Magister Scientiae Dentium - MSc(Dent) / In modern day dentistry, aesthetics forms an integral part of our social perception almost as much as functionality. Malocclusion has been brought to the forefront of developmental anomalies as it can affect mastication, speech as well as the appearance of the face. Furthermore, pre-pubertal and pubertal changes have compounded existing malocclusions in this growth period thus spiraling the need for orthodontic treatment. Therefore, it is essential to determine the normative and selfperceived need for orthodontic treatment in a population. The epidemiological data collected can be used to facilitate policy changes to manage malocclusion in Khomas, Namibia. Aim: The aim of this study was to determine the orthodontic treatment needs of a population of 12-15 year-old children attending a school in Khomas and to express it as percentages of those with subjective and objective orthodontic treatment need over the whole sample population. The objectives were to find associations between treatment needs and some demographic and socioeconomic factors.

Magister Scientiae Dentium - MSc(Dent) / Introduction: Improvement of aesthetics is often the reason patients seek orthodontic treatment. The ability to accurately assess aesthetic treatment need from the viewpoint of the patient is necessary. The threshold for orthodontic treatment is not constant in all countries and no previous attempts to determine this threshold has been made in South Africa. By ensuring that patient’s perceptions of treatment need are incorporated into the index chosen to assess perceived need, accurate data can be obtained. Determining perceived need from the patient’s viewpoint is important, and understanding its relationship with perceived need according to the professional, as well as normative need can facilitate better patient communication and management of expectations. Aims: There were three main aims of this study. First, South African children’s perceptions of treatment need according to the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN) was assessed to determine if they were similar to those of the dentists who established the threshold, or if the threshold of the grading system should be altered to better suit laypeople’s opinions. Second, the newly established threshold could then be used to determine the perceived needs for orthodontic treatment, and compare them to the normative need of the population. Finally, factors that may influence the perceived needs of the patients such as gender, ethnicity and socio-economic position could be investigated. Methodology: A cross-sectional study on 317 children aged between 11 and 14 years was done. 43.8% were male and 56.2 % were female. The sample was chosen from five schools in the Lekwa District of Mpumalanga using a multi-stage sampling technique. The study population comprised of four groups based on ethnicity; Asian (3%), black (74%), coloured (6%) and white (17%). The socio-economic position (SEP) was determined by Principal Component Analysis of household assets. Societal perceived, subjective perceived and self-perceived needs were assessed using a questionnaire and the child-rated AC of the IOTN. An intra-oral examination was conducted using the AC of the IOTN to assess objective perceived need and the modified Dental Health Component (DHC) of the IOTN to assess normative treatment need. Results: Treatment threshold was determined to be grade 3 of the AC of the IOTN according to societal perceived need of the group of South African children, and was confirmed by self-perceived need. Subjective perceived need for treatment was assessed using the AC grade participants felt best reflected their aesthetic impairment, and was found to be 20.2%, compared to actual self-perceived need of 38.5%. The latter was deduced by comparing the child-rated AC (subjective perceived need) to their perception of treatment need of that grade (societal perceived need). The objective perceived need measured by the examiner-rated AC was 60%. Definite need for orthodontic treatment based on the modified DHC of the IOTN was 41.2%. No significant difference between societal perceived or self-perceived need and gender or socio-economic position was found. White children have lower societal perceived treatment need regarding others’ aesthetic impairment. Conclusion: The treatment threshold grade should be lowered to better represent the societal perceived and self-perceived need of the South African population. Normative need was higher than perceived needs from the patients’ point of view (subjective perceived and self-perceived need), but lower than the perceived need from the professional’s point of view (objective perceived need). Ethnicity was found to have an influence on societal perceived need.

Magister Scientiae Dentium - MSc(Dent) / When considering a person's self-esteem, behavioural patterns and personal interactions, the one feature having the most impact is their physical appearance. In an ideal world, every person should have a fair opportunity to reach their full potential in life. Orthodontics can improve a person's quality of life by creating confident smiles and a functional occlusion (Sheiham, 1993). Uncorrected malocclusions can adversely affect one's speech, general health and self-esteem. Improving the general physiological implications malocclusions has on person, may make them more employable and more successful in relationships, creating an overall happier, healthier and more successful community. The more people are offered affordable orthodontic treatment, the more acceptable orthodontic treatment may become. Thus, the perceived benefits of Orthodontic treatment in a population group are Improvement of Oral Health and enhancement of psychosocial welfare. Accurate data on the prevalence, distribution and severity of malocclusion is needed by provincial oral health management. They also need accurate data of the orthodontic treatment need of the children in that specific area. This data is vital for the effective planning of the education, training and deployment of dental workers, as well as the resources and distribution thereof in specific, designated areas (Holtshousen, 1997; So & Tang, 1993). This study's focus was to estimate the prevalence of malocclusion amongst adolescents in Upington area in the Northern Cape, and to determine the need for orthodontic treatment in the area using the Index for Orthodontic Treatment Need (IOTN).

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O objetivo do presente estudo foi estimar a prevalÃncia da maloclusÃo e a necessidade de tratamento ortodÃntico em adolescentes de Fortaleza e graduÃ-la de acordo com sua severidade, a fim de estabelecer prioridades para o tratamento ortodÃntico e determinar quais os componentes da maloclusÃo que mais pesavam na determinaÃÃo desta circunstÃncia. Investigou-se ainda a associaÃÃo da maloclusÃo com idade, gÃnero, renda e escolaridade. A amostra consistiu de 419 adolescentes entre 14 e 19 anos de idade, selecionados aleatoriamente a partir de uma populaÃÃo de estudantes de uma escola pÃblica. Os critÃrios de graduaÃÃo da maloclusÃo e a avaliaÃÃo da necessidade de tratamento ortodÃntico dos sujeitos foram estabelecidos por um consenso de ortodontistas de Fortaleza. Os resultados mostraram que 95,4% dos sujeitos eram portadores de algum tipo de maloclusÃo, sendo que 60,6% do total possuia maloclusÃo grave com necessidade obrigatÃria de tratamento e 34,8% tinham-na moderada, com necessidade relativa de tratamento. Os fatores de maior interferÃncia no estabelecimento da maloclusÃo grave foram a relaÃÃo de molar maior do que meia cÃspide (30,3%), a mordida cruzada (25,7%) e a relaÃÃo de canino maior do que meia cÃspide (22,2%). NÃo houve associaÃÃo da maloclusÃo com as variÃveis sociodemogrÃficas, a nÃo ser especificamente da idade com o componente mordida cruzada (p<0,05), do gÃnero com o componente relaÃÃo de canino maior do que um meio (p<0,05) e da escolaridade da mÃe com o componente relaÃÃo de molar maior do que um meio (p<0,05). / The aim of the present study was to estimate the prevalence of malocclusion and orthodontic treatment need in adolescents of a public school of Fortaleza and grade it according to the severity, to establish priorities in the orthodontic treatment and to determine which components of malocclusion had higher importance in deterrminating malocclusion. Also, were investigated the association between malocclusion and age, gender, income and scholarship. A total of 419 teenagers, between 14 and 19 years old, selected randomly from a population of students of a public school were enrolled in this project. The criteria of graduation and the assessment of malocclusion components were established by a joint of Fortalezaâs orthodontists. The results show that 95,4% of the subjects had some malocclusion, 60,6% of the total had serious malocclusion with compulsory need of orthodontic treatment, and 34,84% had moderate and relative need of treatment. The components with more prevalence, were the molar relation higher than half cusp (30,3%), crossbite (25,7%) and the canine relation higher than a half cusp (22,2%). There wasnât association between malocclusion and social demographic variables except the relation between age and cross bite (p<0,05), gender and canine relation higher than half a cusp (p<0,05) and motherâs degree of education and molar relation higher than half a cusp (p<0,05).

Magister Scientiae Dentium - MSc(Dent) / A public orthodontic system generally is designed to prioritize patients so that those who have the greatest need receive treatment. The aim of this study was to compare the subjective perceptions of the occlusal appearance of 11 to 12 year-old schoolchildren of Nairobi with the modified Aesthetic Component (AC) scale of the Index of Orthodontic Treatment Need (IOTN). The objectives were to assess the children's perception of their occlusal appearance, categorise the occlusal appearance using the AC scale, by both the children and researcher; and to compare the children's' perception and the AC of the IOTN. Satisfaction with appearance of teeth and occlusion as well as peer comparison was investigated. The treatment need and demand was assessed using the modified AC photographs of the IOTN. Altogether, 488 school children (249 girls and 239 boys) assessed their perception of the anterior teeth using a Verbal Descriptor Scale (VDS) and a Visual Analog Scale (VAS) questionnaire. The researcher examined the anterior teeth of the participants and categorised them using the AC of the IOTN. The following results were reported: about two-thirds of the respondents were satisfied with the appearance of their teeth, with the gender difference being statistically significant. About 35% were dissatisfied or very dissatisfied, but reasons for it varied. More than half of the respondents rated their teeth as better than those of their peers and three-quarters were satisfied with their occlusion, the two responses elicited no gender difference. Treatment need was assessed by use of the AC indicated that there was a moderate agreement between researcher and respondents’ in treatment need assessment. The researcher found 36.3% needed treatment against self-perceived need of 30.9%. One-third of the respondents determined by the researcher to 'need treatment', felt 'no need'. There was no statistical gender difference in perceived need for treatment. The selection of ranked photographs of the AC by both researcher and respondents demonstrated skewed distributions towards the 'low ranked' or attractive end of the ranking order irrespective of the state of occlusion. Statistical comparison of the two methods used, namely the VDS and VAS, indicated that the responses were significantly different. Therefore it is suggested that any treatment priority assessment should take perceptions of occlusal appearance. into consideration.

During the last three decades there has been an increased influx of refugees and immigrants into Scandinavia. The overall aim of this thesis was primarily to improve our knowledge of malocclusion and orthodontic treatment need, both normative and self-perceived, in adolescents of varying geographic origin. A further aim was to determine whether any differences with respect to perception of general appearance and psychosocial well-being were related to geographic origin. Papers I and II concerned self perceived and normative orthodontic treatment need. About 500 12-13 year-old subjects, stratified into different groups: A-Sweden, B-Eastern/Southeastern Europe, C-Asia and D-other countries, answered a questionnaire and underwent clinical examination by the author. In paper III the association between the two variables in papers I and II was investigated. Paper IV was a follow up study, at 18-19 years of age, of the relationship between geographic origin and prevalence of malocclusion, self-perceived treatment need, temporomandibular symptoms and psychosocial wellbeing. In Paper V a qualitative study of 19-20 year old subjects was conducted, to identify the strategies they had adopted to handle the issue of persisting poor dental aesthetics. The main findings were that at 12-13 years of age, immigrant subjects had a lower perceived orthodontic treatment need than subjects of Swedish background. Girls of Swedish background had the highest self perceived treatment need, whilst girls of non-Swedish background were most concerned that fixed appliance therapy would be painful. In a few of the clinical variables measured at 12-13 years of age, the Swedish group exhibited the greatest space deficiency and irregularity in both the maxillary and mandibular anterior segments and greater overjet, compared to the Eastern/Southeastern European and Asian groups. The clinical implications were negligible. The orthodontic treatment need according to “Index of Orthodontic Treatment Need - Dental HealthComponent” (IOTN-DHC) grades 4 and 5, ranged from 30 to 40 percent, without any inter-group differences. There were strong associations between subjects perceiving a need for orthodontic treatment and 6IOTN-DHC grades 4 and 5, anterior crossbite and avoiding smiling because they were self-conscious about their teeth. At the age of 18-19 years, the frequency of malocclusion was similar in all groups. Subjects of Asian origin had a higher self-perceived orthodontic treatment need than their Swedish counterparts and a higher frequency of headache than those of Eastern/Southeastern European origin. Psychological wellbeing was reduced in nearly one quarter of the sample, more frequently in girls than boys. No association was found between self-perceived orthodontic treatment need and psychological wellbeing. The theory “Being under the pressure of social norms” was generated in Paper V, and it can be applied to improve our understanding of young adults who have adjusted to living with poor dental aesthetics and also aid to identify those who are not as well-adjusted and would probably benefit from treatment. Undisclosed dental fear is an important barrier to acceptance of orthodontic treatment in early adolescence. Despite demographic changes due to immigration, no major change in the prevalence of malocclusion and normative orthodontic treatment need has been disclosed. This does not apply to adolescents and adults who immigrated at an older age.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A mà oclusÃo à considerada um problema de saÃde pÃblica pois, alÃm de ser bastante prevalente, à capaz de causar importantes prejuÃzos estÃticos e/ou funcionais. Entretanto, os adultos raramente sÃo incluÃdos em programas ou aÃÃes de saÃde pÃblica que estudam problemas de oclusÃo dentÃria, apesar de estarem suceptÃveis Ãs consequÃncias destes distÃrbios da mesma maneira, ou com maior intensidade, que os mais jovens. AlÃm disso, na maior parte das pesquisas que buscam estimar a prevalÃncia da mà oclusÃo e a necessidade de tratamento ortodÃntico, observa-se a exclusÃo de pessoas jà tratadas ortodonticamente, pois se supÃe que elas apresentariam necessidade significativamente menor do que as que nunca foram tratadas. Assim, esta dissertaÃÃo, composta por dois artigos, teve como objetivos: verificar a prevalÃncia e a severidade das mÃs oclusÃes, alÃm de determinar a necessidade de tratamento ortodÃntico, em um grupo de adultos jovens e, em um segundo momento, investigar se existia diferenÃa entre indivÃduos com e sem tratamento prÃvio. Para isso, foi avaliada uma amostra composta por 241 indivÃduos, com idade entre 17 e 33 anos, regularmente matriculados no Curso de Odontologia da Universidade Federal do CearÃ. Os estudantes foram divididos em dois grupos (com e sem tratamento ortodÃntico prÃvio) e examinados de acordo com o Dental Aesthetic Index (DAI). No artigo 1, estudou-se a prevalÃncia e a severidade das mÃs oclusÃes, e tambÃm a necessidade de tratamento ortodÃntico, dos indivÃduos nÃo tratados. No artigo 2, estas mesmas variÃveis foram comparadas entre os grupos tratado e nÃo tratado. Os resultados do artigo 1 demonstraram que o desalinhamento mandibular anterior e o apinhamento dental foram as mÃs oclusÃes mais prevalentes com 94,6% e 91,9%, respectivamente. A mÃdia do escore do DAI foi 25,94 (IC 95% 25,07; 26,81). Pouco mais da metade dos estudantes (51,4%) foram classificados como sem necessidade de tratamento ortodÃntico, enquanto 15,3% da amostra apresentou mÃs oclusÃes severas ou muito severas, o que implica em necessidade de tratamento ortodÃntico altamente desejÃvel ou obrigatÃria. No segundo artigo, observou-se que, diferentemente dos problemas decorrentes da falta de espaÃo, os quais se mostraram menos prevalentes em estudantes tratados previamente (p<0,001), a maioria das mÃs oclusÃes nÃo foi diferente entre os dois grupos (p>0,05). O DAI mÃdio do grupo tratado foi 24,77 (IC 95% 24,03; 25,51) e o do grupo nÃo tratado foi 25,94 (IC 95% 25,07; 26,81). Pode-se concluir que as mÃs oclusÃes relacionadas à falta de espaÃo foram mais prevalentes, embora sem muita severidade. A necessidade de tratamento ortodÃntico nÃo apresentou diferenÃa estatisticamente significante entre estudantes tratados e nÃo tratados (p>0,05), apesar de a severidade da mà oclusÃo dos tratados ter sido menor (p<0,05). / The malocclusion is considered a problem of public health because, beyond being enough prevalent, it is capable to cause important aesthetic and/or functional damages. However, the adults rarely are enclosed in programs or action of public health that to study problems of dental occlusion, although to be susceptible to the consequences of these disturbances in the same way, or with bigger intensity, that the younger. Moreover, in the most part of the research which search to esteem the prevalence malocclusion and the orthodontic treatment need, it is observed the exclusion of orthodontic treated already people, therefore it supposes that they would present significantly lesser need than the ones that had been never treated. Thus, this dissertation, comprised by two manuscripts, had as objectives: to verify the prevalence and the severity of the malocclusions, beyond determining the orthodontic treatment need, in a group of young adults and, in a second moment, to investigate if to exist difference between individuals with and without orthodontic treatment. For this, it was evaluated a sample composed for 241 individuals, with 17-to-33-years old, regularly registered in the College of Dentistry of the Federal University of the CearÃ. The students were divided in two groups (with and without previous orthodontic treatment) and examined according with the Dental Aesthetic Index (DAI). In article 1, it was studied the prevalence and the severity of the malocclusions, and also the orthodontic treatment need, of the individuals untreated. In article 2, these same variables were compared between the treat and untreated groups. The results of the manuscript 1 demonstrated that the anterior irregularity on the mandible and the crowding were the most prevalent malocclusions with 94,6% and 91,9%, respectively. The mean DAI score was 25,94 (CI 95% 25,07; 26,81). Little more than the half of the students (51,4%) were classified as without orthodontic treatment need, while 15,3% of the sample presented severe or very severe malocclusion, which implies a highly desirable or mandatory orthodontic treatment need. In the second article, it was observed that, differently of the problems deriving of lack of the space, which it showed lesser prevalent in previously students treated (p<0,001), the majority of the malocclusions was not different between the two groups (p>0,05). The mean DAI of the treated group was 24,77 (IC 95% 24,03; 25,51) and the untreated group was 25,94 (IC 95% 25,07; 26,81). It can be concluded that the malocclusions related with the lack of the space were the most prevalent, although without very severity. The orthodontic treatment need presented no difference statistically significant between treated and untreated students (p>0,05), in spite of the severity malocclusion of the ones treated had been lesser (p<0,05).

O Índice Dental Estético (DAI) tem sido amplamente usado em estudos envolvendo crianças e adolescentes, mas raramente usado em estudos com adultos. O propósito do presente estudo transversal foi avaliar a confiabilidade do DAI em uma amostra com 120 pacientes adultos, incluindo 46 do sexo masculino (38,3%) e 74 do sexo feminino (61,7%), entre 19 e 78 anos de idade (média de 49,2). Quase todos os pacientes apresentaram-se com muitas perdas dentárias e sem tratamento ortodôntico prévio. A prevalência e a severidade da má oclusão, a necessidade de tratamento ortodôntico, a autopercepção do paciente em relação à necessidade deste tipo de tratamento e a indicação, pelo cirurgião-dentista, foram avaliadas. Além disso, as opiniões subjetivas de 33 ortodontistas em 32 pacientes, por meio de fotografias intra e extrabucais e modelos de estudo foram também analisadas. Teste estatístico Kappa foi usado para avaliar o DAI e as opiniões dos profissionais. Testes qui-quadrado e de Fischer foram usados para verificar a correlação entre sexo, autopercepção e indicação do cirurgião-dentista e o escore do DAI. O teste t-student foi usado para investigar a correlação entre a idade e a necessidade de tratamento ortodôntico. A média do escore DAI foi de 38,5. Quase metade da amostra apresentou má oclusão severa ou muito severa, a qual sugeriu grande necessidade de tratamento ortodôntico. A confiabilidade intra e interexaminador do escore DAI e dos componentes foi muito alta (k>0,9). Inconsistências foram observadas na avaliação dos especialistas (k<0,4). Não houve diferenças estatisticamente significantes (P>0.05) nos escores do DAI entre sexo, idade, autopercepção da necessidade de tratamento, entretanto diferenças significantes foram encontradas em relação às indicações pelo cirurgião-dentista. Os resultados do presente estudo sugerem que a população de adultos com perdas dentárias tem elevada severidade da má oclusão e alta necessidade de tratamento ortodôntico. / Dental Aesthetic Index (DAI) has been broadly used in studies comprising children and adolescent patients but rarely used in adult studies. The aim of the present cross-sectional study was to evaluate the reliability of the DAI index in a sample of 120 adult patients, including 46 male (38.3%) and 74 female (61.7%), aged 19-78 years (mean 49.2). Several patients presented extensive dental missing and no orthodontic treatment. Prevalence, severity of malocclusion, orthodontic treatment need, self-perceived and dentist referral, were assessed. Further, subjective opinions of 33 orthodontists about 32 patients, based upon intra- and extra-oral photographs and study models were evaluated. Kappa statistics was used to assess the DAI and professional opinions. Chi-square test and Fischer test were used to test the correlation between DAI score and sex, self-perceived and dentist referral. Student ttest was used to test the correlation between age and orthodontic treatment need. The mean DAI score was 38.5. Almost half of the sample presented severe or very severe malocclusion, which suggests a substantial treatment need. Intra-rater and inter-rater reliability for DAI score and components was very high (k>0.9). Inconsistencies were observed in the professional evaluation (k<0.4). There were no statistically significant differences (P>0.05) in DAI scores between sex, age, selfperceived need, but significant differences were found between dentist referrals. The findings in the present study suggest that adult dental missing population have high severe malocclusion and high orthodontic treatment need for treatment.

Darbo tikslas - ištirti ortodontinių anomalijų paplitimą, gydymo reikalingumą bei gydymo poreikį tarp Lietuvos moksleivių. Tikslui pasiekti iškelti šie uždaviniai: 1) nustatyti ortodontinių anomalijų paplitimą tarp 10–11 m. ir 14–15 m. amžiaus Lietuvos moksleivių; 2) įvertinti ir palyginti ortodontinių anomalijų gydymo reikalingumą tarp 10–11 m. ir 14–15 m. Lietuvos moksleivių; 3) ištirti Lietuvos moksleivių požiūrį į ortodontinių anomalijų gydymo poreikį; 4) nustatyti moksleivių ortodontinių anomalijų gydymo poreikio sąsajas su demografiniais ir socialiniais veiksniais. Tyrimas atliktas dešimtyje Lietuvos apskričių, 41 atsitiktinai pasirinktoje mokykloje. Tyrimo metu nustatytas dantų susigrūdimas, tarpai tarp dantų, gilus ir kryžminis sąkandis, pirmųjų krūminių dantų tarpusavio santykis pagal Angle klasifikaciją, gydymo reikalingumui nustatyti naudotas ICON indeksas, o gydymo poreikiui bei sąsajoms su socialinias veiksniais - klausimynas. Ortodontinės anomalijos nustatytos 77 proc. 10–11 m. amžiaus ir 61,7 proc. 14–15 m. amžiaus tirtųjų moksleivių. Ortodontinis gydymas reikalingas beveik pusei jaunesniojo amžiaus ir kas trečiam vyresniojo amžiaus moksleiviui, o ortodontinio gydymo poreikis buvo panašus abiejose amžiaus grupėse. / The aim of this study was to assess the malocclusion prevalence, orthodontic treatment need and demand among Lithuanian schoolchildren. The objectives of the study: 1) to describe the malocclusion prevalence among Lithuanian schoolchildren in 10–11 and 14–15-year old age groups; 2) to evaluate the need for orthodontic treatment among 10–11, 14–15 year-old schoolchildren in Lithuania using the ICON index; 3) to investigate the association between normative (objective) and self-perceived (subjective) orthodontic treatment need; 4) to assess the associations of age, gender, and socioeconomic factors with dental appearance satisfaction and demand for orthodontic treatment. The survey was conducted in 41 randomly selected schools in 10 counties of Lithuania. The study recorded crowding, spacing, overbite, crossbite, relationship of the first upper and lower molars according to Angle’s classification, the orthodontic treatment need was assessed using the ICON index and the children were also invited to complete a questionnaire about treatment need and their appearance. The results showed that 77% of 10–11-year-old and 61.7% of 14–15-year-old schoolchildren had malocclusion. The treatment need among younger schoolchildren was higher than in older group. The subjective demand for orthodontic treatment among 10–11-year-old schoolchildren and 14–15-year-old schoolchildren was similar.

O Índice Dental Estético (DAI) tem sido amplamente usado em estudos envolvendo crianças e adolescentes, mas raramente usado em estudos com adultos. O propósito do presente estudo transversal foi avaliar a confiabilidade do DAI em uma amostra com 120 pacientes adultos, incluindo 46 do sexo masculino (38,3%) e 74 do sexo feminino (61,7%), entre 19 e 78 anos de idade (média de 49,2). Quase todos os pacientes apresentaram-se com muitas perdas dentárias e sem tratamento ortodôntico prévio. A prevalência e a severidade da má oclusão, a necessidade de tratamento ortodôntico, a autopercepção do paciente em relação à necessidade deste tipo de tratamento e a indicação, pelo cirurgião-dentista, foram avaliadas. Além disso, as opiniões subjetivas de 33 ortodontistas em 32 pacientes, por meio de fotografias intra e extrabucais e modelos de estudo foram também analisadas. Teste estatístico Kappa foi usado para avaliar o DAI e as opiniões dos profissionais. Testes qui-quadrado e de Fischer foram usados para verificar a correlação entre sexo, autopercepção e indicação do cirurgião-dentista e o escore do DAI. O teste t-student foi usado para investigar a correlação entre a idade e a necessidade de tratamento ortodôntico. A média do escore DAI foi de 38,5. Quase metade da amostra apresentou má oclusão severa ou muito severa, a qual sugeriu grande necessidade de tratamento ortodôntico. A confiabilidade intra e interexaminador do escore DAI e dos componentes foi muito alta (k>0,9). Inconsistências foram observadas na avaliação dos especialistas (k<0,4). Não houve diferenças estatisticamente significantes (P>0.05) nos escores do DAI entre sexo, idade, autopercepção da necessidade de tratamento, entretanto diferenças significantes foram encontradas em relação às indicações pelo cirurgião-dentista. Os resultados do presente estudo sugerem que a população de adultos com perdas dentárias tem elevada severidade da má oclusão e alta necessidade de tratamento ortodôntico. / Dental Aesthetic Index (DAI) has been broadly used in studies comprising children and adolescent patients but rarely used in adult studies. The aim of the present cross-sectional study was to evaluate the reliability of the DAI index in a sample of 120 adult patients, including 46 male (38.3%) and 74 female (61.7%), aged 19-78 years (mean 49.2). Several patients presented extensive dental missing and no orthodontic treatment. Prevalence, severity of malocclusion, orthodontic treatment need, self-perceived and dentist referral, were assessed. Further, subjective opinions of 33 orthodontists about 32 patients, based upon intra- and extra-oral photographs and study models were evaluated. Kappa statistics was used to assess the DAI and professional opinions. Chi-square test and Fischer test were used to test the correlation between DAI score and sex, self-perceived and dentist referral. Student ttest was used to test the correlation between age and orthodontic treatment need. The mean DAI score was 38.5. Almost half of the sample presented severe or very severe malocclusion, which suggests a substantial treatment need. Intra-rater and inter-rater reliability for DAI score and components was very high (k>0.9). Inconsistencies were observed in the professional evaluation (k<0.4). There were no statistically significant differences (P>0.05) in DAI scores between sex, age, selfperceived need, but significant differences were found between dentist referrals. The findings in the present study suggest that adult dental missing population have high severe malocclusion and high orthodontic treatment need for treatment.