Committee Reports > List of Committees > Dáil > 1985 > Committee of Public Accounts > Final Report - Appropriation Accounts 1988

APPENDIX 20

22 Eanair, 1985.

SECONDARY CARE ORTHODONTIC TREATMENT

A Chara,

1. It was indicated in this Department’s letter of 20 Mean Fómhair 1984, concerning payment for specialist orthodontic treatment by fixed appliances that guidelines in relation to the provision of orthodontic treatment would be issued.

2. This matter was dealt with previously in the Department’s letter (M102/471) of 20 Nollaig 1979. It was stated then that the experience in many countries was that where an orthodontic service was provided free of charge the demand for treatment exceeded the real need. This continues to be the case. There is evidence of a similar trend in this country with personal appearance rather than considerations of health or function appearing to form the basis for the demand for orthodontic treatment by a large proportion of patients and their parents. In this connection it must be borne in mind that an association between certain types of dental malocclusion and oral ill-health has not been established. There is no evidence, for instance, that some less severe malocclusions of the teeth have a detrimental effect on oral health if not corrected. Many permutations of orthodontic deviation are, in fact, compatible with both acceptable function or aesthetics. It is therefore very necessary to distinguish between demand for treatment and the need for it.

3. Specialist orthodontic treatment is costly and a number of courses of necessary routine dental treatment can be provided for every orthodontic case undertaken. Unless some control is exercised in relation to the selection of patients for specialist orthodontic treatment an unacceptably high proportion of the limited resources available for dental services generally can be devoted to orthodontics. In this connection dental health status is important. Patients should be free of untreated dental caries with all lesions satisfactorily restored and they should be free from active gingivitis and periodontitis. Prior to the commencement of therapy patients and their parents should be assessed to ensure their understanding of the need to comply with the instructions of the orthodontist and to co-operate fully for the entire period of treatment.

4. The following criteria should be applied in assessing degrees of priority of need for specialist orthodontic treatment on the basis of degree of handicap and severity of malocclusion (the categories are listed in decreasing order of priority)—

A.Patients with cleft palate and/or cleft lip, or with oral pathology, or with an orthognathic surgery requirement.

B.Patients with extreme handicapping malocclusions.

(A malocclusion is extreme and handicapping when—

(i)the horizontal overjet is equal to or greater than 10 mm,

(ii)in the case of inferior protrusion there is a marked discrepancy in the relationship of the apical bases of maxillary and mandibular incisor segments of the jaws,

(iii)there is a deep overbite characterised by the incisors of one jaw not only touching but also traumatising the gingiva or palatal mucosa of the opposite jaw when the teeth are in occlusion,

(iv)there is an open bite or severe cross bite with markedly reduced chewing ability, i.e. occlusal contact on four teeth or less.)

C.Patients with non-handicapping malocclusions associated with a definite treatment need, i.e. patients other than those in categories A and B—

(i)whose mastication and speech is affected or is likely to be affected because of the presence of malocclusion,

(ii)in whom other structures of the mouth are being damaged or are likely to be damaged because of the presence of malocclusion,

(iii)whose malocclusions are of such extent and type that disease prevention considerations constitute definite need of treatment.

5. Health boards will in future be asked to furnish figures of expenditure on specialist orthodontic treatment in each of the three priority categories at A, B and C of paragraph 4 with their annual statistical returns for dental services.

6. The guidelines set out in this letter are not intended to interfere with the customary provision of primary care orthodontic treatment by health board dental surgeons but in this area also it is necessary to monitor the use of resources carefully to ensure that the proportion of the total available which is consumed is not unduly high.

Mise le meas,

To each C.E.O.