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Functional and social discomfort during orthodontic treatment-effects on compliance and prediction of patients’ adaptation by personality

variables

( European Journal of Orthodontics 22 (2000) 307-315)

Group 2Aimi, Awatif, Azizul, Diyana, Khalis, Sakinah, Syafiqah,

Haziq, Hanif, Zafirah

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Introduction

• It is desirable to clarify factors (eg: attitudes to orthodontics and personality variables) that influence behaviour and compliance for effective clinical management.

• As we know, insertion of new orthodontic appliance may diminish cooperation due to:– discomfort of unpleasant tactile sensations

– feeling of constraint in the oral cavity

– stretching of the soft tissues

– pressure on the mucosa

– displacement of the tongue

– soreness of the teeth

– pain.

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• Social discomfort contributed by self confidence that affected by speech impairment and visibility of appliance

• These discomfort might affect the compliance of the patient

• The purpose of this study to investigate any possible correlation between patient’s behaviour and amount of functional and social discomfort experienced during wearing of an orthodontic appliance.

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Subjectsand

Method

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SUBJECTS

• 84 patients– 25: one active upper removable appliance– 31: active upper and lower removable appliances

simultaneously– 14: functional appliance– 14: full bonded fixed appliance

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METHOD

Intensity:•Not at all applicable•A little applicable•Strongly applicable•Very strongly applicable

Examples:•My brace makes it difficult to speak, … swallow,.. Breathe•I don’t like wearing it in public

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• Patient’s attitude to orthodontic treatment evaluated at appointment before appliance insertion via:

Questionnaire: modified rating scales

Severity of malocclusion

Expectation from treatment

Value of dental aesthetic

Acceptance of the appliance

Acceptance of treatment

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• At the 6 months appointment, patient’s cooperation during entire period was retrospectively rated by their clinician using the ‘ Orthodontic Patient Cooperation Scale’.

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Matters to assess

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DISCUSSION

• Aim of this study to find any potential link between patients attitude, that relevant with health behaviour, discomfort experienced with appliance and acceptance

• 4 hypothesis were made.

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• 1. Functional and social discomfort might changes during both short and long term period after appliance insertion.– Evaluation shows significant reduction in

functional discomfort during first week after appliance insertion. This is called short term period adaptation. Social discomfort shoes less consistent and it varies according to individual personalities.

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• 2. Functional and social discomfort might depend on type of appliance worn– The complaint that influenced by appliance were

impaired speech and swallowing, with functional and bimaxilary removable appliance causing higher intensity of complaints.

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• 3. Attitude to orthodontic treatment might help predict the discomfort over both the short and long term courses– Positive expectation from ortho treatment are

closely linked with self efficacy, showing negative correlation of complaint over short and long term course. Patient with self efficacy are less concern with the discomfort of ortho treatment.

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• 4. Functional and social discomfort experienced initialy might help predict long term compliance with treatment.

• No relationship was found between

– the intensity of complaints & acceptance of tx. in general.

– strong correlation of pain associated with appliance acceptance. (Previous study )

• Because pain infliction more likely to be associated with orthodontics and orthodontist.

• Impaired functions

– are blamed on the appliance

– less likely to affect compliance than pain perception

• subject with least concern of appearance show highest acceptance with appliance.

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Conclusion

• Strong interrelationship between patient’s attitude preoperatively , his/her perception of discomfort associated with orthodontic appliances and overall compliance with the treatment

• How to overcome?– Rational restructuring

• Explanation of severity of malocclusion and treatment need• Effects of non-compliance

– Establish sense of personal control over treatment progress and prepare to encounter discomfort during treatment