Assessment of early orthodontic treatment need and its associated factors among Tanzanian children using ipion-index

Abstract

ABSTRACT Background Early orthodontic treatment aims to identifying and intervening occlusal conditions occurring in the primary and early mixed dentition. This treatment is effective and desirable when the correction of malocclusions in young patient is requested, where a stable result may be achievable, less extraction of permanent teeth may be needed, the duration of orthodontic treatment in permanent dentition may be reduced and future costly treatment need may be eliminated. Thus, this study identified EOT need which is pivotal for organizing and planning preventive orthodontic services and care in Tanzanian children. Aim The aim of this study was to assess early orthodontic treatment need and its associated factors among children in Dar es salaam, Tanzania. Methodology This was an analytical cross sectional study, in which primary and nursery school children aged 6 and 9 years from Kinondoni Municipality, in Dar es Salaam were involved. About 720 school children were expected to participate in the study, after being selected by multistage cluster sampling technique. Data collection was done using a questionnaire for obtaining demographic characteristics. A clinical examination form was used for recording occlusal traits and other oral health problems in order to obtain the IPION-scores. Data was coded and analyzed using a computer software, SPSS version 20.0. Frequency distributions of demographic characteristics and various clinical variables were generated. Chi-square and logistic regression models were used to test for statistically significant differences between two variables in bivariate analysis of need for EOT (dependent variable) and factors associated with the need for EOT (independent variables e.g. socio-demographic factors) and in multivariate analysis for interactions between multiple variables, respectively. The p-value for statistical significance was set at p<0.05 and the confidence interval (CI) was at 95%.

Results A total of 667 children (59.5% girls; 52.5% 9-year-olds) were able to participate in the study. Most children had carious teeth (age 6 years, 77.9% and age 9 years, 60%). The most common prematurely lost teeth were the lower second primary molars (these were affected in 6% of 6-year-olds and 4.9% of 9-year-olds). The most commonly recorded occlusal anomaly in both ages was an increased overjet (recorded in 18.9% of 6-year-olds and 34.9% of 9-year-olds). Active frenum was the commonest functional characteristic, found in 16.9% of the 9-year-olds. The overall early orthodontic treatment need per IPION index was 41.7%. Regarding the relationship between socio-demographic characteristics and orthodontic treatment need per IPION index, significantly many 9-year-old boys needed treatment than girls in both ages (in the 6-years, boys 78.3% vs girls 66.5%; p-value 0.024 and in the 9-years, boys 70.5% vs girls 58.7%; p-value 0.030). Following logistic regression model; caries (OR 50.5, CI 13.3-192.4; p<0.001), premature loss of primary teeth (OR 4.5; CI 1.8-11.2; p<0.001), anterior crossbite (OR 5.3, CI 1.6-17.5; p<0.05) and anterior open bite (OR 27.2, CI 5.3-139.8; p<0.001), remained as significant determinants for having a definite treatment need in the 6-year-olds. As for the 9-year-olds; caries (OR 319.9, CI 58.1-1763.4; p<0.001), anterior crossbite (OR 67.6, CI 4.3-1053.1; p<0.05), deep bite (OR 10.3, CI 2.1-51.1; p<0.05), anterior open bite (OR 49.1, CI 8.3-289.9; p<0.001) and lips incompetency (OR 6.2, CI 1.5-25.5; p<0.05), remained as significant determinants for having a definite treatment need. Conclusion Early orthodontic treatment need for malocclusions was high in school children of Kinondoni municipality, Dar es Salaam, Tanzania. Whereby, about half of the participants had a definite EOT need according to the IPION-scores. The factors associated with the overall IPION-score were mainly clinical conditions such as having dental caries, premature loss of primary teeth, anterior crossbite, open bite, deep bite and lip incompetence. The children would thus benefit from preventive and interceptive orthodontic treatment programs.