Abstract
Orthodontics has inherent demands, requiring regular appointments and active patient engagement, but relatively little is established in regard to rates of completion of treatment and possible factors affecting successful completion. These factors may be particularly important for cultural minority groups, such as those in rural Appalachia, given the environmental, social, and economic complexities affecting access to and utilization of treatment. A naturalistic study design was employed, using retrospective data from a rural outpatient general dental office in July 2012. Chart abstraction yielded 219 (55.3% female) orthodontic patients (M age = 11.0 [3.7]). Chi-square tests for independence were conducted for categorical dependent variables. For continuous variables, t-tests were conducted. A logistic multivariate regression analysis was conducted to predict completion/non-completion of treatment, with age, gender, distance traveled, type of malocclusion, and payment type as predictors. Overall, 49.8% of this sample successfully completed orthodontic treatment. Greater successful conclusion of treatment was found in self-pay patients (i.e., 74%) versus those whose care was funded through Medicaid/Children's Health Insurance Program (i.e., 34%) or through private insurance (i.e., 36%). Age, gender, and distance to the office from home had no association relative to successful completion of treatment, although average one-way distance to travel for care was considerable (i.e., 38.8 miles). Rate of successful orthodontic treatment completion was low in this rural sample. Treatment outcome was related to the form of payment for services, with self-pay associated with the highest rate of successful completion.
Highlights
The utilization of orthodontic treatment by cultural minority groups in the USA is significantly less than that of majority populations [1,2,3,4] in spite of treatment need that is at least as great [2, 4]
With reports from practitioners in the field suggesting an alarming rate of orthodontic treatment discontinuation in some population subgroups in Appalachia, this study aimed to document the scope of the problem and to identify possible factors that predict treatment completion and discontinuation
Given the unique nature of the Appalachian sample and environment, as well as oral and other health problems in the region, secondary hypotheses included an array of demographic, orthodontic, and psychosocial factors that the literature has considered in terms of successful completion or possible adverse effects, including age at treatment initiation, gender, and distance traveled between home and the office for orthodontic care, and malocclusion type
Summary
The utilization of orthodontic treatment by cultural minority groups in the USA is significantly less than that of majority populations [1,2,3,4] in spite of treatment need that is at least as great [2, 4]. Orthodontics has inherent demands, requiring regular appointments and active patient engagement, but relatively little is established in regard to rates of completion of treatment and possible factors affecting successful completion. These factors may be important for cultural minority groups, such as those in rural Appalachia, given the environmental, social, and economic complexities affecting access to and utilization of treatment
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