Influence of Mask-Wearing Attitudes on Compliance with Removable Orthodontic Devices: A Cross-Sectional Study

To investigate the impact of mask-wearing on orthodontic patient compliance and to identify factors associated with adherence.

A cross-sectional questionnaire-based survey was conducted among 214 orthodontic patients (64.0% female; predominantly aged 19-30 years) who had used removable orthodontic devices. Data on demographics, treatment duration, appliance type, mask-wearing attitudes and wear times were collected. Key variables included mask-wearing attitudes, which were assessed on a 5-point Likert scale (ranging from "Strongly Disagree" to "Strongly Agree"), actual and recommended wear times of appliances, overall compliance (actual/recommended wear time), and daytime compliance proportion (actual daytime/total wear time).

Although 52.2% of participants agreed that masks facilitated acceptance of unaesthetic appliances, this perception was associated with lower daytime (ρ = -0.568) and overall compliance (ρ = -0.245) (both p < 0.01). Daytime wear proportion strongly correlated with overall compliance (β = 0.74, p < 0.01). Patients with neutral mask attitudes showed higher daytime compliance than those with polarized views (p < 0.01). Gender was the only independent predictor of mask-facilitated compliance, with males reporting higher acceptance (coefficient = -0.71, p = 0.03).

Most orthodontic patients believe that wearing a mask helps them accept less attractive appliances, but this belief did not lead to better treatment compliance. Those with neutral attitudes wore appliances more during the day. Daytime wear strongly predicts overall compliance. For clinicians, this means that patients who count on masks to hide their appliances may need extra attention. Rather than focusing only on reducing aesthetic concerns, efforts should also focus on helping patients build consistent daytime wear habits.