Document Type : Original Article
Department of Dental Services, Muhimbili National Hospital, Dar es Salaam, Tanzania Department of Orthodontics Paedodontics and Community Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
Aim: The aim of this study was to assess the association between malocclusion, self-perception, self-esteem, and socio-demographic factors among primary schoolchildren in Dar es Salaam, Tanzania.
Methods: This was an analytical cross-sectional study that involved children aged 10-12 years from primary schools in Dar es Salaam. A questionnaire was used to obtain information about the participants’ socio-demographics, self-perception and self-esteem. Clinical examination was done to determine their occlusal statuses. Data were analyzed using SPSS software (version 22.0), and Chi-square test and logistic regression model were used to assess statistically significant differences between variables. P<0.05 was considered as significant.
Results: A total of 620 schoolchildren participated in this study. The overall prevalence of malocclusion was 66.5%. Undesirable self-perception was reported in 34.0% and self-esteem issues in 30.0% of the schoolchildren. Significantly, many participants with less educated fathers had malocclusion compared with their counterparts (p=0.002). Furthermore, most children with malocclusion perceived themselves negatively and reported lower self-esteem compared with those who had no malocclusion (78.7% vs. 21.3%, p=0.000 and 75.8% vs. 24.2%, p=0.001, respectively). In the logistic regression model, the presence of malocclusion remained as a significant determinant of schoolchildren perceiving themselves negatively and reporting lower self-esteem (OR: 2.4, CI: 1.62-3.54, p= 0.000 and OR: 1.82, CI: 1.23-2.7, p= 0.003, respectively).
Conclusion: Conclusion: The presence of malocclusion was associated with children's negative self-perception and lower self-esteem. Malocclusion prevention and early interventions in children are highly recommended.
- Singh G. Fixed orthodontic appliances. Text book of orthodontic. New Delhi: Jaypee Publishers; 2007.
- Dhar V, Jain A, Van Dyke TE, Kohli A. Prevalence of gingival diseases, malocclusion and fluorosis in schoolgoing children of rural areas in Udaipur district. J Indian Soc Pedod Prev Dent. 2007;25(2):103-5. doi: 10.4103/0970-4388.33458. PMID: 17660647.
- Seehra J, Fleming PS, Newton T, DiBiase AT. Bullying in orthodontic patients and its relationship to malocclusion, self-esteem and oral health-related quality of life. J Orthod. 2011;38(4):247–56. doi: 10. 1179/14653121141641. PMID: 22156180.
- van Wezel NA, Bos A, Prahl C. Expectations of treatment and satisfaction with dentofacial appearance in patients applying for orthodontic treatment. Am J Orthod Dentofac Orthop. 2015;147(6):698–703. doi: 10.1016/j. ajodo.2015.01.024. PMID: 26038073.
- Gherunpong S, Tsakos G, Sheiham A. A socio-dental approach to assessing children's orthodontic needs. Eur J Orthod. 2006;28(4):393–9. doi: 10.1093/ejo/cji114. PMID: 16723372.
- Jr DF, Silva ÉT, Campos AC, Nuñez MO, Leles CR. Effect of anterior teeth display during smiling on the selfperceived impacts of malocclusion in adolescents. Angle Orthod. 2011;81(3):540–5. doi: 10.2319/051710-263.1. PMID: 21261487.
- Brown JD. Motivational conflict and the self: The doublebind of low self-esteem. Self-Esteem. Springer; 1993;
- Sprecher S, Brooks JE, Avogo W. Self-esteem among young adults: Differences and similarities based on gender, race, and cohort (1990–2012). Sex Roles. 2013;69(5–6):264–75. doi:10.1007/s11199-013-0295-y.
- Marques LS, Filogônio CA, Filogônio CB, Pereira LJ, Pordeus IA, Paiva SM, et al. Aesthetic impact of malocclusion in the daily living of Brazilian adolescents. J Orthod. 2009;36(3):152–9. doi: 10.1179/146531207231 39. PMID: 19741176.
- Motloba DP, Sethusa MP, Ayo-Yusuf OA. The psychological impact of malocclusion on patients seeking orthodontic treatment at a South African oral health training centre. South African Dent J. 2016; 71(5):200–5.
- Mugonzibwa EA, Kuijpers-Jagtman AM, Van't Hof MA, Kikwilu EN. Perceptions of dental attractiveness and orthodontic treatment need among Tanzanian children. Am J Orthod Dentofac Orthop. 2004;125(4):426–33. doi:
10.1016/j.ajodo.2003.11.002. PMID: 15067257.
- Mtaya M. Malocclusion and quality of life in Tanzanian schoolchildren. [PhD dissertation]. Bergen: University of Bergen; 2008.
- de Paula DF, Júnior N, Santos CM, da Silva ÉT, Nunes MF, Leles CR. Psychosocial impact of dental esthetics on quality of life in adolescents. Angle Orthod. 2009;79(6):1188–93. doi: 10.2319/082608-452R.1. PMID: 19852614
- Phillips C, Beal KN. Self-concept and the perception of facial appearance in children and adolescents seeking
orthodontic treatment. Angle Orthod. 2009;79(1):12–6. doi: 10.2319/071307-328.1. PMID: 19123700.
- Abu Alhaija ES, Al-Nimri KS, Al-Khateeb SN. Selfperception of malocclusion among north Jordanian school children. Eur J Orthod. 2005;27(3):292–5. doi: 10.1093/ejo/cjh094. PMID: 15947230.
- Benson PE, Da’as T, Johal A, Mandall NA, Williams AC, Baker SR, et al. Relationships between dental appearance, self-esteem, socio-economic status, and oral health-related quality of life in UK schoolchildren: A 3-year cohort study. Eur J Orthod. 2014;37(5):481–90. doi: 10.1093/ejo/cju076. PMID: 25481920.
- Mtaya M, Brudvik P, Åstrøm AN. Prevalence of malocclusion and its relationship with sociodemographic factors, dental caries, and oral hygiene in 12-to 14-year-old Tanzanian schoolchildren. Eur J Orthod. 2009;31(5):467–76. doi: 10.1093/ejo/cjn125. PMID: 19336630.
- Badran SA. The effect of malocclusion and self-perceived aesthetics on the self-esteem of a sample of Jordanian
adolescents. Eur J Orthod. 2010;32(6):638–44. doi: 10.1093/ejo/cjq014. PMID: 20403957.
- Clijmans M, Lemiere J, Fieuws S, Willems G. Impact of self-esteem and personality traits on the association
between orthodontic treatment need and oral healthrelated quality of life in adults seeking orthodontic treatment. Eur J Orthod. 2015;37(6):643–50. doi: 10.1093/ejo/cju092. PMID: 25700991.
- De Oliveira CM, Sheiham A. The relationship between normative orthodontic treatment need and oral health‐ related quality of life. Community Dent Oral Epidemiol. 2003;31(6):426–36. doi: 10.1046/j.1600-0528.2003.
00002.x. PMID: 14986910.
- Agou S, Locker D, Streiner DL, Tompson B. Impact of self-esteem on the oral-health-related quality of life of children with malocclusion. Am J Orthod Dentofac Orthop. 2008;134(4):484–9. doi: 10.1016/j.ajodo. 2006.11.021. PMID: 18929265.
- Björk A, Krebs AA, Solow B. A method for epidemiological registration of malocculusion. Acta Odontol Scand. 1964;22(1):27–41. doi: 10.3109/00016 356408993963. PMID: 14158468.
- Al‐Emran S, Wisth PJ, Böe OE. Prevalence of malocclusion and need for orthodontic treatment in Saudi Arabia. Community Dent Oral Epidemiol. 1990;18(5):253–5. doi: 10.1111/j.1600-0528.1990.tb0 0070.x. PMID: 2249408.
- Romppel M, Herrmann-Lingen C, Wachter R, Edelmann F, Düngen HD, Pieske B, Grande G. A short form of the
General Self-Efficacy Scale (GSE-6): Development, psychometric properties and validity in an intercultural non-clinical sample and a sample of patients at risk for heart failure. Psychosoc Med. 2013;10:Doc01. doi: 10.3205/psm000091. Epub 2013 Feb 20. PMID: 23429426.
- Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st century–the approach of the WHO Global Oral Health Programme. Community Dent Oral Epidemiol. 2003;31:3-24. doi: 10.1046/j.2003.com122.x. PMID: 15015736.
- Killewo JZJ, Kapiga SH, Semali I, Kwesigabo G. Introduction to epidemiological studies and research methodology. In: Lecture notes in Epidemiology and Research methodology. Dar Es Salaam; 1995.
- 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(2):153–67. doi: 10.1093/ejo/23.2.153. PMID: 11398553.
- Muwazi LM, Rwenyonyi CM, Tirwomwe FJ, Ssali C, Kasangaki A, Nkamba ME, et al. Prevalence of oral diseases/conditions in Uganda. Afr Health Sci. 2002;5(3):227–33. doi: 10.5555/afhs.2005.5.3.227. PMID: 16245993.
- Mugonzibwa EA, Kuijpers-Jagtman AM, Hof MV, Kikwilu EN. Need for orthodontic treatment among Tanzanian
children. East Afr Med J. 2004;81(1):10–5. doi: 10.4314/eamj.v81i1.8788. PMID: 15080509.
- Otuyemi OD, Abidoye RO. Malocclusion in 12-year-old suburban and rural Nigerian children. Community Dent Health. 1993;10(4):375–80. PMID: 8124625.
- Mitchell L. The rationale for orthodontic treatmentPsychosocial well-being. In: An Introduction of Orthodontics. 3rd ed. United States: Oxford Univers1tyPress Inc; 2007.
- Tumurkhuu T, Fujiwara T, Komazaki Y, Kawaguchi Y, Tanaka T, Inazawa J, et al. Association between maternal education and malocclusion in Mongolian adolescents: a cross-sectional study. BMJ Open. 2016;6(11):1–12. doi: 10.1136/bmjopen-2016-012283. PMID: 27803108.
- Watt RG. From victim blaming to upstream action: tackling the social determinants of oral health inequalities. Community dentistry and oral epidemiology. Community Dent Oral Epidemiol. 2007;35(1):1–11. doi: 10.1111/j.1600-0528.2007.003 48.x. PMID: 17244132.
- Klages U, Claus N, Wehrbein H, Zentner A. Development of a questionnaire for assessment of the psychosocial impact of dental aesthetics in young adults. Eur J Orthod. 2006;28(2):103–11. doi: 10.1093/ejo/cji083. PMID: 16257989.
- Mandall NA, Matthew S, Fox D, Wright J, Conboy FM, O'Brien KD. Prediction of compliance and completion of orthodontic treatment: are quality of life measures important? Eur J Orthod. 2008;30(1):40–5. doi: 10.1093/ ejo/cjm077. PMID: 17971352.
- Van der Geld P, Oosterveld P, Van Heck G, KuijpersJagtman AM. Smile attractiveness: self-perception and influence on personality. Angle Orthod. 2007;77(5): 759–65. doi: 10.2319/082606-349. PMID: 17685777.
- Ramos IT, Nabarrette M, Vedovello-Filho M, de Menezes CC, de C. Meneghim M, Vedovello SA. Correlation between malocclusion and history of bullying in vulnerable adolescents. Angle Orthod. 2022;92(5):677– 82. doi: 10.2319/100721-749.1. PMID: 35666207.
- Aikins EA, Onyeaso CO, Isiekwe MC. Self-perception of malocclusion among Nigerian adolescents using the aesthetic component of the IOTN. Open Dent J. 2012;6(1):61–6. doi: 10.2174/1874210601206010061.
- James JM, Puranik MP, Sowmya KR. Self-perception of dental esthetics, malocclusion, and oral health-related quality of life among 13–15-year-old schoolchildren in Bengaluru: A cross-sectional study. J Nat Sci Med. 2020;5(3):262–7. doi: 10.4103/jnsm.jnsm_167_21.
- Taibah SM, Al-Hummayani FM. Effect of malocclusion on the self-esteem of adolescents. J Orthod Sci. 2017;6(4):123–8. doi: 10.4103/jos.JOS_16_17. PMID: 29119092.
- Varela M, García-Camba JE. Impact of orthodontics on the psychologic profile of adult patients: a prospective study. Am J Orthod Dentofac Orthop. 1995;108(2):142– 8. doi: 10.1016/s0889-5406(95)70076-5. PMID: 7625 386.
- Avontroodt S, Lemiere J, Cadenas de Llano-Pérula M, Verdonck A, Laenen A, Willems G. The evolution of selfesteem before, during and after orthodontic treatment in adolescents with dental malocclusion, a prospective cohort study. Eur J Orthod. 2020;42(3):257–62. doi: 10.1093/ejo/cjz048. PMID: 31187855.
- Jung MH. Evaluation of the effects of malocclusion and orthodontic treatment on self-esteem in an adolescent
population. Am J Orthod Dentofac Orthop. 2010;138(2): 160–6. doi: 10.1016/j.ajodo.2008.08.040. PMID: 2069 1357.
- Jung MH. An evaluation of self-esteem and quality of life in orthodontic patients: Effects of crowding and protrusion. Angle Orthod. 2015;85(5):812–9. doi: 10. 2319/091814.1. PMID: 25774755.
- Mandall NA, McCord JF, Blinkhorn AS, Worthington HV, O'Brien KD. Perceived aesthetic impact of malocclusion
and oral self-perceptions in 14-15-year-old Asian and Caucasian children in greater Manchester. Eur J Orthod.
2000;21(2):175–83. doi: 10.1093/ejo/22.2.175. PMID: 10822891.
- Bittencourt JM, Martins LP, Bendo CB, Vale MP, Paiva SM. Negative effect of malocclusion on the emotional and social well-being of Brazilian adolescents: a population-based study. Eur J Orthod. 2017;39(6):628– 33. doi: 10.1093/ejo/cjx020. PMID: 28371848.
- Burden DJ, Pine CM. Self-perception of malocclusion among adolescents. Community Dent Health. 1995;12(2):89–92. PMID: 7648417.