years ago, the New York City Bureau of Dental Health Services
was facing a problem of crisis proportions in its Orthodontic
Rehabilitation Program. The initiative, part of New York State's
Physically Handicapped Children's Programs (PHCP), is
mandated to expand access to orthodontic care for medically indigent
youngsters. Any family with a child under 21 years of age may
apply to the program. Each youngster is screened to determine
eligibility and referred for treatment to local orthodontists,
who are reimbursed for their services based on Medicaid fee schedules.
Because of a lack of staff, a severe backlog of applications
had developed, preventing the program from fulfilling its mandate.
Dr. Ruby Stern, who was then the Director of the Orthodontic Rehabilitation
Program, came up with an ingenious solution to the problem: Form
a partnership with academic dental centers. In addition to having
the clinical staff, the competence and the infrastructure needed
to get eligible youngsters into care in a timely fashion, Dr. Stern
reasoned that dental schools could also provide academic peer review
to ensure that youngsters were receiving quality care. Dr. Stern,
a graduate of the NYU College of Dentistry, immediately thought of
collaborating with her alma mater, as well as with other large dental
education centers in the area.
Nearly a generation later, over 200,000 New York youngsters have
benefited from a citywide orthodontic screening, referral and quality
control program that also includes the Columbia University School
of Dental and Oral Surgery and Montefiore Medical Center. As the
largest of the three facilities, NYU screens and reviews the majority
of applications, and also serves as a local provider of orthodontic
"This is one of New York's great public-health success
stories," says Dr. George Cisneros, Professor and Chair of
the NYU Department of Orthodontics. "When the program began,
only about 2,500 children received care annually. But because bureaucracy
has been minimized, access has become much easier over the years,
and more lives have been improved as a result. This is a perfect
example of how programs designed to address health disparities should
Adds Dr. Stern, "In addition to facilitating orthodontic care
and treatment that enables youngsters to achieve healthy dentition
and a positive self-image, one of the great things about partnering
with an academic dental center is the assurance of clinical excellence
because the quality of the screenings and the annual treatment reviews
are all subject to strict academic standards."
Eligible children receive treatment for a wide range of orthodontic
conditions, including serious bone defects; e.g., cleft palate, abnormal
jaw size, severe crowding of teeth, huge overbites, crooked teeth
and large spaces between teeth and jaws. Some of these conditions,
like cleft palate, have major medical significance and may cause
current or future health problems. Most of them are also accompanied
by social issues, like negative self-image. For society, the question
becomes, "Do poor children deserve orthodontic care?" In
the case of New York State, the answer is a resounding "yes."
According to Dr. Hillary Broder, Acting Chair of the Department of
Community Health at the UMDNJ-New Jersey Dental School and a coauthor
with Dr. Cisneros of an abstract entitled Oral
Health-related Quality of Life Among Children Seeking Orthodontic
Care, "Our data
indicate that children with untreated orthodontic needs, like severe
overbite, spacing and crowding, also have a low quality of life.
The development of an identity can be influenced by often-superficial
and such children experience greater teasing, timidity and anxiety
than children with good occlusal status. The good news is that when
these children's orthodontic needs are met, the quality of
their lives improves."
For the thousands of children and youth who are screened and referred
for orthodontic care each year, the difference can be remarkable.
One such youngster suffered from teeth that were crowded and misaligned,
causing him severe pain as well as an unattractive, tentative smile.
He had several teeth removed and orthodontic treatment to straighten
his remaining teeth. His mother says the difference is remarkable.
"Words cannot express the gratitude that my family feels for the
positive attitude and the new lease on life this program has given
"NYU College of Dentistry is extremely proud to partner with
New York City and New York State to bring the benefits of the Orthodontic
Rehabilitation Program to youngsters who otherwise would not have
access to these important services," says Dean Alfano. "As
an academic health center, NYUCD has an obligation to act in the
public good, and helping to expand access to oral health care, including
orthodontic care for all children, is part of that obligation. In
transforming a childÕs smile, we
are performing both a medically and a socially responsive service
that expands the boundaries
of young lives."