IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89

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IP Indian Journal of Orthodontics and Dentofacial Research

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Original Research Article

Prevalence of dental malocclusion and its gender distribution among dental
students at Kabul university of medical science
Hedayatullah Ehsan 1, *, Mashal Azami1 , Shamila Azimi1
1 School of Dentistry, Ali-Abad University Hospital, Kabul University of Medical Sciences, Kabul, Afghanistan

ARTICLE INFO ABSTRACT

Article history: Aim: The current study aims to provide quantitative and qualitative information about the prevalence of
Received 30-11-2022 dental malocclusions among dental students of Kabul University of Medical Sciences (KUMS) in the
Accepted 06-03-2023 orthodontics department of Ali Abad Teaching Dental Clinic that evaluates the relationship of malocclusion
Available online 03-06-2023 between gender and the major causes of malocclusion in society among genders and the tendency of the
community toward the treatment of dentoalveolar anomalies.
Materials and Methods: This study was a cross-sectional survey that was done randomly among 133
Keywords: students, 68 male (51.12%) and 65 female (48.87%), in an age range of 18–25 years old at Kabul University
Malocclusion
of Medical Sciences, Ali Abad teaching dental clinic faculty of dentistry.
Angle’s classification
Results: show the dental malocclusion classes due to “angle" classification in females in Class I (53.48%),
Dental caries Class II (21.4%), and Class III (23.07%), while in males in Class I (48.33%), Class II (6.66%), and Class
Dental plaque
III (43.33%). The prevalence rate of crowding was 33% in males and 43% in females. It has been studied
Gingivitis
and analyzed separately that the most common oral problems in females were dental caries (53.84%).
According to our survey (65 female participants), no one had periodontitis, while in males, plaque was at a
rate of 28.97%, and the least common was gingivitis (6%), respectively.
Conclusions: The occurrence of dental trauma in boys and heredity in girls may be the most important
factors for dental malocclusion. Girls were more interested in orthodontic treatments, which may be
because they pay more attention to beauty than boys. Moreover, crowding had the highest rate among
participants, followed by deep, open bites and edge-to-edge bites.

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1. Introduction tooth. In class II, the lower first permanent molar and other
lower teeth have a more posterior position and, in class
Occlusion can be defined as the contact between upper and
III, the lower first permanent molar and other lower teeth
lower teeth in all mandibular positions and movements.
have a more anterior position. Malocclusion in itself is not
Different classifications have been presented previously, by
a life-threatening condition; however, it may unfavorably
Angle, of which classification based on the first permanent
affect the social interactions and psychological well-being
molars relationship is now used. Based on this classification,
of patients.
occlusion is divided into three categories: Class I is the
The high prevalence of malocclusion has made it a public
normal relationship between the upper and lower first
health problem in the world; it is now considered the third-
permanent molars. In this class, the lower first permanent
highest oral health priority. 1,2 “A malocclusion is defined as
molar is about 1/4 tooth width anterior to the same upper
an irregularity of the teeth or a mal relationship between
* Corresponding author. the dental arches beyond the range of what is accepted
E-mail address: [email protected] (H. Ehsan). as normal.” 3 Malocclusion is one of the most common

https://doi.org/10.18231/j.ijodr.2023.016
2581-9356/© 2023 Innovative Publication, All rights reserved. 83
84 Ehsan, Azami and Azimi / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89

dental problems as well as dental caries, periodontal disease, 2. Research Objectives

and dental fluorosis. 4 The etiology of malocclusion is
multifactorial and can be a combination of hereditary 1. To find out the prevalence of dental malocclusion in
factors including some stimulus during the formation and both gender males and females.
development of orofacial structures and environmental 2. To identify the major causes and problems of dental
factors such as oral habits, social characteristics, and irregularities.
diet. 5–7 3. To demonstrate the tendency of both genders for
treatment of dental malocclusion.
The prevalence of malocclusion has been reported in a
range from 20% to 80% in the majority of studies. This 3. Materials and Methods
wide range is because of the differences in ethnic groups,
age groups, and registration procedures. 8,9 In the study The ethical committee of Kabul University of Medical
conducted by Proffit et al., in the USA, almost 30% of Sciences approved the study, and permission to survey
people have normal occlusion, and the prevalence of Class dental students. Permission was also obtained from the
I malocclusion was between 50–55%. The prevalence of University Hospital authorities, and themselves.
Class II and Class III malocclusion is about 15% and <1%, This study is a cross-sectional study that has been done
respectively. 10 Another study in Denmark has reported randomly among 133 students, 68 male (51.12%) and 65
the prevalence of normal malocclusion as 14%, Class female (48.87%) in a range age of (18-25) years at Kabul
I malocclusion at 58%, Class II malocclusion at 24%, and University of Medical Sciences, faculty of dentistry, 2020.
Class III malocclusion at 4%. 11 Among the Chinese living The type of research approach was a survey based
in Australia, the prevalence of normal malocclusion was on qualitative and quantitative questions. Data collection
reported to be 7.1%, Class I malocclusion 58.8%, Class II was started from 20 September to 20 November by
malocclusion 21.5%, and Class III malocclusion 12.6%. 12 the distribution of 140 questionnaires among dental
At present, malocclusion is the third most common students at Kabul University of Medical Sciences. Each
dental disease after dental caries and periodontal diseases questionnaire consisted of 12 multiple choice and two-
in the world. So, malocclusion is a multifactorial problem point scale questions. After the expression of consent, the
that concludes several factors like; Caries and premature questionnaires were asked of the participants.
loss of primary teeth are considered predisposing factors The students were examined by a single examiner
for occlusal and space anomalies in mixed and permanent to avoid inter-examiner variations. Before the survey,
dentitions. 13 both the examiner and record assistant underwent clinical
calibration training in the Orthodontics department of Ali-
Relevant studies were carried out in different countries Abad Teaching University. Moreover, their mouths and teeth
to investigate the prevalence of dental malocclusion and its were examined with a sterile mouth mirror, explorer, and
common features of it in terms of gender which showed tweezer under the supervision of orthodontics specialists
different results: A study in India showed that the prevalence for the presence of dental malocclusion class I, class II,
of crowding is 50.4% in boys and 51.4% in girls. Cross- and class III classification based on angle’s definition in
bite was reported at 17.8% and 18.3% in boys and girls, students.
respectively. Angles class I malocclusion was reported
The observation was recorded in the assessment form and
in 78.4% of boys and 80.2% of girls. Angles class II
later transferred to the computer. Dental bites and other oral
malocclusion was reported in 21.5% of boys and 19.8% of
information related to participants were extracted based on
girls and class III malocclusion was observed in 0.1% of
the information contained in the files.
boys. Crowding was found to be the most common feature,
followed by increased overjet, deep bite, and anterior open Before analysis, the dataset was preprocessed for missing
bite in that order. But in another study in Pakistan Agha values and outliers. All the charts and analysis are taken
Khan University, increased overjet was found to be the most place using the excel program.
common feature. In this study, females were observed to
have more class 1 than males. The study showed that oral 3.1. Inclusion criteria
health-related quality of life improves with the treatment of
1. Age group between 18-25 years.
malocclusion.
2. Students who have enough teeth in their jaws.
Besides, in Afghanistan, the nonexistence of enough 3. Students who are willing to participate in the research
investigations or research about oral health especially dental and are satisfied.
malocclusion considering gender is a big challenge, because 4. Students of dentistry faculty. This criterion was related
Afghanistan has been suffering from poverty, conflicts, and to the research objective because conducting the survey
social inequality in terms of living standards, and such was easier on dental students than on other faculties’
conditions are known to severely impact oral health. students.
 Ehsan, Azami and Azimi / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89 85

3.2. Exclusion criteria

1. Age group out of 18- 25 years.
2. Students who have lost their teeth for various reasons.
3. Students who are not satisfied with the research.
4. Students of other faculties except for dentistry faculty.

4. Result
Among the 133 participants who had the characteristics
of sample entry and were accepted to participate in this
research "68" of them were males, "and 65" of them were Fig. 1: a,b: Show the rate of crowding in males (33%) and females
(43%).
females with an age range of 18-25.

Table 1: Gender distribution

Total no. of subjects (N) N (%)
Male 68 51.12
Female 65 48.87
Total 133 100

Angle’s class I, II, and III malocclusions were present in

51.1%, 14.3%, and 33.9%, respectively. The difference in
malocclusion was statistically significant. (Table 2)
It has been shown that the dental malocclusion classes
due to “angle” classification in females’ class I (53.48%)
class II (21.4%) class III (23.07%) while in males’ class
I (48.33%) class II (6.66%) class III (43.33%) therefore the
statistics shows that the prevalence rate of class I in both
genders is high.
Fig. 2: Shows the existence of dental malocclusion among
Table 2: Distribution of angles’ classes due to gender their family members and relatives, which describes the role of
Angle’s Classes inheritance (74%) in girls and (55%) boys, the 23% difference
Gender Class 1 Class 2 Class 3 indicates that inheritance in females is one of the significant factors
Male 48.33% 6.66% 43.33% in causing dental malocclusion because more than one member of
Female 53.84% 21.53% 23.07% the family has the same condition.
Total 51.1% 14.3% 33.9%

Following is the evaluation of the results in terms of

"causal factors (inheritance, trauma), gender, blood groups,
the psychological and aesthetic effect of malocclusion and
interest to treatment.
According to this study, several causal factors were
reported and found which are: crowding, trauma,
inheritance, gender, blood groups, oral bad habits (mouth
breathing, bruxism, nail chewing, thumb sucking, and
tongue thrust), and oral problems. It has shown that each
of these factors has its own direct and indirect relationship
with malocclusion. All these leading factors are described
in separate figures and tables below. For example, One of
the most important human genetic characteristics is the
relationship between the ABO blood group system and
malocclusions which will be discussed in detail in the blood
Fig. 3: Explains trauma during childhood in primary teeth of both
groups factor.
genders. It describes the incidence of trauma in deciduous teeth
It has been studied and analyzed for Oral problems during their childhood (16%) in females and (32%) in males.
separately. In females, the most oral problem was dental
86 Ehsan, Azami and Azimi / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89

caries (53.84%). In males, the most common problem was Another issue that should be found in the influence of
dental plaque (28.97%) and the least were Gingivitis (6%) malocclusion on both genders. In females; very high impact
in females, and (4.67%) in males, respectively. Table 3 (26%), medium impact (40%), very low impact (34%)
and in males; very high impact (33.3%), medium impact
Table 3: Oral problems (33.3%), very low impact (33.3%). Figure 4
Oral Problems Male Female
Caries 28.04% 53.84%
Dental plaque 28.97% 20%
Gingivitis 4.67% 6%
Periodontitis 8.41% 0%
Non-Existing Oral Problems 9.34% 24.61%

The prevalence of these oral bad habits in each gender

has been studied and analyzed separately. In females, the
most common type of bad habit was bruxism (18.46%).
While in males, the most common type of unhealthy habit
was mouth breathing (14.06%). Table 4

Table 4: Oral bad habits

Oral Bad Habits Male Female
Bruxism 7.81% 18.46% Fig. 4: Describes the percentage of psychological and aesthetic
Nail chewing 3.125% 1.53% Effects of dental malocclusion on both genders.
Thumb sucking 1.56% 3.07%
Tongue thrust 0% 1.53% Based on our study, it has shown that each gender has its
Nothing 73.437% 73.84% inclination for treatment of this teeth irregularity. 64.4% out
of 65 females, wanted to be treated immediately without any
Normal bite (2-4 mm) was seen in 63.9% examined financial consideration – a valuable issue for them, (7.6%)
population (63.33% in males and 64.61% in females). were not interested to seek treatment, and (4.6%) don’t want
Similarly, Deep bite/ increased bite was seen in 15.3% and to treat this irregularity means that it is not important for
the open bite was present in 10.5% of cases. The data was themselves. While in males, 45.4% out of 68 wanted to treat
statistically significant. Table 5 this teeth irregularity as soon as possible – a valuable issue
for them, (9%) were not very interested in treatment. It has
Table 5: Dental bites cleared based on this finding that a high percentage of girls
Dental Bites Male Female are willing to seek treatment without any financial problems
Deep bite 11.66% 18.46% or anything else rather than boys. Figure 5
Open bite 10% 7.69%
Crossbite 0% 1.53%
Edge to Edge Bite 15% 0%

Moreover, based on the findings of this study, it is

concluded that blood group types of O and B in both genders
are prominent leading factors to malocclusion in other
words there is a relationship between them based on this
study. Actually, according to the table (6), there is only the
prevalence of blood groups among participating students,
and more details regarding the relationship between them
and malocclusion are discussed in the discussion section.
Table 6

Table 6: Blood groups

Blood Groups Male Female
B 34.8% 30.7%
O 36.3% 36.9% Fig. 5: Shows the interest of participants in treatment in a
AB 6% 10.7% percentage.
 Ehsan, Azami and Azimi / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89 87

5. Discussion participants following the deep bite, open bite, and edge-
to-edge bite. In research in Pakistan, females were observed
In each country, the prevalence of malocclusion is different. to have more class 1 than males. In this study, females were
For example; in Saudi Arabia, its prevalence is 62.4%, in observed to have more class 1 than males as well.
Colombia 88.1%, and in the United States, the prevalence is
The prevalence of dental caries in both genders is
20-43%. 14 While the range of this prevalence in India is 20
more common than other oral problems, while the rate
– 43%. 15 So, these variations will help us to find the leading
of bruxism in females is more common than in other
factors of malocclusion.
oral habits. However, several other factors can lead to
The prevalence of each Angle’s class is also different. In malocclusion such as dental plaque, which causes gingivitis,
Europe and Africa, the prevalence of Angle’s class 1 was so, maybe there is a direct relationship between dental
in a wide range between 10.3-84.3%. 16–25 In our study, the plaque and gingivitis. According to our research, probably
percentage of class 1 malocclusion among Afghan students there is a direct relationship between mouth breathing
was 51.1%, which is a similar finding to studies in Pakistan and oral problems such as caries and gingivitis, and also
and Iran with approximately 54.7%. 16–25 a relationship between open bite, class I, and class II
The prevalence rate of Angle’s class 2 in Afghanistan malocclusion.
is closer to the prevalence rate of it in Pakistan, Iran, and In the presence of teeth irregularity, it becomes difficult
India. Meanwhile, the prevalence of class 3 malocclusion to clean the teeth. Therefore, remaining food in the teeth
in Afghanistan is not at a high rate, and this finding of our for a long time is one of the main factors for the formation
study is also similar to findings found in Iran, Pakistan, and of dental caries, dental plaque, and calculus which are
India. 16–25 In return for these similarities and findings, we observed in both genders. Therefore, irregularity of teeth
can tell that racial, cultural, Climate, nutritional, ethnic, and may cause dental carries directly.
genetic similarities bring about be same findings.
It shows the probable relation between causal factors and
Several factors were examined for the relationship their effect on oral health.
between dental malocclusion and them. Regarding trauma,
this study has shown that the prevalence of trauma in males Table 7: Causal factors and their effects
is more high (32%) than in females (16%) which is similar Causes Effects
to the finding of Rohini Dua and Sunila Sharma’s study; Bruxism Periodontitis
63.2% in males and 36.4% in females. 26 Inheritance is Dental Plaque Gingivitis
another factor that can cause it and based on this study, it Mouth Breathing Caries, Gingivitis
cleared that for those students who had malocclusion, some Class 2, Class3 Open bite
or most of their family members had the same condition Edge to Edge Bite Class 1
which alludes to genetics. In this allusion, blood groups Open bite, Class 2, Class 3 Mouth breathing
have their roles; A study in India has determined the
relationship between the malocclusion and blood grouping
system. 27 Moreover, based on the findings of this study, it This study showed that among participants females are
is concluded that blood group types of O and B in both more interested in treatment and have fewer psychological
genders, as well as the occurrence of dental trauma in males effects of dental irregularities than males. According to the
and heredity in females, maybe the most important factors findings of this research girls with a difference of 20% less
for dental malocclusion among the participants. than boys, they seek treatment, which may be because girls
To compare, a study in India showed that the prevalence pay more attention to beauty than boys.
of crowding was 50.4% in boys and 51.4% in girls, cross- According to the current study and Table 8, there
bite was reported at 17.8% and 18.3% in boys and girls, were many differences between the prevalence of dental
respectively. While in this study the prevalence of crowding irregularities in girls and boys based on the causes and
in boys was 67% and 57% in girls, the crossbite was existing of an unequal number of participants in terms of
1.53% in girls and wasn’t reported in boys. Angle’s class gender, certainly, we can’t judge in which gender the teeth
I malocclusion was reported at 78.4% in boys and 80.2% in irregularities were more or less.
girls. Angles class II malocclusion was reported in 21.5%
of boys and 19.8% of girls and class III malocclusion was Table 8: Prevalence ofdental malocclusion in both sexes
according to its mean
observed in 0.1% of boys. While in this survey angles class
1 malocclusion is 48.3% in boys and 53.8% in girls. Angles Male Female
class II is 6.6% in boys and 21.5% in girls and class III is Oral Problems 17.38% 20.27%
43.3% in boys. In another research, crowding was found Dental Bites 20% 8.46%
Oral Bad Habits 5.31% 6.46%
to be the most common feature, followed by increased
Dental Crowding 33% 43%
overjet, deep bite, and anterior open bite in that order. In
Overall Average of Observation 21.7% 22.88%
this research, crowding has also the highest rate among
88 Ehsan, Azami and Azimi / IP Indian Journal of Orthodontics and Dentofacial Research 2023;9(2):83–89

Note: This study had a limited number of samples and facilities for women, both financially in terms of easy
students were randomly selected. Therefore, the results of access to treatment, especially orthodontists, to offer
the study indicate the prevalence of dental malocclusion more discounts for the treatment of women. In this
among dental students at Kabul University of Medical way, we can increase the interest of people in the
Science, which can’t be attributed to all members of society treatment of dental disorders and also can reduce the
or all students in Afghanistan. rate of dental disorders in society.
3. There is very little research about dental malocclusion
6. Conclusion in Afghanistan, and we cannot further and deeply
evaluate the underlying problems of people with
The following conclusions were drawn from the present insufficient data. Thus, we need more research on
survey: more people in all provinces to have access to more
information and big data to be able to propose and build
1. Angle’s class I malocclusion was 48.3% in males and effective solutions and programs to solve or reduce
53.8% in females. Angles class II was 6.6% in males malocclusion problems. Therefore, we recommend our
and 21.5% in females and class III was 43.3% in males government provide more opportunities for researchers
and 23% in females. regarding such investigations.
2. Class I of malocclusion was more common in females
than males, while class III of malocclusion was more
8. Author Contributions
common in males than females.
3. Crowding had the highest rate among participants H. Ehsan. Contributed to the idea of research, questionnaire
followed by a deep bite, open bite, and edge-to-edge distribution, and collection, interpretation of the results,
bite. preparation of master table results, and writing and data
4. The occurrence of dental trauma in boys and heredity analysis of the paper; M. Azami. Contributed to the idea
in girls may be the most important factors for dental of the research, preparation of master table for results,
malocclusion. interpretation of the results, and writing and revising the
5. Girls were more interested in orthodontic treatments paper; S. Azimi. Contributed to the idea of the research,
which may be because they pay more attention to interpretation of the results, and revised the paper. All
beauty than boys. authors gave final approval and agree to be accountable for
all aspects of the work.
7. Recommendations
9. Conflict of Interest
1. According to our survey conducted among the
students of dentistry faculty at Kabul University of None.
Medical Science, because all those students were
Dental students who had sufficient knowledge and 10. Source of Funding
information about the problems of dental abnormalities
and irregularities, this caused all of them to pay None.
serious attention to their oral health especially dental
irregularities. So, we can understand that having Acknowledgment
knowledge and information about an issue is necessary This article is based on general dentistry which is
to solve or reduce the problem. Thus, we ask and registered with the research committee of Kabul University
highly recommend Afghanistan government reduce of Medical Sciences and OROD (Organization of
dental irregularities in society by spreading sufficient Rehabilitation and Optimal Development). Corresponding
information about it and raising awareness in the to [email protected].
communities. They should inform the public through
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