Malocclusion indices and their applications in public health: a review study


  • Suzely Adas Saliba Moimaz Full Professor, São Paulo State University (UNESP), School of Dentistry, Department of Preventive and Restorative Dentistry, 16015-050 Araçatuba - SP, Brazil
  • Cláudia Silva Gonçalves Post graduate student, São Paulo State University (UNESP), School of Dentistry, Department of Preventive and Restorative Dentistry, 16015-050 Araçatuba - SP, Brazil
  • Fernando Yamamoto Chiba Assistant Professor, São Paulo State University (UNESP), School of Dentistry, Department of Preventive and Restorative Dentistry, 16015-050 Araçatuba - SP, Brazil
  • Artênio José isper Garbin Associate Professor, São Paulo State University (UNESP), School of Dentistry, Department of Preventive and Restorative Dentistry, 16015-050 Araçatuba - SP, Brazil
  • Tânia Adas Saliba Associate Professor, São Paulo State University (UNESP), School of Dentistry, Department of Preventive and Restorative Dentistry, 16015-050 Araçatuba - SP, Brazil



Malocclusion, Public Health, Epidemiologic Methods, Health Surveys


Health indices are important to measurement of the presence and severity of diseases. The objective of this study was to perform a literature review about malocclusion indices and analyze their applications in the public health field. The research was performed by consulting Pubmed, SciELO, Web of Science, Scopus, Bireme and Embase databases, using the following terms: public health, epidemiological methods, indices, epidemiological surveys, preventive dentistry, malocclusion, and orthodontics. Publications on the development and use of malocclusion indices in clinical and epidemiological studies were included, without restrictions of methodology and language. Fifty-two indices and their variations were identified. Of these, most were intended for individual assessments and their use in public health was difficult due to the requirements for their application, including the need for specialists, plaster models analysis, complementary exams such as cephalometric radiographs and photographs, specific equipment, the need for longitudinal monitoring of cases, and exclusively objective or subjective assessments. Some malocclusion indices present positive aspects and partially evaluate physical, functional, psychological, and social conditions. However, it is still challenging to find a unanimous index that fulfills the requirements for assessing the severity, treatment need, and impact of malocclusions on the individual’s quality of life with applicability in public health.


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Orton L, Lloyd-Williams F, Taylor-Robinson D, O'Flaherty M, Capewell S. The use of research evidence in public health decision making processes: systematic review. PLoS One. 2011;6(7):e21704.

Draker HL. Handicapping labio-lingual deviations: a proposed index for public health purposes. Am J Orthod. 1960;46:295-305.

World Health Organization. Oral health surveys: basic methods. 3rd ed. Geneva: WHO; 1987.

Chaves MM. Social Dentistry. 3rd ed. São Paulo: Artes Médicas;1986.

Ghafari M, Bahadivand-Chegini S, Nadi T, Doosti-Irani A. The global prevalence of dental healthcare needs and unmet dental needs among adolescents: a systematic review and meta-analysis. Epidemiol Health. 2019;41: e2019046.

Snowden CB, Miller TR, Jensen AF, Lawrence BA. Costs of medically treated craniofacial conditions. Public Health Rep. 2003;118:10-17.

Prahl-Andersen B. The need for orthodontic treatment. Angle Orthod. 1978;48:1-9.

Garbin AJI, Perin PCP, Garbin CAS, Lolli LF. Malocclusion prevalence and comparison between the Angle classification and the Dental Aesthetic Index in scholars in the interior of São Paulo state - Brazil. Dental Press J Orthod. 2010;15:94-102.

Brazilian Ministry of Health. SBBrazil 2010 Project: National Oral Health Survey - Main Results. Brasília: Brazilian Ministry of Health; 2011 [Accessed 2020 Oct 13]. Available from:

Gray AS, Demirjian A. Indexing occlusions for dental public health programs. Am J Orthod. 1977;72(2):191-97.

Angle EH. Classification of malocclusion. Dent Cosmos. 1899;41:248-64.

Lischer BE. Principles and methods of orthodontia. Philadelphia,PA: Lea & Febiger; 1912.

Stanton FL. A quantitative study of dental occlusion between 2 and 10 years. Dent Cosmos. 1936;78:130-40.

Hellman M. Diagnosis in orthodontic practice. Am J Orthod Oral Surg. 1941;27:681-704.

Moore GR. An introduction to the formulation of a method of occlusal examination for public health survey purposes. Ann Arbo: University of Michigan; 1944.

Massler M, Frankel JM. Prevalence of malocclusion in children aged 14 to 18 years. Am J Orthod. 1951;37:751-68.

Downs WB. Variations in facial relationships: their significance in treatment and prognosis. Am J Orthod. 1948;34:812-40.

Elsasser WA. Studies of dento-facial morphology. I. A simple instrument for appraising variations. Angle Orthod. 1951;21:163-71.

Poulton DR, Aaronson SA. The relationship between occlusion and periodontal status. Am J Orthod. 1961;47:690-9.

Van Kirk LE, Pennell EH. Assessment of malocclusion in population groups. Am J Public Health Nations Health. 1959;49:1157-63.

World Health Organization. Standardization of reporting of dental diseases and conditions: report of an expert committee on dental health; 1962 [Accessed 2020 Oct 13]. Available from:

Bjoerk A, Krebs AA, Solow B. A method for epidemiological registration of malocculusion. Acta Odontol Scand. 1964;22:27-41.

Grainger RM. Orthodontic treatment priority index. Vital Health Stat 2. 1967;25:1-49.

Howitt JW, Stricker G, Henderson R. Eastman esthetic index. N Y State Dent J. 1967;33:215-20.

Freer TJ, Adkins BL. New approach to malocclusion and indices. J Dent Res. 1968;47:1111-17.

Salzmann JA. Handicapping malocclusion assessment to establish treatment priority. Am J Orthod. 1968;54:749-65.

World Health Organization. Oral health surveys: basic methods. Geneva: WHO; 1971.

Summers CJ. The occlusal index: a system for identifying and scoring occlusal disorders. Am J Orthod. 1971;59:552-67.

Andrews LF. The six keys to normal occlusion. Am J Orthod. 1972;62:296-309.

Baume LJ, Horowitz HS, Summers CJ, Dirks OB, Brown WA, Carlos JP, et al. A method for the measurement of occlusal characteristics. (Developed for the commission on classification and statistics of the FDI, (COCSTOC) study group 2 on dentofacial abnormalities, 1969-72). Int Dent J. 1974;24:90-7.

World Health Organization. International classification of diseases, application to dentistry and stomatology (ICD - DA). Geneva: WHO; 1973.

Federation Dentaire Internationale (FDI). A method of measuring occlusal traits. Developed by the FDI commission on classification and statistics for oral conditions, working group 2 on dento-facial anomalies. Int Dent J. 1973; 23:530-37.

Linder-Aronson S. Orthodontics in the Swedish public dental health service. Trans Eur Orthod Soc. 1974;233-40.

Ingervall B, Rönnerman A. Index for need of orthodontic treatment. Odontol Revy. 1975;26:59-82.

Little RM. The irregularity index: a quantitative score of mandibular anterior alignment. Am J Orthod. 1975;68:554-63.

Gottlieb EL. Grading your orthodontic treatment results. J Clin Orthod. 1975;9:155-61.

Kowalski CJ, Prahl-Andersen B. Selection of dentofacial measurements for an orthodontic treatment priority index. Angle Orthod. 1976;46:94-7.

World Health Organization. Oral health surveys: basic methods. 2nd ed. Geneva: WHO; 1977.

Eismann D. Reliable assessment of morphological changes resulting from orthodontic treatment. Eur J Orthod. 1980;2:19-25.

Berg R, Fredlund A. Evaluation of orthodontic treatment results. Eur J Orthod. 1981;3:181-85.

Tedesco LA, Albino JE, Cunat JJ, Green LJ, Lewis EA, Slakter MJ. A dental-facial attractiveness scale. Part I. Reliability and validity. Am J Orthod. 1983;83:38-43.

Cons NC, Jenny J, Kohout K. DAI: the dental aesthetic index. Iowa City: College of Dentistry, University of Iowa; 1986.

Richmond S. Recording the dental cast in three dimensions. Am J Orthod Dentofacial Orthop. 1987;92:199-206.

Evans R, Shaw W. Preliminary evaluation of an illustrated scale for rating dental attractiveness. Eur J Orthod. 1987;9:314-8.

Brook PH, Shaw WC. The development of an index of orthodontic treatment priority. Eur J Orthod. 1989;11:309-20.

Richmond S, Shaw WC, O'Brien KD, Buchanan IB, Jones R, Stephens CD, et al. The development of the PAR index (Peer assessment rating): reliability and validity. Eur J Orthod. 1992;14:125-39.

Richmond S, Shaw WC, Roberts CT, Andrews M. The PAR index (Peer assessment rating): methods to determine outcome of orthodontic treatment in terms of improvement and standards. Eur J Orthod. 1992;14:180-87.

Espeland LV, Ivarsson K, Stenvik A. A new Norwegian index of orthodontic treatment need related to orthodontic concern among 11-year-olds and their parents. Community Dent Oral Epidemiol. 1992;20:274-79.

Ingelsson-Dahlström M, Hagberg C. The longitudinal development of malocclusion in postnormal children with little respectively urgent need for orthodontic treatment. Swed Dent J. 1994;18:49-57.

Peerlings RH, Kuijpers-Jagtman AM, Hoeksma JB. A photographic scale to measure facial aesthetics. Eur J Orthod. 1995;17:101-9.

Brazilian Ministry of Health. SB2000 Project: oral health conditions of the Brazilian population in 2000: examiner's manual. Brasília: Brazilian Ministry of Health; 2001 [Accessed 2020 Oct 13]. Available from: (2001)

World Health Organization. Oral health surveys: basic methods. 4th ed. Geneva: WHO; 1997.

Casko JS, Vaden JL, Kokich VG, Damone J, James RD, Cangialosi TJ, et al. Objective grading system for dental casts and panoramic radiographs. Am J Orthod Dentofacial Orthop. 1998;114:589-99.

Pinskaya YB, Hsieh TJ, Roberts WE, Hartsfield JK. Comprehensive clinical evaluation as an outcome assessment for a graduate orthodontics program. Am J Orthod Dentofacial Orthop. 2004;126:533-43.

Kirschen R. Orthodontic clinical screening in under a minute. Br Dent J. 1998;185:224-26.

Russo E, Grippaudo C, Marchionni P, Deli R. II ROMA index come metronomo della terapia ortodontica nel paziente in crescita. Procedings national congress of SIDO, Firenze 1998;28-31.

Parker WS. A study of 1000 malocclusions selected by the HLD (CalMod) index. Am J Orthod Dentofacial Orthop. 1999;115:343-51.

Daniels C, Richmond S. The development of the index of complexity, outcome and need (ICON). J Orthod. 2000;27:149-62.

Han H, Davidson WM. A useful insight into 2 occlusal indices: HLD(Md) and HLD(CalMod). Am J Orthod Dentofacial Orthop. 2001;120: 247-53.

Capelozza Filho L. Diagnosis in orthodontics. Maringá: Dental Press; 2004.

Pitt S, Hamdan A, Rock P. A treatment difficulty index for unerupted maxillary canines. Eur J Orthod. 2006;28:141-44.

World Heath Organization. Oral health surveys: basic methods. 5th ed. Geneva: WHO; 2013.

Grippaudo C, Paolantonio EG, Pantanali F, Antonini G, Deli R. Early orthodontic treatment: a new index to assess the risk of malocclusion in primary dentition. Eur J Paediatr Dent. 2014;15:401-6.

Frazão P, Narvai PC, Latorre MRDO, Castellanos RA. Prevalência de oclusopatia na dentição decídua e permanente de crianças na cidade de São Paulo, Brasil, 1996. Cad Saúde Pública. 2002;18:1197-205.

Peres KG, Frazão P, Roncalli AG. Padrão epidemiológico das oclusopatias muito graves em adolescentes brasileiros. Rev Saúde Pública. 2013;47:109-17.

Pinto EDM, Gondim PPDC, Lima NSD. Análise crítica dos diversos métodos de avaliação e registro das más oclusões. Rev Dent Press Ortod Ortop Facial. 2008;13:82-91.

Moore GR. The orthodontic program of the Michigan state department of health with a new classification of occlusion for survey purposes. Am J Orthod. 1948;34:355-61.

Moore GR. Measuring and meeting orthodontic needs of a community. J Am Dent Assoc. 1952;45:650-60.

Baume LJ, Maréchaux SC. Uniform methods for the epidemiologic assessment of malocclusion. Am J Orthod. 1974;66:121-9.

Oliveira AGRC, Unfer B, Costa ICC, Arcieri RM, Guimarães LOC, Saliba NA. Levantamentos epidemiológicos em saúde bucal: análise da metodologia proposta pela Organização Mundial da Saúde. Rev Bras Epidemiol. 1998;1:177-89.



Como Citar

Moimaz, S. A. S. ., Gonçalves, C. S., Chiba, F. Y., Garbin, A. J. I., & Saliba, T. A. (2021). Malocclusion indices and their applications in public health: a review study. ARCHIVES OF HEALTH INVESTIGATION, 10(7), 1156–1163.



Original Articles