Orthodontic treatment need and timing: Assessment of evolutive malocclusion conditions and associated risk factors.

AIM: Orthodontic treatment need indexes are indispensable tools for collecting aepidemiological information, to define the need for clinical intervention on a graduated risk scale and to monitor the evolution of clinical conditions over time. The purpose of this research is to evaluate the prevalence of malocclusion and associated risk factors, and to compare the prevalence of malocclusion related to children's growth. Investigating the correlation between malocclusion and dental occlusion development is crucial to define orthodontic timing and the most suitable treatment modalities. MATERIALS AND METHODS: A cross-sectional, multi-center, observational study was carried out throughout Italy: 4,422 patients aged between 2 and 13 years were visited. The patients were divided into two age groups: one composed of patients aged 2 -7 years, and one of children between 8 and 13 years of age. The prevalence data were classified according to the items of the Baby ROMA (first group, deciduous/early mixed dentition) and ROMA Index (second group, late mixed/permanent dentition). Pearson's Chi-square test was applied for the calculation of statistical significance in the comparison of prevalence data between the two age groups (P <0.05). RESULTS: The need for orthodontic treatment among Italian children is high. In the sample aged between 2 and 7 years, the most frequent malocclusions are the moderate and severe open bite (23%), moderate and severe Class II (21.2%), deep bite (18.8%), cross bite (16.5%), Class III (7.7%), and crowding (5.1%). In the sample aged between 8 and 13 years the most frequent malocclusions are crowding (50.8 %), Class II (33.1%), deep bite (19.2%) crossbite (18.1%), Class III (9.1%), open bite (6.6%), facial or mandibular asymmetries (3.3%), and functional asymmetries (3.2%). It was found a statistically significant variation of the different malocclusion conditions according to age. CONCLUSION: The study confirms that some risk factors occur during growth, and worsen the malocclusion. Therefore, it is important to reduce this risk of worsening by counteracting those factors with an early orthodontic intervention. Some malocclusions are less affected by environmental risk factors. In these case it would be better defer treatment until adolescence.

Association between oral habits, mouth breathing and malocclusion in Italian preschoolers.

AIM: This cross-sectional study was carried out to evaluate the prevalence of malocclusion and associated factors in preschoolers with the aim of assessing the existence of an association between bad habits and mouth breathing with the most severe malocclusions. MATERIALS AND METHODS: A sample of 1616 children aged 3-6 years was visited by applying the Baby ROMA index, an orthodontic treatment need index for preschool age. The following were searched: the prevalence of malocclusion, the association of bad habits and mouth breathing with malocclusion, how often are found in association and how this association is statistically significant. Chi-square and Fischer test were applied to verify the statistical significance of the association between the variables. RESULTS: The data show that 38% of the sample need orthodontic treatment and 46% have signs of malocclusion of less severe degree that require a close monitoring and the elimination of risk factors so that they can improve spontaneously with growth. Moreover the prevalence of bad habits and oral breathing increases with increasing severity of the malocclusion, and sucking habits and oral breathing are both closely related to anterior open bite, posterior crossbite and increased overjet. CONCLUSIONS: In the context of prevention and early treatment of disorders of the craniofacial growth, bad habits and mouth breathing, being risk factors of malocclusion, should be intercepted and corrected early on to prevent the development of malocclusion, or the worsening of existing ones. From this point of view it is important to follow the patients with a multidisciplinary approach.

Association between oral habits, mouth breathing and malocclusion.

The ratio of bad habits, mouth breathing and malocclusion is an important issue in view of prevention and early treatment of disorders of the craniofacial growth. While bad habits can interfere with the position of the teeth and normal pattern of skeletal growth, on the other hand obstruction of the upper airway, resulting in mouth breathing, changes the pattern of craniofacial growth causing malocclusion. Our crosssectional study, carried out on 3017 children using the ROMA index, was developed to verify if there was a significant correlation between bad habits/mouth breathing and malocclusion. The results showed that an increase in the degree of the index increases the prevalence of bad habits and mouth breathing, meaning that these factors are associated with more severe malocclusions. Moreover, we found a significant association of bad habits with increased overjet and openbite, while no association was found with crossbite. Additionally, we found that mouth breathing is closely related to increased overjet, reduced overjet, anterior or posterior crossbite, openbite and displacement of contact points. Therefore, it is necessary to intervene early on these aetiological factors of malocclusion to prevent its development or worsening and, if already developed, correct it by early orthodontic treatment to promote eugnatic skeletal growth.

Early orthodontic treatment: a new index to assess the risk of malocclusion in primary dentition.

AIM: A new index targeted on the risk of malocclusions in primary dentition, called Baby-ROMA (Risk Of Malocclusion Assessment) index, was set up to assess risks/benefits in early orthodontic therapies. The Baby-ROMA index was designed from the observation that some of the malocclusion signs, observed in primary dentition, can worsen with growth, others remain the same over time and others can even improve. Therefore it would be important to classify the malocclusions observed at an early stage on a risk- based scale. MATERIALS AND METHODS: The reliability of the index was tested on 200 children, referred by their paediatricians to two different Orthodontic Departments, aged 4-6 years and in full primary dentition. The children were evaluated by two operators, both trained and calibrated on the use of the Baby-ROMA index. RESULTS: The K test showed a high reproducibility of the index. It is shown that 50% of patients presented malocclusion and crossbite had the highest prevalence, followed by tooth decay and early loss of deciduous teeth and negative overjet. CONCLUSION: The Baby-ROMA index was helpful to assess the severity of malocclusion and the timing for orthodontic treatment in very young patients (primary teeth).

Orthodontic treatment timing in growing patients.

AIM: The aim of the study is to estimate the orthodontic treatment timing for the main occlusal problems in growing patients. STUDY DESIGN: a cross-sectional study was carried out in Italian primary and secondary schools from 2008 to 2011; 1375 males and 1642 females, aged between 8 and 13 years, were visited. The sample is divided into two main groups: primary school and secondary school. Selected malocclusion signs were registered according to an occlusal index (ROMA index) by trained and calibrated operators. Prevalence of increased overjet, Class III malocclusion, crossbite, deep bite and open bite observed in each group are compared. A significant decrease of prevalence with age is considered a sign of spontaneous improvement of the malocclusion. RESULTS: Descriptive analyses were performed using frequencies, percentages and chi-square tests to evaluate differences for categorical variables. The level of significance was set at p ≤0.05. Data were analysed with the software SPSS 19.0 for Windows. Class III malocclusion, moderate or severe crossbite and severe increased overjet and overbite seem not to improve spontaneously. CONCLUSION: Early treatment of orthodontic problems that do not improve with age may be helpful to avoid worsening of the condition in permanent dentition. Moderate Class II malocclusion and crossbite treatment can be postponed.

Prevalence of malocclusion in Italian schoolchildren and orthodontic treatment need.

AIM: The aim of the study was to estimate the prevalence of malocclusion and the need for orthodontic treatment in a sample of 3,017 Italian schoolchildren. STUDY DESIGN: 1,375 males and 1,642 females, aged between 8 and 13 years, were visited in primary and secondary schools. Signs of malocclusion were registered according to an occlusal index by trained and calibrated operators. First the prevalence of malocclusion was calculated in accordance to a scale of need for orthodontic treatment (R.O.M.A. index), which considers both malocclusion signs and risk factors for worsening of malocclusion without any treatment and during craniofacial development. Then the distribution of the most frequent characteristics, signs and symptoms was evaluated both within each risk grade and in the basic sample. RESULTS: The overall percentage of children classified as 3, 4 and 5 grade accounted for 75.8% of the sample. The percentage of children classified as 4 and 5 grade are similar to those found in other European countries. The most frequent features found are poor oral hygiene, caries and early loss of deciduous teeth, deviation from full intercuspation, increased overbite and overjet. CONCLUSION: This epidemiological research describes the current orthodontic treatment need in Italy in children with a late mixed dentition.

Orthodontic treatment need in the Italian child population.

AIM: To assess orthodontic treatment need in the Italian child population using the R.O.M.A. (Risk Of Malocclusion Assessment) Index. STUDY DESIGN: Observational study (cross-sectional). MATERIALS, METHODS AND RESULTS: The ROMA Index was used in examining a sample of 420 children (214 males and 206 females; mean age: 9.3 years), none of whom had previously undergone orthodontic treatment. This basic sample was large enough to become the object of an epidemiological study and to be analysed through inferential statistics. After calculating the prevalence of malocclusion on the basis of the degrees of orthodontic risk determined by the Index, we evaluated the distribution of the most frequent characteristics, signs and symptoms within each risk grade. The percentage of children in each risk category was then worked out, together with its 95% confidence interval, in order to verify whether our results could be generalised to the reference population. Significantly, 50% of the examined children were classified as 'at moderate risk', as defined by grade 3 of the Index (non-severe alterations in dental and/or skeletal relationships, but tending to persist and often worsen with growth). Equally remarkably, a further 36% fell within grade 4 of the Index ('great risk'), presenting major craniofacial skeletal malformations and alterations of the occlusion, often in association with systemic or growth disorders likely to worsen the prognosis. Thus, since patients at moderate or great risk amounted to 86% of the basic sample, it appears that our estimate can be generalised to the reference population of Italian pre-adolescent children. CONCLUSION: The study showed a high percentage of children at moderate or great risk (86%), and that this estimate can be generalised to the reference population of Italian pre-adolescent children. These findings should be taken into great account in devising strategies to improve patient service quality, whether in public or private settings, and also in planning preventive measures and interventions.

Validation of the Risk Of Malocclusion Assessment (ROMA) index.

AIM: The aim of this study was to validate the ROMA (Risk Of Malocclusion Assessment) Index, verifying both its reproducibility and its ability to determine treatment priority. MATERIALS AND METHODS: The levels of treatment priority assessed for 75 children examined at the Gemelli General Hospital Orthodontic Service (Rome) ranged from grade 3 to grade 5 of the index. Multivariate analysis was conducted to verify the influence of covariates on the dependent variable. Moreover, the DHC of the IOTN was assessed for all patients, and a bivariate analysis was carried out to investigate its relationship with the ROMA Index. Intra- and inter- examiner reliability was calculated on a sample of 20 children, and the reproducibility of the index was evaluated using the Kappa statistic as a measure of concordance. RESULTS: It arose that there is an inverse relation between risk grades and the time interval from the first examination and start of treatment. According to the index, patients at extreme risk require immediate treatment, whereas priority is lower in case of great or moderate risk. In statistical terms, the study revealed a significant correlation between the ROMA Index and the DHC of the IOTN. With regard to intra- and inter-examiner reliability, the data collected by the two examiners showed a high level of agreement. CONCLUSION: The ROMA index appears quick to apply, reproducible, reliable and sensitive as a mean for carefully identifying different dento-skeletal problems. Furthermore, it is able to determine the priority of every risk grade and the corresponding timing of treatment.

[Appropriateness of hospitalization in the teaching hospital of Chieti using the P.R.U.O. approach]. / Valutazione dell'appropriatezza dei ricoveri con la metodica P.R.U.O. nell'ospedale clinicizzato di Chieti.

This study describes the results of a research carried out to evaluate inappropriate admissions and totally inappropriate hospitalizations (RTI) in the teaching hospital "SS. Annunziata" of Chieti using the 1999 version of the PRUO manual. A random sample of 1218 medical charts, drawn from all the medical charts of patients admitted from June to December 2000 in the units of Medicine, Surgery and Orthopaedics, was selected. The percentage of inappropriate admissions was 38.2%, while totally inappropriate hospitalizations were 18.1%. The highest percentage of inappropriate admissions was in the class of age 55-64 years. Moreover, inappropriate admissions were more frequent in the morning hours (7:00-12:59) and, within the week, on Monday. The first reason of inappropriateness of the admission, was the execution of diagnostic examinations (62.2%), followed by the execution of medical therapy (19.3%) and waiting of surgical intervention (13.4%). Short hospitalizations (2-3 days) are more frequently totally inappropriate as compared to longer hospitalizations. These findings suggest that a system for the assessment of appropriateness of hospitalizations should be established in the Abruzzo region including all accredited public and private hospitals.