The impact of treatment cost on low SES families: an orthodontic viewpoint


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Australasian Orthodontic Journal

Australian Society of Orthodontists

Subject: Dentistry, Orthodontics & Medicine


ISSN: 2207-7472
eISSN: 2207-7480





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VOLUME 35 , ISSUE 1 (May 2019) > List of articles

The impact of treatment cost on low SES families: an orthodontic viewpoint

Lee Smith * / Hannah Jack / Joseph Antoun / Peter Fowler / Keely Blanch / Lyndie Foster Page

Citation Information : Australasian Orthodontic Journal. Volume 35, Issue 1, Pages 13-20, DOI:

License : (CC BY 4.0)

Published Online: 20-July-2021



Background: It is reported that in New Zealand financially disadvantaged adolescents are less likely to access orthodontic treatment than the more affluent in society.

Objectives: The aim of the study was to investigate the attitudes of a group of New Zealand orthodontists towards the current fee-for-service model of treatment funding. A second aim was to explore orthodontists’ perceptions of how the affordability of orthodontic treatment affects low socio-economic families.

Methods: As part of the project, 11 volunteer orthodontists were interviewed. A subsequent content analysis of the collected data was performed.

Results: Most participants reported that parents would feel inadequate if they were unable to secure orthodontic treatment for their child; however, some participants also indicated that it was common for parents to ‘go without’ to fund their child’s treatment. Most participants maintained that the government should only fund treatment for severely disabling malocclusions but not other treatments due to the limited health budget and orthodontic treatment being primarily considered for aesthetic reasons. Some participants reported that if the government funded orthodontic treatment, it would result in over subscription and compromised standards of care.

Conclusion: Despite some low socio-economic families being unable to access orthodontic treatment because of the expense, the current fee-for-service model may be the best method for delivering high standards of orthodontic care.

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1. Perillo L, Esposito M, Caprioglio A, Attanasio S, Santini AC, Carotenuto M. Orthodontic treatment need for adolescents in the Campania region: The malocculsion impact on self-concept. Patient Prefer Adherence 2014;8:353-9.

2. Dimberg L, Arnrup K, Bondemark L. The impact of malocclusion on the quality of life among children and adolescents: a systematic review of quantitative studies. Eur J Orthod 2015;37:238-47.

3. Basha S, Mohamed RN, Swamy HS, Parameschwarappa P. Untreated gross dental malocclusion in adolescents: Psychological impact and effect on academic performance in school. Oral Health Prevent Dent 2016;14:63-9.

4. Peres SH, Goya S, Cortellazzi KL, Ambrosano GM, Meneghim Mde C, Pereira AC. Self perception and maloccclusion and their relation to oral appearance and function. Cien Saude Colet 2011;126:4059- 66.

5. Joshi N, Hamdan A, Fakhouri WD. Skeletal malocclusion: a developmental disorder with a life-long morbidity. J Clin Med Res 2014;6:399-408.

6. English JD, Buschang PH, Throckmorton GS. Does malocclusion affect masticatory performance. Angle Orthod 2002;72:21-7.

7. Chen V, Foster Page L, McMillan J, Lyons K, Gibson B. Measuring the attitudes of dental students towards social accountability following dental edcation - qualitative findings. Med Teach 2016;38:599-606.

8. Feu D, Oliveria BH, Celeste RK, Miguel JA. Influence of orthodontic treatment on adolescents’ self-perceptions of esthetics. Am J Orthod Dentofacial Orthop 2012;141:743-50.

9. Marriot A, Harding W, Devlin N, Benwell G. The delivery of orthodontic care in New Zealand. Part 1: Analysis of a census of orthodontists. N Z Dent J 2001;97:87-92.

10. Smith L, Wong L, Phemister L, Blanch K, Jack H, Fowler P et al. “Why, why, why do I have such big teeth, why?”: Low socioeconomic status and access to orthodontic treatment. N Z Dent J 2018;114:64-72.

11. Healey DL, Gauld RD, Thomson WM. The socio-demographic and malocclusion characteristics of adolescents presenting for specialist orthodontic treatment in New Zealand practices. Aust Orthod J 2015;31:20-5.

12. Foster Page LA, Thompson WM. Malocclusion and uptake of orthodontic treatment in Taranaki 12-13-year-olds. N Z Dent J 2005;101:98-105.

13 Ukra A, Foster Page LA, Thomson WM, Farella M, Tawse Smith A, Beck V. Impact of malocclusion on quality of life among New Zealand adolescents. N Z Dent J 2013:18-23.

14. Benson PE, Da’as T, Johal A, Mandall NA, Williams AC, Baker SR et al. Relationships between dental appearance, self-esteem, socioeconomic status, and oral health-related quality of life in UK school children: A 3-year cohort study. Eur J Orthod 2015;37:481-90.

15. Drugan CS, Hamilton S, Naqvi H, Boyles JR. Inequality in uptake of orthodontic services. Br Dent J 2007;202:E15; discussion 326-7.

16. Thomas DR. A general inductive approach for analyzing qualitative evaluation data. Am J Eval 2006;27:237-46.

17. Maykut P, Morehouse RE. Beginning qualitative research: A philosophical and practical guide. London: Falmer Press; 1994.

18. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health 2000;23:334-40.

19. Breistein B, Burden DJ. Equity and orthodontic treatment: a study among adolescents in Northern Ireland. Am J Orthod Dentofacial Orthop 1998;113:408-13.

20. Kazancı F, Aydoğan C, Alkan Ö. Patients’ and parents’ concerns and decisions about orthodontic treatment. Korean J Orthod 2016;46:20-6.

21. Krey KF, Hirsch C. Frequency of orthodontic treatment in German children and adolescents: influence of age, gender, and socioeconomic status. Eur J Orthod 2012;32:152-7.

22. dos Santos PR, Meneghim MC, Ambrosano GM, Filho MV, Vedovello SA. Influence of quality of life, self-perception, and self-esteem on treatment need. Am J Orthod Dentofacial Orthop 2017;151:143-7.

23. Johal A, Cheung MY, Marcene W. The impact of two different malocclusion traits on quality of life. Br Dent J 2007;202:E2.

24. Fazwan A. Reasons for seeking orthodontic treatment in Qassim region: A pilot study. International Dental Journal of Student’s Research 2002;1:58-62.

25. Tu D, Newcomb R, Edwards R, Walton D. Socio-demographic characteristics of New Zealand adult smokers, ex-smokers and nonsmokers: results from the 2013 Census. N Z Med J 2016;129:43-56.

26. Chestnutt IG, Burden DJ, Steele JG, Pitts NB, Nuttall NM, Morris AJ. The orthodontic condition of children in the United Kingdom, 2003. Br Dent J 2006;200:609-12.

27. Brunelle JA, Bhat M, Lipton JA. Prevalence and distribution of selected occlusal characteristics in the US population, 1988–1991. J Dent Res 1996;75:706-13.

28. Tan A, Bennani F, Thomson WM, Farella M, Mei L. A qualitative study of orthodontic screening and referal practices among dental therapists in New Zealand. Aust Orthod J 2016;32:155-64.

29. McGuiness NJ. Orthodontic evolution: An update for the general dental practitioner. Part 2: psychosocial aspects of orthodontic treatment, stability of treatment, and the TMJ-orthodontic relationship. J Ir Dent Assoc 2008;54:128-31.

30. Horton E. Neoliberalism and the Australian healthcare system (factory). Conference of the Philosophy of Education Society of Australasia; Wellington 2007.