fom: Gas NC, Seng 3, Kohout FI: DAT—Hlo dowel Aecthele ~ Emden, Toode Cty University of Towa, [486 DAI: The Dental Aesthetic Index, An Instructional Manual The Dental Aesthetic Index (DAI) assesses the relative social acceptability of dental appearance based upon the public's perceptions of dental aesthetics. It is obtained from a minimum number of objective physical measurements of occlusal traits that are associated with the public's perceptions of dental aesthetics. The DAI provides dental epidemiologists and social scientists with a research tool to rank a person's dental appearance on a scale of societal norms for socially acceptable dental appearance. It also provides administrators of public or third party financed orthodontic programs with a method to screen and identify children eligible for programs because of the deviation of their dental configurations from society's norms for aesthetic dental appearance. ' The DAI can also be used to estimate need for orthodontic care in target populations. It will help providers and administrators of public orthodontic care justify orthodontic treatment based on the potential social benefits of such care in terms of the improved social functioning and career opportunities that can result from improved dental apearance. ‘Two different samples of 100 dental study models representing a wide range of occlusal conditions found in a natural population of 500,000 children were assessed for social acceptability by large numbers of children ani 2 3 = 5 & a : 5 a z g 5 & = g 2 2 a g 5 3 g z 3 components of the DAI (auxiliaries have reliably measured the DA’ components; intra-class coefficient of reliability = .84). 93 |Table 32 presents the constant, the 10 components and their actual regression weights for computing dental aesthetic scores. It also presents rounded weights for these components that are useful for calculating DAI scores in small scale field surveys. In large surveys it is recommended that the actual weights for each component be used to calculate more accurate DAI scores. Table 32 The Standard DAI Regression Equation: Its Components and Their Actual and Rounded Regression Coefficients (Weights) Regression Coefficients ‘Aotual Rounded DAI Components Weights Weights 1, Missing Visible Teeth 5.76 6 2. Crowding 115 1 3. Spacing 4.31 1 4. Diastema 3.13 3 5. Largest Anterior Irregularity (Upper) 1.3m 1 6. Largest Anterior Irregularity (Lower) 115 1 7. Anterior Maxillary Overjet (Upper) 1.62 2 8. Anterior Mandibular Over jet (Lower) 3.68 4 9. Vertical anterior Openbite 3.69 4 10. Antero-Posterior Molar Relation 2.69 3 CONSTANT 13.36 13 i 4least socially acceptable dental appearance. Figure 1, Page 10, gives scores Would fall in a natural population. Dental Orthodontic Measurements Needed for the Dental Aesthetic Index (DAI). Missing Visible Teeth; Incisors, Canines and Premolars ssing Visible Teeth; Incisors, Canines and Premolars Count the number of missing permanent incisors, canine and premolar teeth on the upper and lower arches. This is done by counting the teeth present starting at the right second premolar and moving forward to the left second premolar. There should be 10 teeth present. If there are less than 10 the difference is the number missing. Record that number on Line 1 of the recording form. A history of all missing anterior teeth should be obtained to determine whether extractions were performed to improve aesthetics. If spaces are closed, do not count the teeth as missing. If a Primary tooth is still in position and its successor has not yet erupted, do_nmot count the tooth as missing. If a missing incisor, canine or premolar tooth is replaced by a fixed prosthesis do not count that tooth as missing. 2. Crowding in the Incisal Segments of the Arch Examine both upper and lower incisal segments for crowding. Crowding in the incisal segment is the condition in which the available space between the right and left canine teeth is insufficient to accommodate all four incisors in normal alignment. Teeth may be rotated or displaced out of alignment in the arch. The number of incisal segments (each incisal Segment consists of four incisors in either the upper or lower arch) with 1 cronding is recorded as 0, 1, or 2. 0 = no segments crowded; 1 segment crowded; 2 = 2 segments cronded. When in doubt assign the lower score. Do not mark the incisal segment crowded if four incisors are in Proper alignment but either or both canines are displaced. 3. Spacing in the Incisal Segment of the arch Examine both upper and lower incisal segments for spacing. When measured in the incisal segment spacing is the condition in which the amount of Space available between the right and left canine teeth exceeds that 95required to accommodate all four incisors in normal alignment. If one or more incisor teeth have proximal surfaces without any interdental contact the segment is recorded as having space. The number of incisal segments in both arches with spacing is recorded as either 0, 1 or 2. 0 = no segments spaced; 1 = 1 segment spaced; 2 = 2 segments spaced. When in doubt assign the lower score. Diastema A midline diastema is defined as the space, in millimeters, between the two permanent maxillary incisors. This measurement can be made at any level between the mesial surfaces of the central incisors and should be recorded to the nearest whole millimeter. Largest Anterior Irregularity on the Upper (Maxillary) Arch Irregularities may be either rotations out of, or displacements from, normal alignment (see Figure 11). GAs ROTATION DISPLACEMENT Anterior Irregularities and Crowding FIGURE 11 Visually sean the four incisors to locate the greatest iregularity between adjacent teeth. Measure the site of the greatest irregularity between adjacent teeth using the handle end of the Boley gauge or a tongue blade and sharp pencil (Figure 12). The edge of the tongue blade is placed into contact with the labial surface of the most lingually displaced or rotated incisor while it is held parallel to the occlusal Plane and at right angles to the normal arch line. A sharp pencil is then Placed on the labial surface of the adjoining tooth and slid along that labial surface to mark the amount of the displacement on the tongue blade. The irregularity in millimeters can then be read from the pencil 96 |Measuring Irregularities with a Boley Gauge or Tongue Blade and Pencil FIGURE 12mark on the tongue blade with a Boley gauge or a millimeter ruler. Record | to the nearest shole millineter. Irregularities may ocour with or without | crowding. If there is sufficient space for all four incisors in normal | alignment but some are rotated or displaced do not mark that segment as | crowded but record the largest irregularity. Irregularities at the distal of the lateral incisors should also be considered, if present. | Largest Anterior Irregularity on the Lower (Mandibular) arch Measurement is the same as on the upper arch except that it is made on the lower (mandibular) arch. The greatest irregularity between adjacent teeth on the lower arch is located and measured as described above for the upper arch. 7. anterior Maxillary Over jet Measurement of the horizontal relation of the incisors is made with the teeth in centric occlusion. Record only the largest maxillary overjet with a Boley gauge or metric ruler to the nearest whole millimeter from the labio-incisal edge of the most prominent upper incisor to the labial surface of the corresponding lower incisor holding the instrument parallel to the occlusal plane, This trait is not recorded if all upper incisors are missing or in lingual crossbite. (See Figure 13). This measurement also can be made by marking the amount of overJet on a tongue blade with a pencil and then measuring with a millimeter ruler or Boley gauge. 8. Anterior Mandibular Over jet (Mandibular Protrusion Record this trait when any lower incisor protrudes anteriorly, or labially, to the opposing upper incisor, i.e., it is in crossbite. Record the largest mandibular overjet (mandibular protrusion) or crossbite, of any of the incisors in the lower arch to the nearest whole millimeter. Measure in the same manner as described for anterior maxillary overjet. (see Figure 14), A tongue blade and pencil may also be used. Do not mark the tooth as a mandibular overJet if a lower incisor is rotated so that one part of the incisal edge is in cross bite (is labial to the upper incisor) but another part of the incisal edge is not in cross bite. 98ANTERIOR MANDIBULAR OVERJET mai NTEPIOR (MANDIBULAR PROTRUSION) ial FIGURE 14 9. Vertical Anterior Openbite If there is a lack of vertical overlap between any of the opposing pairs of incisors (openbite) the amount of openbite is measured directly with a Boley gauge or metric ruler. Record the largest openbite to the nearest whole millimeter (see Figure 15). Vertical Anterior Openbite FIGURE 1510. Antero-Posterior Molar Relation This assessment most often is based on the relation of the permanent upper and lower first molars. If the assessment cannot be based on the first molars because one or both are absent, not fully erupted, or misshaped because of extensive decay or fillings, the relations of the permanent canines and premolars are assessed. The right and left sides are assessed with the teeth in occlusion and only the largest deviation from normal molar relation is recorded. M or Mesial means the lower first molar is to the mesial (or anterior) to its normal (N) relation. D or Distal means the lower first molar is distal (or posterior) to its normal relation. Do not record D or M on the form; record only 0, 1 or 2. ‘The schematic drawings in Figures 16 and 17 are used as a scoring guide. Note the position of the arrows on the first molars and the canines in these drawings to determine the scoring. 100VIEW OF THE TEETH FROM THE RIGHT SIDE Canine Tooth —canine Normal = Code 0 Lower molar is Ye cusp to Lower molar is % cusp to the distal = Code D1 the mesial = Code M1 OOo QOOD Lower molar is one cusp or more Lower molar is one cusp or more to the distal = Code D2 to the mesial = Code M2 Antero-Posterior Molar Relation FIGURE 16VIEW OF TEETH FROM THE LEFT SIDE Canine Tooth Lower molar is % cusp to the mesial=Code M1 COC Lower molar is one cusp or more to the mesial-Code M2 Normal=Code 0 Lower molar is % cusp to the distal-Code D1 0OO®) Lower molar is one cusp or more to the distal-Code D2 Antero-Posterior Molar Relation FIGURE 17DENTAL AESTHETIC INDEX (DAI) RECORDING FORM De. Date. Name____________________Male__ Female Date of Bit, Geographic Location ______________ettnic Group_________ Examine Cases Needing Referral for Further Evaluation Gross Anomaly 0. Cleft Lip or Palate 0. a ‘Traumatic or Surgical Defect 0 aes Deep Overbite impinging on Gingival Tissue O Have you ever had orthodontic treatment? OG we Has any of your teeth been extracted o improve appearance? OO Yes, which teeth 7 EER (0 _ CONSTANT 7) Missing ncleor, canine and premolar teeth-- Maxilary and Mandibular Enter total # 2 Crowding in the incisal segments O=no segment crowded 1= segment crowded 1 2:2 segments crowed 3 Spacing in the incisal segmonis O=no spacing 1 41 segment spaced 2=2 segments spaced 7 poser na 5 Logs ener agua Masa pe) Lap na repay are foray ae 7 Ar Wasiny Gro em '8_Anterior Mandibular Overiet (lower) in mm | orci gerbe n T 10 Antoro-posterior motar relation NormalcO we cusp=t Full Cusp=2 TOTAL (add lines 0 through 11) DIRECTIONS FOR CALCULATING A DAI SCORE For lines 1-10, multiply Column A by Column B and enter the result in Column C Then: add Column C including Line 0 to obtain DAI score, COMMENTS FIGURE 18