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.