Extractions prior to comprehensive orthodontic treatment in the mixed dentition.

Studies concerning the prevalence of extractions prior to orthodontic treatment have been limited in scope. This quasi-experimental analysis from secondary data explores patient and provider variables as they relate to extractions prior to comprehensive orthodontic therapy in the mixed dentition. This national database contains 38,529 children who had at least one comprehensive orthodontic (mixed dentition) visit within a 27-month period (January 1987-March 1989). Because of the relatively small number of Class III malocclusion cases, an equal allocation, random sample method was used in choosing children from the three Angle malocclusion classifications and the seven NIDR regions. Of those selected 24.7% had one or more extractions prior to orthodontic treatment, with 56% occurring at either 11 or 12 years of age. There were slightly more extraction cases for the Class I malocclusion children (26.7%) than either Class II (23.1%) or Class III (24.1%). Those children who had an orthodontic extraction were slightly older (P < 0.05). There were no statistically significant differences relating to orthodontic extractions for the following patient and provider variables: gender, malocclusion classification, years since dental graduation, and type of dental practice. There were regional differences among extraction rates for pediatric dentists, with those from the NIDR Midwest region more likely to have children receiving one or more extractions.

Juvenile orthodontic treatment claims within a large dental insurer.

Despite many investigations regarding the relationship of health care insurance and the use of dental services, few studies have specifically examined coverage for orthodontic care. This preliminary investigation provides descriptive data concerning orthodontic services from one of the nation's largest health care insurance companies. Of the more than 1.3 million juvenile patients (ages 5 through 15 years) treated between 1986 and 1989, approximately 10.6% received comprehensive orthodontic therapy. Claims were also analyzed for variation across states and National Institute for Dental Research (NIDR) regions (with Alaska and Hawaii comprising region VIII) in terms of use and class of malocclusion. The largest percentage of comprehensive orthodontic cases in relation to the number of persons receiving any dental care exists in region III (Midwest) (11.6%). Analysis by state shows Washington, Delaware, and Pennsylvania as the leading orthodontic providers (14.3%, 13.5%, and 13.0%, respectively). Female patients comprised 56.5% of those with full-mouth treatment. Treatment most frequently commences at ages 12 years (23%) and 13 years (21.8%). In terms of classes of malocclusion, comprehensive treatment for Angle Class II is predominant (55.7%), followed by Class I (40.1%), and Class III (4.2%). Relative to total orthodontic use, Region VIII demonstrates the highest concentration of Class I patients (46%). Region I (New England) displays the greatest number of Class II cases (59.8%), whereas the largest number of Class III patients is found in the southeastern United States (region IV) (5.2%). Overall, the use of comprehensive orthodontic treatment is relatively constant over all regions, (except regions V, VI, and VIII, which fall below 10%), and mirrors that of overall dental services.