MEASURING OTHER ORAL CONDITIONS

Malocclusion Malocclusion is a difficult entity to define, because individual perceptions of what constitutes a malocclusion problem differ widely. As a result, no generally accepted epidemiological index of malocclusion has yet been devised. Thoughtful, still-valid commentaries on the problems of classifying and scoring malocclusions were published in the 1970s by Jago and Foster. Angle's classification, which dates from the 19th century, may still be useful in treatment planning, but is of no use in epidemiological surveys. Most other indexes record specific conditions rather than the status of the whole occlusion. The Malalignment Index assesses rotation and tooth displacement, whereas the Occlusal Feature Index records crowding and cuspal interdigitation and vertical and horizontal overbite. The HLD Index was used for assessing treatment needs back when there was a public orthodontic program in New York State. Grainger developed the Treatment Priority Index (TPI) for assessing treatment needs; this index was once used in a national study of orthodontic needs of children. These indexes have not seen much use in the years beyond their introduction. The Occlusal Index, measures nine characteristics: dental age, molar relation, overbite, overjet, posterior crossbite, posterior open bite, tooth displacement, midline relations, and missing permanent maxillary incisors. It demands a fair degree of examiner skill and training. The very proliferation of these indexes, all around the same period in history, underlined the difficulties in measuring this complex condition. The FDI jumped on the bandwagon with its attempt to develop an internationally accepted index and simplified method of determining malocclusion. It was not successful; the result was a carefully qualified method of measuring occlusal traits. It has been used, but seems to be of no more value than the other indexes described. WHO, continuing its efforts to provide simplified, standardized basic methods of recording oral disease, suggests a three category assessment: no anomalies, slight, or

more serious. Slight is defined as tilted or rotated teeth or mild crowding; the more serious anomalies, confined to the four incisors, are as follows: 1. Maxillary overjet estimated to be 9 mm or more. 2. Mandibular overjet, anterior crossbite equal to or greater than a full tooth depth. 3. Open bite. 4. Midline shift estimated to be more than 4mm. 5. Crowding or spacing estimated to be more than 4 mm. The complexities of malocclusion, and the frustrations that have grown up with the inadequacies of these indexes, have led many researchers to believe that functional malocclusion is virtually unmeasurable for epidemiological purposes. In terms of trying to interpret group data on overbites, crowding, and other clinical conditions, that may well be true. Orthodontic indexes developed in the late 1980s, however, take a different philosophical approach in that they assess aesthetics rather than clinical measures of function. One is the Dental Aesthetic Index (DAI), published in 1986 after years of testing. The DAI starts from the premise that the impact of malocclusion on other oral pathology is doubtful, and the main benefit of orthodontic treatment is in the individual's social and psychological Well-being. The DAI makes objective measurements, but of aesthetic acceptability according to social norms. Its validation in a number of different countries provides an impressive scientific base. In Europe, the SCAN (Standardized Index of Aesthetic Need) index scores a self-perception of dental attractiveness from a set of photographs. It uses an ordinal scale from 0.5 to 5.0 to determine the individual's own perception of the aesthetics of his or her own dentition. Oral Cancers and Clefts Like other cancers, oral cancer is usually expressed as a proportion or rate. The age adjusted annual incidence for oral cancer in white patients aged 65 or older, for example, was 19.9 per 100,000 in 1979-1981. Five-year survival rates are also useful cancer measures: a five-year survival rate of 67%, for example, means that 67% of

persons who had the condition diagnosed five years or more ago are still alive. Cancer is a reportable disease; almost all data on cancer epidemiology comes from analysis of regional or national registries. The occurrence of cleft palate is also usually expressed as a proportion; about 1 birth in 700 exhibits this condition. Soft-tissue abnormalities of various kinds, as well as the more rare types of oral pathoses, are also most suitably expressed as proportions or rates. Cleft lip and palate, as a congenital abnormality, is supposed to be recorded on birth certificates.