Social inequality and discontinuation of orthodontic treatment: is there a link?

The aims of this study were to investigate the effects of social inequality on the likelihood of patients discontinuing orthodontic treatment, and to determine which, if any, indicators of social inequality are of greater relevance. In this retrospective study of English and Welsh General Dental Services (GDS) cases, consecutive 'discontinued' cases collected at the Dental Practice Board (DPB) during 1990-91, were compared for age, treatment modality, and measures of social inequality, with a 2 per cent sample of cases contemporaneously submitted as 'complete'. Three deprivation indices, and occupation-based social class spectra of neighbourhoods, were compared between the groups. A model was sought to predict discontinuation/completion using logistic regression analysis. The discontinued sample represented lower social stratum spectra for home and practice areas under all indicators tested, and the subjects were a little older at the start of treatment. Fewer were treated by orthodontically qualified practitioners or with fixed appliances, but more with extra-oral traction. Occupation-based classification (patient's home) and the Carstairs Index (practice area) were selected by the analysis as explaining more of the variation than other measures of social inequality, but the model failed to predict the discontinued cases. Lower social class may be a risk factor for discontinuation of orthodontic treament, but is not a predictor for it. Patients should be considered for, and counselled about, orthodontic treatment on an individual basis. Occupation-based social classifications and the Carstairs Index may be a little more sensitive to orthodontic applications than other indicators of social inequality.