Seventeen 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 care.

"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 be run."

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."

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 my son."