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Using teledentistry to provide interceptive orthodontic services to disadvantaged children

https://doi.org/10.1016/j.ajodo.2007.12.023Get rights and content

Introduction

Socially disadvantaged children have limited access to orthodontic services. We examined the feasibility of a general dental practitioner providing interceptive orthodontic services to disadvantaged children with real-time supervision from an orthodontist using teledentistry.

Methods

Pretreatment and posttreatment orthodontic study models of 30 children treated by a general dentist using teledentistry and 96 children treated by orthodontic residents directly supervised by orthodontic faculty were scored with the peer assessment rating (PAR) index.

Results

Both groups had significant improvements in PAR scores: 35.6% in the teledentistry group and 44.1% in the direct supervision group (P <0.001). There were no significant differences between the groups before treatment or after interceptive orthodontic treatment.

Conclusions

The results of this study suggest that interceptive orthodontic treatments provided by sufficiently prepared general dentists and supervised remotely by orthodontic specialists through teledentistry are a viable approach to reducing the severity of malocclusions in disadvantaged children when referral to an orthodontist is not feasible.

Section snippets

Material and methods

This was designed as a case-control series study: 1 group of subjects was treated at the Yakima Valley Farm Workers Clinic (YVFWC) in Toppenish, Washington, and the other was treated at the Odessa Brown Children's Clinic (OBCC) in Seattle, Washington. Both groups had similar selection criteria, treatment protocols, and outcome measures. The OBCC sample represented all consecutively completed interceptive orthodontic patients from 1998 to 2003 who had pretreatment and posttreatment models. The

Results

Demographically, the patient populations from the 2 sites were similar with respect to sex and overjet but had differences in ethnicity, Angle classification, age at the start of treatment, and overbite (Table I). The split by sex represented the usual orthodontic patient population, with slightly more girls than boys. The ethnicities in the OBCC group reflected the urban clientele at this clinic: mainly black but also Asian, white, and Hispanic patients. In contrast, the YVFWC group was almost

Discussion

The prevalence of malocclusion is high in socially disadvantaged children between the ages of 8 and 12.1, 17 Interceptive orthodontics have been shown to be an effective means to reduce the severity of malocclusions in that age range by using simple and inexpensive approaches.5, 6, 7 In rural areas, the need for orthodontic care is high3; often specialized orthodontic services are rare, inconvenient, or totally unavailable,18 and uptake is low.19 Providing specialized dental expertise to

Conclusions

In spite of some unavoidable limitations in comparability between the groups, interceptive orthodontic treatment supervised remotely through teledentistry was shown to be a promising approach to reducing the severity of malocclusions in disadvantaged children when referral to an orthodontist was not feasible. Although, in most cases, patients who receive interceptive orthodontic treatment would benefit from further treatment in the permanent dentition, these interventions lessen the severity of

References (27)

  • W.R. Proffit et al.

    Prevalence of malocclusion and orthodontic treatment need in the United States: estimates from the NHANES III survey

    Int J Adult Orthod Orthognath Surg

    (1998)
  • M.K. Vakiparta et al.

    Orthodontic treatment need from eight to 12 years of age in an early treatment oriented public health care system: a prospective study

    Angle Orthod

    (2005)
  • K. al Nimri et al.

    Interceptive orthodontics in the real world of community dentistry

    Int J Paediatr Dent

    (2000)
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    Funded by the Northwest/Alaska Center to Reduce Oral Health Disparities and the National Institute of Dental and Craniofacial Research (Grant U54 DE14254).

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