Research Article
Volume 4 Issue 6 - 2016
Assessment of Orthodontic Treatment Needs Among School Going Children Using Index of Orthodontic Treatment Need (IOTN) in Indore (Central India), Madhya Pradesh, India
Aman Sachdeva1, Shweta Raghav2, Kamalshikha Baheti3, Meer Juned Ali4 and Munish Goel5
1Reader, Department of Orthodontics, Darshan Dental College, Udaipur, Rajasthan, India
2Reader, Department of Orthodontics, College of Dental Sciences and Hospital, Rau, Indore, Madhya Pradesh, India
3Reader, Department of Orthodontics, College of Dental Sciences and Hospital, Rau, Indore, Madhya Pradesh, India
4Senior Lecturer, Department of Orthodontics, College of Dental Sciences and Hospital, Rau, Indore, Madhya Pradesh, India
5Professor, Department of Conservative Dentistry, Himachal Dental College, Sundernagar, Himachal Pradesh, India
*Corresponding Author: Dr. Sachdeva A, Department of Orthodontics, Darshan Dental College, Udaipur, Rajasthan, India.
Received: July 13, 2016; Published: August 10, 2016
Citation: Aman Sachdeva., et al. “Assessment of Orthodontic Treatment Needs Among School Going Children Using Index of Orthodontic Treatment Need (IOTN) in Indore (Central India), Madhya Pradesh, India”. EC Dental Science 4.6 (2016): 908-918.
Abstract
Aim: To investigate the frequency of intrafamilial transmission of Helicobacter Pylori and its relation with socioeconomic factors in Epirus.
Background: Oral health is an integral part of general health. Orthodontic treatment needs are increasing day by day as a consequence of changing life style pattern and increased demand for a better personality. As orthodontic treatment is more effective if diagnosed and performed in early stages of life, hence current study attempted to assess orthodontic treatment need amongst school going children.
Objective: The study aimed to evaluate the orthodontic treatment need in school going children in Indore (Central India), Madhya Pradesh, India, to assess the malocclusion traits, concern towards Dental Health and individual aesthetic perception compared to orthodontist’s opinion.
Materials and Methods: The study was carried out on 1822 (985 boys and 837 girls) school going children, aged 11-15 years, from 1st September 2015 to 31st December 2015. Type III examination was conducted and the assessment of malocclusion was done according to the Dental Health Component (DHC) and Aesthetic Component (AC) of Index of Orthodontic Treatment Need (IOTN) as defined by Brook and Shaw, with slight modification for AC assessment.
Results: Statistical Analysis revealed only 14.5% children had no treatment need while 85.5% presented malocclusion with variation in treatment needs. There was insignificant sex difference for aesthetic perception among the children. Distribution of children as attractive or less attractive was done according to the Examiner. Class I was the most common malocclusion and crowding was the most common malocclusion trait. High Intra-examiner and substantial inter-examiner agreements were observed for DHC and substantial intra-examiner and moderate inter-examiner agreements for AC.
Conclusion: The need for orthodontic treatment among children of Central India is comparable to other populations. It can be concluded from the present study that, IOTN is a reliable epidemiologic tool to benefit local health services in planning their budget, and improve focus of services by inducing greater uniformity and standardization in the assessment of Orthodontic treatment need.
Keywords: Orthodontic; Children; IOTN; Index of Treatment Need; Dental Health Component (DHC); Aesthetic Component (AC)
Introduction
Health is a state of complete physical, mental and social well being and not merely the absence of disease or infirmity [1]. Oral health is an integral part of general health [2]. Healthy mouth enables an individual to eat, speak and socialize without active disease or discomfort and contributes to the general well-being. It is concerned with maintaining the health of craniofacial complex, the teeth and gums as well as the tissue of the face and head that surrounds the mouth [3].
Dentofacial appearance has a lot to do with the way the people are perceived in the society [4]. Malocclusion is the second commonest dental anomaly. It may be handicapping to the functional needs and interfering with the well being of the person by adversely affecting dentofacial aesthetics, mandibular function or speech and Psychosocial health of an individual [5]. Adolescents with significant dentofacial in harmonies are considered at risk for negative self-esteem and social maladjustments [6].
In general, malocclusion is defined as an irregularity of the teeth or a molar relationship of the dental arches beyond the accepted range of normal [3]. The main benefit to the patient of Orthodontic treatment may be in improved aesthetics and social-psychological well-being, and additionally, the effect this may have on attitudes to dental health [7]. For Orthodontic treatment to become an integral part of oral health care programs, basic information on treatment needs is required [1]. Hence, many indices have been developed with the intention of categorizing them into various groups according to severity of malocclusion [8] and need of the Orthodontic treatment so that individuals with greatest treatment need can be assigned priority when Orthodontic sources are limited. Various treatment need indices that have been introduced include HLD Index, Treatment Priority Index, Handicapping Malocclusion Assessment Record, Occlusal Index, etc. [9].
However, in order to overcome drawbacks of previous indices, Index of Orthodontic Treatment Priority was introduced by Brook and Shaw in 1989. They later renamed it as- ‘Index of Orthodontic Treatment Need’ [10]. The index defines specific, distinct categories of treatment need, whilst including a measure of function [11]. The IOTN is essentially a method of defining the severity of occlusal traits that may constitute a threat to the longevity of dentition [12]. These traits are then allocated into grades, which define the priority of treatment need. The index incorporates both the Dental Health Component (DHC) and the Aesthetic Component (AC) [12].
The DHC represents biological or anatomical aspects of IOTN that record need for treatment on dental health and functional grounds. The AC measures aesthetic impairment and justifies treatment on social-psychological grounds [7]. Thus, it ranks malocclusion in terms of the significance of various occlusal traits for the person’s dental health and perceived aesthetic impairment with the intention of identifying those persons who would be most likely to benefit from Orthodontic treatment [7]. The use of such an index allows improved focusing of services and has the potential to induce greater uniformity throughout the profession and standardization in the assessment of Orthodontic treatment need [8]. The IOTN has been gaining international recognition as a method of objectively assessing treatment need [13]. The demand for orthodontic treatment is increasing in most of the countries including India. Therefore, rational planning of orthodontic preventive measures on population basis is essential. Thus, the present study is an attempt to use IOTN as a comprehensive approach to allow selective distribution of resources so that the treatment could be provided at a high standard, and to protect children from the risks of unnecessary treatment within a finite framework [8]; thereby, benefitting local health authorities to plan their budget.
Aims and Objectives
The present study aimed to
.The need for orthodontic treatment in school going children aged 11-15 yrs.
.Assess the different malocclusion traits and to find the prevalence of same.
.Find out individual (male and female) perception and concern towards Dental Health.
.Compare Orthodontist’s perception on aesthetic with patient’s /individual perception.
.Find the correlation between DHC and AC.
Material and Methods
The present study was conducted in the Department of Orthodontics and Dentofacial Orthopedics, College of Dental Sciences & Hospital, Rau, Indore (Central India). A simple random sample of 1822 school going children aged 11-15 years (985 boys and 837 girls) formed the sample for the study. The study was conducted from 1st September 2015 to 31st December 2015 as per schedule in the schools. Prior permissions were taken from Heads of the concerned Schools to conduct the oral examination. To avoid any ethical conflict identities of the children were not revealed in the study. Ethical clearance from ethical committee of College of Dental Sciences & Hospital, Rau, Indore was taken prior to the study.
Inclusion Criteria: All children aged 11-15 yrs who had not undergone orthodontic treatment and who agreed to take part in the study were examined. Mean age of the males in sample was 13.37 yrs and for females were 13.21 yrs.
In order to avoid any bias, the monitoring of total evaluation system was done under one person only. To check the reproducibility and reliability of the Index, same orthodontist re-examined 100 children at an interval of 15 days. A presentation was done in school to show all the children to make them aware of the dental diseases and the need for dental health maintenance. Type III Examination, as recommended by the American Dental Association [14], which includes inspection using a mirror and probe, done under good illumination was conducted. The examination was performed under natural light using disposable gloves, tongue blade and mouth mirrors. A periodontal probe was used for millimeter measurement. Both Dental Health Component (DHC) and Aesthetic Component (AC) were recorded to assess treatment needs based on IOTN.
Assessment of DHC
Dental Health Component was recorded by examining following occlusal traits - MOCDO i.e., Missing teeth, Overjet, Cross bite, Displacement, Overbite. All five grades of DHC were defined as per the following Performa (used originally by Brook and Shaw). The Grading was done according to ‘Dental Health Component’ originally used in the study for development of Index of Orthodontic Treatment Need [7]. The five grades for DHC were - Grade 1: No need for Orthodontic treatment, Grade 2: Little need for Orthodontic treatment, Grade 3: Moderate need for Orthodontic treatment, Grade 4: Great need for Orthodontic treatment, Grade 5: Very great need for Orthodontic treatment. The severe most malocclusion trait decided the grade for DHC for an individual [9].
Assessment of AC
Each child was shown the set of illustrated photographs used originally by Brook and Shaw [7] (This set of photographs was originally the SCAN Index - Standardized Continuum of Aesthetic Need- that was utilized by Evans and Shaw in 1987 [15]). All children were told to compare their dental appearance to these standard photographs and grade their aesthetics to the nearest resembling photograph. Grading was done as per the score given by child.
Orthodontist’s opinion for child’s aesthetics was also recorded. However, against the original ten-point scoring from ‘0.5 to 5’ in SCAN Index, the scale was modified to ten-point scoring from Grade 1 (most attractive) to Grade 10 (least attractive’) for ease of recording and tabulation. Correlation between functional components of oral health (DHC) and Orthodontist’s aesthetic opinion (Orthodontist AC) was also evaluated.
Statistical Analysis
The data obtained was analyzed using SPSS package. Chi-square Test using “P” value was used to evaluate - Difference in aesthetic perception between male and female children, Orthodontist’s aesthetic opinion for male and female children, Difference in Orthodontist’s opinion and children’s perception for aesthetics, Distribution of Angle’s malocclusion among male and female children. “P” < 0.05 was considered as statistically significant and “P” values > 0.01 were considered statistically highly significant. Intra- and inter-examiner reliability for DHC and AC were evaluated using Kappa Analysis К (In accordance with Landis and Koch, 1977) [7]. Correlation between DHC and AC was found using ‘Spearman Correlation Coefficient’ (ρ).
Results
DHC grades indicate that out of 1822 children, 14.5% has no need for Orthodontic treatment whereas 85.5% had need for Orthodontic treatment. Severity of malocclusion and range of treatment need varied. 23.36% children had mild need for Orthodontic treatment, 40.08% children had moderate treatment need which formed the highest proportion of DHC distribution, 12.91% had great need of treatment and 9.15% children had very great need for Orthodontic treatment (Figure 1). Overall, Orthodontic treatment need in males was 57.5% that was greater than 33.85% in females. Overall females graded themselves to more attractive side of the scale than males. However, statistically there was insignificant sex difference in aesthetic perception by patient (Figure 2, Table 1).

Figure 1: Percentage distribution of DHC according to IOTN.

Figure 2: Difference in aesthetic perception between males and females.

AC Grade Percentage
  Males Females
1 24.18% 27.17%
2 26.13% 26%
3 27% 26.01%
4 4.5% 10.82%
5 10.45% 4.15%
6 3.98% 4.86%
7 2.67% 0.56%
8 0.58% 0.33%
9 0.45% 0.1%
10 0.16% 0%
Table 1: Difference in aesthetic perception between males and females.
*Statistically there was insignificant sex difference in aesthetic perception by patient.
The Orthodontist graded patients to less attractive side of scale compared to self assessment made by children (Figure 3, Table 2). Statistical analysis using Chi square test (p = 0.447 > 0.05) shows that there is insignificant relation between Orthodontist’s opinion and children’s self-perception for aesthetics i.e., both were independent to each other. Out of 1822 children, only 11.88% children presented normal molar Class I with facial balanced occlusion while 88.12% presented malocclusion. 69.72% presented Angle’s Class I malocclusion, 18.82% Angle’s Class II malocclusion while only 0.42% presented Angle’s Class III malocclusion (Figure 4). Using ‘Chi-square Test’, it was found that ‘Chi-square Test’, x2 =17.60. Since p>0.05, statistically there was significant difference in distribution of malocclusion among males and females with males exhibiting more severe malocclusions than females.

Figure 3: Difference in patient’s aesthetic perception and orthodontist’s opinion of aesthetics.

AC Grade Percentage
  Patient’s Aesthetic Perception Orthodontist’s Opinion of Aesthetics
1 24.85% 12.11%
2 26.19% 18.09%
3 27% 21%
4 11.55% 20.8%
5 5.09% 10.5%
6 3.81% 11.04%
7 0.88% 3.04%
8 0.4% 1.53%
9 0.17% 0.1%
10 0.06% 0.09%
Table 2: Difference in patient’s aesthetic perception and orthodontist’s opinion of aesthetics.
*Statistical analysis using Chi square test (p = 0.447 > 0.05) shows that there is insignificant relation between Orthodontist’s opinion and children’s self-perception for aesthetics i.e both were independent to each other

Figure 4: Distribution of malocclusion among school children.

The most common malocclusion anomaly present in population in decreasing order of occurrence is Crowding > Increased overjet > Increased overbite > Spacing > Anterior cross bite > Retained deciduous teeth > Posterior cross bite > Open bite > Missing teeth > Peg lateral > Supernumerary teeth > Cleft lip and cleft palate (Figure 5, Table 3).

Figure 5: Distribution of malocclusion traits among school children.

Angle’s Classification Percentage of Children
Molar Class I with Balanced Facial Profile 11.88%
Molar Class I Bimax with Protrusion 3.5%
Angle’s Class I Type 1 37.4%
Angle’s Class I Type 2 22.28%
Angle’s Class I Type 3 4.01%
Angle’s Class I Type 4 2.53%
Angle’s Class II Div. 1 14.5%
Angle’s Class II Div. 2 4.32%
Angle’s Class III 0.42%
Table 3: Distribution of malocclusion among school children.
*‘Chi-square Test’, it was found that ‘Chi-square Test’, x2 =17.60. Since p > 0.05, statistically there was significant difference in distribution of malocclusion among males and females with males exhibiting more severe malocclusions than females
Reproducibility of The Index- The intra-examiner agreement for DHC ranged from a kappa value of ‘0.871’ that indicates ‘almost perfect’ (high) agreement between the 1st and 2nd readings for AC by the same examiner. The intra-examiner agreement for AC ranged from a kappa value of 0.765 that indicates ‘substantial agreement’ between the 1st and 2nd readings for AC by the same examiner. The inter-examiner agreement for DHC presented Kappa value of 0.660 that indicates ‘substantial agreement’ between the DHC readings of two examiners at two different examinations. The inter-examiner agreement for AC presented Kappa value of 0.538 that indicates ‘moderate agreement’ between the AC readings of two examiners at two different occasions. Inter-relation between DHC and orthodontist’s aesthetic opinion: Spearman correlation value, ρ: 0.801 implies High Correlation between DHC and examiner’s aesthetic opinion for children (Table 4).
    Dental Health Component
Treatment Need   No Need Little Need Moderate Need Great Need Very Great Need Total
Orthodontist
Aesthetic Opinion
Grade 1 198 10 6 1 2 217
Grade 2 56 184 53 8 14 315
Grade 3 6 103 222 21 15 367
Grade 4 3 94 190 10 34 331
Grade 5 1 10 91 33 38 173
Grade 6   18 126 68 33 245
Grade 7   6 38 48 5 97
Grade 8     5 30 6 41
Grade 9       15 10 25
Grade 10       2 9 11
Grade 11 264 425 731 236 166 1822
Table 4: Inter-relation between DHC & Orthodontist’s aesthetic opinion.
*Spearman correlation value, ρ: 0.801 implies High Correlation between DHC and examiner’s aesthetic opinion for children.
Discussion
Many epidemiological studies have been conducted worldwide utilizing various indices for quantifying the extent of malocclusion. The assessment of treatment need is important in order to provide information on work load, encourage rational decision making on manpower needs, the design of treatment facilities and further training of public health dentists and ancillary personnel [15]. The present epidemiologic study, using Index of Orthodontic Treatment Need (IOTN), was done on school going children because it is a simple and quick method and has been found appropriate for use in school screening Programmes [17,18]. Children between 11- 15 yrs of age were chosen for the study because this represents the early permanent dentition stage which exhibits the characteristics reflected in AC photographs. 1822 school children constituted the core sample of the study. Such a large sample was surveyed to ensure greater representation of population and hence, accuracy in assessing treatment need of Indore children.
Dental Health Component (DHC) – The Functional Component: Distribution of DHC grades shows marked variation in treatment need. While 14.5% children have no treatment need, major proportion of population (84.5%) has treatment needed. Maximum number of children (40.08%) reflected moderate treatment need. These are the children who are at borderline and according to IOTN, they can be instituted treatment when resources are available. While 12.91% had great need of treatment, 9.15% children presented very great need for treatment. Hence, one-fourth of population had definite treatment need (Grade 4 + 5 = 22.06%) and should be prioritized for Orthodontic services. Amongst the whole, only 11.88% children had ideal facial balanced occlusion. This percentage is quite close to no treatment need (14.5%) for DHC distribution. This difference in no treatment need category and ideal facial balanced occlusion can be attributed to presence of other anomalies along with ideal class I molar relationship like presence of supernumerary teeth, spacing, peg lateral, cross bite etc. This shows that DHC is a reliable tool for assessing Orthodontic treatment need based on functional components of oral health in school screening Programmes. The results are in accordance with studies by other researchers [10,19-21]. Also, Intra-examiner reproducibility for DHC was in almost perfect agreement (К = 0.871) while inter-examiner agreement was substantial (К = 0.660). Hence, DHC of IOTN was found to have good reproducibility and reliability for intra- and inter-examinations. These results are also supported by other studies [1,9,10].
In the present study, 88.12% children presented with malocclusion. Distribution of malocclusion in population showed that maximum number of children i.e. 69.72% presented with Angle’s Class I malocclusion, 18.82% presented with Angle’s Class II malocclusion 0.42% presented with Angle’s Class III malocclusions. The distribution of malocclusion traits (anomalies) in the population showed that 59.6% children presented with crowding followed by increased overjet (22.28%) that correspond to high incidences of Class I Type 1 and Class I Type 2 (respectively) The increased incidence of crowding and increased overjet in the population can be attributed to decreasing jaw size with evolution due to shift of diet from coarse to soft. These results are in accordance with the results of studies by other researchers [5,6,22]. With advancing age, there was an increase in incidence of malocclusion and number of anomalies i.e., maximum number of children presenting with a particular malocclusion or anomaly were observed in 15 yrs age group followed by in 14 year age group, 13 yrs age group,12yrs age group and then in 11 yrs age group. These results can be attributed to malocclusion severity due to no Orthodontic intervention at early age.
Aesthetic component: Overall aesthetic perception by children reflected that 24.95% children graded themselves most attractive i.e. they had no treatment need (AC Grade 1). 53.67% children reflected little need (AC Grade 2+3) for treatment, 12.13% reflected moderate treatment need (AC Grade 4), 8.41% children presented great treatment needs (AC Grade 5+6+7) and 0.84% children had very great treatment need (AC Grade 8+9+10). Slightly more number of males expressed desire for treatment (74.5%) compared to females (70.24%). These values are in accordance with the aesthetic perceptions of children i.e., males who graded themselves less attractive expressed greater desire for treatment contrary to females who graded themselves more attractive and expressed comparatively less desire for treatment. This clearly exhibits differences in self-esteem of children in relation to their aesthetic perception. The results are similar to another study [23]. However, statistically, insignificant sex differences were observed for aesthetic perception between males and females. Contrary to self perception by children, examiner’s aesthetic opinion for children overall graded them to less attractive side of scale. The results correspond to the other studies which report that children are less critical in their aesthetic judgments as compared to adults [18,24,25]. This can be attributed to high self-esteem of children who tend to over-rate their dental attractiveness. While Orthodontist can judge child without any bias, the child may be self- biased in rating his/her own aesthetics. Children may not find photographs and their dentition too displeasing in comparison to Orthodontist [7]. Hence, Orthodontist’s opinion is more valid and reliable to judge child’s treatment needs against child perception of aesthetics. However, statistically, there was insignificant sex difference in examiner’s opinion of aesthetics for children. The aesthetic component of IOTN quantifies the likely sociopsychological effects of malocclusion on child. Although the aesthetic component is assessed independently of the dental health component, results showed that most of the children with poor dental aesthetics were also considered to be in need of treatment on dental health grounds e.g., children in no treatment need category in DHC were graded between AC Grades 1-4. Great and Very great treatment needs of DHC correspond to the AC grades extending up to grades 8, 9 and 10. Children who were scored as needing treatment on aesthetic grounds, but not on dental health grounds, mostly comprised children with dentition which were considered to have unattractive aesthetics, but which were not considered to have dental health implication by IOTN, e.g., generalized spacing [25]. In contrast, there were many children who were categorized in the treatment need category although their aesthetic impairment did not fall into the most severe grades. This reflects the fact that many occlusal traits such as ectopic teeth, deep traumatic overbites or cross bites have dental health implications, but do not attract a high aesthetic component score. Using Kappa analysis, intra-examiner reproducibility for AC was found substantial (К = 0.765) whereas the inter-examiner agreement was moderate (К = 0.538). This shows that AC of IOTN is fairly reliable and reproducible. The results are in accordance with the studies of other researchers [1,27,28]. The difference in inter examination reproducibility could be attributed to difference in scoring AC in accordance with the photographs, since photographs present only a 2-dimensional representation of a 3-dimensional object that reduces the prominence of anterior crowding and over jets [28]. Also, there could be difference in individual perception of aesthetics [24]. Overall it took only 2.30 - 3 min for recording malocclusion traits to assess the score for an individual which shows the index is less time consuming [30] and suitable for mass screening. Hence, IOTN can be considered as a reliable epidemiologic tool capable to assess individual’s Orthodontic treatment needs in less time, thereby, managing manpower and effectively using the available resources.
Conclusion
Based on the results obtained, following conclusions can be drawn -
•High incidence of malocclusion was observed in Central India school going children. Based on Dental Health Component of IOTN, 23.36% had little need of Orthodontic treatment and 40.08% had moderate need whereas 22.06% had great need. •Orthodontist graded children to less attractive side of scale in comparison to children themselves. Accordingly, Orthodontist categorized more children to require Orthodontic treatment. A disagreement of 54.16% was observed between Orthodontist’s opinion and children perception for aesthetics. •Orthodontic treatment need in males was 57.5% that was greater than 33.85% in females. •Out of 1822 children, 88.12% presented malocclusion whereas only 11.88% children presented normal molar Class I with facial balanced Occlusion. 69.72% children presented Angle’s Class I malocclusion, 18.82% Angle’s Class II malocclusion while only 0.42% presented Angle’s Class III malocclusion. •Crowding was the most common malocclusion trait present among school going children. •Both Dental Health and Aesthetic Component of IOTN were found to be fairly reproducible and highly correlated to each other as an epidemiologic tool which can be effectively advocated as a tool to assess Orthodontic treatment needs for population. •School Dental Health Programmes can be considered as the need of the population to bring about awareness of Orthodontic and aesthetic problems to foothold malocclusion as an entity at an early age.
Bibliography
  1. Ngom PI., et al. et al. “Orthodontic treatment need and demand in Senegalese school children aged 12-13 years”. Angle Orthodontist 77.2 (2007): 323-330.
  2. Dunning JM. “Principles of Dental Public Health”. 4th edn, Cambridge Harvard University Press (1986).
  3. Yewe Dyer M. “The definition of Oral health”. British Dental Journal 174.7 (1993): 224-225.
  4. Samire B. “Textbook of Orthodontics”, Harcourt (India) Pvt. Ltd: Philadelphia W.B. Saunders (2001).
  5. Kharbanda OP. “What is the prevalence of malocclusion in India? Do we know Orthodontic treatment needs of our country”. Journal of Indian Orthodontic Society 32 (1999): 33-41.
  6. Jenny J. “A social perspective on need and demand for orthodontic treatment”. International Dental Journal 25.4 (1975): 248-256.
  7. Brook PH and Shaw WC. “The development of an index for Orthodontic treatment priority”. European Journal of Orthodontics 11.3 (1989): 309-320.
  8. De Oleveira. “The planning, contracting and monitoring of Orthodontic services, and the use of the IOTN index: a survey of consultants in dental public health in the United Kingdom”. British Dental Journal 195.12 (2003): 704-706.
  9. Arora N. “Can ICON replace PAR and IOTN?: A comparative evaluation of three occlusal indices (PAR, IOTN and ICON) based on the treatment need of Indian Population”. Journal of Indian Orthodontic Society 42 (2008): 25-31.
  10. Peter E and Valoathan A. “IOTN and PAR Index: Comparison and uses”. Journal of Indian Orthodontic Society 30 (1997): 85-89.
  11. Cooper S., et al. “The reliability of the Index of Orthodontic Treatment Need over time”. British Journal of Orthodontics 27.1 (2000): 47-53.
  12. Hamdan AH. “The relationship between patient, parent and clinician perceived need and normative Orthodontic treatment need”. European Journal of Orthodontics 26.3 (2004): 265-271.
  13. Ucuncu N and Ertugay E. “The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population”. Journal of Orthodontics 28.1 (2001): 45-52.
  14. Thilender B., et al. “Prevalence of malocclusion and Orthodontic treatment need in children and adolescent in Bogota, Columbia. An epidemiological survey related to different stages of dental development”. European Journal of Orthodontics 23.2 (2001): 153-167.
  15. Evans R and Shaw WC. “Preliminary evaluation of an illustrated scale for rating dental attractiveness. European”. Journal of Orthodontics 9.1 (1987): 314-318.
  16. Bowden DEJ and Davies AP. “Inter-and intra-examiner variability in assessment of Orthodontic treatment need”. Community Dentistry and Oral Epidemiology 3.4 (1975): 198-200.
  17. So LLY and Tang ELK. “A comparative study using the Occlusal Index and the Index of Orthodontic Treatment Need”. The Angle Orthodontist 63.1 (1993): 57-64.
  18. Hetherington I and White DA. “The diagnostic accuracy and reproducibility of school dental screening using an index of treatment need”. Community Dental Health 21.2 (2004): 170-174.
  19. Birkeland K., et al. “Orthodontic concern among 11-year-old children and their parents compared with Orthodontic Treatment need assessed by Index of Orthodontic treatment need”. American Journal of Orthodontics and Dentofacial Orthopedics 110.2 (1996): 197-205.
  20. Cooper S., et al. “The reliability of the Index of Orthodontic Treatment Need over time”. Journal of Orthodontics 27.1 (2000): 47-53
  21. Soumese M., et al. “Orthodontic treatment need in French school children: An epidemiological study using the Index of Orthodontic Treatment Need” European Journal of Orthodontics 28.6 (2006): 605-609.
  22. Thilander B., et al. “Prevalence of malocclusion and Orthodontic treatment need in children and adolescents in Bagota, Colombia. An epidemiological study related to different stages of dental development”. European Journal of Orthodontics 28.2 (2001): 153-167.
  23. Al-Sarheed M., et al. “Orthodontic treatment need and self perception of 11-16 yr old Saudi Arabian children with sensory impairment attending special schools”. Journal of Orthodontics 30.1 (2003): 39-44.
  24. Soh J and Sandham A. “Orthodontic treatment need in Asian adult males”. Angle Orthodontics 74.6 (2004): 769-773.
  25. Stenvik A., et al. “Lay attitudes to dental appearance and need for Orthodontic treatment”. European Journal of Orthodontics 19.3 (1997): 271-277.
  26. Hedayati Z., et al. “The use of index of Orthodontic treatment need in an Iranian population”. Journal of Indian Society of Pedodontics and Preventive Dentistry 25.1 (2007): 10-14.
  27. Ajayi EO. “Orthodontic treatment need in Nigerian children”. Community Dental Health 25.2 (2008): 126-128.
  28. Ucunucu N and Ertugay E. “The use of the Index of Orthodontic Treatment need (IOTN) in a school population and referred population”. Journal of Orthodontics 28.1 (2001): 45-52.
  29. Buchanan LB., et al. “A comparison of the Index of Orthodontic Treatment Need applied clinically and to diagnostic records”. British Journal of Orthodontics 21.2 (1994): 185-188.
  30. Ovsenik M and Primzoic J. “Evaluation of 3 occlusal indexes: Eismann index, Eismann-Farcnik index, and index of Orthodontic treatment need”. American Journal of Orthodontics and Dentofacial Orthopedics 131.4 (2007): 496-503.
Copyright: © 2016 Aman Sachdeva., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and can be viewed in the current issue pages.

Submission Deadline for January Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the January issue of respective journals. Submissions are accepted on/before December 03, 2020.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk