Consensus on orthodontic treatment eligibility in Finnish health care system - A comparative analysis of assessment

In many European countries, orthodontic treatment is offered in publicly funded healthcare to those with severe malocclusion. In the Finnish public health care, the modified Grainger's treatment priority index (TPI) is used to determine malocclusion severity and treatment eligibility. The uniform use of occlusal indexes is crucial for equitable treatment allocation.

This study aimed to investigate equity in access to orthodontic care in one wellbeing services county in Finland.

We conducted five calibration events, where five orthodontists were calibrated against one gold standard orthodontist with the longest clinical experience. All the orthodontists independently clinically examined random groups of patients using the Finnish modified TPI scoring. The malocclusion severity scores, diagnosis codes, and the determined treatment eligibility were subsequently compared. Agreement between the orthodontists was analyzed with Cohen's Kappa and Bland-Altman statistics.

In total, 166 patients, aged 6-63 years, were examined across the calibrations, each representing a comparison between one of the five orthodontists and the gold standard. The agreement between the orthodontists was found to be substantial. The same judgement on treatment eligibility was made in 145 out of 166 cases (87%), whereas a different decision on treatment eligibility was made in 21 cases (13%).

Despite the high level of interobserver agreement, differences in eligibility judgement were observed, which may have important consequences for the patient with respect to treatment provision. Therefore, systematic calibration and regular training in the use of national occlusal indexes should be implemented for all orthodontists.