Orthodontic treatment need assessment and treatment timing – a questionnaire survey among specialists in Denmark and Sweden

OBJECTIVE: To analyze national and regional differences in assessment of orthodontic treatment needs and timing for treatment between specialists in orthodontics in Denmark and Sweden. Additionally, to map the use of digital platforms in orthodontic referral processes. MATERIALS AND METHODS: A questionnaire comprising 20 items was developed to assess nine patient cases with different malocclusions and sent to nearly 500 board-certified orthodontic specialists in Denmark and Sweden. Each case was documented by clinical photos, line drawings of the head and face, and malocclusion descriptions. Before the start of the survey, the questionnaire was tested in both countries by eight experienced orthodontists. The survey was distributed between 06 November 2024 and 27 January 2025. Data were analyzed using chi-square tests with false discovery rate correction. RESULTS: Two hundred and nineteen responses were included. Both intra-regional and cross-national differences were found in treatment need assessments. Danish respondents showed greater agreement, while Swedish assessments varied more. Digital referral systems were more common in Sweden but linked to an increased tendency to select patient observation rather than making a definitive assessment of treatment need. In Denmark, high agreement (> 80%) was found for treatment need in six of nine cases. One patient case was generally deemed not eligible, while one case demonstrated high variability. Significant regional differences were noted in both treatment need and timing. In Sweden, strong agreement was observed for five cases. One case showed wide variation. Regional differences were significant for some cases, both in need and preferred treatment timing. CONCLUSIONS: Specialists in Orthodontics in Denmark showed more consistent assessments than those in Sweden, likely due to national guidelines. Digital referrals were common in Sweden but linked to more varied evaluations, especially in borderline cases.