{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T21:07:40Z","timestamp":1791839260673,"version":"4.3.4"},"reference-count":30,"publisher":"MDPI AG","issue":"13","license":[{"start":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T00:00:00Z","timestamp":1751846400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: The Index of Orthodontic Treatment Need (IOTN) is widely used to assess the need for orthodontic treatment. IOTN consists of the Dental Health Component (DHC) and the Aesthetic Component (AC), evaluating malocclusion morphologically and aesthetically, respectively. However, the discriminatory power of individual DHC items and their relationship with AC grades remain unclear. Objective: This study aimed to evaluate the effectiveness of individual DHC items in school dental examinations and investigate their contribution to AC grades among junior high and high school students. Methods: A total of 726 students (443 males, 283 females; aged 12\u201318 years) from Tsurumi University Junior and Senior High School, excluding 168 students undergoing or having completed orthodontic treatment, were included. Nine calibrated orthodontists assessed DHC and AC using IOTN during standardized school examinations. The discriminatory power and information precision of DHC items were evaluated by Item Response Theory (IRT) analysis using three-, two-, or one-parameter logistic models depending on convergence. Correspondence analysis visualized the correlation between DHC and AC grades. Simple linear regression analyzed the contribution of each DHC item to AC grades. Results: Orthodontic treatment need was identified in 21.1% of students. Females showed a higher rate of treatment need than males. Correspondence analysis suggested that aesthetic evaluations were more lenient than morphological evaluations. IRT and regression analysis revealed that crowding (4.d), increased overjet (2.a), and increased overbite (2.f) demonstrated high discriminatory power and significant contributions to AC grades. Conclusions: Among the DHC items, crowding, increased overjet, and increased overbite had higher discriminatory power for malocclusion and contributed more significantly to AC evaluations compared to other items.<\/jats:p>","DOI":"10.3390\/jcm14134802","type":"journal-article","created":{"date-parts":[[2025,7,7]],"date-time":"2025-07-07T10:03:27Z","timestamp":1751882607000},"page":"4802","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Correlation Between Dental Health and Aesthetic Components of Malocclusion in Junior High and High School Students: An Epidemiological Study Using Item Response Theory"],"prefix":"10.3390","volume":"14","author":[{"given":"Hiromi","family":"Sato","sequence":"first","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yudai","family":"Shimpo","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toshiko","family":"Sekiya","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruna","family":"Rikitake","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minami","family":"Seki","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Satoshi","family":"Wada","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Kanazawa Medical University, Kanazawa 920-0293, Ishikawa, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0814-0572","authenticated-orcid":false,"given":"Yoshiaki","family":"Nomura","sequence":"additional","affiliation":[{"name":"Institute of Photochemistry and Photocatalyst, University of Shanghai for Science and Technology, Shanghai 20093, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroshi","family":"Tomonari","sequence":"additional","affiliation":[{"name":"Department of Orthodontics, School of Dental Medicine, Tsurumi University, Yokohama 230-8501, Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1093\/oxfordjournals.ejo.a035999","article-title":"The development of an index of orthodontic treatment priority","volume":"11","author":"Brook","year":"1989","journal-title":"Eur. J. Orthod."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"395","DOI":"10.1093\/ejo\/16.5.395","article-title":"The need for orthodontic treatment in the child population of the United Kingdom","volume":"16","author":"Burden","year":"1994","journal-title":"Eur. J. Orthod."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1620\/tjem.212.71","article-title":"Difference in quality of life according to the severity of malocclusion in Japanese orthodontic patients","volume":"212","author":"Tajima","year":"2007","journal-title":"Tohoku J. Exp. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1179\/146531207225022185","article-title":"Evaluation of a quality of life measure for children with malocclusion","volume":"34","author":"Benson","year":"2007","journal-title":"J. Orthod."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1111\/eos.12034","article-title":"Clinical status in adolescents: Is its impact on oral health-related quality of life influenced by psychological characteristics?","volume":"121","author":"Thomson","year":"2013","journal-title":"Eur. J. Oral Sci."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1002\/j.0022-0337.2008.72.8.tb04567.x","article-title":"Effects of malocclusions and orthodontics on periodontal health: Evidence from a systematic review","volume":"72","author":"Bollen","year":"2008","journal-title":"J. Dent. Educ."},{"key":"ref_7","first-page":"321","article-title":"Comparison of microbial composition in the subgingival plaque of adult crowded versus non-crowded dental regions","volume":"15","author":"Chung","year":"2000","journal-title":"Int. J. Adult Orthodon Orthognath. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1902\/jop.1981.52.1.35","article-title":"The relationships between malocclusion, gingival inflammation, plaque and calculus","volume":"52","author":"Buckley","year":"1981","journal-title":"J. Periodontol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"175","DOI":"10.1179\/bjo.21.2.175","article-title":"Use of the Index of Orthodontic Treatment Need (IOTN) in assessing the need for orthodontic treatment pre- and post-appliance therapy","volume":"21","author":"Richmond","year":"1994","journal-title":"Br. J. Orthod."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"125","DOI":"10.1093\/ejo\/14.2.125","article-title":"The development of the PAR Index (Peer Assessment Rating): Reliability and validity","volume":"14","author":"Richmond","year":"1992","journal-title":"Eur. J. Orthod."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"410","DOI":"10.1016\/S0889-5406(96)70044-6","article-title":"Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment Need and the Dental Aesthetic Index","volume":"110","author":"Jenny","year":"1996","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ortho\/27.2.149","article-title":"The development of the index of complexity, outcome and need (ICON)","volume":"27","author":"Daniels","year":"2000","journal-title":"J. Orthod."},{"key":"ref_13","unstructured":"Grainger, R.M. (1967). Orthodontic treatment priority index. Public Health Service Publication No. 1000, Series 2, No.25, Government Printing Office."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1016\/0002-9416(61)90112-9","article-title":"The relationship between occlusion and periodontal status","volume":"47","author":"Poulton","year":"1961","journal-title":"Am. J. Orthod."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.ajodo.2013.04.018","article-title":"Validation of the American Board of Orthodontics Objective Grading System for assessing the treatment outcomes of Chinese patients","volume":"144","author":"Song","year":"2013","journal-title":"Am. J. Orthod. Dentofac. Orthop."},{"key":"ref_16","first-page":"176","article-title":"Self-evaluation of aesthetic dentition using aesthetic component","volume":"51","author":"Fujimura","year":"2001","journal-title":"J. Dent. Health"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1111\/j.1752-7325.1991.tb02221.x","article-title":"Differences in need for orthodontic treatment between Native Americans and the general population based on DAI scores","volume":"51","author":"Jenny","year":"1991","journal-title":"J. Public Health Dent."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Chrapla, P., Paradowska-Stolarz, A., and Skoskiewicz-Malinowska, K. (2022). Subjective and Objective Evaluation of the Symmetry of Maxillary Incisors among Residents of Southwest Poland. Symmetry, 14.","DOI":"10.3390\/sym14061257"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3277","DOI":"10.3390\/ijerph8083277","article-title":"The Dental Aesthetic Index and Dental Health Component of the Index of Orthodontic Treatment Need as tools in epidemiological studies","volume":"8","author":"Chrystiane","year":"2011","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1093\/ejo\/cjl045","article-title":"Orthodontic treatment need in French schoolchildren: An epidemiological study using the Index of Orthodontic Treatment Need","volume":"28","author":"Soumes","year":"2006","journal-title":"Eur. J. Orthod."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1038\/sj.bdj.4808776","article-title":"The relationship between the index of orthodontic treatment need and the consensus opinion of a panel of 74 dentists","volume":"178","author":"Richmond","year":"1995","journal-title":"Br. Dent. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1093\/ejo\/cjp084","article-title":"Diagnostic agreement in the assessment of orthodontic treatment need using the Dental Aesthetic Index and the Index of Orthodontic Treatment Need","volume":"32","author":"Manzanera","year":"2010","journal-title":"Eur. J. Orthod."},{"key":"ref_23","unstructured":"Richmond, S. (1990). A Critical Evaluation of Orthodontic Treatment in the General Dental Service of England and Wales. [Ph.D. Thesis, University of Manchester]."},{"key":"ref_24","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, Wiley. [3rd ed.].","DOI":"10.1002\/9781118548387"},{"key":"ref_25","unstructured":"(2025, May 11). GraphPad Software. Interpreting Logistic ROC Curves. GraphPad Prism User Guide, Version 10. Available online: https:\/\/www.graphpad.com\/guides\/prism\/latest\/curve-fitting\/reg_logistic_roc_curves.htm."},{"key":"ref_26","first-page":"142","article-title":"Epidemiological investigation of malocclusion in Japan using the Index of Orthodontic Treatment Need (IOTN)","volume":"68","author":"Watanabe","year":"2009","journal-title":"Orthod. Waves-Jpn. Ed."},{"key":"ref_27","unstructured":"Proffit, W.R., Fields, H.W., Larson, B.E., and Sarver, D.M. (2019). The Orthodontic Problem. Contemporary Orthodontics, Elsevier. [6th ed.]."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1111\/cdoe.12111","article-title":"Association between malocclusion and headache among 12- to 15-year-old adolescents: A population-based study","volume":"42","author":"Komazaki","year":"2014","journal-title":"Community Dent. Oral Epidemiol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"287","DOI":"10.17219\/dmp\/151577","article-title":"Orthodontic treatment need, the types of brackets and the oral health-related quality of life","volume":"60","author":"Parra","year":"2023","journal-title":"Dent. Med. Probl."},{"key":"ref_30","unstructured":"Tom\u00e1\u0161ik, J., Mihailidis, A., Z\u00faborov\u00e1, V., and Marci\u00e1nov\u00e1, M. (2024). Artificial Intelligence in Orthodontics: Where Are We Now?. Appl. Sci., 14."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4802\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:06:00Z","timestamp":1760033160000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/13\/4802"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,7]]},"references-count":30,"journal-issue":{"issue":"13","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14134802"],"URL":"https:\/\/doi.org\/10.3390\/jcm14134802","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,7]]}}}