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 Table of Contents  
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 57-60

Orthodontic treatment needs in primary school children of Udhampur, India

1 CMDC (SC), Pune, Maharashtra, India
2 Command Military Dental Centre, INHS Sanjivani, Kochi, Kerala, India

Date of Submission31-Jan-2022
Date of Acceptance15-Feb-2022
Date of Web Publication05-Apr-2022

Correspondence Address:
Vineet Sharma
Commandant and Command Dental Advisor (SC), CMDC (SC), PO Wanworie, Pune - 411 040, Maharashtra
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jodd.jodd_5_22

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Objective: Early detection of developing malocclusions and its subsequent management with relatively low cost and uncomplicated orthodontic treatment procedures has the potential to minimize future costly and complicated treatment. The present study was aimed to assess the potential for this approach in children having access to orthodontic care at no cost by the government.
Methods: Each child was independently assessed by an experienced examiner for multiple components of his or her occlusion, including molar relationship, overbite, overjet, open bite, deep bite, and crossbite. DEFT scores were also noted. Informed consent was obtained and all 738 children of ages 7–11 years present at school on the day of the field study were included.
Results: A DEFT score of 1655 (2.24%), potential crowding in 471 (63.82%), retained deciduous teeth in 25 (3.38%), anterior crossbite in 32 (6.79%), and posterior crossbite in 13 (2.76%) was observed.
Conclusions: Most of the developing malocclusions identified in this study would be managed with simple, relatively low-cost interceptive orthodontics, consisting of space maintenance, crossbite correction, and arch expansion.

Keywords: Interceptive, orthodontic treatment need, preventive

How to cite this article:
Sharma V, Vishwaroop. Orthodontic treatment needs in primary school children of Udhampur, India. J Dent Def Sect. 2022;16:57-60

How to cite this URL:
Sharma V, Vishwaroop. Orthodontic treatment needs in primary school children of Udhampur, India. J Dent Def Sect. [serial online] 2022 [cited 2022 Nov 29];16:57-60. Available from: http://www.journaldds.org/text.asp?2022/16/1/57/342649

  Introduction Top

The epidemiological status of malocclusion in a population is imperative for appropriately planned provisioning of orthodontic care in a community. Dental malocclusions are known to exhibit the third-highest prevalence among all known oral pathologies. Dental caries and periodontal disease are ranked above malocclusion among dental public health priorities worldwide.[1]

Preventive orthodontics entails professional interventions that encourage the development of normal occlusion and also aids in the prevention of malocclusion. Once a malocclusion has developed, interceptive orthodontics involves professional interventions to restore occlusion back to normal.[2] Malocclusions are an important public health issue[3] as they are amenable to prevention or interception in most cases. A simple, accurate approach for diagnosing or quantifying the degree of malocclusion is required to detect a developing malocclusion.

In terms of economy of orthodontic screenings, the cost of screening children was significantly cheaper than cost of treatment undertaken in the correction of fully developed malocclusion.[4] Early detection of developing malocclusions and its subsequent management with relatively low cost and uncomplicated orthodontic treatment procedures has the potential to minimize future costly and complicated treatment. In view of this, it was deemed useful to conduct research on orthodontic treatment needs of schoolchildren aged 7–11 years of a government-supported school, in children having access to orthodontic care at no cost by the government.

The present study was to ascertain the prevalence of malocclusion that would be amenable to interceptive and interceptive orthodontic management in 7–11-year-old schoolchildren from the Primary Section of Army Public School at Udhampur. These children were planned to be taken up for follow-up treatment at a government tertiary care dental establishment at no cost to the patients.

  Methods Top

This study had the approval of the institutional ethical committee. Written informed consent was obtained from parents of all children between the ages of 7–11 years old studying in the aforementioned school. Inclusion criteria were age in completed years between 7 and 11 years, parental consent, present on the day of screening and no history of previous orthodontic therapy.

An experienced orthodontist examined each child. Examiner training and calibration were performed using sample study models and the examiner was assessed by a very senior orthodontist.

Infection control protocols as outlined by the Center for Disease Control and Prevention were implemented.[5] All children were examined in an upright position on a chair using disposable mouth mirror, probe, and plastic ruler. Radiographs were not taken due to ethical concerns.

  Results Top

Parental consent was obtained from 784 students between the ages of 7 and 11 years, however, only 738 children present at school on the day of the field study were included in the study.

The Decayed Extracted Filled Teeth (DEFT) score of 1655 (2.24%), potential crowding in 471 (63.82%) children, retained deciduous teeth in 25 (3.38%) children, anterior crossbite in 32 (6.79%) children, and posterior crossbite in 13 (2.76%) children was observed [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5].
Figure 1: Caries with space loss

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Figure 2: Retained deciduous tooth

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Figure 3: Potential crowding

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Figure 4: Anterior crossbite

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Figure 5: Posterior crossbite

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  Discussion Top

There are very few recent studies dealing with preventive and interceptive orthodontics in India.[6],[7],[8] These studies have concluded that:

  1. There is a need to increase awareness for educating people about the benefits of early orthodontic treatment[6]
  2. Preventive and interceptive orthodontic treatment in public dental health-care program is extremely important[7]
  3. A very small percentage of children requiring interceptive orthodontic treatment were willing to accept any treatment, which shows the lack of awareness for early orthodontic treatment.[8]

Early tooth loss could develop into a space shortage due to drift of teeth into the leftover space. Loss of space can be easily managed by using appropriate appliances for maintenance.[9] It was disheartening to observe that none of the children with premature tooth loss in the present study used any appliance for space maintenance. Parents are likely to ignore premature tooth loss in their children for a multitude of causes. They may believe that the permanent tooth will erupt soon and replace the lost tooth. In the present study, the economic status of the families being a reason for not seeking treatment was not considered as all the patients had access to a tertiary care dental facility providing orthodontic treatment at no cost.

Crossbites if left untreated may develop into growth problems and skeletal deviations.[10] This is especially evident in functionally induced posterior crossbites. Even in deciduous dentition, these crossbites should be rectified as soon as possible. Early intervention of anterior crossbites is recommended since the upper incisor may traumatically occlude with the lower incisor, compromising the periodontium causing tooth mobility and fracture of the tooth.[11] In our study, anterior crossbites were observed to be more than twice as frequent as posterior crossbite.

Spontaneous anterior crossbite correction has been recorded in the literature,[10] however, it is rare. Most of these crossbites may be intercepted with success by appropriate usage of removable appliances like the Z-spring appliance.

Early diagnosis and management of developing malocclusion offer a multitude of advantages:

  1. Children during the ages of 7–11 years are often more attentive and cooperative with relatively more time available for treatment due to relatively fewer academic commitments
  2. Early intervention of oral habits such as digit sucking and tongue thrusting which may lead to malocclusion is usually 8 years of age as it simultaneously facilitates the improvement of speech impediments, if any, due to the open bite, which often develops as a result of oral habits. Furthermore, by 8 years of age, the permanent first molars are occluded and fully erupted, thus facilitating good retention of removable appliance therapy at this age.

  Conclusions Top

The prevalence in the present study group of certain variables (caries, premature tooth loss, and crossbite) may lead to the development of malocclusions. This is highly unacceptably in a population having access to orthodontic care at no cost. Thus, it is evident that planning aimed at providing necessary oral health education to the parents of these children and also to ascertain causes, if any, which are impediments to these parents seeking orthodontic treatment must be ascertained and strategies chalked out to overcome the same may be implemented. Most of the developing malformations identified in this study are treated with simple, relatively inexpensive interception corrections that consist of space conservation, crossbite correction, and arch development. The present study demonstrates the need for the implementation of a more robust primary dental health care program for children in the Primary Section of Army Public School.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Brito DI, Dias PF, Gleiser R. Prevalence of malocclusion in children aged 9 to 12 years old in the city of Nova Friburgo, Rio de Janeiro, Brazil. Rev Dent Press Orthodn Ortop Facial 2009;14:118-24.  Back to cited text no. 1
Ricketts RM. Robert M. Ricketts on early treatment: Part 1 and 2. J Clin Orthod 1979;8:23-8.  Back to cited text no. 2
Sheiham A. Guest editorial: The berlin declaration on oral health and oral health services. Quint Int 1993;24:829-31.  Back to cited text no. 3
Hiles AM. Is orthodontic screening of 9-year-old school children cost effective? Br Dent J 1985;159:41-5.  Back to cited text no. 4
Centers for Disease Control and Prevention. Summary of Infection Prevention Practices in Dental Settings: Basic Expectations for Safe Care. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2016. Available form: https://www.cdc.gov/oralhealth/infectioncontrol/pdf/safe-care2.pdf. [Last accessed on 2022 Jan 16].  Back to cited text no. 5
Prabhakar RR, Saravanan R, Karthikeyan MK, Vishnuchandran, Sudeepthi C. Prevalence of malocclusion and need for early orthodontic treatment in children. J Clin Diagn Res 2014;8:ZC60-1.  Back to cited text no. 6
Galui S, Pal S. Early orthodontic treatment needs among 6-9-year-old children of West Bengal. J Oral Res Rev 2021;13:12-7.  Back to cited text no. 7
  [Full text]  
Ilankizhai RJ, Jessy P, Madhulaxmi M. Parental acceptance towards interceptive orthodontic treatment in children – A retrospective study. J Complement Med Res 2020;11:102-110 [doi: 10.5455/jcmr. 2020.11.04.13].  Back to cited text no. 8
Proffitt WR. Treatment planning for preadolescents (early mixed dentition). In: Contemporary Orthodontics. 6th ed. St. Louis, Mo: Elsevier/Mosby 2019.p. 356-88.  Back to cited text no. 9
Faber RD. The differential diagnosis and treatment of crossbites. Dent Clin North Am 1981;25:53-68.  Back to cited text no. 10
Richardson A. Interceptive orthodontics in general dental practice. Part I Early interceptive treatment. Br Dent J 1982;152:85-9.  Back to cited text no. 11


  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]


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