Elsevier

Seminars in Orthodontics

Volume 22, Issue 3, September 2016, Pages 167-176
Seminars in Orthodontics

“Medically necessary” orthodontic care: Challenges and applications

https://doi.org/10.1053/j.sodo.2016.05.003Get rights and content

Medicine targets health in issues of saving life and improving quality of life. Most orthodontic procedures deal with the latter goal. Medical necessity is presented within the scope of pediatric orthodontics, stratified in medically guided treatment, when orthodontic procedures contribute to the correction of a systemic problem, whether or not associated with a local orofacial problem (respiration and sleep disorders, emotional problems, and hospital calls); and orofacial-guided treatment, when addressing growth matters, craniofacial anomalies, and orofacial functions (mastication, understandable speech, and temporomandibular pain). Medical necessity that may involve the care of the orthodontist alone or in a medical team, also brings up the issue of separation between dentistry and medicine, at educational and various operational levels, posing a challenge regarding their integration in the context of health being indivisible.

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)

  • J.E. Theis et al.

    Eligibility for publicly funded orthodontic treatment determined by the handicapping labiolingual deviation index

    Am J Orthod Dentofacial Orthop

    (2005)
  • J.O. Robinson

    The barber-surgeons of London

    Arch Surg

    (1984)
  • J. Barden et al.

    Relative efficacy of oral analgesics after third molar extraction

    Br Dent J

    (2004)
  • J. Chan et al.

    Obstructive sleep apnea in children

    Am Fam Phys

    (2004)
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