Appalachia Sees Disparities in Orthodontic Treatment Completion

Dentistry Today


Only half of the orthodontia patients in Appalachia can complete their treatment, including braces, bite plates, and retainers, which typically costs between $3,000 and $8,000, according to the West Virginia University School of Dentistry. But by more accurately predicting which patients may have more difficulty sticking with treatment, researchers there believe dentists and orthodontists can intervene.

An examination of five years of data from a general dentistry office in rural West Virginia and revealed patterns in who did or didn’t complete treatment. Of the 219 patients whose treatment plans and follow-ups were reviewed, only 49.8% completed their course of treatment. Method of payment was the most reliable predictor of treatment completion.

Nearly three-fourths of patients who paid out of pocket finished their treatment, while only a third of patients using private insurance, Medicaid, or the Children’s Health Insurance Program (CHIP) completed treatment. Other variables such as age, gender, distance traveled, the type of bite misalignment, and length of treatment also were investigated. None correlated to completion of treatment. Culture may play a role in the disparity, the researchers believe.

“There are certain attributes that people have in rural Appalachia, and I’m one of them,” said researcher Chris Martin, DDS, MS, professor of orthodontia. “God, country, family, loyalty, dedication, self-reliance, and perseverance.”

These traits may be positive, Martin said, but they also may encourage people to depend only on themselves and their families, discouraging them from seeking and completing the treatment recommended by their dentists and orthodontists. Also, patients who rely on Medicaid and CHIP may face the additional barriers of not being able to take time off from work, afford childcare, or have access to reliable transportation. 

“It’s not uncommon to have an in-law, sibling, or grandparent drive the patient to the office,” said Martin.

On average, patients in the study drove 38.8 miles one way to reach their provider’s office.

“Oftentimes, people with Medicaid have to travel longer distances to get dental care and orthodontic care,” said Daniel McNeil, PhD, a clinical psychologist and professor of dental practice and rural health. “Think about how difficult it is, particularly when you combine that with, say, the winter weather if you’re trying to travel a long distance in February.”

Poor oral hygiene, missed appointments, and frequently broken appliances are all red flags, the researchers said. Forms of payment may be indicators, too.

“An improper bite can interfere with chewing, speaking, and wearing down of teeth,” said Breana Dieringer, a third-year dental student. “West Virginia has so many rural areas that need access to care, and it’s important to understand the reasoning behind why dental care is not often a priority or a possibility for some families living in these areas.”

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