A White Paper for the American Association of Orthodontists

Adopted November 17-18, 2006

Preamble: The AAO will work with the ADA and other dental organizations to increase access to quality orthodontic care for patients in need.

The AAO defines access to orthodontic care as follows:

Access to orthodontic care is defined as an individual’s ability to seek and receive orthodontic treatment based upon the following criteria:

  1. The availability of orthodontic services as related to the geographical distribution of orthodontic services;
  2. The capacity of the oral health care system to provide orthodontic care;
  3. The individual’s ability to afford necessary orthodontic care;
  4. The individual’s ability to access orthodontic treatment; and,
  5. The individual’s recognition of need and desire to seek orthodontic treatment.

Please note that the AAO firmly believes the most important factor with dental health care is that all individuals have access to primary oral health care.

Geographical Distribution

In certain regions of the country, individuals may have difficulty accessing orthodontic care due to the geographic distribution of orthodontic practices. While it may be economically prohibitive for health care professionals to have an active practice in under-populated regions of the country, many volunteer to travel to community based health care centers to provide services. The AAO actively supports and encourages our members to volunteer time in under-populated regions to provide orthodontic services. State licensing requirements that determine freedom of movement for health care professionals can also be a determent for orthodontists seeking to practice in underserved regions of the country.  Reciprocal state licensing or licensing by credentials should be explored.

Dental Education

Dental education funding as well as the recruitment and retention of dental faculty is at a crisis.  There are a limited number of orthodontists graduating each year in order to replace the number of retiring orthodontists.  The federal government has severely reduced spending on dental education. This could have a negative impact on encouraging dental educators to stay in education which is vital to train all future dentists and dental specialists.

Ability to Afford Necessary Orthodontic Care

Patients’ circumstances may affect their ability to obtain orthodontic care. Those with greater financial means generally have more options available to them than those with limited income. Public funding for those in need without the necessary financial resources should be directed toward primary oral health care which is critical to an individual’s health and well being. With respect to orthodontic care and government resources, we believe that financial support should be directed to those patients where the need is the greatest, such as young people with debilitating malocclusion, cleft palate and other craniofacial deformities. 

The decisions about where to focus resources are best left to the individual states since they are closest to the situation and are most likely to better understand the unique needs and circumstances of the underserved within their states.

Collectively, AAO members provide over $62,000,000 in free and discounted treatment each year to those in need. This information is based on a recent needs assessment survey that had the following results:

  • 87% of practicing AAO members provide free or discounted treatment to those in need
  • The majority provide more than $10,000 in pro bono, free and discounted treatment annually

10% provided more than $20,000 in pro bono, free and discounted treatment annually

Need and Desire to Seek Orthodontic Treatment

Many individuals may be unaware of the need for orthodontic care, some of which may have undiagnosed and severe malocclusions for a lifetime.  The AAO has taken many steps to educate the public as to when orthodontic care may be needed.  In the mid-1990’s, the AAO obtained approval for the expansion of the definition of“orthodontics” to include “dentofacial orthopedics.”  This change was necessary to more accurately inform the public that the field of orthodontics is more than simply “straightening teeth.”  Additionally, the AAO coined National Orthodontic Healthcare Month, which occurs each year in October. The purpose of this program is to make the public aware of the role of orthodontics in the healthcare area.  Most recently, the AAO learned that much of the public was unaware of the different roles of orthodontists and general dentists in relation to providing orthodontic treatment. Therefore, the AAO has devoted substantial resources to a national public relations campaign designed to educate the public as to the role of the orthodontist in the context of overall dental health.  This campaign will include targeted advertising and announcements that are specifically designed to reach those that, based on extensive research, need to know most.

All of the factors described above present unique challenges related to access and cannot be addressed by any single solution. Each challenge will require a specific plan of action devised to be beneficial for all parties involved. The AAO, comprised of individual members and as the leading dental specialty organization in the United States, has been actively involved in serving the underserved. The AAO will continue to do its part by working with local and federal authorities that will provide primary oral healthcare where orthodontic treatment is of the greatest need with debilitating malocclusion, cleft palate and other craniofacial deformities.