Predicting handicapping malocclusion using the Dental Aesthetic Index (DAI)

Area of Science:

• Orthodontics
• Dental Public Health
• Epidemiology

Background:

• The Dental Aesthetic Index (DAI) is a standardized measure of malocclusion severity based on social perceptions of dental aesthetics.
• DAI is utilized globally for epidemiological surveys (e.g., WHO's ICS-II) to assess unmet orthodontic treatment needs and for prioritizing subsidized treatment.

Purpose of the Study:

• To establish a definitive DAI score threshold that accurately distinguishes between handicapping and non-handicapping malocclusions, reflecting orthodontists' clinical judgment.

Main Methods:

• Analysis of 1306 dental models representing untreated malocclusions from a large child population.
• Calculation of DAI scores for each model.
• Correlation of calculated DAI scores with orthodontists' clinical assessments to determine an optimal cut-off point.

Main Results:

• The 86th percentile on the DAI scale demonstrated the highest agreement between DAI scores and orthodontists' decisions.
• A DAI score of 36 at the 86th percentile achieved 88% agreement, 93% specificity, and 54% sensitivity.
• Cases scoring 36 or higher on the DAI are identified as potentially handicapping malocclusions.

Conclusions:

• A DAI score of 36 serves as a reliable decision point for identifying handicapping malocclusions, aligning with expert clinical judgment.
• This validated threshold enhances the utility of the DAI for epidemiological assessment and resource allocation in orthodontic care.