RESUMO
BACKGROUND: Patients enrolled in Medicaid have limited access to orthodontic services in the United States. No studies are available, to the authors' knowledge, regarding the clinical and psychosocial burdens of malocclusion on these patients from an economic perspective. METHODS: The authors conducted a systematic review of the relevant economic literature. They identified issues from the perspectives of the various stakeholders (dentists, patients and parents, Medicaid programs) and developed a conceptual model for studying decision making focused on the strategy of providing early interceptive and preventive treatment rather than, or in addition to, comprehensive care in the patient's permanent dentition. RESULTS: Medicaid coverage and reimbursement amounts vary nationwide, and decision making associated with obtaining care can be complex. The perspectives of all relevant stakeholders deserve assessment. A conceptual framework of the cost-effectiveness of interceptive orthodontic treatment compared with comprehensive treatment illustrates the issues to be considered when evaluating these strategies. CONCLUSIONS: Policymakers and the dental community should identify creative solutions to addressing low-income families' limited access to orthodontic services and compare them from various perspectives with regard to their relative cost-effectiveness. CLINICAL IMPLICATIONS: Dentists should be aware of the multiple problems faced by low-income families in obtaining orthodontic services and the impact of stakeholder issues on access to care; they also should be proactive in helping low-income patients obtain needed orthodontic services.
