Prevalence and Associated Factors for Crossbite Malocclusion in South Indian Subjects - A Retrospective Study
Nor Syakirah binti Shahroom1, Ravindra Kumar Jain2*, Iffat Nasim3
1 Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
2 Associate Professor, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
3 Professor, Department of Conservative Dentistry and Endodontics,, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
*Corresponding Author
Ravindra Kumar Jain,
Associate Professor, Department of Orthodontics, Saveetha Dental College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai 600077, Tamil Nadu, India.
Tel: +919884729660
E-mail: ravindrakumar@saveetha.com
Received: July 30, 2021; Accepted: August 11, 2021; Published: August 18, 2021
Citation:Nor Syakirah binti Shahroom, Ravindra Kumar Jain, Iffat Nasim. Prevalence and Associated Factors for Crossbite Malocclusion in South Indian Subjects - A Retrospective Study. Int J Dentistry Oral Sci. 2021;8(8):4109-4113.doi: dx.doi.org/10.19070/2377-8075-21000839
Copyright: Ravindra Kumar Jain©2021. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution and reproduction in any medium, provided the original author and source are credited.
Abstract
Malocclusion is considered a major public health problem and crossbite is a major orthodontic discrepancy affecting many individuals throughout the world. This may affect the quality of life due to disturbances of oral health and dentofacial aesthetics. A retrospective study was conducted in a University Hospital from July 2019 till March 2020 to assess the prevalence and associated factor for crossbite malocclusion in the South Indian population. Sample sizes of 1017 patients were selected from the case records of patients who reported to the University Hospital for orthodontic treatment. The data variables such as sociodemographic data, presence of crossbite, site of crossbite and presence of class II malocclusion were tabulated and analyzed using SPSS Version 20. Descriptive statistics and Chi-Square tests were performed. A total of 60 records with crossbite were included. The overall prevalence of crossbite in class II malocclusion was 6%. Posterior crossbite was common in males (60%) and females (76%) compared to anterior crossbite. Meanwhile, posterior crossbite was common in class II division 1 (67%) and class II division 2 (60%) than anterior crossbite. However, There was no statistically significant association between gender and malocclusion with crossbite (p>0.05). Thus, it can be concluded that the prevalence of crossbite in class II malocclusion was 6% and no significant difference was seen among gender and malocclusion with site of crossbite.
2.Introduction
3.Conclusion
4.References
Keywords
Crossbite; Fixed Appliance; Malocclusion; Prevalence; Removable Appliance.
Introduction
Crossbite can be defined as an abnormal relationship between one
or more teeth in one arch to the opposing arch in the buccolingual
or labiolingual direction [1]. It is a major orthodontic discrepancy
affecting many individuals in various age ranges. However,
crossbite usually develops during the growing phase of a child
[2]. Interceptive orthodontic treatments are an early intervention
to guide the eruption of teeth and correction of malocclusion
and highly desirable [3]. Crossbite can be divided into anterior or
posterior crossbite.
Anterior crossbite is defined by Salzman as the lingual placement
of maxillary incisors in relation to the opposing mandibular teeth
when both arches are in centric occlusion [4]. It can be further
classified into dentoalveolar, skeletal and functional [5]. Single
tooth crossbite is usually seen in dentoalveolar anterior crossbite
and skeletal crossbite usually seen due to retrognathic maxilla and
prognathic mandible[6]. Functional crossbite is commonly seen
in pseudo-class III malocclusion [6]. Clinically, anterior crossbite
manifests with reverse overjet and premature tooth contact leading
to the displacement of the mandible [7].
Posterior crossbite is defined by Foster as the occlusion of buccal
cusps of the lower teeth outside the arch of the upper teeth
[8]. It may be present as unilateral or bilateral crossbite involving
single or multiple teeth in the functioning occlusal position [9].
The mechanism of posterior crossbite involves shifting of the
mandible to one side where multiple and stable contacts occur,
which results in tooth wear, abnormal growth and development
of teeth and jaws [10]. Crossbite involving canines is considered
as posterior crossbite [11].
Several studies have reported the prevalence of crossbite. In a
study done by Anistotoaei et al, the prevalence of posterior crossbite
was 10.94% [12]. A study on the prevalence of crossbite in
children with sucking habits reported that the tendency to develop
posterior crossbite in the primary dentition is higher for pacifier
suckers than for digit suckers[13]. Anterior and posterior crossbite
in early mixed dentition is believed to be transferred from the
primary to permanent dentition and can have long term effects on
the growth and development of teeth and jaws [14]. Therefore,
interceptive orthodontic treatment is advised to guide a normal
occlusion. There are various challenges faced by the orthodontists
such as dilacerated tooth, extrusion of fractured tooth, deep bite
correction, bonding failure, obstructive sleep apnea, mini implant
failures, maxillary hypoplasia in growing child and side effects of
bisphosphonates on tooth movement [15-23].
However, to overcome the challenges, a proper diagnosis and
treatment planning should be done. Besides that, the quantification
of force delivered by orthodontic auxiliaries also plays an
important role [24]. It is also important to understand the stressed
produce along the surface of the implant to avoid mini implant
failures [25, 26]. Previously our team has a rich experience in
working on various researchprojects across multiple disciplines.
[27-40]. Now the growing trend in this area motivated us to pursue
this project.
Thus, the aim of the study was to assess the prevalence and associated
factor for crossbite malocclusion in the South Indian
population.
Materials and Methods
A retrospective study was conducted involving patients visiting a
dental hospital from July 2019 till March 2020. Ethical approval
was granted by the Institutional Ethics Committee with the following
ethical approval number SDC/SIHEC/2020/DIASDATA/
0619-0320.
Data was collected from the records of the patients who reported
for orthodontic treatment in a University Hospital. Subjects with
class II malocclusion and crossbite were included and subjects
with temporomandibular joint disorder were excluded in the
study. A total of 60 subjects with crossbite were selected in this
study. To minimize bias, cross-verification was done using photographs
and reviewed by the second reviewer.
Data variables including socio-demographic data such as age and
gender, presence of crossbite, site of crossbite and presence of
class II malocclusion were retrieved and recorded. Data were analyzed
using Statistical Package for Social Science, SPSS Version 20
(IBM Corporation, New York, USA). A Chi-square test was done
to establish the association between the categorical variables.
Results & Discussion
The overall objective of this study was to evaluate the association
of crossbite with class II malocclusion and its prevalence in
the South Indian population. The study on prevalence helps the
orthodontist to rule out early diagnosis and treatment plan for a
better treatment outcome.
A total of 60 subjects were selected in the study out of which
58.3% were males and 41.7% were females as shown in Graph
1. The age range of the patients was 9-51 years with a mean age
of 25 years. Crossbite was common in class II division 1 (91.7%)
than class II division 2 (8.3%) as shown in Graph 2. Posterior
crossbite (66.7%) was common followed by anterior crossbite
(33.3%) as shown in Graph 3.
In the present study, the overall prevalence of crossbite in class II
malocclusion was 6%. Anistoroaei et al reported that the prevalence
of crossbite was 3.6%, in which the value was lesser than the
present study [12]. Another study also reported that 2.7% of class II malocclusion had crossbite [13]. Sultana et al reported that the
prevalence of crossbite in class II malocclusion was 18.4% which
was higher compared to the present study [41]. Overall, we can
observe that the prevalence of crossbite in class II malocclusion
was lower compared to class I malocclusion in the previous studies
[12, 41, 42].
Crossbite was more common in males (58.3%) than females
(41.7%). Posterior crossbite was common in males (60%) and females
(76%) compared to anterior crossbite as shown in Graph
4. However, there was no statistically significant association between
gender and crossbite (p>0.05). Previous studies reported
that crossbite in females was higher than males which were contrary
to the present study [1, 12, 41, 43]. However, there was no
statistically significant difference in the previous study which was
similar to the present study [1, 12, 41, 43, 44]. In a study done
by Woitchunas et al reported that males were predominant with
crossbite which was similar to the present study [45]. According
to the site of crossbite, a previous study reported that anterior
crossbite was common in males with 35% and posterior crossbite
was common in females with 47% which was contrary with the
present study [41].
This present study also found that there was no statistically significant
difference between class II malocclusion with crossbite
(p>0.05). Posterior crossbite was common in class II division 1
(67%) and class II division 2 (60%) compared to anterior crossbite
as shown in Graph 5. A previous study reported that there
was a significant association between malocclusion with crossbite
which was contrary to the present study [12]. However, it also
reported that class II division 1 was more prevalent with crossbite
with 3.1% compared to class II division 2 with 0.52% which is in
line with the present study [12]. In a study done by Al-Dabagh in
Yemen, there was no incidence of crossbite seen among class II
malocclusion patients [(1)]. Moreover, this present study revealed
that posterior crossbite (67%) was common compared to anterior
crossbite (33%) which is similar to the previous study [46].
The study on the prevalence of crossbite provides information to
the orthodontist regarding the importance of interceptive treatment
to minimize the risk of crossbite as age increases. There
are various treatment approaches depending on the diagnosis and
prognosis of each case. Orthodontists use various analysis for
diagnosis and treatment planning [35]. Sagittally linear cephalometric dimensions can improve the efficiency diagnosis and treatment
planning in class II and class III tendencies [47]. Meanwhile,
gonial angle in cephalometric analysis can be used as an indicator
in growth patterns [48]. The limitation of this study was a small
sample size and observer bias. Further study can be done to associate
crossbite with other etiological factors and evaluate various
treatment approaches in managing crossbite cases.Our institution
is passionate about high quality evidence based research and has
excelled in various fields [49-59]. We hope this study adds to this
rich legacy.
Figure 1. Pie chart depicting Percentage distribution of gingivitis. Generalised chronic gingivitis (40.7%) (Blue) was more in children followed by localised chronic gingivitis ( 5.8%) (Green). 53.4 % of children had healthy gingiva (Red).
Figure 2. Bar graph depicting the association between the gender and gingival status. X axis denotes genders (Female, Male, Transgender) and Y axis denotes the number of patients by gingival status. Males have a higher prevalence of generalised chronic gingivitis (Blue) compared to other genders. Females have a higher prevalence of Localized chronic gingivitis (Green) compared to other genders. However, there was no statistically significant difference among the different genders (Chi-square P value = 0.793) (p>0.05).
Figure 3. Bar graph shows the association between gender and systemic disease. Bar graph X-Axis represents the various systemic diseases and the Y-Axis shows the number of patients who are involved in the study. Both the males and females had similar distribution of systemic illness with no statistically significant differences. (Pearson Chi square test;P=0.363,P>0.05). It is shown that both the male and female patients are not affected with any systemic disease.
Figure 4. Bar graph shows the association between gender and systemic disease. Bar graph X-Axis represents the various systemic diseases and the Y-Axis shows the number of patients who are involved in the study. Both the males and females had similar distribution of systemic illness with no statistically significant differences. (Pearson Chi square test;P=0.363,P>0.05). It is shown that both the male and female patients are not affected with any systemic disease.
Figure 5. Bar graph shows the association between gender and systemic disease. Bar graph X-Axis represents the various systemic diseases and the Y-Axis shows the number of patients who are involved in the study. Both the males and females had similar distribution of systemic illness with no statistically significant differences. (Pearson Chi square test;P=0.363,P>0.05). It is shown that both the male and female patients are not affected with any systemic disease.
Conclusion
Within the limitations of the study, it can be concluded that the
overall prevalence of crossbite in class II malocclusion was 6%.
Posterior crossbite was common in males and females and also in
class II division 1 and class II division 2 malocclusion which was
not significant.
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