MOI UNIVERSITY

SCHOOL OF MEDICINE

A REPORT FOR RESEARCH INTO: MALOCCLUSION AND ORTHODONTIC

TREATMENT NEEDS AMONG 12-15 YEAR OLDS ATTENDING PRIMARY
SCHOOLS IN ELDORET MUNICIPALITY.

A research report in partial fulfilment of the requirements for community Based Education and
service (COBES IV) MSB 400
©2009
 DECLARATION

We the undersigned, hereby declare that this work is original and has not been presented
elsewhere to the best of our knowledge.

NAME REG.NO. SIGNATURE

DENGA DAISY A…………………….MED/10/05 …………….
KHADOLWA ANGIRA S....................MED/17/03 …………….
MUTHOGA OWEN K………………..MED/1023/05 .……………
WATENGA KIBET E………………...MED/43/05 …………….

These have been our supervisors who have approved and seen us through during the
proposal development:

SUPERVISORS:

Dr. Sang .............................

School of Dentistry
DEDICATION:
We dedicate this research report to all Primary school children in Eldoret municipality.

II
ACKNOWLEDGEMENT
We are greatly indebted to our supervisor, Dr.Sang, School of Dentistry for his guidance
in the proposal content. We wish to thank the COBES committee for equipping us with
necessary skills to come up with the proposal and subsequently this report. We also
appreciate the Ministry of Education Office at the Eldoret Municipal Council for their
devotion to ensuring successful data collection. This endeavor could not have come
through without the entire cooperation of the Primary school going children in Eldoret
Municipality hence we duly accord them our appreciation. We can not overlook the
support our families have accorded us during this venture.More so; we thank the Almighty
God for sufficient grace to undertake to completion this work. All those who in one way
or another played a role in the success of this work are highly appreciated.

III
TABLE OF CONTENTS

DECLATRATION ………………………………………………………………….…..I
DEDICATION………………………………………………………………………….II
ACKNOWLEDGEMENT……………………………………………………………....III
TABLE OF CONTENTS………………………………………………………………..IV
LIST OF ABBREVIATIONS ………………………………………………………….VI
LIST OF TABLES …………………………………………………………………….VII
ABSTRACT……………………………………………………………………………VIII
CHAPTER 1.0 INTRODUCTION ………. ……………………………………………..1
1.1 JUSTIFICATION………………………………………………………...2
1.2 RESEARCH QUESTION..……………………………………………....3
1.3 OBJECTIVES…………………………………………………………....3
1.3.1 BROAD OBJECTIIVES …………………………………..….3
1.3.2 SPECIFIC OBJECTIVES …………………………………...3
1.4 HYPOTHESIS…………………………………………………………...3
CHAPTER 2.0 LITERATUREREVIEW……………………………………………..…..4
CHAPTER 3.0 METHODOLOGY……………………………………………………….5
3.1 STUDYAREAS………………………………………………………….5
3.2 STUDY DESIGN………………………………………………………..5
3.3 STUDY POPULATION ………………………………………………..5
3.4 SAMPLING SIZE ESTIMATION…………..………………………….5
3.5 SAMPLING METHOD AND TECHNIQUES…………………………5
3.5.1 INCLUSION CRITERIA…………………………………..6
3.5.2 SAMPLING PROCEDURE………………………………..6
3.6 METHODS OF DATA COLLECTION………………………………..6
3.7 DATA MANAGEMENT AND PRESENTATION……………………7
3.8 BIAS MINIMISATION………………………………………………...7
3.9 ETHICAL CONSIDERATION ………………………………………..8
CHAPTER 4.0 RESULTS…………………………………………………………….....9

IV
CHAPTER 5.0 DISCUSSION…………...........................................................................11
CHAPTER 6.0 CONCLUSION……………………………………………………….…13
CHAPTER 7.0 RECOMMENDATION………………………………………………....13
CHAPTER 8.0 TIME FRAMEWORK…………………………………………………..14
CHAPTER 9.0 BUDGET…………………………………………………………….….16
APPENDIX I: CLINICAL EVALUATION FORM………………………………….....18
REFERENCES……………………………………………………….….20

V
LIST OF ABBREVIATIONS

IREC-Institutional Research and Ethics Committee.

COBES.-Community Based Education and Service.
WHO.-World Health Organization.
DAI.-Dental Aesthetic Index.

VI
LIST OF TABLES
Table 1: Mean DAI Scores. (n=240)
Table 2: Distribution of orthodontic treatment needs among 12-15 year olds in Eldoret
Municipality according to the DAI Scores.
Table 3: Malocclusion traits among 12-15 year olds in Eldoret municipality.
Table 4: Comparison of results between 12 -15 year olds of Kenyan and Tanzanian origin.
Table 5: budget (pilot study) Table 6: budget (main study)

VII
 ABSTRACT

Topic
Malocclusion and orthodontic treatment needs among 12-15 year olds in Eldoret
municipality.
Introduction
Malocclusion is misalignment of teeth and / or incorrect relation between the teeth and the
two dental arches. The goal of orthodontic treatment is to improve the patient's life
adjustment by enhancing dental and jaw function and dentofacial aesthetic thus
establishing and maintaining physical and emotional fitness Treatment is most successful
in children and adolescents thus the importance of knowing the prevalence of
malocclusion in this age bracket so that such cases can be treated at an early stage.
Research question
Is malocclusion a problem among 12-15 year olds in primary schools in Eldoret
Municipality.
Broad objective
To assess malocclusion and orthodontic treatment needs among 12-15 year olds in Eldoret
municipality.
Hypothesis
Malocclusion is a problem among 12-15 year olds in primary in Eldoret Municipality.
Study area
Eldoret municipality in Kenya.
Subjects
240 selected primary school children at the time of implementation.

Results
The study sample consisted of 240 pupils from which 45.8% were male and 54.2% were
female. The modal age of the evaluated pupils was 12.
80.9%were classified as not requiring treatment,8.8% as requiring elective treatment,4.2%
whom treatment was highly desirable and in 6.3% treatment was mandatory.

VIII
 The mean DAI score was 20.77 in the males and 19.85 in females (table 3), the mean for
both sexes combined was20.31.

Conclusion
In conclusion the prevalence rate of malocclusion in Eldoret Kenya is high like in other
studies done elsewhere: Moshi Tanzania, Brazil, Iran, Italy. There is no major difference
in sexual predilection in occurrence of malocclusion but the prevalence rate in boys is
higher with less handicapping traits compared to the girls.

Recommendations
All children attending regular clinic need oral exam as part of general physical exam
Advocacy for oral hygiene
Treatment of caries best means to reduce the high prevalence of malocclusion traits;
especially, crowding
With the high gross prevalence of malocclusion there is need for regular nationwide oral
survey
Need for more experts in this field

IX
X
CHAPTER 1.0
INTRODUCTION
Malocclusion is misalignment of teeth and / or incorrect relation between the teeth and the
two dental arches i.e. The upper arch known as maxilla and the lower one which is the
mandible.
The main cause of malocclusion is hereditary but can also be as a result of environmental
factors or behavioral such as thumb sucking, tongue thrusting and prolonged use of
suckling bottles in children. If a child has a small jaw his teeth may grow or drift out of
place. This disorder may be coupled with skeletal disharmony of the face, where
relationship between the upper and the
lower jaws are inappropriate. In this case the dental problem is most of the time derived
from the skeletal disharmony.
These abnormalities occur in form of:
Crowding of incisal segment - a condition in which the available space between the right
and left canine teeth are insufficient to accommodate all four incisors in normal alignment.
Diastema - a space between teeth.
Anterior maxillary overjet - is where any upper incisor protrudes anteriorly to the
opposing lower incisor.
Anterior mandibular overjet - this is where any lower incisor protrudes anteriorly or
labially to the opposing upper incisor.
Vertical anterior openbite - it happens when there is lack of vertical overlap between any
of the opposing pairs of incisors.
The goal of orthodontic treatment is to improve the patient's life adjustment by
enhancing dental and jaw function and dentofacial aesthetic thus establishing and
maintaining physical and emotional fitness. Treatment is usually in form of tooth
extraction, alignment using dental braces, replacement of tooth with artificial one and
growth modification in children or jaw surgery (orthognathic surgery) in adults.
Correction may reduce the risk of periodontal disease, gingivitis, and tooth decay as the
teeth will be easier to clean. Alignment is easier, quicker and less expensive if corrected
early. Treatment is most successful in children and adolescents thus the

1
importance of knowing the prevalence of malocclusion in this age bracket so that such
cases can be treated at an early stage.
The demand of orthodontic treatment is increasing in most countries. Therefore,
rational planning of orthodontic measures on a population basis is essential in assessing
the resources required for such services. This stresses the importance of epidemiologic
studies in order to obtain knowledge about the prevalence of different types of
malocclusion and need for orthodontic treatment. Orthodontics is one of the complicated
and long term field requiring highly trained specialist thus the need to know the
prevalence of malocclusion and train more specialists if need be.

1.1 JUSTIFICATION

Many cases of Dental anomalies in primary dentition occurring at ages 12-15 go unnoticed
or neglected resulting in predisposition to dental injuries, crowding, attrition, midline
discrepancies and premature teeth loss and other temporomandibular disorders. In Kenya,
only Nairobi has had the opportunity for such a study (P.M.Nganga et al : Studies are few
and inconclusive, there is need for additional scientific data on malocclusion and
orthodontic treatment needs which can be used for planning appropriate
services.)Therefore it is essential to conduct relative studies in Eldoret and other regions of
the country, merge, compare results and put forward recommendations for need for
treatment of these discrepancies as they occur, to avoid disabling dental related problems
later in life of the affected individual

2
1.2 RESEARCH QUESTION
Is malocclusion a problem among 12-15 year olds in primary schools in Eldoret
Municipality?
1.3 OBJECTIVES
1.3.1 BROAD OBJECTIVE
To asses malocclusion and orthodontic treatment needs among 12-15 year olds in
Eldoret municipality
1.3.2 SPECIFIC OBJECTIVES
 To asses the prevalence of malocclusion among 12-15year olds in Eldoret
Municipality.
 To describe gender distribution of the cases identified.
 To describe the severity of malocclusion in identified cases.
 To asses orthodontic treatment needs among cases identified.

1.4 HYPOTHESIS
Malocclusion is a problem among 12-15 year olds in primary in Eldoret Municipality.

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CHAPTER 2.0
LITERATURE REVIEW
In recent years, much attention has been focused on measuring the severity and prevalence
of malocclusion and orthodontic treatment need worldwide. In particular, the etiological
importance of genetic factors has been reduced, considering that many malocclusions
recognize a post-natal origin, related to non-nutritive or nutritive sucking habits at early
stages of life and traumas. Moreover, the expanded opportunities in orthodontic treatment
demand more careful individual evaluation of treatment needs and standardized criteria for
their assessment. Indeed, it has been reported that a significant number of children are
inappropriately referred for orthodontic treatment, underlying the necessity of objective or
normative assessment of orthodontic treatment by the use of an index.
The Dental Aesthetic Index was developed based on socially defined aesthetic standards
and has been used for epidemiological surveys and as a screening device to determine the
severity and degree of need of treatment.
Studies using the DAI criteria have been done in Brazil, Iran, the Netherlands and USA. In
Africa; it has been used in Nigeria, Tanzania and Kenya.
Other studies have been done using other data collection tools apart from the DAI criteria
and this makes it difficult to compare results.
In a study conducted in Shiraz in the Islamic republic of Iran; only 4.2% had
disabling malocclusion that required treatment, severe and very severe grades of
malocclusion were more common in boys than girls. In another study conducted in June
2006in Brazilian schools by Marques et al, based on the DAI scores they found out that
about 77%of adolescents from North Eastern Brazil were in need for orthodontic treatment
for dental health reasons.
D.S Rwakatema etal in a study done in Moshi, Tanzania noted that despite the high
prevalence of malocclusion (97.6%), some were relatively minor deviations from the
normal hence did not necessarily imply a heavy burden of need and demand of treatment.
The purpose of this study is therefore to determine the prevalence of malocclusion,
severity and degree of need of orthodontic treatment among 12-15 year olds attending
primary school in Eldoret Municipality.

4
 CHAPTER 3.0
METHODOLOGY
3.1 STUDY AREA
 The study was carried out in 8 randomly selected public primary schools out of the
37 in Eldoret Municipality
3.2 STUDY DESIGN
A cross-sectional study.
3.3 STUDY POPULATION
 The study population included 12-15 year olds attending public primary schools in
Eldoret Municipality.
 The total number of students were 10268 in public schools
3.4. SAMPLE SIZE ESTIMATION:
n = z2pq n = 1.96 x 1.96 x 0.5 x 0.5 = 384
d2 0.05 x 0.05
where n= sample size
z= Standard normal score associated with 95% Confidence level
(=1.96)
p= prevalence of malocclusion among 12-15year olds in Eldoret
Municipality.

q= 1-p
d= Amount of discrepancy tolerated
3.5 SAMPLING METHODS AND TECHNIQUES

Random sampling technique was used to get the subjects.

5
3.5.1 INCLUSION CRITERIA

 Public primary schools with classes 6-8.

 All students within the age bracket of 12-15 year olds in public primary schools in
Eldoret Municipality will be included in the study.
.3.5.2 SAMPLING PROCEDURE
 The public primary schools were categorized according to geographical locations
as north, east ,south and west in Eldoret Municipality
 8 primary schools were randomly selected for the study, 2 from each geographical
location
 A proportionate number of students between the age of 12-15yrs were selected
randomly from each school register
3.6 METHODS OF DATA COLLECTION

 Clinical examination using the Dental Aesthetic Index criteria stipulated by W.H.O. Data
was filled in a specially designed clinical examination form.
 For each subject a clinical form related to malocclusion was designed including all
variables with their criteria described in detail by the W.H.O manual (see appendix).
 The examiners [researchers] took part in a 3 day course on the methods of clinical research
and orthodontic diagnosis .Then they had an inter and intra observer calibration test on
plaster models with different types of malocclusion {available in the dentistry
department}. In order to ensure accuracy and consistency of the diagnosis. Finally a pilot
study was conducted

6
 3.7 DATA MANAGEMENT AND PRESENTATION

Data will be analysed by the following:

1. DAI Regression equation to give DAI scores as follows;
Less than 25 – Normal or minor occlusion
No treatment needed or slight need

26-30 - Definite malocclusion: Treatment needed

31-35 - Severe malocclusion: Treatment highly desirable

Above 35 - Very severe (handicapping) malocclusion:Treatment mandatory

2. Tables will be used to present data.

3.8 BIAS MINIMIZATION

 The sampling technique adopted minimized most forms of biases.

 The examiners (researchers) took part in a 3 day course on the methods of clinical research
and orthodontic diagnosis.
 inter and intra observer calibration test on plaster models with different types
of malocclusion then a pilot study was done on ten students

7
 3.9 ETHICAL CONSIDERATIONS

3. Consent: Informed consent from parents, teachers and students involved in the
research.
Team clearly explained the purpose of research and anticipated benefits.
4. Approval: study was approved by IREC
5. Benefits: There will be no direct benefit from participating in the study. However, the
findings and recommendations of the study will benefit the government and other
stakeholders in policy formulation and planning.
6. Confidentiality: All information will be treated with total confidentiality
7. Right to refuse or withdraw: The subject’s participation in the study is entirely
voluntary and one is free to refuse to take part or withdraw at any stage of study without
any consequences.
8. Purpose: This study is purely meant for academic purposes. However findings will be
disseminated to relevant authorities and other stakeholders with specific
9. Procedure: The research involves interviews and clinical examination on the subjects.

10. Risk: There is no risk involved in choosing to participate in the study.

8
CHAPTER 4.0
RESULTS:
Table 1: Gender distribution of mean DAI Scores. (n=240)
Sex n % Mean DAI scores
Male 110 45.8 20.77
Female 130 54.2 19.85
Totals 240 100
The study sample consisted of 240 pupils from which 45.8% were male and 54.2% were
female. The mean DAI score was 20.77 in the males and 19.85 in females as shown in
table 1, the mean for both sexes combined was20.31..
Table 2: Distribution of orthodontic treatment needs among 12-15 year olds in Eldoret
Municipality according to the DAI Scores.(n=240)
DAI Scores Treatment Severity levels M F % of total by Total
%
categories sex

M F

<25 No treatment Normal or minor 83 111 34.6 46.3 80.9

needed malocclusion
26-30 Elective Definite 16 5 6.7 2.1 8.8
treatment malocclusion
31-35 Treatment Severe 5 5 2.1 2.1 4.2
highly desirable malocclusion
≥36 Treatment Very severe 6 9 2.5 3.8 6.3
mandatory malocclusion
Totals 110 130 45.8 54.2 100

80.9%owere classified as not requiring treatment,8.8% as requiring elective

treatment,4.2% whom treatment was highly desirable and in 6.3% treatment was
mandatory as shown in table 2

9
Table 3: Malocclusion traits among 12-15 year olds in Eldoret municipality.
(n=240)
DAI Component Weight N % of total
population
M F M F

Missing teeth ≥1 6 14 2.5 5.8

Crowding(incisal segments) 0 74 114 30.8 47.5
1 6 7 2.5 2.9
2 30 9 12.5 3.8
Spacing(incisal segments) 0 89 86 37.1 35.8
1 11 10 4.6 4.2
2 10 34 4.2 14.2
Midline diastema(mm) ≥1 22 39 9.2 16.3
Anterior maxillary irregularity(mm) 0 56 74 23.3 30.8
1-2 18 11 7.5 4.6
≥3 36 45 15.0 18.8
Anterior mandibular irregularity(mm) 0 70 89 29.2 37.1
1-2 21 35 8.8 14.6
≥3 19 6 7.9 2.5
Maxillary over jet(mm) 0-3 74 116 30.8 48.3
≥4 36 14 15.0 5.8
Mandibular over jet(mm) >0 5 9 2.1 3.8
Open bite(mm) >0 13 22 5.4 9.2
Molar relationship; normal 0 46 54 19.1 22.5
Half cusp 1 57 61 23.8 25.4
Full cusp 2 7 15 2.9 6.3

10
The distribution of the 10 components evaluated to obtain the DAI scores is shown in
table 3, molar relationship abnormalities was the most common trait in both males and
females at 26.7% and 31.7%respectively, followed by anterior maxillary irregularities
with a male prevalence of 22.5% and female prevalence at 23.4%.Incisal segments
crowding was more common in males at 15% compared to 6.7% in females, incisal
segments spacing was more common in females (18.4%) than males (8.8%).. The least
presenting trait in males was the open bite (5.4%) while in females it was crowding (6.7%)
of the total population.

CHAPTER 5.0
DISCUSSION.
The study was carried out in Eldoret municipality in the Rift valley province of Kenya
among 12-15year old children attending public primary schools, it was explorative. From
the findings about 80% of the study population required no treatment, but the 20%
minority that required treatment had difficulty accessing orthodontic services. This could
be attributed to the few number of registered orthodontic specialists almost all of whom
practice in Nairobi, the capital. In fact the orthodontist population ratio in Kenya is about
one in 3 million which is very high compared to one in 61,000 in Ireland. A second reason
is the lack of prioritizing dental health by the government, hence understaffed with less
funding. This combined with the high private orthodontist fees has aggravated the
situation.
There is utmost significance in correcting malocclusion traits at this age group, firstly
treatment results are optimal and secondly the self esteem of the affected is boosted
bearing in mind that these are teenagers heading towards young adulthood where aesthetic
value is highly desired. This will prevent them from sinking into depression secondary to
their dental architecture.
Despite it’s disadvantages of lacking certain features that may be a strong indication for
treatment needs such as midline discrepancy, increased overbite and buccal crossbite, the
DAI was used as a tool due to its simplicity and reliability, does not require too much
expertise and has been used in both developed and developing countries. It has

11
also been recommended by the World Health Organization for epidemiological surveys.
Most studies on orthodontic treatment needs in East Africa have been done using other
indices other than DAI. This makes comparison of the present results difficult. Results of
this study contrasted with D.S Rwakatema etal who did a similar study in Moshi, Tanzania
in 2003. However there was no significant gender difference in the mean DAI scores of
the two populations and diastema was viewed as an aspect of beauty by both. Overall, the
most common presenting trait was anterior molar relation abnormalities in
Kenyans(58.4%) while in Tanzanians was anterior mandibular irregularity(51.6%),the
least presenting trait was mandibular overjet in both populations. Differences could be
attributed to genetic differences in the two populations; it could also be due to researcher
examining skills differences.
In a study conducted in Peru to evaluate the frequency and severity of the malocclusion
and treatment needs in Peruvian young adults. The mean DAI score was
28.87points.Around one-third of the sample presented severe or Very severe
malocclusion, which implies a highly desirable or mandatory orthodontic treatment need.
There is statically significant difference found between the DAI scores according to sex
the male25.24% and the female32.5% the mean was28.87% which is high compared to the
Kenyan population. Approximately one third, 32% of the evaluated adults in that
population needed treatment according to the DAI. In this population malocclusion was
characterized by a relatively high frequency of missing teeth ,appreciable dental crowding
and in adequate anterior relationships which contrast with the Kenyan finding where in
Overall the most common presenting trait was anterior molar relation abnormalities in
Kenyans.
The finding in Eldoret contrasts to the findings in Iran where the prevalence was found to
be 70.1% which is lower than the the Kenyan finding 70.1%had normal or minor
occlusion indicating no need for treatment while only 4.2%had disabling malocclusion
similar to the Kenyan finding of those who required mandatory treatment .however in Iran
severe and very severe grades of malocclusion were more common inboys than girls .this
contrasts the Kenyan finding where we found that occlusion traits were more severe
among the girls the mean DAI score in iran was 23.9 while in Kenya is 20.1 meaning that
occlusion traits in Kenya is milder than in Iran.

12
 CHAPTER 6.0
Conclusion
In conclusion the prevalence rate of malocclusion in Eldoret Kenya is high like
in other studies done elsewhere: Moshi Tanzania, Peru and Iran.There is no major
difference in sexual predilection in occurrence of malocclusion but the prevalence rate in
boys is higher with less handicapping traits compared to the girls. The leading occlusion
trait is mandibular irregularity in both sexes while incisal spacing is a large problem
among the female population, though the prevalence of malocclusion is less in girls when
it occurs its severe requiring mandatory treatment. The severity of occlusion traits in the
study population requiring orthodontic treatment is significant; hence the treatment need
in this population is at the desirable level that is: almost half of the study population
requires orthodontic treatment.

CHAPTER 7.0
Recommendations
• All children attending regular clinic need oral exam as part of general physical
exam.
• Advocacy for oral hygiene.
• Treatment of caries best means to reduce the high prevalence of malocclusion
traits; especially crowding.
• With the high gross prevalence of malocclusion there is need for regular
nationwide oral survey.
• Need for more experts in this field.

CHAPTER 8.0
TIME FRAMEWORK

13
8.1 Time Schedule

Activity Tasks Time period

Development of research -Consultation with IREC, Stakeholders, March-May 2008
proposal KRC and the Head of Department
-Literature review
- Serving of stakeholders and IREC with
the proposal drafts
Pilot study - Seek an expedite approval from IREC February 2009
through HOD Health Management
-Printing of data collection tools
-Selection of schools
- Interact with school management
- Gather preliminary information
Review of data collection - Data entry March 2009
tools - Data summarization and analysis
- Report writing
-Consultation with stakeholders and
Biostatistician
- Restructuring of data collection tools
Collection of data - Printing of data collection tools April-August
- Interviewing subjects 2009
- Carrying out inspections
- Review of school register
Data summarization and - Data entry September 2009
analysis - Data cleaning
- Data analysis
Data presentation - Draft report writing October2009-
- report presentation
- Report writing
- Submission of report

14
 -Dissemination of findings to relevant March 2010
authorities and other stakeholders
-Publication of research

CHAPTER 9.0
BUDGET (PILOT STUDY)

Table 5 : budget (pilot study)

NO ITEMS QUANTITY COST@ Ksh TOTAL Ksh
STATIONERY/ EQUIPMENT
Foolscaps 1 reams 150 150
Ball pens 10 20 200
Pencils 4 10 40
Erasers 04 10 40
Files 01 25 25
Sharpener 04 10 040
Ruler 02 20 040
Clip board 04 120 480
Calculator 01 1000 1000
Paper punch 01 150 150
Stapler 01 200 200
Staples 1 pkt 050 050
Flash disk 01 2500 2500
CP 1 probe 04 1000 4000
Stainless steel orthodontic 04 2500 10000
ruler
tongue spatula 01 pkt 150 150
Disinfectant 500

15
 Pen torch 04 700 2800

OTHER EXPENSES

Airtime 400
Printing of clinical exam 100 5 500
form
Traveling expense 2000
Lunch 50 1000
Contingencies (10%) 2622.50

TOTAL 28847.50

BUDGET- MAIN STUDY

Table 6: budget (main study)

16
NO ITEMS QUANTITY COST@ Ksh TOTAL Ksh
STATIONERY/ EQUIPMENT
Foolscaps 2 reams 300 600
Ball pens 1 pkt 450 450
Pencils 10 16 160
Erasers 05 10 050
Files 02 50 100
Folders 04 50 200
Sharpener 04 10 040
Ruler 02 20 040
Clip board 04 120 480
Calculator 01 1000 1000
Paper punch 01 150 150
Stapler 01 200 200
Staples 1 pkt 050 050
Note books 04 90 360
Compact disk 02 0250 500
Flash disk 02 2500 5000
CP 1 probe 10 1000 10000
Stainless steel orthodontic 04 2500 10000
ruler
tongue spatula 02 pkt 150 300
Disinfectant 1000
Pen torch 04 700 2800

OTHER EXPENSES

Airtime 1500
Printing of clinical exam 768 5 3840
form

17
 Traveling expense 10000
Lunch 50 4000
Contingencies (10%) 5282

TOTAL 58102

CLINICAL EXAMINATION FORM

SEX
Male Female

AGE

DENTOFACIAL ANOMALIES
DENTITION

Missing incisor, canine and pre-molar teeth-maxillary and mandibular-enter numbers of

teeth
SPACING

Crowding in the incisal segment

0= No crowding in the
1= One segment crowded
2= Two segments crowded

Spacing in the incisal segment

0= No spacing
1= One segment spaced

18
2= Two segments spaced

Diastema in m

Largest anterior maxillary irregularity in mm

Largest anterior mandidular irregularity in mm

OCCLUSION

Anterior maxillary overjet in mm

Anterior mandibular overjet in mm

Vertical anterior openbite in mm

Anterior posterior molar relation

0= Normal
1= Half cusp
2=Full cusp
NEED FOR IMMEDIATE CARE AND REFERRAL

Life threatening condition

Pain or infection
0= Absent
1= Present
2= Not recorded

Other condition (specify)

19
Referral
0= No
1= Yes
2= Not recorded

REFERENCES
• 1987:World Health Organization. (1987) Oral Health Surveys. Basic
Methods.(WHO, Geneva).
• 1994 :Thomas M. Graber & Robert L. Vamarsdall, Jr.: Orthodontics- Current
principles and techniques, 2nd edn. Walsworth Publishing co: Missouri
• 1997: Ng’ang’a, P. M., Stenvik A., Ohito F., Ogaard B. The need for orthodontic
treatment in 13-15 year olds in Nairobi, Kenya. Acta Odontol Scand. 55: 325-32.
• 2001:Shyama M, Al-Mutawa SA, Honkala S. malocclusions and traumatic
injuries in disabled schoolchildren and adolescents in Kuwait. Spec Care Dent
21:104–8.
• Ciuffolo F, Manzoli L, D’Attilio M, et al. (2005) Prevalence and distribution by
gender of occlusal characteristics in a sample of Italian secondary school
students: a cross-sectional study. Eur J Orthod 27:601–6.
• F. McDonald & A, J Ireland: Diagnosis of orthodontic treatment. Oxford
University Press: NewYork 2003
• Eduardo bernabe and carlos Flores-Mirb(2005) Orthodontic treatment need in
Peruvian young adults Evaluated through the denta anaesthetic index
 Perillo, C. Masucci, F. Ferro, D. Apicella, and T. Baccetti.Prevalence of
orthodontic treatment need in southern Italian schoolchildren
Eur J Orthod, August 25, 2009; (2009)

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