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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 5  |  Issue : 3  |  Page : 262-267

Self-perception of dental esthetics, malocclusion, and oral health-related quality of life among 13–15-year-old schoolchildren in Bengaluru: A cross-sectional study


1 Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Nellikuzhi, Kerala, India
2 Department of Public Health Dentistry, Government Dental College and Research Institute, Bengaluru, Karnataka, India

Date of Submission31-Dec-2021
Date of Decision24-Jan-2022
Date of Acceptance18-Apr-2022
Date of Web Publication08-Jul-2022

Correspondence Address:
Jesline Merly James
Department of Public Health Dentistry, Indira Gandhi Institute of Dental Sciences, Kothamangalam, Nellikuzhi - 686 691
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_167_21

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  Abstract 


Introduction: Malocclusion is one of the common public health problems worldwide. The study aimed to assess the self-perception of dental esthetics, malocclusion, and oral health-related quality of life (OHRQoL) and to determine the relation between them among 13–15-year-old schoolchildren in Bengaluru. Materials and Methods: In this cross-sectional study, 540 children were selected equally from government, aided, and private schools in Bengaluru. Self-perception of dental esthetics was measured using Oral Aesthetic Subjective Impact Scale (OASIS), whereas malocclusion and OHRQoL were assessed using Dental Aesthetic Index and Oral Health Impact Profile-14 (OHIP-14), respectively. Descriptive and analytical statistics was done using the SPSS 22. Analysis of variance, Kruskal‒Wallis test, and Pearson correlation test were used. P < 0.05 was considered statistically significant. Results: The prevalence of malocclusion was found to be 29.63%. Among schoolchildren, the mean OASIS scores (self-perception) and OHIP-14 scores were 14.62 ± 6.93 and 9.04 ± 8.07, respectively. There was a significant difference among government, aided, and private schoolchildren regarding “definite malocclusion” and mean OHIP scores. Overall, there was a significant weak correlation between the severity of malocclusion and OHIP scores ([r = 0.259], [P = 0.01]) as well as between the severity of malocclusion and OASIS scores ([r = 0. 192], [P = 0.02]). Conclusion: The severity of malocclusion significantly correlated with self-perception of dental esthetics and OHRQoL among schoolchildren. Hence, there is a relation between self-perception of dental esthetics and malocclusion as well as malocclusion and OHRQoL.

Keywords: Dental Aesthetic Index, dental esthetics, malocclusion, oral health-related quality of life, self-perception


How to cite this article:
James JM, Puranik MP, Sowmya K R. Self-perception of dental esthetics, malocclusion, and oral health-related quality of life among 13–15-year-old schoolchildren in Bengaluru: A cross-sectional study. J Nat Sci Med 2022;5:262-7

How to cite this URL:
James JM, Puranik MP, Sowmya K R. Self-perception of dental esthetics, malocclusion, and oral health-related quality of life among 13–15-year-old schoolchildren in Bengaluru: A cross-sectional study. J Nat Sci Med [serial online] 2022 [cited 2022 Aug 17];5:262-7. Available from: https://www.jnsmonline.org/text.asp?2022/5/3/262/350299




  Introduction Top


As most of the intellectual functions depend on perception, it can be accounted as the sixth sense of man.[1] The overall social attention and acceptance, self-esteem, and societal well-being of a person are closely interlinked with esthetics and its personal and social perceptions of the individual.[2] The role of facial esthetics in human communication is very much significant.[3] Irregularities in teeth positions and other malocclusions have a huge impact on the beauty of the smile and quality of life.[4]

Globally, malocclusion stands third among various dental public health problems.[5] It is not accounted as a disease but in a better way expressed as a departure from the norms of esthetics.[6] The etiological factors could be genetic, environmental, or a combination of both along with various local factors.[7] Studies have reported its ill effects on the periodontium and temporomandibular joint.[8] Since it has the potential to regulate form and function, there are chances of impairment of the quality of life of people.[9] Due to its higher prevalence and prevention opportunities, it is considered a public health problem.[10]

It is widely acknowledged that one's failure to satisfy social standards of dental esthetics will generate negative psychosocial outcomes.[11] Malocclusion, in general, impairs beauty and performance, and the services provided by an orthodontist improve one's oral and dental functions.[12] In general, treatment is influenced more by demand than by need.[13]

One of the important motivational factors to seek orthodontic treatment is dental esthetics.[14] In this aspect, the patient's own perception of dental appearance is of utmost importance.[15] Therefore, assessments involving treatment need should render sufficient weightage to esthetic aspects of malocclusion.[16]

Studies have reported the prevalence of malocclusion,[5],[6],[7],[8],[10],[11],[12],[13],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27] its self-perception,[14],[16],[28],[29],[30],[31] and the relationship between malocclusion and oral health-related quality of life (OHRQoL) among children.[19],[20],[27] However, studies assessing the relationship between malocclusion, self-perception of dental esthetics, and OHRQoL in children are scarce. Hence, this study was conducted with an objective to evaluate the relationship between self-perception of dental esthetics, malocclusion, and OHRQoL among 13–15-year-old schoolchildren in Bengaluru. It was hypothesized that there is no relation between self-perception of dental esthetics, malocclusion, and OHRQoL.


  Materials and Methods Top


A cross-sectional study was conducted among 13–15-year-old schoolchildren over a period of 5 months from February 2016 to June 2016 in Bengaluru. A protocol of the intended was submitted to the Institutional Ethical Committee, Government Dental College and Research Institute Bengaluru, India, and the ethical clearance was obtained (GDC/ACM/PG/Ph. D/2015–2016) on December 17, 2015. All the procedures involved in this study adhered to the ethical guidelines of the Declaration of Helsinki. The permission for the study was obtained from the office of the Deputy Director of Public Instructions, Bengaluru. The children were informed about the procedures involved in the study. Voluntary participation was ensured, following which written informed consent and assent were obtained from the parents and children, respectively.

A pilot study was conducted among twenty 13–15 year–old-schoolchildren to assess the feasibility of the study, relevance of the pro forma, and to determine the sample size.

Considering the prevalence of malocclusion (60%), 95% confidence level, and 80% power, the sample size of 512 obtained was rounded off to 540.

The study tools used were the Oral Aesthetic Subjective Impact Scale (OASIS),[31] Dental Aesthetic Index (DAI),[32] and Oral Health Impact Profile-14 (OHIP-14).[33] OASIS is a 5-item closed-ended questionnaire scored on a seven-point Likert scale. DAI determines the severity of malocclusion and treatment needs through the measurement of ten occlusal traits. OHIP-14 is a 14-item closed-ended questionnaire scored on a five-point Likert scale widely used for measuring OHRQoL.

Cross-cultural validation of both questionnaires was performed by means of back-translation method. The questionnaires were translated into the local language (Kannada) and translated back to English by linguistic experts and checked for its agreement. Further, it was assessed for readability and comprehension on a group of twenty children during the pilot study. Necessary corrections and modifications were made. The principal investigator was trained and calibrated in the Department of Public Health Dentistry, GDCRI, Bengaluru. A training and calibration session on the recording of DAI was performed on ten subjects from the outpatient department. The examination was repeated on successive days on the same subjects to determine consistency. The intra-examiner reliability was found to be good (κ =0.85).

List of schools was obtained from the office of the Deputy Director of Public Instructions, Bengaluru. From this, four government, four aided, and four private schools were selected randomly. Forty-five children were selected randomly from each school based on the eligibility criteria to ensure a total participation of 180 each from government, aided, and private schools. Age and gender distributions were maintained equally from each group of schools. Schoolchildren aged 13–15 years with permanent dentition and those who can read, write, and understand Kannada or English were included in the study, whereas those children who were undergoing orthodontic treatment currently or in the past and those with any systemic diseases that may make oral health assessment difficult were excluded from the study.

A specially designed structured pro forma was used to collect the data. It consisted of three parts: the first part included the child's demographic profile and socioeconomic status (Modified Kuppuswamy scale).[34] The second part consisted of OASIS and OHIP-14 scales, and the third part consisted of DAI.

The data were collected from children during school hours. Demographic information and other details were obtained by personal interview. OHIP-14 and OASIS questionnaires were distributed to the participants and instructions were given. Questionnaires were collected back on the same day and checked for its completeness. Oral examination of the children was performed in classrooms on a comfortable chair under natural light by the principal investigator and findings were recorded by a trained assistant.

The armamentarium included: mouth mirror, Community Periodontal Probe (CPI) probe, chip blower, tweezers, kidney trays, gloves, mouth mask, disinfecting solution, cotton, and cotton holders. Sufficient number of autoclaved instruments was taken for the day-to-day examination. Infection control and sterilization measures were observed throughout the study. All possible efforts were made to reduce the incorporation of bias in the study.

The data were entered into a Microsoft Excel sheet. The descriptive and analytical statistics were performed with the Statistical Package for the Social Sciences (SPSS Inc., Chicago, IL, United States) version 22 software. software. Percentages, means, and standard deviations were computed. Statistical tests such as analysis of variance, Kruskal‒Wallis test, and Pearson correlation test were applied between the subgroups. P < 0.05 was considered statistically significant.


  Results Top


The present study included 540 schoolchildren of the age group of 13–15 years in which the participants were distributed equally in all the three age groups gender-wise. Majority of the schoolchildren belonged to lower-middle class.

Most of the schoolchildren chose responses between extreme scores of OASIS scale. Overall, there was a significant difference between the subgroups and for all the questions [Table 1].
Table 1: Mean Oral Aesthetic Subjective Impact Scale scores among schoolchildren

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The prevalence and severity of malocclusion in each subgroup are given in [Table 2]. Overall, there was no significant mean DAI difference between the subgroups.
Table 2: Distribution of schoolchildren according to dentofacial anomalies by the level of severity and treatment needs

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The overall mean OHIP score for schoolchildren was 9.04 ± 8.07. Overall, there was a significant difference in OHIP scores between the subgroups and for most of the questions [Table 3].
Table 3: Mean Oral Health Impact Profile scores among schoolchildren

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OASIS scores increased with an increase in the severity of malocclusion. The highest mean OASIS score was found among very severe/handicapping malocclusion group (mean score = 22.89 ± 3.36). A statistically significant difference was found between OASIS scores and severity of malocclusion in all subgroups except for the severe malocclusion group [Table 4]. Regarding the severity of malocclusion and OASIS scores, significant moderate and weak correlation were observed for overall study population ([r = 0. 474], [P = 0.02]) and with no/minor malocclusion category ([r = 0. 192], [P = 0.02]), respectively.
Table 4: Mean Oral Aesthetic Subjective Impact Scale scores according to the severity of malocclusion among schoolchildren

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As the severity of malocclusion increased, OHIP scores also increased, and the highest mean score was observed among very severe/handicapping malocclusion group (mean score = 31.33 ± 6.45). The difference in OHIP scores was found to be statistically significant between the subgroups for the definitive malocclusion category [Table 5]. With respect to the severity of malocclusion and OHIP scores, there was overall weak significant correlation ([r = 0. 259], [P = 0.01]) as well as with no/minor malocclusion category ([r = 0. 218], [P = 0.03]).
Table 5: Mean Oral Health Impact Profile scores according to the severity of malocclusion among schoolchildren

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  Discussion Top


Studies reported in the literature employing OASIS, DAI, and OHIP-14 are scarce in the literature. Hence, comparisons are made wherever possible.

Many studies have been done in the age groups that ranged from 11 to 35 years and the sample size varied from 50 to 3003.[5],[6],[7],[8],[9],[10],[11],[12],[13],[14],[15],[16],[17],[18],[19],[20],[21],[22],[23],[24],[25],[26],[27] The present study included 540 schoolchildren of 13–15 years in which the participants were distributed equally in all the three age groups in Bengaluru city. In other studies, the participants comprised urban and rural subgroups.[23],[25] The equal number of participants were recruited gender-wise.[17] The difference between subgroups was observed for self-perception of dental esthetics, malocclusion, and OHRQoL which might be attributed to age, gender, and social class.

Increase in OASIS score is indicative of higher self-perception and concern about dental esthetics. For most of the questions, higher mean OASIS scores were found among aided schoolchildren, suggestive of higher perception and concern on dental esthetics and malocclusion. However, studies assessing OASIS in the age group of 13–15 years are lacking.

In the present study, the overall prevalence of malocclusion was about 30%.

The prevalence of no abnormality/minor malocclusion in the literature ranges from 48% to 82.8%.[5],[6],[7],[10],[11],[12],[17],[18],[21],[22],[23],[24],[25] In the present study, nearly 70% of schoolchildren had no abnormality/minor occlusion with no/slight treatment need which is comparable to that in other studies (70.8%).[17]

The prevalence of definite malocclusion ranges from 9.9% to 26%.[5],[6],[7],[10],[11],[12],[17],[18],[21],[22],[23],[24],[25] In the present study, nearly 20% had definite malocclusion with elective treatment needs. The result is comparable to some studies (19.2%–20.4%).[11],[17]

The prevalence of severe malocclusion in the literature ranges from 3.5% to 12.7%.[5],[6],[7],[10],[11],[12],[17],[18],[21],[22],[23],[24],[25],[35],[36] About 6% had severe malocclusion in the current study. The result is comparable to some studies (6.4%–6.5%).[10],[24]

The prevalence of very severe/handicapping malocclusion ranges from 0.5% to 22%.[5],[6],[7],[10],[11],[12],[17],[18],[21],[22],[23],[24],[25],[36] Nearly 4% had very severe/handicapping malocclusion with mandatory treatment need. This is comparable to a study (4.4%).[24],[35]

OHIP score reflects OHRQoL and an increase in OHIP score indicates poor OHRQoL. The mean OHIP score for schoolchildren was 9.04 ± 8.07 and lies between that reported in the literature ([13.74 ± 8.12][19] and [7.42 ± 6.88][20]).

The increase in the severity of malocclusion is associated with an increase in OASIS and OHIP scores. Furthermore, there was a significant weak correlation between the severity of malocclusion and OHIP scores (overall [r = 0.259], [P = 0.02]) which is in line with another study (r = 0.176, P = 0.031).[19] Significant moderate correlation was observed between the severity of malocclusion and OASIS scores ([r = 0. 474], [P = 0.02]).

Thus, the increase in the severity of malocclusion is associated with an increase in OASIS and OHIP scores, suggestive of interrelationship between malocclusion, self-perception, and quality of life.

In this study, it was found that there is a relationship between self-perception of dental esthetics (OASIS) and malocclusion (DAI) as well as malocclusion and OHRQoL (OHIP-14). Hence, the null hypothesis is rejected. Further studies are suggested in other populations in different regions.

However, the study has few limitations. The cross-sectional design and inherent biases in the questionnaire study limit its generalizability. DAI measures almost all the occlusal traits, but it does not consider few anomalies such as posterior crossbite, posterior open bite, midline deviations, or deep bite. Therefore, there can be underestimation of the severity of malocclusion in patients with these dentofacial problems.

For superior uniformity and accuracy, it is better to have a standardized cutoff point for OASIS/OHIP scores. OASIS is a subjective scale with responses only at the extremes of the continuum. This might make it difficult for the respondents to exercise the options appropriately. Hence, further studies are required to assess the applicability of OASIS questionnaire. OHIP is not exclusively meant to measure the oral impacts or the influence of malocclusion. Therefore, there are chances of imprecise reporting of responses as the questionnaire considers all the oral conditions. Hence, the individual and social differences and the resultant responses to the questions might affect the study outcomes.

Individual perceptions change over time and treatment which may be assessed through longitudinal studies. None of the existing quality of life tools measures the impact of malocclusion exclusively. A better tool that measures the impact of malocclusion exclusively should be developed in this regard. As the conditions and factors analyzed in this study vary with ethnicity, the generalizability of the study is limited only to a similar population.


  Conclusion Top


The mean OASIS score and OHIP scores were 14.62 ± 6.93 and 9.04 ± 8.07, respectively. The prevalence of malocclusion was found to be 29.63%. The severity of malocclusion significantly correlated with self-perception of dental esthetics and OHRQoL among schoolchildren.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



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



 

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