Tech tip: non-compliance - part 2

Two weeks ago, we gave you a few tips on how to spot non-compliant patients. Today, our Chief Technology Officer, Dr. James Mah, offers up his three keys for ensuring compliance:

  1. Education
  2. Motivation
  3. Verification
Dr. James Mah"As far as education, clinicians should discuss the basics of tooth movement and the importance of wear time. Relatively continuous pressure to teeth is required for effective tooth movement. Many patients don't know this and fail to achieve the required hours. Compare a patient that wears aligners 20 hours per day to another that wears them 8 hours per day: the first patient will have 2.5 times the continuous forces as the other, and that will be reflected in the resultant tooth movement rates.

Motivation for aligner patients is most often verbal praise for a job well done. In my office, we provide 'wooden nickel tokens' as rewards for cooperation. Patients can trade the tokens for gift certificates and other rewards. Additionally, we remind them that orthodontics is serious business and continually remind them that the result will be well worth the effort.

In situations where compliance is lacking, we often need to have a frank discussion with the patient. Even before treatment begins, I let patients know that treatment success is a team effort between them and my office. I simply state that 50% of their success is up to me and the other 50% is up to them. If they don't live up to their end, we have to accept more compromises. In addition, decreased wear often results in no net tooth movement. When the aligner is worn, teeth begin to move toward the correction but when it is removed the tooth moves back to its original position. I ask patients "Why pay me to rock your teeth back and forth?"

On the topic of verification, first I warn them from the first aligner on that we'll be checking wear "under the microscope" and if I find it lacking, I'll be brutally honest with them. This makes it easier when I come down hard on a patient for non-compliance. I can then say 'I told you from the beginning that I'll be checking.'"

Finally, if you're looking for a few more tips on how to discreetly verify whether a patient is wearing their aligner, keep the following things in mind:

  • Well worn aligners fit loosely and will almost fall out on their own. If there are any tight spots or binding, you can be clear the aligner has not been worn enough.
  • Ask patients to bring in their current aligners. A lot of non-compliant patients will "forget" their aligners at home and encourage their clinician to dispense the next set.
  • Well worn aligners will feature discoloration and the occlusal surfaces will show signs of wear.
  • The next aligner will fit tightly, but won't be too difficult to get in.

And that's it! If you have any tips of your own you'd like to share, we'd love to hear from you!

Until next time...

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