The HLD (CalMod) index and the index question

Area of Science:

• Dental Public Health
• Orthodontics
• Health Services Research

Background:

• Public health programs (Medicaid, Champus) require demonstrating
• medically necessary handicapping malocclusion
• for treatment coverage.
• Historical attempts to define malocclusion based on an
• ideal
• standard have failed statistical validity.
• The American Association of Orthodontists (AAO) has shifted its stance on malocclusion indexing over time.

Purpose of the Study:

• To review the challenges in defining and measuring handicapping malocclusion for public health programs.
• To present the HLD (CalMod) Index as a potential solution for identifying medically necessary malocclusion.
• To evaluate the practical application and effectiveness of the HLD (CalMod) Index.

Main Methods:

• The HLD (CalMod) Index, a modification of earlier suggestions, was developed to identify severe malocclusions and tissue-destructive conditions.
• Screening of over 135,000 patients by qualified orthodontists using the HLD (CalMod) Index.
• Detailed analysis of study models for nearly 50,000 patients screened with the index.

Main Results:

• The HLD (CalMod) Index has been applied and tested across a large patient population.
• Two studies were conducted to assess outcomes and identify areas for improvement.
• Necessary modifications and guidelines were developed based on study findings.

Conclusions:

• The malocclusion index problem is dynamic and requires practical solutions.
• The HLD (CalMod) Index has demonstrated successful application and testing in large numbers.
• This review provides a factual overview of the malocclusion index issue and the HLD (CalMod) Index as a viable solution in the US.