Public assistance orthodontic treatment needs: a report from the state of Indiana.
OBJECTIVE
To determine how many of the orthodontic cases covered by Indiana Medicaid between 1999-2001 would be classified pretreatment as having a malocclusion severe enough to warrant treatment.


METHODS
Six examiners were trained and then paired together to examine 249 patient orthodontic case records, consisting either of pre-treatment photographs only, pre-treatment models only, or both pre-treatment models and photos. The examiners applied the Index of Orthodontic Treatment Needs (IOTN) to assign each case a Grade of One to Five, with Grade One representing Ideal Occlusion and Grade Five being Extreme Malocclusion. When two examiners within a pair could not agree, a third examiner reviewed the case record to determine agreement.


RESULTS
Of the 249 patient cases examined, 9 were not gradable. In the cases where only pretreatment models were available (n=157), 10% received a Grade of One or Two (Ideal Occlusion or Mild Malocclusion, respectively). Among the cases in which both pretreatment models and photos were available (n=46), 44% of the photos were graded One or Two, while only 2% of the models were graded as One or Two. In the cases where only pretreatment photographs were available (n=37), 27% of cases were Grade One or Two.


CONCLUSIONS
While several of the cases (11%) submitted during the time period of 1999 to 2001 to the Indiana State Medicaid Division for reimbursement were rated as having Ideal Occlusions or Mild Malocclusions, the vast majority (89 %) were scored as having either Moderate, Severe, or Extreme Malocclusion.
Dean
Jeffrey A
JA
Department of Oral Facial Development, Riley Hospital for Children, Suite 4205, 702 Barnhill Dr, Indianapolis, IN 46202-5200, USA. jadean1@iupui.edu
McDonald
Shelley M
SM
Walker
Paul O
PO
D003753:Dental Health Surveys; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007196:Indiana / Q000453:epidemiology; D008310:Malocclusion / Q000175:diagnosis / Q000191:economics* / Q000453:epidemiology; D008484:Medicaid / Q000706:statistics & numerical data*; D003765:Models, Dental; D009971:Orthodontics, Corrective / Q000191:economics* / Q000706:statistics & numerical data; D023861:Photography, Dental; D012189:Retrospective Studies