# Correlation Between Dental Health and Aesthetic Components of Malocclusion in Junior High and High School Students: An Epidemiological Study Using Item Response Theory

## TL;DR

This study finds that certain dental issues like crowding and overbite are most important in determining the need for orthodontic treatment in teenagers.

## Contribution

The study introduces a novel use of Item Response Theory to evaluate the effectiveness of specific dental health indicators in relation to aesthetic assessments.

## Key findings

- 21.1% of students were identified as needing orthodontic treatment.
- Females had a higher rate of treatment need compared to males.
- Crowding, increased overjet, and increased overbite showed high discriminatory power and significant contributions to aesthetic evaluations.

## Abstract

Background: The Index of Orthodontic Treatment Need (IOTN) is widely used to assess the need for orthodontic treatment. IOTN consists of the Dental Health Component (DHC) and the Aesthetic Component (AC), evaluating malocclusion morphologically and aesthetically, respectively. However, the discriminatory power of individual DHC items and their relationship with AC grades remain unclear. Objective: This study aimed to evaluate the effectiveness of individual DHC items in school dental examinations and investigate their contribution to AC grades among junior high and high school students. Methods: A total of 726 students (443 males, 283 females; aged 12–18 years) from Tsurumi University Junior and Senior High School, excluding 168 students undergoing or having completed orthodontic treatment, were included. Nine calibrated orthodontists assessed DHC and AC using IOTN during standardized school examinations. The discriminatory power and information precision of DHC items were evaluated by Item Response Theory (IRT) analysis using three-, two-, or one-parameter logistic models depending on convergence. Correspondence analysis visualized the correlation between DHC and AC grades. Simple linear regression analyzed the contribution of each DHC item to AC grades. Results: Orthodontic treatment need was identified in 21.1% of students. Females showed a higher rate of treatment need than males. Correspondence analysis suggested that aesthetic evaluations were more lenient than morphological evaluations. IRT and regression analysis revealed that crowding (4.d), increased overjet (2.a), and increased overbite (2.f) demonstrated high discriminatory power and significant contributions to AC grades. Conclusions: Among the DHC items, crowding, increased overjet, and increased overbite had higher discriminatory power for malocclusion and contributed more significantly to AC evaluations compared to other items.