Zaynab F.doc J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry179 Occlusal features, perception of occlusion and orthodontic treatment need and demand among 13 years aged Baghdadi students Part II: (Cross sectional epidemiological study) Zaynab Mohamed Ridha Al-Chalabi, B.D.S. (1) Fakhri Abid Ali Al-Fatlawi, B.D.S., M.Sc. (2) ABSTARCT Background: The present study aimed to assess the distribution, prevalence, severity of malocclusion in Baghdad governorate in relation to gender and residency Materials and Methods: A multi-stage stratified sampling technique was used in this investigation to make the sample a representative of target population. The sample consisted of 2700 (1349 males and 1351 females) intermediate school students aged 13 years representing 3% of the total target population. A questionnaire was used to determine the perception of occlusion and orthodontic treatment demand of the students and the assessment procedures for occlusal features by direct intraoral measurement using veriner and an instrument to measure the rotated and displaced teeth. Results and conclusions: The presence of malaligned teeth was reported by 39% of the sample. The most prevalent reported types of malaligned teeth were spaced teeth (26.6%); Of the students who stated that they have malaligned teeth, 70.3% thought that it affected their appearance, 17.8% affected chewing, and 7.8% affected speech; The most common reasons for not seeking orthodontic treatment were the thought that treatment is not important or not possible (25.8%) and fear of pain (48.8%).One or more missing teeth due to extraction or trauma were found in 4.9% of the sample,the most common extracted tooth was the mandibular first molar. Crowding was more concentrated in the lower anterior segment while the spacing cases were higher and more concentrated in the upper anterior segment. A maxillary central diastema was found in 18.1 % of the sample with a mean of 0.306 mm. Anterior irregularities were found in (18.36 %maxillary and 26.84% mandibular),mean overjet 3.310 mm, mean overbite was 2.99 mm, Class I Angle class was found in 78.29%, class II in 19.5% and class III in 2.3%. Posterior crossbite found in 5.6%, anterior openbite (1.7%) and midline shift (54.34 %).Normal lip form was found in 86.6%, soft tissue impingement in 3.3%.The treatment need according to DAI show that 72.3% of the sample were found to have no or slight treatment need, 15.9% with treatment elective, 7.3% with treatment highly desirable, and 4.5% with treatment mandatory.Also increase the need and decrease demand for orthodontic treatment among adolescents in the Baghdad commune. This data will be useful for public oral health service and emphasize the need for orthodontic treatment among Baghdadi adolescents. Key words: Occlusal features, perception of occlusion, treatment need. (J Bagh Coll Dentistry 2015; 27(3):179-186). INTRODUCTION Malocclusion is any deviation in the arrangement of the teeth exceeding the standards of normal occlusion. It may be associated with anomalies within the dental arches (i.e. crowding and spacing), malrelation of dental arches (i.e. anteroposterior, vertical and transverse anomalies) and skeletal discrepancies (1). Many studies have reported on the prevalence of malocclusion in different populations (2-4). The prevalence of malocclusion varies between different populations, ethnicities and age groups. Variations within the same population have also been noticed, especially in respect of both crowding and the sagittal dental arch relationship (5,6). Moreover, the criteria for the recorded items (registration methods) seem to play an important role for the variation in the prevalence. (1)Master student. Department of Orthodontics. College of Dentistry, University of Baghdad. (2)Professor. Department of Orthodontics. College of Dentistry, University of Baghdad. A thorough investigation of the occurrence of malocclusions among school–students would be of major importance in the planning of orthodontic treatment in the public dental health services. And moreover, an analysis of the need for orthodontic treatment in the different school classes (7). Analysis of the prevalence rates of malocclusion in such groups may also contribute to understanding of the causes of malocclusion (8). This study was carried out in Baghdad city since there no study has been done since 2002 on permanent dentition and it is designed to provide a base line data on the malocclusion of male and female sample during permanent dentition. MATERIALS AND METHODS The present epidemiological survey was conducted during the period between February to May 2014 in Baghdad cityand five small surrounding villages selected accordingto their geographical location and number of population. J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry180 The Sample The sample consisted of 13-year-old students attending first year intermediate schools.Baghdad were split into two sectors Karkh and Rusafa on either side of the Tigris River. Each sector was handled as a separate entity in respect to the distribution of examination clusters. However, in the data analysis Baghdad was handled as one governorate. Permission was obtained from the directorate of education. The schools authorities were contacted and the purpose of the study was explained to them to assure full cooperation.A multi-stage stratified sampling technique implemented in this investigation and the planning was to be 2540 students included in thesurvey, half of whom (1270 students) urban and the otherhalf rural.Urban students were considered as students living inthe center of Baghdad city taken as clusters of 63 students from 10 randomly selected schools. Rural students were selected randomly from five small villages, two clusters of 63 students from each village. Examination Area Each student was seated on an ordinary chair taken from the host school with his or her head supported in an upright position against the wall directly facing the examiner (9). When possible the examination area waspartitioned or arranged in such a way that student entered at one point and left atanother. Students were not permitted tocrowd around the examiner. Natural daylight was utilized as the light source for the examination, and a portable light was used to supplement natural daylight during examination when needed and in the absence of electricity, the portable light was connected to a 1.5V battery. Questionnaire Before any dental examination wasdone, the date of examination, governorate,location, schools name, school classand gender of the students was registered.Then the students were eachinterviewed individually to obtain firstdemographic information regarding theirname and birth date.The student was asked some questionsregarding his/ her perception of occlusion.This questionnaire was modified from Ingervall et al, Ng’ang’a et al. (10, 11). Clinical Examination Before the intraoral clinical examinationwas commenced, gross anomalies, cleft lipand/or palate, traumatic or surgical defectswere noted and described in the notessection. The intraoral examination was derivedfrom the epidemiological index of Bjork et al.(7) and theFDI index (9), in additionto the Dental Aesthetic Index (12).The following variables were examined: Missing permanent teeth due toextraction or trauma, rotated tooth (>15 degrees),displaced tooth (>1mm), Angle`s classes of occlusion(class I molar occlusion, class II molarocclusion and classIII molar occlusion), overjet (mm), overbite(mm), anterior openbite (mm), posterior crossbite, scissors bite, midline displacement (>0.5mm), maxillary median diastema(≥0.5mm), Anterior irregularities (≥1mm), spacing and crowding (one anteriorsegment and two lateral segments of the botharches), soft tissue impingement, lip formperception of occlusion and treatment need was recorded according to the components of Dental Aesthetic Index (DAI). The DAI scores were dichotomized as “no need for treatment” (DAI < 25) and “in need of treatment” (DAI > 25). Inter-and intra-examiner calibration was performed before the study, to ensure the consistent application of the diagnostic criteria. The results showed no statistically significant difference. RESULTS AND DISCUSSION The total number of examined students was 2738; from which 200casesheets were excluded because ofincomplete or inaccurate information or incorrect age orcurrently undergoing orthodontic treatment and those who have undergone extraction of permanent teeth to improve appearance, giving avalid sample of 2538; 635 males (317urbans and 318rurals) and 635 females (318urbans and 317rurals)(Table 1,2). Table 1: Number and distribution of all the examined students. Location Gender Baghdad Total Karkh Rusafa Urban Males 347 347 694 Females 347 348 695 Total 694 695 1389 Rural Males 337 337 674 Females 337 338 675 Total 674 675 1349 Total Males 684 684 1368 Females 684 686 1370 Total 1368 1370 2738 J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry181 Table 2: Number and distribution of case sheets included in the statistical analysis Missing teeth due to extraction or trauma were found in 4.9% of the sample, most commonly first molars. The results of the present study are in accordance with the studies by Rasheed (13).Rotated teeth (>15˚) were found in 38.3% which slightly lower than that found by Hoffding and Kisling (14); and displaced teeth (>1mm) in 19.6% of the sample which less than found by Rasheed (13). The most prevalent molar relationship in the malocclusion was Angle’s class I occlusion in 78.29%of the sample, class II in 19.5% (17.2% division 1 and 2.3% division 2) and 2.3% had class III malocclusion (1.6% postural and 0.7% true). The distribution of the classes of occlusion according to gender was statistically significant for total sample which was in agreement with Rasheed (15) while The distribution of the classes of occlusion among urban and rural males was much alikewhile rural males showed more class II occlusion (25.7%) than urban males (19.9%). However, this was statistically insignificant for total sample that in agreement with that of Al- Huwaizi (16). (Fig. 1) The mean OJ was (3.31± 0.04) ranging from –5.0 to 14.0 mm. urban males had a statistically insignificantly higher mean overjet than urban females. This is in accordance with the findings of Al-Huwaizi (16) (Fig. 2). The mean overbite of the sample was (2.99 ± 0.03). Males had a higher mean overbite (3.11± 0.05) than females (2.88± 0.04).This was statistically significant for total sample as shown in (Fig. 3).Urban males and females had a higher mean overbite (3.06± 0.04) than rural males and females (2.93± 0.04). However, these differences were statistically insignificant for total sample as shown in (Table 3.49) This is in accordance with the findings of Al-Huwaizi (16) (Fig. 3). Figure 1: Distribution of the Angle’s classification by residency and gender. Prevalence of open bite was found to be 1.7%. A total of 5.6% had posterior crossbite ranging from unilateral involving one or several teeth to bilateral and complete which are in correlation with Al-Huwaizi (16)(Table 3). Scissors bite was found to be 2.3%. Median diastema was present in 18.1%. The prevalence was similar in boys and girls (Table 4). Figure 2: Overjet values of the total sample according to residency and gender. Total Baghdad Gender Residency Rusafa Karkh 635 318 317 Male Urban 636 318 318 Female 1271 636 635 Total 633 315 318 Male Rural 634 317 317 Female 1267 632 635 Total 1268 633 635 Male Total 1270 635 635 Female 2538 1268 1270 Total J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry182 Table 3: Distribution of the posterior crossbite according to type by residency and gender N.S: No Significant difference at P > 0.05. Figure 3: Overbite values of the total sample according to residency and gender. Table 4: Distribution of the width (in mm) of the maxillary central diastema by residency and gender. N.S: No Significant difference at P > 0.05. Urban Rural Total M N=635 F N=636 T N=1271 M N=633 F N=634 T N=1267 M N=1268 F N=1270 T N=2538 N % N % N % N % N % n % n % n % n % Unilateral Right 16 2.5 14 2.2 30 2.4 10 1.6 17 2.7 27 2.1 26 2.1 31 2.4 57 2.2 Unilateral 9 1.4 15 2.4 24 1.9 11 1.7 16 2.5 27 2.1 20 1.6 31 2.4 51 2.0 bilateral 8 1.3 11 1.7 19 1.5 6 0.9 10 1.6 16 1.3 14 1.1 21 1.7 35 1.4 Total 33 5.2 40 6.3 73 5.7 27 4.3 43 6.8 70 5.5 60 4.7 83 6.5 143 5.6 Gender differences X 2 = 4.394, d.f. = 3, p-value = 0.222, NS Residency differences X 2 = 0.586, d.f. = 3, p-value = 0.899, NS Urban Rural Total M N= 635 F N=636 T N= 1271 M N= 633 F N=634 T N= 1267 M N= 1268 F N=1270 T N= 2538 N % N % N % N % N % N % N % N % N % 1 mm 68 10.7 71 11.2 139 10.9 55 8.7 55 8.7 110 8.7 123 9.7 126 9.9 249 9.8 2 mm 30 4.7 35 5.5 65 5.1 26 4.1 29 4.6 55 4.3 56 4.4 64 5.0 120 4.7 3 mm 15 2.4 26 4.1 41 3.2 19 3.0 18 2.8 37 2.9 34 2.7 44 3.5 78 3.1 4 mm 1 0.2 2 0.3 3 0.2 6 0.9 2 0.3 8 0.6 7 0.6 4 0.3 11 0.4 5 mm 1 0.2 0 0.0 1 0.1 0 0.0 1 0.2 1 0.1 1 0.1 1 0.1 2 0.1 Total 115 18.1 134 21.1 249 19.6 106 16.7 105 16.6 211 16.7 221 17.4 239 18.8 460 18.1 Mean 0.287 0.357 0.322 0.297 0.284 0.290 0.292 0.321 0.306 S.E. 0.028 0.031 0.021 0.030 0.029 0.021 0.021 0.021 0.015 Gender differences t-test = -0.966, d.f. = 2536, p-value = 0.334, NS Residency t-test = 1.056, d.f. = 2536, p-value = 0.291, NS J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry183 The maxillary anterior region showed the highest prevalence (15.2%) of spacing (≥2mm) and the mandibular anterior region showed the highest prevalence (12.6%) of crowding (≥2mm). The presence of crowding and spacing in the dental arches may be due to dentoalveolar and tooth size and jaw size discrepancies. The high prevalence of crowding may also partly be explained by the occurrence of caries and molar extraction, which causes the migration of the first permanent molar, inclinations and rotations. Anterior irregularities (≥1mm) were found in (18.36 %maxillary and 26.84% mandibular), the results compared with the Chauhan et al. (17) found that their result quite low as compared to the present study.Midline shift (54.34 %) that close to Abdulla (18). Of the sample, 3.0% had palatal soft tissue impingement, and 0.3% had labial soft tissue impingement that revealed close percentage that recorded by Al-Huwaizi(16).Considering gender and residency difference, soft tissue impingement was statistically insignificantly distributed between them (Table 5). Of the sample, (86.60%) had a normal lip form, (10.13%) had a contracting lip form and 83 students (3.27%) had lip trap. Considering gender difference, lip form was statistically significantly distributed between both genders for total sample; Lip form was also statistically significantly distributed between urbans and rurals for total sample as shown in table (Table 6). Table 5: Distribution of the soft tissue impingement according to type by residency and gender Urban Rural Total M N=635 F N=636 T N=1271 M N=633 F N=634 T N=1267 M N=1268 F N=1270 T N=2538 N % N % N % N % N % N % N % N % N % Palatal 16 2.5 19 3.0 35 2.8 26 4.1 14 2.2 40 3.2 42 3.3 33 2.6 75 3.0 Labial 1 0.2 2 0.3 3 0.2 3 0.5 1 0.2 4 0.3 4 0.3 3 0.2 7 0.3 Gender differences X2 = 1.28, d.f. = 2, p-value = 0.527 (NS) Residency differences X2 = 0.511, d.f. = 2, p-value = 0.775 (NS) N.S: No Significant difference at P > 0.05. Regarding perception of occlusion; the presence of malaligned teeth was reported by 39% of the sample. The most prevalent reported types of malaligned teeth were spaced teeth (26.6%); Of the students who stated that they have malaligned teeth, 70.3% thought that it affected their appearance, 17.8% affected chewing, and 7.8% affected speech; The most common reasons for not seeking orthodontic treatment were the thought that treatment is not important or not possible (25.8%) and fear of pain (48.8%), similar to that of Al-Huwaizi (16) and Al-Zubair (20). The treatment need according to DAI show that 72.3% of the sample were found to have no or slight treatment need, 15.9% with treatment elective, 7.3% with treatment highly desirable, and 4.5% with treatment mandatory.This study showed close levels of orthodontic treatment need to that of Al-Huwaizi(16), Tak et al.(19). Considering gender differences, males showed high mean DAI score (23.67± 0.171) to that of females (22.803± 0.161). This was statistically significant for total sample as shown in (Fig 4,5). The rurals showed a slightly higher mean DAI score (24.050 ± 0.252 for males and 22.778 ± 0.227 for females) than for the urbans (23.246± 0.232 for males and 22.829 ± 0.227 for females). This was statistically insignificant for total sample (Fig 4,5). DAI scores where there is severe malocclusion and treatment is highly desirable or mandatory were found more in the rural sample (13.3%) than in the urban sample (10.3%) this was in agreement with Al-Huwaizi(16),Hemapriya et al. (21)and contradicts the findings of Ansai et al.(22) who found that in his sample urban students had significantly higher DAI scores than rural students and this may be attributed to racial differences. This study suggests that there is need for intensified oral health education in rural areas, targeted at both parents and school children to enable them benefit from interceptive orthodontic care which has numerous benefits. J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry184 Figure 4: Distribution of the total sample according to their DAI scores residency and gender. Table 6: Distribution of lip form according to type by residency and gender HS: Highly significant p <0.01. S: significant p<0.05 Figure 5: Distribution of the mean of the total sample according to their DAI scores residency and gender. Perception of occlusion First of all, we will discuss the three questions regarding the past and present orthodontic treatment of the students. Of the sample, 4.8% did or were doing orthodontic treatment, 1.2% had undergone extractions to improve appearance, and 1.7% reported that their treatment was postponed by a dentist for a later time; giving a total of 7.7% of the sample who have had some type of orthodontic treatment or consultation. • Regarding the self-evaluation of the students to the alignment of their teeth, 39.1% of them answered that they have malaligned teeth. • Concerning the type of malaligned teeth, the children reported their malocclusion type as follow with descending sequence of prevalence spaced, crowded, rotated and displaced teeth Awareness of spacing was a highly significant relation between the positive answers to this choice and the presence of spacing. This sequence different from Al-Huwaizi(13). (Table 7). • Of the 991 students who stated that they have malaligned teeth; 70.3% thought that it affected their appearance, 17.76% affected chewing, and 7.77% affected speech, while 4.14% answered that malaligned teeth did not affect appearance or speech. This result is comparable to that found by Al-Huwaizi(13)andAl-Zubair(20)(Table 8). • The most common reason for not seeking orthodontic treatment was that the students thought that treatment is not important, fear of pain, treatment is expensive, and treatment is not possible. The predominance of fear of pain is similar to that of Al-Huwaizi (13) and Al- Zubair (20). (Table 9). Urban Rural Total M F T M F T M F T n % n % n % n % n % n % n % n % n % Normal 526 82.8 562 88.4 1088 85.6 538 85.0 572 90.2 1110 87.6 1064 83.9 1134 89.3 2198 86.6 Contract 87 13.7 60 9.4 147 11.6 53 8.4 57 9.0 110 8.7 140 11.0 117 9.2 257 10.1 Trap 22 3.5 14 2.2 36 2.8 42 6.6 5 0.8 47 3.7 64 5.0 19 1.5 83 3.3 Total 635 100 636 100 1271 100 633 100 634 100 1267 100 1268 100 1270 100 2538 100 Gender differences X 2 = 28.684, d.f. = 2, p-value = 0.000, HS Residency differences X 2 = 6.999, d.f. = 2, p-value = 0.030, S J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry185 Table 7: Distribution of the answers to question 2 regarding the type of malalignment of teeth by residency and gender S: significant p<0.05N.S: No Significant difference at P > 0.05. Table 8: Distribution of the answers to question 3 regarding the effect of the malalignment of teeth by residency and gender Urban Rural Total M N=221 F N=270 T N=491 M N=215 F N=285 T N=500 M N=436 F N=555 T N=991 N % N % N % N % N % N % N % N % N % Appearance 133 60.2 222 82.2 354 72.2 134 62.3 208 73.1 343 68.5 267 61.2 430 77.5 697 70.3 chewing 60 27.1 29 10.8 89 18.2 48 22.3 39 13.6 87 17.4 108 24.8 68 12.3 176 17.8 speech 23 10.4 15 5.6 38 7.7 13 6.0 26 9.1 39 7.8 36 8.3 41 7.4 77 7.8 No effect 5 2.3 4 1.5 9 1.8 20 9.3 12 4.2 32 6.4 25 5.7 16 2.9 41 4.1 Gender differences X2 = 35.736, d.f. = 3, p-value = 0.000, HS Residencey differences X2 = 13.1, d.f. = 3, p-value = 0.004, HS HS: Highly significant p <0.01. Table 9: Distribution of the answers to question 4 regarding the reason for not seeking treatment by residency and gender Urban Rural Total M N=221 F N=270 T N=491 M N=215 F N=285 T N=500 M N=436 F N=555 T N=991 N % N % N % N % N % N % N % N % N % Treatment is not important 67 30.3 55 20.4 122 24.8 77 35.8 57 20 134 26.8 144 33.0 112 20.2 256 25.8 Treatment is not possible 29 13.1 21 7.8 50 10.2 15 7 24 8.4 39 7.8 44 10.1 45 8.1 89 9 Fear of pain 93 42.1 151 55.9 244 49.7 87 40.5 153 53.7 240 48 180 41.3 304 54.8 484 48.8 Fear of extraction 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Treatment is expensive 17 7.7 12 4.4 29 5.9 20 9.3 31 10.9 51 10.2 37 8.5 43 7.7 80 8.1 Postponed by dentist 4 1.8 7 2.6 11 2.2 2 0.9 4 1.4 6 1.2 6 1.4 11 2 17 1.7 No time for treatment 10 4.5 5 1.9 15 3.0 7 3.3 8 2.8 15 3 17 3.9 13 2.3 30 3.0 Fear of crosscontamination 2 0.9 4 1.5 6 1.2 0 0 0 0 0 0 2 0.5 4 0.7 6 0.6 Hope for spontaneous improvement 1 0.5 0 0 1 0.2 2 0.9 1 0.4 3 0.6 3 0.7 1 0.9 4 0.4 Difficult to used it 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 Poor esthetics of appliances 2 0.9 2 0.7 4 0.8 0 0.0 0 0.0 0 0.0 2 0.5 2 0.4 4 0.4 Don’t know 10 4.5 13 4.8 23 4.7 5 2.3 7 2.5 12 2.4 15 3.4 20 3.6 35 3.5 Gender differences X2 = 29.972, d.f. = 9, p-value = 0.000, HS Residency differences X2 = 23.909, d.f. = 9, p-value = 0.004,HS HS: Highly significant p <0.01. Urban Rural Total M N=221 F N=270 T N=491 M N=215 F N=285 T N=500 M N=436 F N=555 T N=991 N % N % N % N % N % N % N % N % N % Crowded 63 28.5 61 22.5 124 25.1 60 27.9 74 26 134 26.8 123 28.2 135 24.3 258 26 Spaced 61 27.6 88 32.6 149 30.2 36 16.7 79 27.7 115 23 97 22.2 167 30.1 264 26.6 Protruded 39 17.6 63 23.3 102 20.6 58 27 62 21.8 120 24 97 22.2 125 22.5 222 22.4 Rotated and displaced 59 26.7 60 22.2 119 24.1 65 30.2 71 24.9 136 27.2 124 28.4 131 23.6 255 25.7 Gender differences X2 = 9.267, d.f. = 3, p-value = 0.026, S Residency differences X2 = 7.239, d.f. = 3, p-value = 0.065, NS J Bagh College Dentistry Vol. 27(3), September 2015 Occlusal features Pedodontics, Orthodontics and Preventive Dentistry186 REFERENCES 1- Proffit WR, Field HW, Sarver DM. Contemporary orthodontics. 5th ed. St. Louis, Mosby Year Book; 2013. 2- Thilander B, Pena L, Infante C, Parada S, Mayorga, CD. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. Eur J Orthod 2001; 23: 153-67. 3- Ciuffolo F, Manzoli L, D’Attilio M, Tecco S, Muratore F, Festa F, Romano F. Prevalence and distribution by gender of occlusal characteristics in a sample of Italian secondary school students: a cross- sectional study. Eur J Orthod 2005; 27: 601- 6. 4- Josefsson E, Bjerklin K, Lindsten R. Malocclusion frequency in Swedish and immigrant adolescents' influence of origin on orthodontic treatment need. Eur J Orthod 2007; 29: 79-87. 5- Kerosuo H, Laine T, Honkala E, Nyyssonen V. Occlusal characteristics among a group of Tanzanian and Finnish urban school children. Angle Orthod 1991; 6:49-55. 6- Abu Alhaija ESJ, Al-Khateeb SN, Al-Nimri KS. Prevalence of malocclusion in 13-15 year-old north Jordanian school children. Community Dent Health, 2005; 22: 266-271. 7- Björk A, Krebs ÅA, Solow B.A method for epidemiological registration of malocclusion. Acta Odontol Scand 1964; 22: 27-41. 8- Helm S. Malocclusion in Danish children with adolescent dentition: an epidemiologic study. Am J Orthod 1968; 54: 356-66. 9- Baume LJ, Horowitz HS, Summers CJ, Backer Dirks O, Carlos JP, Cohen LK.A method for measuring occlusal traits developed by the FDI commission on classification and statistics for oral conditions. Int Dent J 1973; 23: 530-7. 10- Ingervall B, Mohlin B, Thilander B. Prevalence and awareness of malocclusion in Swedish men. Comm Dent Oral Epidemiol 1978; 6: 308-14. 11- Ng’ang’a PM, Stenvik A, Ohito F, Ogaard B. The need and demand for orthodontic treatment in 13- to 15-year-olds in Nairobi, Kenya. Acta Odontol Scand 1997; 55: 325-8. 12- Cons NC, Jenny J, Kohout FJ. The Dental Aesthetic Index: Iowa City. A master thesis, College of Dentistry, University of Iowa, USA, 1986. 13- Rasheed TA. Dental anomalies associated with malocclusion among 13 year old Kurdish students. J Bagh Coll dentistry, 2013; 25(2): 173-78. 14- Hoffding J, Kisling E. Premature loss of primary teeth: Part I: It's over all effect on occlusion and space in the permanent dentition. ASDC J Dent Child. 1978. 15- Rasheed TA. Occlusal features and treatment need among 13 year old Kurdish students in Sulaimania. A master thesis, College of Dentistry, University of Sulaimania. 2005. 16- Al-Huwaizi AF. Occlusal feature, Perception of occlusion, orthodontic treatment need and demand in 13 years old Iraqi student. Ph.D. Thesis, College of Dentistry, Baghdad University, Iraq, 2002. 17- Chauhan D, Sachdev V, Chauhan T, Gupta KK.A study of malocclusion and orthodontic treatment needs according to dental aesthetic index among school children of a hilly state of India. J Inte Soc Pre and Comm Dent 2013; 3(1): 32-7. 18- Abdulla NM. Occlusal features and perception: a sample of (13-17) years old adolescent. A master thesis, College of Dentistry, Baghdad University, 1996. 19- Tak M, Nagarajappa R, Sharda AJ, Asawa K, Tak A, Jalihal S, Kakatkar G. Prevalence of malocclusion and orthodontic treatment needs among 12‑15 years old school children of Udaipur, India. Eur J Dent 2013; 7: 45-53. 20- Al-Zubair NM. Perception of occlusion and reasons for not seeking orthodontic treatment among Yemeni children. J Orthod Res 2014; 2(2): 68-37. 21- Hemapriya S, Ingle NA, Chaly PE, Reddy VC. Prevalence of Malocclusion and Orthodontic Treatment Needs Among 12 and 15 Years Old Rural School Children in Kancheepuram District, Tamilnadu. J Oral Health Comm Dent 2013; 7(2): 84-90. 22- Ansai T, Miyazaki H, Katoh Y, Yamashita Y, Takehara T, Jenny J, Cons NC. Prevalence of malocclusion in high school students in Japan according tothe Dental Aesthetic Index. Community Dent Oral Epidemiol 1993; 21(5): 303-5. الخالصة .ھدف ھذه الدراسة تقییم التوزیع واالنتشار، شدة سوء االطباق في محافظة بغداد على أساس نوع الجنس واالقامة: الخلفیة م ن ) طالب ة 1351طال ب و 1349(طال ب 2700ض مت العین ھ . ددة المراحل تراصفیة قد استعلمت في ھذا البحث كي تجعل العین ھ ممثل ة للمجتم ع طریقة االنتخاب متع: المواد والطرق .من مجموع الطالب بھذا العمر% 3سنة یمثلون 13المدارس المتوسطة بعمر وآل ة verinerتمتعملیةالتقییملخواصاآلطباقبواسطةالفحصالسریریالمباشربأس تعمال ش مل البح ث اس تمارة اس تبیانیة لمعرف ة ادراك الطال ب الطباق ھ والطل ب عل ى المعالج ة التقویمی ة .لقیاساألستدارھواألنحراففیاألسنان . (%26.6)االجایة االكثر انتشارا حول نوع عدم انتظام االس نان كان ت االس نان المتباع دة بنس بة .غیر منتظمةمن الطالب أجابوا بأن عندھم أسنان %) 39.1: (واالستنتاجات النتائج األس باب األكث ر . تؤثر عل ى النط ق % 7.7تؤثر على مضغ الطعام و % 17.7أجابوا بأن أسنانھم تؤثر على مظھرھم و% 70.3فیما یتعلق باألجوبة حول تأثیر االسنان غیر المنتظمة من العینة ك ان ل دیھا س ن أو أكث ر مفق ود بس بب القل ع %) 4.9(%).48.8(والخوف من االلم %) 25.8(شیوعا لعدم طلب المعالجة التقویمیة كان اعتقاد الطالب بأن العالج لیس مھم لت أس نان متباع دة كان ت المنطق ة االمامی ة العلوی ة وأكث ر منطق ة أكث ر منطق ة ش م . أو التعرض الى صدمة خارجیة والسن المقلوع األكثر شیوعا ك ان الض رس االول ف ي الف ك الس فلي في الفك العل وي و % 18.36( التراكبات السنیة االمامیة .0.306من العینة بمعدل % 18.1الفتحة العلویة الوسطیة وجدت في . شملت أسنان متزاحمة كانت المنطقة االمامیة السفلیة م ن العین ة والص نف % 78.29ص نف االطب اق االول وج د ف ي . مل م 2.99مع دل العض ة للعین ة ك ان . مل م 3.31سنان االمامیة للعینة ك ان معدل بروز اال.)في الفك السفلي% 26.84 لخط الوس طي وج د انحراف ا%. 1.7العضة االمامیة المفتوحة في %. 5.6العضة الخلفیة المعكوسة وجدت في . من العینة% 2.3من العینة والصنف الثالث في % 19.5الثاني في م ن العین ة % 72.3التي سجلت في ھ ذه الدراس ة DAIنتیجة ال.من العینة% 3.3اصطدام القواطع باللثة وجدت في .من العینة كان لدیھم شكل شفة طبیعي%) 86.6(%. 54.3في ل دیھم حاج ة الزامی ة % 4.5لدیھم حاجة شدیدة ال ى المعالج ة التقویمی ة و % 7.3و لدیھم حاجة اختیاریة الى المعالجة التقویمیة % 15.9لدیھم حاجة قلیلة الى المعالجة التقویمیة و وھ ذه البیان ات تك ون مفی دة لخدم ة ص حة الف م العام ة وللتأكی د .أیضا زیادة في الحاجة وقلة في الطلب على المعالجة التقویمیة بین المراھقین في مجتمع بغ داد .الى المعالجة التقویمیة .لتقویمیة بین المراھقین في بغدادة اعلى ضرورة المعالج