Psychosocial Impact of Malocclusion among Adolescents

Siti Bahirrah

Department of Orthodontics, Faculty of Dentistry, Universitas Sumatera Utara, Jl.Alumni No.2 Kampus USU, Medan,

20155, Indonesia

Keywords: Malocclusion, Adolescents, Psychosocial

Abstract: Introduction: Adolescence is a transitional period into adulthood from childhood. During the time of growth

and development, adolescents will often be facing an oral health problem. One of the problems encountered

by them will be a malocclusion. Malocclusion is defined as an occlusion which deviates from the standard

categorized as normal. Malocclusion may be caused setbacks to the person which will affect the psychosocial

condition of the adolescents. Methods: The aim of this research is to determine the effect of malocclusion

towards the psychosocial condition based on Aesthetic Component and PIDAQ among senior high school

adolescents. Chi-square test was used in this research. This is descriptive analytics research. The population

of this research was the student's senior high school with a total of 963 people who were then selected by

simple random sampling method. The sample size of the research is 100 people. Conclusion: This shows that

no effect was found between malocclusion and psychosocial condition among adolescents.

1 INTRODUCTION

Adolescence is a transitional period into adulthood

from childhood. During the time of growth and

development, adolescents will often be facing oral

health problem such as malocclusion.(Wagiran et al.,

2014;Laguhi et al., 2014)

Malocclusion is defined as

an occlusion which deviates from the standard

categorized as normal. A normal occlusion is defined

when the tooth arrangement in the arch is well

organized and there is a harmonious relationship

between the upper and lower teeth.

Malocclusion is not a disease but if left untreated

will cause disruption in the mastication, ingestion,

speech and facial symmetry resulting in both physical

and mental disorders. (Laguhi et al., 2014).

Malocclusion is not a disease secondary to

microorganism, bacteria, and virus but a

disharmonious relationship between upper and lower

arch or an irregular dental arch arrangement.

Malocclusion happened due to skeletal factor, a

genetic factor that includes facial type, racial

influence, growth and development patterns, and

habits. .(Wagiran et al., 2014)

Based on the national basic health report

(Riskesdas) in the year 2013, as much as 14 provinces

were facing oral health problems which make up

25.4%. The prevalence of malocclusion in Indonesia

is still high which is around 80% of the total

population, therefore can be classified as a major oral

health problem. This is aggravated by the low

awareness towards the dental treatment and bad oral

habits such as thumb sucking because the number and

severity of malocclusion will increase therefore it

must be prevented or handle. The research about

malocclusion helps in orthodontic treatment planning

and also evaluating health services. (Laguhi et al.,

2014).

Malocclusion can be caused disturbance for the

patients. From the psychic aspect, malocclusion can

affect esthetics, causing low self-esteem and low

satisfaction towards facial appearance. In the

individual facing malocclusion, bad impression and

negative reactions from the patients which can affect

the self-esteem of the patients.(Wagiran et al., 2014)

Based on the research conducted by Kustiawan

(2003), non-attractive facial appearance has a

negative impact towards the individual psychological

development, especially during the adolescents

period.(Wagiran et al., 2014)

Based on the results by Dewi (2008) regarding the

relationships between the gender and quality of life

shows that there is a significant relationship between

gender and psychic discomfort, inability in terms of

psychic and social. Female adolescents complain

more frequently compared to male (p<0.05). This is

Bahirrah, S.

Psychosocial Impact of Malocclusion among Adolescents.

DOI: 10.5220/0009863101890193

In Proceedings of the 2nd International Conference on Tropical Medicine and Infectious Disease (ICTROMI 2019), pages 189-193

ISBN: 978-989-758-469-5

189

mainly due to the females which are more sensitive to

the changes in life, especially towards the esthetic

problems. (Dewi, 2007).

In the research done by

Anosike et al also stated that there is a significant

difference between malocclusion and quality of life

based on gender. In their research showed that the

males were showing more attention about themselves

(22.3%), lower psychological condition towards the

malocclusion happened (17%) and more embarrassed

by their oral cavity (18.7%).

Based on the research by (De Paula et al., 2009)

regarding the Psychosocial Impact of Dental

Esthetics on Quality of Life in Adolescents from 301

adolescents with age ranged from 13 to 20 years old

from the public school in the city of Goiania, Brazil,

can be concluded that oral health condition not only

affecting the oral functions and appearance only but

also affecting from the psychology point of view. The

results of the research proved that there is a verbal

defect in the oral health problem which is the decline

in social interaction due to oral health is reported by

88% of the adolescents, 98.3% of the total subjects

showed a few stages of psychosocial effects and 72%

from the samples showed dissatisfaction with a few

parts of the body.(Deswita et al., 2013). The research

conducted by (Paula DF et al., 2011) showed that

PIDAQ score was the highest in the subjects with

high Dental Aesthetic Index (DAI) score, high smile

line and unsatisfactory with the appearance of the

teeth.

In the research by (Bellot - Arcis et al., 2015) on

the adolescents aged 12-15 years old showed that

average total PIDAQ score was 32.2, with average

DSC (Dental Self-Confidence) score of 11.3, average

SI (Social Impact) score of 6.1, average PI

(Psychological Impact) score of 5.9, average AC

(Aesthetic Concern) score of 7.44. The highest

PIDAQ score was found in the subjects with large

overjet dan overbite, the disturbed eruption of the

tooth, and displacement teeth. The results also

showed that there is no difference in PIDAQ score

between the male and female besides that PI score

where the females have higher score compared to the

males. Therefore, they concluded that the higher the

severity of malocclusion in an individual, the higher

the effect towards the psychosocial status. (Bellot -

Arcis et al., 2015)

Based on the description above, malocclusion can

affect the psychosocial condition of the adolescents,

therefore the author is interested in determining the

effect of malocclusion towards the psychosocial

condition based on the Aesthetic Component and

PIDAQ among the senior high school adolescents in

SMAN 14 Medan.

2 METHODS

This is descriptive analytical research with cross-

sectional design. Examination of malocclusion and

psychosocial condition was done on the senior high

school adolescents in SMAN 14 Medan. The total

sample was 100 people consists of 50 males and 50

females. Criteria of the sample in this research

include full permanent dentition except for the third

molar, having malocclusion, none or having

orthodontic treatment, no history of trauma in the face

and neck, no congenital disorder and compliance to

become respondents. Simple random sampling

method was used in obtaining samples.

This research was done by taking intraoral

photometry. First, cheek retractor was put on in the

mouth of the samples, then the patient was instructed

to gulp to achieve centric occlusion. Then a digital

camera was used to capture photos. Then the photo is

printed in 3R size on photo print paper with the

measurement of 7.5cm x 10.5 cm. The photo is

measured in accordance with the Aesthetic

Component (AC) scale. Then the author gives a brief

explanation to the subjects which fulfilled the

inclusion criteria about the procedures in filling the

questionnaire. Then the adolescents who were chosen

to be the subjects will fill the questionnaire on the data

sheet. Then, the author will begin the data collection

of the questionnaire. Analysis of the questionnaire

data will be done using the SPSS program. The data

collected will be presented in the table form with the

results presented in number form.

3 RESULTS

Table 1: Frequency Sample Distribution based on Gender

Gender Frequency (n) Percentage (%)

Male 50 50 %

Female 50 50 %

Total 100 100%

Table 1 shows total samples of 100 people where 50

people (50%) were males whereas 50 people (50%)

were females.

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Table 2: Frequency Sample Distribution of Orthodontic

Treatment Needs to be based on AC

Orthodontic

Treatment Needs

Frequency (n) Percentage (%)

No Need 75 75%

Moderate Need 2 2%

Great Need 23 23%

Total 100 100%

Table 2 above shows the distribution of samples in

which orthodontic treatment need was measured

based on AC. The samples with no need of

Orthodontic Treatment consists of 75 people (75%),

the moderate need of Orthodontic Treatment consists

of 2 people (2%) and great need of Orthodontic

Treatment consists of 23 people (23%).

Table 3: Frequency Sample Distribution of Orthodontic

Treatment Needs To be Based on AC in Different Genders

Orthodontic

Treatment Needs

Gender

Male Female

No Need 34 41

Moderate Need 1 1

Great Need 15 8

Total (%) 50 % 50 %

Table 3 shows the distribution of a sample of

Orthodontic Treatment Needs to be based on AC in

different genders. Samples which possesses no need

of Orthodontic Treatment among the males consists

of 34 people (34%) whereas among the females

consists of 41 people (41%), in moderate need of

Orthodontic Treatment among the males and females

were the same which consists of 1 people each (1%),

and in great need of Orthodontic Treatment among

the males were 15 people (15%) whereas among the

females were 8 people (8%).

Table 4: Average PIDAQ score among the senior high

school adolescents SMAN 14 Medan based on Gender

Average PIDAQ

Score

Gender Total

Average

PIDAQ

Score

Male Female

Dental Self-

Confidence (DSC)

10,54 12,10 11,32

Social Impact (SI) 8,60 8,56 8,58

Psychological

Impact (PI)

9,40 9,90 9,65

Aesthetic Concern

(AC)

2,58 1,98 2,28

Total 31,12 32,54 31,83

Table 4 above shows that average PIDAQ score

among the adolescents of both genders in SMAN 14

Medan with Orthodontic Treatment Needs to be

based on AC. The average score of Orthodontic

Treatment Needs to be based on AC among the senior

high school adolescents in SMAN 14 Medan were

DSC 11.32; SI 8.58; PI 9.65; and AC 2.28. The

average total score of DSC in the males was 10.54

whereas the females were 12.10. The average total

score of SI in the males was 8.60 whereas the females

were 8.56. The average total score of PI in the males

was 9.40 whereas the females were 9.90. The average

total score of AC in the male was 2.58 whereas the

females were 1.98.

Table 5: Psychosocial condition with Orthodontic

Treatment Needs to be based on AC among the senior high

school adolescents in SMAN 14 Medan based in Different

Genders.

Psychosocial

Condition of

Adolescents

Gender

Total (%)

Male Female

Good 28 22

50 %

Moderate 19 28

47 %

Bad 3 0

3 %

Total

100%

Table 5 above shows that the psychosocial condition

of adolescents in SMAN 14 with Orthodontic

Treatment Needs to be based on AC in different

genders. From 100 samples, there were 50 people

(50%) having good psychosocial status, 47 people

(47%) having moderate psychosocial status and 3

people (3%) having bad psychosocial status. Total

samples having good psychosocial condition among

the males were 28 people (28%) whereas among the

females were 22 people (22%). Total samples having

moderate psychosocial condition among the males

were 19 people (19%) whereas among the females

were 28 people (28%). Total samples having bad

psychosocial condition among the males were 3

people (3%) whereas none among the females.

Psychosocial Impact of Malocclusion among Adolescents

191

Table 6: Frequency Sample Distribution with Orthodontic

Treatment Needs to be based on Ac and Psychosocial

Condition based on PIDAQ among the adolescents in

SMAN 14 Medan in Different Genders

Orthodont

Treatment

Needs

Psychosocial Condition

Good Moderate Bad

Male Female Male

Female Male Femal

Mild 18 20 13 21 3 0

Moderate 1 0 0 1 0 0

Great 9 2 6 6 0 0

Total

(28%)

(22%)

(19%)

(28%)

(3%)

(0%)

50% 47% 3%

100%

Table 6 above shows that the distribution of samples

in which the Orthodontic Treatment Needs to be

based on AC with the psychological condition based

on genders. From the 50 adolescents having good

psychosocial status, 28 people (28%) were males

whereas 22 people (22%) were females. From the 47

adolescents having a moderate psychosocial status,

19 people (19%) were males whereas 28 people (28%)

were females. From the 3 adolescents having the bad

psychosocial status, 3 people (3%) were males and

none were females (0%).

Table 7: Effect of Malocclusion towards the Psychosocial

Condition among the senior high school adolescents in

SMAN 14 Medan.

Orthodo

ntic

Treatme

nt Needs

Psychosocial Condition

Analysi

s Test

Good Moderate Bad

0,877

Male

Femal

Male

Femal

Male

Femal

No Need 18 20 13 21 3 0

Moderat

e Need

1 0 0 1 0 0

Great

Need

9 2 6 6 0 0

Total

(28%)

(22%)

(19%)

(28%)

(3%)

(0%)

50% 47% 3%

100%

Table 7 above shows that results from the Chi-Square

test, p coefficient of 0.877 were obtained, where

p<0.05, therefore, Ho was accepted. Based on the

statistical analysis, it can be concluded that there is no

effect on the analytical variables. This showed that

there is no effect between malocclusion towards

psychosocial condition among the senior high school

adolescents in SMAN 14 Medan.

4 DISCUSSION

Psychosocial condition of 100 subjects with a level of

orthodontic treatment needs based on AC were 50

samples having the good psychosocial condition, 47

samples having the moderate psychosocial condition,

and 3 samples having the bad psychosocial condition,

it can be seen in Table 5. The results of this study are

proportional to the results of the study from Sambeta

on 50 students of SMAN 1 Luwuk, where the good

psychosocial condition were 23 people, the moderate

psychosocial condition were 23 people, and 4 people

having the poor psychosocial condition (Sambeta et

al., 2016). The results of this study are also supported

by the results of research by Puspitasari on 96

students from FEB University of Muhammadiyah

Surakarta with age ranged from 20-25 years, where

47 people having the good psychosocial condition, 46

people having the moderate psychosocial condition,

and 3 people having a bad psychosocial condition.

(Puspitasari,2014). The results from this research are

slightly different from the results of the research by

Liling DT on 214 junior high school students in

Makassar, where 94 people having good psychosocial

status, 55 patients having moderate psychosocial

status and 65 people having poor psychosocial status.

(Liling, 2013). This difference may be due to the

differences in sample size and population and age of

the samples between both of the studies.

The level of orthodontic treatment needs to be

based on AC grouped with psychosocial conditions in

adolescents SMAN 14 Medan. The sample

distribution measured by the level of orthodontic

treatment needs to be based on AC with the

psychosocial conditions based on sex can be seen in

Table 6. From the 50 students with good psychosocial

status, 28 people were male (28%) and 22 people

were female (22%). From the 47 students with

moderate psychosocial status, 19 were male (19%)

and 28 were females (28%). From the 3 students with

poor psychosocial status, 3 were male (3%) and none

were females (0%).

Levels of orthodontic treatment needs based on

AC were then associated with psychosocial

conditions among the senior high school adolescents

SMAN 14 Medan, can be seen in Table 7. Based on

the statistical chi-square test, there is no effect of

malocclusion towards psychosocial condition among

ICTROMI 2019 - The 2nd International Conference on Tropical Medicine and Infectious Disease

192

the senior high school adolescents in SMAN 14

Medan. The subjects from this study who had poor

psychosocial status were only 3% compared with

those with good and moderate psychosocial status

with a percentage of 50% and 47% respectively. The

results of this study is supported by the research of De

Paula et al on 301 adolescent samples with the age

ranged from 13 to 20 years in which they found that

despite the dissatisfaction with dental appearance was

strongly related to the severity of the tooth structure,

it was not uncommon to find some patients with

severe malocclusion, feeling satisfied with their

dental aesthetic.(De Paula et al., 2009)

The authors 'opinion on the phenomenon is due to

the lacking of students' knowledge and awareness in

SMAN 14 about malocclusion, thus affecting their

subjective perception of malocclusions. This situation

is also influenced by other factors such as the location

of the school and the economic conditions of the

study subjects. This is seen in some respondents with

a moderate and great orthodontic treatment needs to

consider their teeth to be more attractive than not

having any treatment. This opinion is in line with

Dewi's research on 413 students in Medan and found

that 82.6% of the respondents studied were confident

that their teeth arrangement were in the good

category.(Dewi,2007)

5 CONCLUSION

Ap coefficient of 0.877 was obtained from the test

results, therefore it can be concluded that the H0 was

accepted. This shows that no effect was found

between malocclusion and psychosocial condition

among the senior high school adolescents in SMAN

14 Medan.

COMPETING INTEREST

There is no conflict of interest.

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