The study further confirmed previous data finding that individuals under 18 years old and females had the greatest orthodontic expenditures per capita for the study period which examined data from 1996 to 2016. 

A new study looking at two decades of U.S. consumer spending on orthodontic care finds that total orthodontic expenditures almost doubled from $11.5 billion in 1996 to $19.9 billion in 2016. The study, published in the journal BMC Oral Health, reports that on an individual level, the average orthodontic expenditure per person increased from $42.69 in 1996 to $61.52 in 2016. The study did identify periods where total orthodontic expenditures decreased, with the greatest decrease from $15.9 billion to $12.7 billion—a 30% decrease—from 2001 to 2002. 

Out-of-pocket expenses represented the highest total expenditure and while the amount of out-of-pocket expenses increased by $3.3 billion over the years, they decreased as a percentage of total expenditures by 8% from 59% in 1996 to 51% in 2016, the study reports. Meanwhile, public insurance increased the most over the study period but still accounted for the smallest percentage of expenditures. The study found that orthodontic expenditures in public spending accounts such as Medicare and Medicaid did substantially increase after the enactment of the Affordable Care Act in 2010. 

According to the study’s authors, led by Man Hung, PhD, associate dean for research and professor at Roseman University of Health Sciences in Utah, one explanation for the increase in U.S. expenditures on orthodontic care over the two decades could be tied to the increase in the number of orthodontists. The researchers point out, however, that in contrast to the the 8.4% increase in expenditure, the number of orthodontists per 100,000 population over the study period only increased by 0.45%. 

When analyzing the data collected, the researchers found that while there were fluctuations in orthodontic, dental, and medical expenditures over the study period, the fluctuations varied to a lesser degree among dental and medical expenditures. The researchers posit that this is because orthodontic care is more a luxury as it depends on out-of-pocket payments and is more sensitive to social and economic conditions such as the housing crisis, the tech bubble burst, the global recession, and events like 9/11 which correlated with a 30% decrease in orthodontic visits. 

Confirming data found in previous studies, the researchers here found that individuals under 18 years old had the greatest orthodontic expenditures per capita. Females also accounted for the majority of orthodontic expenditures throughout the entire study period. 

The study’s authors were surprised to find that Blacks exhibited the greatest year-to-year fluctuation in expenditure and a sharp peak in Asian orthodontic expenditure in 2016. According to the study, this suggests that Blacks and Asians might be the most vulnerable population to economic downturns.