Annemieke Bos

Patient Compliance: A Determinant of Patient Satisfaction?

Recent studies have shown that there is a distinct relationship between patient satisfaction and patient compliance in orthodontic treatment. The aim of this study was to investigate whether patient compliance, as noticed and recorded by the orthodontist during treatment, can be used as a determinant of patients satisfaction in the long run. Documentation of 100 patients who completed active orthodontic treatment in the year 2000 at the Academic Centre of Dentistry Amsterdam was analyzed, and compliance scores for patients were computed. Three years after completion of active orthodontic treatment, a questionnaire about satisfaction was sent to all subjects. Items were divided over six subscales on the basis of item content. Compliance and satisfaction scores of both sexes were compared, and correlations between compliance and satisfaction were explored. Regression analyses were done to examine the predictive value of sex and compliance on patient satisfaction. No significant correlations between compliance and satisfaction scores were found. Sex, but not compliance, predicted the patients satisfaction with the doctor-patient relationship and the situational aspects of the treatment. Compliance, as noticed and recorded by the orthodontist during treatment, is not a decisive determinant of patient satisfaction in the long run. Sex, however, is a predictor of patient satisfaction with regard to the doctor-patient relationship and the situational aspects of the orthodontic treatment.

Patients’ and parents’ expectations of orthodontic treatment

Objective To investigate the expectations of children and their primary care-givers towards orthodontic treatment and to compare the results with those of a UK sample. Design A questionnaire survey of children and their primary care-givers attending for their first consultation. Setting The Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA), the Netherlands. Subjects and methods A total of 168 subjects (84 patients and 84 parents) completed the questionnaire. The children were aged 10 to 14 years. The responses of the children and parents and differences between boys and girls were examined using parametric statistical methods. The data from the Dutch sample were compared with a similar UK sample. Results Patients and parents shared similar expectations of orthodontic treatment, with the exception of expectations of having a brace fitted at the first appointment, orthodontic treatment involving headgear, any problems with orthodontic treatment, duration of orthodontic treatment and concerning reactions from the public. Among the child participants, boys and girls only differed in their expectations of orthodontic treatment involving jaw surgery. Differences between Dutch and English participants were found regarding the first visit, type of orthodontic treatment, reactions from the public, and pain and problems with orthodontic treatment. Conclusions Since the expectations of patients and their parents differ on several aspects, effective communication between the orthodontist, patient and parent is considered to be essential. Our hypothesis that Dutch patients’ and parents’ expectations of orthodontic treatment differ from the expectations of English patients and parents was supported.

On the use of personality characteristics in predicting compliance in orthodontic practice

Cooperation of the patient during orthodontic treatment is a major determinant of a successful treatment result. Unfortunately, noncompliance is a serious problem in orthodontics. A patient’s noncompliance can result in a longer treatment time, destruction of the teeth and periodontium, extraction of additional teeth, collapse of a corrected malocclusion after treatment, frustration for the patient, and additional stress for the orthodontist and staff. Predicting patient compliance could be helpful in anticipating problems that might arise during orthodontic treatment. In previous studies, it has been hypothesized that personality traits might at least partly determine a patient’s motivation for orthodontic treatment, as well as adherence with health guidelines in general. For example, Allan and Hodgson characterized cooperative orthodontic patients as enthusiastic, energetic, self-controlled, responsible, and obliging. Uncooperative patients were typified as hard-headed, temperamental, impatient, individualistic, and intolerant of prolonged effort. More recently, it has been stated that high-need achievers cooperate better orthodontically than do low-need achievers, that high-need affiliators cooperate better than low-need affiliators, and that internally motivated patients cooperate better than externally motivated patients. Furthermore, it has been suggested that orthodontic patients who are obedient, have high self-esteem, and are accommodating comply better than do patients who are nervous, agitated, passive, introverted, and dominating. However, other studies that used personality variables to predict adherence during orthodontic treatment have been unsuccessful in obtaining a clear answer or have found contradicting results. For instance, Nanda and Kierl reported that neither attitude toward orthodontic treatment, need for approval, nor need for achievement was a significant predictor for a patient’s cooperation in orthodontic treatment. Albino et al found that variables such as anxiety, self-concept, social desirability, and need for achievement do not appear to have great value in predicting adolescent orthodontic cooperation. Results of empirical studies so far are often statistically nonsignificant or at best inconsistent. Of course, part of these disappointing findings might be due to the research methods used. Most estimates of adherence are based on feedback from patients in orthodontic treatment. These samples could be biased because the patients are “ill” and have a vested interest in appearing compliant. Moreover, orthodontists and their patients readily overestimate patient adherence. In the present study, an additional effort to assess the impact of personality aspects on patient compliance is presented, this time using less-biased healthy subjects who had recently received orthodontic treatment.

Satisfaction with orthodontic treatment

OBJECTIVES To examine the satisfaction of patients with their orthodontic treatment at the Department of Orthodontics at the Academic Centre for Dentistry Amsterdam (ACTA) in The Netherlands. MATERIALS AND METHODS To analyze differences in satisfaction through time, the results of patients treated at ACTA in 2008 and 2009 were compared with the results of patients treated at ACTA in 2000. A validated questionnaire about patient satisfaction was used. The total scale was divided into six subscales. A questionnaire was sent to all patients younger than 30 years who finished orthodontic treatment in 2008 and 2009 at ACTA. RESULTS The internal consistency of the total scale and the six subscales of the questionnaire was satisfactory. Respondents scored highest on items about satisfaction with the doctor-patient relationship (mean 4.24; SD 0.63) and lowest on items regarding their satisfaction with psychosocial improvement (mean 2.88; SD 0.87). Compared to the results of the sample from 2000, significant differences were found on the subscales doctor-patient relationship, residual category, and psychosocial improvement as well as on the total sum scale. CONCLUSIONS The doctor-patient relationship remains the most important factor contributing to patient satisfaction. However, the results show that, overall, patients are more satisfied with their orthodontic treatment than patients were a decade ago.

Expectations of treatment and satisfaction with dentofacial appearance in patients applying for orthodontic treatment

INTRODUCTION Satisfaction with dentofacial appearance and expectations of orthodontic treatment have been analyzed in many studies. In 2002, in a study in The Netherlands, significant correlations were found between dental satisfaction and orthodontic treatment expectations. Satisfaction significantly decreased with increasing age. The aim of this study was to compare the satisfaction and expectations of current patients with the results of a study 10 years ago. METHODS A questionnaire about dentofacial satisfaction and a questionnaire about the expectations of orthodontic treatment were completed by 146 subjects. The mean scores in the present study were compared with the mean scores 10 years ago. RESULTS The subjects in the present study were more satisfied with their dental appearance. Differences in expectations were found on the subscales of general well-being and self-image. As in the study in 2002, no significant correlations were found between sex, satisfaction, and expectations of orthodontic treatment. Dentofacial satisfaction predicts expectations about orthodontic treatment, especially in the group of subjects aged 17 years and above. CONCLUSIONS The subjects in this study had greater expectations of orthodontic treatment about general well-being and were more satisfied with their dental appearance than were the subjects studied 10 years ago.

Overjet reduction in relation to wear time with the van Beek activator combined with a microsensor

Introduction: The aim of this study was to use a microsensor to investigate the association among overjet reduction, treatment duration, and wear time of the van Beek activator. Methods: The study sample comprised patients (n = 28) with a mean age of 11.60 (±1.25) years at start of treatment treated with the van Beek activator. The prescribed wear time was 12 hours per day. The evaluation period was limited to the first 3 appointments. The wear times during the 3 intervals were assessed. Treatment periods with good compliance were characterized by a wear time of 8 hours or more per day. Results: The medians of overjet were 9.00 mm at the start of treatment and 5.75 mm at the third appointment. The mean total wear time throughout the evaluation period was 7.75 (±3.66) hours per day. Significant correlations were found at the 3 intervals. Patients with a mean wear time of 8 hours or more per day achieved significantly greater overjet reductions. Patients with good compliance of at least 5 months showed significantly greater overjet reductions. Conclusions: Significant overjet reduction was achieved with a minimum daily wear time of 8 hours for at least 5 months. The level of compliance had a strong tendency to be maintained throughout the treatment period. No patient achieved the prescribed wear time of 12 hour per day. HighlightsWe investigated the association between overjet reduction and wear time.Significant overjet reduction was achieved with a daily wear time of 8 hours.Significant overjet reduction was achieved in a treatment period of at least 5 months.A daily wear time of less than 8 hours showed no significant overjet reduction.No patient achieved the prescribed wear time of 12 hour per day.