How do the IOTN scores compare with what parents and
dentists think relative to orthodontic treatment need?Te vast majority
of individuals who had orthodontic treatment feel that they benefted
from the treatment and are pleased with the result.Today, medical and dental interventions that are intended to make the individual either "better than
well" or "beyond normal" are called enhancements. Typical medical
and surgical enhancements are drugs to treat erectile dysfunction,
face lifts, and hair transplants. In dentistry, a good example of
enhancement is tooth bleaching. In this context, orthodontics often can be considered an enhancement technology. It is increasingly accepted that appropriate care
for individuals often should include enhancement to maximize
their quality of life. If you really want it because you are convinced
you need it, perhaps you really do need it--whether it is orthodontics or many other types of treatment. Medicaid and Medicare
and many insurance companies now have accepted the reality that
at least some enhancement procedures have to be accepted as
reimbursable medical expenses. Similarly, when orthodontic benefts
are included in insurance coverage, the need for treatment is no
longer judged just by the severity of the malocclusion. Te bottom
line: Enhancement is appropriate dental and orthodontic treatment,
just as it is in other contexts. A key question, of course, is "Does orthodontic treatment really
increase quality of life and self-esteem?"Dentists usually judge that only about one-third of their patients
have normal occlusion, and they suggest treatment for about 55%
(thereby putting about 10% in a category of malocclusion with
little need for treatment). It appears that they include all the children
in IOTN grade 3 and some of those in grade 2 in the group who
would beneft from orthodontics. Presumably, facial appearance
and psychosocial considerations are used in addition to dental
characteristics when parents judge treatment need or dentists decide
to recommend treatment. *******************************************
Who Seeks Treatment? Demand for treatment is indicated by the number of patients who
actually make appointments and seek care. Not all patients with
malocclusion, even those with extreme deviations from the norm,
seek orthodontic treatment. Some do not recognize that they have
a problem; others feel that they need treatment but cannot aford
it or cannot obtain it.
Both the perceived need and demand vary with social and
cultural conditions. More children in urban areas are thought (by
parents and peers) to need treatment than children in rural areas.Another
way to put this issue is "Does having a less than ideal smile afect
the way people act and live?" Tis question was examined by the
American Dental Association's Health Policy Institute in 2015.31
An online survey was conducted by the Harris Poll, and nearly
15,000 responses from a randomly selected group of individuals
age 18 and older were analyzed. Te study group was evaluated
as a whole, by economic status (low, middle, and high household
income), and by age (18 to 34, 35 to 49, 50 to 64, and 65 or
older). Tis national data set tells an interesting story related to
dental esthetics. Twenty-nine percent of low-income adults and
28% of young adults (18 to 34) believed the appearance of their
mouth and teeth afected their ability to interview for a job. Tat
is over one-fourth of these groups. Twenty-fve percent of all adults
said they avoid smiling, 23% feel embarrassed, and 20% experience
anxiety because of the condition of their mouth and teeth. But
low-income and young adults felt the greatest impact, with a
minimum of 30% in each of these two groups indicating that they
experienced a problem related to the appearance of their teeth
very often or occasionally. Finally, 82% of all responders agreed
with the statement "It is easier to get ahead in life if I have straight,
bright teeth."For instance,
a Brazilian study showed that adults with ideal smiles are considered
to be more intelligent and have a greater chance of fnding a job,37
and a systematic review documented patient satisfaction after
orthodontic treatment combined with orthognathic surgery.38 Te
data can be summarized succinctly: If your dental and facial
appearance difers signifcantly from that of your group, you beneft
socially from correcting this.A number of studies have
documented improvement in quality-of-life scores and self-esteem
in children and adolescents,33 and reports have shown quality-of-life
efects after orthodontic treatment in children of African, European,
and Asian descent.34-36 Multiple studies have shown that this is
true for adults as well, and the range of improvements in quality
of life extend further than one might have thought.In
Switzerland, where high average incomes and supplemental social
programs mean that essentially all citizens who want treatment
can get it, 56% of the 2012 population aged 15 to 24 years were
receiving or had received orthodontic treatment.32 Acceptance of
treatment is at similar levels in the Scandinavian countries for the
same reasons.Nevertheless, Medicaid and related programs
support only a tiny fraction of the population's orthodontic care. 1.22). 1.23).