Objectives: More than 30 states use the Salzmann Index or the Handicapping Labiolingual Deviation Index to determine which patients receive tax-supported orthodontic treatment. The indexes use a criterion which produces a numerical value reflective of the severity of the malocclusion. The aim of the study is to evaluate the validity of these indexes by comparing subjective evaluations of orthodontic treatment need to objective scores produced by indexes of malocclusion. Methods: 20 orthodontic faculty and residents (VAS Group) were asked to evaluate the severity of malocclusion of 20 patients, prior to beginning orthodontic treatment, using a subjective scale, a Visual Analog Scale (from “No need for treatment” to “Severe need for treatment”). The 20 patients consisted of a variety of malocclusions including Class I, Class II, Class III, anterior crossbite, posterior crossbite, impaction. A separate group of 3 residents (IS Group) evaluated the same patient malocclusions using the aforementioned indexes of malocclusion. The results were analyzed to identify a correlation between the subjective scale (VAS) and objective scales (IS). Results: In total, 20 residents and faculty evaluated the severity of malocclusions. There was a weak correlation between the Salzmann scores and the Visual Analog Scale scores (Correlation Coefficient, R2=0.2359). There was a moderate correlation between the Handicapped Labiolingual Deviation index scores and the Visual Analog Scale scores (Correlation Coefficient, R2=0.4486). When comparing the faculty versus the residents in the VAS Group there was a strong correlation between them (Correlation Coefficient, R2=0.7901). Although, there was a strong correlation, on average the faculty scored the malocclusions with 15% more severe need for treatment than did the residents. Conclusion: Overall, there was a weak correlation for the Salzmann Index and a moderate correlation for the Handicapped Labiolingual Deviation Index, indicating neither indexes are optimal for evaluation of malocclusions. More emphasis has to be placed on identifying an objective method to evaluating the severity of malocclusions. / Oral Biology

Introduction: The Salzmann Evaluation Index (SEI) was chosen by the state of Pennsylvania to evaluate the treatment needs of prospective orthodontic patients and to help determine the allocation of funding for orthodontic treatment, with a score of 25 being the threshold for funding allocation. This study will compare the summed scores of the columns under the inter-arch deviation (IAD) rows, which represent eight types of malocclusion (overjet, overbite, anterior crossbite, anterior openbite, Class II, Class III, posterior crossbite, and posterior openbite) to determine whether there is a difference in the scores of those approved and denied orthodontic insurance coverage. Materials and Methods: 560 Patients with SEI >25, submitted for Medicaid orthodontic insurance approval from Temple University were stratified into “approved” (n=289) and “unapproved” (n=271) for treatment. Their mean IAD column scores (representing the malocclusions listed above) were compared and tested with Wilcoxon test for significance. Results: Anterior crossbite, anterior openbite, posterior crossbite, and posterior openbite were identified as significantly higher scores in the “approved” group compared to the “unapproved” group. Overjet, overbite, Class II, and Class III had no significant differences between approved and unapproved groups. Conclusions: Patients with anterior crossbite, anterior openbite, posterior crossbite, and posterior openbite may be more likely to receive coverage for orthodontic treatment by Medicaid insurance companies in Pennsylvania. Scores denoting presence of overjet, overbite, Class II, and Class III malocclusions were not different in patients approved and denied coverage for orthodontic treatment. / Oral Biology

Thesis--Munich. / Cover title ; t.p. wanting. Vita. Includes bibliographical references (p. 262-272).

No description available.

Jakob Vetter zeigt in seiner Untersuchung zu ‚Fortes fortuna adjuvat‘: Armut, Risikodenken und Männlichkeitskonstruktionen in Christian Gotthilf Salzmanns Roman Carl von Carlsberg (1783-1788), dass die Wahrnehmung des sozialen Phänomens Armut vor allem über normative geschlechtsspezifische Narrative strukturiert wird und der bürgerlich geprägte abendländische Armutsdiskurs im späten 18. Jahrhundert primär um die Frage kreist, ob und wie Armut durch individuelle Entscheidungen verhindert oder behoben werden kann. Diese Armutsnarrative sind dabei stark geschlechtlich codiert. Der im Zentrum der Analyse stehende Roman Salzmanns wurde zeitgenössisch zwar breit rezipiert, ist von der Forschung aber stark vernachlässigt worden. In seiner Analyse des in seiner Gestaltung und generischen Hybridität nach wie vor einzigartigen Romans arbeitet Jakob Vetter die bemerkenswerte literarische Umsetzung von spätaufklärerischen Armutsnarrativen heraus und weist eine hochsignifikante Brüchigkeit und Widersprüchlichkeit nach.

Introduction: Historically, in Pennsylvania, the Salzmann Evaluation Index (SEI) (Figure 2) was used to evaluate the medical necessity of orthodontic care and whether the government will cover costs for low-income patients. Approval discrepancies occur between doctor index scoring and insurance funding with the SEI, leading to questions about how indices determine funding. Each state and insurance administrator decides which, if any, medically necessary malocclusions to include that automatically qualify for treatment coverage. As of 2022, a major insurance administrator in the state of Pennsylvania added an additional qualifying criterion: the orthodontic criteria index (OCI), ten occlusal characteristics that lead to an automatic qualification (Figure 3). This leaves the possibility that a patient may qualify on one or both indices. This study is the first to evaluate the frequency of approvals between SEI and OCI in Pennsylvania. The secondary objectives for this investigation are to evaluate the OCI criteria insurance administrator approval rate compared to the doctors’ scoring and to evaluate if sex, age, race/ethnicity, and submission year impact insurance funding decisions and to evaluate the OCI criteria insurance administrator approval rate compared to the doctors’ scoring. The results of this study may promote standardization for the state of Pennsylvania to readily adopt a list of Automatic Qualifiers for all Medicaid insurance administrators. Materials and Methods: All subjects had no orthodontic treatment and underwent routine screening and record-taking through the Temple University Kornberg School of Dentistry Orthodontic Screening Clinic from November 1, 2022, to March 31, 2023 (n = 171). For all orthodontic providers, scoring SEI and OCI was calibrated in September 2022. Malocclusion characteristics of 171 subjects between the ages of 9-20 were characterized for treatment need with standardized SEI and OCI criteria. SEI gives a numeric score of treatment need by accessing intra-arch and inter-arch tooth position relationships. OCI is a binary list for the presence of specific severe malocclusion criteria, which leads to automatic qualification for treatment. Approval thresholds were at least one OCI AQ or a SEI≥25. Patient data, including age, date of initial submission, sex, race and ethnicity, date of submission, insurance response, and orthodontist scoring, was recorded. Insurance submission records were analyzed, and funding decisions based on the Salzmann Evaluation Index (SEI) and the Orthodontic Criteria Index (OCI) were recorded. Malocclusion severity evaluation had an inter-examiner reliability of 90%, using the Salzmann Evaluation Index, with a score of >25 determining treatment need or one of the ten automatic qualifiers from the Orthodontic Criteria Index form was perceived regardless of the Salzmann Evaluation Index score. Both indices scored, along with intraoral and extraoral photographs, a cephalogram, a panoramic radiograph, and an intraoral impression, were sent to Insurance Administrator A, a primary Medicaid company for patients at TUKSoD. An employee of the insurance administrator received the records submitted and made a funding decision. Results: Overall insurance approval was 38.6%. Doctor approval rates were 42.7% for OCI and 24.6% for SEI. The overall doctor versus approval discrepancy was 39.7% for both SEI and OCI combined. Patients who qualified for treatment with one or more OCI had an average SEI of 18. Only 24.6% of SEI scores ≥25 were approved. The greatest agreement between insurance and doctor approvals was for the OCI category: impacted of canines or incisors. There was no statistically significant difference in the approval rate between the OCI and SEI for gender, ethnicity, or submission year. Age groups have a statistically significant discrepancy (P<0.01). Conclusion: There is a moderate level of agreement between insurance approval and doctor-determined scores. There is greater agreement between OCI doctor scores, and insurance approval compared to SEI. A significant approval rate variance occurs with age for SEI. Age group and % SEI Variance have an inversely proportional relationship, possibly due to differences in opinion about what constitutes a permanent dentition (impacted permanent or over-retained primary teeth). The newly implemented OCI criteria have less funding variance and produce greater agreement between insurance and clinician assessment than SEI. / Oral Biology