Gender Differences in Malocclusion Awareness Among Adolescents in Zawia, Libya: A Cross-Sectional Questionnaire-Based Study

Abstract

Malocclusion is highly prevalent among adolescents and significantly impacts oral function, aesthetics, and psychosocial well-being. Late adolescence (15-17 years) represents a critical period for self-image development and orthodontic treatment-seeking. However, data on knowledge and awareness of malocclusion in Western Libya remain scarce. This study was conducted to assess and compare knowledge and awareness of malocclusion, its etiology, problems, complications, prevention, and benefits of treatment between male and female late adolescents in Zawia City, Libya. A cross-sectional questionnaire-based study was conducted among 610 school students (310 males, 50.8% and 300 females, 49.2%) aged 15-17 years in Zawia City during 2026. A validated self-administered questionnaire comprising seven axes (forms, causes, problems, complications, prevention, benefits, and personal experience) was used. Data were analyzed using the chi-square test and Cramer's V coefficient to measure association strength. Ethical approval was obtained and informed consent was secured. Females demonstrated significantly higher knowledge of spaces between teeth (p=0.038, V=0.104), protruding jaws (p<0.001, V=0.159), and protruding teeth (p=0.002, V=0.141). Regarding etiology, females showed superior awareness of genetic causes (p=0.010, V=0.122) and bad oral habits (p=0.017, V=0.116), while males were more aware of tooth decay (p=0.015, V=0.117). Highly significant gender differences favoring females were observed for aesthetic problems (p<0.001, V=0.208), functional problems (p=0.001, V=0.158), premature tooth loss (p=0.010, V=0.122), jaw problems (p<0.001, V=0.179), avoidance of bad habits (p=0.005, V=0.131), use of space maintainers (p<0.001, V=0.225), improving smile aesthetics (p=0.007, V=0.127), and improving speech (p<0.001, V=0.176). Females also reported higher concern about alignment (p<0.001, V=0.216) and previous professional diagnosis (p=0.002, V=0.142). No significant gender differences were found for history of previous orthodontic treatment (p=0.440). Female late adolescents in Zawia exhibited significantly higher knowledge and awareness across most domains, particularly aesthetic and preventive aspects, reflecting greater aesthetic self-monitoring. School-based gender-targeted oral health education programs are recommended to improve awareness, especially among males.