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 Table of Contents  
Year : 2020  |  Volume : 12  |  Issue : 2  |  Page : 129-134

The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study

Department of Preventive Dental Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia

Date of Submission04-Aug-2019
Date of Acceptance15-Oct-2019
Date of Web Publication28-Mar-2020

Correspondence Address:
Dr. Fahad Alharbi
Department of Preventive Dental Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj 11942.
Saudi Arabia
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jioh.jioh_200_19

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Background: Malocclusion is one of the most prevalent dental problems. The prevalence of malocclusion differs globally among various populations. It is essential to estimate its prevalence in order to allocate proper resources for preventive strategies and intervention plans. Aim: This study aimed to evaluate the status of malocclusion among school children in Al Kharj city, Saudi Arabia. Materials and Methods: This is a cross-sectional study. A group of 680 school children in Al Kharj city, Saudi Arabia, aged 11–14 years participated in the study. The occlusal parameters recorded in this study were molars relationship, overbite, crowding, midline diastema, anterior open bite, anterior crossbite, and posterior crossbite, using gloves, light source, mouth mirror, and ruler. Results: A Class-I molars relationship was observed in 84.9% of the total sample, whereas Class-II and -III molars relationships were observed in 9% and 6.2%, respectively. Normal overbite was found in 87.1%. The most widespread orthodontic problem was crowding (40.3%), followed by midline diastema (29.6%). A posterior crossbite was found in 3.8% of the sample, whereas 11.76% had an anterior crossbite. Conclusion: Crowding has the highest level of frequency among orthodontic problems. Class I, normal overjet, and normal overbite were frequent findings among Saudi adolescents in Al Kharj city.

Keywords: Angle’s Classification, Malocclusion, Occlusal Traits

How to cite this article:
Alharbi F. The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study. J Int Oral Health 2020;12:129-34

How to cite this URL:
Alharbi F. The prevalence of malocclusion traits in Saudi Arabia 2015–2019: An epidemiological cross sectional study. J Int Oral Health [serial online] 2020 [cited 2022 Aug 17];12:129-34. Available from:

  Introduction Top

Although orthodontic treatment is an elective treatment, it has been claimed that it provides benefits to the patient in four domains: a reduction in dental caries susceptibility, improved dental health, and reduced temporomandibular dysfunction (TMD) and traumatic dental injury. Nevertheless, these claims are not supported by evidence.[1] The World Health Organization (WHO) stated that orthodontic treatment’s main benefit is the improved self-esteem of the patients and their greater quality of life. Nonetheless, many authors have ascertained the functional benefits of orthodontic treatment in terms of improving mastication in cases such as anterior open bite and enhancing the acceptability of better oral hygiene.

The prevalence of malocclusion varies among different investigations. Many factors contribute to this, including the time of the study, the geographic area, and the criteria used for the sample selection such as age and gender. For example, Profitt[2] reported that 57–59% of the Americans had at least some degree of orthodontic treatment need, whereas in the UK the percent was 59.9%[3] and 92% in Jordan.[4] In Saudi Arabia, it was reported that 40%–62.4% of the population had some degree of orthodontic treatment need.[5],[6],[7]

It is imperative, when planning large-scale health-care activities, to obtain an updated estimation of the prevalence of active diseases to enable policy makers to set priorities and allocate resources for prevention and early intervention if needed. Also, such information provides guidance on the need to train orthodontists to meet the public demand for orthodontic treatment.

The number of individuals who are seeking orthodontic treatment has risen in Saudi Arabia in the last two decades because of the increased knowledge of the benefits of orthodontic treatment in regards to self-esteem.[8],[9],[10] Although some orthodontic treatment is provided by government-funded orthodontic departments, the vast majority is provided in the private sector.[9],[10] The mismatch between the demand for orthodontic treatment by the public and the capacity to provide the treatment free of charge by the governmental hospitals created a gap that is filled by private orthodontic clinics.

The aim of this study was to estimate the prevalence of malocclusion traits among the Saudi adolescents in Al Kharj city, Saudi Arabia, in order to provide an epidemiological reference for intervention and prevention of the occurrence of malocclusion.

  Materials and Methods Top

Study design

This epidemiological cross-sectional study was undertaken in eight governmental schools in Al Kharj city which is located 80 km from Riyadh and has 376,325 habitants. The sample comprised 680 schoolchildren with a mean age of 12.3 years (standard deviation [SD] ± 1.0) ranging from 11 to 14 years of age. The study was conducted from January 2018 to April 2018 as a part of the dental awareness campaign performed by final-year undergraduate students.

Sampling criteria

The nature of the study is descriptive analysis. Stratification by age, gender, or socioeconomic status was not applied. Sample size was made by enrolling all the students in this study by a convenience sampling technique. Sample size calculation was performed assuming the prevalence of malocclusion to be 23% based on a previous study.[11] In total, 500 subjects will be appropriate to detect statistically significant difference of 5% and 80% power for subgroup analysis.

All subjects were Arabic descendants and with no history of orthodontic treatment. The subjects who had developmental anomalies, such as ectodermal dysplasia, cleft lip or palate, and Down syndrome, were excluded from the study. Parents and guardians were notified about the activity by school administrations with the option of excluding their children data.

Method of examination and observational parameters

A dental examination was carried out after all of the infection control measures were undertaken and each case was examined using a pair of disposable gloves, a mask, and a disposable examination kit.

The data were collected by four experienced dentists from the College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia, who were fully trained and calibrated by an experienced orthodontist with a correlation of more than 0.7, which was considered acceptable.

The malocclusion traits in the dental examination were predefined and included the following: occlusal relationship, crowding, spacing and midline diastema, overjet, overbite and open bite, and crossbite, as shown in [Table 1].
Table 1: Description for different types of malocclusions

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  Statistical Analysis Top

Data were recorded on a Microsoft Excel 2015 spreadsheet computer program (Microsoft, Redmond, WA). The Statistical Package for the Social Sciences software version 22.0 (SPSS, Chicago, IL) was used for the analysis. Descriptive statistics of the malocclusion traits were reported.

  Results Top

A group of 680 male subjects met the inclusion criteria; the average age was 12.3 years (SD ± 1.0) with no withdrawals from the study. The overall distribution of the malocclusion traits is presented in [Table 2].
Table 2: The distribution of different malocclusion traits in the sample of 680 schoolchildren

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According to the results, 84.9% of the students had a Class-I molars relationship, 9% a Class II, and only 6.2% a Class III [Figure 1]. Thirty percent of the schoolchildren had midline diastema and 40.3% had some degree of crowding. [Table 2] represents the distribution of midline diastema, in which 70% had no midline diastema, 29.6% had 1–2 mm midline diastema, and only 0.4% had a midline diastema between 2 and 3 mm. In total, 1.76% of the sample had an open bite. Normal overbite was found in 87.1% of the students and 13.53% showed an increased overbite. A posterior crossbite was found in 3.8% of the sample and 11.76% had an anterior crossbite. According to Index of treatment need –aesthetic component, 17.94% showed no need or a mild need for treatment [Figure 2], whereas 39.12% and 42.94% showed a moderate and severe need for treatment, respectively. [Table 2] shows the distribution of malocclusion traits in the 680 schoolchildren.
Figure 1: The distribution of malocclusion in schoolchildren aged 11–14 in Al Kharj

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Figure 2: The aesthetic component (AC) of the IOTN

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  Discussion Top

This cross-sectional study is the first study to the best of the author’s knowledge to look at the prevalence of malocclusion traits in Al Kharj city. The study included participants aged 11–14 years in which the malocclusion during adolescence had a negative impact on psychological well-being and interpersonal relationships and associated with bullying and a lower level of self-esteem among teenagers.[12],[13] The findings of this study revealed an increase in the orthodontic treatment need; hence, it is necessary to offer information to the public policy makers who implement future plans to accommodate the demand for orthodontic treatment in terms of funding for orthodontic departments and training dental and orthodontic practitioners. Currently, most orthodontic treatment is provided by the private sector,[14],[15] although funded treatment is provided by the public sector. The regulations regarding eligibility criteria for treatment in public funding orthodontic departments should be revised to ensure that these departments provide treatment to patients who need it the most.[9],[10],[14],[15] Also, the introduction of fees for treatment in publically funded orthodontic departments, with exemptions for those who cannot afford them, might help to ensure the better allocation of financial and manpower resources.[10]

The findings of this study show that a Class-I molars relationship is more prevalent than a Class-II and -III molars relationship. Similar figures were found in other cities in Saudi Arabia[5],[7-9],[11],[16-26] and other countries in the Middle East.[4],[27-29] Interestingly, the reported figures of malocclusion traits differed from those reported in this study and retrospective studies performed on dental models retrieved from academic orthodontic departments and hospital orthodontic departments. For example, Aldress[19] reported that 57.47% of 602 dental casts of patients attending King Saud University in Riyadh had a Class-I molars relationship, whereas Aljundi and Riba[24] reported that 23.33% in a sample of 510 dental models at the National Guard Hospital in Riyadh had Class-I molars relationship. However, 84.9% of the public schoolchildren in Al Kharj had a Class-I molars relationship. This variation could be explained by the fact that their samples were selected from patients seeking orthodontic treatment who are more inclined to have Class-II and -III molars relationships as compared with the general population.[30]

Another finding in this study is that more than three-quarters of the selected sample of schoolchildren in Al Kharj showed a moderate-to-severe need for orthodontic treatment. That was more than what was reported in Jeddah, which may be because of the variation in the sample or because of examiner subjectivity.[8]

As the results show, crowding was the most common orthodontic problem in the selected sample, in which 40.3% had some degree of crowding. In other cities, crowding was in a range between 26.6% and 74%.[8],[9],[11],[16],[21-23],[25],[26] Also, midline diastema was found in a third of the current sample, which was similar to Albarakati and Al-Dlaigan’s[18] finding in their investigation that included 1,825 schoolchildren in Riyadh aged 12–16 years. Similarly, anterior crossbite was found in 11.76% of the sample, whereas, in other cities, anterior crossbite ranged from 2.80% to 22.30%.[8],[9],[13],[18-21],[23],[24]

Posterior crossbite was found in less than 4% in this study, whereas other studies performed in public schools in the other cities reported prevalence ranging from 3% in Jeddah to 21.4% in Makkah.[8],[24] Anterior open bite prevalence found in adolescents in Al Kharj was the least prevalent malocclusion trait (1.76%) in comparison with other studies, which reported prevalence ranging from 4% to 7.20%.[8],[9],[13],[18-21],[23],[24][Table 3] presents a comparison between the prevalence of malocclusion traits in Al Kharj and other cities in Saudi Arabia. The variation between the reported figures could be attributed to the true variation between the population, the variation in the methods of measurements, or examiner subjectivity.
Table 3: The prevalence of malocclusion in different cities in Saudi Arabia (%)

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The findings of this study are limited by the sample size and recording methods used for malocclusion. Ideally, larger samples are needed to estimate more precise figures for the prevalence of malocclusion traits. Also, a more clear-cut stratification of the selected samples based on several factors such as gender, socioeconomic status, and age would be suggested to evaluate the influence of these factors on the extent to which different groups of people are concerned with their appearances. Similarly, using dental casts and radiographic records would provide more objective findings. Also, it would provide a more valid archive of the collected data on which future research and policy planning can build.

  Conclusion Top

Class I has the highest percentage of the prevalence of malocclusion among Saudi adolescents in Al Kharj aged 11–14 years in comparison with Class II and Class III. Also, crowding is the most prevalent orthodontic problem. The presented information of this study can be used to plan future investigations in which larger samples are included in order to formulate preventive measures and to meet the orthodontic treatment need in Al Kharj city.

Data availability statement

Data set is available at the preventive Dental Sciences Department, the College of Dentistry, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.

Ethical policy and institutional review board statement

This study was approved by the College of Dentistry, Prince Sattam Bin Abdulaziz University Al Kharj, Saudi Arabia (academic year 2017–2018). The approval was obtained from the Ministry of Education via schools’ administrations.


The author would like to thank Drs. MG Inderjit, BS Rajashekhara, George Sam, and Narendra Varma for their support and advice in this project.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

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  [Figure 1], [Figure 2]

  [Table 1], [Table 2], [Table 3]

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