Medicaid and privately financed orthodontic patients have similar occlusal and psychosocial outcomes Gregory J. King, DMD, DMSc; H. Asuman Kiyak, PhD; Geoffrey M. Greenlee, DDS, MSD, MPH; Greg J. Huang, DMD, MSD, MPH; Charles F. Spiekerman, PhD University of Washington, School of Dentistry, Seattle, WA Abstract Objective: This study compares occlusal and psychosocial outcomes from compre- hensive orthodontic treatment in Medicaid (MC) and privately financed (private pay, PP) patients. Methods: Two cohorts received comprehensive orthodontics: MC (n = 66); PP (n = 60). A calibrated, blinded examiner scored dental casts at baseline (pretreat- ment, T1) and after completing 2 years of treatment (posttreatment, T2) using the Peer Assessment Rating (PAR) and the Index of Complexity, Outcome, and Need (ICON). The prevalence of patients in the validated ICON categories for treatment need, complexity, and improvement were calculated. Questionnaires to assess body image (BI) and expectations/experiences were administered. Occlusal measures at T2 were compared after adjustment for baseline characteristics. Psychosocial mea- sures were compared between and within groups. Occlusal and psychosocial asso- ciations were evaluated. Results: MC was 1.3 years younger (P < 0.001) and had worse malocclusions at base- line (PAR 32 versus 25; P < 0.001); (ICON 64 versus 56; P = 0.06). After adjustment for age and initial severity, estimated average differences between groups at T2 (MC- PP) were slight: 1.5 [95 percent confidence interval (CI) -2.9, 5.9] and 2.4 (95 percent CI -4.4, 8.9) for PAR and ICON, respectively. More PP completed treatment under 2 years (85 percent versus 62 percent; P = 0.03). At baseline, both groups needed treatment, but MC malocclusions were more complex (P = 0.05). At T2, both groups were acceptable and there were no differences in ICON improvement categories. Group differences in psychosocial measures and associations between psychosocial and occlusal measures were evident in the “teeth” domain but weak or lacking elsewhere. Conclusions: Occlusal and psychosocial outcomes from orthodontics in MC and PP were comparable, despite worse MC malocclusions at baseline. Introduction Access to orthodontic services for children of low-income families is severely limited compared with the general popu- lation (1-3). Although the sources of this disparity are complex, one key component is a shortage of providers who accept Medicaid (MC) patients (4). Orthodontists and family dentists cite barriers for why they elect not to be MC provid- ers in three general categories: low reimbursement rates, complexity of public programs, and patients who are at high risk for poor outcomes (2,5). Compromised orthodontic results are associated with issues related to the nature and severity of the malocclusion (6,7); the skill of the clinician (8,9); and poor patient compli- ance (10).A case-control study comparing the effectiveness of early partial orthodontic treatment in MC and privately financed patients found that, despite indications of poorer compliance in MC patients, comparable early treatment results were obtained in both groups (11). Comprehensive orthodontic treatment is significantly more complex and compliance dependent than early treatment and, because the patients are older, psychosocial and developmental Keywords malocclusion; orthodontics; corrective; Medicaid; occlusal; dental health services; financing; public; body image. Correspondence Dr. Gregory J. King, Department of Orthodontics, University of Washington, School of Dentistry, Box 357446, Seattle, WA 98195-7446. Tel.: 206-543-2533; Fax: 206-685-8163; e-mail: gking@u.washington.edu. Gregory J. King, H. Asuman Kiyak, Geoffrey M. Greenlee, Greg J. Huang, and Charles F. Spiekerman are with the University of Washington, School of Dentistry. Received: 5/18/2011; accepted: 8/5/2011. doi: 10.1111/j.1752-7325.2011.00288.x Journal of Public Health Dentistry . ISSN 0022-4006 1 Journal of Public Health Dentistry •• (2011) ••–•• © 2011 American Association of Public Health Dentistry