Investigating the Relationships Among Age, Occlusal Traits, and Malocclusion Severity in Preschool Children. A Cross-sectional Study

Background : The aim of this cross-sectional epidemiological study was to explore the associations of age and occlusal factors with the severity of malocclusion among preschool children attending public kindergarten in Tirana, the capital city of Albania. Methods: Clinical data regarding malocclusion traits were collected from October 2023-May 2024 by examining 3- to 6-year-old children who were frequenting 18 randomly selected public kindergartens in Tirana, Albania. A child presenting one of the following altered occlusal traits was recorded as having malocclusion: class II or III canine relationship, distal step (Ds), increased overjet (OVJ), deep overbite (OVB) >50% or anterior open bite (AOB), cross bite (CB) either anterior (ACB) or posterior (PCB). The relationships between categorical variables were evaluated with the continuity correction test, Fisher’s exact test for 2 × 2 tables and the Pearson chi-square test for r × c tables. Binary logistic regression analysis and multivariable logistic regression analysis were used to determine the risk factors affecting a child’s malocclusion severity. Results: A total of 719 children aged 3–6 years (362 females and 357 males) with a mean age of 4.03 years who met the inclusion criteria were included in the study. There were no differences in terms of age or sex. The OVJ frequency and incidence of deep OVB>50% were 15.4%, and deep OVB was more common in the 4-year-old group. The incidence of AOB was 2.6%, which was greater among 5-year-old children. The multivariate regression analysis revealed that children in the 4-year-old group had a 1.62-fold greater risk of developing severe malocclusion (OR (95% CI):1.62 (1.05–2.50); p =0.030). Those with increased OVJ had a 15.15-fold greater risk of developing more severe malocclusion (OR (95% CI):15.15 (5.87–39.09) p <0.001). Conclusions: The results of this study demonstrate that an age of 4 years, increased OVJ, a class III canine relationship and primary second molars in Ds are factors associated with the severity of malocclusion among preschool children.