A social perspective on need and demand for orthodontic treatment.

In addition to needs fostered by actual physical disabilities resulting from malocclusion, need and demand for orthodontic treatment may develop entirely apart from any consideration of health needs. In fact, improvement of physical function is not the primary motivation of many persons who receive orthodontic care. A variety of social factors are related to perceived needs for acceptable dentofacial appearance and to public demand for orthodontic services. Since early times human teeth have been the object of mutilations to satisfy sociocultural expectations. The mutilation, and even removal of teeth, to achieve dental cultural norms in, so-called, primitive societies may appear barbaric to an ethnocentric society. However, a significant sociocultural need can be met equally by the African or Brazilian who has had teeth filed to a point and by the Western adolescent who having had four teeth surgically removed to provide space in the arch then undergoes two years of orthodontic therapy to reposition and straighten the remaining teeth. From a sociological point of view, the need and desire of members of a society to achieve a culturally acceptable body image constitutes neither frivolity nor luxury. If children's teeth do not naturally meet the norm for esthetic dental appearance, the response of families to sociocultural expectations and pressures produces a culturally valid need for orthodontic intervention. Other social factors affecting perceived need and demand for orthodontic care are socioeconomic, desire for upward social mobility, and social change with regard to public attitudes toward the availability of dental health services and the increasing removal of financial barriers. Potential changes in present US orthodontic practice may be required if care is to be delivered to significantly larger segments of the population.