Utility of the Dental Aesthetic Index in Industrialized and Developing Countries

To be truly useful, an index must be applicable universally without modification. The data presented in this article support the use of the standard DAI without modification to assess need for orthodontic treatment in both developing and industrialized countries. When students from Thailand, Australia, the German Democratic Republic, and Native Americans residing on Indian reservations rated the same 25 occlusal stimuli (photographs of dental configurations) for dental aesthetics, their ratings of these stimuli when arranged in rank order were highly correlated with those of US students. These 25 occlusal stimuli were a subset of the original 200 occlusal stimuli used in deriving the standard DAI regression equation. This article presents data indicating that when a Native American DAI was derived based on Native American ratings of the same 200 occlusal stimuli used in deriving the standard DAI, the Native American DAI and the standard DAI had the same ten components (orthodontic measurements) and strikingly similar regression coefficients (weights). Further analysis indicated that the two equations were sufficiently similar to justify using the standard DAI to obtain DAI scores on Native Americans and to estimate the relative social acceptability of their dental aesthetics. If ratings for dental aesthetics for the full set of 200 stimuli were available for each of the countries where only 25 were rated, we expect that, as in the case of Native Americans, a country-specific DAI, if computed, would be sufficiently similar to the standard DAI that no modification would be needed to allow use of the standard DAI in that country.(ABSTRACT TRUNCATED AT 250 WORDS)     

Differences in Need for Orthodontic Treatment Between Native Americans and the General Population Based on DAI Scores

Clinical impressions by Indian Health Service (IHS) dentists of a greater frequency of severe dental malrelations among Native Americans than in the general US population have never been objectively confirmed. This study uses the DAI as the standard to determine whether there is a greater prevalence of severe malocclusions among Native Americans. Four hundred eighty-five Native American students in grades 7-12 from two remote sites--Pine Ridge, SD, and Many Farms, AZ--and one nonremote site--Lapwai, ID--were scored for the DAI. The mean scores from each reservation, as well as the mean score from the three reservations combined, were significantly higher, indicating poorer aesthetics, than the mean DAI score from a large sample of the general US population. These data confirm the clinical impressions of IHS dentists that Native Americans residing on reservations have significantly poorer dental aesthetics than the aesthetics found in the general US population; therefore, Native Americans have greater needs for orthodontic treatment.     

Deficits in perceptions of oral health relative to general health in populations

OBJECTIVE: To compare perceptions of general health versus oral health within two populations. METHODS: Secondary analysis of cross-sectional survey data obtained from representative samples of dentate adults in Australia and the United States. Australian data were collected in the 2002 National Dental Telephone Interview Survey and United States data were from the NHANES, 1988-1994. A stratified analysis compared self-ratings of general and oral health among groups classified by age, socioeconomic status and access to dental care. RESULTS: In Australia, 43.6% rated their dental health 'very good' or 'excellent' whereas 58.6% rated their general health 'very good' or 'excellent'--a deficit of 15.0%. In the US, there was a comparable deficit of 24.2%. The deficit could be explained as a 'generation gap' where oral health ratings of the youngest cohort resembled the general health ratings of middle-aged adults in Australia and retirees in the US. An 'affluence gap' was evident where the oral health ratings of wealthier adults resembled the general health ratings of disadvantaged adults. Among Australians with private dental insurance who had visited a dentist in the past year the oral health deficit was negligible. Similar stratification in the US sample considerably attenuated the deficit. CONCLUSION: There is a deficit in perceived oral health compared with general health at all stages of adulthood and spanning the socioeconomic spectrum. The deficit was diminished among insured adults who had made a dental visit within the preceding year, suggesting that improved access to dental services may help redress the discrepancy.     

Perception of personal dental appearance in Nigerian adolescents

BACKGROUND: The purpose of this study was to investigate the relationship among Nigerian adolescents' awareness of malocclusion, their satisfaction with personal dental appearance, and the severity of their occlusal irregularities. MATERIAL: The sample consisted of 577 randomly selected secondary school adolescents-306 (53%) boys and 271 (47%) girls aged 12 to 17 years (mean age, 14.73 +/- 1.12). A pretested questionnaire was used to assess the subjects' awareness of malocclusion and satisfaction with personal dental appearance; the actual severity of malocclusion was determined by using the dental aesthetic index (DAI), performed by an orthodontist in a school environment under natural illumination. RESULTS: Statistically significant, negative, weak correlations were found between awareness of malocclusion and satisfaction at the various DAI scores as follows: < or =25 (r = -0.3774, P < .001), 26 to 30 (r = -0.4305, P < .001), 31 to 35 (r = -0.5137, P < .001), and > or =36 (r = -0.5104, P < .001). Analysis of variance (ANOVA) did not show a significant value of any of the 3 factors. Multivariate analysis with age as the covariate did not show a significant effect. Also, the association between socioeconomic status and the variables was not significant ( P > .05). Generally, no statistically significant sex differences were found in relation to the DAI scores, awareness, or satisfaction ( P > .05). CONCLUSIONS: Significant, negative, weak correlations were found between Nigerian adolescents' awareness of malocclusion and satisfaction with personal dental appearance at the various severity levels of malocclusion. It would be worthwhile to assess such a relationship with the index of orthodontic treatment need in the Nigerian population.     

Perceptions of occlusal conditions in Australia, the German Democratic Republic and the United States of America

An instrument developed by Jenny et al. (1980) for rating the public's perceptions of the social acceptability of a wide variety of occlusal configurations was administered to children and adults in Australia, the German Democratic Republic and the United States of America and also to US orthodontists. Mean scores for the 7 groups of subjects from the 3 countries were arranged in rank order from the least socially acceptable to the most socially acceptable and compared. The results indicate that use of the social acceptability scale of occlusal conditions (SASOC) is a highly reliable method for scoring and rank-ordering the aesthetic acceptability of occlusal morphologies. Spearman rank-order correlation coefficients between the ranking of SASOC stimuli by all 7 groups of subjects from the 3 countries ranged from 0.85 to 0.97. The probability of such correlations occurring by chance is less than 1 in 10000 (P less than 0.0001). SASOC proved capable of rank-ordering a wide range of occlusal morphologies for aesthetics with excellent consistency along the entire spectrum from the least acceptable to the most socially acceptable in all 3 countries. The data indicate that norms for socially acceptable dental appearance are essentially the same in Australia, the German Democratic Republic and the United States of America.     

An assessment of relationship between self-esteem,orthodontic concern,and Dental Aesthetic Index (DAI) scores among secondary school students in Ibadan,Nigeria

OBJECTIVE: To ascertain the correlation between self-esteem, orthodontic concern and orthodontic status using DAI scores in a group of Nigerian potential orthodontic patients. DESIGN: A cross-sectional analytical study. SETTING: Secondary schools reflecting a good socio-economic spread of adolescents in the town. PARTICIPANTS: Randomly selected 520 junior and senior students 276 (53.1%) males and 244 (46.9%) females with mean age of 15.02 +/- 3.26 (SD) years participated in the study. METHODS: Each student was asked to fill in the questionnaire on orthodontic concern and Global Negative Self-Evaluation scale (GSE) with subsequent assessment of the occlusion according to the DAI by one orthodontist. After obtaining consent, thirty students were re-examined to test intra-examiner reliability which was good (r = 0.98, P < 0.001). RESULTS: The correlations between self-esteem, orthodontic concern and DAI scores were tested using Spearman rank order correlation coefficient. Significant positive correlations were observed between self-esteem and orthodontic concern according to DAI treatment category needs (r = 0.274, p<0.01; r = 0.396, p<0.01; r = 0.347, p<0.05) except for the severe malocclusion group which was positive but not statistically significant (r = 0.136, p> 0.05). Significant correlation was equally noted between DAI scores and orthodontic concern (r = 0.191, p<0.01). CONCLUSION: Significant positive correlation existed between self-esteem in a group of Nigerian adolescents and their orthodontic concern as well as between their DAI scores and orthodontic concern. DAI should be a relevant and useful occlusal index for the Nigerian orthodontic population.     

Malocclusion and orthodontic treatment need of secondary school students in Nigeria according to the dental aesthetic index (DAI)

The aims of this study were to measure the distribution, prevalence and the severity of malocclusion and treatment need amongst randomly selected (n = 703) rural and urban Nigerian children aged 12-18 years (mean 14.0 +/- 1.84) using the dental aesthetic index (DAI), and to assess whether malocclusion was affected by age, gender and socio-economic background. Data were collected according to the method recommended by WHO. Most of the children (77.4 per cent) had a dental appearance which required no orthodontic treatment. Over 13 per cent fell into the group where treatment for malocclusion is considered to be 'elective'. However, a substantial proportion (9.2 per cent) of the population had severe to handicapping malocclusion where treatment is 'highly desirable' or 'mandatory'. There were no statistically significant differences (P > 0.05) in DAI scores between age groups, gender and socio-economic background. This study also found that Nigerian adolescents had better dental appearance and less orthodontic treatment need compared with the Caucasian and Oriental populations.     

DIFFERENCES IN SOCIAL PERCEPTIONS BETWEEN MALE AND FEMALE FIRST-YEAR DENTAL STUDENTS

Male and female first-year dental students generally possess the same attitudes and the same perceptions about themselves, dentists they observe, and about their ideals for dentists and patients. The null-hypothesis, that is, assuming no difference between the two groups on the basis of these data, is accepted. In general, one must assume that those women who choose dentistry as a career are not significantly different from their men counterparts, although indirect evidence shows a possible exception of a more compassionate identification with the patient by female students. The findings suggest that it would not be appropriate or accurate to either admit or exclude male or female students based on what may well be "sexist" assumptions regarding women's perceptions of themselves as dentists or their perception of their relationships to patients. The findings should be generalized very cautiously beyond the UCLA School of Dentistry. However, at the time this study was conducted, this dental school had both the largest number of female students and the highest percentage of female students in the United States. The study is limited to perceptual differences of freshmen and does not attempt to deal with issues such as productivity or longevity of professional involvement. These issues may have some bearing on the formation of attitudes toward women entering the profession, but additional longitudinal studies following the careers of the current cohort of female dental students will be necessary to allay criticisms of women in dentistry.     

Results of a dental fear survey in Japan: implications for dental public health in Asia

The purpose of this investigation was to initiate the study of dental fear in Japan. 415 college students, aged 18-22 yr were surveyed. A standardized questionnaire which has been used in the United States was translated into Japanese and was administered to the students. More than 80% of those surveyed reported some dental fear. Six to 14% of the students reported extreme fear of the dentist. The majority of the subjects admitted that they delayed making dental appointments due to fear. Muscle tension was the most common physiological symptom reported. The dental drill and needle were the most fear-provoking stimuli.     

Socialization of new dental therapists on entering the profession

Dental therapy is relatively new in the United States. This qualitative study examines the experiences and impressions of the inaugural class of the first dental school-based dental therapy program in the United States. A grounded theory design using open-ended interviews and focus groups was carried out with the nine students in the class at the beginning of their program and after the fall and spring semesters of their first year. Student responses were audiotaped, transcribed verbatim, and presented to the students for feedback and clarification. Results show that students started with an idealistic perception of dental therapy that was consistent with the specific provision of the law creating dental therapy. The team learning approach in which dental therapy students learn alongside dental and dental hygiene students provided the social interaction that allowed them to better articulate and distinguish dental therapy from those other dental professions. In the absence of dental therapists who could serve as role models, the program director, who is perceived to be the dental therapy expert, has assumed the role of the primary socializer. Faculty members are challenged to fulfill their role as role models regardless of their perception of the dental therapy model.     

Disparity in orthodontic utilization and treatment need among high school students

OBJECTIVES: The aim of this cross-sectional study was to assess the disparity in utilization of orthodontic services among high school students and to measure and characterize the extent of unmet treatment needs among untreated students at the time of examination. METHODS: The sample consisted of 2,808 tenth grade students enrolled in different public and private high schools. All subjects completed a dental survey that included questions on demographic, dental health, and orthodontic services, and assessment of smile using the visual analog scale. A subsample of dental study casts that were available for 561 untreated subjects were scored using the Dental Aesthetic Index (DAI) to estimate unmet treatment need. RESULTS: The orthodontic utilization rate was 37 percent. The odds of being orthodontically treated were 8.7 times greater among those with dental visits within the past year than among those without, and three times greater among Caucasians than among other ethnic groups. The DAI indicated that the unmet treatment need was 29 percent, with ethnic minority groups having 2.6 greater odds of needing treatment than Caucasians. CONCLUSION: Minority groups and infrequent dental attenders may experience disparities in unmet orthodontic treatment need.     

Faculty and student perceptions of academic integrity at U.S. and Canadian dental schools

The issues of cheating and plagiarism in educational settings have received a large amount of attention in recent years. The purpose of this study was to assess the degree to which academic integrity issues currently exist in the dental schools throughout the United States and Canada. An online survey was developed to gather data pertaining to this topic from two key groups in dental education: faculty and students. Responses were obtained from 1,153 students and 423 faculty members. The results of the survey clearly reveal that cheating is a significant problem in dental schools and that significant differences exist between students' and faculty members' perceptions of academic integrity. The challenge for dental schools is to identify effective strategies to prevent cheating opportunities and to implement and enforce effective means of dealing with specific examples of cheating.     

Students' perceived importance of diversity exposure and training in dental education

Intercultural competence is an important component of the doctor-patient relationship in the multicultural climate evolving in the United States. We hypothesized that 1) exposure to racial and ethnic diversity in the student body, faculty, staff, and patient population in dental school and 2) a dental school curriculum that includes presentations on issues concerning racial and ethnic diversity will contribute to students' feeling more competent and confident to enter the multicultural work environment that is rapidly developing in the United States. A Likert-type scale questionnaire was administered to 627 fourth-year dental students enrolled in seven dental schools representing geographically diverse regions of the United States. Of these, 376 questionnaires were returned for a response rate of 60 percent. Results indicated that both the perception of diversity in the school environment and the presentation of diversity-specific content in the curriculum had moderately positive and significant correlations with the students' perception of their competency or ability to serve and work with diverse populations. The respective Pearson correlation coefficients for diversity in the school environment and diversity curriculum were .497 (p<.001) and .459 (p<.001). These results support the hypotheses that diversity exposure and training in the dental school environment are important for dental students entering a multicultural workplace.     

Appraisal of the dental school learning environment: the students' view

The majority of studies examining dental school curriculum have addressed organization, structure, and content issues from the perspectives of administrators, faculty, practitioners/alumni, and professional organizations. However, few studies have focused on students' opinions of dental school. The purpose of this study was to determine students' perceptions of the learning environment, intellectual climate, and teacher-student relationships in dental school. This report describes how the "dental version" of the Medical Student Learning Environment Survey (MSLES) was used to identify students' perceptions of their dental education. Freshman and junior dental students' perceptions were measured with the Dental Student Learning Environment Survey (DSLES), which evaluates learning environment, intellectual climate, and relationships among students and teachers in seven areas: flexibility, student-to-student interaction, emotional climate, supportiveness, meaningful experience, organization, and breadth of interest. The DSLES was mailed to twenty-three dental schools in North America with eighteen of the schools distributing the inventory. A total of 619 dental students responded. Results were differentiated between freshman and junior dental students. Both freshman and junior students provided the highest (most positive) ratings for the DSLES subscales of "breadth of interest" (interest in dentistry and outside interests are encouraged) and "meaningful learning experience" (significance of courses to dentistry). Freshman students provided the lowest (least positive) ratings for "emotional climate" (students' responses to the way their courses were conducted and stress levels), and junior students provided the least positive ratings for "faculty supportiveness" (extent of faculty support and encouragement provided to students). The DSLES identified students' perceptions of their educational experience and localized areas for improvement. By addressing these areas of concern, faculty can increase student satisfaction with their dental education.     

Orthodontic treatment needs: comparison of two indices.

The Index of Orthodontic Treatment Needs (IOTN) and the Dental Aesthetic Index (DAI) were developed and both claimed to contain the aesthetic and dental components in their criteria of assessing malocclusion. This study was undertaken to assess the reliability of these two indices in assessing orthodontic treatment needs. The indices were applied to 120 pre-treatment study models selected from orthodontic patient records treated at the Department of Orthodontics, University of North Carolina, United States of America. The sample consisted of 60 African-Americans (Black) and 60 American Caucasians (White), age ranged from 12 to 16 years (Mean 13.8). The results showed that the IOTN and the DAI were highly correlated and highly associated statistically (p < 0.0001). The findings of this study indicated that the two indices could be used consistently to identify orthodontic treatment needs in different ethnic groups and are capable of classifying the subjects according to their malocclusion severity for those subjects eligible for treatment in fund constrained situation.     

The relationship between dental aesthetic index (DAI) and perceptions of aesthetics,function and speech amongst secondary school children in Ibadan,Nigeria

Objective. The purpose of the study was to investigate the relationship between a professionally derived index, the Dental Aesthetic Index, and some indications for orthodontic treatment as perceived by potential patients. Methods. An epidemiological survey of 614 secondary school students, 327 males (53·3%) and 287 females (46·7%) was carried out in Ibadan, Nigeria. Children aged 12–18 years (mean age, 14·9 ± 2·9 SD) were randomly selected, none of them had received previous orthodontic treatment. One examiner assessed the students using the Dental Aesthetic Index (DAI). Subjects were also asked to complete a questionnaire consisting of three questions concerning appearance, function, and speech, using a 5‐point Likert scale. Results. Weak but statistically significant correlations were found for subjective assessments of appearance of teeth and the DAI (r = 0·174; P < 0·01) and between biting/chewing and appearance of teeth (r = 0·095; P < 0·05). Statistically significant correlations were found between appearance of teeth and speech (r = 0·148; P < 0·01) and biting/chewing and speech. The last showed the strongest correlation (r = 0·268; P < 0·01). Conclusion. The study has shown weak but significant correlation between DAI and children's perceptions of the appearance of their teeth. We recommend further study involving both DAI and Index of Orthodontic Treatment Need (IOTN) for comparison in the Nigerian population.     

Evaluation of aesthetics for the different classifications of the Tooth Surface Index of Fluorosis

Abstract The prevalence of dental fluorosis for children both from fluoridated and non-fluoridated communities has increased dramatically in some regions of North America. This study evaluated the aesthetics of dental fluorosis for school-aged children from a reference population of 1131 children. The methodology from the Social Acceptability Scale of Occlusal Conditions (SASOC), part of the Dental Aesthetics Index (DAI), was used to assess fluorosis-related aesthetics. Pairs of semantic differentiated adjectives adapted from SASOC were used to rate fifty 35 mm slides of anterior teeth. Sampling of children from the different categories of the Tooth Surface Index of Fluorosis (TSIF) on anterior permanent teeth was weighted to permit sufficient numbers of slides for the different classifications of the TSIF. Each slide was presented to a stratified random sample of pairs of parents and children who were participants in the original study. A convenience sample of dental professionals was also included. Analysis compared different classifications of “affected” slides (non-zero TSIF scores), with the mean aesthetic score computed from all “non-affected” slides (TSIF=0). Results from children, parents, and professionals showed that there were highly significant differences between ratings of low and high TSIF scores. The only non-significant differences were between TSIF 4 and TSIF 5 & 6, which all three groups did not distinguish, as well as TSIF 1 versus TSIF 2 & 3, which children could not distinguish.     

Transcultural barriers and cultural competence in dental hygiene practice

AIM: The aim of this paper is to highlight the need to integrate cultural care into dental hygiene practice. BACKGROUND: Culture can be better understood through the concepts, beliefs, and norms of the culturally diverse population of the United States. It is important to understand cultural perceptions of oral health in order to manage transcultural barriers that may arise during the utilization of oral healthcare services. It is assumed cultural competence can only be achieved through the knowledge of various cultural backgrounds in an extremely diverse US population. CONCLUSIONS: There is a need to integrate cultural awareness, knowledge, identification, and respect into the dental hygiene curriculum through the incorporation of competencies and standards associated with dental hygiene practice. Future dental hygienists should be culturally competent to render oral care to an ever expanding and diversified US population.     

2种量表在评定青少年主观(牙合)美观程度中的应用

目的:采用视觉模拟量表(visualizedanaloguescale,VAS)和正畸治疗需要指数的美学量表(aestheticcompo鄄nent,AC)分别量化评定青少年的自身牙合美观程度,比较两者的评定效能及信度。应用SPSS11.0统计软件包进行相关分析。方法:随机抽取上海地区11～13岁青少年共302例(男148例,女154例),分别采用2种量表进行牙合美观程度的主观评价,同时由正畸医生进行牙合美观程度的客观评定。结果:Spearman相关检验显示,自评AC及VAS均与性别无关(P>0.05);VAS分值与主观牙合美观满意度显著相关(r=0.80,P=0.000),且与正畸医生的专业评定一致性较高;自评AC等级与主观牙合美观满意度无显著相关性(P=0.441)。结论:应用VAS量表评定青少年主观牙合美观程度的可信度较高且简单易用,适合定量分析,为今后量化评定主观正畸治疗需求提供了一种新方法。