[Diagnostic Prevalence of Dental Findings in Children, Adolescents and Young Adults with Mental Disorders Compared to Healthy People - an Analysis and Estimation Based on Claims Data from 2019]. / Zahnmedizinische Diagnoseprävalenzen bei Kindern, Jugendlichen und jungen Erwachsenen mit psychischen Störungen im Vergleich zu Gesunden-Analyse und Abschätzung kassenärztlicher Abrechnungsdaten (2019).

AIM: To analyse oral health-related diagnostic prevalences in children, adolescents (KiJu), young adults with mental/behavioural disorders (PEVS) and those of the general population in Germany based on claims data. METHOD: Anonymously provided ZI (Zentralinstitut)-data sets of GKV-insured persons (0-44 years) were i. e. stratified according to gender, age groups, ICD-K00-K14 diagnosis. RESULT: No reliable oral or dental health-related information was generated from the requested data set. Regardless of the F diagnosis, according to the data set, 1.8% of all 11,854,384 KiJu-GKV-insured persons and 0.2% of 18-44-year-olds (23,348,399 GKV-insured persons) had a diagnosis related to the dental hard tissue (ICD-10 K02/K03.2). Based on available literature on the prevalence of caries in KiJu with PEVS, a mean unweighted prevalence of 51% can be assumed. According to the available literature on the prevalence of caries in KiJu with PEVS a mean unweighted prevalence of 51% can be calculated. Following this and the diagnosis prevalence of PEVS in 0- to 17-year-olds from 2017, an estimated 957.952 children with PEVS should also have a caries. CONCLUSION: The nationwide data on the prevalence of oral health-related diagnoses made by physicians in the general population and in people of the same age with PEVS are very low. Apparently, dental diagnoses are only given very rarely by general practitioners and paediatricians, among others. The existing literature as well as the clinical experience of the authors indicate that this claim data is not suitable to realistically represent the dental and oral health of the examined group of people. Thus, for networking, the improvement of health care research and the care, e. g. of subgroups of the society, is an interprofessional dental/medical, data protection-compliant central database to be driven forward.

Operator-related aspects in endodontic malpractice claims in Finland.

OBJECTIVE: We analyzed operator-related differences in endodontic malpractice claims in Finland. MATERIALS AND METHODS: Data comprised the endodontic malpractice claims handled at the Patient Insurance Centre (PIC) in 2002-2006 and 2011-2013. Two dental advisors at the PIC scrutinized the original documents of the cases (n = 1271). The case-related information included patient's age and gender, type of tooth, presence of radiographs, and methods of instrumentation and apex location. As injuries, we recorded broken instrument, perforation, injuries due to root canal irrigants/medicaments, and miscellaneous injuries. We categorized the injuries according to the PIC decisions as avoidable, unavoidable, or no injury. Operator-related information included dentist's age, gender, specialization, and service sector. We assessed level of patient documentation as adequate, moderate, or poor. Chi-squared tests, t-tests, and logistic regression modelling served in statistical analyses. RESULTS: Patients' mean age was 44.7 (range 8-85) years, and 71% were women. The private sector constituted 54% of claim cases. Younger patients, female dentists, and general practitioners predominated in the public sector. We found no sector differences in patients' gender, dentists' age, or type of injured tooth. PIC advisors confirmed no injury in 24% of claim cases; the advisors considered 65% of injury cases (n = 970) as avoidable and 35% as unavoidable. We found no operator-related differences in these figures. Working methods differed by operator's age and gender. Adequate patient documentation predominated in the public sector and among female, younger, or specialized dentists. CONCLUSIONS: Operator-related factors had no impact on endodontic malpractice claims.

Dental treatment injuries in the Finnish Patient Insurance Centre in 2000-2011.

Objective The Patient Insurance Centre in Finland reimburses patients who sustained injuries associated with medical and dental care without having to demonstrate malpractice. The aim was to analyse all dental injuries claimed through the Patient Insurance Centre over a 12-year period in order to identify factors affecting reimbursement of claims. Methods This study investigated all dental patient insurance claims in Finland during 2000-2011. The injury cases were grouped as (K00-K08) according to the International Classification of Diseases (ICD-10). Calendar year, claimant's age and gender, dental disease group and health service sector were the explanatory factors and the outcome was the decision of a claim. Multiple logistic regression modelling was used in the statistical analyses. Results The total number of decisions related to dental claims at the PIC in 2000-2011 was 7662, of which women claimed a clear majority (72%). Diseases of the pulp and periapical tissues (K04) and dental caries (K02) were the major disease groups (both 29%). Of the claims 40% were eligible for reimbursement, 27% were classified as insignificant or unavoidable injuries and 32% were rejected for other reasons. The proportion of reimbursed claims declined during the period. Patients from the private sector were more likely to be eligible for compensation than were those from the public sector (OR = 1.89, 95% CI = 1.71-2.10). Conclusions The number of dental patient insurance claims in Finland clearly rose, while the proportion of reimbursed claims declined. More claims received compensation in the private sector than in the public sector.

A retrospective audit of population service access trends for cleft lip and cleft palate patients.

UNLABELLED: Population prevalence of orofacial clefts (OFCs) is well documented but the service utilisation patterns of these patients have received limited consideration. OBJECTIVE: To analyse 10-year trends in the utilisation of subsidised OFC related services in Australia. DESIGN: Retrospective audit of service utilisation and claims datasets. METHODS: Using state-wide hospital admission data, all persons treated for Cleft Palate Only (CPO) and Cleft Lip Only (CLO) as their primary diagnosis from 1999 to 2009 in Western Australia were included in the data frameset. Additionally, National Medicare out-of-hospital claims from 2003 to 2013 were added to the data frameset. The socioeconomic status and accessibility to services were analysed as effectors of service-mix such as age group, gender and geographic location. RESULTS: Of 721 in-hospital care episodes in Western Australia, 69% had CPO and 31% CLO as their principal diagnosis. Hospitalisations occurred from 0-69 years of age, but three quarters of all episodes occurred from 0-4 years of age (averaging one to two episodes per child). Whilst total hospitalisations were about four times higher for patients resident in high access areas, adjustment for population found the poorest 20% of the population having substantially lower hospital admission rates than the rest of the population. In Australia, claims for out-of-hospital cleft-related services varied between States. The overall pattern of out-of-hospital Medicare claims nationwide showed orthodontic services having the highest number of claims, followed by prosthodontic then oral surgical services. CONCLUSION: These data provide a picture of diverse service utilisation and leads to some interesting conclusions about geographic and economic access as well as cost-shifts between State and Commonwealth.

Impact of chronic condition status and severity on dental utilization for Iowa Medicaid-enrolled children.

BACKGROUND: Although Medicaid-enrolled children with a chronic condition (CC) may be less likely to use dental care because of factors related to their CC, dental utilization for this population is poorly understood. OBJECTIVE: To assess the relationship between CC status and CC severity, respectively, on dental utilization for Iowa Medicaid-enrolled children. RESEARCH DESIGN: Retrospective cohort study of Iowa Medicaid data (January 1, 2003 to December 31, 2006). SUBJECTS: Medicaid-enrolled children aged 3 to 14 (N = 71,115) years. MEASURES: The 3M Corporation Clinical Risk Grouping methods were used to assess CC status (no/yes) and CC severity (episodic/life-long/malignancy/complex). The outcome variable was any dental utilization in 2006. Secondary outcomes included use of diagnostic, preventive, routine restorative, or complex restorative dental care. RESULTS: After adjusting for model covariates, Iowa Medicaid-enrolled children with a CC were significantly more likely to use each type of dental care except routine restorative care (P = 0.86) than those without a CC, although the differences in the odds were small (4%-6%). Compared with Medicaid-enrolled children with an episodic CC, children with a life-long CC were less likely to use routine restorative care (P < 0.0001), children with a malignancy were more likely to use complex restorative care (P < 0.03), and children with a complex CC were less likely to use each type of dental care except complex restorative care (P = 0.97). CONCLUSIONS: There were differences in dental utilization for Iowa Medicaid-enrolled children by CC status and CC severity. Children with complex CCs were the least likely to use dental care. Future research efforts should seek to understand why subgroups of Medicaid-enrolled children with a CC exhibit lower dental utilization.

ACC claims for sports-related dental trauma from 1999 to 2008: a retrospective analysis.

OBJECTIVE: To describe trends in sports-related dental injuries reported to ACC in the past 10 years. DESIGN: Retrospective case series. METHODS: De-identified data on orofacial injuries were obtained from ACC for the financial years 1999-2008, and new claims were identified for each year (with recurring claims omitted from the analysis). Patterns in new-claim data were identified by age, sex, region and the sport involved. Trends in claims for the sport categories were also identified RESULTS: The annual number of claims ranged from 24,998 to 31,257; overall, 38.7% of claims were made by females and 61.3% by males, and these proportions remained largely unchanged during the observation period. For sports-related claims, those aged 11-20 years had the highest percentage of claims (with between 41.7% and 44.4%, depending on year) while those older than 60 had the smallest percentage of claims, with 0.5% to 1.1%. Sport was involved in 20.6% to 26.2% of new claims. The highest percentage of injuries was attributable to rugby (between 22.2% and 33.1%, depending on the year). Water sports contributed to between 14.2% and 20.8% of claims. Cycling increased from 1.5% in 1999 to 15.3% in 2006, and then decreased to 10.6% in 2008. Hockey, basketball, soccer, cricket and netball had 4.4%, 4.8%, 6.9%, 4.7% and 3.9% respectively. CONCLUSIONS: Although its share has decreased in recent years, rugby remained the greatest contributor to sport-related orofacial injuries, with water sports consistently second (cycling had the largest change, with a rapid increase in the past 3 years). There is a need to re-examine mouthguard (and other injury prevention) policies for particular sports.

A comparison of dental service use among commercially insured women in Minnesota before, during and after pregnancy.

BACKGROUND: The authors examined and compared dental services used by women before, during and after pregnancy. METHODS: In their study, the authors combined medical and dental claims data for 3,462 pregnant women in Minnesota with commercial dental insurance who had been pregnant between Jan. 1, 2004, and Dec. 31, 2005. The authors used McNemar pairwise comparisons, with each subject serving as her own control and her use of various dental services before pregnancy as her own baseline, to evaluate and compare the dental services used during and after pregnancy. RESULTS: During pregnancy, subjects' use of several dental services-radiographs, restorative services, third-molar extractions and anesthesia-decreased significantly (P < .001) in comparison with their prepregnancy use. After pregnancy, subjects' use of checkups, radiographs and restorative services showed significant increases (P < .001). CONCLUSIONS: The significant decreases in use of these services during pregnancy and significant increases after pregnancy may suggest that these women and their dentists were using these services only conservatively during pregnancy or postponing their use altogether until after delivery. CLINICAL IMPLICATIONS: This study's findings may provide useful background information to medical and dental providers, health care plan administrators and policymakers as they consider recommendations regarding oral health care for women during pregnancy.

Bisphosphonate use and the risk of adverse jaw outcomes: a medical claims study of 714,217 people.

BACKGROUND: While osteonecrosis of the jaw (ONJ) has been associated with the prolonged use of bisphosphonates (BPs), there is limited information about the risk of ONJ among users of oral BPs or about the magnitude of the risk among users of intravenous (IV) BPs. METHODS: The authors studied medical claims data from 714,217 people with osteoporosis or cancer to identify diagnostic codes or procedure codes for three outcomes: inflammatory conditions of the jaws, including osteonecrosis; major jaw surgery necessitated by necrotic or inflammatory indications; and jaw surgeries necessitated by a malignant process. The authors calculated stratified odds ratios and 95 percent confidence intervals. RESULTS: The results indicate that oral administration of BPs decreases the risk of adverse bone outcomes. In contrast, IV administration strongly and significantly increases the risk (P < .05) of adverse jaw outcomes or surgery. Across both osteoporosis and cancer, patients receiving IV BPs had a fourfold increased risk of having inflammatory jaw conditions and a greater than sixfold increased risk of having undergone major surgical resection in the jaw. CONCLUSIONS: Mode of bisphosphonate use results in different risk profiles for adverse jaw outcomes. While the authors documented an increased risk of inflammatory conditions and surgical procedures of the jaw for users of IV BPs, they did not find these observed increases for users of oral BPs. CLINICAL IMPLICATIONS: Physicians and dentists must be aware of the higher frequency of adverse jaw effects in patients receiving IV BPs, especially osteonecrosis of the jaw. While the authors' results have internal consistency, more clinical studies are needed to replicate and clarify the observed associations over long follow-up periods.

Dentists in the DTSS between July 2007 and July 2008.

UNLABELLED: Recent attention in the media concerning the Dental Treatment Services Scheme (DTSS) centres on the number of contracting dentists as a surrogate measure of the availability of services to adult medical card holders in the Republic of Ireland. AIM: To determine the trend in the number of contracting dentists on the DTSS panel during the year 07/'07 to 07/'08. METHODS AND DATA: Data were extracted from the database of monthly claims for remuneration, submitted by providers, which is held by the HSE. RESULTS: The average number of contractors was 1,258. The trend over the year was a reduction of 1.6% in contractor numbers. The average number of 'active' contractors was 833. The trend over the year was a reduction in 'active' contractor numbers of 6.2%. In any month, approximately 34% of contracting dentists were not active. CONCLUSIONS: The trend in the number of contracting dentists was a poor indicator of the trend in availability of services to medical card holders. A better approach would be to count the number of 'active' contractors, in conjunction with their geographic spread and medical card holder density.

Scope of practice comparison: a tool for curriculum decision making.

The proportion of claims filed for specific dental procedures (ADA codes # 05110, 05120, 03320, 03330, 04260, 02150) between January 1, 2000 and June 30, 2004 by Texas general practitioners participating in a preferred provider network was compared to the proportion of these procedures performed by students graduating from the three Texas dental schools during the same period. Analysis of the data revealed that Texas dental students provide class two amalgam restorations in permanent teeth (02150) at approximately the same frequency as Texas general practitioners. Both groups provide periodontal osseous surgery (04260) at an extremely low frequency (<0.02% of total procedures). Bicuspid endodontic procedures (03320) were performed at a slightly higher frequency by students (0.43% of all procedures) than by general practitioners (0.36% of all procedures), and molar endodontic procedures (03330) were performed at a slightly higher frequency by general practitioners (0.65%) than by students (0.36%). Significant discrepancies between the groups were noted for the two complete denture procedures (05110, 05120). Students provided these procedures at frequencies fifteen times (05110) and twenty-five times (05120) greater than general practitioners. Dental schools should use data provided by scope of practice analyses to help determine an appropriate breadth and depth for their educational programs.

Using Medicaid claims to construct dental service market areas.

OBJECTIVE: To use Medicaid claims data to construct patient origin-based market areas for dental services and compare constructed market areas with those based on the practice county. DATA SOURCES: North Carolina Medicaid claims, eligibility, and provider files, the Cooperative Health Information Systems' dentist licensure files, and the Log Into North Carolina data. STUDY DESIGN: A visit-level file was created from the Medicaid claims data and aggregated by provider practice county and patient county of residence. Using the aggregated file and an algorithm based on the Elzinga-Hogarty approach, patient travel patterns were used to construct mutually exclusive patient origin market areas. DATA ANALYSIS: Market area characteristics were compared across definitions using Pearson correlation coefficients. In addition, estimations of provider participation were performed using market area characteristics as control variables. The beta coefficients associated with market area characteristics were compared across market area definitions. PRINCIPAL FINDINGS: Medicaid claims data, when combined with provider licensure files, can be used to construct market areas based on patient origin data. However, measures of market area characteristics are correlated highly between the two types of market areas studied. Furthermore, beta coefficients on market area variables in models of provider participation are similar in sign, significance, and magnitude across market definitions. CONCLUSIONS: Compared with market areas constructed using patient origin data, county-based market areas adequately proxy for dental markets. Using the county as the market area also avoids the time and computational costs associated with using a patient origin-based approach and facilitates the use of widely available data.

Epidemiologic study of dental emergencies among utilizers in an insured population in Washington, USA.

This is a study of the epidemiology of dental emergencies based on information abstracted from the microfilmed dental claim forms of a large American insurance program in 1981-82. Overall, about 4% of all dental visits were classifiable as emergencies. There were significant seasonal and age variations in dental emergencies. There was no variation with respect to geographic regions in the State of Washington (USA) or sex. Paradoxically, residents in regions having fluoridated water supplies were at equal risk of developing dental emergencies due to dental caries, relative to those residing in non-fluoridated regions. There was also no difference in risk associated with insurance deductibles, although generally deductibles are thought to deter first-contact visits.

Dental services, costs, and factors associated with hospitalization for Medicaid-eligible children, Louisiana 1996-97.

OBJECTIVE: This study compared types and costs of dental services rendered to children who had received care in a hospital operating room (H) with children who had not (NH). METHODS: The study population consisted of all children aged 1-5 years who received a dental service reimbursed by the Louisiana Medicaid EPSDT program from October 1996 through September 1997. Claim files were provided by the Louisiana Bureau of Health Services Financing. A treatment intensity index [TII = 3 x (# extractions) + 2 x (# pulpotomies + # crowns) + # simple restorations] was calculated for H children (n = 2, 142) and NH children (n = 38,423). Using logistic regression, a dichotomous hospitalization variable (H vs NH) was regressed against treatment intensity and selected personal and parish (county) characteristics for each of the five age groups. Total and average reimbursement per child were calculated for both groups of children, by age. RESULTS: The mean treatment intensity scores for H and NH children were 24.02 (SD = 11.82) and 2.16 (SD = 4.78), respectively. For all age groups, children with treatment intensity scores greater than 8 were at least 132 times more likely to be hospitalized than were children with scores less than or equal to 8. The mean cost for care provided to H children was $1,508 compared with $104 for NH. Total costs for dental care rendered to H children (5% of the study population) were $3,229,851 (45% of total dental costs for the study population). CONCLUSION: Reducing severe caries through early interventions could provide substantial cost savings.

Dental negligence: a study of cases assessed at one specialised advisory practice.

AIM: To undertake a review of cases from one dental advisory practice in England over a period of 5.5 years to provide a profile of the type of work undertaken. DESIGN AND SETTING: Compensation claims for dental negligence seen at one dental advisory practice between 1991 and 1996. METHODS: 437 claims were reviewed for: the nature of the complaint; defendant details; plaintiff details; method of funding; duration and outcome of claim. Comparisons were made with previously published data. The relationship between method of funding of a claim and the likelihood of the claim being successful was investigated. RESULTS: 28% of complaints concerned oral surgery and 24%, restorative procedures. In 72% of cases, the compensation claim was made directly against the dentist who had provided treatment for the patient. The majority of claims were gender and age biased; females (63%) and younger people (18-45 years of age) (68%) were more likely to bring actions for dental negligence. Only 3% involved elderly patients (> or = 60 years old). Claims supported by the government legal aid scheme were more likely to be withdrawn or rejected than those privately funded. Nearly all cases were completed in under one year (81%). CONCLUSIONS: Results are similar to previously published studies. A large proportion of claims concerned restorative or oral surgery procedures carried out in general or community practice.

Quality assurance in medicine: a dental audit system.

Two principal components of a quality assurance system for dental plans are described, using a case report to illustrate the methodology. Criteria of acceptable quality of patient care for general practice were developed first. Then plan, practice and patient profiles, derived from claims or encounter data, were used to identify the nature and extent of aberrant patterns which were uncovered. Based on analysis of the profiles, site visits were made to a targeted sample of practices and selected patient dental records were evaluated for various levels of the process of care. Categories were rated as either acceptable or unacceptable. Principal dentists were debriefed on the findings and a report including corrective action plans prepared for the responsible agency. Follow-up to monitor compliance is planned. Although aberrant profiles do not necessarily mean that care is unacceptable, the findings from the record review confirmed the concerns raised by the data analysis.

Louisiana dentists' attitudes toward the dental Medicaid program.

PURPOSE: This study was performed to determine factors associated with Louisiana dentists' participation in the Dental Medicaid Program. METHODS: Surveys were mailed to all pediatric and general dentists as reported by the Louisiana State Board of Licensing. A second mailing was made to non-respondents. RESULTS: Surveys from 956 of 1,926 dentists (50%) were returned. Of 607 general dentists and 40 pediatric dentists who treated dental Medicaid-enrolled children in the past year, 269 (44%) and 18 (45%), respectively, treated all Medicaid-enrolled children. Newly graduated dentists were more likely to be actively enrolled than their more established counterparts (chi 2 = 10.67; p = 0.01). Medicaid reimbursement levels were viewed as "much less" than private fees by 62%, "less" by 33% and "the same" by 4% of the respondents. Broken appointments were the most prevalent reported problem (80%), followed by low fees (61%), patient non-compliance (59%), unreasonable denial of payments (57%), slow payment (44%), and complicated paperwork (42%). With the exception of the perceived importance of Medicaid reimbursement levels, active and inactive general and pediatric dentists' perceptions of the importance of Medicaid issues were not significantly different. These findings indicated that significantly more Medicaid-active general dentists who allocated 10% of their office visits to Medicaid-eligible children felt that slow payment (p = 0.002) and complicated paperwork (p < 0.001) were more important problems than general dentists who allocated less time to Medicaid-eligible children. CONCLUSIONS: Louisiana dentists' sources of dissatisfaction with Medicaid are similar to those of dentists in other states. Some of the issues are programmatic and are within the power of the dental Medicaid director and state legislature to address. Patient-related issues such as frequent broken appointments may be addressed by assigning case managers to Medicaid beneficiaries.

Developing population profiles from dental claims data for conceptualizing effectiveness of care.

The purpose of this study was to explore longitudinal observational analysis of insurance claims data with goal of graphically demonstrating that effective dental care leads to the diminished use of services in subsequent time intervals. Using the Rand HIE claims data, definitions of the best patients for whom claims data would be profiled and the best parameters to use in rate calculations for the time series graphs were empirically derived. Profiles using these definitions were found to be very similar to a conceptual model of such profiles.

Sport-related dental injury claims to the New Zealand Accident Rehabilitation & Compensation Insurance Corporation, 1993-1996: analysis of the 10 most common sports, excluding rugby union.

A large number of New Zealanders participate in sport, either formally or informally; sporting injuries are common. In New Zealand, the Accident Rehabilitation & Compensation Insurance Corporation (ACC) is the main organisation that covers sports-related dental claims. Rugby union claims are the most common. The ACC's national data from 1993 to 1996 relating to dental claims for sports injuries (excluding rugby union) were analysed. This study identified 45 other sports in which participants are also at risk for dental injuries. Total claims per sport for each year were determined, and the "top 10" sports for claims per year were identified and compared for any change over the years studied. The top 10 sports for 1993 and 1994 were, in descending order: swimming, rugby league, basketball, cricket, hockey, soccer, netball, squash, softball-baseball, and tennis. Data for 1995 and 1996 revealed a similar trend, except that touch rugby displaced tennis as the tenth-ranked sport. The most common age group for claims was the age group 10-19 years, with a male:female ratio of approximately 2:1. Many sports, in addition to rugby union, place their participants at risk of dental injury. Awareness of prevention of dental injuries should be more widely promoted for all sports.

Geographic accessibility and utilization of orthodontic services among Medicaid children and adolescents.

OBJECTIVES: To describe rates of Medicaid-funded services provided by orthodontists in Iowa to children and adolescents, identify factors associated with utilization, and describe geographic barriers to care. METHODS: We analyzed enrollment and claims data from the Iowa Medicaid program for a 3-year period, January 2008 through December 2010. Descriptive, bivariate, and multivariable logistic regression analyses were performed with utilization of orthodontic services as the main outcome variable. Service areas were identified by small area analysis in order to examine regional variability in utilization. RESULTS: The overall rate of orthodontic utilization was 3.1 percent. Medicaid enrollees living in small towns and rural areas were more likely to utilize orthodontic services than those living in urban areas. Children who had an oral evaluation by a primary care provider in the year prior to the study period were more likely to receive orthodontic services. Service areas with lower population density and greater mean travel distance to participating orthodontists had higher utilization rates than smaller, more densely populated areas. CONCLUSIONS: Rural residency and increased travel distances do not appear to act as barriers to orthodontic care for this population. The wide variability of utilization rates seen across service areas may be related to workforce supply in the form of orthodontists who accept Medicaid-insured patients. Referrals to orthodontists from primary care dentists may improve access to specialty care for Medicaid enrollees.

Socioeconomic deprivation and NHS orthodontic treatment delivery in Scotland.

OBJECTIVE: The purpose of this observational study was to investigate the relationship between deprivation and the delivery of primary care NHS orthodontic services across Scotland. METHOD: Deprivation was measured using the Scottish Index of Multiple Deprivation (SIMD). The Information Services Division, NHS National Services Scotland, supplied data on all claims for orthodontic treatments in Scotland for the years 2008 and 2009. Each claim was assigned to a SIMD quintile (SIMD 1 being the most deprived, and SIMD 5 the least deprived), and odds ratios were calculated. RESULTS: Uptake of orthodontic services is highest in the least deprived areas. Patients from the least deprived areas are nearly twice as likely to receive orthodontic treatment as those from the most deprived areas (odds ratio of 1.90 with a 95% confidence interval (CI) 1.86 to 1.94). CONCLUSION: Patients from more the most deprived backgrounds are less likely to receive orthodontic treatment than those from more affluent backgrounds, which does not necessarily reflect need.