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FACTORS AFFECTING PATIENTS' COOPERATION DURING ORTHODONTIC TREATMENT
MIRZAKHOUCHAKI Behenam, MSc. Orthodontics, Cleft Lip
and Palate Fellowship
OLYAEE Pooya, Dental Student
Department of Orthodontics, Dental Faculty,
Summary
The
purpose of this study is to determine factors affecting patient's cooperation
(appliance wear) during removable orthodontic treatment.
In
this cross-sectional descriptive study, fifty-three patients (sixteen males
and thirty seven females), with an average age of 11.2 years, who sought orthodontic
treatment were studied.
Two
forms were distributed among the patients. The goal was to understand experiences
and perceptions of treatment from the patients' viewpoint, and the way these
affected cooperation. The effect of these parameters on the average daily
hours of appliance wear, and average of appliance wear per session was investigated.
Descriptive data were derived by SPSS 12.
The
patient and the parents were asked to write down the hours appliance wear
per session and per day, and show it to their doctor at each visit, as a motivating
factor and to increase patient cooperation. Encouragement of the patient both
by the dentist and the parents in a variety of ways (orally, giving rewards…)
is a good way to obtain better treatment results, and should always be taken
into consideration. Seeking orthodontic therapy in the private sector is better
if financial resources are available. Involving the patient’s mother in the
orthodontic treatment results in better patient cooperation.
INTRODUCTION:
There
is probably no other area of health care that requires cooperation to the extent that orthodontics does.
The first condition required for carrying out a successful orthodontic treatment
involves patient cooperation. Frequently, the uncooperative patient is labeled
as having a poor or defiant attitude toward orthodontic treatment1,2.
So far, several investigations have been carried out on patient cooperation.
Nanda R S, and Keirl M J investigated the prediction of cooperation
in orthodontic treatment, and found that variables assessing the orthodontist's
perception of orthodontist-patient relationship had the strongest association
with patient compliance3. Communication between the orthodontist
and the patient, and general information about orthodontic treatment are two
important factors in patients' compliance4. The results obtained
from a study by
Witt E. et al noted that appliance wear is determined by treatment-related factors such as patient personality and parental attitudes. Patient attitudes are the critical link between these influences7.Bartsch A. et al, in another study found that the actual compliance rate was associated with characteristics of the patient and his family background8. Pratelli showed that there was a generally approving attitude toward treatment among parents whose children were orthodontic patients9. Several other studies have proved that parents have a determining and critical role in cooperation of their children10,11.Richter DD. Et al, concluded that academic performance in school was correlated with compliance12.
The purpose of this study is to determine factors affecting patient's cooperation ( appliance wear) during removable orthodontic treatment.
METHOD AND MATERIALS:
In this cross-sectional descriptive study, fifty-three patients (sixteen males and thirty seven females) , with an average age of 11.2 years, who sought orthodontic treatment at the Orthodontics Ward of Tabriz Dental Faculty, and at a Private Dental Office were studied.
Two forms were distributed among the patients. The purpose of which was to understand experiences and perceptions of treatment from the patients' viewpoint, and the way these affected cooperation. The effect of these parameters on the average daily hours of appliance wear, and average of appliance wear per session was investigated.
The first form was distributed among patients on the appliance insertion day and was a blank timetable (report-card) with the intent of obtaining a record of the mean hours of wear of the removable appliance per session and per day. The patients were asked to fill it in after each time they wore the appliance, and to write the total hours of appliance wear per day. Patients were asked to complete these forms a thirty day period. Afterward a second form - which was based on the personal feelings and perceptions of the patient - was distributed among them to compare the various factors at the start and during the treatment process. The data was processed by SPSS (version12) software and analyzed.
RESULTS:
The relationship between the different factors and the mean hours of appliance wear per day, and per session of wear were as shown in table1:
Table1. The relationship between the different factors and the
mean hours of appliance wear per day, and per session of wear.
|
|
Daily Average |
Average of Each time |
|
Sex |
P=0.33, t= 0.9 |
P=0.4,t=0.8 |
|
Age |
P=0.11 |
P=0.9 |
|
Patients grade of study |
P=0.04 |
0.8 |
|
Father’s ethnicity |
P=0.39,t=-0.8 |
P=0.007,t=-2.8 |
|
Mother’s ethnicity |
P=0.26,t=-1.1 |
P=0.4,t=-0.83 |
|
Father’s occupation |
P=0.85 |
P=0.59 |
|
Mother’s occupation |
P=0.7 |
P=0.047 |
|
Father’s educational degree |
P=0.9 |
P=0.59 |
|
Mother’s educational degree |
P=0.87 |
P=0.63 |
|
Who trained the patient |
P=0.01 |
P=0.6 |
|
People pay more attention to me while
wearing the appliance |
P=0.27 |
P=0.6 |
|
Feeling discomfort in public |
P=0.17 |
P=0.99 |
|
wearing the appliance lessens my self
confidence |
P=0.97 |
P=0.9 |
|
dentist's encouraging |
P=0.05 |
P=0.1 |
|
parents encouraging |
P=0.5 |
P=0.8 |
|
filling the
report-cards |
P=0.59 |
P=0.34 |
In the male group the mean hours of wearing the appliance per day was 15.9 hours with standard deviation of 6.5, and an average of 14.3 hours in the female group with standard deviation of 4.8. The relation between sex and daily hours of wearing the appliance was non-significant. ( t=0.9, p=0.33)
In the male group the mean hours of wearing the appliance per session was 5.9 with standard deviation of 2.9, and an average of 5.3 hours in the female group with standard deviation of 2.1. The relation between sex and hours of wearing the appliance in each time was non-significant. (t=0.8, p=0.4)
The correlation between daily hours of wearing and age was -0.22 ( p=0.11), and with hours of wearing per session was -0.016( p=0.9).
There
was a significant relation between patients’ grade of study at school and
the mean hours of appliance wear per day (p=0.04).
The average hours of patients with Turk fathers was 14.8(SD=5.3) this figure was 18.1(SD =6.4) among patients with Persian fathers.
There was a meaningful relation between fathers' ethnicity and the mean hours of wearing the appliance in each time ( p=0.007, t=-2.8) The average hours of patients with Turk fathers was 4.4(SD=1.9) this figure was 9.9(SD =7.3) among patients with Persian fathers.
The average hours of patients with Turk mothers was 15.3(SD=5.3) this figure was 11(SD =1.3) among patients with Persian mothers.
The average hours of patients with Turk mothers was 5.6(SD=2.3) this figure was 4.1(SD =0.64) among patients with Persian mothers.
There
was a meaningful relation between mothers' occupation and the mean hours of
wearing the appliance per session ( p=0.047) . Patients with clerk mothers
had an average of 4.6 (SD =1.3) but the patients with housewife mothers had
an average of 5.8 (
There was no meaningful relation between filling the report cards and mean hours of wearing the appliance in each time and daily. But it should be noted that only 3.8% of the patients believed that filling the report card had no effect on their cooperation. This means that 96.2% of our patients have stated an increase in their cooperation following filling out the report cards.
Daily hours of appliance wear in patients trained by the orthodontist and dental students are shown in the table2. The patients who were trained to use the appliance by the orthodontist had a higher average of appliance wear.
Table2.Comparison
between the mean hours of wear between patients trained
by
orthodontist and student.
|
N |
Mean |
SD |
|
|
Trained by orthodontist |
35 |
16.1 |
5.1 |
|
Trained by student |
18 |
12.4 |
5.1 |
|
Total |
53 |
14.9 |
5.4 |
Patients’ grade of study and daily hours of wearing the appliance are shown in the table3. It can be seen that high school students have the highest average.
Table3.
Patients’ grade of study and daily hours of wearing the appliance
|
|
N |
Mean |
SD. |
|
Pre-school |
3 |
15.9 |
0.3 |
|
Primary school |
27 |
15.6 |
5.3 |
|
Junior high school |
13 |
11.7 |
5.4 |
|
High school |
9 |
17.3 |
4.5 |
|
Total |
53 |
14.9 |
5.3 |
DISCUSSION AND CONCLUSION:
There was no significant relationship between sex and hours of wearing the appliance. There is controversy about the relationship between sex and cooperation in the literature, however, our study achieved the same conclusion as Agar's study, and was different from Clemmer's 13,14.
The relation between patients’ grade of study and daily hours of appliance wear was significant (p=0.04). High school students had the highest average which shows that higher level of education has a positive effect on patient cooperation. This may be because of their better perception of the need for orthodontic treatment.
Patients with Persian fathers have a better cooperation. This might be due to cultural differences in the region9.
Patients who had housewife mothers had a better cooperation which may be due to more supervision and encouragement by housewives. It may be concluded that involving mothers in their child's treatment can improve cooperation. This conclusion is in agreement with Witt's Study7.
The patients who were trained to use the appliance by the orthodontist had a higher average of wearing the appliance. We believe that being trained by a specialist to use the appliance has a better result. This may be a result of the better perception of the orthodontist from the importance of orthodontist-patient relationship and providing the patients and parents with more information .This is in agreement with the study performed by Nanda R S, Kierl M J3.
Eighty two percent (82%) of the cases stated that both the dentist and their parents encouraged them to wear the appliance, which seems reasonable regarding the good cooperation in this group of patients .Encouragement and the reward/award system may be a good way to increase cooperation12.
SUGGESTIONS:
1- Ask the patient and the parents to
write down the hours of appliance wear per day, and present it to the doctor
at each visit, as a motivating factor and to increase patient cooperation.
2- Encouragement of the patient both
by the dentist and the parents in a variety of ways (orally, giving reward...)
is a good way to obtain better treatment
results, and should be considered.
3- Seeking orthodontic therapy in private
sector may be better if the family is financially able.
4-Engaging the patient's mother in the
orthodontic treatment results in better patient cooperation.
References
1- Gross AM, Samson G, Dierkes M (1985) Patient cooperation in treatment with removable appliances: a model of patient noncompliance with treatment implications, American Journal of Orthodontics 87 (5):392-7.
2- Amoric MP, Choukroun MG (2002) Treatment with or without cooperation, Orthodontics France 73(4):429-37.
3- Nanda R S, Kierl M J (1992) Prediction of cooperation un orthodontic treatment, American Journal of Orthodontics and Dentofacial Orthopedics 102(1):15-21.
4- Brattstrom V, Ingelsson M, Aberg E (1991) Treatment cooperation in orthodontic patients, British Journal of Orthodontics 18(1):37-42.
5- El-Mangoury NH (1981) Orthodontic cooperation, American Journal of Orthodontics 80 (6):604-22.
6- Albino JE, Lawerence SD, Lopes CE, Nash LB, Tedesco LA (1991) Cooperation of adolescents in orthodontic treatment, Journal of Behavioral Medicine 14(1):53-70.
7- Witt E, Bartsch A, Sahm G, Schneider S (1992) The determinants of wear behavior in treatment with removable orthodontic appliance, Fortschr Kieferorthop 53(6):322-.
8- Bartsch A, Witt E, Sahm G, Schneider S (1993) Correlates of objective patient compliance with removable appliance wear, American Journal of Orthodontics and Dentofacial Orthopedics 104(4):378-86.
9- Pratelli P, Gelbier S, Gibbons D E (1998) Parental perception and attitudes on orthodontic care, British Journal of Orthodontics 25(1):41-46.
10- Lewit D W, Virolainen K (1968) Conformity and independence in adolescents' motivation for orthodontic treatment, Child Development 39:1188-1200.
11- Witt E, Bartsch A, Sahm G, Schneider S (1992) The determinants of wear behavior in treatment with removable orthodontic appliance, Fortschr Kieferorthop 53(6):322-
12- Richter D D, Nanda R S, Sinha P K, Smith D W, Currier G F (1998) Effect of behavior modification on patient compliance in orthodontics, Angle Orthodontics 68 (2):123-32.
13- Bartsch A, Witt E, Dietz I, Dietz P (1993) The clinical and psychological indicators of behavior in wearing removable appliance, Fortschr Kieferorthop 54(3):119-28.
14- Agar U, Dorul C, Bicakci AA, Bukusoglu N (2005) The role of psycho-social factors in headgear compliance. European Journal of orthodontics 27(3):263-7.
15- Clemmer E J, Hayes E W (1979) Patient cooperation in wearing headgear American Journal of Orthodontics 75(5):517-24.