What do orthodontic patients think about their retainers?

Over the past few years, research into retention has increased.  We now know that there are minimal differences in the success rates of bonded and removable retainers. It is also clear that part-time wear of removable retainers is effective.  This information has come from randomised trials and has been condensed by high-quality systematic reviews.  Nevertheless, we understand that effective removable appliance retention relies on our patients’ cooperation.  Paradoxically, we know little about the factors that influence their cooperation.  This new study closely examines the factors influencing cooperation from the patients’ perspective.

A team from Yorkshire, England, did this study. The Journal of Orthodontics published their paper.

I want to declare an interest. I contributed to Simon Littlewood and Sophy Barber’s research and clinical training.

What did they ask?

They did this study to

“Explore young people’s experience of orthodontic retention and factors influencing adherence to wearing retainers”.

What did they do?

The team conducted a qualitative research study based in two orthodontic clinics in Yorkshire, UK. They performed the study in several stages. These were

• Using a purposive sampling approach, they enrolled 12 participants aged between 13 and 18 years.
• They interviewed the participants at two time points. These were at debond and 6 months later.
• The data was analysed using standard methods for qualitative data.

This is a good place for me to explain their methods. I have limited experience in conducting qualitative research, so I hope I have this correct.

Firstly, qualitative research is an approach that explores and understands behaviors by gathering non-numerical data, such as interviews, observations, and focus groups, to gain in-depth insights into people’s experiences, motivations, and perspectives. It focuses on the “why” and “how” rather than the “what” and “how many.” 

Its a great advantage of qualitative research is that it allows the identification of new information that investigators may not have considered. Importantly, it captures people’s values and perceptions.  As a result, it is ideal for orthodontic research, particularly as we need to move from recording small, perhaps unimportant values such as proportions of millimetres.

This study team used a technique called “photo-elicitation” in which the participants took photographs of objects that reflected their feelings. A researcher then used these as prompts for interviews.

I hope that I have provided a simple outline, and you can appreciate that this is a relatively new technique with great potential for orthodontic research.

What did they find?

When reading a qualitative research paper, you will not encounter complex tables of familiar data. The results are presented as a narrative, allowing the reader to draw their own conclusions. Consequently, this represents my interpretation of their findings.

They identified three main themes

• Experience of wearing retainers
• Adapting to retainers
• Motivation for retainer wear adherence

The main points of these themes were

Experience of wearing retainers

It was important to see that participants experiences of retainers were derived from their own experience of wearing fixed or removable appliances.

When they looked at their immediate experience they found that most patients adapted to the retainers relatively easily. Importantly, they did not disrupt their lives.

I thought that it was really interesting to find that their peers accepted they were wearing retainers. However, when they were with family members rather than friends they were not keen to wear the retainer.

Adapting to retainers

 When they first started wearing their retainers, forgetfulness was a barrier to wear.  However, over time they made conscious decisions not to wear the retainer.

Importantly, at first reminders such as alarms, “parental reminders” helped the young people get retainer wear into their routines. Nevertheless, in the long term these reminders became less important.

They also took responsibility for their retention and this shifted from the orthodontist being responsible for their care.

Motivation for retainer wear adherence

The most important finding (my opinion) was that the young people expressed a newfound confidence and happiness with the results of their treatment. This served as the main motivation for them to continue with retention.  Importantly, not having anything stuck to their teeth acted as a reward for completing treatment; they did not want to jeopardise this.

The main reason for wearing retainers was to avoid relapse. Nevertheless, they were not keen on lifelong retention and having to spend a minute a day cleaning their retainers for the rest of their life!

The teams’ conclusion was 

“Understanding early experiences of retainer wear can help clinicians to provide timely and well-targeted interventions and information. Co-constructing unique adherence strategies may help to overcome the initial adaptation phase, with particular emphasis on understanding the individual”.

What did I think?

This is an interesting and clinically relevant study.  It was important that the results captured much more patient-relevant information than simply measuring millimetres of relapse.  It was great to see a study that focused on patient outcome measures. I have previously discussed the value of this.

I have considered how these findings could influence my clinical practice. You may already do this, but I would ensure that I provide them with the following information when I fit the retainers.

• The orthodontist has done their part, and now it’s up to you to ensure that your teeth stay straight.
• When you first receive your retainers, it is helpful to make wearing them part of your daily routine.  
• You should find reminders to help you remember to wear the retainer, until it becomes a habit to wear the retainers without thinking about it
• You will get used to wearing the retainer
• Your friends will not be bothered by your retainers.

I hope that you can see the value of this form of research. The paper is open access and it is worth reading it to see the comments that the participants made in the interviews.

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