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Prevalence of malocclusion and its common traits in Saudi males of Aseer region

Article · January 2016

DOI: 10.4103/2348-2915.194834

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Zakirulla Meer Syed Sadatullah

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Original Article
Prevalence of malocclusion and its
common traits in Saudi males of Aseer
region
Zakirulla Meer, Syed Sadatullah1, Mohammad A. Wahab2,
Abdel B. Mustafa3, Stephen A. Odusanya3, Pervez A. Razak4

Departments of Pediatric
Dentistry and Orthodontic
Sciences, 1Maxillofacial
Surgery and Diagnostic
Sciences, 2Orthodontics,
3
Oral and Maxillofacial
Surgery and 4Community
Dentistry, College of
Dentistry, King Khalid
University, Abha,
Kingdom of Saudi Arabia
ABSTRACT
Background: To evaluate the prevalence of malocclusion and its common characteristics in young male
population of Aseer province. Methods: One thousand eight hundred and twenty Saudi male students between
the age of 15 and 17 years were chosen from 3408 pupils studying in different middle schools of Abha region.
Oral examination was performed to check the prevalence of malocclusion according to Angles classification
and the individual traits including crowding, spacing, deep bite, anterior open bite, and anterior cross bite.
Results: The prevalence of Class I, II, and III malocclusions was 62.3%, 28.4%, and 9.3%, respectively. Crowding
was the most common individual trait (43.8%) while anterior open bite was the least prevalent (7.2%).
Conclusion: There was high prevalence of malocclusion observed in the study population. Nearly half of them
were suffering from crowding of teeth.

Address for correspondence:

Dr. Zakirulla Meer,
E‑mail: tamer@kku.edu.sa KEY WORDS: Crossbite, crowding, malocclusion, occlusal traits, prevalence, spacing

Introduction The demand for orthodontic treatment has been rapidly

increasing and is influenced by socioeconomic factors, cultural

O cclusal malrelationship is not a disease, but a morphologic

variation commonly occurring without a pathologic
condition.[1] Such a manifestation is commonly known as
malocclusion. Dental malocclusions are the third highest
prevalent oral pathologies, next to tooth decay, and periodontal
disease. They are categorized as the third most severe problems
affecting oral health.[2] The high occurrence of malocclusion
is related to a number of genetic and environmental factors.
Premature tooth loss, missing teeth, discrepancy in jaw, and
tooth size are a few to name.[3] Finger or thumb sucking habit
and excessive mouth breathing also lead to improper occlusion
relationship. The reported incidence in different populations
varies from 39% to 93% making it clear that a high percentage
of individuals have less than ideal occlusion.[4‑6] Untreated
malocclusions lead to increase in the prevalence of dental caries
and temporomandibular disorders.[7] It affects the appearance,
mastication, and speech of an individual while having an impact
on the social, physical, and emotional wellbeing.
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background, the sufferer’s perceived need for treatment,
and anticipated improvement of self‑image.[8,9] The studies
have reported that people who are satisfied with their facial
appearance seem to be more self‑confident and have higher
self‑esteem than those who are dissatisfied with their facial
appearance.[10,11] The early recognition of malocclusion is
indispensable for positive prognosis of its treatment.[12]
Therefore, collection of epidemiological data on the prevalence
is essential in assessing the resources needed to plan and
implement preventive and therapeutic measures. It also provides
valuable information regarding the etiology of malocclusion and
its preference to specific ethnic groups.[13]
The prevalence of malocclusion is not alike various ethnic
groups and countries worldwide. A number of investigators have
reported the prevalence and need for orthodontic treatment in
the Saudi Arabian population.[14‑16] Most of these studies were
This is an open access article distributed under the terms of the Creative
Commons Attribution‑NonCommercial‑ShareAlike 3.0 License, which allows
others to remix, tweak, and build upon the work non‑commercially, as long as the
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For reprints contact: reprints@medknow.com

DOI: How to cite this article: Meer Z, Sadatullah S, Wahab MA, Mustafa AB,
10.4103/2348-2915.194834 Odusanya SA, Razak PA. Prevalence of malocclusion and its common traits in
Saudi males of Aseer region. J Dent Res Rev 2016;3:99-102.

© 2016 Journal of Dental Research and Review | Published by Wolters Kluwer - Medknow 99 
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Meer, et al.: Prevalence of malocclusion in Saudi population

done in big cities on patients reporting to clinics for dental Results

treatment. No study, to the best of our knowledge, was done
across a huge geographically and ethnically identical Saudi
population. A vacuum for this information prompted to initiate
the current study in the Southern region of Saudi Arabia. The
purpose of this investigation was to determine the prevalence of
malocclusions and its common traits in Saudi male population
of Aseer region.
Methods
This cross‑sectional epidemiological study comprised 1820
Saudi Middle School male students randomly selected from
3408 pupils. The screening was performed in twenty boys schools
over a period of 3 months. It was part of “Oral Health Screening
Program” approved by Scientific Research Committee of
King Khalid University, College of Dentistry (KKU/COD)
Abha. Permission was obtained from the school authorities
before carrying out oral health awareness demonstrations and
oral examination during school hours. The oral examination
was carried out in school premises under sufficient lighting
conditions using examination gloves, sterile disposable tongue
depressors (to retract cheek), mouth masks, and torch light.
Criteria to include students in the study population were as
follows.
• Age range of 15–17 years
• No previous orthodontic treatment performed
• Presence and complete eruption of all permanent teeth
excluding third molars
• Absence of large fillings, fractured, or malformed teeth
• No previous history of permanent teeth extraction
• No apparently evident craniofacial deformities or syndrome
• Saudi Arabian national.
The observed data were recorded in a prepared form by seven
experienced examiners from KKU/COD. All the examiners
involved in the study were calibrated, and interexaminer
reliability was calculated using kappa statistics (κ =0.94).
All interarch parameters were scored with the teeth in
maximum intercuspal relation. The different characteristics
of malocclusion that were noted included Angles classification,
crowding, spacing, deep bite, anterior open bite, and anterior
cross bite. The details of criteria employed to score the
malocclusion are given in Table 1. The recorded malocclusions
were calculated as frequency and percentage values.
Table 1: Description for different types of malocclusions
Malocclusion Criteria for recording the malocclusion
characteristic
Classification of Angles classification of malocclusion
malocclusion
Crowding Drift of >1 mm between the contact points
of permanent teeth shifted away from the
arch line
Spacing Space in the upper and lower dental arches
>2 mm (excluding midline diastema)
Deep bite >3 mm
Anterior open bite >2 mm
Anterior cross bite Teeth with abnormal labiolingual relationship
High incidence of caries, filled and extracted teeth meant
that more than 40% of the screened boys were left out of the
study. One thousand eight hundred and twenty boys meeting
the selection criteria were shortlisted from the main data
pool of 3408 students for analysis. The prevalence of Angles
Class I, II, and III malocclusion was 62.3%, 28.4%, and 9.3%
respectively [Figure 1]. The distribution of other malocclusions
trait recorded is given in Figure 2. Crowding was the most
common malocclusion (43.8%) followed by deep bite (21%) and
spacing (16.7%). Anterior cross bite (12.6%) and anterior open
bite (7.2%) were the least prevalent traits. Due to time restrain
and to avoid intraobserver bias in the huge study population,
the degree of malocclusion was not recorded. Students needing
immediate dental treatment were referred to KKU/COD Dental
Clinics.
Discussion
Numerous studies have been published describing the
prevalence of malocclusion and its different types.[17‑19] The
reported prevalence varies from group to group. The number
of patients seeking orthodontic treatment in Saudi Arabia has
increased markedly during recent years.[20] As a result, health‑care
planners are compelled to have relevant epidemiological data
on different types of malocclusions to estimate and plan for
treatment. Although Angle’s classification has less versatility, it
is universally accepted as a reliable system that can be used in
large study populations avoiding intraobserver bias.[14,21] Class I
molar relationship is the most prevalent form of occlusion in
any population. The frequency distribution of Angle’s classes
of malocclusion in Aseer region was in close agreement with
other studies done on Saudi population.[14‑16,22,23] Majority of
these studies may not completely represent the occurrence
of malocclusion solely because of the insufficient sample
size.[24] The prevalence of Class I malocclusion observed in this
study was less than Latino[21] and Lithuanian populations.[25]
Similarly, Class III malocclusion was less prevalent in Saudi
population compared to Turkish[26] population. Conversely,
the Americans[27] and Columbians[6] had less cases of Class III
reported than the current study. This is consistent with the fact
that youngsters are highly concerned about their appearance
even though the malocclusion may or may not affect their
functional ability. In Saudi Arabia, governmental sectors provide
Figure 1: Prevalence of malocclusion

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Figure 2: Prevalence of different types of malocclusion trait
free orthodontic treatment for Saudi citizens, and they have
good exposure to resources available.
The type of malocclusion is a key factor that drives a patient to
seek orthodontic treatment.[28] If this is any indication, crowding
should keep the orthodontist of this region very busy. It is the
most common malocclusion trait found in the present study
43.8% and numerous previous studies.[22,27‑29] Jones, however,
reported a higher incidence of crowding (67.4%) in population
of Central region of Riyadh.[24] Similarly, 81.4% of female
population in the Western region had some degree of incisor
crowding. This is substantially higher than the findings of our
study in females. The high prevalence of crowding seems to be
associated with high incidence of caries. This has been explained
by the cascading effect of caries in deciduous molars followed
by extraction, and the migration of the first permanent molars,
resulting in inclination and rotation of teeth in the anterior
sextant.[6]
Consistent with the observations of Corruccini and Whitley,
spacing occurred less frequently (16.7%) when compared
to crowding.[30] Higher incidence of spacing was reported in
Columbian children (25.9%).[6] Similarly, in the present study
anterior open bite (7.2%) was found less common than deep
bite (21%). Al‑Hummayani reported an identical pattern of
anterior open bite and deep bite prevalence.[31] However, this
observation differs from the findings of Nashashibi et al.[32] and
Al‑Emran et al.,[22] wherein the prevalence of open bite cases
outnumbered deep bite. Elsewhere, other studies have reported
a higher prevalence of anterior open bite (10.2%) and lower
prevalence (3%) than the present study.[6,33]
In the present study, 12.6% of the study subjects displayed
anterior cross bite. Higher prevalence than this was reported
by Burden et al., Hill, Behbehani et al., and Oshagh et al.[34‑37]
Higher prevalence for cross bite can be attributed to variation
in growth and disproportion in the dentoalveolar width and
genetic factors. An early interception of cross bites should be
aimed at to prevent asymmetric growth abnormalities of the
mandible and maxilla.[38]
Conclusion
Saudi Arabia is one of the most populated countries in the
Middle East. Its big cities in the Western, Central, and the
Eastern region are inhabited with ethnically mixed cosmopolitan
Journal of Dental Research and Review ● Jul-Sep 2016 ● Vol. 3 ● Issue 3 101 
Meer, et al.: Prevalence of malocclusion in Saudi population
population. The influx of urbanization, to a large extent, has
still evaded the Southern region resulting in a racially preserved
society. The advantage of this study over similar studies on
Saudi population is that it involved a huge cross section of
ethnically alike individuals of the Southern region. However,
this study could not include females from the same population.
Nevertheless, a high prevalence of malocclusion was recorded
with crowding being the most common malocclusion trait.
Epidemiological data on the prevalence of malocclusion are
an important determinant in planning appropriate levels of
orthodontic services. Further large‑scale studies are required in
different regions of Saudi Arabia to provide accurate estimates
of the orthodontic treatment need in the Saudi population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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