Malocclusion and Esthetic Perception Among Young Adults in Riyadh Region of Saudi Arabia.

Aim: To assess the malocclusion and esthetic perception among young adults in Riyadh region. Methodology: A total of 667 subjects aged above 6 years were included in this study. Link containing questionnaires were sent through social media, email, and WhatsApp. Questions were related to the effect of malocclusion on oral health such as dental caries, gum disease, difficulty in tooth brushing, perception of their teeth in the way of alignment, and smile personality.
Results: 54.1% of participants said malocclusion can cause dental caries, 63.3% said it will lead to gum disease, and 72% were of the opinion that it will make tooth brushing difficult. 27.9% of study subjects were not happy with the alignment of their teeth. None of the responses were found to be statistically significant according to age (P > 0.05). Most of the questions were statistically significant according to gender (P < 0.05).
Conclusion: Majority of study subjects had good knowledge about malocclusion and oral health. Perception about esthetics was more among women than men. More than 90% of subjects thinks beautiful smile is a part of personality. Copyright:

INTRODUCTION

A person's social interaction is also dependent on his/her esthetic appearance and morphology of their facial structure. Hence esthetics and facial profile play a role in the psychological wellbeing of a person.[12]

Misalignment or incorrect relation between upper and lower teeth or jaws results in malocclusion. Malocclusion which results in facial changes is often self-perceived and affects self-confidence and quality of life.[34567]

Moreover, malocclusion results in periodontal disease, dental caries, and can be a predisposing factor for traumatic dental injuries and temporomandibular joint problems.[89]

The prevalence of malocclusion varies from country to country and also depends on ethnicity, gender, etc. Studies have reported 39%–93% of prevalence of malocclusion.[10]

The reason to take orthodontic treatment to correct malocclusion is a subjective opinion and also depends on the individual's knowledge of how malocclusion affects their appearance, self-esteem, oral health, and quality of life. It also depends on the subject's age and gender.[11] In a study by Essamet and Darout among university students of Saudi Arabia (SA), the authors reported that over 65% of the study sample had a high knowledge of orthodontic treatment needs but no significant variation was found based on age or gender.[12]

The potential barrier for orthodontic treatment is financial costs and the time-consuming nature of the treatment. But the main motivation to get irregular teeth aligned comes from the knowledge of malocclusion and the harm it has on oral health. Hence the present study was undertaken to assess knowledge of malocclusion and esthetic perceptions among young adults in Saudi Arabia.

OBJECTIVES

To assess awareness about malocclusion and esthetic perceptions of young adults in Riyadh region of Saudi Arabia. To compare awareness of malocclusion and esthetic perception according to age, and gender.

METHODOLOGY

This was a cross-sectional study conducted on subjects living in Riyadh, Saudi Arabia. The age group was divided into subjects below 18 years, 18–25 years, and aged above 25 years. Official permission was obtained from the College of Dentistry, Prince Sattam Bin Abdul-Aziz University. A total of 667 subjects were included in the study. The questionnaire consisted of awareness about malocclusion, habits causing malocclusion, dental problems arising due to malocclusion, and self-perceptions about esthetics and interest of taking orthodontic treatment. The questionnaire was in Arabic and English languages. It was sent through social media. i.e., Whatsapp, Snapchat, and Google Form. Those participants denying consent were excluded. Subjects were asked to fill the questionnaire and resend without discussing with anyone.

Sample size

Sample size was estimated using the formula

n = N/1 + Ne2

where

n = sample size

N = total population, i.e., 300000 mv

e = margin of error, kept at 4%

n = 300000/1 + 300000 × 0.05 × 0.05

n = 300000/481

n = 623 samples were found to be sufficient.

A total of 700 questionnaires were sent, out of which 667 were finally considered for analysis.

Validation of questionnaire

To validate the questionnaire, questions were prepared initially in English and then translated to Arabic. Then it was translated back to English.

METHOD

A questionnaire was sent to individuals through social media, i.e., WhatsApp, Snapchat, which also had a consent form and explanation about the study.

Statistical analysis

Descriptive statistics were computed and Chi-squared test with 95% confidence interval (CI) and P value < 0.05 was considered as statistically significant.

RESULTS

77.8% of study participants were aware of the importance of alignment of teeth. 54.1% of study participants thought that malocclusion can cause dental caries, 63.3% thought that malocclusion can cause gum diseases, and 72.0% thought that malocclusion leads to difficulty in tooth brushing [Table 1]. 57.3% of study participants are aware of the different habits that cause malocclusion. Only 48.7% of study participants responded that they were happy with their teeth arrangement. Nearly one-fourth of the participants reported that they were made fun of for their teeth. 91.3% of the participants thought that a beautiful smile is part of one's personality. 65.4% of study participants desired to get their irregular teeth corrected.

Table 1

Response of study participants to questions related to malocclusion and esthetic perceptions

Question	Response	Frequency	Percentage
Are you aware about importance of aligned teeth?	Yes	519	77.8
	No	148	22.2
Do you think malocclusion can cause dental caries?	Yes	361	54.1
	No	306	45.9
Do you think malocclusion can cause gum disease?	Yes	422	63.3
	No	245	36.7
Do you think malocclusion can make tooth brushing more difficult?	Yes	480	72.0
	No	187	28.0
Are you aware of different habits that cause malocclusion?	Yes	285	42.7
	No	382	57.3
Are you happy with the arrangement of your teeth?	Yes	325	48.7
	No	186	27.9
	Not sure	156	23.4
If you are not happy with the arrangement of your teeth, what is the reason?	Irregular	171	25.6
	Gaps	121	18.1
	Forwardly placed	102	15.3
Has anyone made fun of your teeth?	Yes	162	24.3
	No	505	75.7
Are you confident about your smile?	Yes	371	55.6
	No	163	24.4
	Not sure	133	19.9
Are you happy to smile for photographs?	Yes	408	61.2
	No	259	38.8
Do you think a beautiful smile is a part of personality?	Yes	609	91.3
	No	58	8.7
Do you think you require orthodontic treatment to correct your teeth alignment?	Yes	436	65.4
	No	154	23.1

[Table 2 shows a comparison of awareness of malocclusion and esthetic perception according to age. Age group was considered as below 21 years and above 21 years. None of the responses were found to be statistically significant according to age (P > 0.05).

Table 3 shows comparison of awareness of malocclusion and esthetic perception according to gender. Most of the questions were statistically significant according to gender (P < 0.05).

Table 3

Comparison of awareness and perception of malocclusion and esthetics according to gender

Question	Chi-squared test	P	Significance
Are you aware about importance of aligned teeth?	27.98	<0.001	HS
Do you think malocclusion can cause dental caries?	0.111	0.804	NS
Do you think malocclusion can cause gum disease?	4.170	0.049	S
Do you think malocclusion can make tooth brushing more difficult?	2.098	0.168	NS
Are you aware of different habits that cause malocclusion?	8.189	0.005	S
Are you happy with the arrangement of your teeth?	8.892	0.012	S
If you are not happy with the arrangement of your teeth, what is the reason?	8.011	0.046	S
Has anyone made fun of your teeth?	9.549	0.003	S
Are you confident about your smile?	0.619	0.734	NS
Are you happy to smile for photographs?	2.508	0.127	NS
Do you think a beautiful smile is a part of personality?	5.553	0.027	S
Do you think you require orthodontic treatment to correct your teeth alignment?	2.175	0.337	NS

DISCUSSION

Malocclusion is the third major problem after dental caries and periodontal diseases.[8] Malocclusion can cause dental caries and periodontal disease, and even temporomandibular disorders.[9]

Individuals will have differences in their attitude and how they perceive their dental appearance.[13] In the present study, questions were asked regarding malocclusion and its effect on oral health and individual perception of their smile and alignment of teeth.

In the present study, 54.1% of the participants believed malocclusion could cause dental caries and 63.3% believed that it could lead to gum diseases, and 72% were of the opinion that it could cause difficulty in tooth brushing. Some previous studies have shown an association between crowding and dental caries, the reason being the accumulation of plaque.[141516] Even in case of spacing, the same thing will happen and is a risk factor for dental caries.[17]

In the present study, 48.7% of participants were happy with the arrangement of their teeth while 27.9% said they were not, and 23.4% were not sure, making around 50% of the study participants not happy with the arrangement of their teeth. This result is in consistent with the study by Tin-Oo MM, et al.[18] where 52.8% were not satisfied with their dental appearance, and the percentage of non-satisfaction with teeth arrangement was nearly 50%.

In our study, 57.3% of participants responded that they did not know the different habits that cause malocclusion, which is in contrast to studies by Chhabra S, et al.[19] and Hirst et al.[20] who reported 24.9% and 30%, respectively.

In the current study, 55.6% of study participants were confident about their smile and 38.8% were unhappy to smile for photographs. This result is in contrast to a study done by Faizee SH, et al.[21] where 77.7% were confident about their smile and 63.9% were unhappy to smile for photographs.

Poor self-esteem is one of the reasons for participants to say they need orthodontic treatment or correction.[22] In the present study, 65.4% of participants said they may require orthodontic correction of their teeth.

CONCLUSION

The present study revealed that a majority of the study participants had fair knowledge about malocclusion and its effect on oral health. More than 90% of the respondents thought a beautiful smile was a part of one's personality. Further malocclusion is affected in early ages; hence parental knowledge about malocclusion is very important so that they can undergo necessary treatment during the period of 12–13 years to correct malocclusion. Thus, further studies should be considered to learn about parental knowledge and perception about malocclusion.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

Table 2

Comparison of awareness of malocclusion and esthetic perception according to age

Question	Chi-squared test	P	Significance
Are you aware about importance of aligned teeth?	0.139	0.251	NS
Do you think malocclusion can cause dental caries?	3.064	0.093	NS
Do you think malocclusion can cause gum disease?	1.784	0.186	NS
Do you think malocclusion can make tooth brushing more difficult?	3.200	0.076	NS
Are you aware of different habits that cause malocclusion?	0.000	1.000	NS
Are you happy with the arrangement of your teeth?	1.463	0.481	NS
If you are not happy with the arrangement of your teeth, what is the reason?	4.382	0.223	NS
Has anyone made fun of your teeth?	0.208	0.710	NS
Are you confident about your smile?	2.090	0.352	NS
Are you happy to smile for photographs?	2.057	0.164	NS
Do you think a beautiful smile is a part of personality?	0.321	0.671	NS
Do you think you require orthodontic treatment to correct your teeth alignment?	1.558	0.459	NS