Orthodontic care in Sweden : outcome in three counties

Abstract

The main aim of these studies was to evaluate the outcome of orthodontic care in Sweden from the professional's and the patient's perspective. A new model for priority-planning and for evaluating the different factors influencing the decision of orthodontic treatment was devised. Treatment desire, followed by treatment need and treatment benefit were the most important factors to consider when deciding whether or not treatment should be carried out. The model was applied to estimations of 942 19-year-old individuals with and without previous orthodontic treatment from three Swedish counties.

Thirty-seven percent of the individuals in the entire sample had been treated. General practitioners had treated 21% and specialists 16% of the individuals. Regardless of differences in the available resources and the structure of the free public orthodontic care, a substantial proportion of the untreated individuals had malocclusions with treatment need, but they had no treatment desire. The standard of the treatments in the counties showed a good correlation with the available resources in terms of orthodontic specialists and the possibilities there of supervising non-specialist care and of treating patients in need of specialist treatment.

Questionnaires were sent to 27-year-olds, both to those who had had and to those who had not had previous orthodontic treatment, and their perceptions of their own dental arrangement and any orthodontic care they may have received as a child or an adolescent were analysed. Most of the respondents were satisfied with their earlier decision, whether to choose orthodontic treatment or not. Dental professionals were considered to have had the greatest influence on this decision, which means that the desire for treatment may be guided by the orthodontist. Individuals with malocclusions and treatment need, but who had refused offered treatment, were in general more discontented with their dental arrangement; more than half of them now regretted their decision. Individuals treated by specialists were more contented than individuals treated by general practitioners.

The influence of perceived treatment difficulty on the outcome of and investment in orthodontic treatments was also studied. About one-fourth of the treatments evaluated were classified as easy, one-fourth as moderately difficult, and one-half as difficult. The perceived treatment difficulty was associated on a group basis with the pretreatment need. The treatment outcome became less favourable and the treatment investment more expensive the greater the perceived difficulty. The outcome measures were in general more favourable for specialist treatments than for treatments provided by general practitioners, despite the specialist treatments on the average being classified as more difficult than those provided by general practitioners. Easy treatments were found to be extremely cost-effective.

It was concluded that general practitioners should preferably treat uncomplicated cases, and an increased use of fixed appliances would be desirable in the treatment of moderately difficult cases. Difficult cases should be treated exclusively by specialists. Cases with little need or benefit of treatment or a poor prognosis should be given low treatment priority. Patients and parents should in these cases be informed about the small benefit expected and the risks involved with the treatment. Finally, more information needs to be given to individuals with malocclusions and treatment need and who refuse offered treatment.