Towards a comprehensive model for the study of compliance in orthodontics

The aims of the present study were to explore methods used by Dutch orthodontists in daily practice to estimate and stimulate patient compliance, and to develop a theoretical model of compliance. A questionnaire, containing 38 items, was distributed among participants at the annual congress of the Dutch Society of Orthodontists in September 2002. The items concerned the need for and the level of patient adherence during orthodontic treatment, modes of estimating and stimulating compliance, and perceived reasons for non-compliance. Based on this pilot study and on an extensive literature search, a model for future research was developed in which concepts related to compliance in orthodontics were systematically organized. Of the 88 orthodontists who attended the congress, 51 responded (mean age 47 years, 22 per cent females). The respondents considered compliance to be of vital importance for a successful treatment result. Most patients were regarded as moderate compliers. The respondents believed that a lack of awareness of dental problems, a lack of motivation to co-operate, and personal problems were the main reasons for non-compliance. Only indirect methods were used to estimate compliance. It was concluded that Dutch orthodontists used subjective methods to measure compliance in daily practice, and that a theoretical model was needed to be able to examine compliance in orthodontics in a more systematic way. A multiple assessment of compliance, using a variety of research methods, seems to be the most appropriate way at present to ensure accuracy in measuring levels of patient compliance in orthodontics.