Trends in orthodontic treatment prevalence in Switzerland

BACKGROUND: Orthodontic treatment is increasingly common across Europe, but little is known about long-term population trends and social disparities in Switzerland, where orthodontic care is mainly privately financed. OBJECTIVE: To examine temporal and sociodemographic patterns of orthodontic treatment in Switzerland between 2002 and 2022 and to identify associated inequalities. METHODS: Data came from three waves of the Swiss Health Survey (2002, 2012, 2022), a nationally representative cross-sectional study. The analytic sample comprised 53,019 individuals aged ≥ 15 years. The outcome was self-reported lifetime experience of wearing braces. Covariates included survey year, sex, age, education, language region, and urbanicity. Statistical evaluation included survey-weighted multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (95% CI). Interaction terms were used to test temporal changes. RESULTS: The prevalence of orthodontic treatment rose from 23.0% in 2002 to 34.8% in 2022. Women were more likely than men to report treatment (aOR 1.59, 95% CI 1.51-1.68). Among adults (≥ 20 years), a strong educational gradient persisted: those with upper-secondary (aOR 2.82; 95% CI 2.43-3.28) or tertiary education (aOR 4.58; 95% CI 3.92-5.34) had significantly higher odds of treatment compared to those with compulsory education. Living in rural or intermediate regions was associated with lower odds compared to urban areas (aOR 0.93; 95% CI 0.88-0.99). Furthermore, residents of French-speaking (aOR 0.84; 95% CI 0.78-0.91) and Italian-speaking regions (aOR 0.79; 95% CI 0.71-0.89) showed lower treatment uptake than those in German-speaking Switzerland. Significant interactions of age and urbanicity with survey year reflect that prevalence increases over the past 20 years occurred particularly among younger individuals and those outside urban areas. CONCLUSION: Orthodontic treatment in Switzerland has increased significantly, becoming a new norm for younger generations. However, this growth is not equitable; access remains heavily patterned by education, region, and urbanicity. In a predominantly privately financed system, these persistent disparities suggest that orthodontic care remains socially stratified.