the DHC of the IOTN by one of two examiners, after proper training and calibration to reduce any possible inter-examiner error. In addition, the self-perceived need for orthodontic treatment was determined by asking each subject to evaluate his/her own attractiveness by comparing it to the standard photographs of the AC of the IOTN. The IOTN score and the incidence of each variable were calculated statistically. The AC and DHC categories were compared between the two groups using the Z test. The dental health component and the esthetic component - 5 -

6 were also compared using the Z test and were correlated using Pearson's Correlation coefficient. The protocol of the present study was approved by the Ethical Committee of the Faculty of Dentistry at King Abdulaziz University. Results The highest incidence of orthodontic problems in the current study was for displacement (89.1%), followed by crossbite (44.5%), deep overbite (33.6%) and increased overjet (33.6). Impaction incidence was relatively low (8.2%). The incidence of cleft lip and palate was 3.9 % (Table.1) Results of the EC revealed that among the 743 patients studied, 60.6% expressed no or slight need for treatment, while 23.3% expressed moderate to borderline need and 16.1% thought they needed orthodontic treatment. Comparing these estimates to professional judgments using the Z- test, the DHC was significantly (<0.05) different from the EC in the three groups; only 15.2% conformed to little or no need for treatment (grades I & II), while 13.2% were assessed as in borderline need (grade III). On the other hand, 71.6% were professionally assessed as in need for treatment (Table 2 & Figure 1). Pearson s correlation between the EC and DHC proved a weak correlation (t = 0.27) between the two components. Comparing the grades of DHC between the KAAU group and the PDP group (Table 3 & Figure 2)) revealed that the proportion of the sample estimated to need mild or no treatment (Grade 1 & 2) was significantly higher in the KAAU group (18.2%) than - 6 -

7 that of PDP Group (9.4%) (p<0.05). The other two grades; border line and need treatment, were insignificantly different between the two groups. Comparing the grades of the EC between the KAAU group and the PDP group (Table 4 & Figure 3) revealed that the need for treatment score as perceived by the subjects was significantly different between the two groups; No or slight treatment grade was higher in the KAAU group (72.7%) than PDP group (37.4%), border line grade and need for treatment grades were higher in the PDP group (40.55% & 22.04% respectively) than in the KAAU group (14.3% & 12.9% respectively). Discussion The results of the DHC shed some light on the pattern of malocclusion that is seen in Jeddah area, which is dominant mainly of displacement, crossbite, deep bite and increased overjet. However, larger scale studies are required to evaluate the actual pattern of malocclusion in the Western Area of Saudi Arabia via conducting survey studies on a random sample. The significant differences between the EC and DHC and the weak correlation between the perceptive (demand) and actual need for orthodontic treatment indicates a general lack of awareness among the people about the severity of their existing malocclusion which could be attributed to their weak oral health knowledge as well as parent's neglect to the orthodontic problems. This is in agreement with several other studies [8-10]. Moreover, the perception of occlusal traits in the buccal segments is generally underestimated by people when compared to those present in the anterior - 7 -

8 segment [22-23]. The results can also be attributed to the nature of the IOTN itself. The scores of the DH component could be exaggerated by the rank of displacement, which could give a high score in otherwise normal occlusion. In addition, the standard photographs of the EC do not show common orthodontic problems such as open bite and Class III malocclusion. These shortcomings of the IOTN indicate the need to modify the index to include open bite and Class III dental occlusion. The results also have shown less awareness and appreciation of the severity of their malocclusion among patients seeking treatment in a governmental dental clinic such as KAAU, when compared to those paying for their treatment at private dental polyclinics. This could explain the less compliance seen among those patients. Little awareness for the actual need for treatment in the KAAU group could be attributed to the free treatment provided, which attracts anyone to seek treatment regardless of the severity of his or her chief complaint. Therefore, the use of DHC of the IOTN as a screening tool to reevaluate the waiting list of people seeking orthodontic treatment at governmental clinics is recommended to identify those patients who could benefit the most from such free services and subsequently reducing the long waiting lists at such centers. In addition, the application of minimum charge for treatment at the governmental dental clinics could serve the same purpose. Conclusion There was a definitive need for orthodontic treatment among Saudis living in the city of Jeddah, which was not matched with a similar level of perceptive need by the same population. The grades of EC and DHC were significantly different between those - 8 -

9 patients seeking free treatment at governmental dental centers and those who pay for their treatment at private dental practices. Competing interests The author declares that there are no competing interests. Acknowledgements The author would like to thank Prof. Hala Amer, Dr. Amna Siddiqi and Dr. Reema Al Ghaithy at the Faculty of Dentistry, King Abdulaziz University for their valuable contributions

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14 Figures Figure 1 - Graphical representation table 2 Figure 2 - Graphical representation of table 3 Figure 3 - Graphical representation of table 4 Tables Table 1 - The incidence of the orthodontic problems as assessed by the DHC of the IOTN Table 2 - Comparison of the EC and the DHC overall grades Table 3 - Comparison of the proportions of the two samples estimated to need orthodontic treatment (DHC) Table 4 - Comparison of the Perceptive Need to Orthodontic Treatment (EC) between the KAAU group and PDP group

15 Table1: The incidence of the orthodontic problems as assessed by the DHC of the IOTN Orthodontic Problem Incidence % Grade 1 Grade 2 Grade 3 Grade 4 Grade 5 Pre/post-normal occlusion 3 3 Displacement Crossbite Open bite Overbite Overjet Reverse overjet Scissors bite Partially erupted Impaction Submerged deciduous 0 0 Supernumerary Hypodontia Cleft lip- Palate

16 Table 2: Comparison of the EC and the DHC overall grades Group/Grade EC DHC % N % N Z test P-value No/Slight Need < 0.05* Moderate need < 0.05* Need TX < 0.05* Total 743 * Significant at p < 0.05 Figure 1: Graphical representation table EC DHC 50 % No/Slight Need Moderate Need Need TX Group/Grade

17 Table 3: Comparison of the proportions of the two samples estimated to need orthodontic treatment (DHC) Group/Grade KAAU PDP % N % N Z test P-value Little/No TX. (Gr.1&2) < 0.05* Border line (Gr.3) > 0.05 Need TX. (Gr.4&5) > 0.05 Total * Significant at p < 0.05 Figure 2: Graphical representation of table KAAU PDP % & & 5 Group/Grade

18 Table 4: Comparison of the Perceptive Need to Orthodontic Treatment (EC) between the KAAU group and PDP group Group/ Grade KAAU PDP % N % N Z test P-value No/ Slight need (Gr.1-4) < 0.05* Moderate/Border line (Gr.5-7) < 0.05* Need treatment (Gr.8-10) < 0.05* Total * Significant at p < 0.05 Figure 3: Graphical representation of table KAAU PDP 50 % Group/Grade