MORGANTOWN — Only half of Appalachians who begin orthodontic care, such as braces or retainers, complete their course of treatment entirely, research by the West Virginia University School of Dentistry suggests.

Method of payment is believed to be the most reliable indicator among the 219 patients reviewed over five years: only one-third of patients who relied on insurance, public or private, completed treatment. By comparison, nearly three-fourths of those who paid out-of-pocket for orthodontia finished care entirely.

Researches explored others variables such as age, gender, distance traveled for care, length of treatment, and the type of bite misalignment — none appearing to correlate to whether treatment was completed.

The cause may instead hide in part within the culture of Appalachia, suggested Dr. Chris Martin, WVU professor of orthodontia, who led the research. The region's spirit of self-reliance may discourage patients who would otherwise rely on insurance from completing treatment, he continued, as opposed to t hose who would have the means to fund the full treatment themselves.

Patients covered by public insurance, like Medicaid or the Children's Health Insurance Program — often already low income or otherwise disadvantaged — may not be able to afford leaving work, arranging for childcare or have access to reliable transportation to complete training.

"Oftentimes people with Medicaid have to travel longer distances to get dental care and orthodontic care," said researcher Daniel McNeil, WVU clinical psychologist and professor of dental practice and rural health. "Think about how difficult it is, particularly when you combine that with, say, the winter weather if you're trying to travel a long distance in February."

Patients in the study drove an average 38.8 miles one way to reach their orthodontics appointment. Orthodontic treatments typically cost between $3,000 and $8,000 over the course of the procedure.

Other red f lags include poor oral hygiene, frequently broken orthodontic gear, and missed appointments, research suggests.

"An improper bite can interfere with chewing, speaking and wearing down of teeth," said Breana Dieringer, a third-year WVU dentistry student who assisted in the study. "West Virginia has so many rural areas that need access to care, and it's important to understand the reasoning behind why dental care is not often a priority or a possibility for some families living in these areas."

The study was published in the medical journal "Frontiers in Public Health" in July 2017.

Follow reporter Bishop Nash on Twitter at @BishopNash.

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