The Person Behind the Smile: A Review of Patient-Centred Orthodontic Care and a Pragmatic Framework

Contemporary orthodontics is experiencing rapid technological advancement, yet its impact on outcomes that matter most to patients remains uncertain. Although patient-centred care has been widely advocated, a clear and teachable framework to support its consistent application across the orthodontic treatment journey is still lacking. Drawing on a critical review of current evidence, this article proposes a pragmatic, evidence-informed framework to address the mismatch that often arises between clinician-defined treatment goals and patient perceptions, expectations, and experiences, from the initial consultation through to retention. It examines key domains shaping patient-centred orthodontic care, including perceptions of dentofacial aesthetics, communication, treatment burden, adherence, and long-term stability, and considers how these factors interact across different stages of care. The proposed framework describes patient-centred orthodontics as a continuous clinical process centred on patient values and supported by five interconnected principles, summarised within the FACES framework: Focus on the patient behind the smile, Align treatment decisions with patient expectations while mantaining sound clinical judgement, Communicate clearly to reduce uncertainty and build trust, Ease treatment burden, and Sustain adherence and long-term stability. This framework offers a pragmatic and teachable structure for more consistent reflection, teaching, and application of patient-centred principles in everyday orthodontic practice.