Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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Chairman, Research Group, Charutar Arogya Mandal, Karamsad
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Ex-Member, Governing Body, National Neonatology Forum, New Delhi
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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
C.S. Ramesh Babu,
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Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : June | Volume : 17 | Issue : 6 | Page : ZC60 - ZC66 Full Version

The Prevalence of Malocclusion among Six-and Nine-year-old School-going Children of Visakhapatnam: A Cross-sectional Study


Published: June 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/60457.18120
Usha Kiran Vudata, Narsimha Rao V Vanga, Srinivas Kumar Chandrabhatla

1. Assistant Professor, Department of Dental Surgery, Rangaraya Medical College, Kakinada, Andhra Pradesh, India. 2. Professor and Head, Department of Paediatric Dentistry, GITAM Dental College, Visakhapatnam, Andhra Pradesh, India. 3. Professor, Department of Paediatric Dentistry, GITAM Dental College, Visakhapatnam, Andhra Pradesh, India.

Correspondence Address :
Dr. Usha Kiran Vudata,
Department of Paediatric Dentistry, GITAM Dental College, Visakhapatnam-530045, Andhra Pradesh, India.
E-mail: ushadrkiran@gmail.com

Abstract

Introduction: Malocclusion profoundly impacts a child’s emotional well-being and affects an individual’s quality of life. Early identification improves the chances of organising preventive and interceptive treatment to limit the intensity of developmental aberrations. The data for malocclusion among children of Visakhapatnam is lacking.

Aim: To study and evaluate the prevalence of malocclusion and ascertain gender dimorphism among six and nine-year-old school-going children of Visakhapatnam

Materials and Methods: A cross-sectional, double-stage sample study was conducted among 616 school-going children of Visakhapatnam, Andhra Pradesh, India, by a single calibrated examiner using a modified Index for Preventive and Interceptive Orthodontic Needs (IPION). IBM Statistical Package for the Social Sciences (SPSS), version 25.0, was used to analyse data and Pearson’s Chi-square test to elicit gender differences in the prevalence of malocclusion traits.

Results: Prevalence among six-year-old children: interproximal caries-38.4%, premature tooth loss-10.1%, supernumerary teeth-0.3%, upper molar rotation-0.3%, lower molar tipping-2%, anterior crossbite-2.7%, posterior crossbite-0.7%, overjet more than 3 mm-5.1%, overbite more than 2/3rd-8.4%, open bite-2%, incompetent lips-13.8%. Prevalence among nine-year-old children: interproximal caries-49.5%, premature tooth loss-8.8%, active frenum-2.8%, supernumerary teeth-0.6%, diastema-3.4%, upper molar rotation-2.2%, lower molar tipping-5%, impended eruption of first permanent molar-1.3%, overjet more than 3 mm-11%, overbite more than 2/3rd-12.5%, open bite-2.2%, anterior crossbite-8.2%, posterior crossbite tendency-3.1%, Class I-75.6%, Class II-18.8%, Class III (functional shift)-0.6%, Class III (no functional shift)-3.76%, incompetent lips-16.3%.

Conclusion: Children from both cohorts demonstrated malocclusion traits. The nine-year-old group had greater prevalence for all components examined except premature tooth loss. No statistically significant gender dimorphism was found in both cohorts.

Keywords

Diastema, Open bite, Overbite, Supernumerary, Tooth loss

According to Edward H Angle, in studying a case of malocclusion, give no thought to the methods of treatment or appliances until the case shall have been classified and if, all peculiarities and variations from the normal in type, occlusion, and facial lines have been thoroughly comprehended, then the requirements and proper plan of treatment become apparent (1).

Early orthodontic treatment is conceivably easy to perform, consumes less time, and is pocket friendly. Such interceptive measures may not always lead to a final result but do contribute to a considerable lessening of further orthodontic treatment need in children (2). The clinical guidelines by the American Academy of Paediatric Dentistry (AAPD) also draw attention to the fact that ‘early diagnosis and successful treatment of the developing malocclusion can have both short-term and long-term benefits along with functional harmony and dentofacial aesthetics’ (3).

Globally, malocclusion ranges between 39-98% (4),(5),(6),(7). India has an estimated 20-43% of children (4) demonstrating malocclusion and 31.4% (7) of them are from the southern macro-region. Children aged 4-6 years particularly, had a high prevalence of overjet and overbite (81.6% and 84.5%, respectively) (5), with a majority of them showing deviations like lower anterior crowding, crossbites, open bite, and pseudo-Class III during the early mixed dentition (6).

Establishing credible evaluation methods for malocclusion is a difficult and daunting task (8). Though several indices have been developed to organise malocclusion into relevant groups, none of them ensure an all-inclusive criterion (9). Some of these indices like the Dental Aesthetic Index (DAI), Index of Orthodontic Treatment Need (IOTN), and Index of Complexity Outcome and Need (ICON) include a subjective method (9) to evaluate malocclusion, but studies [10,11] have shown that parents and patients cannot efficiently assess such subjective traits at an early age and may not comprehend their long-term implications. Trained clinicians can diagnose these problems and intercept or prevent most of them.

The IPION is a valid, quick, and easy-to-use tool that permits early detection of malocclusion with minimal subjectivity (12),(13),(14). It is the sole index that records malocclusion traits specifically in children aged six and nine years (12). These cohorts are important in dentofacial development because the age of six years marks the beginning of mixed dentition and the age of nine years heralds the eruption of the canine-premolar group of teeth. So, these age groups benefit the most from early orthodontic interventions (15).

There has been a particularly growing interest and an increasing demand for orthodontic services (15). Though studies [3-5] have reported malocclusion among Indian children using various indices, such data is lacking in this geographic region for children in mixed dentition. Therefore, the present study was undertaken to ascertain malocclusion among six and nine-year-old school children using IPION. The null hypothesis was that school-going children aged six and nine years did not have malocclusion traits and the alternate hypothesis was that these children did demonstrate such characteristics. Hence, the present study aimed to study the prevalence of malocclusion among school-going children of Visakhapatnam, Andhra Pradesh, India, aged six and nine years and also, to determine gender dimorphism for the examined malocclusion traits for both age groups.

Material and Methods

A cross-sectional double-stage sample study was conducted among six and nine-year-old school-going children of Visakhapatnam, Andhra Pradesh, India, for 15 months (December 2018 to February 2020). The study was approved by the Institutional Ethical Committee.

Sample size calculation: The sample size was calculated based on the formula (Daniel 1999) n=Z2P(1-P)/d2 {confidence level (Z)=95%, expected prevalence (P)=0.05, and, the margin of (d)=5%} (16). As there was no previously reported data regarding malocclusion among the target population, the probability was set at 50% and the minimum sample size of 384 was arrived at. Using the two-stage stratified random sampling method, 24 schools representing all the constituency areas of Visakhapatnam were selected in the first stage. In stage two, children aged six years (5.9-7 years) and nine years (8.6-9.6 years) (8) were chosen from the selected schools. Permission and informed consent were obtained from the concerned school authorities and parents. Following universal precautions and infection control procedures based on the World Health Organisation (WHO) Oral Survey Basic Methods (17) and abiding by the World Medical Association (WMA) Declaration of Helsinki, a single, calibrated examiner conducted the study.

Inclusion criteria: Children aged six and nine years enrolled in the schools of Visakhapatnam were included in the study.

Exclusion criteria:

• Children of ages other than six and nine years enrolled in the schools of Visakhapatnam.
• From the age groups of six and nine years, children who were not willing to participate in the study, children who were undergoing orthodontic treatment at the time of the study, and children with congenital craniofacial abnormalities, were excluded from the study.

Study Procedure

The IPION screens children in their mixed dentition and determines the need for preventive and interceptive orthodontic treatment need (12),(13),(14),(18). The components examined for both cohorts are listed in (Table/Fig 1). Children were called out based on the roll call of their respective classes and were made to rinse their mouths before the examination. They were examined at their school premises in well-lit classrooms or corridors (Table/Fig 2),(Table/Fig 3) using a mouth mirror and an explorer (Type 3 examination) (17).

Originally, Coetzee CE and de Muelenaere KR used a custom-built plastic IPION ruler for measuring the malocclusion traits (13). In the present study, while all components were examined and evaluated based on the IPION criteria, two of them were modified (evaluation of upper molar rotation and lower molar tipping) for ease of clinical application. Following the premature loss of a 61maxillary primary molar, rotation of the upper permanent molar from the same quadrant was ascertained when an imaginary line extending between the distobuccal cusp and mesiolingual cusp of the maxillary first permanent molar crossed distal to the contact point of contralateral primary first and second molars. Disposable wooden spatulas (19) were used to create this imaginary line in the maxillary arch of the child’s oral cavity (Table/Fig 4). Following premature loss of a mandibular primary molar, tipping of the lower first permanent molar of the same quadrant was evaluated. A metal scale was modified to measure an acute angulation of 15o (Table/Fig 5). The metal scales were used as: a) They could be easily/accurately modified from a conventional metal scale to reflect the 15° inclination; b) They could be easily cleaned and sterilised after each survey day; c) Would not break or have wear-and-tear during the long survey period of the current study. This scale was held parallel to the gingival margins of the mandibular teeth in that quadrant and when the long axis of the mandibular first permanent molar was inclined more than 15o mesially, it was recorded as a tipped mandibular first permanent molar (Table/Fig 6). After examination, scores were recorded on a separate datasheet for each child. At the end of each survey day, the final score for each child was calculated and the data was transferred to separate Excel sheets for both cohorts (Microsoft® excel® 2019 MSO, version 2211). The sample selection and distribution has been given in (Table/Fig 7).

Statistical Analysis

Once the survey was completed, data was analysed using IBM SPSS. Armonk, NY: IBM Corp; 2017 version 25.0, for computation of prevalence rate of the recorded malocclusion traits in both age groups. Pearson’s Chi-square test (significant if p<0.05) was used to evaluate gender differences. Additionally, Mann-Whitney U test was used to compare means of the variables. Wilcoxon W-test and z-test were used to compare the group means (significant, if p<0.05). All applicable Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines were adhered to (20).

Results

A total of 616 children {297 children from the six-year-old group (male-168 children, female-129 children) and 319 children from the nine-year-old group (male-160 children, female-159 children)-(Table/Fig 7)} were evaluated during this study. Children from both cohorts demonstrated malocclusion and therefore, the null hypothesis was rejected. The study results are tabulated in (Table/Fig 8),(Table/Fig 9). The observations from (Table/Fig 8) reflect that the examined six-year-old children demonstrated a particular prevalence for the primary component (interproximal caries-38.4%, and early tooth loss-10.1%) and the soft tissue components of IPION (lip incompetency-13.9%) along with overjet (5.1%) and overbite (8.5%). Supernumerary teeth (0.3% and crossbites (anterior crossbite-2.7% and posterior crossbite-0.7%) were also noted. The observations from (Table/Fig 9) show that approximately half of the examined nine-year-old children (49.5%) had interproximal caries, 7.2% had an anterior crossbite, 3.1% showed a posterior crossbite and 1.3% of them had impended eruption of first permanent molar. The older group of children also demonstrated an increased prevalence for all the examined components except for early tooth loss. (Table/Fig 10) shows the comparative prevalence of malocclusion traits between the six and nine-year-old. No statistically significant gender dimorphism was seen in both cohorts (p-value >0.05).

Discussion

Early identification of malocclusion improves the chances of organising preventive and interceptive treatments (7). Recording metric parameters during mixed dentition stages aids to differentiate between conditions that self-correct and a few others that may progress into serious functional and physical handicaps (21). Characteristics like overjet, overbite, and crossbites can be rectified with simple methods and reduce the need for further treatment (15).

Interproximal caries and premature loss of primary teeth were evaluated in both cohorts. Proximal caries compromises arch circumference and may jeopardise the space available for succedaneous teeth (3),(11),(22). Chewing efficiency is directly proportional to the number of occlusal contact areas and influences masticatory performance. The ensuing deviations in muscular activity lead to variations in arch growth and verticle jaw dimensions (22). Similarly, early loss of one or more primary teeth results in an estimated three-fold increase in orthodontic treatment need (1).

The current study found that the primary mandibular first molar most frequently demonstrated interproximal caries in both cohorts, similar to the findings by Rapeepattana S et al., and Tungaraza JP et al., [14,18]. The tooth lost early was the primary maxillary first molar in the six-year-old group and the primary mandibular second molar in the nine-year-old group. Karaiskos N et al., (23) reported similar results for the six-year-old group and in the nine-year-old group, the results match the findings of studies from Philadelphia, Thailand, and Tanzania (Table/Fig 11) (12),(14),(15),(18),(23),(24).

Approximately, 1/3rd of the primary dentition with a supernumerary tooth demonstrate one such tooth in their permanent dentition too and in about 2% of the population, maxillary incisors are impacted or ectopically erupted due to a supernumerary tooth (3). Such teeth may also hinder normal eruption of the succedaneous teeth, cause over-retention of deciduous teeth, root deflection, tooth displacement, diastema, aberrant root resorption, or cystic lesions. The findings of the current study (Table/Fig 12) are at par with the global prevalence of 0.3-0.8% in the primary dentition and 0.52% to 2% in the mixed dentition (6),(12),(14),(15),(25),(26),(27),(28).

A diastema of 2 mm is a common finding in children (26%) and shows spontaneous closure. But a diastema of more than 2 mm may not close spontaneously and is seen in about 6% of adolescents and adults (1),(3) with a global prevalence ranging from 12.2-38.18% (12),(14),(25). The current study found it to be 3.4% in the nine-year-old group (girls-0.9%, boys-2.5%). This greater prevalence among boys as compared to girls is in agreement with Babler-Zeltmann S et al., but in contradiction to studies in the Indian population (25),(26),(27). A thick, abnormal labial frenum could be an aetiological factor for midline diastema. The prevalence of an active labial frenum in the nine-year-old children of the current study are similar to the findings by Rauten AM et al., (15).

Literature mentions several methods to assess upper molar rotation like plaster models (29), photocopies of plaster models (29), and panoramic and lateral cephalograms (30). For lower molar tipping, techniques like plaster models (29), and panoramic radiographs (30) have been used. In the present study, a novel modification was used for an easier clinical appraisal (detailed in methodology). The nine-year-old children demonstrated an increased prevalence for both these parameters. This could be due to the time elapsed after premature loss and also the lack of space management interventions. Furthermore, the effects of premature loss of primary second molars could be different at the ages of 6, 7, and 8 years (31). Haider Z reported an upper molar rotation of 7.41% and lower molar tipping of 9.26% in nine-year-old children (12). The higher prevalence reported by Rapeepattana S et al., (upper molar rotation-13.7%, lower molar tipping-23.1%) could be due to the greater incidence of interproximal caries (91.6%) and premature loss of primary second molar (24.5%) in that study population (14).

Impended eruption of first permanent molars was seen in 1.3% of nine-year-old children of the current study. Babler-Zeltmann S et al., reported delayed eruption of the first permanent molar in 1.4% of nine-year-old children (25), while Arathi R et al., reported delayed eruption of all first permanent molars in a nine-year-old female child (32). Crossbites may alter skeletal growth pattern, compromise arch perimeter, damage periodontal tissues, and lead to temporomandibular disorder or pseudo-Class III. As age increases, differential diagnosis becomes difficult and treatment outcomes are less favourable (31). Early detection and management are vital because lesser than 10% of functional crossbites are self-correcting (3). Globally, anterior crossbites range from 2.2-30.7% (13),(15),(18),(24),(25),(33) and posterior crossbites from 4.3-17% in children aged 6-10 years [13,14,34]. The higher prevalence of crossbites observed in older group children was in agreement with studies in this region of India (4),(5) and reiterates the importance of early identification of any developing malocclusion (Table/Fig 13) (5),(6),(8),(14),(15),(18),(24),(25),(33),(34),(35).

An overjet of more than 8 mm increases the prevalence of traumatic dental injuries by about 40% (3). While digit sucking and pacifier use increase the chances of anterior open bite (3),(31), a deep overbite may cause eustachian tube dysfunction (36). Keski-Nisula K et al., attributed an anterior open bite of 4.6% among children aged 4-7.8 years to the significantly greater use of pacifiers (33). Olatokunbo da Costa O et al., found an overjet of 44.6% among six and 12-year-old children and attributed it to the greater incidence of digit sucking among those children (34). The global prevalence of overjet and the relation of anterior teeth in the verticle direction (overbite and open bite) differs based on the demographics of the region (Table/Fig 14) (4),(5),(8),(14),(18),(24),(26),(33),(34),(35),(37). The findings from the current study are comparable to results by Ibrahim MM in age-matched children (24).

An ideal occlusion during childhood results in an ideal occlusion during adulthood. Class I interdigitation is the most desirable occlusion with normal skeletal, soft tissue profile and favorable sagittal relationship. Class II demonstrates a convex profile and Class III shows excessive mandibular growth. Some features which can influence the dental arch status in mid-adolescent stage can be easily recognised during transitional dentition (1). Results from the current study and other studies for anteroposterior molar relation are listed in (Table/Fig 15) (5),(6),(15),(24),(27),(37).

Equilibrium between intraoral and extraoral muscles influences the developing dentition and affects tooth eruption. Incompetent lips predispose the maxillary incisors to traumatic dental injury (31) and alter the jaw posture at rest, leading to variation in lip-tongue equilibrium and altered occlusal forces (11). The findings of the present study for the prevalence of lip incompetency (Table/Fig 16) are in agreement with other studies among 6 to 11-year-old children (14),(18),(34). The higher prevalence (43.6%) found among 6- and 12-year-old Nigerian children (34) could be due to the greater incidence of deleterious oral habits found in them.

The findings of the present study highlight the need to evaluate children in their early stages of growth and follow them till the completion of growth. This enables the application of preventive and interceptive methods to avert or minimise any developing malocclusion identified among the population of this region. This is the first study conducted in India to examine malocclusion characteristics and evaluate treatment needs among children in their mixed dentition using IPION. Of all the studies done worldwide using this index, the present study has examined and reported all the components of IPION that reflect a developing malocclusion in children. Such evaluation aids in patient and parent education. The data from the present study contributes to establishing a baseline for further longitudinal studies, evaluation of causative factors of malocclusion, and planning and implementation of any preventive and interceptive treatment methods necessary.

Limitation(s)

Radiographic evaluation (for detection of supernumerary and unerupted permanent teeth) and appraisal of deleterious oral habits (to ascertain the causes of some of the malocclusion characteristics) were not done in the present study.

Conclusion

Both cohorts demonstrated malocclusion and no gender dimorphism was detected. Nearly half of the nine-year-old children had interproximal caries and about 1.3% had impended eruption of first permanent molars. Mandibular teeth showed greater premature loss compared to the maxillary teeth in both age groups. Crossbites and supernumerary teeth were also detected which mandate action as and when detected. The nine-year-old children showed greater prevalence for all the examined components except premature tooth loss. This emphasises the importance of early detection of any developing malocclusion characteristics. The novel modifications of IPION to evaluate molar rotation and tipping are easier to use clinically. Conclusively, the present study reflects the malocclusion status in the examined cohorts and signifies the need for preventive and interceptive orthodontic treatments among them.

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DOI and Others

DOI: 10.7860/JCDR/2023/60457.18120

Date of Submission: Sep 28, 2022
Date of Peer Review: Nov 30, 2022
Date of Acceptance: Jan 25, 2023
Date of Publishing: Jun 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Sep 29, 2022
• Manual Googling: Jan 19, 2023
• iThenticate Software: Jan 24, 2023 (2%)

ETYMOLOGY: Author Origin

EMENDATIONS: 7

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