Orthodontic treatment of patients with special needs in Switzerland

Individuals with special healthcare needs have increased orthodontic treatment need, but access to care may be insufficient. The aim of this study was to assess the uptake of patients with special needs in orthodontic settings throughout Switzerland. A web-based survey was sent to all specialist orthodontist members of the Swiss Orthodontic Society. From 220 questionnaires sent, 60% were returned (n=131). 84% of participants responded that they treat patients with special needs, but most orthodontists saw only two new patients per year with special needs. Patients most frequently treated were those with Down syndrome, autism spectrum disorder, or intellectual deficiency. Many practitioners use fixed, removable or functional appliances for treatment of these patients, while aligner use was much less prevalent. Interceptive measures were also used. Chairside time was increased on average by 50%, and treatment duration increased by 25% when compared to other patients. Treatment goals for about half of these patients was compromised. Of orthodontists not providing treatment to individuals with special needs, 79% stated they would not be interested in treating these patients, while 56% of orthodontists already providing treatment stated they would not be interested in treating more of these patients. Reasons given included the lack of additional strategies to treat these patients, lack of referrals, problems with cooperation, and time constraints. In conclusion, roughly four in five orthodontists in Switzerland treat patients with special needs, with most of these orthodontists seeing one or two new patients with special needs annually. The majority of practitioners do not wish to increase their intake of patients with special needs.