1. Powerpoint Templates Page 1 Functional and social discomfort during orthodontic treatment-effects on compliance and prediction of patients’ adaptation by personality variables ( European Journal of Orthodontics 22 (2000) 307-315) Group 2 Aimi, Awatif, Azizul, Diyana, Khalis, Sakinah, Syafiqah, Haziq, Hanif, Zafirah

2. Powerpoint Templates Page 2 Introduction It is desirable to clarify factors (eg: attitudes to orthodontics and personality variables) that influence behaviour and compliance for effective clinical management. As we know, insertion of new orthodontic appliance may diminish cooperation due to: – discomfort of unpleasant tactile sensations – feeling of constraint in the oral cavity – stretching of the soft tissues – pressure on the mucosa – displacement of the tongue – soreness of the teeth – pain.

3. Powerpoint Templates Page 3 Social discomfort contributed by self confidence that affected by speech impairment and visibility of appliance These discomfort might affect the compliance of the patient The purpose of this study to investigate any possible correlation between patient’s behaviour and amount of functional and social discomfort experienced during wearing of an orthodontic appliance.

4. Powerpoint Templates Page 4 Subjects and Method

5. Powerpoint Templates Page 5 SUBJECTS 84 patients –25: one active upper removable appliance –31: active upper and lower removable appliances simultaneously –14: functional appliance –14: full bonded fixed appliance

6. Powerpoint Templates Page 6 METHOD Appliance insertion Mark the intensity of 13 complaints (functional and social discomfort) Keep the diary for 7 days Collected after 14 days Retrospective evaluation of discomfort 14 days, 3 and 6 months after appliance insertion Intensity: Not at all applicable A little applicable Strongly applicable Very strongly applicable Examples: My brace makes it difficult to speak, … swallow,.. Breathe I don’t like wearing it in public

7. Powerpoint Templates Page 7 Patient’s attitude to orthodontic treatment evaluated at appointment before appliance insertion via: Questionnaire: modified rating scales Severity of malocclusion Expectation from treatment Value of dental aesthetic Acceptance of the appliance Acceptance of treatment

8. Powerpoint Templates Page 8 At the 6 months appointment, patient’s cooperation during entire period was retrospectively rated by their clinician using the ‘ Orthodontic Patient Cooperation Scale’.

9. Powerpoint Templates Page 9 Matters to assess Effects of discomfort on compliance Intensity of complaints Acceptance of appliance (pt) and treatment (op) RELATIONSHIP : Patient’s attitude to Treatment and intensity of discomfort Patient’s attitude before app insertionIntensity of complaints as recorded in protocol Influence of appliance type on perceived discomfort Comparison between patients’protocol of that wearing different types of app Adaptation of ortho appliance over time via “scales value” from functional and social discomfort diaries

10. Powerpoint Templates Page 10 DISCUSSION Aim of this study to find any potential link between patients attitude, that relevant with health behaviour, discomfort experienced with appliance and acceptance 4 hypothesis were made.

11. Powerpoint Templates Page 11 1. Functional and social discomfort might changes during both short and long term period after appliance insertion. – Evaluation shows significant reduction in functional discomfort during first week after appliance insertion. This is called short term period adaptation. Social discomfort shoes less consistent and it varies according to individual personalities.

12. Powerpoint Templates Page 12 2. Functional and social discomfort might depend on type of appliance worn –The complaint that influenced by appliance were impaired speech and swallowing, with functional and bimaxilary removable appliance causing higher intensity of complaints.

13. Powerpoint Templates Page 13 3. Attitude to orthodontic treatment might help predict the discomfort over both the short and long term courses –Positive expectation from ortho treatment are closely linked with self efficacy, showing negative correlation of complaint over short and long term course. Patient with self efficacy are less concern with the discomfort of ortho treatment.

14. Powerpoint Templates Page 14 4. Functional and social discomfort experienced initialy might help predict long term compliance with treatment. No relationship was found between –the intensity of complaints & acceptance of tx. in general. –strong correlation of pain associated with appliance acceptance. (Previous study ) Because pain infliction more likely to be associated with orthodontics and orthodontist. Impaired functions –are blamed on the appliance –less likely to affect compliance than pain perception subject with least concern of appearance show highest acceptance with appliance.

15. Powerpoint Templates Page 15 Conclusion Strong interrelationship between patient’s attitude preoperatively, his/her perception of discomfort associated with orthodontic appliances and overall compliance with the treatment How to overcome? – Rational restructuring Explanation of severity of malocclusion and treatment need Effects of non-compliance – Establish sense of personal control over treatment progress and prepare to encounter discomfort during treatment