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Braces for children: benefit (still) uncertain

2019-10-01T11:11:15.835Z


Despite missing data and unclear effect, there are no cuts in the subject of braces. Although there is now a four-point plan - until results are available, years will pass.



The orthodontists in Germany must fear for the time being no consequences - although the Federal Audit Office had missed them in 2018 a slap in the face: Because almost half of the children and adolescents for more than a billion euros will be treated without the nature, duration and success of the treatment are clear if the benefits had to be "finally explored", the Federal Court of Auditors called for in 2018.

Research is done. After months of talks between the Federal Ministry of Health, health insurances and the dental profession, there is now a plan with four measures on the table. Nevertheless, critics are not enthusiastic: "Now the long slumber of the Federal Government takes its revenge," says Kirsten Kappert-Gonther, for the Greens in the Health Committee of the Bundestag. "Until data on the type, duration and success of the treatment are available, years will come."

The four-point plan includes the following measures:

  • Interviewing patients: In order to obtain data on the distribution of dental (mal) positions, they should be collected in the next German Oral Health Study (DMS). Since 1989, several thousand people have undergone regular dental examinations and interviews in these studies. In 2022, the sixth oral health study is planned. Tooth positions were previously included only in the first DMS. This should now allow a comparison over three decades.
  • Evaluate billing data: The health insurance funds and the dentists' associations are to evaluate their orthodontic billing data in retrospect. This is to clarify how many tooth positions were treated in which form, how long and at what cost.
  • Guideline for treatment: A new guideline should identify the "ideal treatment time" for "orthodontic anomalies". However, she was registered anyway since January. The reasoning does not address the question of whether braces are really always necessary, but is based on very positive effects, such as that caries and periodontitis "by the correction of malocclusions partially preemptive influenced" would.
  • Compare people with and without clips: The so-called NAKO health study should also be evaluated with regard to the consequences of orthodontic treatments. The NAKO (National Cohort) is a long-term population study of more than 20 years among the causes of common diseases. By collecting orthodontic data, one can compare how oral health develops in people with and without braces.

The Federal Ministry of Health believes that these measures can "significantly expand the knowledge about the orthodontic care of the population and the effects of different treatment measures within a reasonable time frame of two to three years". It was assumed that the suggestions made in the opinion could be largely implemented.

The Bundestag Audit Committee has now taken note of the Ministry's report, stressing that a report on the state of play "on the promised measures" is expected by 31 March 2022.

The original proposals of the Federal Court of Audit had gone much further: He had specifically recommended not only to record and evaluate the orthodontic supply situation, treatment needs and treatment goals, but also to demand a review of the cash benefit and the numerous self-payer benefits.

"What we need is a fundamental reform of orthodontics," says Alexander Spassov, himself an orthodontist and critic of his colleagues since he researches the subject. It has long since "a mountain" of evidence about benefits, harm, efficiency: "If the planned measures are not embedded in an overall strategy, the results will be useless." To evaluate billing data, for example, one needs quality criteria at the same time. "We need to have a discussion about it," Spassov demands, "which should be considered as a benefit and harm in orthodontics and what is really medically necessary."

Already now, patients need better protection against interventions with questionable benefits, Kirsten Kappert-Gonther claims. Necessary are simpler ways to obtain second opinions and to have a cost estimate.

The author of the text is employed in addition to her job as a freelance journalist at the consumer center NRW as a consultant for the health market.

Source: spiegel

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