ORIGINAL RESEARCH |
https://doi.org/10.5005/jp-journals-10015-2043 |
Awareness and Attitude of Parents Regarding Malocclusion and Early Interception of Oral Habits-associated Dentofacial Deformity in Children
1-3,5,6Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
4Department of Periodontics and Preventive Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India
Corresponding Author: Anagha Chonat, Department of Pediatric and Preventive Dentistry, Adhiparasakthi Dental College and Hospital, Melmaruvathur, Tamil Nadu, India, Phone: +91 8075476822, e-mail: dranagha89@gmail.com
ABSTRACT
Aim: This questionnaire study was formulated to investigate the awareness and attitude of parents toward malocclusion and early orthodontic treatment, thereby determining whether there is an association between parental perceptions toward their child’s orthodontic treatment.
Materials and methods: This descriptive, cross-sectional study was aimed to investigate parents’ awareness and concerns toward the effects of malocclusion and early orthodontic treatment. Parents of 500 children aged between 5 and 14 years diagnosed with oral habits associated malocclusion were only considered. An interviewer-administered structured close-ended questionnaire consisting of 10 questions was presented to the parents. The first segment consisted of questions related to parent’s awareness of habits and malocclusion. The second segment questions were aimed to assess the attitude and concerns regarding of malocclusion and orthodontic treatment. The data collected were tabulated on a Microsoft Excel computer program, and descriptive statistics using the Chi-square test were carried out. The statistical analysis was performed using SPSS software V.20.0.
Results: A total of 500 parents whose children were identified with malocclusion associated with habits completed the questionnaire, of which most parents (64%) noticed their child’s irregular teeth. While 18% did not know any kind of oral habit causing irregular teeth in children, 66% did not believe that irregularly arranged teeth due to oral habits have an ill effect on a child’s growth.
Conclusion: Overall, a lack of awareness regarding malocclusion and early orthodontic treatment in children was observed among the parents. Parents should be motivated, informed, and educated regarding the prevention of malocclusion. More efforts should be made to initiate guardian/parental awareness about malocclusion and treatment in children.
Clinical significance: Early implementation of preventive and interceptive orthodontics can help prevent further dentofacial complications and expenses of orthodontic treatment. It becomes the primary responsibility of dental health care professionals to educate the patient, their parents and create a general awareness about preventive and interceptive orthodontics and its benefits.
How to cite this article: Chonat A, Vasanthakumari A, Arumugam S, et al. Awareness and Attitude of Parents Regarding Malocclusion and Early Interception of Oral Habits-associated Dentofacial Deformity in Children. World J Dent 2022;13(3):266-270.
Source of support: Nil
Conflict of interest: None
Keywords: Dentofacial deformity, Early interception, Malocclusion, Oral habits
INTRODUCTION
The developing dentition and occlusion have a more significant effect on the well-being of infants, children, and adolescents. The American Academy of Pediatric Dentistry recognizes the importance of managing the developing dentition and occlusion, including recognizing, diagnosing, and appropriate treatment of dentofacial abnormalities.1
Malocclusion is the malalignment between the arches or within the arches in any plane or any anomalies in the tooth position, which is a common oral disease generally affecting children. Malocclusions can be perceived as an oral disease that can abrupt normal oral functions such as mastication, aesthetics, and the individual’s quality of life. The most common causes for the development of malocclusion are genetic, environmental, systemic causes, and harmful oral habits. Hence, oral habits, the primary cause of dentofacial deformities in children, require immediate attention for prevention. The relationship between oral habits and unfavorable dental and facial development is associational rather than cause and effect.2 Habits of sufficient frequency, duration, and intensity may be associated with dentoalveolar or skeletal deformations such as increased overjet, reduced overbite, posterior crossbite, or long facial height. The duration of force is more important than its magnitude; the resting pressure from the lips, cheeks, and tongue significantly impacts tooth position, as these forces are maintained most of the time.3 Malocclusion is frequently the outcome of deleterious oral habits and also with a general misconception that milk teeth will exfoliate, and there is less necessity for professional dental advice. Most of the cases are still not treated appropriately due to parents’ unawareness and lack of knowledge about malocclusion.4 Preventive orthodontics mainly focuses on patient’s and parent’s education, supervision of growth, and development of dentition and craniofacial structures. Interceptive orthodontics is done to intercept the developing malocclusions, as the name suggests. This helps to prevent extensive malocclusion and often expensive future orthodontic treatment. Preventive and interceptive orthodontic therapy also includes myofunctional and orthopedic treatment, which aims at jaw changes correction during the developmental stage to prevent further surgical procedures in the future, along with space maintainers, habit breaking appliances, serial extractions, crossbite, diastema correction, and arch expansions. Once, when dentofacial deformities develop, correction of it is often extensive and expensive.5,6
Oral health education starts from footprints of awareness. Knowledge and awareness are essential prerequisites for changes in behavior related to health and disease anticipation.5 Growing children require appropriate guidance for healthy growth and maintenance of their teeth, which makes the parent an active participant in the prevention and treatment of malocclusion and thus is majorly affected by their knowledge and attitude regarding various harmful oral habits, preventive regular dental visits, care of primary teeth, and apprehension for any irregularities in the dental arch, etc.6,7
Thus, considering malocclusion and its economic and psychological ramifications, education, and avoiding going into expensive orthodontic treatment are important. This questionnaire study was formulated to investigate the awareness and attitude of parents regarding malocclusion and concerns regarding early interception of oral habits associated dentofacial deformity in children.
MATERIALS AND METHODS
The study was designed to be a cross-sectional study. The study was conducted as an institutional study, with the advantage being a large data availability and the disadvantage being assessment of patients belonging to a similar geographic location. The approval was granted by the institutional ethical committee. The study included patients within the age group 5–14 years who visited the Department of Pediatrics and Preventive Dentistry, Adhiparasakthi Dental College and Hospital. The survey was conducted from March 2021 to July 2021. Patients with self-correcting anomalies and medically compromised, patients with special needs was excluded from the study. The oral screening was carried out by trained personnel from the Department of Pediatrics and Preventive Dentistry, using clinical mouth mirrors and probes with emphasis on adverse oral habits. Parents of 500 children diagnosed with dentofacial deformity associated with oral habits (289 male and 211 females) willing to participate in the study were included after explaining the procedure and obtaining informed consent. An interviewer-administered questionnaire was used to gather the data on the prevalence of habits. Both oral and general habits, parental attitudes, knowledge, and self-awareness questions were included in the proforma adopted from Deepika P et al.,8 Pandey M et al.,9 Chhabra N et al.,10 Jeevanandan et al.,11 and Thirunavukkarasu R et al.12
A structured closed-ended multiple choice questionnaire consisting of ten questions was presented to the parents. First segment consisted of questions related to parent’s awareness on habits and malocclusion. The second segment questions aimed to assess the attitude and concerns regarding orthodontic treatment. The data collected were tabulated on a Microsoft Excel computer program, and descriptive statistics using Chi-square test was performed, and graphs plotted to arrive at final results. A p value of less than 0.05 was considered to be statistically significant. The statistical analysis was performed using SPSS software V.20.0.
RESULTS
Of the screened patients visiting the Department of Pedodontics and Preventive Dentistry, 500 children diagnosed of dentofacial deformity associated with oral habits was identified, among which 249 and 251 children were between the age group of 5–9 and 10–14, respectively (Table 1), where girls (65%) had a significant share over boys (35%). Assessing the prevalence of these deleterious oral habits, it was found that characteristic mouth breathing habit was more prevalent followed by thumb sucking and tongue thrusting habit.
| Age | Count | Percentage |
|---|---|---|
| 5–9 | 249 | 49.7 |
| 10–14 | 251 | 50.3 |
| Mean ± SD | 9.7 ± 2.5 | |
It was observed that only 11.8 % of parents visit dentists for regular dental check-ups of their children. Out of 500 children, most parents (64%) noticed their child’s irregular teeth (Table 2). While 82% did not know any kind of oral habit causing irregular teeth in children, 66% did not believe that irregularly arranged teeth due to oral habits have an ill effect on a child’s growth. However, 65.6% have not known about early interceptive orthodontic treatment but 62.4% know that orthodontic treatment can improve facial appearance (Fig. 1).
| Sex | Count | Percentage |
|---|---|---|
| Male | 177 | 35.4 |
| Female | 323 | 64.6 |
Fig. 1: Percentage distribution of the sample according to awareness
The majority of the parents, 64.6 % favored aesthetics as a critical concern regarding irregularly arranged teeth in children; only 21.2% had a concern regarding the difficulty in speaking. At the same time, 14.3% parents were concerned about the difficulty in chewing food (Fig. 2). The major concern of parents (66.7%) of children between the age group of 10–14 was difficulty in chewing food, while 55% parents of children between the age group of 5–9 had a major concern regarding the difficulty in speech (Fig. 3).
Fig. 2: Percentage distribution of the sample according to major concern regarding irregularly arranged teeth
Fig. 3: Comparison of major concern regarding irregularly arranged teeth based on age
When it came to the primary concern regarding the early orthodontic treatment, a longer duration of treatment was a major concern of parents (56.1%). While the cost of the treatment (28.6%) and pain during the treatment (15.3%) was other major concerns of parents (Fig. 4) based on age group, pain during the treatment was the major concern of parents of children between the age group of 5–9 while the cost of the treatment was the major concern of parents between the age group of 10–14 (Fig. 5).
Fig. 4: Percentage distribution of the sample according to major concern regarding early orthodontic treatment
Fig. 5: Comparison of major concern regarding early orthodontic treatment based on age
DISCUSSION
Malocclusion is the second most frequent dental disease in children and young adults, next to dental caries. The prevalence of malocclusion in India varies from 20–43%.12,13 The present study has presented the results of parental knowledge and awareness regarding malocclusion in their children. This survey found that the majority of parents (82%) didn’t know about any oral habits causing irregular teeth in a child’s oral cavity, and only 18 % had answered positively; however, in a study done by Pandey M et al., 55.0 % of the subjects between 12 and 15 age group had seen irregularity in the dentition.9 As per the study, 66% of the parents did not believe that malaligned teeth have ill effects on the child’s normal growth. Although 62.4% of parents know that orthodontic treatment can improve facial appearance, 65.6% did not know about early interceptive orthodontic treatment in children. However, according to a study by Sing K et al., Information about oral health among the Indian population is still very limited, especially for rural people, who constitute more than 70% of the population.14
In the present study, less than one-fourth of the parents (11.8%) took their child to a dentist for an annual routine check-up. Similar findings were seen in the study done by S. Grewal and Kaur et al. also observed a primarily missing effort of parents for an annual routine dental checkup in Indian children.15
Oral habits (mouth breathing, thumb sucking, tongue thrusting, lip biting, etc.), if they persist beyond the preschool age, have been considered an important etiological factor associated with the development of malocclusion. The majority of parents, 64% in the present study, were aware of any irregular teeth in their children, and 82% didn’t know about oral habits causing irregular teeth in children. In contrast, in a study done by Chandra S et al.6 and by Hirst et al.16 only 24.9% and 30% of the respondent, respectively did not know about oral habits and their role in malocclusion. Usually, esthetics is the most common and primary concern for the treatment of irregular teeth. In the present study, aesthetics is the most important reason for the treatment of irregular teeth in a child, which was consistent with the findings of the study done by Edwards et al., in which most of the respondents considered esthetic as a prime reason for the treatment of irregularity in dentition.17
Weidel et al. reported that children wearing removable appliances experienced speech difficulties and suggested that could probably be the reason why most patients and their parents fear such treatment options leading to poor acceptance rates of interceptive orthodontic treatment.18 However, in our study, parents (56.1%) were concerned about the long duration of treatment, while the cost of the treatment was another major concern. Results suggest that public information about deleterious effects of malocclusion and its treatment needs to be improved. Thickett E et al. and various other authors have suggested that parents need to be informed about orthodontic treatments, length of treatments, alternatives available, and the risks and benefits of treatments that may influence desire and demand for treatment and produce a shift in their attitudes.19,20
This study also had its fair share of limitations as the study was conducted only among the parents visiting the Department of Pedodontics and Preventive Dentistry along with their wards. Various factors such as patient educational level and socioeconomic status could affect the acceptance rate, which should also be considered during the study. Distribution of educational pamphlets and educational talk delivery with a computer aided media and study models has been conducted to create awareness among parents and children.
CONCLUSION
Malocclusion is a common oral disorder in children. Overall, a lack of awareness regarding malocclusion and early interception in children was observed among the parents. Early implementation of preventive and interceptive orthodontics can help prevent further dentofacial malocclusion associated complications. creating awareness among parents helps in limiting the deleterious effects of malocclusion by early interception. More efforts should be made to motivate, inform, and educate parents regarding the prevention of malocclusion in their children.
CLINICAL SIGNIFICANCE
Early implementation of preventive and interceptive orthodontics can help prevent further dentofacial complications and expenses of orthodontic treatment. It becomes the primary responsibility of the dental health care professionals to educate the parents, and the children regarding deleterious effects of oral habits associated malocclusion and create a general awareness about preventive and interceptive orthodontics and its benefits.
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