<b>Prevalence of Malocclusion and its Social Impact Among Underprivileged Children Living in Lahore, Pakistan</b>

Background: Malocclusion is a common pediatric oral health condition that may coexist with poor oral hygiene, unmet orthodontic treatment need, and appearance-related psychosocial concerns, particularly among children from low-resource settings. Objective: To estimate the prevalence and pattern of malocclusion, determine orthodontic treatment need, and examine the association between malocclusion severity and self-reported psychosocial distress among underprivileged schoolchildren in Lahore, Pakistan. Methods: This retrospective cross-sectional analysis included routinely collected school dental screening data from 574 children aged 7–15 years at an underprivileged school in Lahore. Malocclusion was classified using Angle’s classification, and orthodontic treatment need was assessed using the Index of Orthodontic Treatment Need. Secondary oral health indicators included DMFT/DEFT, Gingival Index, and OHI-S scores. Psychosocial concerns were assessed using a simplified locally adapted child-friendly questionnaire. Descriptive statistics, chi-square tests, ANOVA, and correlation analysis were performed. Results: Malocclusion was present in 394 children (68.6%), with Class I malocclusion being most frequent (47.2%), followed by Class II (16.4%) and Class III (5.1%). Definite orthodontic treatment need was observed in 32.4%, while 59.2% had borderline or definite need. Mean DMFT/DEFT, Gingival Index, and OHI-S scores differed significantly across occlusion categories. Embarrassment about dental appearance was reported by 40.4% of children, and IOTN severity correlated moderately with psychosocial distress (r = 0.462, p < 0.001). Conclusion: Malocclusion and orthodontic treatment need were common in this underprivileged school population and were associated with self-reported psychosocial concerns. School-based screening, oral hygiene education, and early referral pathways may help identify children requiring further dental and orthodontic assessment