A qualitative study of orthodontic screening and referral practices among dental therapists in New Zealand

Background: Appropriate screening and referral is important in delivering effective and timely orthodontic treatment. In New Zealand, dental therapists are usually the initial contact for oral health care (including the assessment of malocclusion) in child and adolescent patients. Objective: To investigate the orthodontic screening and referral practices of dental therapists in New Zealand. Methods: Ten registered dental therapists from Auckland and Dunedin were interviewed using a semi-structured approach. Participants were selected based on years of work experience, where they practised, their educational background, and their sector of work (private/public). Results: Three main themes were identified: (1) the orthodontic screening and referral process; (2) the factors affecting orthodontic referral; and (3) their attitudes towards orthodontic treatment. Orthodontic screening and referrals were uniform among public dental therapists but varied for private dental therapists with regard to the type of malocclusions referred, the frequency of the referrals and to whom they referred. Factors that affected orthodontic referrals included participants' orthodontic educational background, work experience, Continuing Professional Development courses attended, and the opinions of orthodontists and/or dentists. Dental therapists found that most patients were receptive to the idea of orthodontic treatment, but that cost was a major concern. Dental therapists were enthusiastic about the development and use of resources that could aid in the orthodontic screening and referral process. Conclusions: This study has provided valuable insights into the current orthodontic referral process of New Zealand dental therapists. Variations among public and private therapists were identified. The implementation of an orthodontic referral guideline was viewed favourably by dental therapists.