Prevalence and predictors of immediate treatment need for anterior crossbite in primary dentition: a Baby ROMA study

This study aimed to estimate the prevalence of anterior crossbite among Syrian children in the primary dentition and to classify the severity of identified cases utilizing the Baby ROMA index. The research specifically evaluated the distribution of crossbite in relation to age, gender, and tooth type, as well as identifying predictors associated with the necessity for immediate orthodontic intervention. A cross-sectional study involving 2,700 children aged 3 to 5 years was conducted in public kindergartens in Damascus using multistage cluster sampling methods. Anterior crossbite was assessed clinically by a single calibrated examiner, with a reliability re-examination of 10% of cases yielding a Kappa value of 0.85 to 0.95. The affected cases were categorized into severity grades based on the Baby ROMA criteria. Analyses included descriptive statistics, Chi-square tests, McNemar tests, and multivariable binary logistic regression. The overall prevalence of anterior crossbite was determined to be 15.6%. In terms of severity classification, 61.4% (equating to 9.6% of the total sample) were classified as Grade 4N, indicating a requirement for immediate treatment, while 38.6% (6.0% of the total sample) were designated Grade 2N, suggesting monitoring only. The prevalence did not demonstrate any significant differences based on gender (p = 0.979); however, age significantly influenced the clinical presentation (p < 0.001). The maxillary lateral incisors were the most frequently involved teeth, and a significant difference was observed between sides (p < 0.001). Multivariable regression analysis identified the involvement of lateral incisors (OR = 21.1) and canines (OR = 10.85), along with left-side involvement (OR = 2.17), as the strongest predictors for classification into the immediate treatment group (Grade 4N); age was not found to be a significant predictor. The findings indicate a notable prevalence of anterior crossbite in the primary dentition, and the Baby ROMA index served as a practical framework for stratifying these cases by clinical urgency. These results underscore the importance of integrating dental and functional assessments to classify and prioritize high-urgency cases early, thereby preventing progression to more serious occlusal and skeletal complications.