title: Severity of malocclusion in adolescents: populational-based study in the north of Minas Gerais, Brazil.
abstract: OBJECTIVE
  To identify the factors associated with severity of malocclusion in a population of adolescents.
  
  
  METHODS
  In this cross-sectional population-based study, the sample size (n = 761) was calculated considering a prevalence of malocclusion of 50.0%, with a 95% confidence level and a 5.0% precision level. The study adopted correction for the effect of delineation (deff = 2), and a 20.0% increase to offset losses and refusals. Multistage probability cluster sampling was adopted. Trained and calibrated professionals performed the intraoral examinations and interviews in households. The dependent variable (severity of malocclusion) was assessed using the Dental Aesthetic Index (DAI). The independent variables were grouped into five blocks: demographic characteristics, socioeconomic condition, use of dental services, health-related behavior and oral health subjective conditions. The ordinal logistic regression model was used to identify the factors associated with severity of malocclusion.
  
  
  RESULTS
  We interviewed and examined 736 adolescents (91.5% response rate), 69.9% of whom showed no abnormalities or slight malocclusion. Defined malocclusion was observed in 17.8% of the adolescents, being severe or very severe in 12.6%, with pressing or essential need of orthodontic treatment. The probabilities of greater severity of malocclusion were higher among adolescents who self-reported as black, indigenous, pardo or yellow, with lower per capita income, having harmful oral habits, negative perception of their appearance and perception of social relationship affected by oral health.
  
  
  CONCLUSIONS
  Severe or very severe malocclusion was more prevalent among socially disadvantaged adolescents, with reported harmful habits and perception of compromised esthetics and social relationships. Given that malocclusion can interfere with the self-esteem of adolescents, it is essential to improve public policy for the inclusion of orthodontic treatment among health care provided to this segment of the population, particularly among those of lower socioeconomic status.
authors.affiliation: Departamento de Ciências Exatas, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil.
authors.forename: Marise Fagundes
authors.initials: MF
authors.lastname: Silveira
authors.affiliation: Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil.
authors.forename: Rafael Silveira
authors.initials: RS
authors.lastname: Freire
authors.affiliation: Faculdades Integradas Pitágoras de Montes Claros, Montes Claros, MG, Brasil.
authors.forename: Marcela Oliveira
authors.initials: MO
authors.lastname: Nepomuceno
authors.affiliation: Departamento de Odontologia, Universidade Estadual de Montes Claros, Montes Claros, MG, Brasil.
authors.forename: Andrea Maria Eleutério de Barros Lima
authors.initials: AM
authors.lastname: Martins
authors.affiliation: Departamento de Medicina Preventiva, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brasil.
authors.forename: Luiz Francisco
authors.initials: LF
authors.lastname: Marcopito
mesh_terms: D000293:Adolescent; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D004955:Esthetics, Dental / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000453:epidemiology*; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors; D012720:Severity of Illness Index; D012959:Socioeconomic Factors