Referral and treatment practices in Orthodontis: a questionnaire study to dentists and dental hygienists in Troms County

Objective: The purpose of this study was to find out how screening and referring arrangements of patients with malocclusions was working between different dental professional groups in the public dental health services in Troms County. We also wanted to find out to what extent general dentists in Troms County were involved in interceptive orthodontic treatment. Material and Methods: The study subjects were dental hygienists, dentists and orthodontists in Troms County. All dentists and dental hygienists working in the dental public health care in Troms County were invited to participate in the survey. After several reminders 18 dental hygienists, 39 general dentists and 6 orthodontists responded (total N=63). The data was collected through a questionnaire, which included questions on personal data, orthodontic screening, treatment and referring, and a clinical photo of a unilateral posterior crossbite. Results: The response rate was 64%. The most common age of referring children to orthodontic treatment was at 12-13 years of age. Late referral age (14 years or older) was significantly more often favored by dentists, as compared to the dental hygienists. 71% of dental hygienists preferred referring patients straight to a specialist, and the rest made the decision between dentist and specialist. There was no significant difference (P=0,741) in the approximated number of referrals made by the dentists and dental hygienists. 62% of the dentists and 44% of the hygienists considered that treatment of unilateral posterior crossbite belonged to both dentists and specialists. Almost one third of the dentists reported that they did no orthodontic treatment at all. The most common malocclusion treated by the dentists was unilateral posterior crossbite. The procedures related to orthodontics done by dentists in their daily practice, were screening for malocclusion, preventive palpation of the position of permanent canines and primary tooth extractions due to orthodontic reasons. 83% of the orthodontists consulted dentists regarding interceptive orthodontic treatments and/or planning treatments of patients. Conclusions: The majority of dentists in Troms County were involved in orthodontic treatment, but only to a small extent. Dental hygienists and dentists referred approximately the same number of patients to orthodontic treatment, but general dentists may prioritize later age of referral. Availability of continuing education in orthodontics might enhance the treatment skills and interest in orthodontics among the general practitioners.