Here are a few tricks to make you feel more confident about assessing the compliance level you are getting from individual patients. Creating an atmosphere in which we get good compliance in most cases in our offices is our responsibility but the compliance level in individual cases is up to the patient. You certainly can help them but the first thing you need to do is accurately assess how much compliance you’ve gotten in the past.

1) Did the patient come in the door with elastics on. If not, that’s a bad sign.

2) Ask the patient to take their elastics off and watch them do so. If they remove the elastics effortlessly and quickly and don’t need a mirror then they are likely wearing their elastics. If not well, that’s a bad sign. If the patient doesn’t have elastics on when they come in then ask them to put the elastics on and take them off to evaluate their acumen.

3) Ask the patient “How did it go with your rubber bands?” in a nice tone while smiling at them and see what they say. More often than not they will tell you the truth. If you need clarification you can ask the patient to give themselves a grade on their elastic wear. If they tell you they didn’t wear the elastics much, don’t give them a hard time – thank them for their honesty and suggest they do better.

4) Don’t gripe at patients for not wearing elastics. If you do they are unlikely to wear them and they are very likely to lie to you about it.

5) How does the patient’s oral hygiene look? Poor oral hygiene and poor compliance with elastics go hand and hand.

6) If the patient and parent claim compliance and you’re unsure because of a lack of results, just say, “Wow, that’s weird, normally when people wear elastics like you’re talking about we get more movement. I guess we may have to consider removal of teeth or jaw surgery. That’s a bummer… Or would you like to give it another go with elastics and see if we can get some more movement this time?” This gets the point across without attacking anyone. Take photos and OJ measurements at every visit on this kind of patient.

7) Don’t Piss Momma Off – be sure to use this kind of scripting to avoid upsets.

8) In chronic cases, compare the photos and OJ measurements you took last time to what you see this time and let mom see the difference – or lack thereof.

Look, when patients actually wear their elastics 24/7, the results can be frightening and overcorrection is not uncommon. Once you’ve seen the results of honest-to-goodness-full-time-wear a few times, it’s difficult for a noncompliant patient to fool you. It’s important to get to the bottom of exactly what is going on with each patient so you can plan appropriately and so you can document accurately. If the compliance is not what it should be then having regular conversations with mom and great documentation are essential. We want everyone to have a great result just like we want our own children to grow up and be successful but we have shockingly little control over either when it comes right down to it because we cannot control what others do. We are no different than waiters at a nice restaurant – we describe the options and make recommendations but the patients make their own choices and we all have to live with them (unless you want to use Class II Correctors… No Thanks!).

In the future we will discuss scripting ideas to motivate noncompliant patients.