IAJPS 2019, 06 (08), 14520-14526 Amra Minhas Abid et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN: 2349-7750

INDO AMERICAN JOURNAL OF PHARMACEUTICAL SCIENCES

Available online at: http://www.iajps.com Research Article

EVALUATION OF ORTHODONTIC STATUS AND TREATMENT NEED IN PATIENTS REPORTING TO ORTHODONTIC DEPARTMENT OF KRL GENERAL HOSPITAL, ISLAMABAD: AN EPIDEMIOLOGICAL STUDY USING DENTAL AESTHETIC INDEX (DAI) 1Dr Amra Minhas Abid, 2Dr. Mariya Mujib, 3Dr. Sultan Abdul Haseeb 1Consultant Orthodontic /Assistant Professor /HOD Orthodontics Department KRL Hospital, 2Third Year Postgraduate FCPS Trainee Orthodontics KRL Hospital, 3Intern, Orthodontics Department. Article Received: June 2019 Accepted: July 2019 Published: August 2019 Abstract: Objective: The study was done to evaluate the malocclusion status and its impact on aesthetics, using the DAI to assess the treatment need in patients reporting to Dental Department of KRL Hospital Islamabad. Study Design: Retrospective, Descriptive, and cross sectional. Place and Duration: The study was carried out in the Dental Department of KRL Hospital, Islamabad. Material and Methods: Using the Dental Aesthetics Index (DAI) to observe and quantify the occlusal characteristics and to designate the extent of malocclusion. The data was analyzed using Statistical Package for Social Sciences Software for Windows version 22.0 (SPSS Inc, Chicago, III). Results: There were a total of 120 individuals included in the study for which the descriptive stats showed that 51 need minor treatment, 22 lie in the moderate treatment need category, 21 in severe treatment need and 26 in very severe treatment need categories. One-way ANOVA was conducted between the groups divided on the basis of DAI Scores i.e. Minor Treatment Need, Moderate Treatment Need, Severe Treatment Need and Very Severe Treatment Need. The one-way ANOVA results were then assigned group wise to determine whether the treatment need is significant or not. It was determined that all categories fell under the result of insignificant need for treatment. Conclusion: In conclusion, we can determine that the DAI is an important index in the prevention, intervention, and treatment planning of the orthodontic problems on a very nascent level. This makes it an important tool for diagnostic purposes in the Pakistani population. It is efficient and descriptive in its scoring methodology and ease of use. Corresponding author: Dr. Amra Minhas Abid, QR code Consultant Orthodontic /Assistant Professor / HOD Orthodontics Department KRL Hospital.

Please cite this article in press Amra Minhas Abid et al., Cytotoxicity And Antibacterial Activity Of The 70%Ethanolic Extract Of The Stem Bark Of Piptadeniastrum Africanum Hook (Fabaceae)., Indo Am. J. P. Sci, 2019; 06(08).

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IAJPS 2019, 06 (08), 1-7 Amra Minhas Abid et al ISSN 2349-7750

INTRODUCTION: ease of use. It was established by Cons et al in 1986 Primarily most patients who seek orthodontic that encompasses various aspects of treating treatment do it for aesthetic purposes. The purpose of malocclusion on a holistic level 6-9. Its universality orthodontic treatment is to focus on occlusion and is determined by how commonly it is used now. function as well, besides just aesthetics.1 The reason aesthetics are an important deciding factor in The DAI is a score based analytical index which initiation of orthodontic treatment is because of the takes aesthetics, occlusion and clinical observations social and psychological factors associated 3 with and quantifies them according to different scores. For aesthetic distortion due to these, the aesthetics are determined according to the malocclusion. Malocclusion is defined as the social norms, and the occlusion according to Angle’s disorientation of teeth from the normal. Various classification of malocclusion7-8. Upon completion indices exist to find out the deviation of occlusion of the evaluation of the patient according to the DAI, from standard in order to help orthodontists in the total scores are calculated according to the degree reaching a substantial treatment goal. These indices of severity. A score of 25 or less designates a need help with the assessment of malocclusion, and for either no treatment, or minor treatment 3. A score categorizing it on the basis of treatment needed. Of between 26 to 30 implies an elective treatment might all the indices that have come to be accepted, the be requires 4. For scores between 31-35, treatment Dental Aesthetic Index (DAI) 5 is the most becomes highly desirable. For scores of 36 and commonly used index, and is adopted by the World above, treatment becomes essential. Health Organization (WHO) due to its simplicity and

Table 1

Due to the convenience of the DAI in the diagnosis of malocclusion and its indexing, the DAI can be Aims and Objectives: used in primary and secondary care hospitals in third The study was conducted in Orthodontics world countries like Pakistan, following the referral Department of KRL Hospital . The study design was of the patient to either a tertiary care hospital with retrospective and we were to evaluate the Orthodontic facilities, or an independently practicing malocclusion severity levels, their distribution, and orthodontist 9. Thus, the purpose of the study was to their treatment needs. evaluate the malocclusion status and its impact on Our specific objectives were aesthetics, assed using the DAI. The research was done on the orthodontic status and treatment need in 1. To determine the extent of malocclusion. patients reporting to Dental Department of KRL 2. To determine what patients come under the Hospital Islamabad. umbrella of treatment need. 3. To evaluate need-based orthodontic www.iajps.com Page 14521

IAJPS 2019, 06 (08), 1-7 Amra Minhas Abid et al ISSN 2349-7750

treatment on the basis of DAI. just one segment, and two was assigned to spacing in two or more than two segments. A score for 4 was Purpose of the study: assigned to midline diastema, having a weightage of Pakistan’s annual budget allocation for healthcare is 3. The fifth and sixth components of DIA correspond not enough to cover the basic healthcare needs of to misalignment in the anterior segment of maxillary patients who are dependent on government facilitated and mandibular dentition respectively. This healthcare. Factoring dental treatment into this, on a component is assigned a score of 1. The seventh and primary healthcare level, most of the patients eighth portion of the DAI respectively deal with requiring dental treatment are deprived of facilities to overjet in the maxillary segment having a score of even diagnose malocclusion. Thus, we conducted this two and mandibular segment having a score of 4. The study to see the prevalence of malocclusion and how ninth component consists of anterior open bite with a DAI is a universally accepted diagnostic index which measuring score of 4. The tenth component uses can be used even in rural areas because of its Angle’s classification of molar relationship to simplicity and ease of use. determine the scores. If the molar relationship is normal then we assign a score of 0. A score of 1 MATERIAL AND METHOD: designates half cusp Class II or Class III, whereas 2 Study Design: signifies full cusp Class II or Class III. Our study design was descriptive, retrospective, and cross-sectional. The scores of all these components were tabulated and multiplied by previously assigned weightage as Sample: per the DAI and a constant was added to get to the The sample size was calculated using the WHO final DAI score of each study model. calculator. According to our reference articles the population proportion of the patients seeking Statistical Analysis: treatment was calculated as 0.72 with a precision of We used Statistical Package for Social Sciences 10% and level of significance was set at 5%. Software for Windows version 22.0 (SPSS Inc, According to this, minimum sample size required to Chicago, III) for our studies by inputting the data we test our hypothesis should be more than 80. So we had collected and comparing it to the DAI. took a sample size of 120 patients – randomly selected from the outpatient department of KRL The data that we gained was evaluated for descriptive Hospital’s Orthodontic Unit of Dental Department. statistics like percentage frequencies of qualitative The age range in the sample size of the patients was and quantitative variables. Mean, standard deviation, between 12 to 70 years. and frequencies were calculated for all the DAI scores. Each DAI component was compared using Method: the one-way ANOVA test. A value of P less than We used the Dental Aesthetics Index to analyze the 0.05 was considered as the significant level. occlusal characteristics and to weigh the extent of malocclusion by using study casts. DAI consists of RESULTS: ten occlusal traits for assessing and quantification of Out of total 120 individuals that were included in the malocclusion. The first step is to observe the number study, the descriptive stats showed that 51 individuals of missing teeth in the casts. This was given a score fall into the category of minor treatment need, 22 in of 6. The second component of DAI was to evaluate the moderate treatment need, 21 in severe treatment crowding in the anterior/incisal segment which was need and 26 in very severe treatment need; according assigned a score of 1. After that, spacing was to the DAI scoring criteria, as shown in in Table 1 inspected in the incisal segment which was scored as below. 0 having no spacing, 1 designating a lone space in Table 2

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IAJPS 2019, 06 (08), 1-7 Amra Minhas Abid et al ISSN 2349-7750

According to our study, the individuals needing treatment had a minimum age of 31 and a maximum minor treatment ranged from a minimum age of 8 to of 35, with the mean being 32.5. The patients with a maximum of 25, having a mean of 17.4. Those very severe treatment need ranged from the minimum patients who needed moderate treatment fell under age of 37 to 46, with a mean of 40.8 of all the the range of minimum being 26 to a maximum of 30, subjects included in our study, the age ranged with a mean of 28. The category needing severe between twelve to seventy, with a mean of 40.35.

Table 3

Gender wise distribution of our study showed that in of ±1.5. Men who fell under the severe treatment men, the number of males who needed no or minor need category were 15 in number, having a mean age treatment were 30 with a mean of 17 and a Standard of 32.3 and a SD of ±1.44. The 18 males who were Deviation (SD) of ±4.5. Those 16 men who needed categorized as having severe treatment need had a moderate treatment had a mean age of 27.8 with a SD mean age of 40.9, with a SD of ±3.1.

Table 4

One-way ANOVA was conducted between the The one-way ANOVA results were then assigned groups divided on the basis of DAI Scores i.e. Minor group wise to determine whether the treatment need Treatment Need, Moderate Treatment Need, Severe is significant or not. Treatment Need and Very Severe Treatment Need.

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IAJPS 2019, 06 (08), 1-7 Amra Minhas Abid et al ISSN 2349-7750

Table 5

In the Minor Treatment Need Group, there was scoring makes it easy to interpret the requirement of an insignificance for treatment reported [F (1, 49) = orthodontic treatment if the patient is referred to 0.370, p = 0.546]. Similarly, in the group that orthodontic specialist from a primary care or required Moderate Treatment, the one-way ANOVA secondary care system15. showed that there was also an insignificance in the requirement for treatment [F (1, 20) = 1.399, p = The advantages of using DAI as the index of choice 0.251]. The results for the group with Severe is because of its convenience, however it is unable to Treatment Need also showed an insignificance in express the malocclusion traits such as crossbite, treatment requisite [F (1, 19) = 0.876, p = 0.361]. open bite, midline shift and deep over bite. Along Conclusively, the results for Very Severe Treatment with that DAI measurements are calculated using a Need group also showed particular insignificance in millimeter scale which can account for minor errors the results to determine treatment need [F (1, 24) = of precision 17. DAI Scores are mainly used as 0.023, p = 0.881]. excellent predictors of future orthodontic treatment receipt 19. DISCUSSION: The appearance of patient is a prominent factor in An important aspect for defining a gold standard deciding the need for orthodontic treatment. index lies in its proper assessment capabilities. There Therefore, various indices have been proposed to are two general ways to define a panel for obtaining evaluate and quantify the aesthetic needs to help the gold standard index - either Likert scale method or by orthodontist to classify the extent of malocclusion 10. consensus method 22. These methods determine a Index of Orthodontic Treatment Need (IOTN) is one solid index. However, one of the drawbacks of the of the indices that is predominantly used, but it does DAI is that it relies heavily on the perceived aesthetic not take into consideration the aesthetic need of the standards among the patients. Thus the more the patient. On the other hand, DAI does incorporate that, variance in the opinion of the demographic and assesses it to produce a score to determine the population of the subject, the more there is a variance treatment need. This enables the DAI to create in the scoring using DAI 21. However, it has been boundaries at which the treatment level is determined determined that the DAI scoring has generally 12.* A score of 36 is considered to be the cut-off captured the mainstream and universal perception of point at which the malocclusion is deemed aesthetics, making it a reliable tool to quantify debilitating or not. treatment need as perceived by the patients.

The DAI is considered as a more feasible index to In Pakistan, we see that many children with severe incorporate into treatment planning because of the malocclusion do not have proper access to fact that it is an easier index to use 11. It is numeric orthodontic treatment. With the passing of time, the in its description of treatment need designation. It general population is becoming more aware of what factors in the malocclusion traits such as constitutes orthodontic treatment and the number of morphology, aesthetics and function. It does not persons seeking orthodontic treatment is increasing require the use of radiographic imaging to formulate 20. This increase in the demand of orthodontic a treatment plan, making it an index of choice for treatment is not corresponding with the ease of early dental care primary care setups, especially in third orthodontic diagnosis and intervention available to world countries like Pakistan. Furthermore, the the general and rural population 18. We know that www.iajps.com Page 14524

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with orthodontic issues, prevention can only help so personal dental appearance among Turkish much and is not much affective in eliminating the university students. The European Journal of problem. Interceptive orthodontics is an option that Orthodontics. 2009 Jan 6;31(2):168-73. can help the patient control the malocclusion without 5. Jenny J, Cons NC. Comparing and contrasting the need for a later treatment 14. This can help in the two orthodontic indices, the Index of competent treatment of skeletal and non-skeletal Orthodontic Treatment Need and the Dental orthodontic concerns. Aesthetic Index. American journal of orthodontics and dentofacial orthopedics. 1996 Various studies have shown that using the DAI 2, it is Oct 1;110(4):410-6. seen that younger children have a higher need of 6. Brook PH, Shaw WC. The development of an orthodontic treatment than older patients 13.This index of orthodontic treatment priority. The shows us that DAI can play an interceptive role in European Journal of Orthodontics. 1989 Aug providing orthodontic treatment if we factor in the 1;11(3):309-20. patient’s chronological age. 7. Bernabé E, Flores-Mir C. Orthodontic treatment need in Peruvian young adults evaluated through In conclusion, we can determine that the DAI is an dental aesthetic index. The Angle Orthodontist. important index in the prevention, intervention, and 2006 May;76(3):417-21. treatment planning of the orthodontic problems on a 8. Pérez MA, Neira Á, Alfaro J, Aguilera J, Alvear very nascent level 16-20. This makes it an important P, Fierro Monti C. Orthodontic treatment needs tool for diagnostic purposes in the Pakistani according to the dental aesthetic index in 12- population. It is efficient and descriptive in its year-old adolescents, Chile. Revista Facultad de scoring methodology and ease of use. Odontología Universidad de Antioquia. 2014 Dec;26(1):33-43. CONCLUSION: 9. Ashari A, Mohamed AM. Relationship of the The treatment needs of the patients reporting to the Dental Aesthetic Index to the oral health-related Orthodontincs Department of KRL, General Hospital, quality of life. The Angle Orthodontist. 2015 Islamabad were almost equally distributed according May 27;86(2):337-42. the the four groups mentioned in the DAI. The extent 10. Cardoso CF, Drummond AF, Lages E, Pretti H, of treatment need was basically characterized by Ferreira EF, Abreu MH. The dental aesthetic extent of crowding, midline diastemas, increased index and dental health component of the index overjet, open bite tendency and anterior crossbites. of orthodontic treatment need as tools in According to our study DAI has served as a gold epidemiological studies. International journal of standard for designating the malocclusion traits thus environmental research and public health. 2011 objectifying their specific treatment. The decision to Aug;8(8):3277-86. find the exact cut-off points that will determine the 11. Twigge E, Roberts RM, Jamieson L, Dreyer treatment extent are can be obtained precisely CW, Sampson WJ. The psycho-social impact of through the DAI. malocclusions and treatment expectations of adolescent orthodontic patients. European REFERENCES: journal of orthodontics. 2015 Dec 26;38(6):593- 1. Goyal S, Goyal S, Muhigana A. Assessment of 601. malocclusion severity levels and orthodontic 12. Cosyn J, Thoma DS, Hämmerle CH, De Bruyn treatment needs using the Dental Aesthetic Index H. Esthetic assessments in implant dentistry: (DAI): A retrospective study. Rwa Med J. 2013 objective and subjective criteria for clinicians Sep;70(3):20-7. and patients. Periodontology 2000. 2017 2. Shrestha RM, Lamichhane B, Sharma AK, Feb;73(1):193-202. Shrestha S. Dental Aesthetic Index among 13. Øzhayat EB. Responsiveness of the prosthetic Nepalese Orthodontic Patients. Orthodontic esthetic scale. Clinical oral investigations. 2017 Journal of Nepal. 2015;5(2):9-13. Apr 1;21(3):907-13. 3. Pratiwi AP, Lubis MM. The Relationship of 14. Gupta A. Orthodontic treatment needs of Dental Perception and Orthodontic Treatment children living in orphanage according to Dental Need Based on Dental Aesthetic Index of SMA Aesthetic Index (DAI). J Dent Health Oral Negeri 15 Medan Student. InInternational Dental Disord Ther. 2015;2(1):00036. Conference of Sumatera Utara 2017 (IDCSU 15. Almeida AB, Leite IC, Melgaço CA, Marques 2017) 2018 Feb 7. Atlantis Press. LS. Dissatisfaction with dentofacial appearance 4. Hamamci N, Başaran G, Uysal E. Dental and the normative need for orthodontic Aesthetic Index scores and perception of treatment: determinant factors. Dental press www.iajps.com Page 14525

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