Early screening for orthodontic treatment Differences in assessments made by a consultant orthodontist and three public health dentists

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Abstract
The aim of the present study was to compare the differences in the assessments of occlusal and functional features, the need for and timing of orthodontic treatment and the complexity of treatment made by a consultant orthodontist and three public health dentists. The data comprised the examinations of 260 children aged 7-8 yr (87% of total age group of the community) attending the first grade of primary school in a medium-sized town in eastern Finland. The examinations were carried out according to agreed criteria. The main indications for treatment were Class II malocclusion, lateral crossbite and crowding. When assessing treatment need, agreement between the orthodontist and the three dentists was fairly good (agreement in 69%, Kappa statistic 0.51), sensitivity for each dentist ranged from 0.86 to 0.97 and specificity from 0.72 to 0.92. The agreement on the timing of treatment was poor (agreement in 49%, Kappa statistic 0.18). In most cases of disagreement, the dentists would begin the treatment earlier than the orthodontist. The agreement on the complexity of treatment was rather poor (agreement in 61%, Kappa statistic 0.22). In most cases of disagreement, the treatment was regarded as more complex by the orthodontist than by the dentists. When dentists work with a consultant orthodontist, it seems justified to have the dentist screen the children at the age of 7-8 yr for early orthodontic treatment, but the orthodontist should assess the timing and complexity of treatment.