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Year : 2020  |  Volume : 7  |  Issue : 3  |  Page : 124-127

Prevalence of Class 2 Division 1 malocclusion among schoolchildren in Dakshina Kannada, India

Department of Pedodontics and Preventive Dentistry, KVG Dental College and Hospital, Dakshina Kannada, Kannada, India

Date of Submission21-Feb-2020
Date of Decision01-Apr-2020
Date of Acceptance29-May-2020
Date of Web Publication08-Oct-2020

Correspondence Address:
Philu Achaam Philip
Department of Pedodontics, KVG Dental College and Hospital, Kurunjibag, Sullia, Dakshina Kannada - 574 327, Kannada
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jdrr.jdrr_16_20

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Aim: To determine the prevalence of malocclusion in the district of Dakshina Kannada, India. Methodology: The study had a total of 3500 children within the age group of 8–14 years, and they were classified into four groups of normal occlusion, Angle's Class I, Class II Division 1, and Class II Division 2 malocclusion. Results: No statistically significant gender differences among the children were found. Conclusion: The prevalence of malocclusion was 66.6%, with majority of them with a Class I malocclusion (45.2%), followed by Class II Division I malocclusion (17.6%) and least being Class II Division II (3.8%).

Keywords: Functional appliance, malocclusion, prevalence

How to cite this article:
Sathyaprasad S, Philip PA, Vijaynath S, Neethu K S, Manoharan V. Prevalence of Class 2 Division 1 malocclusion among schoolchildren in Dakshina Kannada, India. J Dent Res Rev 2020;7:124-7

How to cite this URL:
Sathyaprasad S, Philip PA, Vijaynath S, Neethu K S, Manoharan V. Prevalence of Class 2 Division 1 malocclusion among schoolchildren in Dakshina Kannada, India. J Dent Res Rev [serial online] 2020 [cited 2023 Jan 30];7:124-7. Available from: https://www.jdrr.org/text.asp?2020/7/3/124/297516

  Introduction Top

Well-aligned teeth and an esthetic smile mirror a positive status and irregular or protruded teeth mirror a negative status at all social levels. In this era, every race and sex, a balanced facial feature is said to be a feast to the eye. Well-aligned teeth give an added boost to the personality of the individual apart from contributing to a healthy oral cavity and stomatognathic system.[1]

Malocclusion compromises the health of oral tissues and also can lead to psychological and social problems.[2] Malocclusion can be defined as an occlusion in which there is mal-relationship between the arches in any of the three planes or anomalies in tooth position beyond normal limits. Early identification of malocclusion can lead to preventive and interceptive measures that can further alleviate the developing malocclusion.[1] The important oral diseases must be subjected to periodic epidemiological surveys according to the World Health Organization.[1] A varying range of prevalence of malocclusion has been reported in different countries, which ranges from 88.1% in Colombia,[3] 62.4% in Saudi Arabia,[4] the United States with a prevalence of 20%–35%,[5] and 20%–43% in India.[6] Analysis of the prevalence rates of malocclusion in such groups may lead us to an understanding of the etiology of malocclusion.[1]

A varied etiology of Class II malocclusion was noticed such as the skeletal, soft tissues, dental-associated factors, genetic, and habits. Class II malocclusion was usually accompanied by the skeletal discrepancies.[7] Protrusion of the maxilla, retrusion of the mandible, and combination of both lead to a skeletal Class II malocclusion.[8] According to McNamara, 75% of Class II skeletal discrepancy cases were reported as a result of mandibular retrognathia.[9] Growth modification, dental camouflage, and orthognathic surgery during growth period, end of growth period, and after the completion of growth, respectively, are the treatment modality available for any skeletal problem.

In a particular population, it is needed to know the incidence of different categories of malocclusion so as to provide the basis for planning preventive and interceptive orthodontics. A rational planning of preventive and therapeutic orthodontic measures in children can be implied when there is proper recognition of malocclusion by public dental health services. Good documentation is valuable from an epidemiologic standpoint because it describes the range of occlusal variations within the community in which preventive and interceptive treatment may be undertaken.

With increasing interest in the early detection and treatment of malocclusion and a corresponding emphasis on preventive and interceptive procedures using various appliances like twin block, headgear etc which can alter the path of growth in the jaws, it would be beneficial to collect more information on patients at younger age levels and minimize the future potential irregularities in the developing dentofacial complex.[10],[11] Therefore, the aim of this study is to estimate the prevalence of Class II malocclusion in school-going children during their mixed dentition period from Dakshina Kannada district, India.

  Materials and Methods Top

The study sample consisted of 3500 children (1774 boys and 1726 girls) aged between 8 and 14 years, and they were randomly chosen from different schools and school camps conducted and held in Dakshina Kannada. The first permanent molars were present in all the chosen candidates and had no previous history or exposure to any kind orthodontic treatment. A single operator examined the entire sample after obtaining an informed consent from the children and their parents. This study was conducted with the approval from the school authority. Using sterile mouth mirror, probe, and flashlight, the children were examined at their respective schools. The children were asked to swallow and then to bite on his or her teeth together so as to maintain a centric occlusion position after which the occlusal relationship was evaluated. A direct lateral view of the dentition in occlusion of each side was recorded after the cheeks were completely retracted. With the first permanent molars as guidance, the occlusion was classified as described by Angle into normal occlusion or malocclusion. Normal was described as children with Class I molar relationship, minimal overbite and overjet, proper alignment, and minimal crowding. Class I malocclusion was described when Class I molar relation existed with one or more of these characteristics: crowded incisors or canines, or both (Dewey Type I), protruded maxillary incisors (Dewey Type II), anterior end-to-end occlusion or anterior crossbite or both (Dewey Type III), unilateral or bilateral posterior crossbite (Dewey Type IV), mesial drift of molars (Dewey Type V), anterior or posterior open bite, and deep anterior overbite.

  Results Top

A total of 3500 children were examined during the survey. Among these, 1774 (50.68%) boys and 1726 (49.31%) girls were participated in the study.

[Table 1] shows the prevalence of every malocclusion in the total sample. Normal occlusion was found in 1169 of the students representing 33.4% of the total sample. One thousand five hundred and eighty-two children comprising 45.2% of the total sample had Class I occlusal relationship. Six hundred and sixteen children representing 17.6% of the sample were found to be have Class II Division I occlusal relationship, whereas 133 children accounting for 3.8% of the sample had Class II Division II occlusal relationship.
Table 1: Occlusal classification

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[Graph 1] shows the graphical representation of various malocclusions in the given sample population.

[Table 2] depicts the gender-wise distribution of various sagittal relationships; there was an equal distribution of various malocclusions among the two six groups. No significant statistical differences were seen among the two groups as tested by the Chi-square test by taking P < 0.05 as statistically significant.
Table 2: Gender distribution of occlusal variations

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[Graph 2] shows the gender-wise distribution of different malocclusions.

  Discussion Top

Skeletal jaw discrepancies in Class II malocclusion are commonly occurred either due to mandibular deficiency or maxillary excess or both. The best time to treat a Class II malocclusion is initiated at the beginning of CS3 cervical vertebral maturation stage at approximately 8–14 years of age that produces maximum treatment effects.[7] Therefore, functional appliances have become part of pedodontic practice. There are different treatment protocols, based on characteristics of the presenting malocclusion, such as anteroposterior discrepancy, age, and patient compliance. The usage of twin block, headgear, bionator, activator, Herbst appliance, and Frankel II regulator gives an effective growth modification in cases characterized by moderate-to-severe skeletal Class II malocclusion.

When stimulation or acceleration of mandibular growth is necessary, functional appliance like twin block is given that is designed to position the mandible downward and forward, thus removing restrictive and abnormal muscular activity that hinders the normal development of both maxilla and mandible. Functional appliances act by altering the muscle tension or by reducing the condylar tissue pressure on the condyle, hence directing the condyle of the mandible out of the fossa which causes additional growth (remodeling of the glenoid fossa more anteriorly). Even though the effect on the maxilla is small, it still restrains maxillary growth.[8]

Headgear is used in cases where Class II Division I is caused due to maxillary prognathism as they deliver an extraoral force to the maxilla in the posterior direction.[9] The result anticipated is the continuous growth of the mandible by suppressing or restricting the normal downward and forward maxillary growth. This is intended so that the mandible will “catch up” with the maxilla, thus correcting the anteroposterior skeletal discrepancy.

A study done by Ghafari et al. found that both the headgear and function regulator were effective in treating the Class II Division I malocclusion of prepubertal children. The common mode of action in these appliances was the possibility to generate differential growth between the jaws.[11]

The prevalence of Class II Division 1 (17.6%), in the present study, was greater than the rates reported by Sridharan et al. (8.8%),[12] Das et al. (6.8%),[2] and Trehan et al. (5.5%).[13] However, Lauc from Hvar Island[14] and Josefsson et al.[15] for a Swedish population found more occurrence of Class II malocclusion in their population (>45%) and explained this as a result of genetic influence.[16]

In this study, results described that 66.6% of the schoolchildren surveyed had presented with a malocclusion of which Class 1 malocclusion was 45.2%, Class II Division 1 was 17.6%, and Class II Division 2 was 3.8%. This goes hand in hand to the findings of Prasad A Rajendra and Savadi S where an epidemiological study was conducted to evaluate the malocclusion in the age group of 5–15 years in Bengaluru city, who reported a high incidence of malocclusion representing 85.7% of the population with 51.5% presenting with Class I, 4% with Class II, and 0.9% with Class III. The study also resembles the findings of Das et al.,[2] who performed an epidemiological study of malocclusion within the age group of 8–12 years in Bengaluru city in 2008, and had reported a high incidence of malocclusion, represented by 71% of the sample. The findings of this present study differ from the studies conducted by Das et al.[2] who found only a 28.8% prevalence of malocclusion in schoolchildren in Udupi, Karnataka. These contrasting findings may be due to change in the geographical location and lifestyles. In addition to it is also in accordance with those of Trehan et al.[13] who reported 36.6% as the prevalence of malocclusion in Delhi, while Sidhu in their study found a higher prevalence rate of Angle's malocclusion of 90% in the age group of 6–30 years.[17] In this study, the prevalence of Class II malocclusion shows 21.4% which is less than the study conducted by Panhalkar et al.[18] in Maharashtra where it was showed to be 32.7%. This difference can be explained due to the difference in socioeconomic status in two areas. This is similar to the findings done by Khandelwal et al. who found 46.59% of Class II malocclusion in 201 males hailing from Indore.[19]

There was no significant difference between boys and girls and neither in the overall prevalence of malocclusion nor in various forms of malocclusion.

  Conclusion Top

A. Prevalence of malocclusion was found to 66.6%

B. Class II Division 1 malocclusion was found to be 17.6%

C. No statistically significant sex differences were found among the children.

From the results of the study, it can be concluded that Class II Division I malocclusion is one of the most commonly affecting, i.e., 17% of the population in 8–14-year-old age. Along with these results, a high percentage of cases with Class I malocclusion were found.

Knowledge of the prevalence of malocclusion in these age groups helps in utilizing the growth spurts and growth potentials, which improves the facial profile, thereby reducing psychological trauma and significantly reducing the severity of future orthodontic and orthopedic corrections. Thus, pedodontists can play a pivotal role in the interception of these malocclusions at the grass-root level, thereby decreasing the financial expense of the future laborious orthodontic and orthopedic corrections.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

Siddegowda R, Satish RM. The prevalence of malocclusion and its gender distribution among Indian school children: An epidemiological survey. SRM J Res Dent Sci 2014;5:224.  Back to cited text no. 1
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Das UM, Venkatsubramanian, Reddy D. Prevalence of malocclusion among school children in Bangalore, India. Int J Clin Pediatr Dent 2008;1:10-2.  Back to cited text no. 2
Thilander B, Pena L, Infante C, Parada SS, de Mayorga C. Prevalence of malocclusion and orthodontic treatment need in children and adolescents in Bogota, Colombia. An epidemiological study related to different stages of dental development. Eur J Orthod 2001;23:153-67.  Back to cited text no. 3
Al-Emran S, Wisth PJ, Böe OE. Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia. Community Dent Oral Epidemiol 1990;18:253-5.  Back to cited text no. 4
Proffit WR, Fields HW Jr., Moray LJ. Prevalence of malocclusion and orthodontic treatment need in the United States: Estimates from the NHANES III survey. Int J Adult Orthodon Orthognath Surg 1998;13:97-106.  Back to cited text no. 5
Shivakumar KM, Chandu GN, Reddy VV, Shafiulla MD. Prevalence of malocclusion and orthodontic treatment needs among middle and high school children of Davangere city, India by using Dental Aesthetic Index. J Indian Soc Pedod Prev Dent 2009;27:211-8.  Back to cited text no. 6
[PUBMED]  [Full text]  
Proffit WR, Fields HW Jr., Sarver DM. Contemporary Orthodontics. Elsevier Health Sciences; 2006.  Back to cited text no. 7
Bishara S. Textbook of Orthodontics. Saunders Company; 2001. p. 336-43, 218-20.  Back to cited text no. 8
Rita SN, Sadat SA. Growth modification in Class II malocclusion: A review. Update Dent Coll J 2014;4:23-6.  Back to cited text no. 9
Peter S. Epidemiology, etiology and classification of malocclusion. In: Preventive and Community Dentistry. 3rd ed.. New Delhi: Arya Publishing House; 2006.  Back to cited text no. 10
Ghafari J, Shofer FS, Jacobsson-Hunt U, Markowitz DL, Laster LL. Headgear versus function regulator in the early treatment of Class II, division 1 malocclusion: A randomized clinical trial. Am J Orthod Dentofacial Orthop 1998;113:51-61.  Back to cited text no. 11
Sridharan K, Udupa V, Srinivas H, Kumar S, Sandbhor S. Prevalence of class II malocclusion in Tumkur population. J Dent Sci Res 2011;2:1-5.  Back to cited text no. 12
Trehan M, Chugh VK, Sharma S. Prevalence of malocclusion in Jaipur, India. Int J Clin Pediatr Dent 2009;2:23-5.  Back to cited text no. 13
Lauc T. Orofacial analysis on the Adriatic Islands: An epidemiological study of malocclusions on Hvar Island. Eur J Orthod 2003;25:273-8.  Back to cited text no. 14
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.  Back to cited text no. 15
Bilgic F, Gelgor IE, Celebi AA. Malocclusion prevalence and orthodontic treatment need in central Anatolian adolescents compared to European and other nations' adolescents. Dental Press J Orthod 2015;20:75-81.  Back to cited text no. 16
Kharbanda, Sam S. Prevalence studies on malocclusion in India: Retrospect and prospect. J Indian Orthod Soc 1993;24:115-8.  Back to cited text no. 17
Panhalkar P, Yusuf AR, Garinger CR, Pawar RL, Phaphe SA, Mane PN. Prevalence of malocclusion among school children in western Maharashtra. Int J Appli Dent Sci 2018;4:39-44.  Back to cited text no. 18
Khandelwal A, Jalili VP, Jain S. Incidence of malocclusions in males of Indore, Malwa. J Indian Dent Assoc 2010;4:357-8.  Back to cited text no. 19


  [Table 1], [Table 2]


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