Theis Jeff E, Huang Greg J, King Gregory J, Omnell M Lena
Department of Orthodontics, University of Washington, Seattle, WA 98195, USA.
Am J Orthod Dentofacial Orthop. 2005 Dec;128(6):708-15. doi: 10.1016/j.ajodo.2004.10.012.
Access to orthodontic care for Medicaid patients has been limited, in part because of orthodontists' reluctance to treat severe malocclusions for low reimbursements. Limited orthodontic treatment in the mixed dentition (phase 1 treatment) has been proposed to address this issue, because the intent of phase 1 treatment is to improve or prevent severe malocclusions. Orthodontists might be more willing to provide shorter, simpler treatment. The purpose of this study was to determine whether phase 1 treatment would reduce malocclusion severity to the extent that eligibility for subsequent Medicaid-funded treatment was significantly reduced.
Eligibility was determined by the handicapping labiolingual deviation (HLD) index, which is used by several states for this purpose. Eligibility was also determined with the index of complexity, outcome, and need (ICON). This allowed us to compare these 2 indexes. Pre-phase 1 and post-phase 1 index scores were calculated by using study casts from 193 patients treated at the University of Washington orthodontic clinic and the Odessa Brown Children's Dental Clinic, both in Seattle.
Using the HLD index, we found that eligibility for orthodontic treatment decreased by 62% after phase 1 treatment. This change was statistically significant at P < .0001. The ICON found significantly more treatment need before phase 1 (90%) than did the HLD index (35%) (P < .0001).
Early interceptive treatment significantly reduces eligibility for comprehensive Medicaid-funded orthodontic treatment. The HLD index is a useful tool for determining Medicaid eligibility.
医疗补助患者获得正畸治疗的机会有限，部分原因是正畸医生不愿因低报销费用而治疗严重错颌畸形。有人提出在混合牙列期进行有限的正畸治疗（第一阶段治疗）来解决这个问题，因为第一阶段治疗的目的是改善或预防严重错颌畸形。正畸医生可能更愿意提供更短、更简单的治疗。本研究的目的是确定第一阶段治疗是否会将错颌畸形的严重程度降低到显著减少后续医疗补助资助治疗资格的程度。
资格由妨碍性唇舌向偏差（HLD）指数确定，有几个州为此使用该指数。还使用复杂性、结果和需求指数（ICON）来确定资格。这使我们能够比较这两个指数。通过使用来自西雅图华盛顿大学正畸诊所和敖德萨·布朗儿童牙科诊所接受治疗的193名患者的研究模型，计算第一阶段治疗前和治疗后的指数得分。
使用HLD指数，我们发现第一阶段治疗后正畸治疗资格下降了62%。这一变化在P <.0001时具有统计学意义。ICON发现第一阶段治疗前有治疗需求的患者比例（90%）比HLD指数（35%）显著更高（P <.0001）。
早期阻断性治疗显著降低了获得医疗补助全面资助正畸治疗的资格。HLD指数是确定医疗补助资格的有用工具。
