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Patients with low socio-economic status: is orthodontic treatment more complex?
Nathan Wybier1,2, Alexandre Hutin1,2, Fabien Subtil3,4
1Département d’orthodontie, Faculté d’Odontologie, rue Guillaume Paradin, 69372 Lyon cedex 08, France
Introduction:
Patients from low socioeconomic backgrounds are empirically considered more difficult to treat. The objectives were to evaluate low socioeconomic status of patients as a factor associated with increased treatment need and the correlation between socioeconomic status and dysmorphosis on one hand, and cooperation level on the other.
Material And Methods:
This was a retrospective comparative monocentric observational cohort study. Included subjects were under 16 years old at the time of orthodontic braces placement and were beneficiaries of the complémentaire santé solidaire (C2S) or not (non-C2S). Evaluated criteria included treatment need (IOTN-DHC), antero-posterior and vertical dysmorphosis (FMA, ANB, IMPA, I/F), and compliance. Fisher and Wilcoxon tests were performed. A 5% threshold was retained.
Results:
Overall, 173 patients were included and divided into two groups: C2S/non-C2S. Neither treatment need nor skeletal and alveolar-dental dysmorphosis are correlated with socioeconomic status. Cooperation is correlated with low socioeconomic status across all evaluated criteria: three times more bracket debondings, three times more remarks about failure to wear elastics, 1.25 times more missed appointments, ten times more treatment abandonments.
Conclusion:
It may not be dysmorphosis that makes orthodontic treatment of low socioeconomic status patients more difficult, but rather a lack of cooperation. This calls for clinical and policy interventions to increase patient involvement in treatment. Randomized trials are needed to corroborate the results.
