Orthodontic treatment timing: a survey of orthodontists

There has been much debate with respect to the ideal time to initiate orthodontic treatment. Recent clinical trials have tested the effects of early orthodontic treatment. The purpose of this study was to understand orthodontists' perspectives on the best time to initiate treatment, factors that preclude early treatment, and experiences with compliance or adherence problems among their younger patients. Questionnaires were distributed to 335 practicing orthodontists throughout the United States. Respondents were first asked to indicate the best stage to initiate orthodontic treatment for 41 different types of occlusal deviations. They were then asked what conditions might preclude early orthodontic treatment. After one reminder, 137 questionnaires (41%) were returned. The sample consisted of practitioners with 3 to 52 years of experience and represented 46 different orthodontic training programs; 19% were female. The majority (92%) were in private practice. Among the 41 conditions listed, orthodontists would most likely treat 21 in the early mixed dentition, especially anterior crossbites (> 76%); 13 in the late mixed dentition, especially deepbite (> 60%) and mandibular inadequacy (> 59%); and 4 in either stage. Only two conditions would be treated in later stages (maxillary midline diastema, 43%; and congenitally missing teeth,39%). One third would postpone treating mandibular prognathism until adulthood. Patient variables that precluded treatment were behavior (98%) and compliance (96%) problems. Finances (76%) and family disruptions (57%) were less important deterrents to treatment. Orthodontists' experience with Phase I treatment influenced their decisions (p < 0.01). Orthodontists who have been in practice longer were more likely to treat temporomandibular joint sounds (p < 0.003) and deviations in opening (p < 0.002) than less experienced orthodontists; the latter were more likely to refer such patients to temporomandibular disorder specialists. These findings suggest that early orthodontic intervention is the norm, but practice characteristics affect treatment timing.