Orthodontic Experiences and Outcomes: What do our patients think?
We are all aware of the frenetic pace of life and our various commitments and priorities. We must find the time to talk and reflect. Perhaps the rate and focus of orthodontic research is a metaphor for our busy lives? There are lots of journals replete with publications. These papers often focus on our priorities- treatment efficiency and improved outcomes. Rarely do we seem to take stock of the impacts of our treatment on patients. Both in relation to the process of treatment and the outcomes of treatment. As a result, we have less reliable information on this fundamental aspect of orthodontics than perhaps we should.
This systematic review was carried out in New Zealand. The European Journal of Orthodontics published this study.
Hisham Mohammed, Ben K. Daniel, Michael Skilbeck, Reginald Kumar Jr., Jamin B. Halberstadt and Mauro Farella
Eur J. Orthod. 2022. doi: 10.1093/ejo/cjac008
What did they do?
They conducted a qualitative systematic review using meta-ethnography. They wanted identify key themes relating both to orthodontic experiences and outcome from the perspectives of orthodontic patients.
The authors included data from primary studies reporting qualitative data from patients who had completed orthodontic treatment.
The authors performed a comprehensive literature search, including five electronic databases. They also searched for unpublished literature. Next, they assessed the quality of the primary studies using the Critical Appraisal Skills Programme (CASP) tool. Finally, they analysed the data using meta-ethnography. This involves seven steps to allow for a synthesis of findings from a range of primary studies.
What did they find?
They included and combined data from six primary studies. Four were carried out in the UK, one in the USA, and one in Brazil, with adolescents and teenagers interviewed in three and adults in the other three studies. Importantly, they identified several key themes. These were related to past treatment experience, satisfaction with the outcome, and living with retainers. Specific points of interest include:
- Their relationships with clinical staff influenced their orthodontic experiences. Peer influence was variable.
- Dietary changes and pain experience were both noted.
Satisfaction with Outcome:
- They reported positive quality of life changes, improved confidence and self-esteem,
- Improved appearance was the main driver for treatment and patients saw this as a critical benefit.
- The patients equated straight teeth to healthy teeth and felt that there oral health had benefited.
Living with Retainers:
- They reported challenges associated with retainer wear. These included, the need for better education around their importance and the challenge of long-term retainer wear.
What did I think?
I thought that this was an interesting study. Of course, I am biased as I have been involved in qualitative research studies, and I find some genuinely revelatory. The data were largely intuitive. However, it underlined some important aspects of treatment that we should not lose sight of. As is often the case, my enthusiasm is tempered a little by the yield from the review, with relatively few studies being included. Nevertheless, the authors have managed to give us some helpful insight into how our patients view what we do for them.
It was interesting to see that the main perceived benefit of orthodontics was a change in smile aesthetics. There were ‘downstream effects’ of this cosmetic change, including enhancing quality of life and self-esteem. Patients also referred to better function. This may not be consistent with objective findings. Interestingly, the authors linked this to ‘Pygmalion effects’ whereby high treatment expectations may improve performance or perception of performance.
Patients were relatively poorly versed in the need for retention, especially in the long term. As is so often the case, the findings concerning retention raised more questions than were answered.
- How do we prepare patients better for retention?
- Can we educate them concerning the long-term implications?
- How can we reduce the onus on retention many years following completion of active treatment?
What can we conclude?
Orthodontic treatment does entail negative effects in terms of social interaction, pain and dietary implications. However, these impacts seem counterbalanced by the perceived aesthetic benefits allied to related improvements in terms of quality of life and self-confidence. Nevertheless, the impacts of long-term retention are hard to overstate.
In a sense, this study allows us to pause for thought. It also reaffirms that while the treatment process has associated drawbacks, what we do is undoubtedly valued. Some solace as we put our feet up after a busy day….
Professor of Orthodontics, Trinity College Dublin, The University of Dublin, Ireland