Objectively measured patient cooperation during early orthodontic treatment: Does psychology have an impact?

Background. The effectiveness of orthodontic treatment with removable appliances arouses controversy concerning the level of patients' compliance. The compliance depends on factors controlled by the orthodontists, by the patients themselves and by their caregivers, and those beyond any control. Objectives. The purpose of this study was to assess the extent to which the personality traits of patients and their caregivers affect the cooperation in removable appliance therapy. Material and methods. A total of 38 patients (19 boys, 19 girls) aged 9-12 years, presenting malocclusions suitable for removable appliance therapy were randomly selected. The EAS-C Temperament Questionnaire, Generalized Self-Efficacy Scale, NEO-Five Factor Inventory and Parental Attitude Scale developed by Plopa were employed to evaluate the patients' and the caregivers' temperamental dispositions. Electronic sensors were employed to objectively assess patients' cooperation. Results. Statistical analysis revealed a high positive correlation between removable appliance wear time and the results of the GSES and the SPR-R, a strongly positive correlation between wear time and the NEOFFI-C results and a strongly negative correlation between wear time and the EAS-C-Emo measurement. The level of a generalized sense of efficacy, conscientiousness and the severity of requirements imposed on the child were the factors related to the caregivers, positively correlating with patients' cooperation. Conclusions. The cooperation of children treated with removable appliances may be foreseen with observation of the patients' and their caregivers' traits. Objective evaluation of the patients' cooperation and psychological tests may be valuable tools for the re-assessment of the paradigm of early orthodontic treatment.