Malocclusion, orthodontic treatment need and oral health-related quality of life in adolescents : a comparison between public and private schools in Beirut -

Abstract

Adolescence is a vulnerable period in molding occlusion and is when disparities in malocclusion are aggravated by social inequalities. The aim of this study was to assess how social inequalities contribute to the burden from malocclusion in adolescents.A comparative cross-sectional study of secondary school adolescents aged 11-18 years attending public and private schools in Beirut-Lebanon.A sample of 656 adolescents aged 11-18 years attending 7 public and 9 private schools were screened by a calibrated examiner. Crowding and sagittal, vertical and transverse indicators of malocclusion were recorded. Parents answered a questionnaire on child- and family-related demographic, socio-economic (SE) and behavioral factors. Adolescents answered the Child Perceptions Questionnaire on oral health-related quality of life (OHRQoL). The modified index for orthodontic treatment need (IOTN) was computed. Multiple logistic and linear regressions were performed to explore the determinants of sagittal malocclusion (overjet), crowding and IOTN and to associate IOTN with OHRQoL.One in seven adolescents is in need for orthodontic treatment. Malocclusion and treatment need (IOTN) were comparable between private and public schools. After adjusting for appropriate variables, income was the strongest predictor of overjet and IOTN. Economically disadvantaged children had strikingly elevated odds of being in need for orthodontic treatment (OR=23). Age and childhood feeding mode significantly predicted overjet. Mouth breathing showed a positive association with crowding and IOTN. Bottle feeding duration was negatively associated with crowding severity. Adolescents in definite need for treatment reported significantly lower OHRQoL.The burden from unmet orthodontic treatment need is unequally distributed along the social spectrum. The implications for inequities in quality of life are contrary to the concepts of social justice and the fundamentality of oral health as a universal right. Our findings highlight the importance of promoting time