TREATMENT DIFFICULTY AND TREATMENT OUTCOME IN ORTHODONTIC CARE

The influence of perceived treatment difficulty on the outcome of and investment in orthodontic treatment was studied in 19-year-old individ uals treated by general practitioners or specialists within the totall y subventioned Swedish system for orthodontic care. A total of 313 ind ividuals were evaluated according to treatment outcome and treatment i nvestment. About one-quarter of the treatments evaluated were classifi ed as easy, one-quarter as moderately difficult, and one-half as diffi cult. The perceived treatment difficulty was on a group basis associat ed with the pretreatment need. The treatment outcome became less favou rable and the treatment investment more expensive the-greater the perc eived difficulty. More than one-quarter of the treatments provided by general practitioners were classified as difficult compared with th re e-quarters of those provided by specialists. The outcomes were, in gen eral, more favourable for specialist treatments than for those provide d by general practitioners, although the individuals treated by specia lists, on the average, were classified as more difficult than those pr ovided by general practitioners. Easy treatments were found to be extr emely cost-effective and should be carried out when possible. General practitioners should preferably treat uncomplicated cases, and an incr eased use of fixed appliances would be desirable in the treatment of m oderately difficult treatments. Difficult cases should be treated excl usively by specialists. Cases with little need or benefit of treatment , or a poor prognosis should be given low treatment priority, and pati ents and parents should in these cases be informed about the small exp ected benefit and risks involved.