Orthodontic abnormalities cover a various set of clinical situations, the assessment of which is often subjective. They can be sources of malfunctioning or aesthetic deficit. The need for the treatment of malocclusions is due, on the one hand, to care provision, and on the other hand, to the patient’s financial positions and to how the patient cares for his or her oral health. These treatments are generally expensive and long lasting.
Treatment needs may be difficult to assess and vary by practitioner or patient. Treatment decision must be based on objective criteria   . Thus, accurately assessing the care needed is an approach that must be duplicable, irrespective of the practitioner together with a universal language accessible to all stakeholders (practitioner, patients, insurance, health mutual). For this, several indexes have been created as the IOTN index (Index of Orthodontic Treatment Need)   or index of need for orthodontic treatment, which enables a classification of the malocclusion of each patient by scoring it. It is easy to use and to be reproduced. The score varies according to the level of severity of the anomaly. It is proportional to the need for treatment according to two components: a Dental Health Component (DHC) and an Aesthetic Component (AC).
In literature, authors like Utomi et al.  found the need for orthodontic care in 68% of patients in a university hospital center in Nigeria.
The aim of this study is to describe the malocclusions in patients received in consultation in the Dental Surgery Unit of the Yalgado Ouedraogo Teaching Hospital and assess their care needs with reference to IOTN index.
2. Material and Method
2.1. Framework and Study Type
This is a diagnostic, prospective, cross-cutting descriptive study conducted from January to December 2016 focusing on dental malocclusions and normative needs in orthodontics care among the population. It was conducted in Burkina Faso, in the Dental Surgery Unit of the Yalgado Ouédraogo Teaching Hospital Center.
2.2. Inclusion Criteria
The patient must be aged between 12 and 16 years at the time of the consultation in this unit during the survey period and agree to participate in the study.
2.3. Exclusion Criteria
Any under 12-year patient or any patient beyond 16 years and any patient who has received orthodontic treatment were excluded from the sample.
The sampling was at random or fortuitous. We selected all patients received for orthodontic consultation from January 1 to December 31, 2016.
2.5. Data Collection
The examiner, equipped with an examination tray, reported on the patient’s sheet, the variables listed according to the series of full-color photographs (Figure 1), the IOTN rule (Figure 2) and the dental health table (Table 1).
Figure 1. IOTN aesthetic sheet to conduct a direct assessment on the patient  .
Figure 2. Small ruler dental health component measurement  .
Table 1. Dental health component  .
The collection of photographs (Figure 1) is classified on a scale of 1 to 10 according to their attraction; 1 being the most attractive value and 10 the least attractive. This assessment of the dental aesthetic is done directly on the patient. The level of attractiveness of the patient’s smile is classified by both, the patient, then the practitioner:
―from level 1 to level 4, there is no need for treatment or this need is low;
―from level 5 to level 7, this requires moderate treatment; and
―from level 8 to level 10, the need for treatment is obvious.
The dental index is calculated from dental parameters measured using directly the ruler on the patient with reference to the table of the dental health component (Table 1). These dental parameters are classified from 1 to 5:
―levels 4 and 5; the need for treatment is established;
―levels 3; this requires moderate treatment;
―levels 1 and 2; no or limited treatment required.
2.6. Data Processing
Data were manually analyzed and then processed with SPSS (Statistical Package of the Social Science) Software version 21. The processing was performed with the Software Office 2013 version. The quantitative variables were described according to their number and their rate with the significance level p = 0.05. Qualitative variables were described by their regularity and rates. Cohen’s Kappa nonparametric test was used to estimate the correlation between patient and practitioner scores. The confidentiality of data collected and patient anonymity were maintained throughout the study.
Out of the 290 patients received in consultation over the period, 81met the inclusion criteria and were therefore involved in the study.
3.1. Patients’ Social Characteristics
Patients’ age is given in Figure 3. Consultation at 16 years is the most frequent, with 22 patients (17.82%). The average age was 14.05 ± 1.56 years. Concerning gender, there were 32 boys or 39.5% against 49 girls or 60.5% of the number of both categories. Gender ratio is 0.65.
3.2. Malocclusions Rate
3.2.1. Aesthetic Component
The patient’s perception of his malocclusion is mainly between 2 and 6 for 72.8% of patients. In this same score range, the practitioner classifies 76.6% of patients. For a score less than or equal to 5; 49 patients are ranked against 53 according to the practitioner. Some patients outperform their score. The Table 2 reports the various scores on aesthetic.
3.2.2. Dental Health Component
The pathologies listed were diverse, including sagittal, vertical and transverse cases. It appears that our patients suffered from dental abnormalities both in
Figure 3. Patients distribution per age.
Table 2. Aesthetic component.
position and number. Table 3 reports these various malocclusions. Agenesis and dental avulsions were less frequent; they only concern 4 patients. Den to-maxil- lary disharmony, deficiency or excess are the most encountered with a score equal to or greater than 2 for displacement of contact point in 77.8% of patients.
3.3. Care Need
The previous pathologies required appropriate care among these patients received in consultation. More than the half (56.8%) clearly needed to receive care according to their IOTN index (Table 4). The assessment of the aesthetic aspects by patients is consistent with that of practitioners in 81.48% of cases. Only one
Table 3. Dental health component.
Table 4. Orthodontic care needs.
patient had a score lower than that found by the practitioner. Concerning the other 14 patients or 17.28%, their scores are higher than the practitioner’s assessment. Patients tended to overestimate their dental abnormalities. The difference is statistically significant with t = 3.32 for a confidence level of 0.05. However, Cohen’s nonparametric kappa test (test that measures inter-judges fidelity; when the judges have a high degree of agreement the value is close to 1, otherwise the value is close to 0) gave a good correlation between the patient and practitioner scores at 0.77.
4.1. Method Quality and Validity
There are several orthodontic indexes to quantify abnormalities and the degree at which they require treatment. The ideal index must be  :
―flexible (it must enable to make measurements at different times and with different practitioners);
―valid (assess what it is made for);
―quantified by the parameters assessed;
―implemented quickly by qualified practitioners.
Among the main orthodontic indexes  -  : DAI (Dental Aesthetic Index), ICON (Index of Complexity, Outcome and Need), we have chosen IOTN (Index of Orthodontic Treatment Need) developed in 1989 by Shaw for its easy implementation and reproducibility. However, this index does not specify the psychological impact of malocclusion and its impact on the patient’s life quality  .
4.2. Patients’ Social Characteristics
Girls are more numerous to consult. It is true that they represent the majority of our population  . In addition, they are more concerned about their appearance. Aesthetics ranks top among their reasons for consultation.
Our results reveal a high rate of consultation for the 16-year-old and then 12-year-olds. Indeed, at 12 years, this corresponds to the appearing of all the permanent teeth, excepted wisdom teeth. An assessment of care needs is objective at this period. It is usually at this age that multi-band orthodontic treatment starts. Moreover, health insurances and health-care mutual are often reluctant to cover orthodontic care started after 16-year-olds. Financial constraints may account for so many consultations at this age.
Malocclusions Prevalence and Care Needs
Our sample includes patients in consultation. They are either referred or come on their own for an orthodontic consultation. As a result, they all have abnormalities at different levels of severity. Nevertheless, it appears that 8.6% do not require any care need according to IOTN index. The need for treatment was necessary in 91.4%. This score is comparable to those found in patients by Bourne et al.  and Ghijselings et al.  at 78% and 80.3%, respectively. Yet, these are higher than the rates of 42.6% and 27.3% in the respective studies by Ngom et al.  and Perillo et al.  involving Senegalese and Italian school children. This difference can be explained by the fact that, since school children are not a consulting population, the prevalence of orthodontic anomalies is necessarily lower, at first sight.
Also, our results show that patients tend to overestimate their dental misalignments according to the aesthetic component compared to practitioner’s opinion. Among school adolescents in Nigeria, Aikins et al.  find a significant difference between the assessment made by patients due to aesthetic reasons and that made by orthodontists
This negative perception of one’s malocclusion has a psychological impact that motivates the consultation. According to Kolawole et al.  , with equal pathology, the psychological impact of dental esthetics varies significantly from one schoolchild to another. This psychological component should also be taken into account in care needs. The individual infected may see his or her malocclusion differently, and the way he or she takes it is not necessarily due to its severity   .
Our results enable us to say that the need for teeth care is proven in patients received for orthodontic consultation in the Dental Surgery Unitat Yalgado Ouédraogo Teaching Hospital. Esthetics remains an important factor in the quest for orthodontic treatment.
The aesthetic deficit is source of psychological impact that should be taken into account when assessing the need for treatment. The female population, more concerned with their appearance, seems more interested in repairing their malocclusions. The pathologies listed are diverse, including dental congestion, displacement of the bone bases, dental inclusion or agenesis, overbite, open bite.
This study should be extended to a non-consulting population such as schoolchildren, to be able to generalize the results to the whole population.
Conflicts of Interest
The authors declare to have no conflicts of interest.
Ethics Statement/Confirmation of Patient Permission
Ethics approval not required. Patient permission obtained.