Page 22 - MDJ 2022 Jan-Jun, Volume 45 Number 1

Lee / Ebin

dentists in the East Coast of Sabah. There were similar
studies on patients requesting orthodontic treatment that
found less than half of the patients had definite orthodontic
treatment need. 7,18 Epidemiological studies also found less
than half of the patients had definite treatment
need. 12,16,19,20

Consideration of the perceived need of the patient
is important to increase mutually satisfying results for both
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the clinician and the patient, because not all patients
would agree to undergo orthodontic treatment despite a
definite orthodontic treatment need. There were some
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referred patients who refused orthodontic treatment, while
others were keen to have treatment even for mild
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malocclusion.
In our study, the types of malocclusion based on
IOTN-DHC were mainly crowding, increased overjet, and
Figure 2: Type of malocclusion based on the orthodontic impacted teeth. With regard to the occlusal findings for
treatment need of the referred patients. crowding and increased overjet, the results were similar to
other studies. 6,7,18,23,24 However, impacted teeth were
the need for orthodontic treatment. It also allows relatively uncommon in other studies. 6,18 Crossbite and
orthodontists to standardise their approach in evaluating reverse overjet, which may have benefited from early
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treatment need. Although widely used to grade several interceptive treatment, each presented at less than 10 %
common occlusal traits, the IOTN-DHC is not a reliable among our patients. Studies found that the percentage rate
predictor of the potential impact of malocclusion on future of these occlusal disharmonies appeared to be high and
dental health. This is because patients with high IOTN therefore early treatment had been recommended. 25,26
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scores were not necessarily would have future dental These may indicate the need to improve the orthodontic
health problem if they did not undergo orthodontic knowledge among dental therapists to allow them to detect
treatment. malocclusion in the primary school dental service and
make a timely referral to dentists.
In our study, nearly three-quarters of the patients
were female. According to a study, the majority of Overall, these findings are important and useful
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orthodontic patients are female, even though male for planning of the annual budget and manpower need in
patients had a higher treatment need. 16,17 In addition, the government orthodontic specialist clinic, and also to
malocclusion has a higher impact on the oral health-related assess the level of understanding and usage of IOTN-DHC
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quality of life in females. Therefore, females appeared to among dentists. Orthodontic treatment need assessment
be more concerned about facial and dental aesthetics. It also plays an important role in resource planning,
may also indicate that the levels of awareness and interest preparation, and distribution, so that suitable patient
in orthodontic treatment are higher in females. selection and timely referrals can be carried out.

All patients were screened by dentists before The findings might not be representative of the
being referred for orthodontic consultation, although the actual orthodontic treatment need, as the data collected for
primary source of referral could be dental therapists. This this study were the dental records of the referred patients
is because dentists have the main responsibility to identify at the government orthodontic specialist clinics only. For
and to refer patients who would require and benefit from future studies, epidemiological multicentre research on
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orthodontic treatment in a timely manner. Patients with school children might provide more accurate findings of
congenital syndromes and craniofacial deformities were the orthodontic treatment need in Sabah.
excluded because they were referred by specialists from
other specialties during multidisciplinary clinical sessions. CONCLUSION
The syndromes and craniofacial deformities themselves
may act as comorbidities to the primary area of interest, More than three-quarters of the referred patients
which is the severity of the malocclusion as assessed by had definite orthodontic treatment need. Crowding was the
the IOTN-DHC. most common type of malocclusion.

Patients with IOTN-DHC Grade 4 and 5 were ACKNOWLEDGEMENTS
considered to have definite orthodontic treatment need.
More than three-quarters of the referred patients had We would like to thank the Director General of
definite orthodontic treatment need, similar to findings by Health Malaysia and the Principal Director of Oral Health
Al-Jobair et al. (2016). Thus, this showed a good level of Programme for permission to publish this article.
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IOTN-DHC usage and understanding among the referring

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