Severity of malocclusion and its association with caries risk level in the primary dentition: a single-centre cross-sectional survey.

PURPOSE: Dental caries and malocclusion are prevalent in children and frequently coexist. Whether malocclusion severity is independently associated with elevated caries risk, remains poorly characterised, particularly in Saudi Arabia. The aim was to examine whether malocclusion severity in the primary dentition is independently associated with caries risk level in Saudi preschool children.

MATERIALS AND

METHODS

A single-centre cross-sectional survey was conducted at Qassim University, enrolling 250 Saudi children aged 3-6 years with complete primary dentitions. Malocclusion severity was graded using a five-point Malocclusion Severity Index (MSI; grades 0-4). Caries risk was classified as Low, Moderate, or High using the AAPD 2023 Caries Risk Assessment tool. Secondary outcomes were dmft/dmfs, ICDAS-II lesion staging, and the modified plaque (mPI) and gingival (mGI) indices. Regression models adjusted for sugar exposure, fluoride toothpaste use, caregiver caries and household income.

RESULTS

Among 250 children, 109 (43.6%) had high caries risk and 222 (88.8%) had early childhood caries (mean dmft 4.6 ± 2.8). Moderate-to-severe malocclusion (MSI ≥ 3) was present in 97 (38.8%). A significant monotonic relationship was observed across MSI grades (Jonckheere-Terpstra z = 8.34, p < 0.001). MSI was the strongest independent correlate of High CRA (aOR: 3.94, 95%CI: 2.16, 7.19, p < 0.001) and dmft count (adjusted IRR: 1.48 per unit, p < 0.001).

CONCLUSIONS

Malocclusion severity in the primary dentition was independently associated with caries risk level.