Oral health disparities in Appalachia: orthodontic treatment need and demand.
BACKGROUND
Significant oral health disparities affect people in West Virginia and elsewhere in Appalachia. Although oral diseases such as caries are a major problem, little is known about the occlusal status of this under-served group.


METHODS
Fifty-eight adolescents (ages 12-17 years) and 78 of their parents underwent an orthodontic examination as part of a larger study on oral health in two rural West Virginia counties. Two orthodontists used a standardized index to rate their need for orthodontic care. Participants were interviewed regarding their demand for and history of orthodontic care.


RESULTS
The study results show that parents had a high rate of complete or partial edentulism, an infrequent history of orthodontic treatment, great unmet orthodontic need and less demand for orthodontic care than was suggested by their clinically determined need. The adolescents were similar to national norms with regard to orthodontic treatment history and need, but lower with regard to demand.


CONCLUSIONS
The adolescents' similarity to general population norms with regard to previous orthodontic care and level of occlusal status is promising. Nevertheless, their lower recognition of a need for treatment suggests possible future oral health problems and a lower oral health quality of life. Their parents, however, were considerably worse off, in comparison with their adolescent children and adult comparison samples, with regard to orthodontic care and other oral health status measures.


CLINICAL IMPLICATIONS
Culturally sensitive psychoeducational methods to promote recognition of oral health needs may be required among adolescents in Appalachia to have an impact on oral health values and to prevent oral health problems. Issues of orthodontic care utilization and, perhaps, access to care need to be addressed among adults in Appalachia.