Deepak P Bhayyaa/Tarulatha R Shyagalib

Purpose: To record, determine and discuss the gender influence on the overall prevalence of occlusal characteristics of primary dentition of 4- to 6-year-old children of Bagalkot City, India. Materials and Methods: A total of 1000 children (583 boys and 417 girls) 4 to 6 years old were evaluated clinically for primary molars, primary canines, developmental spaces, measurements of overjet and overbite, crowding, anterior or posterior cross bite, midline discrepancies, lateral profile, as well as assessment of the presence of lip incompetency. A stratified cluster random sampling procedure was executed to collect the representative sample. Results: Highly significant differences between males and females were observed for the prevalence of flush terminal plane molar relationship, class I and II canine relationship, overjet and overbite of 0 to 2 mm, and for both convex and straight profile. A significant difference was seen for the occurrence of mesial step and asymmetric molar relationship, presence of developmental and primate spaces, shift in maxillary dental midline, presence of both single tooth anterior and bilateral posterior cross bite, overjet of 2 to 4 mm and convex profile. Conclusions: The data revealed that most of the children had a malocclusion and that there was a significant difference between male and female occlusal characteristics. This highlights the importance of identifying children who are in need of orthodontic treatment for dental health or aesthetic reasons. The study also indicated that the prevalence of most of the occlusal characteristics were comparable with other communities, but there existed substantial differences in prevalence of some traits. Key words: gender, malocclusion, occlusion, prevalence
Oral Health Prev Dent 2011; 9: 17-27. Submitted for publication: 01.05.10; accepted for publication: 10.05.10.

s deciduous teeth have to be exfoliated eventually, our social community has given very least importance to this aspect. However, maintaining the integrity of deciduous teeth and occlusion leads to their preservation up to exfoliation, which in turn forms one of the most important steps in preventive aspects of pedodontics.
a Reader,

Certain characteristics of the primary dentition and occlusion have been described that may be required in the smooth transition from primary to permanent dentition and therefore development of ideal occlusion in permanent dentition (Foster, 1982; Joshi et al, 1984; Bacetti et al, 1997). These characteristics of primary dentition include: Presence of spaces between primary teeth, also called developmental spaces. Presence of spaces mesial to canine in the maxillary arch and distal to canine in the mandibular arch, also called primate or anthropoid spaces. Vertical position of incisor teeth, with lower incisors touching the cingulum of the upper incisors.

Department of Pediatric and Preventive Dentistry, Darshan Dental College and Hospital, Loyara, India. Department of orthodontics and dentofacial orthopedics

b Reader,

Darshan Dental College and Hospital, Loyara, India. Correspondence: Dr Deepak P Bhayya, Department of Pediatric and Preventive Dentistry, Darshan Dental College and Hospital, Loyara, Udaipur, India. Tel: +91-9928413378. Fax: +91-2942452273. Email: drdeepu20@yahoo.com

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Gender Inuence on Primary Dentition in Bagalkot City, India

No t fo rP Occlusal Characteristics of ublicati on te ss e n c e 4- to 6-Year-Old Children of

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operative behaviour were excluded. Any disturbance in the above-mentioned characteristics of the primary occlusion may result in malocclusion in the permanent dentition. Previous studies have highlighted that the status of primary dentition affects the development of permanent dentition to such an extent that some of the malocclusion traits present in primary dentition will be reflected or worsened in permanent dentition (Bougue, 1908; Infante, 1975; Richardson, 1982; Onyeaso, 2008). Analysis of the prevalence of occlusal traits in isolated human populations can provide valuable information regarding the etiology of malocclusions and other complex traits (Lauc, 2003). There have been very limited studies in gender-wise occlusal traits particular in the Bagalkot city, therefore the aim of the present study is: To assess the overall prevalence rates of different occlusal characteristics of primary dentition in 4- to 6-year-old children in Bagalkot City, India. To determine the influence of gender on the occurrence of various occlusal characteristics in primary dentition of 4- to 6-year-old children of Bagalkot City, India. To compare and discuss the results with different population groups. The parents and children were informed regarding the purpose of the study and informed consents were obtained. Ethical clearance was also obtained from the ethical committee of P.M.N.M. dental college and hospital. Clinical examination was done by a single operator, under the supervision of the senior operator for standardisation of the methodology. Occlusal parameters (Banker et al, 1984; Otuyemi et al, 1997; Alamoudi, 1999; Abu Alhaija and Qudeimat, 2003) were recorded using a mouth mirror, a straight probe, graded stainless steel wire and dental floss, under natural daylight. A portable light was used whenever required for proper illumination and entered in the specially designed data sheet. Occlusal parameters measured for the study are:

Molar relationship
Flush terminal plane: The distal surface of the

MATERIALS AND METHODS

A total of 1257 children, between the age of 4 and 6 years, who were residents of Bagalkot City and attended different nursery, kindergarten and primary schools were examined. One thousand children who fulfilled the selection criteria were selected for this cross-sectional study. The following criteria were used to select the children who participated in this study: Children with a complete set of primary dentition without premature loss of primary teeth. No erupted permanent teeth. Children free from proximal caries. Children with occlusal fissure caries without loss of proximal surfaces and with well-adapted occlusal restorations were included in the study. Children free from abnormal oral habits.
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maxillary and mandibular primary second molars lies in the same vertical plane in centric occlusion. Mesial step: The distal surface of the mandibular primary second molar is anterior to the distal surface of the maxillary second molar in centric occlusion. Distal step: The distal surface of the mandibular primary second molar is posterior to the distal surface of the maxillary second molar in centric occlusion.

Canine relationship

The primary canine relationship was recorded for right and left sides separately when the teeth were in centric occlusion.
Class I: Tip of the maxillary primary canine falling

in the same vertical plane as the distal surface of the mandibular primary canine in centric occlusion. Class II: Tip of the maxillary primary canine in anterior relationship to the distal surface of the mandibular primary canine in centric occlusion.

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Distal surfaces of the maxillary and mandibular second molars in the same vertical plane, also called ush terminal plane. Canines in class I occlusion.

pyrig No Co t fo Children with fractured teeth and r any Pu tooth bli anomaly in size, shape or number were excluded cat ion from the study. te Children with systemic diseases and s very uncose n ce

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 Class III: Tip of the maxillary primary canine in

Open bite Spaces

Primate spaces: Spaces between lateral incisor and canine in the maxillary arch and between the canine and the first molar in the mandibular arch. Developmental or generalised or physiological spaces: Any spaces other than primate spaces, specifically in anterior teeth. The anterior open bite was recorded when there was no vertical overlapping of the incisors. Incisors in edge-to-edge relationship were not considered to be in open bite. The posterior open bite was recorded when canines or molars showed no vertical intercuspation leaving space between them in centric occlusion. It was further characterised as unilateral or bilateral.

Crowding Overbite
Crowding was recorded as present or absent in maxillary and mandibular arches separately when the incisors showed signs of overlapping or rotation and when there was a complete lack of space. The patient was asked to close in centric occlusion. The labial surface of the mandibular central incisor was marked with a sharp pencil at the level of the incisal edge of the maxillary central incisor. The distance of this mark from the incisal edge of the mandibular central incisor was measured as overbite with the help of a graded stainless steel wire. Overbite was graded as: 0: 1: 2: 3: No overbite 12 mm 24 mm > 4 mm

Mid-line discrepancy
Mid-line discrepancy was assessed by visually examining the mid-line of the dentitions, while in centric occlusion. This was further confirmed by using a dental floss passing from the forehead of the child along the mid-line of the nose down to the chin while the child parted the lips and the dentition were still in centric occlusion. When there was a shift, a determination was made of the jaw affected as a shift in the maxilla, a shift in the mandible or a shift in both.

Overjet
Any overjet was recorded as a linear measurement in millimetres between labial surfaces of the maxillary and mandibular central incisors with the help of a gauge 21 stainless steel wire. Overjet was graded as: 1: 02 mm 2: 24 mm 3: > 4 mm

Cross bite
The anterior cross bite was recorded to be present when one or more of the maxillary incisors occluded lingually to the mandibular incisors. Posterior cross bite was recorded to be present when one or more of the maxillary canines or molars occluded lingual to the buccal cusps of the opposing mandibular teeth. These were further characterised as unilateral or bilateral.

Lateral Prole
Lateral profile was assessed by examining the patient from the side and was characterised as a straight profile, convex profile or concave profile.

Scissors bite
The scissors bite was recorded when lingual cusps of one or more maxillary molars occluded buccally

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posterior relationship to the distal surface of the mandibular primary canine in centric occlusion.

pyr Bhayya/Shyagali Co ig No t fo rP to the buccal surfaces of corresponding mandibular ub lica teeth. tio n te ss e n c e

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Table 1 Distribution of the study sample Mean age (yrs) Gender Males
583 (58.3%)

Females
417 (41.7%) 1000

4.8 years

Lip Competency
The lips were assessed by viewing the patient for competency or incompetency of lips. An intra-examiner reliability test was performed by examining a group of 25 children, at two different time periods of one week apart. These results were then subjected to Cohens kappa statistical analysis. The findings revealed that the kappa coefficient for various occlusal characteristics ranged from 0.82 to 0.94. Prevalence rates of different occlusal characteristics studied were calculated. SPSS version 15.0 statistical package was used. A chi-square test was performed to compare the proportions of these occlusal characteristics among different genders; a value of P < 0.05 was regarded as significant.

males (15.7%) than in females (11.9%). Prevalence of developmental spaces in both maxillary and mandibular arches was found to be higher in males (39.3% and 32%) than females. Moreover, the prevalence of primate space was significantly higher in males (58% and 15%). There was no significant difference between the genders in the prevalence of crowding both in maxilla and mandible. Even though the prevalence of cross bite was found to be higher in males, there was no significant difference between the two genders except for bilateral posterior cross bite, which was significantly higher in females (0.7%). Scissor bite on the other hand showed a similar prevalence in males (0.5%) and females (0.7%). The anterior open bite was prevalent in females (1.7%) but no significant different was observed between males and females (82.5% and 80.3%). Overjet of 0 to 2 mm was more prevalent in males (84.7%) and overjet between 2 and 4 mm was more prevalent in females (84.2%).

DISCUSSION
The results of the present study showed that the majority of children had a flush terminal molar relationship followed by mesial and distal step. This finding however indicates the normal development of the molar relationship, but also a slightly higher prevalence of mesial step molar relationship in 36% of the population may lead to development of malocclusion in the future. Similar results have been reported by Nanda et al (1973) in a study on Indian children, and Mahmoodian et al (2004), for Iranian children. But a slightly higher prevalence of flush terminal plane has been reported by Farsi and Salama (1996) and Otuyemi et al (1997), in contrast to Jones et al (1993), Ferreira et al (2001), and Kisling and Krebs (1976) who reported a higher prevalence of mesial step. However Almeida et al (2008) have reported only 9.7% prevalence of distal step in Brazilian preschool children, which is very low in comparison to the present results. This difference in prevalence may be due to the difference in the ethnicity of the population being examined. The study also revealed that a majority of children had a class I canine relationship followed by a class II and class III relationship. The present findings were in agreement with the reports of previous

RESULTS
Distribution of the study sample is shown in Table 1. Overall prevalence of different occlusal characteristics of the population being examined is shown in Table 2. The flush terminal molar relationship was found to be most prevalent in 52.5%, canine relationship was class I in 84% of the sample, while maxillary developmental spaces were most common at 35.4% as compared to mandibular. The same was true with the primate spaces with 47.6% more prevalent in maxilla. A small percentage of the sample showed crowding, cross bite, midline discrepancies, scissor bite, open bite, increased overjet and overbite as shown in Table 2. Gender differences in the occlusal characteristics for various traits are shown in Tables 3 to 6 (Abu Alhaija and Qudeimat, 2003). There existed a highly significant difference between males (55.9%) and females (47.7%) for the prevalence of flush terminal plane molar relationship, whereas mesial step molar relation and asymmetric molar relationships showed a significant difference.

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pyrig No Co t fo r P to be The Class I canine relationship was found ub lica significantly higher in females (86.5%) than in tio males (82.1%) and prevalence of a Class II canine n te e ss relationship was found to be significantly higher in c en

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pyr Bhayya/Shyagali Co ig No t fo rP Table 2 Total prevalence of occlusal parameters in the primary dentition of children between the ages of ub 4 and 6 (N = 1000) lica tio n te Occlusal parameter Particulars No. of Children Prevalence ss e n c e

by N ht

Molar relationship

Flush terminal Mesial step Distal step Asymmetric

525 359 84 32 840 142 3 15 354 257 476 129 17 46 4 56 0 6 13 3 3 6

52.5% 35.9% 8.4% 3.2% 84% 14.2% 0.3% 1.5% 35.4% 25.7% 47.6% 12.9% 1.7% 4.6% 0.4% 5.6% 0% 0.6% 1.3% 0.3% 0.3% 0.6% 1% 0% 0% 84.5% 11.9% 3.6% 81.6% 15.7% 2.7% 37.1% 58.9% 4% 4.5%

Canine relationship

Class I Class II Class III Asymmetric

Developmental spaces

Maxillary Mandibular

Primate spaces

Maxillary Mandibular

Crowding

Maxillary Mandibular

Midline discrepancy

Shift in maxillary Shift in mandibular Shift in both

Cross bite

Anterior single Anterior multiple Posterior unilateral Posterior bilateral

Scissor bite Open bite Anterior Posterior unilateral Posterior bilateral Overjet 02 mm 24 mm > 4 mm Overbite 02 mm 24 mm > 4 mm Lateral profile Straight Convex Concave Lip incompetency

10 0 0 845 119 36 816 157 27 371 589 40 45

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pyrig No Co t fo rP Table 3 Distribution of molar and canine relationships in primary dental arches by gender ub lica Prevalence tio n Occlusal characteristics Signicance t e Male Female ss e n c e N = 583 N = 417

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Flush terminal Mesial step Molar relationship Distal step Asymmetric Class I Class II Canine relationship Class III Asymmetric

326 (55.9%) 201 (34.5%) 46 (7.8%) 10 (1.7%) 479 (82.2%) 92 (15.7%) 3 (0.5%) 9 (1.5%)

199 (47.7%) 158 (37.9%) 38 (9.1%) 22 (5.3%) 361 (86.5%) 50 (11.9%) 0 (0%) 6 (1.4%)

Highly Significant r2 = 30.7, P < 0.001 Significant r2 = 5.2, P < 0.05 Not Significant r2 = 0.8, P = 0.37 Significant r2 = 4.5, P < 0.05 Highly Significant r2 = 16.6, P < 0.001 Highly Significant r2 = 12.4, P < 0.001 Not Significant r2 = 3.0, P = 0.08 Not Significant r2 = 0.6, P = 0.43

studies by Abu Alhaija and Qudeimat (2003), Otuyemi et al (1997), Nanda et al (1973), Farsi and Salma (1996), Almeida et al (2008) and Yilmaz et al (2006) in different population groups. However, Yilmaz et al (2006) and Almieda et al (2008) have reported a high prevalence of class III canine and low prevalence of class II canine relationship in comparison to the present. The overall prevalence rate of developmental spaces and primate spaces was more in the maxilla than in the mandible and the findings were in agreement with Mahmoodian et al (2004), Ohno et al (1990), and Otuyemi et al (1997). However in reference to primate spaces, Otuyemi et al (1997) reported higher prevalence in the mandibular arch, which contradicts the present findings. A higher prevalence of developmental spaces in both arches was reported by Banker et al (1984) and Abu Alhaija and Qudeimat (2003) in different population groups. In comparison to the present study, much higher rates of maxillary primate spaces were reported in previous studies by Joshi and Makhija (1984), Banker et al (1984), Abu Alhaija and Qudeimat (2003), Ferreira et al (2001) and Ohno et al (1990). A lower prevalence of crowding was observed in both maxilla and mandible (1.7% and 4.6% respec-

tively) for the overall population and it may be suggestive of a lower tendency for crowding in the permanent dentition. The prevalence rate of crowding reported in the present study is much lower than those reported in the earlier studies by Otuyemi et al (1997), (24.4%, 26.3%), Alamoudi (1999) (5.4%, 13.4%), Abu Alhaija and Qudeimat (2003) (38.2%, 21.6%) and Almeida et al (2008) (7%, 11.3%). All of the above studies revealed that mandibular crowding was more prevalent then the maxillary crowding. The total prevalence of mid-line discrepancy was 6%, in which the shift in the mandible was higher (5.6%) than the maxilla (0.4%). However, higher prevalence rates of mid-line shift in the both maxilla and mandible were reported by Bernal and Tsamtsouris (1986) in 3- to 5-year-old children (9%). Similar to the present report, a low prevalence of midline shift has been reported by Otuyemi et al (1997) in Nigerian children (5.7%), Alamoudi (1999) in Saudi Arabian children (5.7%, 4.8%) and Imudom (1994) in Chinese children. In the present study, anterior cross bite was observed at only 1.9%. A similar prevalence has been reported by Farsi and Salama (1996) at 1.7%. In contrast, a higher prevalence of anterior cross bite

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Table 4

pyr Bhayya/Shyagali Co ig No t fo rP Distribution of spaces, crowding and midline discrepancy in primary dental arches by gender ub lica Prevalence Signicance tio n Occlusal characteristics Arch te ss e n c e Male Female

by N ht

Developmental spaces Spaces

Maxilla

229 (39.3%)

125 (30%)

Significant (r2 = 9.20, P < 0.05) Significant (r2 = 29.8, P < 0.05) Significant (r2 = 14.3, P < 0.05) Significant (r2= 6.97, P < 0.05) Not significant (r2 = 0.002, P = 0.97)

Mandible

187 (32.1%)

70 (16.8%)

Primate spaces

Maxilla

307 (57.7%)

169 (40.5%)

Mandible

89 (15.3%)

40 (9.6%)

Present Crowding

Maxilla

10 (1.7%)

7 (1.7%)

Mandible Absent Maxilla Mandible Shift in Midline discrepancy Shift in Mandible Maxilla

33 (5.7%) 573 (98.3%) 550 (94.3%) 0 (0%) 39 (6.7%)

13 (3.1%) 410 (98.3%) 404 (96.9%) 4 (1%) 17 (4.1%) Significant (r2 = 5.62, P < 0.05) Not significant (r2 = 3.14, P = 0.08) Not significant Not significant (r2 = 3.58, P = 0.06)

Shift in

Both

0 (0%)

0 (0%)

was reported by Jones et al (1993) (5%). Prevalence of posterior cross bite in the present study was 0.6%. But the previous studies by Abu Alhaija and Qudeimat (2003), Otuyemi et al (1997), Farsi and Salama (1996), Almeida et al (2008) and Kurol and Berglund (1992)) showed a higher prevalence for posterior cross bite, which was in contrast to the present finding. Overall prevalence of scissor bite was only 0.6% and this finding was in accordance with previous studies on different populations (Kisling and Krebs, 1976; Otuyemi et al, 1997; Tschill et al, 1997; Farsi and Salama, 1996). Overbite in the range of 0 to 2 mm was significantly higher in males than in females. Higher prevalence rates of overbite (mandibular incisors covered by maxillary incisors completely) have been reported by Abu Alhaija and Qudeimat (2003)

(27%), Trottman et al (1999) (6.1%) and Otuyemi et al (1997) (5.7%). The present study showed that the majority of children in the sample had overjet in the range of 0 to 2 mm (84.5%). Similar results were observed in a study by Farsi and Salama (1996), however higher prevalence rates of increased overjet have been reported by Banker et al (1984) (43.5%), Tschill et al (1997) (16.7%) and Otuyemi et al (1997) (14.7%). These findings indicate an absence of deleterious habits or skeletal discrepancies in the majority of the children being examined. The majority of the children in the sample had a convex profile (58.9%), followed by straight profile (37.1%) and concave profile (4%). A convex profile may eventually get reduced by the differential growth of mandible, whereas straight and concave

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Bhayya/Shyagali Table 5 Distribution of cross bite, overbite and overjet in primary dental arches by gender
Prevalence Occlusal characteristics Males No. (%) Anterior single tooth 6 (1%) Females No. (%) 0 (0%)

pyrig No Co t fo rP ub lica tio n Signicance te ss e n c e

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Significant (r2 = 4.32, P < 0.05) Not significant, (r2 = 1.88, P = 1.88) Not significant, (r2 = 2.15, P = 0.14) Significant (r2 = 4.21, P < 0.05) Not significant (r2 = 0.17, P = 0.68) Highly significant (r2 = 26.1, P < 0.001) Not significant (r2 = 2.3, P = 0.13) Not significant (r2 = 0.04, P = 0.84) Not significant (r2 = 3.33, P = 0.07) Highly significant (r2 = 24.2, P < 0.001) Significant (r2 = 4.0, P < 0.05) Not significant (r2 = 1.02, P = 0.31)

Cross bite

Anterior multiple teeth

10 (1.7%)

3 (0.7%)

Posterior unilateral

3 (0.5%)

0 (0%)

Posterior bilateral

0 (0%)

3 (0.7%)

Scissor bite 02 mm Overbite

3 (0.5%) 481 (82.5%)

3 (0.7%) 335 (80.3%)

24 mm > 4 mm Anterior open bite 02 mm

88 (15.1%) 14 (2.4%) 3 (0.5%) 494 (84.7%)

69 (16.5%) 13 (3.2%) 7 (1.7%) 351 (84.2%)

Overjet 24 mm > 4 mm 65 (11.1%) 24 (4.1%) 54 (12.9%) 12 (2.9%)

profile children may eventually end up having a class III profile. The present findings were similar to that of Mahmoodian et al (2004) who studied the primary dentition of Tehranian children. The majority of the children in the sample had competent lips. There are no reported studies in the literature regarding lip competency in children between the ages of 4 and 6.

Gender difference for the prevalence rate of occlusal characteristics

In the present study, the flush terminal molar relationship was found significantly higher in males,

whereas females had a significantly higher prevalence for mesial step molar relationship. Imudom (1994) reported similar findings in a study on Chinese children. However, in previous studies by Otuyemi et al (1997) and Yilmaz et al (2006), no significant differences in molar relationships were reported between males and females. The present findings suggest that females have a chance of developing a class III molar relationship, which may lead to fully-fledged malocclusion in later stages of development. A statistically significant difference between males and females was observed for the canine relationship: females showed more Class I canine relationship and males showed more Class II rela-

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Table 6 Distribution of lateral prole in children by gender

Lateral Prole Straight Convex Concave Lip incompetency Competent Incompetent 557 (95.5%) 26 (5.5%) 398 (95.4%) 398 (95.4%) Males 228 (39.1%) 325 (55.7%) 30 (5.1%) Females 143 (34.3%) 264 (63.3%) 10 (2.4%)

pyr Bhayya/Shyagali Co ig No t fo rP ub lica Signicance tio n te Highly significant e s s c en (r2 = 19.5, P < 0.001)

by N ht

Significant (r2 = 6.3, P < 0.05) Highly significant (r2 = 45, P < 0.001)

Not significant (r2 = 0.01, P = 0.94)

tionship. This is in agreement with Imudom (1994), but in contrast to the findings of Otuyemi et al (1997) and Yilmaz et al (2006), who reported no significant difference between the two genders. A higher prevalence of class II canine relationship in boys is indicative of a definitive malocclusion tendency. When developmental and primate spaces were considered, males showed a higher prevalence of developmental spaces as well as primate spaces than females. The present findings were in agreement with Joshi and Makhija (1984) and Imudom (1994). However, Otuyemi et al (1997) and Mahmoodian et al (2004) reported no differences in primate spaces between males and females. The above findings are suggestive of reduced crowding tendency in males when compared to females in permanent dentition. The prevalence of crowding showed no significant difference between males and females in the present findings, which is in contrast to the reports of Alamoudi (1999) and Imudom (1994). However, Mugonzibwa et al (2008) found no significant gender difference, which is similar to the present results. The present study showed mid-line shift in the maxilla to be significantly higher in females than in males. This finding is also supported by the fact that the posterior cross bite tendency was also higher in females and is in agreement to reports by Alamoudi (1999), whereas Otuyemi et al (1997) reported no differences in mid-line shift between males and females.

The prevalence of posterior bilateral cross bite was significantly higher in females (0.7%) than in males (0%) and the present findings were similar to the reports of Tschill et al (1997). However, Farsi and Salama (1996) reported no significant differences in the posterior bilateral cross bite between males and females. However, if the existence of the posterior cross bite is not corrected in the initial stages, there are chances of occlusal prematurity, leading to cross bite tendency in the permanent dentition and also the chance of developing temporomandibular joint problems will increase. With regard to gender, there was no significant difference in the prevalence rate of scissor bite. Also, no significant difference was found in open bite between males and females. Similar results have been reported by Otuyemi et al (1997). When the overall prevalence rate of anterior open bite was considered, only 1% of the sample had anterior open bite, which was in contrast to other studies by Tschill et al (1997) (37.4%), Abu Alhaija and Qudeimat (2003) (5.7%) and Otuyemi et al (1997) (5.3%). This particular finding may be suggestive of a lower prevalence of habits in this group of children. However, although gender differences in overjet in primary dental arches have not been reported in the literature, it was evident from the present study that overjet between 0 and 2 mm was significantly higher in males than in females, whereas overjet between 2 and 4 mm was significantly higher in females than in males. For proper treatment planning, this difference in gender must be taken into consideration.

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5.

6.

7.

8. 9.

10.

11.

12.

CONCLUSION
Overall prevalence of occlusal traits showed the existence of qualities that deviate from the norm and may ultimately lead to the development of malocclusion. A gender influence was also observed on the occurrence of different occlusal traits. Both of these findings indicate the need for early correction of the malocclusal traits and also emphasise the need for planning treatment based on the gender of the child. Further results of the present study also suggest that there was a significant difference among different population groups for the prevalence of occlusal traits owing to variability in ethnicity. A need for further investigation pertaining to the maintenance of these malocclusion traits in the future is emphasised.

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14.

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16.

17.

18. 19.

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REFERENCES
1. Abu Alhaija ES, Qudeimat MA. Occlusion and tooth arch dimensions in the primary dentition of preschool Jordanian children. Int J Paediatr Dent 2003;13:230239. 2. Alamoudi, N. The prevalence of crowding, attrition, midline discrepancies and premature tooth loss in the primary dentition of children in Jeddah, Saudi Arabia. J Clin Pediatr Dent 1999;24:5358. 21.

22.

23.

the mixed dentition. Am J Orthod Dentofacial Orthop 1997; 3:502509. Banker CA, Berlocher WC, Mueller BH. Primary dental arch characteristics of Mexican-American children. ASDC J Dent Child 1984;5:200202. Bernal M, Tsamtsouris A. Signs and symptoms of temporo mandibular joint dysfunction in 3 to 5 year old children. J Pedod 1986;10:127140 Bishara SE, Justus R, Graber TM. Proceedings of the workshop discussions on early treatment. Am J Orthod Dentofacial Orthop 1998;113:5 Bougue EA. Some results from orthodontia in deciduous teeth. J Am Med Assoc 1908;1:267269. Farsi NMA, Salama FS. Characteristics of primary dentition occlusion in a group of Saudi children. Int J Paediatr Dent 1996;6:253259. Ferreira RL, Barreira AK, Soares CD, Alves AC. Prevalence of normal occlusion traits in deciduous dentition. Pesqui Odontol Bras 2001;15:2328. Foster TD. The development of the occlusion of the teeth. In Foster, TD (ed). A Textbook of Orthodontics, ed 2. Oxford: Blackwell Scientific, 1982: 4553. Gianelly AA. One-phase versus two-phase treatment. Am J Orthod Dentofacial Orthop 1995;108:556559. Imudom S, So LLY, Hagg EUO. Occlusal characteristics of 5-year-old southern Chinese children [thesis]. Hong Kong: University of Hong Kong, 1994. Infante PF. Malocclusion in the deciduous dentition in white, black and Apache Indian children. Angle Orthod 1975;45:213218. Jones ML, Mourino AP , Bowden TA. Evaluation of occlusion, trauma and dental anomalies in African-American children of metropolitan Headstart programs. J Clin Pediatr Dent 1993;18:5154. Joshi MR, Makhija PG. Some obstructions on spacing in the normal deciduous dentition of 100 Indian children from Gujarat. Br J Orthod 1984;1:7579. Kaufman A, Koyoumdjisky E. Normal occlusal patterns in the deciduous dentition in preschool children in Israel. J Dent Res 1967;46:478482. Kisling E, Krebs G. Patterns of occlusion in 3-year-old Danish children. Community Dent Oral Epidemiol 1976;4:152159. Kurol J, Berglund L. Longitudinal study and cost-benefit analysis of the effect of early treatment of posterior cross-bites in the primary dentition. Eur J Orthod 1992;14:173179. Lauc T. Orofacial analysis on the Adriatic islands: an epidemiological study of malocclusions on Hvar Island. Eur J Orthod 2003;25:273278. Mahmoodian J, Afshar H, Hadjhashem M. Determination of primate space on 4 to 5 years old children of Tehrans kindergarten in 2000. Journal of Dentistry, Tehran University of Medical Sciences 2004;1:2126. Mugonzibwa EA, Eskeli R, Laine-Alava MT, Kuijpers-Jagtman AM, Katsaros C. Spacing and crowding among African and Caucasian children. Orthod Craniofac Res 2008;11:8289. Nanda RS, Khan I, Anand R. Age Changes in the occlusal pattern of deciduous dentition. J Dent Res 1973;52:221 224.

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Although opinion on the optimal orthodontic treatment varies among the orthodontic community, the College of Diplomats of the American Board of Orthodontics held workshop discussions on early treatment during their meeting, concluding that almost all types of malocclusions could benefit from early treatment (Bishara et al, 1998). On the other hand, it has been suggested that the best time for orthodontic treatment would be in early permanent dentition (Gianelly, 1995). The opinions of orthodontists concerning the timing of treatment are largely based on clinical experience. Profile consideration showed significantly higher prevalence of straight as well as concave lateral profile in males than in females. Significantly more females showed convex profile than males. A previous study has reported significant positive correlations between the mixed and primary dentition periods of assessments, indicating the maintenance of the similar occlusal traits, which persist in the deciduous dentition period (Onyeaso and Isiekwe, 2008).

pyrig No Co t fo AC. Revised 3. Almeida ER, Narvai PC, Frazo P , Guedes-Pinto r P occlusal criteria for assessment and interpretation of the ub lic deviations in the deciduous dentition; a public health perati spective. Cad Saude Publica 2008;24:897904. on t eof 4. Baccetti T, Frachi L. Early dentofacial features Cl II malocss e n c e clusion. A longitudinal study from the deciduous through

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30. Trottman, A, Martinez NP , Elsbach HG. Occlusal disharmonies in the primary dentitions of black and white children. ASDC J Dent Child 1999;66:332336. 31. Yilmaz Y, Grbz T, Simek S, Dalmi A. Primary canine and molar relationships in centric occlusion in three to six-yearold Turkish children: a cross-sectional study. J Contemp Dent Pract 2006;7:5966.

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24. Ohno N, Kashima K, Sakai T. A study on interdental spaces of the deciduous dental arch in Indian sample. Aichi Gakuin Daigaku Shigakkai Shi. 1990;28:7991. 25. Onyeaso CO, Isiekwe MC. Occlusal changes from primary to mixed dentitions in Nigerian children. Angle Orthod 2008;78:6469. 26. Otuyemi OD, Sote EO, Isiekwe MC, Jones SP . Occlusal relationships and spacing or crowding of teeth in the dentitions of 3-4-year-old Nigerian children. Int J Paediatr Dent 1997;7:155160. 27. Proffit WR. Treatment timing: Effectiveness and efficiency. In: McNamara JA Jr, Kelly KA (eds). Treatment timing: Orthodontics in four dimensions. Craniofacial Growth Series. Ann Arbor: Department of Orthodontics and Pediatric Dentistry and the Center for Human Growth and Development, University of Michigan 2002;39:1324.

pyr Bhayya/Shyagali Co ig No t fo 28. Richardson A. Interceptive orthodontics in general r P dental practice. Br Dent J 1982;152:8589,123127,166170. ub lica 29. Tschill P , Bacon W, Sonko A. Malocclusion in the deciduous t dentition of Caucasian children. Eur J Orthod 1997;19:361 ion te 367. ss e n c e

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