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Timm LH, Farrag G, Wolf D, Baxmann M, Schwendicke F. Effect of electronic reminders on patients' compliance during clear aligner treatment: an interrupted time series study. Sci Rep 2022; 12:16652. [PMID: 36198717 PMCID: PMC9534859 DOI: 10.1038/s41598-022-20820-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/19/2022] [Indexed: 12/02/2022] Open
Abstract
Patient compliance is relevant to achieving therapeutic goals during clear aligner therapy (CAT). The aim of this study was to evaluate the efficacy of remote electronic (e-)reminders and e-feedback on compliance during CAT using an interrupted time series (ITS) analysis. We used routinely collected mobile application data from a German healthtech company (PlusDental, Berlin). Our primary outcome was self-reported compliance (aligner wear time min. 22 h on 75% of their aligners were classified as fully compliant, min. 22 h on 50-74.9% of their aligners: fairly compliant; min. 22 h on < 50% of their aligners: poorly compliant). E-reminders and e-feedback were introduced in the 1st quarter of 2020. Compliance was assessed at semi-monthly intervals from June-December 2019 (n = 1899) and June-December 2020 (n = 5486), resulting in a pre- and post-intervention group. ITS and segmented regression modelling were used to estimate the effect on the change in levels and trends of poor compliance. Pre-intervention, poor compliance was at 24.47% (95% CI: 22.59% to 26.46%). After the introduction of e-reminders and e-feedback (i.e., post-intervention), the percentage of poorly compliant patients decreased substantially, levelling off at 9.32% (95% CI: 8.31% to 10.45%). E-reminders and e-feedback were effective for increasing compliance in CAT patients.Clinical Significance: Orthodontists and dentists may consider digital monitoring and e-reminders to improve compliance and increase treatment success.
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Affiliation(s)
- Lan Huong Timm
- Sunshine Smile GmbH, Windscheidstraße 18, 10627, Berlin, Germany.
- DrSmile - DZK Deutsche Zahnklinik GmbH, Königsallee 92a, 40212, Düsseldorf, Germany.
| | - Gasser Farrag
- Sunshine Smile GmbH, Windscheidstraße 18, 10627, Berlin, Germany
| | - Daniel Wolf
- Sunshine Smile GmbH, Windscheidstraße 18, 10627, Berlin, Germany
| | | | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité - Universitätsmedizin Berlin, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Vithanaarachchi N, Medagama T, Nawarathna L. Assessment of contributing factors for discontinuation of orthodontic treatment. APOS TRENDS IN ORTHODONTICS 2020. [DOI: 10.25259/apos_143_2019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives:
The aims of this study were to assess the prevalence and associated contributory factors for discontinuation of orthodontic treatment.
Materials and Methods:
A hospital-based retrospective study was conducted with the treatment records, whose orthodontic treatment was commenced in the year 2015 at the Division of Orthodontics, University Dental Hospital, Peradeniya. Information regarding age, gender, type of malocclusion, Index of Orthodontic Treatment Need, appliance type, duration of treatment, extraction versus non-extraction, stage of treatment, and the cost of treatment was obtained from the patient’s records. Statistical analysis was performed using the statistical software R 3.5.0.
Results:
The sample consisted of 310 treatment cases, of which 40 (12.9%) patients were discontinued. Among the discontinued patients, 50.6% were male and 49.3% were female. The discontinuation rate in the group of 12–17 years was higher than the other age groups, which was statistically significant (P = 0.005). Among the group of discontinued treatment, 49.3% were of Class II division 1 malocclusion and 37.1% and 37.4% of patients were in Grade 3 and 4 of IOTN, respectively. About 37% of patients have been discontinued before completion of 1 year which was statistically significant (P = 0.0005). About 59.5% of non-extraction patients were in the treatment discontinuation group which was also statistically significant (P = 0.023). About 32.5% of the patients who discontinued have obtained the treatment with the lowest cost with statistical significance (P = 0.026).
Conclusion:
Children with borderline and moderate occlusal irregularities treated with simple removable appliances which are affordable with low cost were more prone to discontinue in the early phase of active treatment.
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Affiliation(s)
| | - Thimuthu Medagama
- Departments of Community Dental Health University of Peradeniya, Kandy, Sri Lanka,
| | - Lakshika Nawarathna
- Departments of Statistics and Computer Science, University of Peradeniya, Kandy, Sri Lanka,
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Simon L, Choi SE, Ticku S, Fox K, Barrow J, Palmer N. Association of income inequality with orthodontic treatment use. J Am Dent Assoc 2020; 151:190-196. [PMID: 32130948 DOI: 10.1016/j.adaj.2019.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/24/2019] [Accepted: 11/25/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Income inequality has been associated with worse oral health outcomes and reduced dental care use. It is unknown whether income inequality may motivate people to seek orthodontic treatment. METHODS This was a logistic mixed-effects model of deidentified claims from a private insurer in the United States with enrolled members having at least 1 orthodontic visit in the calendar year as the dependent variable. Total number of dental visits, age, and sex were individual-level covariates. Median household income, Gini coefficient, female population proportion, number of practicing dentists and orthodontists, population size, and population density were zip code-level covariates. RESULTS A total of 1,860,709 people had at least 1 orthodontic claim. Adjusting for population demographics, the Gini index was significantly positively associated with orthodontic use for children but not for adults (odds ratio, 1.69 for children; P < .0001). Being female was the strongest predictor of orthodontic use for adults and was a significant predictor of use for children (odds ratio, 1.50 and 1.45, respectively; P < .0001). CONCLUSIONS The Gini index is associated with orthodontic use in children in a privately insured population. Individual characteristics are more predictive of orthodontic use among privately insured adults. PRACTICAL IMPLICATIONS Demographic and economic traits of communities can affect oral health care use; effects on orthodontic use may be more dramatic than on other forms of oral health care.
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Crerand CE, Da Silveira AC, Kapa H, Litteral J, Markey MK, Mercado A, Scott M. Adherence to Orthodontic Treatment in Youth With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2019; 57:218-227. [PMID: 31394915 DOI: 10.1177/1055665619867556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA.,Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Hillary Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Mia K Markey
- The University of Texas at Austin, Austin, TX, USA.,The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ana Mercado
- Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Section of Plastic and Reconstructive Surgery, Nationwide Children's Hospital, Columbus, OH, USA.,Division of Orthodontics, Nationwide Children's Hospital and The Ohio State University, Columbus, OH, USA
| | - Michelle Scott
- Division of Plastic and Reconstructive Surgery, Cleft Lip and Palate Center and Center for Complex Craniofacial Disorders, Children's Hospital of Philadelphia, Philadelphia, PA, USA
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Crerand CE, Kapa HM, Litteral J, Da Silveira AC, Markey MK. Adherence to Orthodontic Treatment in Youth With Craniofacial Conditions: A Survey of US Orthodontists. Cleft Palate Craniofac J 2019; 56:1322-1332. [PMID: 31159560 DOI: 10.1177/1055665619853132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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.
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Affiliation(s)
- Canice E Crerand
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.,Departments of Pediatrics and Plastic Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Hillary M Kapa
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer Litteral
- Center for Biobehavioral Health, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | | | - Mia K Markey
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, TX, USA.,Department of Imaging Physics, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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