2020, Number 4
Prevalence of malocclusions in patients of the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM. 2019
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ABSTRACT
Introduction: the WHO considers malocclusions a public health problem occupying third place in frequency among oral cavity affections. The Oral Health Brigades Programme of the Faculty of Dentistry, UNAM provides care to the most vulnerable populations in Mexico. Objective: determine the prevalence of malocclusions in patients aged 6 to 18 years who are treated in the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM, in the states of Tabasco, Queretaro and Chihuahua during the year 2019. Material and methods: a cross-sectional study was carried out in 244 patients aged 6 to 18 years; a clinical history and physical examination were taken with prior informed consent. Results: according to molar class, 119 (48.77%) patients presented class I on the right side, 56 (22.95%) class II and 37 (15.16%) class III. On the left side 126 (51.64%) had class I, 45 (18.44%) class II and 39 (15.98%) class III. Regarding pernicious habits, the most frequent were found to be tongue thrust with 85.25% (208), followed by chewing objects with 59.84% (146), onychophagia with 54.10% (132), lip sucking with 43.85% (107), mouth breathing with 36.89% (90). Conclusions: the prevalence of malocclusions was presented equally in the three states of Mexico. It is important to eliminate pernicious habits and start treatment at an early age.INTRODUCTION
The Oral Health Brigades Programme of the Faculty of Dentistry of the UNAM (National Autonomous University of Mexico) provides attention to the most vulnerable populations of Mexico, due to the fact that these populations have difficulty in obtaining access to health services. Malocclusions are part of the problems identified in these brigades, as they are a public health problem, occupying third place in frequency among oral diseases, preceded only by cavities and periodontal (gum) disease according to the WHO.1 Malocclusions have a multifactorial origin, being the result of a combination of environmental factors, which act during the growth and development of the face, as well as genetic factors, which are inherited, and specific factors, such as teratogens.
The classification of occlusion, which is still used today, was described by Dr. Edward H. Angle in 1899, where he postulates that the maxillary first molar of the second dentition is fundamental in occlusion. This is because during mandibular protrusion and retrusion movements it is the one that remains fixed, while the mandibular first permanent molar is the one that modifies its position.
In this way he described the ideal occlusion where the mesiovestibular cusp of the upper first permanent molar occludes in the vestibular sulcus of the lower permanent first molar and the teeth are aligned in a uniformly curved occlusion.2 Another classification is proposed by Mateu3 who classifies malocclusions according to the size of the maxillae into micrognathism and macrognathism.
In the sagittal or anteroposterior direction, Angle's classification is structured as follows:
- • Class I: neutrocclusion, with the mesiobuccal cusp of the upper first permanent molar occluding in the mesiobuccal groove of the lower first permanent molar and the anterior sector is compromised with different variants.3-5
- • Class II: distoclusion, where the lower first permanent molar is distal to the upper first permanent molar. It is divided into: division 1, characterised by an increased overjet and upper incisors proclination; and division 2, where the overjet is decreased and the crowns of the upper incisors are in retrusion. In both cases there may be either left or right subdivision, but it will not indicate that distoclusion is present only on the side mentioned.6
- • Class III: mesioclusion, where the lower first permanent molar is located mesial to the upper one, it can also present right or left subdivision.4,6
In the vertical direction we find:
- • Open bite: is the alteration where the upper and lower dental organs do not contact each other, causing a separation between the maxilla and mandible.7
- • Deep bite: refers to a state of increased vertical overbite.8
The most studied factors that form malocclusions are: the presence of parafunctional habits, premature tooth loss and loss of space caused by dental cavities or inadequate restorations. Reduced or lack of hygiene measures are an important factor for the development of dental caries and periodontal disease, which are considered an aetiological factor for malocclusions, due to the loss of space within the dental arch.
The aim of the study was to determine the prevalence of dental malocclusions in children and adolescents between 6 and 18 years of age, who were treated in the Oral Health Brigades Programme of the Faculty of Dentistry of the UNAM, in the states of Tabasco, Queretaro and Chihuahua during the 2019 school year.
MATERIAL AND METHODS
An analytical cross-sectional study was carried out in 244 patients of both sexes in the age range of 6 to 18 years old, who were treated during the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM, and who agreed to participate. The locations and populations were randomly selected.
The following data were collected by means of the clinical history: sociodemographic data, oral hygiene measures, Angle's classification for mixed dentition, secondary dentition and terminal planes in primary dentition, as well as pernicious oral habits related to malocclusions.
A clinical examination was performed, with prior informed consent of the parents or guardians. Patients who did not wait for the examination, those under six years of age and those over 18 years of age at the time of questioning were eliminated. The data were collected in special formats for subsequent analysis with the statistical programme Stata 13©.
RESULTS
The sample consisted of a total of 244 patients, 128 (52.46%) were male and 116 (47.54%) were female, aged 6 to 18 years.
From the total number of patients, 243 were born within Mexico and one woman was from Texas. There were 98 patients from the state of Tabasco (47 men and 51 women), 2 from Quintana Roo (1 man and 1 woman), 3 from Mexico City (2 men and 1 woman), 100 patients from Queretaro (54 men and 46 women), 7 from Guanajuato (3 men and 4 women), 1 woman from Michoacan, and 3 from the State of Mexico (1 man and 2 women), 27 patients from Chihuahua (18 men and 9 women), and 2 men from Nuevo Leon.
Patients were checked whether they had a health service or not, of whom 23 reported not having Social Security (9.43%); of the remaining 221 patients, 53 were affiliated to ISSSTE (21.72%), 14 to IMSS (5.73%), 1 to SEDENA (0.40%), 147 to Seguro Popular (60.24%) and 6 to another type of service (2.45%). A total of 93.03% (227) of the patients reported to be healthy. On the other hand, the main diseases presented were: 2 with diabetes (0.81%), 6 with asthma (2.4%), 1 with Moebius syndrome (0.40%) and 8 reported having another disease or condition (3.2%) (allergic rhinitis, planovalgus foot deformity, drug allergy, spastic quadriparesis, hyperactivity and psychomotor disability).
Regarding the hygiene habits of the patients reviewed, the majority of patients (108) reported brushing their teeth twice a day, while 13 patients indicated that they do not brush their teeth daily, because they do it occasionally or "when they remember". In addition, 93.8% (229) do not floss, with no significant difference between men and women.
From the total of 244 patients, the terminal plane on the right side could be evaluated in 30 patients, of whom 18 had a flush terminal plane and 12 mesial step. No patient had exaggerated mesial step or distal step. In the remaining 214 patients the terminal plane could not be assessed. In the data obtained for the terminal plane on the left side, 31 patients could be evaluated and 213 were non-assessable. There was a record of 17 patients with a flush terminal plane and 14 with a mesial step, as on the right side, there was no record of exaggerated mesial step or distal step (Table 1).
Using Angle's classification on the right side, the results for mixed and permanent dentition showed that there were 32 patients where the dentition was non-assessable, due to a loss of the first molar or absence of the first molar due to age at eruption; 119 patients (48.77%) presented class I molar, 56 (22.95%) class II and 37 (15.16%) class III. While on the left side 34 were non-assessable, 126 (51.64%) had class I, 45 (18.44%) class II and 39 (15.98%) class III (Table 2).
In the analysis of the aetiological factors of malocclusion, 60.25% (147) of the patients surveyed had or had had childhood caries, so they may have suffered premature extraction or decreased arch length.
Concerning pernicious habits, the most frequent were tongue thrust with 85.25% (208), followed by object biting with 59.84% (146), onychophagia with 54. 10% (132), lip sucking with 43.85% (107), mouth breathing with 36.89% (90), prolonged pacifier-sucking or nursing bottle with 32.79% (80), dental trauma with 18.44% (45) and finally digital sucking with 13.93% (34). In none of the habits mentioned was there any significant difference in occurrence by sex (Figure 1).
Table 3 describes the position of the anterior and posterior sectors of the maxillae, finding that in the anterior sector open bite was the most frequent with 31.97% (78), followed by sector without alteration with 27.46% (67), edge to edge bite 20.49% (50), overbite/overjet 17.21% (42) and finally crossbite 2.46% (6), one patient was recorded as non-assessable due to the presence of the upper incisors. In the posterior sector it was found that the majority of patients had no malocclusion 91.80% (224), followed by crossbite with 6.97% (17) and finally open bite with 1.23%.
The results on crowding (Table 4), it was found that 51.23% of the crowding was more frequent only in the anterior sector, while only 2.05% was in the anterior and posterior sectors; and 26.64% presented diastemas in the anterior sector and 1.64% in the posterior sector.
DISCUSSION
The study was carried out as part of the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM, which allowed us to learn about the oral health situation of vulnerable populations in the states of Tabasco, Queretaro and Chihuahua, while at the same time bringing us closer to the situation throughout Mexico, where there is a high prevalence of malocclusions and where the aetiological factors that cause them can be detected.
We found that our results coincided with those obtained by Tokunaga,9 Talley et al.,10 and Murrieta,11 in terms of molar classification; class I is the most frequent, followed by class II and finally class III, without finding statistically significant differences between sex, age and socioeconomic level.
In contrast to the study conducted by Aamodt12 in a Mayan population in Chiapas, where Angle's class II was found to be the most frequent, followed by class III and class I. In the Tabasco region of Nacajuca, where the population is of Chontal Mayan origin, we found different results.
In the study carried out by Reyes4 in the city of Puebla in the infant population, a higher prevalence of class II malocclusion was found with 52.5%, followed by class III and class I malocclusion, and an association was found between gender and malocclusion, in contrast to our study where no relationship was found between gender and malocclusion.
On the other hand, Mendoza13 mentions that tongue interposition is the most common pernicious habit in the population, which coincides with our results, and the habits that follow in frequency appear in a very similar order to our study. This indicates that there is a constant development of these habits, and therefore, it is important to take the necessary measures to reduce the appearance of pernicious habits and thus reduce the prevalence of malocclusions. This indicates that there is a constant development of these habits, and therefore, it is important to take the necessary measures to reduce the appearance of harmful habits and thus reduce the prevalence of malocclusions. Furthermore, it also mentions that open bite is the most frequent alteration of the anterior sector, as in our study, followed by anterior crowding. Similarly, Mendoza found that the mesial step was the most frequent,13 while in our results we found that the flush terminal plane was the most frequent. For the secondary dentition, he mentions that class I is the most frequent,13 as in our results, and in both cases it is found that the patients have a tendency towards Angle class I.
In the study carried out by Silva,14 it was found that overbite was the most frequent alteration and the least observed was posterior crossbite, while in our study it was found that open bite was the most frequent in the anterior sector and crossbite in the posterior sector due to the pernicious habits that originate such malocclusions.
Most of the studies carried out in the Mexican population agree that no statistically significant differences are found between age, sex and malocclusions, and our study was no exception.
CONCLUSIONS
With regard to the class molar and pernicious habits of the populations analysed, we found that the results coincide with other studies also carried out in Mexican populations, without finding any relationship between age and sex with the prevalence of malocclusions.
There are communities in Mexico where access to health services is difficult, and where there is a high prevalence of malocclusions and diseases of the oral cavity. It is thanks to projects such as the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM, that these populations have an option for oral health care. In addition, an important part of dental treatment is to identify any of the aetiological factors of malocclusions in order to provide mainly preventive treatment at an early age.
ACKNOWLEDGEMENTS
I thank the Oral Health Brigades Programme of the Faculty of Dentistry, UNAM, and DDS Juan Carlos Rodríguez Avilés for their support and facilities for this study.
REFERENCES
WHO Expert Committee on Dental Health & World Health Organization. Normas para la notificación de enfermedades y alteraciones dentales: informe de un Comité de Expertos en Higiene Dental [se reunió en Ginebra del 14 al 20 de noviembre de 1961] [Internet]. Organización Mundial de la Salud; 1962 [consultado 22 marzo 2022]. Disponible en: https://apps.who.int/iris/handle/10665/38245
AFFILIATIONS
1 Cirujana dentista egresada. Facultad de Odontología de la Universidad Nacional Autónoma de México. México.
2 Profesora del Departamento de Ortodoncia. Facultad de Odontología de la Universidad Nacional Autónoma de México. México.
CORRESPONDENCE
Kenya Isabel Montes de Oca Suárez. E-mail: kenya.mdos@gmail.comReceived: Junio 2020. Accepted: Mayo 2022.