Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample Size Calculation and Sample Selection
2.2. Inclusion and Exclusion Criteria
2.3. Questionnaire Survey
- Part I: The child’s background information, age, and sex;
- Part II: The child’s deleterious oral habits: digit-sucking, lip-biting, tongue-thrusting, object-biting, bruxism, unilateral chewing, and mouth-breathing;
- Part III: The child’s feeding pattern: infant feeding practice in the first 6 months of life, duration of breastfeeding and bottle feeding, pacifier use, delivery method, and gestational age at delivery.
2.4. Oral Examination
2.4.1. The Sagittal Relationship of the Second Primary Molars
- Flush terminal plane: The distal surfaces of the maxillary and mandibular second primary molars were in the same vertical plane.
- Distal step: The distal surface of the mandibular second primary molar lay distal to that of the maxillary second primary molar.
- Mesial step: The distal surface of the mandibular second primary molar lay mesial to that of the maxillary second primary molar.
- The sagittal relationship of the primary molars was recorded as distal or mesial step if the flush terminal plane was on one side and the distal or mesial step was on the other side.
2.4.2. The Sagittal Relationship of the Primary Canines
- Class I: The distal surface of the mandibular primary canine and cusp tip of the maxillary primary canine were on the same vertical plane.
- Class II: The distal surface of the mandibular primary canine lay distal to the cusp tip of the maxillary primary canine.
- Class III: The distal surface of the mandibular primary canine lay mesial to the cusp tip of the maxillary primary canine.
- The sagittal relationship of the primary canines was recorded as class II or III if class I was on one side and class II or III was on the other side.
2.4.3. Sagittal Anomalies
- Overjet (mm): Examiners measured the distance between the incisal edge of the most protruded upper primary incisor and labial surface of the corresponding lower primary incisor, parallel to the occlusal plane. Overjet was categorized as normal (>0 mm and ≤4 mm), increased (>4 mm), and edge-to-edge (upper and lower incisal edges met edge-to-edge) incisor relationship.
- Anterior crossbite was diagnosed when any upper primary incisor or canine was positioned inside the lingual surfaces of the lower front teeth.
2.4.4. Vertical Anomalies
- Deep overbite was diagnosed when the coverage of the lower incisors by the most protruded upper primary incisor was more than half.
- Anterior open bite was diagnosed if no vertical overlap was found between the upper and lower primary incisors when the posterior teeth were in contact.
2.4.5. Transversal Anomalies
- Posterior crossbite was diagnosed when any lower primary posterior tooth was placed buccal to the upper primary molars. Both unilateral and bilateral posterior crossbites were recorded.
- Scissor bite was diagnosed if one or more maxillary molars were occluded buccally to the buccal surfaces of the mandibular molars.
- Midline deviation was diagnosed if the midline of the mandibular primary incisors had a deviation ≥2 mm from that of the maxillary primary incisors.
2.4.6. Space Discrepancies
- Crowding was diagnosed if overlapping of erupted primary teeth was >2 mm.
- Spacing was diagnosed if the generalized space between the primary teeth was >2 mm.
2.5. Statistical Analysis
3. Results
3.1. Association between Dental Caries and Malocclusion
3.2. Association between Deleterious Oral Habits and Malocclusion
3.3. Association between Feeding/Delivery Methods and Malocclusion
3.4. Binary Logistic Regression Analysis of Relative Factors and Deep Overbite
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Age and Sex | n | % | Malocclusion | p Value | |
---|---|---|---|---|---|
n | % | ||||
Age | |||||
3 | 170 | 11.7 | 133 | 78.2 | 0.001 * |
4 | 743 | 51.1 | 518 | 69.7 | |
5 | 541 | 37.2 | 342 | 63.2 | |
Sex | |||||
Boy | 769 | 52.9 | 516 | 67.1 | 0.300 |
Girl | 685 | 47.1 | 477 | 69.6 | |
Total | 1454 | 100.0 | 993 | 68.3 |
Variable | Age 3 (Year) | Age 4 (Year) | Age 5 (Year) | Total | p Value | ||||
---|---|---|---|---|---|---|---|---|---|
n | % | n | % | n | % | n | % | ||
Molar relationship | |||||||||
Flush terminal plane | 96 | 56.5 | 442 | 59.5 | 310 | 57.3 | 848 | 58.3 | 0.524 |
Distal step | 30 | 17.6 | 112 | 15.1 | 101 | 18.7 | 243 | 16.7 | |
Mesial step | 44 | 25.9 | 189 | 25.4 | 130 | 24.0 | 363 | 25.0 | |
Canine relationship | |||||||||
Class I | 94 | 55.3 a | 483 | 65.0 a | 350 | 64.7 a | 927 | 63.8 | 0.008 * (b < a) |
Class II | 43 | 25.3 a | 164 | 22.1 a | 138 | 25.5 a | 345 | 23.7 | |
Class III | 33 | 19.4 a | 96 | 12.9 a,b | 53 | 9.8 b | 182 | 12.5 | |
Sagittal Anomalies | |||||||||
Increased overjet | 18 | 10.6 | 92 | 12.4 | 72 | 13.3 | 182 | 12.5 | 0.638 |
Edge-to-edge incisor relationship | 2 | 1.2 | 20 | 2.7 | 17 | 3.1 | 39 | 2.7 | 0.384 |
Anterior crossbite | 22 | 12.9 | 66 | 8.9 | 25 | 4.6 | 113 | 7.8 | 0.001 * |
Vertical Anomalies | |||||||||
Deep overbite | 92 | 54.1 | 368 | 49.5 | 247 | 45.7 | 707 | 48.6 | 0.122 |
Anterior open bite | 2 | 1.2 | 10 | 1.3 | 5 | 0.9 | 17 | 1.2 | 0.786 |
Transversal Anomalies | |||||||||
Posterior crossbite | 1 | 0.6 | 1 | 0.1 | 0 | 0 | 2 | 0.1 | - |
Scissor bite | 0 | 0 | 2 | 0.3 | 0 | 0 | 2 | 0.1 | - |
Midline deviation | 14 | 8.2 | 56 | 7.5 | 47 | 8.7 | 117 | 8.0 | 0.752 |
Space Discrepancies | |||||||||
Crowding | 22 | 12.9 | 69 | 9.3 | 61 | 11.3 | 152 | 10.5 | 0.273 |
Spacing | 80 | 47.1 | 398 | 53.6 | 293 | 54.2 | 771 | 53.0 | 0.247 |
Variable | Frequency (%) | Caries Prevalence | |
---|---|---|---|
n (%) | p Value | ||
Molar relationship | |||
Flush terminal plane | 848 (58.3%) | 619 (73.0%) | 0.287 |
Distal step | 243 (16.7%) | 172 (70.8%) | |
Mesial step | 363 (25.0%) | 277 (76.3%) | |
Canine relationship | |||
Class I | 927 (63.8%) | 691 (74.5%) | 0.058 |
Class II | 345 (23.7%) | 237 (68.7%) | |
Class III | 182 (12.5%) | 140 (76.9%) | |
Sagittal Anomalies | |||
Increased overjet | |||
Presence | 182 (12.5%) | 134 (73.6%) | 0.955 |
Absence | 1272 (87.5%) | 934 (73.4%) | |
Edge-to-edge incisor relationship | |||
Presence | 39 (2.7%) | 31 (79.5%) | 0.387 |
Absence | 1415 (97.3%) | 1037 (73.3%) | |
Anterior crossbite | |||
Presence | 113 (7.8%) | 79 (69.9%) | 0.375 |
Absence | 1341 (92.2%) | 989 (73.8%) | |
Vertical Anomalies | |||
Deep overbite | |||
Presence | 707 (48.6%) | 476 (67.3%) | <0.001 * |
Absence | 747 (51.4%) | 592 (79.3%) | |
Anterior open bite | |||
Presence | 17 (1.2%) | 12 (70.6%) | 0.785 |
Absence | 1437 (98.8%) | 1056 (73.5%) | |
Transversal Anomalies | |||
Posterior crossbite | |||
Presence | 2 (0.1%) | 1 (50.0%) | - |
Absence | 1452 (99.9%) | 1067 (73.5%) | |
Scissor bite | |||
Presence | 2 (0.1%) | 2 (100.0%) | - |
Absence | 1452 (99.9%) | 1066 (73.4%) | |
Midline deviation | |||
Presence | 117 (8.0%) | 89 (76.1%) | 0.504 |
Absence | 1337 (92.0%) | 979 (73.2%) | |
Space Discrepancies | |||
Crowding | |||
Presence | 152 (10.5%) | 115 (75.7%) | 0.515 |
Absence | 1302 (89.5%) | 953 (73.2%) | |
Spacing | |||
Presence | 771 (53.0%) | 532 (69.0%) | <0.001 * |
Absence | 683 (47.0%) | 536 (78.5%) |
Variable | Prevalence of Deep Overbite (Present/Total) | p Value | Prevalence of Increased Overjet (Present/Total) | p Value | Prevalence of Crowding (Present/Total) | p Value |
---|---|---|---|---|---|---|
Digit-sucking | ||||||
Presence | 43.8% (179/409) | 0.021 * | 13.9% (57/409) | 0.307 | 9.5% (39/409) | 0.474 |
Absence | 50.5% (528/1045) | 12.0% (125/1045) | 10.8% (113/1045) | |||
Lip-biting | ||||||
Presence | 67.0% (75/112) | <0.001 * | 20.5% (23/112) | 0.009* | 17.0% (19/112) | 0.021 * |
Absence | 47.1% (632/1342) | 11.8% (159/1342) | 9.9% (133/1342) | |||
Tongue-thrusting | ||||||
Presence | 48.6% (34/70) | 0.993 | 10.0% (7/70) | 0.515 | 10.0% (7/70) | 0.899 |
Absence | 48.6% (673/1384) | 12.6% (175/1384) | 10.5% (145/1384) | |||
Object-biting | ||||||
Presence | 51.5% (102/198) | 0.381 | 16.7% (33/198) | 0.059 | 6.6% (13/198) | 0.057 |
Absence | 48.2% (605/1256) | 11.9% (149/1256) | 11.1% (139/1256) | |||
Bruxism | ||||||
Presence | 46.6% (144/309) | 0.423 | 15.5% (48/309) | 0.072 | 10.0% (31/309) | 0.785 |
Absence | 49.2% (563/1145) | 11.7% (134/1145) | 10.6% (121/1145) | |||
Unilateral chewing | ||||||
Presence | 49.2% (30/61) | 0.929 | 6.6% (4/61) | 0.160 | 8.2% (5/61) | 0.557 |
Absence | 48.6% (677/1393) | 12.8% (178/1393) | 10.6% (147/1393) | |||
Mouth-breathing | ||||||
Presence | 44.2% (50/113) | 0.333 | 13.3% (15/113) | 0.800 | 13.3% (15/113) | 0.309 |
Absence | 49.0% (657/1341) | 12.5% (167/1341) | 10.2% (137/1341) |
Variable | Prevalence of Deep Overbite (Present/Total) | p Value | Prevalence of Increased Overjet (Present/Total) | p Value | Prevalence of Crowding (Present/Total) | p Value |
---|---|---|---|---|---|---|
Feeding methods in first 6 months | ||||||
exclusive breastfeeding | 47.7% (353/740) | 0.697 | 11.9% (88/740) | 0.683 | 9.9% (73/740) | 0.207 |
exclusive bottle-feeding | 48.2% (92/191) | 14.1% (27/191) | 14.1% (27/191) | |||
mixed feeding | 50.1% (262/523) | 12.8% (67/523) | 9.9% (52/523) | |||
Duration of breastfeeding | ||||||
Never | 48.2% (92/191) | 0.802 | 14.1% (27/191) | 0.686 | 14.1% (27/191) | 0.302 |
0–6 months | 49.4% (196/397) | 13.1% (52/397) | 10.6% (42/397) | |||
6.1–12 months | 49.5% (289/584) | 12.5% (73/584) | 9.2% (54/584) | |||
>12 months | 46.1% (130/282) | 10.6% (30/282) | 10.3% (29/282) | |||
Duration of bottle-feeding | ||||||
0–12 months | 50.5% (214/424) | 0.602 | 12.3% (52/424) | 0.703 | 10.1% (43/424) | 0.935 |
12.1–18 months | 48.8% (181/371) | 13.7% (51/371) | 10.2% (38/371) | |||
>18 months | 47.3% (312/659) | 12.0% (79/659) | 10.8% (71/659) | |||
Use of pacifier | ||||||
Yes | 46.3% (107/231) | 0.445 | 13.0% (30/231) | 0.814 | 12.6% (29/231) | 0.256 |
No | 49.1% (600/1223) | 12.4% (152/1223) | 10.1% (123/1223) | |||
Way of delivery | ||||||
Natural labor | 48.8% (441/903) | 0.835 | 12.0% (108/903) | 0.411 | 11.0% (99/903) | 0.417 |
Cesarean section | 48.3% (266/551) | 13.4% (74/551) | 9.6% (53/551) | |||
Gestational age | ||||||
Preterm birth | 54.1% (59/109) | 0.151 | 17.4% (19/109) | 0.247 | 10.1% (11/109) | 0.772 |
Term birth | 47.6% (595/1250) | 12.2% (153/1250) | 10.3% (129/1250) | |||
Posterm birth | 55.8% (53/95) | 10.5% (10/95) | 12.6% (12/95) |
Variable | Prevalence of Deep Overbite (Present/Total) | OR (95%CI) |
---|---|---|
Dental caries in anterior maxillary teeth | ||
Presence | 58.5% (581/993) | 0.70 (0.56–0.86) |
Absence | 66.2% (305/461) | |
Digit-sucking | ||
Presence | 43.8% (179/409) | 0.73 (0.58–0.92) |
Absence | 50.5% (528/1045) | |
Lip-biting | ||
Presence | 67.0% (75/112) | 2.36 (1.56–3.56) |
Absence | 47.1% (632/1342) |
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Lin, L.; Chen, W.; Zhong, D.; Cai, X.; Chen, J.; Huang, F. Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study. Healthcare 2023, 11, 1050. https://doi.org/10.3390/healthcare11071050
Lin L, Chen W, Zhong D, Cai X, Chen J, Huang F. Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study. Healthcare. 2023; 11(7):1050. https://doi.org/10.3390/healthcare11071050
Chicago/Turabian StyleLin, Lude, Wanting Chen, Dejun Zhong, Xiayuan Cai, Jieyi Chen, and Fang Huang. 2023. "Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study" Healthcare 11, no. 7: 1050. https://doi.org/10.3390/healthcare11071050
APA StyleLin, L., Chen, W., Zhong, D., Cai, X., Chen, J., & Huang, F. (2023). Prevalence and Associated Factors of Malocclusion among Preschool Children in Huizhou, China: A Cross-Sectional Study. Healthcare, 11(7), 1050. https://doi.org/10.3390/healthcare11071050