Appliance selection of the General Orthodontic Service in England and Wales

Key Points

In brief

• Six factors, which influence appliance selection in the GDS, were identified. Notably, practitioners with Royal College diplomas or memberships in orthodontics were significantly more likely to use treatments involving fixed appliances, particularly those involving both arches.

• This highlights the value of postgraduate orthodontic courses, and may explain some of the conflicting reports on their value in previous studies.

• However, there was still a marked overall trend to use removable appliances for GDS orthodontic treatments, despite more than half the cases being treated by an orthodontically qualified practitioner.

• This may suggest that service conditions in the GDS need to be re-evaluated if further improvements in GDS orthodontics are to be encouraged.

• Although social class had no direct influence on appliance selection, there appeared to be fewer orthodontically qualified GDS practitioners in neighbourhoods with high 'manual class' populations.

Abstract

Aim To elucidate factors that influence choice of appliance type in General Dental Service (GDS) orthodontics in England and Wales.

Method Records were obtained for 1527 cases, representing a systematic 2 per cent sample of GDS cases completed during 1990-91. Evaluation involved Discriminant Analysis to find the most influential factors in appliance choice. Factors considered included patient and practitioner characteristics, and features of the malocclusion as assessed by Occlusal Indices.

Results Full data were available for 1217 cases. 24 per cent of treatments included use of dual- and 26 per cent single-arch fixed appliances. Appliance choice was predictable in 55 per cent of cases. Older patients, orthodontically qualified practitioners, high Peer Assessment Rating score at start, permanent dentition, lower grades of the Dental Health Component of the Index of Orthodontic Treatment Need at start, and practitioners with high gross earnings from orthodontics, all tended to be associated with more frequent use of fixed appliances.

Conclusions Possession of a diploma or membership in orthodontics was associated with more frequent use of both dual- and single- arch fixed appliances. Better appliance selection, and thus more effective treatments in the GDS, may result from a greater availability of practitioners with formal postgraduate training in orthodontics.

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