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 Table of Contents  
Year : 2018  |  Volume : 5  |  Issue : 1  |  Page : 14-19

Assessment of the correlationship of self-perception of dental appearance, smile, and willingness to undergo treatment among school children with dental esthetic index at Thiruchengode

Department of Orthodontics and Dentofacial Orthopaedics, Vivekanandha Dental College for Women, Affliated to Tamil Nadu Dr. MGR Medical University, Namakkal, Tamil Nadu, India

Date of Web Publication21-Dec-2018

Correspondence Address:
K Preethi
D/o Mr. R. Kumaragurubaran, “Saraswathi Illam,” No: 138, LGB Nagar Main Road, Karur - 639 002, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jiadsr.jiadsr_35_17

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Aim: The aim of the survey was to assess the correlation of DAI with self-perception of smile, self-assessment of dental appearance and desire to uptake treatment. Methods: 400 school children aged 12-15 years from Thiruchengode were clinically examined using DAI. Subjective assessment of their smile and dental appearance and desire of treatment uptake were elicited by 10-point questionnaire. Correlation of clinical assessment and variables of subjective assessment were analyzed using Chi square test and Kappa statistics. Results: A statistically significant correlation was present between DAI and self-perception of dental appearance and also between DAI and their dental appearance when compared with the peer group. DAI score presented only 4.8% of children needed mandatory treatment. Distribution of children dissatisfaction of dental appearance was significant and no significant relation on willingness to uptake treatment. Conclusion: A wide range of school children perceived dissatisfaction of their appearance but their desire to uptake the orthodontic treatment was not significant.

Keywords: Dental esthetic index score, orthodontic treatment need, school children, self perception

How to cite this article:
Preethi K, Nagalakshmi S, Rajkumar B K, Vinoth S, Dayanithi D, Bandhari D P. Assessment of the correlationship of self-perception of dental appearance, smile, and willingness to undergo treatment among school children with dental esthetic index at Thiruchengode. J Indian Acad Dent Spec Res 2018;5:14-9

How to cite this URL:
Preethi K, Nagalakshmi S, Rajkumar B K, Vinoth S, Dayanithi D, Bandhari D P. Assessment of the correlationship of self-perception of dental appearance, smile, and willingness to undergo treatment among school children with dental esthetic index at Thiruchengode. J Indian Acad Dent Spec Res [serial online] 2018 [cited 2019 Jul 16];5:14-9. Available from: http://www.jiadsr.org/text.asp?2018/5/1/14/248279

  Introduction Top

Esthetics is the most common reason for children to seek orthodontic treatment. A “good dental appearance” has been shown to be related to a person's social and intellectual competence, peer group acceptance and hence related to successful life outcomes than people with lower attractiveness.[1] There is a greater chance of malocclusion having an impact on quality of living among schoolchildren who have negative self-perceptions regarding their dental esthetics, smile, and such children more frequently perceive the need for orthodontic treatment. The World Health Organization (WHO) has recommended Dental Esthetic Index (DAI) for assessing dentofacial anomalies in their oral health survey. DAI is a cross-cultural index focused on socially defined dental aesthetics.[2]

The DAI looks into the esthetic aspects of occlusion. The DAI links clinical and esthetic components, mathematically, to produce a single score. This score reflects the malocclusion severity. DAI effectively recognizes the conditions that cause potential psychosocial problems.[3]

The psychosocial component of malocclusion will continue to be one of the strongest motivators for orthodontic treatment. The benefits of taking orthodontic treatment are for prevention of tissue damage, correction of the esthetic component and to improve the physical function.

During adolescence, there is an increased concern for dental appearance. The desire to look good, self-esteem awareness and willing to undergo orthodontic treatment influence the uptake of orthodontic treatment. The benefit the individual receives from orthodontic treatment will depend on the severity of the malocclusion as well as the patient's own perception of the problem. Not all patients with malocclusion, even though with severe malocclusion seek orthodontic correction. Some do not recognize that they have a problem and some may not be unhappy about their dental appearance. There may be others who are aware of the problem but are not willing for the treatment. Therefore, the study is designed to understand and motivate the children requiring orthodontic correction and enable them to become confident healthy individuals. Self-perception of the individual's appearance has an influential impact on their social and psychological adjustments and builds in confidence.[4]

The aim of this study was to assess the correlations between DAI and self-perception of their appearance among school children of 12–15 years of age.

The objectives of the study were:

  1. To evaluate the relationship between DAI and perception of smile
  2. To evaluate the relationship between DAI and perception of dental appearance
  3. To evaluate the correlation between DAI and self-appraisal of the dental appearance on comparison with their face
  4. To evaluate the correlation between DAI and appearance of their own teeth when compared with their classmate
  5. To evaluate the relationship between DAI and willingness to uptake orthodontic treatment.

  Materials and Methods Top

The cross-sectional study was conducted among school children of 12–15 years of age. The sample size included 500 school children, both age and gender matched. The school children were selected from Thiruchengode, rural area in Namakkal Dist. List of schools in Thiruchengode was obtained from the Directorate of education at Namakkal District. Eight schools were randomly selected. Informed consent was obtained. The study included children of 12–15-year-old, who were willing to participate. The children who had or who were undergoing orthodontic treatment, including interceptive orthodontics were excluded from the study. Children who already decided to uptake orthodontic treatment and those who were physically and mentally challenged were also excluded from the study.

The school children were interviewed with following ten questions privately, the questions were verbally explained. The perception of smile, the perception of dental appearance, self-assessment of dental appearance when compared to face, self-assessment of dental appearance on comparing with classmates and friends and willingness to undergo orthodontic treatment were assessed using prestructured questionnaire with ten questions, [Figure 1] given in both English and Tamil (vernacular language). Oral examination was done by two well-trained examiners. The instruments used were autoclaved community periodontal index probe, plain mouth mirror, and a light source. Five to six minutes were taken for the questionnaire and oral examination for each child. Children were assessed clinically with DAI for determining their level of malocclusion [Figure 2] and [Figure 3]. It contains ten components which include:
Figure 1: Pre- structured questionnaire

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Figure 2: Components of Dental Aesthetic Index regression equation and their actal and rounded regression coefficients (weights)

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Figure 3: Dental Aesthetic Index Score (DAI Score)

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  1. Number of missing visible teeth (incisors, canines, and premolars in the maxillary and mandibular arches)
  2. Crowding in the incisal segments: 0 = No segment crowded 1 = 1 segment crowded, 2 = 2 segment crowded
  3. Spacing in incisal segments: 0 = no spaced; 1 = 1 segment spaced, 2 = 2 segment space
  4. Midline diastema in mm
  5. Largest anterior irregularity on the maxilla in mm
  6. Largest anterior irregularity on the mandible in mm
  7. Anterior maxillary overjet in mm
  8. Anterior mandibular overjet in mm
  9. Vertical anterior open bite in mm
  10. Antero-posterior molar relation: largest deviation from Normal either left or right: 0 = normal, 1 = half cusp either mesial or distal, 2 = one full cusp or more either mesial or distal.

Statistical analysis

The data collected was analyzed using IBM SPSS software for windows version 16 (SPSS Inc., Chicago). Frequency tables were computed. Chi-square test and Kappa statistics were used to test the association between DAI score and esthetic perception and willingness to undergo orthodontic treatment.

  Results Top

Of the total 400 patients, 78.3% were satisfied with their smile, but only 44.3% liked the appearance of the smile very much. Nearly 57.5% liked the way their teeth look, and when asked how much they liked the look of the teeth, 49.5% liked it quite a bit.

Nearly 54% of children felt they did not have straight teeth and when compared to their face, 22% felt it as a below average feature of their face and 9% as the poorest feature of their face. 47.8% of children felt their teeth were looking good, but only 22.5% felt their teeth to be nicest among classmates and friends. About 53.5% of participants felt the teeth needed straightening but only 28% desired to wear braces to correct it shown in [Table 1].
Table 1: The frequency distribution of the questions

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On considering DAI score 65.5% did not need orthodontic correction, 21.8% needed elective treatment, 8% needed desirable treatment and 4.8% required mandatory treatment.

Chi-squared test and kappa statistics was used to evaluate the significant relationship between DA1 scores and their esthetic perceptions. [Table 2] shows that there was no statistically significant correlation between the DA1 score and self-satisfaction.
Table 2: Relationship of Dental Aesthetic Index with Q2 (How much do you like the appearance of your smile?)

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A strong statistical significant correlation was seen between DA1 score and the way their teeth look [Table 3].
Table 3: Correlation of Dental Aesthetic Index and Q4 (How much do you like the way your teeth look?)

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The correlation of DAI score with how straight their teeth are and how they considered these features when they compared to their entire face was not significant. The frequency distribution showed less variation [Table 4].
Table 4: Relationship between Dental Aesthetic Index and Q6 (How would you consider your teeth as compared to your entire face?)

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When comparing the scores of how good looking their teeth are with their friends and classmates and their DA1 scores, Kappa statistics showed a strong significant correlation in [Table 5].
Table 5: Relationship between Dental Aesthetic Index and Q8 (Compared to their classmate how their teeth look?)

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Statistically, no significance was observed between DA1 scores and their assessment of treatment need and willingness to undergo treatment using braces among the participants [Table 6].
Table 6: Relationship between Dental Aesthetic Index and Q10 (if it were possible would you want to wear your braces?)

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  Discussion Top

In the past decade, there has been an increase in awareness regarding esthetic appearance, and many are motivated to seek orthodontic treatment. For public health and epidemiological survey purpose, various indices such as Summers' Occlusal Index,[5] Salzmann's Handicapping Malocclusion Assessment Record,[6] and Grainger's Treatment Priority Index,[7] The DAI[2] and Index of Orthodontic Treatment Need (IOTN)[8] had been developed, which assist the dental professionals to categorize the severity of malocclusion and its treatment need. The DAI have an advantage over IOTN, as the esthetic perception by DAI are linked with anatomic trait measurements, which produce a single score by regression analysis. Cons, Jenny, and Kohout developed the DAI in 1987 which is simple and easy to use without the use of radiographs in assessing the severity of malocclusion and need for orthodontic treatment.[2] DAI) was selected as the epidemiological screening tool because of its reliability and validity. This DAI was integrated into items of the International Collaboration Study of Oral Health Outcomes and guidelines by the WHO.[9] DAI was used to assess the severity of malocclusion and treatment requirement in the present study as it focuses on clinical and subjective esthetic factors and malocclusion.[10] DAI scores >31 require mandatory treatment, and it is useful to identify the group of children who definitely need orthodontic treatment. Facial appearance especially dental esthetics had a strong impact on the psychological and social adjustments.[11],[12] Expectation and opinion of the patient toward dental esthetics cannot be underestimated, as it is they who benefit from improved esthetics after orthodontic treatment.[13],[14] Professional opinion and patient opinion of facial appearance, dental esthetics, and malocclusion may not be coincident, and often orthodontic treatment is influenced by the perception of the patient regarding their appearance.[15],[16] To evaluate the patient's perception of malocclusion, a prestructured questionnaire containing ten questions reflects and projects the dental appearance and self perception of smile and willingness to uptake orthodontic treatment was used in this study.[13]

The age of 12–15 years was chosen in this study as all permanent teeth would have erupted, except 3rd molar and malocclusion and dentofacial anomalies will be well expressed.[10] The study was done among school children in rural area of Thiruchengode, Namakkal dist., with same demographic and cultural characteristics. The children were age and gender matched.

In the present study, on comparing the DAI score with their perception of smile, there was no significant correlation. This result was in agreement with Nayak et al. but it was contradicting the results of Jenny et al. which had a strong significant correlation.[13],[17]

There was a significantly strong association between perception of dental appearance and DAI, which is in accordance with the results of Nayak et al., Jenny et al. and Onyeso et al.,[13],[17],[18] but this result is, in contrast, to study by Shue Te Yeh et al.[19] The study shows that a person's perception of esthetic smile is not just dependent on pleasing dental appearance. Dissatisfied dental appearance may be a good indication for uptake of orthodontic treatment need.

The association between DAI with the children's self assessment of the relative appearance of teeth as compared to their face showed no significant correlation present and this result is not similar with a study by Jenny et al. and Nayak et al.[9],[13]

The relationship between DAI and self perception of dental appearance when compared to their classmates and friends have strong significant co relation, and the results corroborated the Cons et al. study.[2] DAI scores and their desire to uptake orthodontic treatment showed no significant association. This is not in agreement with studies by Holmes, Espealand, Gosney, and Birkeland.[8],[20],[21],[22]

Only 4.8% of the children examined required mandatory treatment as per DAI score. Dissatisfaction with individual's smile and dental appearance is a good motivating factor for uptake of orthodontic treatment.[23] In the study dissatisfaction with their dental appearance is this could be socioeconomic status, parent's knowledge on malocclusion and need of orthodontic treatment, their awareness regarding the available treatment in their locality which needs to be evaluated in further studies. more in distribution, but their willingness to undergo orthodontic treatment was not significant. The reason for this could be socioeconomic status, parent's knowledge on malocclusion and need of orthodontic treatment, their awareness regarding the available treatment in their locality which needs to be evaluated in further studies.

  Conclusions Top

High distribution of school children did not require orthodontic treatment and only 4.8% children needed mandatory treatment. There was a significant correlation between DAI scoring and the dissatisfaction regarding their dental appearance and also between DAI and their dental appearance when compared with the peer group (classmates and friends). No statistically significant association present between DAI and smile perception, self-assessment of dental appearance on comparison with their face and desire to uptake orthodontic treatment.

Although the dissatisfaction regarding the dental appearance was high, the willingness to uptake treatment was significantly low. Further studies are needed to evaluate the role of socioeconomic status, rural location, high cost, parent awareness regarding malocclusion, and treatment availabilities in influencing their willingness to undertake orthodontic treatment.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Traebert ES, Peres MA. Do malocclusions affect the individual's oral health-related quality of life? Oral Health Prev Dent 2007;5:3-12.  Back to cited text no. 1
Cons NC, Jenny J, Kohout FJ, Songpaisan Y, Jotikastira D. Utility of the dental aesthetic index in industrialized and developing countries. J Public Health Dent 1989;49:163-6.  Back to cited text no. 2
Borzabadi-Farahani A. An overview of selected orthodontic treatment needs indices. In: Naretto S, ed. Principles in Contemporary Orthodontics. Los Angeles: InTech; 2011:9;216-32.  Back to cited text no. 3
de Paula Júnior DF, Santos NC, da Silva ET, Nunes MF, Leles CR. Psychosocial impact of dental esthetics on quality of life in adolescents. Angle Orthod 2009;79:1188-93.  Back to cited text no. 4
Summers CJ. A System for Identifying and Scoring Occlusal Disorders. The Occlusal Index [Dissertation]. Ann Arbor (Mich): University of Michigan; 1966.  Back to cited text no. 5
Salzmann JA. Handicapping malocclusion assessment to establish treatment priority. Am J Orthod 1968;54:749-65.  Back to cited text no. 6
Grainger RM. Orthodontic Treatment Priority Index. In: Public Health Service Publication No. 1000, Series 2, No 25. Washington, DC: US Government Printing Office; 1967.  Back to cited text no. 7
Espeland LV, Ivarsson K, Stenvik A. A new Norwegian index of orthodontic treatment need related to orthodontic concern among 11-year-olds and their parents. Community Dent Oral Epidemiol 1992;20:274-9.  Back to cited text no. 8
WHO. Oral Health Surveys: Basic Methods. 5th ed. Geneva: WHO; 1997.  Back to cited text no. 9
Nagalakshmi S, James S, Rahila C, Balachandar K, Satish R. Assessment of malocclusion severity and orthodontic treatment needs in 12-15-year-old school children of Namakkal District, Tamil Nadu, using Dental Aesthetic Index. J Indian Soc Pedod Prev Dent 2017;35:188-92.  Back to cited text no. 10
[PUBMED]  [Full text]  
Burden DJ. Oral health-related benefits of orthodontic treatment. Semin Orthod 2007;13:76-80.  Back to cited text no. 11
Albino JE, Lawrence SD, Tedesco LA. Psychological and social effects of orthodontic treatment. J Behav Med 1994;17:81-98.  Back to cited text no. 12
Nayak UA, Winnier J, Rupesh S. The relationship of dental aesthetic index with dental appearance, smile and desire for orthodontic correction. Int J Clin Pediatr Dent 2009;2:6-12.  Back to cited text no. 13
Tuominen ML, Nyström M, Tuominen RJ. Subjective and objective orthodontic treatment need among orthodontically treated and untreated Finnish adolescents. Community Dent Oral Epidemiol 1995;23:286-90.  Back to cited text no. 14
Tang EL, So LL. Correlation of orthodontic treatment demand with treatment need assessed using two indices. Angle Orthod 1995;65:443-50.  Back to cited text no. 15
Bergström K, Halling A, Huggare J. Orthodontic treatment demand – Differences between urban and rural areas. Community Dent Health 1998;15:272-6.  Back to cited text no. 16
Jenny J, Cons NC, Kohout FJ, Jakobsen J. Differences in need for orthodontic treatment between native Americans and the general population based on DAI scores. J Public Health Dent 1991;51:234-8.  Back to cited text no. 17
Onyeaso CO. Orthodontic treatment need of Nigerian outpatients assessed with the dental aesthetic index. Aust Orthod J 2004;20:19-23.  Back to cited text no. 18
Shue-Te Yeh M, Koochek AR, Vlaskalic V, Boyd R, Richmond S. The relationship of 2 professional occlusal indexes with patients' perceptions of aesthetics, function, speech, and orthodontic treatment need. Am J Orthod Dentofacial Orthop 2000;118:421-8.  Back to cited text no. 19
Holmes A. The prevalence of orthodontic treatment need. Br J Orthod 1992;19:177-82.  Back to cited text no. 20
Birkeland K, Boe OE, Wisth PJ. Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by index of orthodontic treatment need. Am J Orthod Dentofacial Orthop 1996;110:197-205.  Back to cited text no. 21
Gosney MB. An investigation into some of the factors influencing the desire for orthodontic treatment. Br J Orthod 1986;13:87-94.  Back to cited text no. 22
Patil SP, Harsha RH, Mane AB, Sharma JH, Patil PR. Factors influencing the perceived orthodontic treatment need and its relationship with awareness of malocclusion among college adolescents. J Indian Assoc Public Health Dent 2014;12:179-84.  Back to cited text no. 23
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  [Figure 1], [Figure 2], [Figure 3]

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6]


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