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     Malocclusion is defined as the condition when the dental arches are
mal-related to each other or there is irregularity in teeth positions beyond
the normal limits (Walther et al., 1994), it is mostly a developmental
condition rather than pathological (Meer et al., 2016) and according to
WHO, dental malocclusion comes in the third place after dental caries and
periodontal disease as the most prevalent oral pathosis (WHO, 1962).

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     There are
many suggested etiological factors of malocclusion, this may include inherited
traits such as abnormal teeth number, form, jaw size and form, or acquired due
to habits such as nails biting, thumb sucking and premature loss of predecessor’s
teeth or in retained deciduous and delayed eruption of permanent one, or combination
of both causes (G Dale, 1985).

     As a result of malocclusion, dental caries and periodontal diseases
might be initiated (Greiger, 2001) and due to the unpleasant dentofacial
appearance, some psychosocial problems might be developed (Kenealy et al.,
1989). Malocclusion could also have unfavorable effects on oral functions
including: mastication, swallowing, and speech (Proffit and Fields, 2000). Furthermore,
if malocclusion remains untreated it will increase
incidence of temporomandibular joint disorders (Housten, 2000). A study was
conducted in Abah city, Saudi Arabia has reported that 42.8% of 250 patients
attending dental clinics had a definitive degree of malocclusion, and the
prevalence of TMD among them was 41.6% (Haralur et al., 2014).

     So since malocclusion
may affect patient’s functions and appearance, it is better to be identified
and treated at early stages to avoid more complications (ADA, adopted 1995,
Revised 1997) and to give more favorable prognosis (Adib, et al., 2010).

    According to numerous previous studies, the prevalence
of malocclusion is widely various among several populations around the whole
world, these variations may be due to the different age, number and ethnicity
of the studied populations (Abu Alhaija et al., 2005). Another important
factor that could be contributed in the variations of malocclusion, is the
diverse registration methods (Mtaya et al., 2009). “Pattern of skeletal
and dental malocclusions in Saudi orthodontic patients differs, based on the
variability of the methods used to assess the anteroposterior jaw-base
relationship” (Aldrees, 2012).

Table 1 is taken as it is form a previous study, it is showing the
various prevalence of malocclusion in different populations, with different age,
using dissimilar registration methods (Mtaya et al., 2009).











     For the
local previous studies, in southern region of Saudi Arabia, a study was
conducted, included only males but with a huge cross section of different
ethnicities, the prevalence of malocclusion was high and crowding was the
highest recorded trait (Meer, et al., 2016).

     While in
Riyadh, Moshabab A Asiry, reported that predominance of class I
molar and canine relationships among 1825 Saudis (1007 males and 818 females)
of 12-16 years old, crowding followed by spacing was the most prevalent
malocclusion trait (Asiry, 2015).

     For the
eastern region of Saudi Arabia, a study was conducted on 330 female patients
who attended orthodontic screening clinic in Dammam Central Hospital, the
sample was divided into two groups; adolescents (12-17 years) and adult (18-35
years), representing 23% and 77% of the total sample respectively. The study
revealed that adolescents had more discrepancies in overjet and overbite as
well as spacing problems than adults and the most common reasons for seeking
orthodontic treatment among the two groups, were crowding and spacing (Albarakati and Taher, 2010).

     If we take a look outside of Saudi Arabia,
we find that more than 70% of young adolescent Kuwaitis had moderate to severe
malocclusion, with incisor malalignment. (Behbehani et al., 2005). While in Turkey only 3.5% of
1507 patients had normal occlusion (Celikoglu et al., 2004).

    On the other hand, a study in Denmark approved there is a strong relationship
between malocclusion and temporomandibular disorders (TMD), that the most
prevalent signs and symptoms of TMD among the studied subjects (104 children
aged 7-13 with different severity of malocclusions) were weekly headache and
tenderness in many facial muscles (Sonnesen et
al., 1998).

     In Colombia, South America, 88% of 4724
children aged 5-17 years had mild to severe occlusal and dental anomalies as
well as spacing discrepancies (Thilander et al., 2001).

     Therefore, it is mandatory to screen the
status of occlusion and understand
the overall picture of the disease prevalence to develop the proper prevention
and treatment programs.

 And since there are insufficient existing
studies about prevalence of malocclusion in Saudi Arabia, which are only
confined to certain regions of the country, further studies in the other
regions, would be of a great benefit in assessing and improving the resources
needed to overcome the increasing number cases of malocclusion. Thus, the aim
of this study was to assess the prevalence of
malocclusion among school children in Makkah city for the previous mentioned


and method


    The study was conducted in Makkah City,
Saudi Arabia, among 400 Saudi schoolchildren (200 females and 200 males) aged
12-15 years. The sample was selected from ten intermediate schools which
randomly chosen from different five areas included; east, west, north, south
and middle of Makkah city (2 schools pre each province).

    The subjects were selected randomly
according to the inclusion and exclusion criteria, only the Saudi students who
had full erupted dentition mesial to first molars were included. While the ones
who had caries or large restorations, missing teeth, previous orthodontic
treatment, previous extractions or maxillofacial surgeries or syndromes were excluded
from the study.

Ethics and Human Subjects Issues:

     Ethical approval from institutional reviewing board was given and an
informed consent was signed by the participant’s parents after
explaining the purpose and style of the study.

Validity of The Data:

     The examiners were calibrated through a
power point presentation that covers the different aspects of the entire
examination in addition to the Inter-examiner and Intra-examiner agreement were
assessed at two separate occasions to ensure repeatability of the collected

Clinical examination:

     Clinical examination was carried out in
each school by 4 examiners using a disposable mouth mirror, ruler (start
numbering with zero) and light source. The following traits were recorded:

relationship for right and left side recorded according to Angel’s Classification:

–       Class I: Mesiobuccal cusp of the upper first molar occludes with
Mesiobuccal groove of the lower first molar in maximum intercuspation.

–       Class II: Mesiobuccal cusp of upper first molar occludes mesial to
Mesiobuccal groove of the lower first molar in maximum intercuspation.

–       Class III: Mesiobuccal cusp of upper first molar
occludes distal to Mesiobuccal groove of the lower first molar in maximum

·      Canine relationship for both right and left side:

–       Class I: Maxillary canine cusp tip occludes with the embrasure
between the mandibular canine and first premolar.

–       Class II: Maxillary canine cusp tip occludes mesial to the embrasure
between the mandibular canine and first premolar.

–       Class III: Maxillary canine cusp tip occludes distal to the embrasure
between the mandibular canine and first premolar.

Missing teeth: Due to other reasons than
extraction, such as congenitally missing or being impacted.

·      Crowding/Spacing: which can be classified according to the amount
in mm into:

–       Mild: more than zero up to 4 mm

–       Moderate: more than 4 mm up to 8 mm

–       Severe: more than 8 mm

·      Overjet: It’s the amount of horizontal overlap the upper incisors make
with the lower incisors in maximum intercuspation. Its Normal range 2-5 mm.

·      Overbite: It’s the amount of vertical overlap the upper incisors
make with lower incisors in maximum intercuspation and measured in thirds (how
many thirds of the clinical. The normal range 1/3 – 1/2.

·      Anterior crossbite: Occurs when the upper incisors occlude lingual
to lower incisors.

·      Posterior crossbite: Occurs when the buccal cusps of the upper
teeth occlude medial to the buccal grooves/embrasures between the lower buccal
segment teeth.

·      Scissor’s bite: Occurs when the lower buccal segment teeth are completely
confined within the upper buccal segment teeth.

·      Maxillary diastema: When there is a space between the upper central

deciduous teeth.

Statistical analyses:

     Statistical Package for
social sciences (SPSS) version 20 was used to enter and analyze the obtained
data. Descriptive statistic was carried out to determine prevalence, mean, median
and standard deviation of the sample. The P value for statistical significance
was set at 0.05.


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