Objective and Methods According to official data (2005), 40% of Belgian children start orthodontic treatment before adulthood. In the past 30 years, the number of orthodontic treatments almost tripled. To determine clear indications for orthodontics, a literature review according to evidence-based medicine principles was undertaken.
Results Not treating malocclusions has few proved adverse effects. Exceptions are extreme overjet of front teeth (increased trauma risk) and ectopically positioned teeth (increased risk of root resorption). Concerning psychosocial well-being, dental status in adulthood, although statistically significant, appeared to be of minor importance. At present, only a few orthodontic indications are adequately supported by evidence. A moderate quality of evidence exists that treatment of large overjet or maxillary protrusion are efficient. A low quality of evidence exists that treatment of impacted teeth decreases the risk of root resorption and that cross-bites can be corrected in the primary dentition. More studies are needed on the treatment of anterior open bite, crowding, deep overbite with gingival trauma, supernumerary teeth or dental agenesis and also on the use of space maintainers in deciduous teeth and long-term stability of the obtained results. Expert consensus exists on the need for orthodontic treatment for orofacial clefts and some other severe deviations. Orthodontic indices, grading malocclusion severity, are not scientifically validated, but their usefulness in organisational issues is internationally accepted.
Conclusions Paediatricians can inform patients that for many orthodontic treatments, studies on effectiveness are lacking. In case of budgetary restraints, reimbursement should be reserved for patients who need it most, selected by an orthodontic index.