A closer look at general dental service orthodontics in England and Wales II: What determines appliance selection?

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.