A Randomized Controlled Trial to Compare 3 Methods Designed to Enhance Adherence among Orthodontic Patients

The purpose of this study was to compare 3 methods designed to enhance adherence to oral hygiene instructions in orthodontic patients: mind map, if-then plan, and leaflet. The study was a 3-arm parallel trial involving 90 orthodontic patients. The 3 groups were mind mapping, if-then planning, and patient information tools (leaflet). Group allocation was randomized in a 1:1:1 ratio. Allocation was concealed using sealed envelopes. The participant and their parents as well as the researcher undertaking the intervention and assessing the outcomes were not blinded. The statistician undertaking the analysis was blinded. Primary outcomes were plaque levels and bleeding point index. Secondary outcomes were patients' knowledge of behaviors deemed important during orthodontic treatment and self-reported behavior. Participants were assessed at 4 time points: at the fitting of the fixed appliance (T1), at initial follow-up 6 wk later (T2, at which time they were randomly allocated to the 3 groups of intervention), 6 wk after the intervention (T3), and 18 wk postintervention (T4). Mean levels of buccal and lingual plaque, as well as the proportion of sites with bleeding sites, showed no significant differences over time (buccal plaque, F_time = 3.74, P = 0.06; lingual plaque, F_time = 2.78, P = 0.06; bleeding on probing, F_time = 0.68, P = 0.51) or between interventions over time (buccal plaque, F_int × F_time = 0.38, P = 0.68; lingual plaque, F_int × F_time = 0.30, P = 0.88; bleeding on probing, F_int × F_time = 0.70, P = 0.59). There were no harmful consequences detected for any of the interventions. No single method of presenting the information proved superior to any other. This trial was registered with the Guy's & St Thomas's NHS Trust Research & Development Database. Knowledge Transfer Statement: Enhancing patient adherence to advice given by their clinician is an important component of orthodontic treatment. This study explored the use of structured techniques to enhance adherence. All 3 techniques enhanced adherence over the 18-wk study period when orthodontic treatment was being provided, but no single method proved superior to any other.