An Evaluation of the HLD Index as a Decision-Making Tool

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Abstract
The index of handicapping labio-lingual deviations (HLD index) is a composite occlusal index intended to assist the dental program administrator to identify children with "handicapping" malocclusions. To evaluate its use for this purpose, the distributions of HLD index scores were determined for 2 groups of children previously judged to have (or not to have) "handicapping" malocclusions on the basis of clinical evaluation by orthodontists. The distributions of HLD scores in the 2 groups were greatly overlapped. Somewhat better separation of the distributions was achieved by the assignment of weighting constants to each of 5 component measurements of the HLD index, using the linear discriminant function model. With the clinical judgment as the standard, decisions made with this weighted index resulted in the "misclassification" of about 20% of the children when the decision point was selected to equalize false-positive and false-negative classifications. The clinician''s concept of "handicapping," although undefined, may involve factors that cannot be mathematically simulated by a linear function of HLD index component scores.

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