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

Abstract

During the course of treatment orthodontic patients frequently endure a number of functional complaints and are anxious about their appearance. The aims of this longitudinal study were to follow the progress of patients' adaptation to discomfort, to elucidate the putative relationship between the type of appliance worn and functional and social discomfort experienced, to study potential predictability by their attitude to treatment and to evaluate the effects of discomfort as predictors of patients' compliance. Eighty-four patients undergoing either removable, functional, or fixed appliance treatment monitored their complaints during the first 7 days of treatment and rated them retrospectively 14 days, and 3 and 6 months after appliance insertion. The most frequent complaints were impaired speech, impaired swallowing, feeling of oral constraint and lack of confidence in public. A significant reduction in the number of complaints was observed between 2 and 7 days after insertion of the appliance. No further differences were revealed after longer periods of appliance wear. The type of appliance had an effect on impaired speech and swallowing. Patients' expectations of favourable treatment performance and appreciation of dental aesthetics were predictive of reported feeling of oral constraint and lack of confidence in public. There was a relationship between the complaints and acceptance of the appliance, as well as between lack of confidence in public and compliance with treatment. The results of this study highlight the importance of patients' attitudes to treatment and of functional and social discomfort associated with appliance wear for the theory and practice of the management of orthodontic patients, and the necessity for early intervention by clinicians.

Impacts on Daily Performances Related to Wearing Orthodontic Appliances

“…Eating, speaking, and smiling were the daily perfor- mances most commonly affected (Table 1), supporting previous findings by Scheurer et al, 5 Sergl et al, 2 and Mandall et al 9 Scheurer et al 5 found that biting and chewing were the most painful everyday activities affected in the week after insertion of appliances. Sergl et al 2 reported that the main short-and long-term impacts of wearing appliances were on speech and swallowing as well as in reduced confidence when in public. And Mandall et al 9 reported that undergoing orthodontic treatment caused impacts related to aesthetic as well as to functional limitations.…”

“…Over the short-and long-term courses of treatment, fixed or functional appliances have been previously reported to produce a higher intensity of discomfort than removable appliances. 2,[5][6][7] The present findings provide useful information in relation to the likelihood of pain, discomfort, and side effects for patients undergoing orthodontic treatment. However, further studies are needed, especially longitudinal studies, to assess the change over time of the condition-specific impacts related to wearing orthodontic appliances.…”

“…1,2 However, while most previous studies have only assessed the experiences of pain and discomfort among orthodontic patients immediately after insertion of appliances or during the progression of treatment, [2][3][4][5][6][7][8] few studies have assessed the sociodental impacts of wearing orthodontic appliances. 2,5,9,10 Due to its large psychosocial component, orthodontics is one of the dental treatments that requires the use of oral health related quality of life (OHRQoL) measures.…”

“…2,5,9,10 Due to its large psychosocial component, orthodontics is one of the dental treatments that requires the use of oral health related quality of life (OHRQoL) measures. 11,12 However, specific rather than generic OHRQoL measures should be used because the focus of specific measures makes them potentially more responsive to small, but clinically important changes in health.…”

Bad pint

“…A study has found that complaints of fixed appliances included altered speech and swallowing 4 and it would be wise to warn patients regarding this. Fixed orthodontic appliances are not known to inhibit the function of the soft tissues during the oral phase of swallowing or the gag reflex.…”