“Medically necessary” orthodontic care: Challenges and applications
Section snippets
Medicine and dentistry: One and separate?
The schism likely stems from ensconced history and entrenched stakeholders, thus must be considered regarding dentistry in general from a historical depth, and regarding orthodontics specifically within the frame of the discipline itself. Integration, when approached, may be cast in various scenarios.
Pediatric orthodontics
Adhering to the AAO definition would be practical to discern medical necessity in orthodontics. The following two key components emerge from the definition: (1) malocclusion compromising physical, emotional or dental health and (2) treatment by the orthodontist alone or with other providers when indicated. Health issues are approached in this section as they relate to the target of treatment being medically, or orofacially guided.
Defining medically necessary orthodontic care (MNOC)
The discussion of MNOC recalls the question of whether a malocclusion is malformation or malady.21 Orthodontic conditions are inherently of a chronic nature, and do not pose an immediate health risk. Given that severity varies across malocclusions, should medically necessary care be subjected to the evaluation of need, as delineated through various orthodontic malocclusion severity indices [treatment priority index,22 ICON,23 IOTN,24 PAR index,25 ABO discrepancy index (DI),26 Salzman
Conclusions
The issue of health essentially reflects the role of a competent health provider, for any part of the body, in a world where medicine is compartmentalized in various specialties and subspecialties. However, if the goal of medicine is “seeking health,” health is an indivisible concept, despite the specificity of its parts.
Dentistry is a discipline of “medicine” that aims mostly at improving quality of life. Medical necessity was presented in the general context of dentistry being a separate
References (28)
Was the destiny of orthodontics written in the stars?
Am J Orthod Dentofacial Orthop
(2015)Centennial inventory: the changing face of orthodontics
Am J Orthod Dentofacial Orthop
(2015)Reflections on an academic career in teaching and research
Am J Orthod Dentofacial Orthop
(1993)Emerging paradigms in orthodontics- An essay
Am J Orthod Dentofacial Orthop
(1997)Evidence-based therapy: an orthodontic dilemma
Am J Orthod Dentofacial Orthop
(2006)- et al.
Component analysis of Class II, division 1 discloses limitations for transfer to Class I phenotype
Sem Orthod
(2014) - et al.
Monitoring growth during orthodontic treatment
Sem Orthod
(1995) - et al.
Longitudinal evaluation of the treatment Priority Index (TPI)
Am J Orthod Dentofacial Orthop
(1989) - et al.
Comparing and contrasting two orthodontic indices, the Index of Orthodontic Treatment Need and the Dental Aesthetic Index
Am J Orthod Dentofacial Orthop
(1996) - et al.
The ABO discrepancy index: a measure of case complexity
Am J Orthod Dentofacial Orthop
(2004)
Eligibility for publicly funded orthodontic treatment determined by the handicapping labiolingual deviation index
Am J Orthod Dentofacial Orthop
The barber-surgeons of London
Arch Surg
Relative efficacy of oral analgesics after third molar extraction
Br Dent J
Obstructive sleep apnea in children
Am Fam Phys
Cited by (5)
Comparing the Salzmann Index to automatic qualifying conditions when selecting medically necessary orthodontic patients
2023, American Journal of Orthodontics and Dentofacial OrthopedicsThe Salzmann Index and discrepancy index correlation: Determining a threshold discrepancy index score for Medicaid approval
2021, American Journal of Orthodontics and Dentofacial OrthopedicsWays and pathways of global orthodontic postgraduate education
2020, Seminars in OrthodonticsCitation Excerpt :Is orthodontic treatment medically necessary? ( Fig. 3) The response is affirmative considering the orthodontic association with growth modification, respiratory problems and their consequences in children, bone generation for restorative procedures (essentially tissue engineering), the orthodontist's pivotal role in sleep apnea and craniofacial anomalies teams, temporomandibular dysfunction treatment, the potential effect on gastrointestinal health of malocclusion-related masticatory function, and even the psychological impact of malocclusion.27–29 Some of these topics are common to hospital-based programs and are integrated in their curricula.
COVID-19 Has Clarified 2 Foundational Policy Questions in Dentistry
2020, JDR Clinical and Translational ResearchBarriers to the use of dental services by children in lebanon and association with parental perception of oral health care
2020, Eastern Mediterranean Health Journal