His “happy teeth”, Gaston hardly cared until an orthodontist suggested he correct this slight defect. As the teenager was approaching 16, he had to act quickly: in a few months, the treatment would no longer be covered by Social Security. “This tiny imperfection was supposed to be fixed in six months”, remembers his mother, Stephanie. A year and a half later, Gaston still has his mouth lined with metal: “The spacing has just shifted to the side and we have no visibility on how long it will still take, while it is a significant financial burden. I have the impression of having put my finger in a gear”deplores Stéphanie, whose phone calls to the cabinet, to obtain information, remain unanswered.
Nathalie is convinced of the need for ” big works “ undertaken in the mouths of two of his three children, who were missing certain permanent teeth. Yet sometimes she feels “reduced to a number or rather, to a bank card”. “Behind the chic facade of the ultra-modern office, it’s the factory, an army of assistants take care of the children on the assembly line. Appointments last barely five minutes and, every six months, you have to pay €900! she gasps. Fortunately, we have good mutual insurance. »
Trivialization
When talking to parents about orthodontics, the same questions come up: is it really necessary? Aren’t we paying too much or too long? Despite these doubts, the offices of specialists are always full and it often takes months to obtain an appointment. According to a Health Insurance report published in July 2022, the rate of orthodontic use rose from 16% in 2013 to 20% in 2021. And adolescents are on the front line: in 2017, the DREES estimated that 38 % of ninth graders wore braces (40% for girls, 36% for boys).
“It has almost become a must”, notes child psychiatrist Stéphane Clerget (1). The latter sees in it all the characteristics of a ” Rite of passage “. “It’s a long and sometimes painful process, an apprenticeship during which young people have the impression of gaining mastery over their physical development”, describes the practitioner, for whom opacity dominates: “Parents, who generally don’t know anything about it, are forced to take the word of the ‘specialists’. »
At the risk of imposing superfluous treatments on their offspring? Doctor Nicolas Goossens, orthodontist and secretary general of the French Federation of Orthodontics (FFO), believes on the contrary that the needs of the population are not sufficiently covered. Far from reflecting a trend, the increase in treatments can be explained both by demography (a peak in births during the 2010s), technical progress (effective, and therefore shorter, care makes it possible to take charge of more children) and the fact that today’s parents have often gone through braces themselves and are therefore more supportive.
Health before aesthetics
“The aesthetic aspect, the alignment of the teeth, is the icing on the cake and not the objective of the treatment”insists Nicolas Goossens, recalling that orthodontics is a medical specialty. “Badly positioned teeth or a palate that is too narrow are likely to cause significant functional problems, in terms of chewing – with premature wear of the teeth –, breathing or diction”, he explains. Orthodontic treatment can, for example, prevent the onset of sleep apnea, a pathology that has recently been discovered to often occur in childhood.
For her colleague Caroline Paluch-Bouden, it is sometimes on the side of the parents that the aesthetic requirements are felt. “Some worry as soon as there is a small crooked incisor when it is common between 6 and 8 years old, when the permanent teeth come out and the jaw has not grown enough. » The doctor must frequently encourage them to wait before undertaking any treatment. Sometimes the urgent requests come from the children themselves: “Many complain about the teasing of their comrades. They are tough on each other. There is a pressure that weighs on them younger and younger ”she notes.
A specialist in school bullying, the therapist Emmanuelle Piquet, founder of the centers À 180 degrees, school chagrin, regularly receives children with a complex about their teeth and this vulnerability makes them potential prey for bullies. “We are constantly reducing the mold into which our children and adolescents must fit in order to satisfy an ideal of perfection, she observes. In addition to performing well in class, you must not be fat, you must have white, well-aligned teeth, be appreciated by others… These very modern injunctions generate very great suffering in families. »
Advertising, television, cinema, sport… The “ultra-brite” smile is everywhere. “In the West, we have never shown our teeth as much as in the 21ste century, notes Stéphane Clerget. Watch movies in black and white, people didn’t reveal them. Beautiful and healthy teeth have always been a sign of good health, but today it is also a marker of social success, of power. Symbolically, this way of showing off has almost a carnivorous side: you show your teeth not only to seduce, but also to impress the other. »
Filon commercial
A logic to which adolescents do not escape. The “selfie generation” takes care of its image and the face, displayed and multiplied on social networks, becomes a fundamental identity factor. “Many teenagers ask me for invisible devices, especially these transparent aligners whose merits are praised by influencers on TikTok or Instagram. But this device is not suitable for all patients.warns Nicolas Goossens, annoyed to see unscrupulous dental surgeons embarking on orthodontics by joining forces with manufacturers for whom the installation of gutters is first and foremost a commercial vein.
Also, the secretary general of the FFO recommends that families check that the practitioner they are addressing appears in the directory of the National Council of the Order of Dental Surgeons as “specialist in dentofacial orthopedics”. Because engaging in treatment is far from trivial, if only financially. Sara, a single mother, is still hesitating: “The micro-enterprise mutual fund that employs me does not cover the costs for my two children. If I launch the two treatments simultaneously, we won’t go on vacation for three years, she calculates. At the same time, I feel guilty for not being a good mother: if I don’t, they may later accuse me of having made savings on the back of their health. »
“This dilemma is more common than you might think, especially in the middle class, which does not benefit from assistance schemes such as complementary health care. The weight of excess fees constitutes a barrier to access to care and reinforces inequalities in terms of oral health”, notes the economist and dentist Anne-Charlotte Bas, lecturer in public health at the University of Paris. In fact, according to a study by the Drees (Research, Studies, Evaluation and Statistics Department) carried out in 2017, half of the children of executives wore braces, compared to 28% among the children of workers. .
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High rates and variable reimbursement
In France, orthodontic prices are left to the discretion of practitioners. The average price for a semester of care is 728 € (up 10% since 2013), with significant regional disparities: from 597 € in the Territory of Belfort at 898 € in the Hauts-de-Seine.
Orthodontics is one of the treatments with the highest out-of-pocket costs for households: 167 € on average per semester, i.e. 334 € per year. The sum varies considerably depending on the type of supplementary insurance taken out, with individual insurance generally reimbursing less well than group insurance for large companies.
In its report “Expenses and products 2023”, the Caisse Primaire d’Assurance Maladie recommends integrating orthodontic treatments in the 100% dental health basket, but this would imply limiting billing fees.