Assessment Of Treatment Need Research Articles

Johtajien käsitykset e-palveluiden yleistymisen vaikutuksista hoidon tarpeen arviointitoimintaan – laadullinen tutkimus erikoissairaanhoidon yhteispäivystyksestä

Sähköisten terveydenhuoltopalveluiden (e-palvelut) yleistyminen muuttaa hoidon tarpeen arviointitoimintaa erikoissairaanhoidon yhteispäivystyksessä. Päivystyksellisellä hoidon tarpeen arvioinnilla tarkoitetaan ammattilaisen suorittamaa arviota potilaan tarvitsemasta päivystyshoidosta. E-palveluiden yleistyessä ihmiset arvioivat yhä useammin itse omaa hoidon tarvettaan sähköisillä työkaluilla ennen päivystykseen saapumista ja ilman kontaktia terveydenhuollon ammattilaiseen. E-palveluiden käyttöönotto on haasteellista ilman ymmärrystä teknologian, ihmisten ja toimintaympäristön välisistä suhteista. Tämän tutkimuksen tarkoituksena on kuvata johtajien käsityksiä 1) päivystyksen hoidon tarpeen arviointitoiminnasta, 2) e-palveluiden yleistymisen vaikutuksista hoidon tarpeen arviointitoimintaan, 3) e-palveluiden yleistymisestä aiheutuvaan toiminnan muutokseen varautumisesta ja 4) toiminnan muutoksen onnistumiseen vaikuttavista tekijöistä.
 Tutkimusaineisto kerättiin syksyllä 2019 teemahaastattelulla viiden yliopistosairaanhoitopiirin yhteispäivystyksen operatiivisesta johtamisesta vastaavilta hoitotyön johtajilta ja lääkärijohtajilta (n=10). Aineisto analysoitiin sisällönanalyysillä.
 Tulosten mukaan e-palveluiden yleistymisen vaikutukset kohdistuvat yhteispäivystyksessä ihmisiin ja toimintaan. Ammattilaisten työ, asiakkaiden toimintamallit sekä hoidon tarpeen arviointitoiminta muuttuvat ja päivystystoiminta kehittyy. Johtajat ymmärtävät e-palveluiden yleistymisen vaikutukset sosioteknisen lähestymistavan mukaisena, koko yhteispäivystystä koskevana toiminnan muutoksena. E-palveluiden yleistymisestä aiheutuvaan toiminnan muutokseen on varauduttu, mutta siinä on myös haasteita. Varautumista pyritään edistämään ja siihen tarvitaan tukea. Yhteispäivystyksessä toiminnan muutoksen onnistumiseen vaikuttavat esimerkiksi asenne, hyötyjen osoittaminen, toimintaympäristö ja resurssit.
 Edellytykset e-palveluiden käyttöönoton onnistumiselle yhteispäivystyksen hoidon tarpeen arviointitoiminnassa ovat optimistiset. Toiminnan muutokseen on tärkeää varautua ja huomioida muutoksen onnistumista edesauttavat ja estävät tekijät. Ilman riittävää taloudellista varautumista toiminnan muutoksen onnistuminen voi olla vaikeaa. Tuloksia voidaan hyödyntää e-palveluiden käyttöönotossa ja kehittämisessä yhteispäivystyksen hoidon tarpeen arviointitoimintaa tukeviksi sekä toiminnan muutosten ennakoinnissa ja johtamisen tehostamisessa.

Agreement and association between normative and subjective orthodontic treatment need using the Index of Orthodontic Treatment Need.

AIMS:To determine the association and level of agreement between young adults’ perception of orthodontic treatment need (subjective need) and the orthodontists’ assessment of treatment need (normative objective need).METHODOLOGY:For this study, 670 students [280 males and 390 females; mean age (standard deviation) of 15.32 (1.81) years] were selected from public and private schools from different demographic areas of Jeddah city, Saudi Arabia, and divided into two age groups (12–15 years) and (16–19 years). All the participants were examined, and the Index of Orthodontic Treatment Need (IOTN) components [dental health component (DHC) and aesthetic component (AC)] were recorded.RESULTS:Kappa statistics showed a statistically significant but fair agreement between clinician AC (CAC) and student AC (SAC) assessments in both age groups (k = 0.343 and 0.334, respectively; P < 0.001), whereas Spearman's correlation coefficient showed a statistically significant but moderate association (r = 0.487 and 0.517, respectively; P < 0.001). The degrees of agreement were 76.4% and 76.7% at the no-need and mild-need levels of treatment, respectively. There was a statistically significant but weak association between the subjective and normative needs (SAC and IOTN-DHC) in both age groups (r = 0.336 and 0.360, respectively; P < 0.001). However, the degrees of agreement were 58.9% and 61.5% at the no-need and mild-need levels of treatment, respectively.CONCLUSION:Significant but weak positive association was found between the normative and subjective orthodontic treatment needs, indicating a lack of understanding of the nature of malocclusion and its consequences. Thus, promoting further knowledge and awareness of malocclusion are indicated.

Perceived and Assessed Dental Treatment Needs of Schoolchildren in Benoe Division, Cameroon.

Oral health surveys combining clinical and subjective measures are effective to inform oral health policy, practice, and evaluation of oral health interventions. However, only a few studies have examined the agreement between these measures in developing countries. This study investigates dental treatment needs among Cameroon's schoolchildren; specifically, we aim to estimate the extent to which perceived and clinical measures are in agreement. Using a multistage sampling technique, we randomly selected 11 schools and their pupils to participate in this study. We conducted an oral clinical examination using a mouth mirror and blunt probe in a classroom to evaluate children's oral health. In addition, the participants filled out a questionnaire on sociodemographic characteristics, oral health behavior, and perceived treatment needs. To fulfill our aims, we use descriptive statistics and unconditional logistic regression. Out of 700 children invited to participate, 692 completed the study (98.8%). The mean age of the children was 11.45 y (SD = 1.21), and there were slightly more boys ( n = 366, 52.9%) than girls ( n = 326, 47.1%). The majority of the children (85.2%) felt that their oral health was good, and more than half (53.2%) reported a perceived need for dental treatment. While 68.2% ( n = 472) had at least 1 objective treatment need, only 65.8% of them perceived this need, indicating a medium level of sensitivity (65.9%, 95% CI = 61.4% to 70.2%). In addition, we observed a high positive predictive value (84.5%, 95% CI = 80.4% to 88.1%) for perceived treatment need to detect clinically evaluated dental treatment need. Our findings show that perceived treatment has a high positive predicted value to determine clinical treatment need. Subjective assessment of treatment need may be an alternative low-cost option to help policy makers to design oral health interventions for Cameroonian children. This study illustrates the potential of schoolchildren in a low-income country to make a good prediction of their dental treatment needs. The majority of these countries lack the human and material resources to conduct oral health surveys that include clinical assessment of treatment needs. Therefore, stakeholders can rely on data from self-administered oral health surveys to inform policy and delivery of services to schoolchildren in resource-limited settings.

Quality-of-Life in Children with Orofacial Clefts and Caregiver Well-being

Quality of life is a valid patient-reported parameter that provides an assessment of treatment need or outcomes complementary to standard clinical measures. Such patient-reported assessments are particularly salient when examining chronic conditions with prolonged treatment trajectories, such as cleft lip and palate. This critical review identifies key questions related to ongoing research on the oral health–related quality of life (OHRQoL) in children with cleft and caregiver well-being. Details of the design and results from 2 longitudinal multicenter studies are presented. This article also provides an update on recent published reports regarding OHRQoL in individuals with cleft. Methodological issues in OHRQoL research are discussed, including condition-specific versus generic instruments, incorporating positive items in OHRQoL instruments, calculating minimally important differences in OHRQoL, implementing mixed methods design, and utilizing validated short assessment forms in OHRQoL research. Finally, new directions for research in cleft as a chronic condition are identified and discussed.

Talking about paranoid experiences: Interactional dynamics of accomplishing disclosure of psychotic symptoms in triadic conversation.

The present study is the first to investigate, using conversation analysis, the effects of a family member’s participation in conversation regarding the assessment of need for treatment. We aim at describing the course of a treatment negotiation, focusing on interactional dynamics and on disclosure of paranoid symptoms in a clinically challenging situation characterized by an acutely psychotic patient with (1) disorganized discourse, (2) poor insight, (3) aspiration to avoid hospital treatment, and (4) a relative who was supporting in-patient care. In the triadic conversation, in which the patient, his relative, and the psychiatrist participated, different consecutive phases were distinguished. The Relative Prominent Information Phase (RIP) was characterized by the relative’s statements on the patient’s problematic behavior, and conflicting views between the patient and his relative led to denial of symptoms by the patient. When the patient was prominent in the latter Patient Prominent Information Phase (PIP), the display of several different social actions and corresponding linguistic devices were linked with more overt talk about paranoid experiences by the patient, albeit in a disorganized manner. RIP and PIP were followed by an Evaluation and Decision Phase (EDP).

Mind the gap: What is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians?

Alcohol-related harms cause great concern to Aboriginal and Torres Strait Islander (Indigenous) communities in Australia as well as challenges to policy makers. Treatment of alcohol use disorders forms one component of an effective public health response. While alcohol dependence typically behaves as a chronic relapsing condition, treatment has been shown to be both effective and cost-effective in improving outcomes. Provision of alcohol treatment services should be based on accurate assessment of treatment need. In this paper, we examine the likely extent of the gap between voluntary alcohol treatment need and accessibility. We also suggest potential approaches to improve the ability to assess unmet need. Existing methods of assessing the treatment needs of Indigenous Australians are limited by incomplete and inaccurate survey data and an over-reliance on existing service use data. In addition to a shortage of services, cultural and logistical barriers may hamper access to alcohol treatment for Indigenous Australians. There is also a lack of services funded to a level that allows them to cope with clients with complex medical and physical comorbidity, and a lack of services for women, families and young people. A lack of voluntary treatment services also raises serious ethical concerns, given the expansion of mandatory treatment programmes and incarceration of Indigenous Australians for continued drinking. The use of modelling approaches, linkage of administrative data sets and strategies to improve data collection are discussed as possible methods to better assess treatment need. [Brett J, Lee K, Gray D, Wilson S, Freeburn B, Harrison K, Conigrave K. Mind the gap: what is the difference between alcohol treatment need and access for Aboriginal and Torres Strait Islander Australians? Drug Alcohol Rev 2016;35:456-460].

Pattern of Malocclusion at the Orthodontic Unit, Lagos State University Teaching Hospital, Lagos Nigeria

Objective The aim of this study was to determine the pattern of malocclusion among patients attending the orthodontic clinic, Dental department, of the Lagos State University Teaching Hospital. Method A retrospective study of one hundred and sixty nine patients who attended the orthodontic clinic, LASUTH from January 2007 to December 2008 was conducted. Information regarding age, sex, and type of malocclusion and index of orthodontic treatment need (The dental health component) was obtained from the patients’ record files. Results The patients’ ages ranged from 4 to 34 years with a mean age of 14.08 ± 5.80. There were 95 (55.9%) females and 74 (44.1%) males. The commonest type of malocclusion was Angle’s class 1 seen in 136 (80%), while Class 2 and Class 3 accounted for 26 (15.4%) and 7 (4.1%) respectively. Crowding was noted in 64 (38.1%) patients while 73 (42.3%) had spacing. Only 14 (8.2%) had associated oral habits such as thumb-sucking, lip sucking, tongue sucking and tongue thrusting. No crowding, spacing or associated oral habit was observed in 18 (11.4%)of the patients. Assessment of need for treatment ,using the dental health component of the index of orthodontic treatment (IOTN), showed 62 (36.7%) had mild need, 76 (45.0%) moderate need , 24 (14.2%) severe treatment need and 7 (4.1%) extreme need for treatment. The degree of need for treatment was not significantly related to patient’s age or gender (p-value>0.005). Conclusion The pattern of malocclusion seen among patients attending orthodontic clinic, LASUTH is comparable to the outcome of previous studies done in other centers in Nigeria. There also seems to be an increasing number of adult patients seeking orthodontic treatment. Majority of the patients require mild to moderate orthodontic intervention. Keywords: malocclusion, Angles classification, oral habits, index of orthodontic treatment need

Preadolescent orthodontic treatment need: Objective and subjective provider assessments and patient self-reports

In the age of evidence-based dentistry, an interesting question is whether dentists' subjective or general assessments of preadolescent orthodontic treatment need are correlated with objectively determined need. In addition, because children from socioeconomically disadvantaged and underrepresented minority backgrounds in the United States have limited or no access to orthodontic treatment, it is worthwhile to investigate whether unmet orthodontic treatment need is correlated with preadolescent smile assessments and desire for braces. Our objectives were to explore (1) whether pediatric residents' objective and subjective assessments of preadolescent orthodontic treatment need are correlated and also correlate with the treatment recommendations made, (2) whether preadolescent responses concerning their smile-related quality of life and desire for braces are correlate, and (3) whether dentist and patient assessments are related. Data were collected from 1566 preadolescents (age range, 8-11 years; 47.3% boys, 52.7% girls; 55.7% black, 39.7% white, 2.9% Hispanic) in oral examinations and face-to-face interviews. Malocclusion was determined with the index of orthodontic treatment need. Objective and subjective orthodontic treatment need indicators were correlated (r = .719, P <0.001). Pediatric residents' recommendations for orthodontic treatment were correlated with both the objective assessment of treatment need (r = .547, P <0.001) and the subjective assessment of treatment need (r = .522, P <0.001). Both sets of malocclusion indicators correlated with the patients' self-perceptions (r = -.145, P <0.001; r = -.177, P <0.001) and their desire for braces (r = .106, P = 0.001; r = .141, P <0.001). Patient desire for braces was significantly correlated with smile-related quality-of-life scores (r = .665, P <0.001). Although subjective and objective assessments of preadolescent orthodontic treatment need are rather consistent, the percentage of actual treatment recommendations exceeded both the subjective and objective assessments of treatment need. Preadolescent self-assessments and desire for braces were significantly correlated, and also correlated with the treatment recommendations and the objective and subjective components of the index of orthodontic treatment need score.

Transparent criteria for specialist level adolescent psychiatric care

Rising health care costs and long waiting lists pose a challenge to public specialist level health services. In Finland, the Ministry of Social Affairs and Health required all medical specialities to create a priority-rating tool for elective patients, preferably giving a numerical rating ranging 0-100, with 50 as an entry threshold. To create and test the psychometric properties of a point-count measure for prioritising entry to public specialist level adolescent psychiatric services. Around 710 referred adolescents were given ratings on 17 items focusing on symptom severity, problem behaviours, functioning, progress of adolescent development and prognosis. The structured ratings were compared to an overall assessment of need for treatment on a VAS scale. In order to ensure that the tool was not inappropriately sensitive to confounding by non-disturbance related factors, the associations between the structured priority rating and sex, age, referring agent, study site and diagnosis were analysed. Of the 17 items, 15 were included in the final priority-rating tool. The requirement than threshold score for entry to services being set at 50 points necessitated scoring factors rather than individual items. Four blocks of items were formed: symptoms and risks; impaired functioning; other relevant issues, and prognosis without specialist level treatment. Most of the referred adolescents scored over the threshold of 50. When diagnosis was controlled for, scoring over 50 was largely independent of age, sex, referring agent or study site. The structured priority ratings corresponded well with clinical global rating of need for care. The tool was not inappropriately sensitive to age, sex, referring agent or study site. In the future, follow-up studies will be needed to evaluate the predictive value of priority ratings.

Orthodontic treatment need in Asian adult males.

Orthodontic treatment in adults has gained social and professional acceptance in recent years. An assessment of orthodontic treatment need helps to identify individuals who will benefit from treatment and safeguard their interest. The purpose of this study was to assess the objective and subjective levels of orthodontic treatment need in a sample of orthodontically untreated adult Asian males. A sample of male army recruits (n = 339, age 17-22 years, Chinese = 258, Malay = 60, Indian = 21) with no history of orthodontic treatment or craniofacial anomalies participated in the study on a voluntary basis with informed consent. Impressions for study models were taken. Objective treatment need was assessed based on study model analysis using the Index of Orthodontic Treatment Need (IOTN). Questionnaires were used to assess subjective treatment need based on subjective esthetic component (EC) ratings. Fifty percentage of the sample had a definite need for orthodontic treatment (dental health component [DHC] grades 4 and 5), whereas 29.2% had a moderate need for treatment (DHC grades 3). The occlusal trait most commonly identified was dental crossbite. Malay males had the highest percentage with a definite need for treatment for both dental health and esthetic reasons in comparison with Chinese and Indian males. However, there was no difference in the level of treatment need among the ethnic groups (P > .05). No correlation between objective and subjective EC scores was found (P > .05). A high level of investigator-identified treatment need was not supported by a similar level of subject awareness among the adult sample.

A critical appraisal of the use of tools for assessing dental fear in children

Objective: The aim of this article is to review and evaluate the uses of the various tools for assessing dental fear in the child. Method: A search and review of publications related to the various identified tools used for assessing dental anxiety in children was done. Attention was paid to the empirical findings with the main focus being the function for which the instruments were designed. The features as an ideal instrument for use in the measurement of dental fear in the child were examined. Results: The findings indicate that most of the existing tools can be appropriately used for epidemiological studies as well as for diagnostic purposes with some limitations. However, none of the existing tools are appropriately designed for determining treatment needs as well as for assessing treatment outcomes. Conclusion: It was concluded that there is a need to develop culturally sensitive instruments which would enhance the objective assessment of treatment need and treatment outcomes of dental fear in children. Key Words: Dental; Fear; Children; Appraisal; Measures African Journal of Oral Health Vol.1(1) 2004: 54-63

Evaluation of orthodontists' perception of treatment need and the peer assessment rating (PAR) index.

This paper examines the relationship between orthodontists' subjective assessment of treatment need and objective measurements obtained during standardized intra- and extraoral examinations. Logistic regression modeling was used to develop predictive models of treatment need. Data were obtained from 1155 eighth-grade students by four orthodontists who used standardized examination forms to assess demographics, trauma, skeletal relationships, morphologic malocclusion traits, and mandibular function. At the conclusion of the examination, the orthodontist rated the subjective treatment need as none, elective, recommended, soon, or immediate. For some analyses, the categories were collapsed to represent no need and need. The peer assessment rating (PAR) index (American validated version) was computed from the clinical exam findings and scoring of dental models; PAR scores were used to document malocclusion severity and treatment difficulty. Spearman rank correlation coefficients quantified the relationship between PAR scores and need categories. Logistic regression analysis modeled treatment need using components of the PAR index as well as other variables. The components of these models, as well as sensitivity and specificity, were compared with malocclusion severity/treatment difficulty scores obtained from malocclusion assessments using the PAR index. The five subjective treatment need categories and the PAR index scores were significantly correlated (rho = 0.62, p<0.001). Significant differences were detected between the need and no need groups for all PAR components (p<0.001). PAR index scores and predicted probabilities from logistic regression models performed equally well for classification purposes (no need, need). The data suggest that the PAR index is highly correlated with orthodontists' subjective assessment of treatment need when that assessment is made in the absence of financial considerations and patient desires.

Accidental Exposures to Blood and Other Body Fluids in a Large Academic Medical Center

Healthcare workers' and students' exposures to bloodborne pathogens during a 1-year period (1997) at a large university academic medical center were analyzed. The university health manages the Blood-Borne Pathogen Post-Exposure Control Program at the university and treats all reported exposures of students, faculty, and staff. Comparative exposure rates for all categories of healthcare workers, the work site where injuries occurred, and the circumstances involved in 298 exposure incidents are outlined. A standardized postexposure prophylaxis protocol provides for definition of the health status of all known source patients and assessment of the potential need for treatment of the exposed clinician. Implications of the study for focusing on improvements in training healthcare workers in proper procedures and the use of personal protective equipment in dealing with blood-borne pathogens are discussed.

Awareness of periodontal diseases: the professional and the civil servant

Newly qualified dentists and dental hygienists should have a good level of awareness of periodontal diseases. However, for a variety of reasons this knowledge may not be regularly updated or applied in practice. This paper considers how professional awareness can be influenced by such factors as: maintaining an up to date understanding of the nature of periodontal diseases, the routine use of appropriate screening and examination techniques, factors influencing assessment of treatment need, patient records, continuing professional education and an understanding of patient expectations. It goes on to describe how civil servants may help to stimulate improvements in awareness levels to periodontal diseases by promoting continuing education, epidemiological research and national oral health strategies as well as through legislation and regulation. The paper concludes that although a range of organisations can promote improvements in professional awareness, unless simultaneous efforts are made to improve the awareness of the general public to periodontal diseases, it is difficult to see how there can be an improvement in the periodontal health of the population.

Using Social Indicators to Predict Addiction

Because of cost and other constraints, states often find it difficult to estimate need for treatment of alcohol-related problems from routine surveys. The social undesirability of illegal drug use makes the assessment of need for treatment of their use even more difficult. This paper uses independently obtained treatment need estimates to provide parameters for short-term prediction. We obtained the parameters by regressing the proportions of people addicted to alcohol (or drugs) in counties on social-indicator-based relative treatment need estimates for alcohol (or drugs). In addition to integrating estimates coming from independent sources, our approach presents an important tool for planning and resource allocation.

Orthodontic concern among 11-year-old children and their parents compared with orthodontic treatment need assessed by Index of Orthodontic Treatment Need

The aims of the study were to compare the opinions of both the children and the parents with an orthodontist's assessment of treatment need, to investigate the children's self-esteem, and parents' opinion of treatment results. The study group of 359 children (51% girls, 49% boys, mean age 10.6 years) and their parents were asked about their opinions in separate questionnaires. The self-esteem of the children was measured by the global negative self-evaluation scale (GSE). An orthodontist assessed the children's dental casts with the Index of Orthodontic Treatment Need (IOTN). Allocated to the dental health component (DHC) of lOTN, 53.2% children had very great to moderate need and 46.8% had little to no need. No sex difference was noted. The children's own assessments of the aesthetic component (AC) of lOTN were closer to the attractive end of the scale than the orthodontist's ( p < 0.05). Desire for treatment was more frequent than dissatisfaction with children's occlusion ( p < 0.001). The patients' orthodontic concern correlated significantly with both DHC and AC grades ( p < 0.001). The children's GSE scores were not correlated to components of lOTN. For children with very great need, high self-esteem was related to orthodontic concern. The parents (90.8%) perceived dental esthetics to be equally important for girls and boys. Most parents (93.0%) thought the results of orthodontic treatment were good. The results indicate meaningful association between orthodontic concern and orthodontic treatment need assessed by lOTN. However, some patients with great need do not express orthodontic concern, whereas others with near ideal occlusion express concern. (Am J Orthod Dentofac Orthop 1996;110:197-205.)

Parents' views on their own child's dentition compared with an orthodontist's assessment

A questionnaire was sent to the parents of 261 7-8-year-old children, asking their views on their own child's dental appearance and function, their own dental appearance, history of orthodontic treatment in the family, and the best age for starting orthodontic treatment for children. Parents' opinions were compared with an orthodontist's assessment of treatment need. Parents' anxiety about their child's dentition coincided in 60 per cent with the orthodontist's assessment, agreement being stronger for malocclusions affecting the anterior teeth. The parents regarded the child's dental appearance and function to be good or rather good in 59 and 53 per cent, respectively, with only a few (7 and 9 per cent) regarding it as poor or rather poor. There was a statistically significant association between parents' anxiety and their opinion on the child's dental appearance and function, but no association was found between their anxiety and opinions on their own dental appearance. Most parents thought 7-8 years to be the best age for starting orthodontic treatment. The study indicates that in a dental care system, where children visit their dentist regularly, the parents' awareness of orthodontic problems agrees fairly well with the orthodontist's assessment of treatment need and the parents also seem to accept the concept of early treatment.

Expert Systems in Orthodontic Clinical Diagnosis

Abstract Computer-aided diagnosis of orthodontic anomalies is of particular interest in the screening of potential patients. General practitioners and public dental health workers would find considerable benefit in a reliable automated system capable of reflecting the clinical assessments of orthodontists. This study investigates the application of an expert system (Xpert Rule™) to the assessment of treatment need using thirteen traits of malocclusion to construct a knowledge base. Decision trees were generated using a pruning option available with the expert system. The results of the study are encouraging and suggest that an expert system is able to generate a useful clinical screening device. Further modification of the knowledge base is required to provide a broader range of case types, particularly those of less common occurrence. lt is also suggested that the random aggregation of cases is not the most effective means of developing a knowledge base.

Benefit related assessment of treatment need among institutionalised elderly people.

It has been assumed that improved oral health leads to a better quality of life for elderly people. It is, however, difficult to assess the benefit of oral health care, especially dental treatment in terms of life quality. The normative assessment, based solely on clinical diagnosis, often leads to an overestimation of the true need for treatment, especially among the 'frail elderly', some of whom do not want treatment, either because there is no perceived need or expressed demand. Others are very ill, and some in such a poor mental condition that they can not express any demand for treatment, and would probably not benefit from treatment e.g. new dentures. The realistic treatment need is an attempt to assess the true need for treatment in relation to the benefit provided. It is a combination of the normative need, the self-perceived need, and the expressed demand for treatment, and takes into account the mental and physical state of the individual, as well as ethical considerations.

Recording and measuring malocclusion: A review of the literature

The methods of recording and measuring malocclusion can be broadly divided into two types: qualitative and quantitative. Among the qualitative methods of recording malocclusion, Angle's method of classifying malocclusion with or without modifications is probably the most widely used. The "WHO/FDI Basic Method for Recording of Malocclusion" was published in 1979 to establish an assessment format to determine the prevalence of malocclusion and to estimate treatment needs of a population. Among the many occlusion indices developed by various research workers, the occlusal index developed by Summers appeared to have the least amount of bias, is best correlated with clinical standards and has the highest validity during time. More recently, methods have also been developed to enable assessment of treatment need according to grade index scales. However, experience in using these methods is still very limited.