Friday, August 12, 2011

Orthodontic treatment increased nearly 50%. Why? Marketing?

From the Wall Street Journal- November 16, 2010
by  Nancy Keates at

The number of children 17 and younger getting orthodontic treatment has grown 46% over the past decade to 3.8 million in 2008,... figure available from the American Association of Orthodontists
The association doesn't break the number down further by age, but Lee W. Graber, the Association's president, estimates that in his own practice 15% to 20% of the 7- to 10-year-olds he sees get treatment.
"Fifteen years ago we rarely saw kids until they were teenagers," Dr. Graber says...
In the U.S., the shift to earlier treatment dates back to around 1990, the year the orthodontists association began encouraging the screening of 7-year-olds, with magazine ads and videos aimed at parents. Better diagnostic technology also has led to more early treatment. Increased insurance coverage has played a role, too...
[ Basically saying a market was created to rake in the dough?  Shocking! 
Question: Who created the market?  Answer: The American Association of Orthodontists. 
Question: Who convinced insurance companies to increase their coverage?  Answer: The AAO?  Question: How did they convince insurance companies to start picking up more of the tab? Answer: False or misleading information, junk science? 

Same questions to go out to Medicaid. ]

Since 1990, three randomized clinical trials—at the University of Florida involving 261 children, at the University of North Carolina involving 166 children and at the University of Manchester, England, involving 174 children—found early treatment of Class II Malocclusions was less efficient than treatment that began in adolescence. 

In a two-phase, 10-year study published in 1998 and 2004, the North Carolina researchers found about 75% of patients treated early with either headgear or a functional appliance, like braces, showed improvement. But after a second phase of fixed-appliance treatment for both the previously treated patients and untreated controls, the researchers found early treatment had little effect on treatment outcomes (measured as skeletal change, alignment and occlusion of teeth) or on the length and complexity of treatment.

"There is no doubt about this conclusion," says Gregory King, professor of orthodontics at the University of Washington, Seattle. "It is no more effective to do it early than later. You end up in the same place."
...Kate Heald, a 39-year-old mother in Natick, Mass., was shocked when the orthodontist said her daughter Rose, then seven, should get braces. "We hadn't seen any second-graders walking around with braces at her school," Ms. Heald says. Rose had crowding and an overbite, causing her teeth to stick out a little.
...After three days in the braces, Rose's teeth started to look better, Ms. Heald says. After 10 months, including treatment with a semi-permanent wire,and a cost of about $3,500, Ms. Heald says Rose's teeth are lined up perfectly. But the orthodontist says her daughter will probably need braces again in adolescence. "It's not your profession. You want them to have a beautiful smile," Ms. Heald says. "But it seems crazy to make them go through it twice."...

...Michelle Parven, 41, an art teacher also from Natick, Mass., says her son Will was in third grade when he was referred to an orthodontist located in the same office as his dentist. The orthodontist recommended braces. "I thought, 'Isn't that awfully young?' " Ms. Parven recalls. One year later, she got a second opinion. An orthodontist told her Will had an underbite and should get a palatal expander; he would need braces again at around 13, for a total cost of about $3,000. "I feel like orthodontics is a money maker and some take advantage of that," Ms. Parven says, adding she is happy she went with the second recommendation....
The article also mentions orthodontists feel pressured to treat early since,  "We aren't trying to grab business," says Cynthia Beeman, associate professor of orthodontics at the University of Kentucky College of Dentistry in Lexington. "It is in the culture now that kids want to look like celebrities."

[Well, which is it?  Is it because a market was created by the organization/lobbyist or are parents really beating down the door wanting in? Both?  More of one or the other?  Who knows! But something is not passing the smell test here.  See Byron Harris' report out of Texas on this very subject.]

Read the full WSJ article here

From the same article:

A Skeptical Parent's Guide to Orthodonture

Don't be shocked if your first-grader is referred to an orthodontist. Here's a glossary of some common appliances and treatments.
Palatal Expander
What It's For: A severe crossbite. Patients whose upper jaw isn't wide enough for the lower jaw.
What It Does: Widens the upper jaw so upper teeth line up better with lower teeth. Also allows teeth to straighten out, with or without braces, keeping more of the adult teeth intact. Expanders are either permanently fixed in the mouth for several months, or they are removable. When turned with a key, a screw in the center of the expander puts gradual outward pressure on the upper jaw's left and right halves, causing more bone to grow between the two halves. Side effects may include pain if turned too aggressively, headache, excess saliva and temporary speech impediments, such as lisps and garbling.
Early Treatment? In some cases. Studies indicate there's a strong argument for early treatment when the desired shift in the jaw is lateral. When the desired shift isn't lateral, treatment can wait until closer to adolescence. Also, in many cases an expander to reduce crowding can wait. Braces may still be needed later; an orthodontist can't know until permanent teeth come in.
Cost: $1,100 to $3,000 (sometimes the fee includes braces if needed later)
What They're For: An anterior crossbite, when one or more teeth on top are behind teeth on the bottom (an underbite); buck teeth (an overbite); crooked teeth; spacing.
What They Do: Move teeth. Kids with baby teeth who get braces usually get what's called "two by four"—braces on the first permanent molars in the back and the four incisors in the front, resulting in two bands and four brackets. Sometimes additional teeth are included in the braces to give more support for tooth movement.
Early Treatment? In some cases. Studies indicate early treatment with braces is effective for anterior crossbites and helps prevent damage to teeth and supporting structures. But for overbites, early treatment is no more effective than waiting for the adult teeth tocome in and treating all at once. Orthodontists, though, say there may be psychological reasons for treating early.
Cost: $900 to $5,000
What It's For: To correct an overbite or buck teeth.
What It Does: Pushes upper teeth back; prevents upper jaw from growing forward by holding upper teeth and jaw while lower jaw grows. It's usually worn 10 to 14 hours a day for one to 12 months.
Early Treatment? Not usually. Studies indicate no measurable benefit from early treatment of this type.
Cost: $2,000 to $4,000
Face Mask
What It's For: A severe anterior crossbite, or underbite with the lower jaw outgrowing the upper jaw
What It Does: Sometimes called a "reverse pull headgear," it pulls the jaw and teeth forward to encourage growth of the upper jaw. It looks a little like a catcher's mask, with a face frame and a head cap that are attached by rubber bands or elastics. It's usually worn 14 to 16 hours a day for 12 to 18 months.
Early Treatment? Yes. There is strong evidence that this can make the jaws more even when used while the patient's jaw is still growing and can help avoid surgery later.
Cost: $2,000 to $4,000
What It's For: Severe crowding
What It Does: Serial extraction involves pulling baby teeth to speed up the eruption of permanent teeth, usually the pre-molars, which will ultimately be pulled out as well. It eases the entry of adult teeth and in most cases braces will be needed.
Early Treatment? Yes.
Cost: $200 to $500
Source: Cameron Jolley, WSJ reporting. Prices include care by the orthodontist and cost of appliances