Reminders improve oral hygiene and adherence to appointments in orthodontic patients: a systematic review and meta-analysis

Abstract

Background: Reminders are implemented in healthcare services to increase compliance with treatment and to decrease the rate of failed appointments. Their effects in the provision of orthodontic care are not yet fully understood.

Objectives: The main objectives of this review were to assess the effectiveness of reminder systems in improving oral hygiene (OH) and adherence to appointments in orthodontic patients.

Search methods: An unrestricted search was conducted in six electronic databases and was supplemented by an extensive manual search up to January 2018.

Selection criteria: Only randomized controlled trials (RCTs) evaluating the effectiveness of reminders in orthodontics were included.

Data collection and analysis: Two authors were independently involved in study selection, data extraction, and bias assessment. A random-effects model with its corresponding 95% confidence interval (CI) was generated for comparable outcomes. Periodontal parameters were evaluated in the short term (1-3 months) and in the long term (>3 months). Cochrane risk of bias tool was utilized for bias assessment and the quality of the resultant evidence was graded. Additional subgroup and sensitivity analyses were implemented.

Results: Fourteen RCTs involving 2078 participants met the inclusion criteria; five studies were excluded from the quantitative synthesis due to high risk of bias. Small but statistically significant standardized mean differences in the plaque index scores were recorded favoring patients receiving reminders in the short-term (-0.38; 95% CI: -0.65 to -0.10) and in the long-term (-1.51; 95% CI: -2.72 to -0.30). Patients receiving reminders were less likely to miss their appointments with a relative risk of (0.39; 95% CI: 0.22 to 0.70) and less likely to develop white spot lesions (0.45; 95% CI: 0.31 to 0.65).

Conclusions: There is moderate-to-high quality of evidence that reminders have a positive effect on OH and adherence to appointments in orthodontic patients. These effects were demonstrated in the short- and long-term. Future high-quality RCTs should be designed with longer follow-up periods.

Registration: PROSPERO (CRD42017084479).

Conflict of interest: None.