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Pathways to orthodontic care

S Kisely1, K Howell, J Green

  • 1Department of Public Health and Health Promotion, Medical School, University of Manchester.

Journal of Public Health Medicine
|June 1, 1997
PubMed
Summary
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Orthodontic care access is inequitable, with referrals not based on objective need. Resources require better allocation using the Index of Orthodontic Treatment Need (IOTN) for fairer distribution.

Area of Science:

  • Dental Public Health
  • Orthodontics
  • Health Services Research

Background:

  • Growing waiting lists for orthodontic treatment in Northamptonshire highlighted service access issues.
  • Prevalence of dentofacial anomalies is consistent across demographics, yet certain groups are over-represented in treatment.
  • Valid indices like the Index of Orthodontic Treatment Need (IOTN) are crucial for focusing services.

Purpose of the Study:

  • To identify variables influencing access to orthodontic care.
  • To assess if orthodontic services are delivered based on objective measures of need.
  • To analyze factors affecting referral pathways and treatment duration.

Main Methods:

  • Analysis of referral speed, appropriateness, timing, duration, and pathway complexity for new specialist orthodontic referrals.

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  • Examination of socio-demographic factors, residence, and IOTN as potential explanations for pathway length.

    • Main Results:

    • Over-representation of socio-economic groups I and V, and under-representation of males and socio-economic class IV in referrals.
    • Significant variation in waiting times and pathway complexity.
    • Over a quarter of referrals were inappropriate; IOTN did not determine access speed.
    • Adult patients experienced longer waiting times for treatment.

    Conclusions:

    • Orthodontic care delivery is not based on objective need and is inequitably distributed.
    • Improved resource allocation using IOTN and established protocols is necessary.
    • Referrals should be directed to the most appropriate providers based on need.