Prediction of compliance and completion of orthodontic treatment: are quality of life measures important?

The effect of text message reminders on compliance with Twin Block appliances: A randomised controlled trial

AIMS

The aim of this study was to evaluate whether text reminders influence patient compliance with Twin Block appliances. The null hypothesis was that there was no statistically significant differences in Twin Block compliance between those who receive text reminders and those that do not.

DESIGN

Single-blind parallel randomised controlled clinical trial.

SETTING

Health Service Executive (HSE) orthodontic outpatient clinic in Dublin, Ireland.

PARTICIPANTS

A total of 59 patients aged 11-15 years with a 5a Index of Orthodontic Treatment Need (IOTN grade) starting treatment with Twin Block appliances.

METHODS

A computer-generated unstratified allocation sequence was used to randomise the participants into the control group (CG) or the text group (TG). Both groups were asked to wear their appliances full-time. In addition to the same verbal and written instruction received by the CG, the TG received text message reminders, every 3 days, to wear their appliances. The primary outcome measure was wear time reported by Theramon® sensors embedded in the appliances. Data on wear time were uploaded from the Theramon® sensors onto cloud software. Participants in both groups were asked to fill out wear diaries and submit these at each visit. Treating clinicians and the primary investigator were blinded to the allocation group. Participants were followed up for 4 months. Participants were not blinded to their treatment group.

RESULTS

In total, 29 participants were allocated to the CG and 30 to the TG. The data for 53 participants were analysed, 24 from the CG and 29 from the TG. The median hours/day of wear recorded using the Theramon® sensors was 13.77 (interquartile range [IQR] = 10.19) for the CG and 17.72 (IQR = 5.62) for the TG. The difference in wear time recorded was not statistically significant (P = 0.16).

CONCLUSION

The study concluded that text message reminders had no statistically significant influence on patient compliance with Twin Block appliances.

The use of the Hanks Herbst vs Twin-block in Class II malocclusion: A randomized controlled trial

INTRODUCTION

This 2-arm parallel study aimed to compare and evaluate the efficiency of Hanks Herbst (HH) and Twin-block (TB) functional appliances in treating adolescents with Class II malocclusion.

METHODS

A parallel-group randomized controlled trial was undertaken in a single United Kingdom hospital. Eighty participants were recruited and randomized in a 1:1 ratio to receive either the HH or TB appliance. Eligibility criteria included children aged 10-14 years with an overjet of ≥7 mm without dental anomalies. The primary outcome was the time (in months) required to reduce overjet to normal limits (<4 mm). Secondary outcomes included treatment failure rates, complications and their impact on oral health-related quality of life (OHRQOL). Randomization was accomplished using electronic software with allocation concealed using sequentially numbered, opaque, and sealed envelopes. Blinding was only applicable for outcome assessment. Data were analyzed using descriptive statistics and regression analyses to detect between-group differences, including Cox regression for time to treatment success.

RESULTS

HH was significantly faster than TB in reducing the overjet to within normal limits (95% confidence interval [CI], -3.00 to -0.03; P = 0.046). Mean overjet reduction was more efficient with the HH than the TB appliance (ß = 1.3; 95% CI, 0.04-2.40; P = 0.04). Fifteen (37.5%) of the participants in the TB group and 7 (17.5%) in the HH group failed to complete the treatment (hazard ratio = 0.54; 95% CI, 0.32-0.91, P = 0.02). However, TB was associated with fewer routine (incidence rate ratio = 0.81; 95% CI, 0.7-0.9; P = 0.004) and emergency (incidence rate ratio = 0.1; 95% CI, 0.1-0.3; P = 0.001) visits. Chairside time was greater with the HH (ß = 2.7; 95% CI, 1.8-3.6, P = 0.001). Participants in both groups experienced complications with similar frequency. A greater deterioration in OHRQOL was found during treatment with the TB.

CONCLUSIONS

Treatment with HH resulted in more efficient and predictable overjet reduction than TB. More treatment discontinuation and greater deterioration in OHRQOL were observed with the TB. However, HH was associated with more routine and emergency visits.

REGISTRATION

ISRCTN11717011.

PROTOCOL

The protocol was not published before trial commencement.

FUNDING

No specific external or internal funding was provided. Treatment for participants was provided as part of routine orthodontic treatment in the hospital.

Reflection on patients' experience with orthodontic appliances wear and its impact on oral health related quality of life: observational comparative study

BACKGROUND

The objective of this study was to explore and compare patient's experience with the use of a removable functional appliance or fixed orthodontic appliance and its influence on oral health-related quality of life.

MATERIAL AND METHODS

This clinical trial included 81 participants having Class II Division 1 and age ranging between 10 and 16 years. The participants were included in any of a three equal groups according to the set inclusion and exclusion criteria; Group 1: patients treated with a Twin-Block functional appliance; Group 2: patients treated with a fixed orthodontic appliance only; and Group 3 (control group): patients not in orthodontic treatment yet. The COHIP SF-19 was used. Patients were given the questionnaire as follows: Group 1: (1) after at least 8 months from starting treatment; (2) after completing phase 1 by 2-3 months without wearing the appliance; Group 2: (1) just before debonding; (2) after finishing the treatment by 2-3 months without any appliances; and Group 3: (1) at the patient's first visit to the orthodontic clinic; (2) after 2-3 months from the first visit to the orthodontic clinic and before starting any treatment.

RESULTS

The 81 participants were 31 males and 50 females with median age of 13 years. The total COHIP SF-19 scores at baseline were 57 (49-64), 67 (63-72), and 47 (42-53) for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively. Two-month mean scores adjusted to the baseline scores were 64.82 ± 1.15, 65.65 ± 1.47, and 54.45 ± 1.44 for the Twin-Block, the fixed appliance, and the malocclusion groups, respectively.

CONCLUSIONS

Both at baseline and two-months (adjusted to the baseline scores), participants in the malocclusion group showed compromised socio-emotional quality of life and reported the poorest total OHRQoL. At the baseline, better socio-emotional and total OHRQoL was reported by the fixed appliance group compared to the Twin-Block group but, after two months both groups gave similar sores. Therefore; patients' perceptions about their experience with the orthodontic appliance might change.

Dentoalveolar, skeletal, pharyngeal airway, cervical posture, hyoid bone position, and soft palate changes with Myobrace and Twin-block: a retrospective study

BACKGROUND

The primary aim of this study was to evaluate the dentoalveolar, skeletal, pharyngeal airway, cervical posture, hyoid bone position, and soft palate effects of the Myobrace and Twin-block appliances. The second was to compare them in terms of ease of use by assessing the factors that may influence patient compliance.

METHODS

The study included thirty-six Class II division 1 patients (19 females, 17 males; mean age, 12.14 ± 1.23) who had previously been treated in the Orthodontic Clinic at Sivas Cumhuriyet University Faculty of Dentistry. The patients were divided into two groups: Group 1: Myobrace (n = 18), and Group 2: twin block (n = 18). The effects of the appliances on the skeletal, dentoalveolar, soft tissue, craniocervical, and other anatomic structures were assessed using 46 measurements (22 linear and 24 angular), on pre and post-treatment cephalometric radiographs. AudaxCeph 5.0 software (Ljubljana, Slovenia) was used for the analysis. To analyze the changes after one year of treatment, a paired sample t-test and Wilcoxon signed-rank test were used. Intergroup comparison was performed using the Student t-test and the Mann-Whitney U test.

RESULTS

In the Myobrace and Twin-block groups, there was a significant increase in SNB (°) (p = 0.004, p = 0.001), IMPA (°) (p = 0.005, p = 0.001) and a significant drop in U1/SN (°) (p = 0.021, p = 0.005). The lengths of Cd-Gn (mm), Go-Pg (mm), and Cd-Go (mm) increased significantly in the Twin-block group (p = 0.003, p = 0.010, p = 0.001), whereas the Myobrace group did not change. Similarly, there was no significant difference in pharyngeal and soft palate measurements in the Myobrace group but a statistically significant decrease in SP length and angle in the Twin-block group (p = 0.001, p = 0.006). Increases in SN/OPT (°) (p = 0.032, p = 0.001) and SN/CVT (°) (p = 0.012, p = 0.001) were statistically significant in both groups. Myobrace was more difficult to use while sleeping, whereas the twin block caused more nausea.

CONCLUSIONS

Both appliances can be used for mandibular advancement. The Twin-block appliance, on the other hand, was more effective and patient-friendly.

Orthodontic apps: an assessment of quality (using the Mobile App Rating Scale (MARS)) and behaviour change techniques (BCTs)

BACKGROUND

Apps have been shown to be an effective tool in changing patients' behaviours in orthodontics and can be used to improve their compliance with treatment. The Behaviour Change Techniques (BCTs) and quality (using MARS) within these apps have previously not been published.

OBJECTIVES

1. To evaluate the quality of these apps aiming to change behaviour. 2. To assess BCTs used in patient focused orthodontic apps.

METHODS

The UK Google Play and Apple App Stores were searched to identify all orthodontic apps and 305 apps were identified. All 305 apps were assessed for the presence of BCTs using an accepted taxonomy of BCTs (Behaviour Change Wheel (BCW)), widely utilised in healthcare. Of those containing BCTs, the quality was assessed using the Mobile App Rating Scale (MARS), a validated and multi-dimensional tool which rates apps according to 19 objective criteria. Data collection was carried out by two calibrated, independent assessors and repeated after 6 weeks for 25% of the apps by both assessors.

RESULTS

BCTs were found in 31 apps, although only 18 of them were analysed for quality and 13 apps were excluded. Six different BCTs were identified: these were most commonly 'prompts/cues', and 'information about health consequences'. All apps were shown to be of moderate quality (range 3.1-3.7/5). Inter-rater and intra-rater reliability for BCT and quality assessment were excellent.

CONCLUSIONS

The current availability of orthodontic apps of sufficient quality to recommend to patients is very limited. There is therefore a need for high-quality orthodontic apps with appropriate BCTs to be created, which may be utilised to improve patients' compliance with treatment.

Factors Influencing Patient Compliance during Clear Aligner Therapy: A Retrospective Cohort Study

Compliance is highly relevant during clear aligner therapy (CAT). In this retrospective cohort study, we assessed compliance and associated covariates in a large cohort of CAT patients. A comprehensive sample of 2644 patients (75.0% females, 25.0% males, age range 18–64 years, median 27 years), all receiving CAT with PlusDental (Berlin, Germany) finished in 2019, was analyzed. Covariates included demographic ones (age, gender) as well as self-reported questionnaire-obtained ones (satisfaction with ones’ smile prior treatment, the experience of previous orthodontic therapy). The primary outcome was compliance: Based on patients’ consistent use of the mobile application for self-report and aligner wear time of ≥22 h, patients were classified as fully compliant, fairly compliant, or poorly compliant. Chi-square test was used to compare compliance in different subgroups. A total of 953/2644 (36.0%) of patients showed full compliance, 1012/2644 (38.3%) fair compliance, and 679/2644 (25.7%) poor compliance. Males were significantly more compliant than females (p = 0.000014), as were patients without previous orthodontic treatment (p = 0.023). Age and self-perceived satisfaction with ones’ smile prior to treatment were not sufficiently associated with compliance (p > 0.05). Our findings could be used to guide practitioners towards limitedly compliant individuals, allowing early intervention.

Predictors of patient compliance during Class II division 1 malocclusion functional orthodontic treatment

OBJECTIVES

To determine factors that could predict Class II/1 malocclusion patient compliance during functional treatment.

MATERIALS AND METHODS

The sample consisted of 77 subjects (aged 11-13 years; 47% girls) presenting with Class II/1 malocclusion. Inclusion criteria were distal molar relationship, overjet greater than 5 mm, and confirmed pubertal growth spurt. Removable functional appliances (62% Twin Block [TB], 38% Sander Bite Jumping [BJ]) with built-in maxillary expansion screws were used. Follow-up period was 1 year. Patients and parents independently filled out the Child Perception Questionnaire, Parental/Caregiver Perception Questionnaire, and Family Impact Scale to assess emotional and social well-being, oral symptoms, functional limitations, parental emotions, family activities, conflicts, and financial burden as possible predictors of compliance during treatment. Sex, overjet, and appliance type were also analyzed.

RESULTS

There were more noncompliant than compliant patients (55% vs 45%). Parental perception of altered emotional well-being of their children was the strongest predictor, increasing compliance odds 3.4 times (95% confidence interval [CI], 1.2-9.4; P = .017). Patients were 3.2 times (95% CI, 1.1-9.3; P = .033) more likely to cooperate with TB compared with BJ appliance. OJ ≥ 8 mm increased compliance odds 3.1 times (95% CI, 1.0-9.4; P = .044).

CONCLUSIONS

Parental perception of child's emotional well-being alteration, severity of malocclusion, and type of appliance are major predictors of compliance. Psychosocial issues and oral function limitations reported by children and family impact are of negligible influence.

Factors affecting dental self-confidence and satisfaction with dental appearance among adolescents in Saudi Arabia: a cross sectional study

Background

Dental appearance affects facial beauty, social interaction and psychological well-being particularly among adolescents. The aim of the current study was to determine factors affecting adolescent dental self-confidence and satisfaction with dental appearance in Saudi Arabia.

Methods

A cross-sectional study was conducted in the Eastern Province of Saudi Arabia among 3500 students attending intermediate and high schools. Data was collected from 2637 students using the translated Arabic version of the psychosocial impact of dental esthetics questionnaire (PIDAQ) in addition to questions about smile esthetics satisfaction and demographic variables including; gender, age, school grade, and parental level of education. Statistical analysis was performed by using logistic regression to assess the effect of demographical variables on PIDAQ and its domains at 5% significance level.

Results

About 80% of the participants were satisfied or somewhat satisfied with their smiles. Tooth alignment and tooth color were the most cited reasons for adolescents’ dissatisfaction about their smile, 34% and 33% respectively. Females and participants’ fathers’ university education figured in a statistically significant way regarding higher PIDAQ and aesthetic concerns. Females were 70%, and those with fathers’ university education were 22% more likely to have a negative psychological impact. Females expressed aesthetic concerns nearly two times more than males. Participants whose fathers possessed university education had an aesthetic concern 1.25 times more compared to those whose fathers had no school or limited school education. Females and those with mothers who had university education were less likely to have positive dental self-confidence.

Conclusions

Most adolescents exhibited satisfaction with their own smiles. Smile dissatisfaction in the remaining participants was related to teeth alignment, color and shape. Females were more concerned with dental esthetics and smile satisfaction than males. Females and participants whose fathers had a university education exhibited higher psychosocial impact than males and those with or without school education. However, males showed greater self-confidence in their dental aesthetics.

Traditional vs digital communication channels for improving compliance with fixed orthodontic treatment

OBJECTIVES

To compare the efficacy of traditional and digital communication strategies in improving compliance with fixed orthodontic therapy and to investigate the effect of gender, baseline oral hygiene habits, socioeconomics, and parents' education on orthodontic compliance.

MATERIALS AND METHODS

Orthodontic patients were randomly allocated to three groups. Group 1 received traditional communication including verbal and written instructions, whereas group 2 and group 3 received, in addition to traditional communication, weekly text messages or e-mails with audiovisual links, respectively. Baseline demographics (age, gender, baseline oral hygiene habits, socioeconomics, and parents' education) as well as compliance indicators (treatment duration, failed appointments, incidence and total number of appliance breakages) were recorded. For statistical analysis, Pearson chi-square, independent t-test, and one-way analysis of variance were used (P < .05).

RESULTS

Of 120 patients (aged 12 to 18 years) recruited, 108 completed the trial (G1 = 37, G2 = 35, G3 = 36). Weekly text messages failed to improve patient compliance. On the other hand, sending weekly e-mails with audiovisual links significantly (P = .014) reduced the incidence of appliance breakage as compared with the control group. Females had a significantly lower incidence of breakage (P = .041) and a fewer total number of breakages (P = .021). Patients from households with high income had significantly better compliance (P < .05). A higher level of parents' education was significantly associated with a lower incidence and total number of breakages (P < .01).

CONCLUSIONS

Communication with patients using link-rich e-mails and reminders could improve patient compliance with fixed orthodontic treatment. Female patients, high household income, and high parent education are associated with better compliance with fixed orthodontic treatment.

Assessing the Effectiveness and Acceptability of a Personalized Mobile Phone App in Improving Adherence to Oral Hygiene Advice in Orthodontic Patients: Protocol for a Feasibility Study and a Randomized Controlled Trial

Background

Orthodontic treatment is a common health care intervention; treatment duration can be lengthy (2-3 years on average), and adherence to treatment advice is therefore essential for successful outcomes. It has been reported that up to 43% of patients fail to complete treatment, and there are currently no useful predictors of noncompletion. Given that the National Health Service England annual expenditure on primary-care orthodontic treatment is in excess of £200 million (US $267 million), noncompletion of treatment represents a significant inefficient use of public resources. Improving adherence to treatment is therefore essential. This necessitates behavior change, and interventions that improve adherence and are designed to elicit behavioral change must address an individual’s capability, opportunity, and motivation. Mobile phones are potentially an invaluable tool in this regard, as they are readily available and can be used in a number of ways to address an individual’s capability, opportunity, and motivation.

Objective

This study will assess the effectiveness and acceptability of a personalized mobile phone app in improving adherence to orthodontic treatment advice by way of a randomized controlled trial.

Methods

This study will be conducted in 2 phases at the Eastman Dental Hospital, University College London Hospitals Foundation Trust. Phase 1 is feasibility testing of the My Braces app. Participants will be asked to complete the user version of the Mobile Application Rating Scale. The app will be amended following analysis of the responses, if appropriate. Phase 2 is a randomized controlled trial to test the effectiveness and acceptability of the My Braces app.

Results

This study was approved by the London – Bloomsbury Research Ethics Committee on November 5, 2019 (reference 19/LO/1555). No patients have been recruited to date. The anticipated start date for recruitment to phase 1 is October 2020.

Conclusions

Given the availability, affordability, and versatility of mobile phones, it is proposed that they will aid in improving adherence to treatment advice and hence improve treatment completion rates. If effective, the applicability of this methodology to developing behavior change/modification interventions and improving adherence to treatment across health care provides an exciting opportunity.

Trial Registration

ClinicalTrials.gov NCT04184739; https://clinicaltrials.gov/ct2/show/NCT04184739

International Registered Report Identifier (IRRID)

PRR1-10.2196/18021

Effect of fixed mechanotherapy on psychosocial impact of malocclusion using PIDAQ in the Indian population - A follow up study

Background

The presence of malocclusion in an individual not only distresses the oral form and function but also has a significant impact on the psychological and social well-being of an individual. Adoption of a patient centered approach during the correction of malocclusion serves to benefit both the individual and the orthodontic fraternity, as it aims to improve the function, aesthetics and subsequently, the overall quality of life.

Materials and methods

In this study, the psychosocial impact of malocclusion was evaluated on 93 patients using the IOTN (Index of Orthodontic Treatment Needs) and the PIDAQ (Psychosocial impact of dental aesthetics questionnaire) indices. The questionnaires were paired accordingly and statistically analysed. Association of the age and gender with the psychosocial impact of malocclusion was also assessed.

Results

Mean total and the individual component scores of the PIDAQ were assessed pre and post treatment and a significant reduction in the scores was observed. The IOTN-AC (IOTN - Aesthetic Component) scores also improved drastically with treatment. However, no statistically significant association of age, education level or socioeconomic class with the psychosocial impact of malocclusion was observed.

Conclusion

The significant improvement in the mean PIDAQ and IOTN-AC scores obtained after completion of fixed orthodontic treatment, indicate the high initial psychosocial impact of malocclusion which significantly reduced with treatment, accenting the role of orthodontics in improving the overall psychological and social well-being of an individual.

Factors related to the psychological impact of malocclusion in adolescents

To study the association between orthodontic treatment need and the psychosocial impact of dental aesthetics in a sample of adolescents, as well as other associated factors. A transversal study was conducted on 1,158 adolescents (12–16 years old) examined at the schools selected for the 2018 epidemiological study on oral health in the Comunidad Valenciana (Spain). The need for orthodontic treatment was determined by DAI and IOTN. The psychosocial impact was established by the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). Other variables considered were sex, social class, DMFT index and Body-Mass Index, and having previously worn or presently wearing an orthodontic device. A lineal regression statistical technique was applied to study the significant associations with the scoring obtained in PIDAQ. The PIDAQ scores revealed a significant and positive lineal relationship with regard to need for orthodontic treatment: DAI (ẞ = 0.20) and IOTN-DHC (ẞ = 4.87), in women (ẞ = 2.66) and a negative one for having previously worn an orthodontic device (ẞ = − 5.74). The rest of the variables had no statistical significance (p > 0.05). The psychosocial impact of dental aesthetics in adolescents is associated with the presence of malocclusion and the female sex, while the condition of having previously worn an orthodontic device reduces the psychosocial impact.

Oral health-related quality of life in orthodontics: a cross-sectional multicentre study on patients in orthodontic treatment

Objective

This study aimed to assess oral health-related quality of life (OHRQoL) in relation to associated covariates in orthodontic patients of different age groups (children, adolescents, and adults) in a cross-sectional study.

Methods

A total of 898 subjects (50.6% females, 49.4% males; mean age 16.89 years) undergoing orthodontic treatment anonymously completed the German version of the Oral Health Impact Profile (OHIP-G14) to assess OHRQoL in addition to completing 23 other items. Descriptive, exploratory statistical analysis and multiple linear regression modelling were performed.

Results

The mean score of the OHIP-G14 was 8.3 for the 6- to 11-year olds, 8.9 for the 12- to 17-year olds, and 12.6 for adults. Physical pain (Subscale 2) was the highest factor in all groups. Additionally, a relevant factor was Subscale 3 (psychological discomfort). A linear regression model showed that, in the adolescent group, aesthetics in combination with pain had a significant negative influence on OHRQoL, whereas, in the adult group, function in combination with pain showed the same significant negative influence. Second, except for the children, fixed appliances had a significant negative effect on OHRQoL compared to removable appliances.

Conclusions

Our study showed that the majority of the 6- to 11-year olds and 12- to 17-year olds reported a good OHRQoL. Nevertheless, adolescents and adults who reported aesthetic/pain and function/pain problems, respectively, as reasons for orthodontic treatment showed a significant occurrence for reduced OHRQoL. Fixed appliances, in comparison with removable appliances, also resulted in a significant reduction in OHRQoL for both groups.

Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate

OBJECTIVE

To identify rates of nonadherence to orthodontic treatment among youth with cleft lip and/or palate (CL/P) and to compare demographic and clinical characteristics of patients categorized as adherent or nonadherent.

DESIGN

Retrospective chart review.

SETTING

Orthodontic treatment program affiliated with a US pediatric hospital-based craniofacial team.

PARTICIPANTS

Medical charts of 54 patients with CL/P beginning phase I or phase II orthodontics between 2011 and 2014 (54% male; mean age: 11.7 ± 3.2 years) were reviewed.

MAIN OUTCOME MEASURE(S)

Data abstracted included demographic and clinical characteristics. Patients were classified as nonadherent based upon treatment termination due to nonadherence, treatment courses extending beyond 3 years, and information about missed appointments, poor oral hygiene, and broken appliances.

RESULTS

In all, 24% had treatment terminated due to nonadherence and were significantly more likely to have behavioral health diagnoses (P = .01) or visits (P = .02) and social work consults (P = .01) than patients without termination. Thirty-seven percent had treatment courses beyond 3 years; youth with longer courses were significantly more likely to have cleft lip and palate versus cleft palate only or cleft lip (P = .03). Patients who missed more than 4 appointments were less likely to have behavioral health diagnoses (P < .01) compared to those with fewer missed appointments. Poor hygiene and broken appliance notations were common. Youth with poor hygiene notations were significantly older (P < .01) at treatment initiation than those without notations.

CONCLUSIONS

Nonadherence was associated with diagnosis, age, and history of behavioral health or social work involvement. An understanding of adherence and relationships with clinical and demographic factors can inform clinical care and support intervention development to improve outcomes.

Adherence to Orthodontic Treatment in Youth With Craniofacial Conditions: A Survey of US Orthodontists

OBJECTIVE

(1) To explore orthodontists' perceptions of nonadherence and related factors in their patients with craniofacial conditions; (2) to examine differences in adherence perceptions by provider characteristics; (3) to evaluate current adherence interventions.

DESIGN

Cross-sectional.

SETTING

United States-based orthodontists affiliated with a nonprofit association for providers treating oral cleft and craniofacial conditions received survey invitations via list-serv, e-mail, and social media.

PARTICIPANTS

Thirty-eight orthodontists participated (mean age = 50.5 ± 10.7 years; 76% Caucasian; 55% male; 54% private practice).

MAIN OUTCOME MEASURE

An 80-item survey assessed demographic characteristics; frequencies of various adherence problems and adherence-related prolonged or terminated treatment; importance of adherence to treatment outcomes; factors that may impact adherence; interest in improving adherence; and use of adherence-enhancing interventions.

RESULTS

Adherence problems were common, yet 80.6% of participants rated adherence as "very important" to cleft treatment outcomes. Child behavior and motivation, caregiver reinforcement of behavior, and provider communication with the family were identified as factors that greatly impact adherence. Orthodontists in university-affiliated programs were more likely to rate individual, family, health-care system, and community factors as impacting adherence compared to private practice orthodontists; 80.6% used adherence interventions; these strategies were all rated as "sometimes successful."

CONCLUSIONS

Nonadherence to cleft lip/palate-related orthodontic care is common and potentially detrimental to care. Current interventions are not uniformly successful and could be better tailored. Understanding provider, patient, and family factors that affect adherence can inform individualized treatment planning to improve adherence and ultimately, treatment outcomes.

Three-Dimensional Assessment of the Oral Health-Related Quality of Life Undergoing Fixed Orthodontic Therapy

Aims and Objectives:

Discomfort associated with the use of fixed orthodontic appliances may have a negative influence on the patient's oral health-related quality of life (OHRQoL). In general, OHRQoL assessments have the potential to provide information on the need to improve the overall quality of care. This study aims to assess the impact of fixed orthodontic appliances on OHRQoL of Saudi population and to explore the impact of the patient's gender and age on perceived treatment.

Subjects and Methods:

This cross-sectional study used a generic measure of OHRQoL the Arabic version of the Oral Health Impact Profile (OHIP-14), which is a responsive measure to changes in oral health conditions. Data were collected using self-completed e-questionnaire which was distributed through social media and were analyzed using Statistical Package for Social Sciences (SPSS) version 21.0.

Results:

A total of 149 subjects, 110 (73.8%) were females and 39 (26.2%) were males. Adolescents between 13 and 20 years were 63 (42.3%) and adults between 21 and 30 years were 86 (75.7%). A response rate of 100% was obtained. The prevalence of oral health impacts according to OHP-14 was 22.5%. OHIP-14 consists of 14 items covering seven domains. A three-dimensional structure was used to test the existence of separate dimensions: functional limitation, pain discomfort, and psychosocial impact. A significant difference was found between males and females in the first dimension (P = 0.038) and the third dimension (P = 0.022). In addition, a significant difference was also found between the two age groups included in the study within the third dimension (P = 0.025).

Conclusion:

Fixed orthodontic appliances had an evident impact on OHRQoL. However, males had significantly altered functional limitations while females had a higher psychological impact. Furthermore, adults had a significantly higher psychological impact than adolescents.

[Discontinuation of Orthodontic Treatment: what are the early predictive factors?]

INTRODUCTION

Discontinuation of orthodontic treatment has iatrogenic, psychological, ergonomic and financial consequences. The objective of this study was to investigate early risk factors (prior to installation) of discontinuation of orthodontic treatment.

MATERIALS AND METHODS

We performed a case-control study between a group of patients who dropped their orthodontic treatment ("A") and a randomly selected group of patients who had completed their orthodontic treatment ("NA"). The two groups were compared, with descriptive, uni and multivariate analyzes. The risk factors assessed were age, gender, socioeconomic status, type of treatment, dysmorphism, malocclusion, need for treatment, compliance.

RESULTS

In the dropout group 55 patients were included ("A") and 100 in the non-abandoned ("NA") group randomly selected. The subject at risk of abandonment was a girl of less than 11 years of age with a low socio-economic level with antero-posterior and vertical skeletal dysmorphisms, a molar class II, a teeth crowding, a small aesthetic prejudice or, on the contrary, very important, complex treatment (with extractions or with surgery) and having delays or missed appointments before the installation of the orthodontic appliance.

CONCLUSION

Patients' motivation needs to be strengthened for both extremes: treatments that appear simple and conversely for complex cases requiring strong cooperation.

Socioeconomic disparities in orthodontic treatment outcomes and expenditure on orthodontics in England's state-funded National Health Service: a retrospective observational study

Background

This study aimed to assess whether there are potential areas for efficiency improvements in the National Health Service (NHS) orthodontic service in North West England and to assess the socioeconomic status (SES)-related equity of the outcomes achieved by the NHS.

Methods

The study involved a retrospective analysis of 2008–2012 administrative data, and the study population comprised patients aged ≥10 who started NHS primary care orthodontic treatment in North West England in 2008. The proportions of treatments that were discontinued early and ended with residual need (based on post-treatment Index of Orthodontic Treatment Need [IOTN] scores that met or exceeded the NHS eligibility threshold of 3.6) and the associated NHS expenditure were calculated. In addition, the associations with SES were investigated using linear probability models.

Results

We found that 7.6% of treatments resulted in discontinuation (which was associated with an NHS annual expenditure of £2.3 m), and a further 19.4% (£5.9 m) had a missing outcome record. Furthermore, 5.2% of treatments resulted in residual need (£1.6 m), and a further 38.3% (£11.6 m) had missing IOTN data (due to either a missing outcome record or an incomplete IOTN outcome field in the record), which led to an annual NHS expenditure of £13.2 m (44% of the total expenditure) on treatments that are a potential source of inefficiency. Compared to the patients in the highest SES group, those in the lower SES groups were more likely both to discontinue treatment and to have residual need on treatment completion.

Conclusions

Substantial inefficiencies were evident in the NHS orthodontic service, with 7.6% of treatments ending in discontinuation (£2.3 m) and 5.2% ending with residual need (£1.6 m). Over a third of cases had unreported IOTN outcome scores, which highlights the need to improve the outcome monitoring systems. In addition, the SES gradients indicate inequity in the orthodontic outcomes, with children from disadvantaged communities having poorer outcomes compared to their more affluent peers.

Electronic supplementary material

The online version of this article (10.1186/s12903-017-0414-1) contains supplementary material, which is available to authorized users.

Orthodontic Treatment Completion and Discontinuation in a Rural Sample from North Central Appalachia in the USA

BACKGROUND

Orthodontics has inherent demands, requiring regular appointments and active patient engagement, but relatively little is established in regard to rates of completion of treatment and possible factors affecting successful completion. These factors may be particularly important for cultural minority groups, such as those in rural Appalachia, given the environmental, social, and economic complexities affecting access to and utilization of treatment.

DESIGN AND METHODS

A naturalistic study design was employed, using retrospective data from a rural outpatient general dental office in July 2012. Chart abstraction yielded 219 (55.3% female) orthodontic patients (M age = 11.0 [3.7]). Chi-square tests for independence were conducted for categorical dependent variables. For continuous variables, t-tests were conducted. A logistic multivariate regression analysis was conducted to predict completion/non-completion of treatment, with age, gender, distance traveled, type of malocclusion, and payment type as predictors.

RESULTS

Overall, 49.8% of this sample successfully completed orthodontic treatment. Greater successful conclusion of treatment was found in self-pay patients (i.e., 74%) versus those whose care was funded through Medicaid/Children's Health Insurance Program (i.e., 34%) or through private insurance (i.e., 36%). Age, gender, and distance to the office from home had no association relative to successful completion of treatment, although average one-way distance to travel for care was considerable (i.e., 38.8 miles).

CONCLUSION

Rate of successful orthodontic treatment completion was low in this rural sample. Treatment outcome was related to the form of payment for services, with self-pay associated with the highest rate of successful completion.

Patient survey on Invisalign® treatment comparing [corrected] the SmartTrack® material to the previously used [corrected] aligner material

OBJECTIVES

In 2013, a novel material SmartTrack^® was introduced to replace the previous material used for Invisalign^® aligners. We conducted this study to test how this transition was accepted by patients during ongoing Invisalign^® treatment.

METHODS

We surveyed a total of 72 patients (68 % women, 32 % men, mean age: 29.3 ± 9.2 years) who had worn the new material for a mean of 6 months. They completed a questionnaire with 25 items that compared both materials in terms of pain, pressure upon insertion, comfort, mucosal irritation, phonetics, discoloration, and taste.

RESULTS

On a numerical rating scale (NRS) ranging from 0 to 10, the new aligner material was rated by the respondents to cause significantly (p < 0.001) less maximum pain than the old material (2.8 vs. 3.8). Significant reductions were obtained for duration of pain (p < 0.001) and duration of pressure (2.5 vs. 1.9 days; p = 0.001) upon insertion of the aligners. Over 90 % of the respondents indicated less or equal pain during eating, felt that the new material offered a tighter fit, and provided more favorable ratings for impairment, durability, and discoloration. Improved comfort was reported by 50 % of the respondents.

CONCLUSIONS

The new material was favorably rated by the patients and showed significant reductions in pain intensity, pain duration, and pressure upon insertion. Important clinical parameters like overall comfort and impairment also were improved. The clinical effectiveness of the new material remains to be investigated.

Impact of Malocclusion on the Quality of Life of Brazilian Adolescents: A Population-Based Study

The objective of this study was to evaluate the impact of malocclusion on the quality of life (QOL) of adolescents in Brazil. We carried out a cross-sectional study in a sample population of 1015 schoolchildren aged 12 to 15 years from São Luís, Maranhão, Brazil. The explanatory variable was malocclusion, evaluated on the basis of the normative need or the adolescent’s self-perceived need for dental treatment. Normative need for dental treatment was determined by professional diagnosis, made on the basis of Angle’s classification, the Dental Aesthetic Index, and other morphological deviations (e.g., posterior crossbite, posterior open bite, and deep overbite). We analyzed the impact of malocclusion on the QOL using the Portuguese version of the Oral Health Impact Profile-14. Associations were estimated by using the prevalence ratio (PR) in Poisson regression analysis, with hierarchized modeling. An alpha of 5% was adopted as the criterion for statistical significance. The QOL of adolescents was impacted by malocclusion, classified by a normative need for treatment according to the Dental Aesthetic Index (PR = 1.27; 95% confidence interval [CI] = 1.03–1.56) or by the self-perceived need for treatment (PR = 2.54; 95% CI = 1.81–3.56). Certain sociodemographic variables, including the head of the family (PR = 1.52; 95% CI = 1.02–2.23), greater educational level of the head of the family (PR = 0.32; 95% CI = 0.17–0.61), and female sex (PR = 1.40; 95% CI = 1.05–1.89), had negative associations with QOL. We conclude that malocclusion has a negative impact on the QOL of adolescents, associated with socioeconomic conditions and the cosmetic effects of malocclusion.

Longitudinal evaluation of the impact of dental caries treatment on oral health-related quality of life among schoolchildren

This study aimed to evaluate the impact of dental caries treatment on oral health-related quality of life (OHRQoL) among schoolchildren and the responsiveness of the Child Perceptions Questionnaire (CPQ8-10 ) instrument. Brazilian schoolchildren, 8-10 yr of age, were randomly selected and assigned to two groups--dental caries treatment (DCT) and caries-free (CF)--according to their caries experience [decayed, missing, or filled primary teeth (dmft) and decayed, missing or filled secondary teeth (DMFT) values of ≥ 0]. The CPQ8-10 instrument was administered at baseline and at 4 wk of follow-up (i.e. 4 wk after completion of dental treatment). In the DCT group, increases in CPQ8-10 scores were observed between the baseline and follow-up results. However, longitudinal evaluation of the CF group demonstrated no statistically significant difference in CPQ8-10 scores. Responsiveness of the CPQ8-10 instrument (magnitude of change in CPQ8-10 scores) in the DCT group was greater (effect size >0.7) than in the CF group. The findings of this study show that dental caries treatment has an important impact on OHRQoL of children. The CPQ8-10 was considered an acceptable instrument for longitudinal measurement of changes in OHRQoL.

Expectations of orthodontic treatment in adults: the conduct in orthodontist/patient relationship

INTRODUCTION

The high demand for orthodontic treatment, evidenced over the last few decades, has been justified mainly by the greater importance given to facial esthetics, influencing individual's self esteem. However, the professional frequently does not meet all the patient's expectations, for not establishing good communication and not knowing about the critical points during orthodontic treatment.

OBJECTIVE

The aim of this study was to elucidate patients' desires and doubts regarding orthodontic treatment, by means of a survey applied to 60 adult patients.

RESULTS

The analysis of results revealed that most individuals (38.3%) noticed treatment success after its conclusion. Occlusion deviation was pointed out by 66.7% as the main reason for seeking treatment, and esthetics ranked as second (with 48.3%). Treatment time was considered within the prediction by 46.7% of the interviewees and the results were judged as very good by 43.3%. The social relations of most participants were not affected by treatment (73.3%). Also, 58.3% of the interviewees reported pain as the main complaint and 53.3% found it difficult to use dental floss. Most participants saw the orthodontist as a professional who was concerned about their health (76.7%), and believed that he/she was more able to treat them (96.6%) when compared with the general practitioner.

CONCLUSIONS

The orthodontist/patient relationship enables an understanding of the expectations regarding orthodontic treatment, resulting in greater motivation and cooperation, leading to a successful outcome.

Oral health-related quality of life in patients with dentofacial deformity: a new concept in decision-making treatment?

BACKGROUND

The parameters for the indication of surgical-orthodontic treatment by professionals do not always coincide with the factors which motivate patients to seek treatment.

PURPOSE

The purpose of this review is to check the main applications of oral health-related quality of life (OHRQoL) assessment in the treatment of dentofacial deformities and discuss how this approach enriches the traditional diagnostic evaluation and the treatment plan.

RESULTS

The indicators of OHRQoL are psychometric tools which can help orthodontists and maxillofacial surgeons in making individual treatment decisions, which include the following: (1) public health triage, (2) decision to treat or not to treat, (3) stipulating the ideal time for treatment, (4) decision making in borderline cases, (5) estimating if the patient will follow the treatment, and (6) they also act as tools to evaluate health services and patient satisfaction or dissatisfaction with the treatment performed.

CONCLUSION

It was concluded that the psychometric and morphological information tended to complement each other and helped to achieve better results, thereby leading to successful professional-patient relationships.

Self-ligating brackets and their impact on oral health-related quality of life in Chinese adolescence patients: a longitudinal prospective study

INTRODUCTION

Although the associations between orthodontic and oral health-related quality of life (OHRQOL) have been explored, little research has been done to address the influence of brackets type on perceived OHRQOL. The aim of this study was to assess whether the levels of OHRQOL in Chinese adolescence patients were influenced by the type of brackets.

MATERIALS AND METHODS

One hundred fifty Chinese orthodontic adolescence patients completed the 14-item Oral Health Impact Profile (OHIP-14, Chinese version) at five distinct intervals: after insertion of the fixed appliance at 1 week (T1), 1 month (T2), 3 months (T3), and 6 months (T4); and after treatment (T5).

RESULTS

Patients with self-ligating brackets were associated with less pain and discomfort at any intervals compared with conventional brackets, but no significant difference of overall OHIP-14 scores could be found between two groups. Moreover, in both groups, overall scores at T1 and T2 were significantly higher than the scores at any other intervals in both groups.

CONCLUSIONS

The type of orthodontic appliance did not affect oral health-related quality of life in Chinese adolescence patients.

Quantifying patient adherence during active orthodontic treatment with removable appliances using microelectronic wear-time documentation

OBJECTIVES

The aim of this study was to quantify the wear times of removable appliances during active orthodontic treatment.

MATERIALS AND METHODS

The wear times of 141 orthodontic patients treated with active removable appliances in different locations were documented over a period of 3 months using an incorporated microsensor. Gender, age, treatment location, health insurance status, and type of device were evaluated with respect to wear time. Significant associations between wear times and patient factors were calculated using non-parametric tests.

RESULTS

The median daily wear time was 9.7 hours/day for the entire cohort, far less than the 15 hours/day prescribed. Younger patients wore their appliances for longer than older patients (7-9 years 12.1 hours/day, 10-12 years 9.8 hours/day, and 13-15 years 8.5 hours/day; P < 0.0001). The median wear time for females (10.6 hours/day) was 1.4 hours/day longer than males (9.3 hours/day; P = 0.017). Patients treated at different locations wore their devices with a difference of up to 5.0 hours/day. Privately insured patients had significantly longer median wear times than statutorily insured patients. No significant difference in wear time was noted according to device type.

CONCLUSIONS

The daily wear time of removable appliances during the active phase of orthodontic therapy can be routinely quantified using integrated microelectronic sensors. The relationship between orthodontist and patient seems to play a key role in patient adherence. Wear-time documentation provides the basis for more individualized wear-time recommendations for patients with removable appliances. This could result in a more efficient, shorter, and less painful orthodontic therapy.

The association between oral health literacy and failed appointments in adults attending a university-based general dental clinic

OBJECTIVES

The purpose of this study is to determine the association between personal characteristics, a person's oral health literacy, and failing to show for dental appointments at a university dental clinic.

METHODS

A secondary data analysis was conducted on data collected from 200 adults at a university dental clinic between January 2005 and December 2006. In the original study, an oral health literacy instrument, the Rapid Estimate of Adult Literacy in Medicine and Dentistry (REALM-D), was administered, sociodemographic and health information seeking behavior was gathered, and electronic records were reviewed.

RESULTS

Descriptive and bivariate analyses and a classification and regression tree (CART) analysis were conducted. Seeking health information through fewer sources vs. multiple sources was the strongest predictor of failing to show. The subjects' oral health literacy, as measured by the REALM-D List 3 score, was the next most significant variable. Classification and regression tree analyses also selected gender, chief complaint, age, and payment type as predictor variables.

CONCLUSIONS

Multiple factors contribute to failing to show for dental appointments. However, individuals who use fewer sources of oral health information, a subset of health literacy skills, are more likely to fail to show for dental appointments.

Motivation for orthodontic treatment investigated with Q-methodology: patients' and parents' perspectives

INTRODUCTION

Motivation and cooperation are vital components of orthodontic treatment if a good outcome is to be achieved. In this study, we used Q-methodology to investigate motivating factors among adolescents seeking orthodontic treatment and parents wanting their children to undergo orthodontic treatment. This technique asks participants to rank a series of statements, and the analysis of this ranking then provides insight into the participants' opinions.

METHODS

Each of these complementary studies was divided into 2 phases: interviews to generate a list of reasons for seeking orthodontic treatment and the use of Q-methodology to assess and categorize the relative importance of these reasons for the groups of participants. In the patient study, 32 items were generated from the interviews and placed in order of importance on a Q-methodology grid by 60 patients who were about to commence orthodontic treatment. The rankings were subjected to factor analysis, which categorized the patients' views into groups of shared opinions. The same methodology was used with the parent group, and a Q-methodology grid was designed to accommodate 35 items that were then ranked by the 60 parents. The rankings were subjected to factor analysis as for the patient group.

RESULTS

For the patients, factor analysis identified 3 factors, all of which included esthetics, as important. The remaining respondents had more individual viewpoints and did not map to any of the 3 factors. For the parents, factor analysis identified 4 factors, all of which included treatment in adolescence to prevent future problems, as important.

CONCLUSIONS

This study showed that Q-methodology is a novel and efficient tool that can be used in dental research with few difficulties. It might prove useful for the aspects of care for which subjective views or opinions play an important role.

Oral Health-Related Quality of Life (OHQoL) among adolescents seeking orthodontic treatment

AIM

The aim of this study was to assess the effect of different orthodontic treatment needs on the OHQoL of adolescents.

MATERIALS AND METHODS

200 subjects (100 males and 100 females), 11 to 15 years of age were recruited for the study. OHQoL was assessed with the short form of the oral health impact profile (OHIP-14), and malocclusion severity was assessed with the index of orthodontic treatment need (IOTN). The Chi-square test was used to analyse the qualitative data. The level of significance was 0.05.

RESULTS

The more severe the malocclusion the worse was the impact on the OHQoL. Orthodontic treatment need had almost similar impact on the daily activities of both males and females. Pronunciation and taste was not significantly affected by the need for orthodontic treatment in either males or females. The proportions of orthodontic patients who found it uncomfortable to eat any food and had to interrupt their meals were significantly correlated with orthodontic treatment needs in both males and females.

CONCLUSION

Orthodontic treatment need had an impact on OHQoL of adolescents with no significant difference between males and females.

CLINICAL SIGNIFICANCE

Orthodontists should be aware of the impact caused by malocclusion and orthodontic treatment on the quality of life of the patients and should provide regular positive reinforcements to them.

Development of a measure for orthodontists to evaluate patient compliance

INTRODUCTION

Interruption of treatment and poor compliance are problems in orthodontics, especially when the patient does not pay for treatment. The aim of this study was to develop a measure for orthodontists, regardless of type of practice, to assess their opinions about patient compliance.

METHODS

A questionnaire, based on an orthodontic patient cooperation scale, was modified in 2 pilot phases. The piloted version was tested among 249 respondents. A principal component analysis was performed that included factors with an eigenvalue greater than 1. Reliability was assessed by means of internal consistency with Cronbach's alphas and by test-retest (n = 40) measures, using an intraclass correlation coefficient. To assess construct validity, the responses of private and public practitioners were analyzed with chi-square and t tests.

RESULTS

The response rate was 77%. The final questionnaire showed good reliability: Cronbach's alpha coefficient was 0.878, and the intraclass correlation coefficient after the test-retest was 0.868. The participation rate was good, there were few missing values, and the study was multifaceted; thus the questionnaire also showed good validity for face, content, and construct. The differences between private and public practitioners were statistically significant. Five factors describing the different aspects of compliance were shown.

CONCLUSIONS

Observed differences between public and private orthodontists and dentists performing orthodontics indicated clearly the need to develop a specific measure for countries with a publicly funded system of oral health care. The measure showed good reliability and validity for face, content, and construct among Finnish orthodontists and dentists performing orthodontics. The predictive validity of the measure to assess actual patient compliance remains to be tested.

Effect of anterior teeth display during smiling on the self-perceived impacts of malocclusion in adolescents

OBJECTIVE

To investigate the impact of the anterior teeth display during smiling (ATDDS) on the self-perceived psychosocial impacts of malocclusion in adolescents.

MATERIALS AND METHODS

This cross-sectional study included a convenience sample of 301 adolescents (mean age 16.1 years, SD 1.8 years; 58.1% female). Two instruments were used for data collection: (1) the Dental Aesthetic Index (DAI) and (2) the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ). In addition, ATDDS was assessed in posing smiling, and adolescents' satisfaction with their dental appearance was investigated. Data analysis included descriptive statistics, Kruskal-Wallis test and Mann-Whitney U-test, Spearman correlation, and multiple linear regression analysis.

RESULTS

Significant associations were observed between independent variables (ATDDS, DAI scores, and satisfaction with dental appearance) and total PIDAQ score (R(2)  =  0.37) and dental self-confidence (R(2)  =  0.37), psychological impact (R(2)  =  0.30), esthetic concern (R(2)  =  0.20), and social impact (R(2)  =  0.15).

CONCLUSION

The excessive anterior teeth display during smiling may potentially influence the self-perceived psychosocial impacts of malocclusion in adolescents depending on the severity level of malocclusion and the self-reported satisfaction with dental appearance.

Psychosocial impact of dental esthetics on quality of life in adolescents

OBJECTIVE

To test the hypothesis that several dimensions of the self-perceived psychosocial impacts of dental esthetics are not associated with grades of malocclusion, oral health-related quality-of-life measures, and body self-image in adolescents.

MATERIALS AND METHODS

This cross-sectional study included a convenience sample of 301 adolescents (mean age 16.1 +/- 1.8 years, 58.1% female subjects). Demographic data were collected and dental conditions were assessed. The Dental Aesthetic Index (DAI) was used for assessment of malocclusion and determination of orthodontic treatment needs. The short form of the Oral Health Impact Profile (OHIP-14), the Psychosocial Impact of Dental Aesthetics Questionnaire (PIDAQ), and the Body Satisfaction Scale (BSS) were used to measure adolescents' self-perceived variables.

RESULTS

All variables (DAI, OHIP-14, and BSS) were correlated with PIDAQ (P < .001). Stepwise multiple regression analysis revealed significant associations (P < .001) of independent variables with the total score of PIDAQ (R(2) = 0.29) and dental self-confidence (R(2) = 0.30), social impact (R(2) = 0.14), psychological impact (R(2) = 0.23), and esthetic concern (R(2) = 0.13).

CONCLUSION

The hypothesis is rejected. A broad range of adolescents' self-perceived impact of dental esthetics is influenced by severity of malocclusion, oral health-related quality of life, and body satisfaction.