journal of dentistry 42 (2014) 249–255
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden
Cross-bite and oral health related quality of life in young people Mohd Masood a,*, Yaghma Masood b, Tim Newton c a
Centre of Studies for Community Dentistry, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia Centre of Studies for Oral Pathology, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia c Unit of Dental Public Health and Oral Health Services Research, King’s College Dental Institute, King’s College London, Denmark Hill, London, UK b
article info
abstract
Article history:
Objectives: This study sought to assess the impact of posterior cross-bite on OHRQoL in
Received 22 June 2013
young people aged 15–25 and to determine whether the impact on higher domains of Oral
Received in revised form
Health Impact Profile-14 (physical disability, psychological disability, social disability and
23 November 2013
handicap) is a direct function of the cross-bite or mediated through the lower domains of
Accepted 13 December 2013
OHIP-14 (functional limitation, pain and discomfort). Methods: One hundred and forty-five young adults [72 cross-bite cases and 73 controls] aged 15–25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi
Keywords:
MARA participated in this study. Participants completed the OHIP-14 and had a clinical
Oral health related quality of life
examination for cross-bite. Data analyses included descriptive statistics, t-test and bivariate
Cross bite
and multivariate regression modelling.
OHIP
Results: There was no significant difference between the case and control groups in gender, age and education level. The mean scores (SD) for OHIP-14 total and all domains were significantly higher in cross-bite patients as compared to controls. The bivariate and multivariate regression analyses showed functional limitation was significantly associated with all the higher domains in all four models, whereas pain was only significantly associated with the psychological domain and discomfort was only significantly associated with the physical disability domain. Conclusion: The possession of a posterior cross bite has a significant association with OHRQoL especially on the functional limitation and psychological disability domains, among 15–25 years old young people. The relationship of cross-bite and lower domains of OHIP-14 with higher domains of OHIP-14 was in agreement with the relationships proposed by Locker’s conceptual model of oral health. Clinical significance: Patients with a cross bite were more limited in their oral functions and experienced greater psychological discomfort than did controls. It is possible that part of patients’ rationale for seeking treatment would be to alleviate such impacts on their oral health related quality of life. # 2013 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +60 162209941. E-mail addresses: [email protected] (M. Masood), [email protected] (Y. Masood), [email protected] (T. Newton). 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.12.004
250
1.
journal of dentistry 42 (2014) 249–255
Introduction
Posterior cross-bite has been defined as, ‘‘a transversal arch discrepancy in which the palatal cusps of one or more of the upper posterior teeth do not occlude in the central fossae of the opposing lower teeth. A posterior cross-bite may be unilateral or bilateral when the patient bites into maximum intercuspation’’.1,2 Studies have suggested that the prevalence of a posterior cross-bite ranges between 8% and 16% of the population.1 The aetiology of cross-bites is complex and may include prolonged retention or premature loss of deciduous teeth, crowding, palatal cleft, arch deficiencies, oral digit habits, oral respiration during growth periods, and malfunctioning temporomandibular joints. Posterior cross-bite may have long-term effects on the growth and development of the teeth and jaws.1 The abnormal movement of the lower jaw may place strain on the orofacial structures, causing adverse effects on the temporomandibular joints and masticatory system. Also, the asymmetrical function and activity of the jaws in patients with a posterior cross-bite have been reported to cause different development of the right and left sides of the mandible.2 Studies of adolescents and adults have revealed that patients with posterior cross-bite have an increased risk of developing craniomandibular disorders, and show more signs and symptoms of these problems. In most cases, the cross-bite is accompanied by a mandibular shift, a so-called forced cross-bite, which causes midline deviation. A forced bite may cause alterations in the activity of the jaw muscles and may lead to skeletal changes with asymmetry of the face in the course of facial growth.2 Conditions affecting oral health such as dental caries and periodontitis,3,4 including cross-bite, have consequences not only for physical well-being as mentioned above, but can also impair quality of life by affecting function, appearance, interpersonal relationships, socializing, self-esteem and psychological well-being.5,6 The concept of oral health-related quality of life (OHRQoL) corresponds to the impact of oral health or diseases on the individual’s daily functioning, well-being or the conduct of valued activities.7–9 To date, much OHRQoL research has been based implicitly on Locker’s (1988) conceptual model of oral health.10 This model states that there are five consequences of oral disease: impairment, functional limitation, pain/discomfort, disability, and handicap. Further the model proposes that these domains are sequentially related. Impairment (structural abnormality e.g. cross-bite) leads to functional limitation (restrictions in body functions, e.g., difficulty chewing) and pain/discomfort (self-reported physical and psychological symptoms), which, in turn, lead to disability (limitations in performing daily activities, such as an unsatisfactory diet) and then to handicap (social disadvantage, such as social isolation).11 Functional limitation may also lead directly to handicap. The model can be conceptualized as comprising lower order impacts (impairment, functional limitation, pain/discomfort), which may cause higher order impacts manifest as handicap and disability (physical disability, psychological disability, social disability, and handicap). The Oral Health Impact Profile (OHIP) is one of the most frequently used OHRQoL measures which is based on Locker’s conceptual model of oral health.10 The OHIP measures the impact of oral disease in the
seven domains of Locker’s model. The disability domain of Locker’s conceptual model is further divided into physical, psychological and social disability domains.10 Research is required to understand the physical, social, and psychological impact of cross-bite on OHRQoL and its individual domains, since it sheds light on the effects of cross-bite on people’s lives and provides more understanding of the demand for orthodontic treatment. In addition, since social and psychological effects are the key motives for seeking treatment in general, OHRQoL in conjunction with objective measures (e.g. IOTN) of malocclusion can be considered a good reflection of treatment need and outcome.5 Such research may be of great value to researchers, health planners, and oral health care providers.12 Previous research exploring the relationship between malocclusion and OHRQoL, as well as the impact of orthodontic treatment on OHRQOL has, in some instances, found a strong relationship between malocclusion or orthodontic treatment need and OHRQoL,13–16 but other research has found no clear relationship.17,18 However to date the impact of cross-bite on OHRQoL has not been explored. Therefore, this study was conducted to assess the impact of posterior crossbite on OHRQoL in young people aged 15–25, who sought orthodontic treatment in the Department of Orthodontics at Universiti Teknologi MARA Malaysia and to determine the impact of cross-bite and lower domains of OHIP-14 (functional limitation, pain and discomfort) on higher domains of OHIP-14 (physical disability, psychological disability, social disability and handicap).
2.
Methods
2.1.
Study design
One hundred and forty-five young adults, aged 15–25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi MARA, in Malaysia participated in this study. Most participants were motivated by their parents to seek an orthodontic consultation. A convenience consecutive sampling approach was used. The participants were recruited at their first visit for orthodontic screening before starting any orthodontic treatment. The parents, or wherever possible the participants, signed an informed consent form, and agreed to participate in the study. To be eligible, the participant had to be in good general health. Participants who required a surgical intervention or who had chronic medical conditions, severe dentofacial anomalies such as cleft lip and palate, untreated dental caries, and poor periodontal health status as indicated by a community periodontal index score of 3 or more were excluded, as were those who had undergone previous orthodontic treatment. This was to prevent possible confounding effects of these conditions on the participants’ quality of life and to achieve a homogeneous group population. The Universiti Teknologi MARA (UiTM) Research Ethics Board approved all study procedures.
2.2.
Outcome variable (OHIP-14)
OHRQoL was measured using a Malay language translated version of the 14-item Oral Health Impact Profile (OHIP-14).
251
journal of dentistry 42 (2014) 249–255
The OHIP-14 has good reliability, validity, and precision.16,19 The Malay version of OHIP-14 has also been found to be valid and reliable and has been used in a nationally representative survey to obtain population estimates for prevalence, extent, and severity of the impact of conditions on oral health related quality of life.19 OHIP-14 assesses the burden of oral health status on life quality across seven conceptual domains (two items per domain) of oral health-related quality of life by asking respondents to rate the frequency of occurrence of a particular problem as captured by the individual item. Ratings are made on a 5-point Likert scale: 0 = never; 1 = hardly ever; 2 = occasionally; 3 = fairly often; 4 = very often/every day. Summary OHIP-14 scores were calculated by summing ordinal values for 14 items (range from 0 to 56; domain scores can range from 0 to 8). Higher OHIP-14 scores indicate worse and lower scores indicate better oral health-related quality of life. All participants completed the OHIP-14 without any help or assistance from parents or guardians before any orthodontic treatment.
2.3.
Cross bite
After completion of the OHIP-14, clinical examinations were conducted. The occlusal relationships were examined by direct visual inspection with the teeth in centric occlusion. Posterior cross-bite was diagnosed when an inverted relationship of occlusion was observed between at least 1 posterior tooth in the transverse plane. Patients who had a cross-bite by this definition were classified as cases for this study and patients who were detected negative for cross-bite and other malocclusal traits (such as overjet, reverse overjet, overbite, open-bite, crowding, impeded eruption, defects of cleft lip and palate as well as any craniofacial anomaly, Class II and Class III buccal occlusions, and hypodontia) were classified as controls. Age, sex, and educational background were recorded because of their potential associations with both outcome and explanatory variables.
2.4.
Examiners reliability tests
Clinical examination for cross-bite was performed by two trained and calibrated examiners. To assess intra- and interexaminer reliability, 20 individuals who were not part of the present study were randomly selected and re-examined at a 2– 4 week interval after their first examinations. Intra-examiner reliability for the examiners was almost perfect with kappa = 0.91 and 0.96. Excellent agreement was found for the inter-examiner reliability with Kappa = 0.85.
2.5.
Statistical analysis
The data were analyzed by using R-Project software (version 2.13.2).20 Data analyses included descriptive statistics for cross-bite and control groups, the chi-squared test was used to compare case and control groups. The mean total OHIP-14 scores and its domains for cross-bite patients and controls were compared using the student’s t-test. Bivariate and multivariate regression models were used to determine the association between OHRQoL and cross-bite, sex, age and education level. In the linear regression analyses, OHIP-14
scores were used as continuous outcome variable. Bivariate linear regressions were performed individually in separate models with each explanatory variable; cross-bite (no = 0, yes = 1), gender (male = 0 and female = 1), age groups (15–18 years = 0, 19–21 years = 1, 22–25 years = 2) and educational level (secondary education = 0 and university education = 1). Additionally, multivariate linear regression modelling was carried out in order to explore the impact in higher order domains of OHIP-14 (physical disability, psychological disability, social disability and handicap) attributable to the lower order domains of OHIO-14 (functional limitation, pain and discomfort) and cross-bite while adjusting age, gender and education level. Separate models for each higher domain were conducted with all lower domains were entered as predictors along with age, sex, education level and cross bite.21
3.
Results
The socio-demographic characteristics of the participants are summarized in Table 1 for both case and control groups. There were no significant differences between the case and control groups in gender, age and education level (Table 1). Frequency of impact for OHIP-14 domains in cross bite and control groups is given in Appendix 1. Supplementary material related to this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.jdent.2013.12.004. Table 2 displays the mean, standard deviation, median and the range for the total OHIP-14 score and its domains for both case and control groups. The mean scores (SD) for the total OHIP-14 and all domains were significantly higher in crossbite patients as compared to controls. The social disability (2.85 2.06) domain of OHIP-14 showed least impact due to cross-bite. Whereas, the psychological discomfort domain had the highest impact with a mean (SD) of 4.24 1.69. Table 3 summarizes the bivariate and multivariate analyses to establish the association between OHIP-14 and crossbite, gender, age group and education level. Although crossbite only accounted for 11% of the variation in OHIP-14 score, this association was highly significant ( p < 0.001). People with
Table 1 – Sociodemographic characteristics of cross bite patients and controls. Cross bite (n = 71)
Control group (n = 72)
Chi-square test
p-Value
Gender Male Female
29 42
27 45
0.0568
0.8116
Age 15–18 years 19–21 years 22–25 years
7 19 45
10 26 36
2.6114
0.271
6
11
1.0057
0.3159
65
61
Variable
Education level Secondary education University education
252
journal of dentistry 42 (2014) 249–255
Table 2 – Mean, standard deviation (SD), median and range observed in Oral Health Impact Profile-14 (OHIP-14) in case and control groups. OHIP domain
Functional limitation Physical pain Psychological discomfort Physical disability Psychological disability Social disability Handicap OHIP total a
Cross bite (n = 71)
Control group (n = 72)
t-Test results
Mean SD
Median
Range observed
Mean SD
Median
Range observed
Mean difference
t-Test
p-Valuea
3.89 1.95 3.45 1.56 4.24 1.69 3.14 2.02 2.86 1.75 2.85 2.06 3.11 2.07
4 4 5 4 3 3 4
0–6 0–6 0–6 0–6 0–6 0–6 0–6
2.18 1.86 2.18 1.63 2.62 1.82 2.04 1.61 1.97 1.69 1.81 1.68 2.33 1.77
2 2 3 2 2 2 2
0–6 0–5 0–5 0–4 0–5 0–6 0–6
1.71 1.27 1.62 1.10 0.89 1.04 0.78
5.3 4.7 5.5 3.5 3.0 3.3 2.4
Available online at www.sciencedirect.com
ScienceDirect journal homepage: www.intl.elsevierhealth.com/journals/jden
Cross-bite and oral health related quality of life in young people Mohd Masood a,*, Yaghma Masood b, Tim Newton c a
Centre of Studies for Community Dentistry, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia Centre of Studies for Oral Pathology, Faculty of Dentistry, Universiti Teknologi MARA, Shah Alam, Malaysia c Unit of Dental Public Health and Oral Health Services Research, King’s College Dental Institute, King’s College London, Denmark Hill, London, UK b
article info
abstract
Article history:
Objectives: This study sought to assess the impact of posterior cross-bite on OHRQoL in
Received 22 June 2013
young people aged 15–25 and to determine whether the impact on higher domains of Oral
Received in revised form
Health Impact Profile-14 (physical disability, psychological disability, social disability and
23 November 2013
handicap) is a direct function of the cross-bite or mediated through the lower domains of
Accepted 13 December 2013
OHIP-14 (functional limitation, pain and discomfort). Methods: One hundred and forty-five young adults [72 cross-bite cases and 73 controls] aged 15–25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi
Keywords:
MARA participated in this study. Participants completed the OHIP-14 and had a clinical
Oral health related quality of life
examination for cross-bite. Data analyses included descriptive statistics, t-test and bivariate
Cross bite
and multivariate regression modelling.
OHIP
Results: There was no significant difference between the case and control groups in gender, age and education level. The mean scores (SD) for OHIP-14 total and all domains were significantly higher in cross-bite patients as compared to controls. The bivariate and multivariate regression analyses showed functional limitation was significantly associated with all the higher domains in all four models, whereas pain was only significantly associated with the psychological domain and discomfort was only significantly associated with the physical disability domain. Conclusion: The possession of a posterior cross bite has a significant association with OHRQoL especially on the functional limitation and psychological disability domains, among 15–25 years old young people. The relationship of cross-bite and lower domains of OHIP-14 with higher domains of OHIP-14 was in agreement with the relationships proposed by Locker’s conceptual model of oral health. Clinical significance: Patients with a cross bite were more limited in their oral functions and experienced greater psychological discomfort than did controls. It is possible that part of patients’ rationale for seeking treatment would be to alleviate such impacts on their oral health related quality of life. # 2013 Elsevier Ltd. All rights reserved.
* Corresponding author. Tel.: +60 162209941. E-mail addresses: [email protected] (M. Masood), [email protected] (Y. Masood), [email protected] (T. Newton). 0300-5712/$ – see front matter # 2013 Elsevier Ltd. All rights reserved. http://dx.doi.org/10.1016/j.jdent.2013.12.004
250
1.
journal of dentistry 42 (2014) 249–255
Introduction
Posterior cross-bite has been defined as, ‘‘a transversal arch discrepancy in which the palatal cusps of one or more of the upper posterior teeth do not occlude in the central fossae of the opposing lower teeth. A posterior cross-bite may be unilateral or bilateral when the patient bites into maximum intercuspation’’.1,2 Studies have suggested that the prevalence of a posterior cross-bite ranges between 8% and 16% of the population.1 The aetiology of cross-bites is complex and may include prolonged retention or premature loss of deciduous teeth, crowding, palatal cleft, arch deficiencies, oral digit habits, oral respiration during growth periods, and malfunctioning temporomandibular joints. Posterior cross-bite may have long-term effects on the growth and development of the teeth and jaws.1 The abnormal movement of the lower jaw may place strain on the orofacial structures, causing adverse effects on the temporomandibular joints and masticatory system. Also, the asymmetrical function and activity of the jaws in patients with a posterior cross-bite have been reported to cause different development of the right and left sides of the mandible.2 Studies of adolescents and adults have revealed that patients with posterior cross-bite have an increased risk of developing craniomandibular disorders, and show more signs and symptoms of these problems. In most cases, the cross-bite is accompanied by a mandibular shift, a so-called forced cross-bite, which causes midline deviation. A forced bite may cause alterations in the activity of the jaw muscles and may lead to skeletal changes with asymmetry of the face in the course of facial growth.2 Conditions affecting oral health such as dental caries and periodontitis,3,4 including cross-bite, have consequences not only for physical well-being as mentioned above, but can also impair quality of life by affecting function, appearance, interpersonal relationships, socializing, self-esteem and psychological well-being.5,6 The concept of oral health-related quality of life (OHRQoL) corresponds to the impact of oral health or diseases on the individual’s daily functioning, well-being or the conduct of valued activities.7–9 To date, much OHRQoL research has been based implicitly on Locker’s (1988) conceptual model of oral health.10 This model states that there are five consequences of oral disease: impairment, functional limitation, pain/discomfort, disability, and handicap. Further the model proposes that these domains are sequentially related. Impairment (structural abnormality e.g. cross-bite) leads to functional limitation (restrictions in body functions, e.g., difficulty chewing) and pain/discomfort (self-reported physical and psychological symptoms), which, in turn, lead to disability (limitations in performing daily activities, such as an unsatisfactory diet) and then to handicap (social disadvantage, such as social isolation).11 Functional limitation may also lead directly to handicap. The model can be conceptualized as comprising lower order impacts (impairment, functional limitation, pain/discomfort), which may cause higher order impacts manifest as handicap and disability (physical disability, psychological disability, social disability, and handicap). The Oral Health Impact Profile (OHIP) is one of the most frequently used OHRQoL measures which is based on Locker’s conceptual model of oral health.10 The OHIP measures the impact of oral disease in the
seven domains of Locker’s model. The disability domain of Locker’s conceptual model is further divided into physical, psychological and social disability domains.10 Research is required to understand the physical, social, and psychological impact of cross-bite on OHRQoL and its individual domains, since it sheds light on the effects of cross-bite on people’s lives and provides more understanding of the demand for orthodontic treatment. In addition, since social and psychological effects are the key motives for seeking treatment in general, OHRQoL in conjunction with objective measures (e.g. IOTN) of malocclusion can be considered a good reflection of treatment need and outcome.5 Such research may be of great value to researchers, health planners, and oral health care providers.12 Previous research exploring the relationship between malocclusion and OHRQoL, as well as the impact of orthodontic treatment on OHRQOL has, in some instances, found a strong relationship between malocclusion or orthodontic treatment need and OHRQoL,13–16 but other research has found no clear relationship.17,18 However to date the impact of cross-bite on OHRQoL has not been explored. Therefore, this study was conducted to assess the impact of posterior crossbite on OHRQoL in young people aged 15–25, who sought orthodontic treatment in the Department of Orthodontics at Universiti Teknologi MARA Malaysia and to determine the impact of cross-bite and lower domains of OHIP-14 (functional limitation, pain and discomfort) on higher domains of OHIP-14 (physical disability, psychological disability, social disability and handicap).
2.
Methods
2.1.
Study design
One hundred and forty-five young adults, aged 15–25 years, attending orthodontic clinics at the Faculty of Dentistry, Universiti Teknologi MARA, in Malaysia participated in this study. Most participants were motivated by their parents to seek an orthodontic consultation. A convenience consecutive sampling approach was used. The participants were recruited at their first visit for orthodontic screening before starting any orthodontic treatment. The parents, or wherever possible the participants, signed an informed consent form, and agreed to participate in the study. To be eligible, the participant had to be in good general health. Participants who required a surgical intervention or who had chronic medical conditions, severe dentofacial anomalies such as cleft lip and palate, untreated dental caries, and poor periodontal health status as indicated by a community periodontal index score of 3 or more were excluded, as were those who had undergone previous orthodontic treatment. This was to prevent possible confounding effects of these conditions on the participants’ quality of life and to achieve a homogeneous group population. The Universiti Teknologi MARA (UiTM) Research Ethics Board approved all study procedures.
2.2.
Outcome variable (OHIP-14)
OHRQoL was measured using a Malay language translated version of the 14-item Oral Health Impact Profile (OHIP-14).
251
journal of dentistry 42 (2014) 249–255
The OHIP-14 has good reliability, validity, and precision.16,19 The Malay version of OHIP-14 has also been found to be valid and reliable and has been used in a nationally representative survey to obtain population estimates for prevalence, extent, and severity of the impact of conditions on oral health related quality of life.19 OHIP-14 assesses the burden of oral health status on life quality across seven conceptual domains (two items per domain) of oral health-related quality of life by asking respondents to rate the frequency of occurrence of a particular problem as captured by the individual item. Ratings are made on a 5-point Likert scale: 0 = never; 1 = hardly ever; 2 = occasionally; 3 = fairly often; 4 = very often/every day. Summary OHIP-14 scores were calculated by summing ordinal values for 14 items (range from 0 to 56; domain scores can range from 0 to 8). Higher OHIP-14 scores indicate worse and lower scores indicate better oral health-related quality of life. All participants completed the OHIP-14 without any help or assistance from parents or guardians before any orthodontic treatment.
2.3.
Cross bite
After completion of the OHIP-14, clinical examinations were conducted. The occlusal relationships were examined by direct visual inspection with the teeth in centric occlusion. Posterior cross-bite was diagnosed when an inverted relationship of occlusion was observed between at least 1 posterior tooth in the transverse plane. Patients who had a cross-bite by this definition were classified as cases for this study and patients who were detected negative for cross-bite and other malocclusal traits (such as overjet, reverse overjet, overbite, open-bite, crowding, impeded eruption, defects of cleft lip and palate as well as any craniofacial anomaly, Class II and Class III buccal occlusions, and hypodontia) were classified as controls. Age, sex, and educational background were recorded because of their potential associations with both outcome and explanatory variables.
2.4.
Examiners reliability tests
Clinical examination for cross-bite was performed by two trained and calibrated examiners. To assess intra- and interexaminer reliability, 20 individuals who were not part of the present study were randomly selected and re-examined at a 2– 4 week interval after their first examinations. Intra-examiner reliability for the examiners was almost perfect with kappa = 0.91 and 0.96. Excellent agreement was found for the inter-examiner reliability with Kappa = 0.85.
2.5.
Statistical analysis
The data were analyzed by using R-Project software (version 2.13.2).20 Data analyses included descriptive statistics for cross-bite and control groups, the chi-squared test was used to compare case and control groups. The mean total OHIP-14 scores and its domains for cross-bite patients and controls were compared using the student’s t-test. Bivariate and multivariate regression models were used to determine the association between OHRQoL and cross-bite, sex, age and education level. In the linear regression analyses, OHIP-14
scores were used as continuous outcome variable. Bivariate linear regressions were performed individually in separate models with each explanatory variable; cross-bite (no = 0, yes = 1), gender (male = 0 and female = 1), age groups (15–18 years = 0, 19–21 years = 1, 22–25 years = 2) and educational level (secondary education = 0 and university education = 1). Additionally, multivariate linear regression modelling was carried out in order to explore the impact in higher order domains of OHIP-14 (physical disability, psychological disability, social disability and handicap) attributable to the lower order domains of OHIO-14 (functional limitation, pain and discomfort) and cross-bite while adjusting age, gender and education level. Separate models for each higher domain were conducted with all lower domains were entered as predictors along with age, sex, education level and cross bite.21
3.
Results
The socio-demographic characteristics of the participants are summarized in Table 1 for both case and control groups. There were no significant differences between the case and control groups in gender, age and education level (Table 1). Frequency of impact for OHIP-14 domains in cross bite and control groups is given in Appendix 1. Supplementary material related to this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.jdent.2013.12.004. Table 2 displays the mean, standard deviation, median and the range for the total OHIP-14 score and its domains for both case and control groups. The mean scores (SD) for the total OHIP-14 and all domains were significantly higher in crossbite patients as compared to controls. The social disability (2.85 2.06) domain of OHIP-14 showed least impact due to cross-bite. Whereas, the psychological discomfort domain had the highest impact with a mean (SD) of 4.24 1.69. Table 3 summarizes the bivariate and multivariate analyses to establish the association between OHIP-14 and crossbite, gender, age group and education level. Although crossbite only accounted for 11% of the variation in OHIP-14 score, this association was highly significant ( p < 0.001). People with
Table 1 – Sociodemographic characteristics of cross bite patients and controls. Cross bite (n = 71)
Control group (n = 72)
Chi-square test
p-Value
Gender Male Female
29 42
27 45
0.0568
0.8116
Age 15–18 years 19–21 years 22–25 years
7 19 45
10 26 36
2.6114
0.271
6
11
1.0057
0.3159
65
61
Variable
Education level Secondary education University education
252
journal of dentistry 42 (2014) 249–255
Table 2 – Mean, standard deviation (SD), median and range observed in Oral Health Impact Profile-14 (OHIP-14) in case and control groups. OHIP domain
Functional limitation Physical pain Psychological discomfort Physical disability Psychological disability Social disability Handicap OHIP total a
Cross bite (n = 71)
Control group (n = 72)
t-Test results
Mean SD
Median
Range observed
Mean SD
Median
Range observed
Mean difference
t-Test
p-Valuea
3.89 1.95 3.45 1.56 4.24 1.69 3.14 2.02 2.86 1.75 2.85 2.06 3.11 2.07
4 4 5 4 3 3 4
0–6 0–6 0–6 0–6 0–6 0–6 0–6
2.18 1.86 2.18 1.63 2.62 1.82 2.04 1.61 1.97 1.69 1.81 1.68 2.33 1.77
2 2 3 2 2 2 2
0–6 0–5 0–5 0–4 0–5 0–6 0–6
1.71 1.27 1.62 1.10 0.89 1.04 0.78
5.3 4.7 5.5 3.5 3.0 3.3 2.4
