Tackling adolescent compliance
Featured Products Promotional FeaturesPosted by: Dental Design 14th January 2024
A person’s teenage years are a time of tumultuous change. It’s a period of immense physical, mental and social adjustments, where individuals come to terms with a greater sense of self and individuality.
In dentistry, the early teenage years are also an optimal time to carry out orthodontic work, since the mouth is still growing.[i] Such treatments at this age are so common that they’re almost seen as a rite of passage.[ii]
Dental work with teens can be difficult for a number of reasons. But, when treatment can be so fruitful in this period, it’s important to understand how clinicians can best work with teens to secure a brilliant outcome.
Following guidance
Teenage oral health often simmers down to questions of compliance. General oral hygiene routines are sometimes forgone as schoolwork, friendships and hobbies take on greater importance in everyday life. If this upkeep isn’t maintained, patients may experience enamel demineralisation and gingivitis, which actually affects 50% to 70% of patients with fixed orthodontic appliances.[iii]
Imploring adolescents to maintain a fantastic oral hygiene routine – generally consisting of tooth brushing multiple times a day, paired with the use of interdental brushes – is only made more challenging given the difficulties fixed orthodontic appliances create. Food can be trapped easily and become difficult to dislodge.[iv]Teenagers will need to take their time removing debris from their appliance to maximise their health, as well as the eventual aesthetic outcomes.
When it comes to removable appliances, compliance becomes increasingly important to achieve a successful treatment outcome.[v] The time spent wearing an aligner is, theoretically, somewhat similar to a fixed appliance. The latter stays on 24/7, but removable appliances must be worn for 20-22 hours a day (major brands recommend they are removed only when eating, drinking and toothbrushing)[vi] for predictable treatment. Teenage patients need to not only maintain compliance with their oral hygiene, but also reliably wearing the appliance. This becomes a concern when some reports suggest patients often wear the aligner for up to five hours less than indicated by their clinician.[vii]
Patient-dentist relationship
Communicating effectively with these patients is fundamental for reinforcing ideal habits. But first, a dental professional must take on the question held by so many teachers and parents; how do I get through to this individual?
The way clinicians and patients interact directly influences the level of cooperation seen throughout treatment.[viii] Building a healthy relationship on trust and honesty is key, and could be achieved with an individualised approach. Active listening and showing empathy are useful if patients experience anxiety in appointments, and could help build this relationship.[ix] Nerves are often to be expected. More than half of the UK population suffer from fear or anxiety when visiting the dentist,[x] and this may only be enhanced with the introduction of a new, long-term orthodontic device.
Interestingly, some younger patients may be somewhat eager to get braces, viewing them as a part of growing up.[xi] After all, from the perspective of this patient, the only people they know with such treatment are those older and bigger than them; taking a similar a path could feel like a coming-of-age transition. An enthusiasm to undertake this care may be promising for compliance, and should therefore be encouraged where appropriate.
Breaking barriers
Patients will only choose to be treated when the “positive” motivation is stronger than the “negative”.[xii] In adolescent orthodontic treatment, the expected advantages include a greater aesthetic and functional outcome, resulting ultimately in improved confidence.[xiii] Linking oral health and orthodontic advice to important aspects of adolescent life, such as self-esteem, “fitting in” and happiness in social circles, through dating or popularity, may be a way to positively frame the oral health needs.
Treatment downsides may not only include short-term changes to appearance, but the pain caused by an appliance too. With fixed braces, this usually occurs during the first few days following a bond-up procedure as tooth movement is triggered, but could also be from scratchy arch wires – whether leftover or uncut – which may cause traumatic ulcers.[xiv]
Helping teenage patients cope with the pain of fixed appliances can not only help deliver consistent results, but may encourage overall compliance as they avoid becoming disenfranchised with the treatment. Clinicians could suggest a solution like the Orthodontic Relief Wax from Kemdent, a soft gum protector that can simply be applied to cover brackets and protruding wires that are often irritating throughout treatment. Patients can quickly remedy any pain by warming the wax in their hands, and applying it for a smooth intraoral solution. Plus, the relief wax is conveniently stored in a recyclable, eco-friendly tin that can be carried with them throughout the day.
Encouraging and attaining compliance in the teenage orthodontic patient is not often simple. Building an effective relationship with enthusiastic and reluctant patients alike, and focusing on the advantages of undergoing treatment and keeping up a good oral hygiene routine could be key to working towards an optimal final result.
For more information about the leading solutions available from Kemdent, please visit
www.kemdent.co.uk or call 01793 770 256
[i] NHS, (2022). Braces and orthodontics. (Online) Available at: https://www.nhs.uk/conditions/braces-and-orthodontics/ [Accessed December 2023]
[ii] British Orthodontic Society, (N.D.). Orthodontics for Children & Teens. (Online) Available at: https://bos.org.uk/patients/treatments/orthodontics-for-children-teens/
[iii] Huang, J., Yao, Y., Jiang, J., & Li, C. (2018). Effects of motivational methods on oral hygiene of orthodontic patients: A systematic review and meta-analysis. Medicine, 97(47).
[iv] Anuwongnukroh, N., Dechkunakorn, S., & Kanpiputana, R. (2017). Oral hygiene behavior during fixed orthodontic treatment. Dentistry, 7(10), 1-5.
[v] Tsomos, G., Ludwig, B., Grossen, J., Pazera, P., & Gkantidis, N. (2014). Objective assessment of patient compliance with removable orthodontic appliances: a cross-sectional cohort study. The Angle Orthodontist, 84(1), 56-61.
[vi] Srivastava, R., Jyoti, B., Gupta, M., & Shastri, A. (2016). Aesthetic Removable Orthodontic Alternative-Invisalign. Dentistry: Advanced Research, 2016, G113.
[vii] Torsello, F., D’Amico, G., Staderini, E., Marigo, L., Cordaro, M., & Castagnola, R. (2022). Factors influencing appliance wearing time during orthodontic treatments: a literature review. Applied Sciences, 12(15), 7807.
[viii] Torsello, F., D’Amico, G., Staderini, E., Marigo, L., Cordaro, M., & Castagnola, R. (2022). Factors influencing appliance wearing time during orthodontic treatments: a literature review. Applied Sciences, 12(15), 7807.
[ix] Yuan, S., Freeman, R., Hill, K., Newton, T., & Humphris, G. (2020). Communication, trust and dental anxiety: a person-centred approach for dental attendance behaviours. Dentistry Journal, 8(4), 118.
[x] Dental Phobia, (2018). The #1 Resource on Dental Phobia. (Online) Available at: https://www.dentalphobia.co.uk/ [Accessed December 2023]
[xi] Longstaff, S., Davies, K., & Benson, P. (2021). Exploring 10–15-year-old patients’ perspectives of fixed orthodontic treatment. Journal of Orthodontics, 48(2), 110-117.
[xii] Torsello, F., D’Amico, G., Staderini, E., Marigo, L., Cordaro, M., & Castagnola, R. (2022). Factors influencing appliance wearing time during orthodontic treatments: a literature review. Applied Sciences, 12(15), 7807.
[xiii] Twigge, E., Roberts, R. M., Jamieson, L., Dreyer, C. W., & Sampson, W. J. (2016). The psycho-social impact of malocclusions and treatment expectations of adolescent orthodontic patients. European journal of orthodontics, 38(6), 593-601.
[xiv] Hafiz, A., Jamal, A., Azura, N., Sahudi, R., & No, M. M. (2019). The impact of fixed appliances (Braces) on quality of lifes. Journal of International Dental and Medical Research, 12(2), 650-654.
