A useful insight into 2 occlusal indexes: HLD(Md) and HLD(CalMod)

Maryland and California are among the states that have adopted the Handicapping Labiolingual Deviation (HLD) Index to determine eligibility for public funding of orthodontic treatment. As a result of several lawsuits against the state, California has developed and employed a modification of that index, called the HLD(CalMod) index. This study compared and contrasted the effects of analyzing prospective patients with the HLD(Md)-the HLD index as used in Maryland-and the HLD(CalMod) indexes. The specific aims of this study were to observe (1) the correlation between the 2 occlusal indexes in determining patients' eligibility for treatment with public funding, (2) the characteristics of patients eligible according to each index, and (3) the major contributing factors in assigning patients as eligible under each index. Initial study models of 313 patients from the orthodontic clinic at the University of Maryland were scored by both HLD(Md) and HLD(CalMod) indexes. According to the scores, the patients were divided into 2 groups-those with handicapping malocclusions and those without handicapping malocclusions. Scores from each index were analyzed by the Pearson product moment correlation. The Angle classification for each patient was also recorded with the HLD variables. The mean and the percentage of the total score for each variable were calculated. The following conclusions were obtained: (1) Of the 313 patients, 127 (41%) were approved for treatment by the HLD(Md) index, and 110 (35%) were approved for treatment by the HLD (CalMod) index.(2) The correlation between the 2 indexes (R = 0.78) was not very strong, indicating the power of the additional variables introduced in the HLD(CalMod) index. (3) The use of the HLD(CalMod) index directs more public funding toward patients with severe Class II malocclusions than does the HLD(Md) index.