[Psychological determinants of compliance in orthodontic patients--a contribution to the question of cooperative prognosis]

Lüscher colour test in orthodontic patients. Practicability for compliance assessment?

The Lüscher colour test has been repeatedly recommended as a tool for the prediction of orthodontic treatment course and patient cooperation despite its scientific shortcomings. A series of studies involving patients aged 9 to 16 years undergoing treatment with removable appliances at various orthodontic practices and at one university clinic provided no evidence of systematic correlations between Lüscher test colour preferences and cooperation with appliance wear. There was only slight consistency in colour preferences in a re-test conducted a few months after baseline measurements. Statistical evaluation of specific hypotheses and exploratory analysis of the global potential of the test provided no support for generalizable and useful correlations between colour preferences and patient compliance. Therefore the Lüscher test cannot be generally recommended for the rating of patient compliance in the clinical orthodontic practice.

[A retrospective examination of the acceptance of removable appliances]

In order to study the subjective attitudes of patients and their parents to orthodontic treatment questionnaires were handed out to both groups. One hundred and forty five patient questionnaires and those answered by 114 parents formed the base of the study. The majority of the patients were only able to provide partial answers to precise questions about their treatment. Speech impairment, pressure, and salivation were given as being the most vexatious aspects of the treatment. The majority of the patients and the majority of parents favored removable appliances over fixed appliances. The patients' social environment did not negatively influence their attitude to orthodontic treatment.

Correlates of objective patient compliance with removable appliance wear

Patient compliance is considered a major problem in orthodontics. Yet, to date, few conclusive findings have been noted on determinants and consequences of failing adherence, probably because of method flaws and a lack of objective criteria. By following an outline of conceptual issues and selected research, we considered an investigation into correlates of patient compliance with removable appliance wear. We studied a sample of 77 university clinic patients ages 9 to 14 years over several months by means of psychologic inventories and electronic measurement of removable appliance wear. The actual compliance rate proved to be associated with many variables. Among those, characteristics of the patient and his family background, such as conformity and degree of consistent parental support and supervision are interpreted as determinants of satisfactory adherence, whereas treatment related and interactional correlates, such as duration of treatment, dominance of provider, and interpersonal perceptions, are conceived of in terms of mutually interdependent and/or consequent variables. The factors identified might be paralleled in the wearing of headgear and intraoral elastics that require a similar degree of active patient cooperation. After a critical discussion of our data in the light of previous findings, suggestions are provided for future research along with conclusions for clinical practice.

[The clinical and psychological indicators of behavior in wearing a removable appliance]

Compliance with wearing removable appliances cannot be determined directly from progress noted in the course of treatment. The orthodontist's judgement is influenced by many and varied observations and the evidence they yield is often unclear. We studied 104 orthodontic patients aged nine to 16 years using as data treatment records, provider and patient questionnaires, and oral hygiene indexes. In addition the Luescher psychological color test was administered to a subgroup and the duration of compliance wear was objectively measured. We found little consistency among different compliance indicators. Studying the patient's keeping of appointments, his oral hygiene habits, and appliance maintenance did not result in general conclusions pertaining to the patient's compliance with wearing the appliance. Only over a longer period it is possible to determine through clinical observation the patient's cooperation in his treatment. More promising on the other hand for better evaluating patient compliance behavior is the combination of information obtained clinically with the results obtained through psychological tests.

Treatment co-operation in orthodontic patients

The aim of the present investigation was to determine the reasons for lack of patient co-operation and premature termination of orthodontic treatment. Over a period of 10 years files at the School of Dentistry, Huddinge, Sweden, showed that 80 patients (4 per cent) terminated treatment prematurely. These patients were interviewed regarding their reasons for not completing treatment. Lack of motivation was the most common reason given. Insufficient information about orthodontic treatment and lack of communication between the orthodontist and patient were the basis for the reasons given. Orthodontists require more knowledge of psychology and should have some training in information communication in order to further reduce the level of discontinued treatments.