title: A critical view of treatment priority indices in orthodontics.
abstract: Indices for orthodontic treatment prioritization are usually based on morphological and sometimes functional deviations from a concept of an ideal occlusion. However, such morphological variation from a constructed norm only reflects normal biological variation and should never serve as a basis for treatment decisions. Evaluation of treatment need must instead be based on consequences of malocclusion for the subject. Existing indices for orthodontic treatment need focus either more generally on malocclusion or specifically on aesthetics. Aesthetic indices are usually based on some kind of public concensus. In this study, two groups of patients each containing four subjects were selected. Four represented subjects estimated to have malocclusions of average severity (level A), close to a level where selections are usually made. The other four subjects (level B) represented more severe malocclusions reflecting cut-off levels in a system with a more limited budget. The different indices used turned out to offer very little help in the selection of patients and did not reflect the stated ranking of treatment need by seven groups of orthodontists and postgraduate students, all in all 40 persons. Apart from being based on very questionable treatment--motivating factors, these indices cannot serve the basic purpose of creating relevant cut-off points for treatment need.
authors.affiliation: Department of Orthodontics, Faculty of Odontology, Göteborg University, Sweden. mohlin@odontologi.se
authors.forename: Bengt
authors.initials: B
authors.lastname: Mohlin
authors.forename: Juri
authors.initials: J
authors.lastname: Kurol
mesh_terms: D000293:Adolescent; D002648:Child; D003753:Dental Health Surveys; D004955:Esthetics, Dental; D005260:Female; D006292:Health Priorities; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D008310:Malocclusion / Q000191:economics / Q000473:pathology / Q000628:therapy; D020380:Needs Assessment; D015588:Observer Variation; D009971:Orthodontics, Corrective / Q000191:economics / Q000706:statistics & numerical data*; D018579:Patient Selection; D012720:Severity of Illness Index