Access to orthodontic care for Medicaid patients has been limited, in part because of orthodontists' reluctance to treat severe malocclusions for low reimbursements. Limited orthodontic treatment in the mixed dentition (phase 1 treatment) has been proposed to address this issue, because the intent of phase 1 treatment is to improve or prevent severe malocclusions. Orthodontists might be more willing to provide shorter, simpler treatment. The purpose of this study was to determine whether phase 1 treatment would reduce malocclusion severity to the extent that eligibility for subsequent Medicaid-funded treatment was significantly reduced.
Eligibility was determined by the handicapping labiolingual deviation (HLD) index, which is used by several states for this purpose. Eligibility was also determined with the index of complexity, outcome, and need (ICON). This allowed us to compare these 2 indexes. Pre-phase 1 and post-phase 1 index scores were calculated by using study casts from 193 patients treated at the University of Washington orthodontic clinic and the Odessa Brown Children's Dental Clinic, both in Seattle.
Using the HLD index, we found that eligibility for orthodontic treatment decreased by 62% after phase 1 treatment. This change was statistically significant at P < .0001. The ICON found significantly more treatment need before phase 1 (90%) than did the HLD index (35%) (P < .0001).
Early interceptive treatment significantly reduces eligibility for comprehensive Medicaid-funded orthodontic treatment. The HLD index is a useful tool for determining Medicaid eligibility.
"In countries where orthodontic treatment is subsidized to some extent by public funding, different indices are used to determine eligibility for such treatment ( Järvinen, 2001 ; Mandall et al. , 2005 ; Theis et al. , 2005 ). Whether these indices select the same patients or not, is an important question. "
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the association between self-perceived orthodontic treatment need and malocclusion in 12 to 13-year-old-adolescents of Swedish and immigrant background. The sample consisted of 379 students, stratified according to geographic background: both parents born in A/Sweden (n=269), B/Eastern Europe (n=56), and C/the Middle East (n=54). Registrations were based on a questionnaire, a clinical examination, radiographs, and patient records. Treatment need was classified according to the Dental Health Component (DHC) of the Index of Orthodontic Treatment Need (IOTN). Logistic regression analysis was used for comparison of the results. There was a strong association between subjects who thought that they needed an orthodontic appliance and IOTN-DHC grades 4 and 5, an anterior crossbite, those who avoided smiling because of their teeth, and those who considered their teeth to be somewhat worse or much worse than those of their peers. The self-perceived need for orthodontic treatment was significantly (P<0.05) higher in the Swedish than in the eastern European group.
The European Journal of Orthodontics 12/2008; 31(1):95-102. DOI:10.1093/ejo/cjn069 · 1.48 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In this paper we have proposed novel wavelet-based texture image retrieval and digital image watermarking techniques. For texture image retrieval we have used standard deviation and energy as a feature measure and Canberra distance metric as dissimilarity measure. Large texture database of 1856 images is used to check the retrieval performance. Proposed retrieval method is far superior to the traditional method, which uses wavelet coefficients energy as a feature and Euclidean distance metric as dissimilarity measure. We have proposed two watermarking algorithms. In first proposed method a binary seal is embedded into the region of interest. This method is robust against lossy compression, distortion due to noise and cropping. In second algorithm spread spectrum technique is used to embed the watermark. This method is robust against median filtering and scaling.
Information, Communications and Signal Processing, 2003 and the Fourth Pacific Rim Conference on Multimedia. Proceedings of the 2003 Joint Conference of the Fourth International Conference on; 01/2004
[Show abstract][Hide abstract] ABSTRACT: A survey was conducted in 2006 to determine, on a state-by-state basis, the availability of Medicaid-funded orthodontic treatment and, when available, the criteria and the funding rates.
All 50 states were contacted by e-mail, telephone, or standard mail to obtain answers to the following questions. Does your state provide Medicaid coverage for orthodontic services? What qualifications are required to be reimbursed? What is the patient cutoff age for reimbursement of services? Is an index used to assess malocclusion? If so, which index? What is the primary training of the reviewer? How are services reimbursed? Is limited treatment covered? Is interceptive treatment covered? What is the total amount reimbursed for 24 months of treatment for comprehensive adolescent care?
Wide variations of responses were received from the states, with no statistical significance between any questions based on geographic regions or reimbursement rates, although some trends appeared to exist.
This study provides state-by-state details of Medicaid programs for orthodontic services and details the extensive variations in programs.
American journal of orthodontics and dentofacial orthopedics: official publication of the American Association of Orthodontists, its constituent societies, and the American Board of Orthodontics 01/2008; 132(6):728.e1-8. DOI:10.1016/j.ajodo.2007.05.011 · 1.38 Impact Factor
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