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Year : 2014  |  Volume : 5  |  Issue : 4  |  Page : 224-229

The prevalence of malocclusion and its gender distribution among Indian school children: An epidemiological survey

Department of Orthodontics, Vokkaligara Sangha Dental College and Hospital, Bangalore, Karnataka, India

Date of Web Publication20-Nov-2014

Correspondence Address:
Roopa Siddegowda
Santhrupthi Nilaya, #415, 7th Cross, Mahadeshwara Extension,Mysore - 570 016, Karnataka
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0976-433X.145118

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Context: Since antiquity malocclusion is a problem. People have different perception about the problem which varies according to their geographical location and cultural background. The problem of malocclusion is more severe in developing countries like India. It can compromise the oral health tissues and can lead to social and the psychological problems. Aims: To assess the prevalence of malocclusion and its gender distribution among the Indian school children. Settings and Design: School settings and Descriptive cross-sectional survey. Materials and Methods: A cross-sectional epidemiological survey was conducted in all the 30 districts of Karnataka, India. School children in the age group of 10-16 years were the target population. Population proportionate technique was employed for the sample size estimation. A total sample of 9505 was randomly selected from 102 schools all over Karnataka, India. Ackermann-Proffit classification of malocclusion was used to record the malocclusion. Statistical analysis used: Simple Descriptive statistics. Results and Conclusion: Prevalence of crowding is 50.4% in boys and 51.4% in girls. Cross-bite was reported in 17.8% and 18.3% in boys and girls, respectively. Angles class I malocclusion was reported in 78.4% of boys and 80.2% of girls. Angles class II malocclusion was reported in 21.5% of boys and 19.8% of girls and class III malocclusion was observed in 0.1% of boys.

Keywords: Ackermann - profit system, boys, girls, Indian school children, malocclusion, prevalence

How to cite this article:
Siddegowda R, Satish RM. The prevalence of malocclusion and its gender distribution among Indian school children: An epidemiological survey. SRM J Res Dent Sci 2014;5:224-9

How to cite this URL:
Siddegowda R, Satish RM. The prevalence of malocclusion and its gender distribution among Indian school children: An epidemiological survey. SRM J Res Dent Sci [serial online] 2014 [cited 2023 Mar 31];5:224-9. Available from:

  Introduction Top

At all social levels, well-aligned teeth and a pleasing smile reflects positive status, and irregular or protruding teeth reflects negative status. [1],[2] In majority, balanced facial feature is considered to be pleasing to the eye in each race and sex. [3] Malocclusion can be defined as an occlusion in which there is mal-relationship between the arches in any of the three planes or anomalies in tooth position beyond normal limits. If a malocclusion is identified early, simple, preventive and interceptive measures can alleviate a developing malocclusion. The incidence of various categories of malocclusion in a particular population is necessary to provide a basis for planning preventive and interceptive orthodontics. The recognition of malocclusion as an important problem in the public dental health services for children implies a need for rational planning of preventive and therapeutic orthodontic measures.

The main oral diseases should be subjected to periodic epidemiological surveys according to the World Health Organization. The prevalence of malocclusion has been found to vary in different countries, ranging from 88.1% in Colombia, [4] 62.4% in Saudi Arabia, [5] 20-35% in United States [6] and 20-43% in India. [7] It is necessary to carry out epidemiologic studies of malocclusion in all regions and from different geographic areas. Analysis of the prevalence rates of malocclusion in such groups may also contribute to an understanding of the causes of malocclusion. [8] Good documentation is valuable from an epidemiologic standpoint because it describes the range of occlusal variations within the community in which orthodontic treatment may be undertaken. With this background we undertook a survey to assess the prevalence of malocclusion and its gender distribution among the Indian school children.

Objective of the study

To assess the prevalence of malocclusion and its gender distribution among the Indian school children.

  Materials and methods Top

Karnataka is a vast state in India constituting 30 districts. The state covers an area of 191,976 square kilometers (74,122 sq mi), or 5.83% of the total geographical area of India. The population is diverse and consists of various ethnic groups. Karnataka is one of the major states of South India and ninth largest state in India in terms of Population.

This was a cross-sectional epidemiological survey conducted with a prior permission from the Ministry of Higher Primary and Secondary Education Board of Karnataka, India. The survey was carried out in selected schools in all the district head quarters. Children in the age group of 10-16 years were included in the study and constituted the study population. Population proportionate technique was employed for sample size estimation. According to the population census 2011, the total population in Karnataka is 6, 11, 30,704, out of which 10-16 years old children constituted 29% (According to National Family Health Survey-2, India {1998-99}, child population in the age group of 10-16 years was taken as a reference). The estimated sample size was 9505. In the first stage of sampling, list of schools was obtained by the Karnataka Higher Primary and Secondary Education Board. A total of 102 schools were randomly selected and were surveyed during the year 2012. All children in the age group of 10-16 years, from the selected schools in each district all over Karnataka and children who obtained written informed consent from parents to participate in the study were included. Exclusion criteria used were-history of previous orthodontic treatment, rampant caries, multiple missing teeth, mutilated malocclusion and other craniofacial anomalies like cleft lip and palate, facial hemiatropy, cleidocranial dysplasia, etc.

Ethical clearance to conduct the survey was obtained from the Institutional Review Board (Vokkaligara Sangha Dental College and Hospital). Prior permission to conduct the survey was taken from the concerned school authorities.

The oral examination was done by an Orthodontist in day light using mouth mirror and dental probe. The observations were recorded in the assessment form and later transferred to the PC by three trained experts. Ackermann-Proffit [9] classification of malocclusion was used to record the malocclusion. The Dental Health check-up was done for the remaining children and an oral health education lecture was given to all the children in the school to create awareness about Dental health and Orthodontic treatment.

Ackermann-proffit system of classification of Malocclusion

The description of the criteria in each of these categories are as follows:

1. Alignment -

i. Midline -

0- -Midlines coinciding,

1- < half the lower incisor width,

2- > half the lower incisor width.

ii. Spacing -

0- Absent,

1- Midline diastema,

2- Anterior spacing ,

3- Generalized spacing

iii. Crowding -

0- Absent,

1- Anterior crowding [a] Mild ,[b] Moderate, [c] Severe,

2- Posterior crowding

iv. Protrusion of teeth-

0- Absent

1- Protrusion of upper teeth,

2- Protrusion of lower teeth,

3- Protrusion of both upper and lower teeth

v. Retrusion of teeth-

0- Absent

1- Retrusion of upper teeth,

2- Retrusion of lower teeth,

3- Retrusion of both upper and lower teeth.

2. Skeletal deviations -

1. Profile-

1- Straight profile,

2- Anterior divergent,

3- Posterior divergent,

4- Convex profile,

5- Concave profile

3. Transverse deviation-

Crossbite -

0-No crossbite,

1- Single tooth crossbite,

2- Two or more teeth crossbite,

3- Anterior teeth crossbite,

4- Posterior Unilateral crossbite,

5- Posterior Bilateral crossbite

4. Anteroposterior deviations-

i. Molar relation-

1- Class I,

2- Class II [a] div1 [b] div2 [c]subdivision

3- Class III [a]sub division

ii. Overjet-

1-Normal overjet[1-3 mm]

2-Moderate overjet[3-5 mm]

3- Increased overjet[> 6 mm]

4- Reduced overjet[< 1 mm]

5- Reverse overjet

5. Vertical deviations-

i. Overbite-

1- 1/3 rd of lower incisor overlap

2- 2/3 rd of lower incisor overlap

3- Completely locked lower incisors

4- Edge to edge bite

ii. Openbite-

0-Openbite absent

1- Open bite < 2 mm

2- Open bite > 4 mm

Statistical analysis

Data were coded and entered into excel sheet. To maintain the data quality (validity) rechecking and cross checking was done during data entry phase. Later, data were transferred into SPSS windows version 16, where cleaning, coding, recording, crosschecking, processing and analysis of the data were done.

  Results Top

Descriptive statistics for the distribution of occlusal traits of the total sample were presented using frequencies and percentages. The gender distribution is presented in [Table 1].
Table 1: Gender distribution of the sample

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Section1: Alignment discrepancies.

34.3% of boys and 32.4% of girls had midline discrepancy as shown in [Table 2]. Midline diastema was observed in 6% of boys and 6.3 % of girls [Table 3]. Mild to moderate crowding was observed in 36.7% boys and 36.7% of girls and severe crowding was reported in 6.4% and 7.2% in boys and girls respectively as shown in [Table 4]. Protrusion of both upper and lower teeth was observed in 28.2% of boys and 28.5% in girls [Table 5]. Retrusion of upper and lower teeth were 11.7% and 11.3% in boys and girls, respectively [Table 6].
Table 2: Frequency of midline deviations according to gender

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Table 3: Frequency of spacing discrepancy

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Table 4: Frequency of crowding

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Table 5: Frequency of protrusion of teeth

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Table 6: Frequency of retrusion of teeth

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Section 2: Antero-posterior deviations

The prevalence of Angle Class I, Class II and Class III molar relations were 78.4%, 21.5% and 0.1% boys. In girls, 80.2%, 19.8% and 0% were the prevalence of Class I, Class II and Class III molar relations respectively as shown in [Table 7]. Increased over-jet was observed in 27.4% of boys and 26.4% of girls as shown in [Table 8].
Table 7: Distribution of Angles molar relation

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Table 8: Frequency of over-jet

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Section 3: Transverse discrepancy

Cross-bite was reported in 17.8% of boys and 18.3% of girls as shown in [Table 9].
Table 9: Frequency of cross-bite

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Section 4: Vertical discrepancy

Increased overbite was reported in 54.4 % of boys and 56.4% of girls as represented in [Table 10]. Open-bite of 3.2% in boys and 2.9% in girls was observed [Table 11].
Table 10: Frequency of over-bite

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Table 11: Frequency of open-bite

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Section 4: Skeletal deviations

68.9% of convex profile and 0.6% of concave profile was seen in boys. 64.7% and 0.5% were the convex and concave profile respectively in girls which is represented in [Table 12].
Table 12: Distribution of profile

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  Discussion Top

There are numerous studies [10],[11],[12] published describing the prevalence of malocclusion and its different types. But some authors [13],[14] found many difficulties to compare these findings because of the great variability of methods and indices used by one examiner and another to record occlusal relationships. Distribution of different type of malocclusion may show great variability even in a population of same origin. [15]

In our study, boys presented with high number of class II and class III malocclusion which is in correspondence to the results of Onyeaso et al. [12] who reported that males were found to have significantly more of classes II and III molar relationships than females. The most important single factor that has influenced extreme of variation in prevalence of malocclusion is differences in methodology in recording the traits of malocclusion.

Our survey included children of 10-16 years age group of which reported the gender distribution of malocclusion. Ackermann-Proffit classification of malocclusion was used to record the severity of malocclusion which is not generally used in prevalence studies. This classification overcomes the limitations of the Angle system. Malocclusion is recorded in all the three planes of space (i.e, sagittal, transverse and vertical planes).

  Conclusion Top

The following conclusions were drawn from the present survey.

  1. The prevalence of malocclusion in boys was 50.4% of crowding, 6% of midline diastema, 17.8% of cross-bite, 27.4% of increased overjet and 56.4% of deepbite.
  2. The prevalence of malocclusion in girls 51.4% of crowding, 5.2% of midline diastema, 6.3% of cross-bite, 27.4% of increased overjet and 56.4% of deepbite.

We thank the school authorities and the children for their cooperation in conducting the survey.[16]

  References Top

Shaw WC. The influence of children′s dentofacial appearance on their social attractiveness as judged by peers and lay adults. Am J Orthod 1981;79:399-415.  Back to cited text no. 1
Shaw WC, Rees G, Dawe M, Charles CR. The influence of dentofacial appearance on the social attractiveness of young adults. Am J Orthod 1985;87:21-6.  Back to cited text no. 2
Bravo LA. Soft tissue facial profile changes after orthodontic treatment with four premolars extracted. Angle Orthod 1994;64: 31-42.   Back to cited text no. 3
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.   Back to cited text no. 4
al-Emran S1, Wisth PJ, Böe OE. Prevalence of malocclusion and need for othodontic treament in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:253-5.  Back to cited text no. 5
Proffit WR, Fields HW Jr, Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: Estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg 1998;13:97-106.   Back to cited text no. 6
Shivakumar KM, Chandu GN, Subba Reddy VV, Shafiulla MD. Prevalence of malocclusion and orthodontic treatment needs among middle school and high school children in Davangere city, India using Dental Aesthetic Index. J Indian Soc Pedod Prev Dent 2009;27:211-8.  Back to cited text no. 7
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Helm S. Malocclusion in Danish children with adolescent dentition: An epidemiologic study. Am J Orthod 1968;54:352-66.  Back to cited text no. 8
Ackerman JL, Proffit WR. The characteristics of malocclusion: A modern approach to classification and diagnosis. Am J Orthod 1969;56:443-54.  Back to cited text no. 9
Baume LJ. Uniform methods for the epidemiologic assessment of malocclusion: Results obtained with the World Health Organization standard methods (1962 and 1971) in South Pacific populations. Am J Orthod 1974;66:251-72.  Back to cited text no. 10
Bezronkow. Basic method for recording occlusal traits. Bull World Health Organ 1979;57:955-61.  Back to cited text no. 11
Tang EL, Wei SH. Recording and measuring malocclusion: A review of the literature. Am J Orthod Dentofacial Orthop 1993;103:344-51.  Back to cited text no. 12
Grainger RM. Orthodontic treatment priority index. Washington: US Public Health Service, 1968. Publication No 1000-Series 2, No 25. Washington, DC: National Center for Health Statistics; 1967.  Back to cited text no. 13
Salzman JA. Handicapping malocclusion assessment to establish treatment priority. Am J Orthod 1968;54:749-65.  Back to cited text no. 14
Sayin MO, Türkkahraman H. Malocclusion and crowding in an orthodontically referred turkish population. Angle Orthod 2004;74:635-9.  Back to cited text no. 15
Onyeaso CO, Aderinokun GA, Arowojolu MO. The pattern of malocclusion among orthodontic patients seen in Dental Centre, University College Hospital, Ibadan, Nigeria. Afr J Med Med Sci 2002;31:207-11.  Back to cited text no. 16


  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12]

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