Adherence to clinical practice guidelines amongst adolescents with buccal fixed orthodontic appliances in northeast Netherlands: a cross-sectional study

Background Adolescents undergoing orthodontic fixed appliance treatment face an increased risk of dental caries and developing white spot lesions (WSLs) due to challenges in maintaining effective oral hygiene. Preventive measures, including adherence to clinical guidelines, are important to reduce these risks. Objective To analyse adherence to clinical practice guidelines (CPGs) amongst patients undergoing orthodontic treatment with buccal fixed appliances in the northeast of the Netherlands. Methods A survey was presented to 539 adolescents aged 12-17 undergoing buccal fixed appliance treatment. Participants were recruited from ten orthodontic practices. The survey assessed adherence to the six recommendations of the Dutch CPGs. An adherence sum score (range 0 to 6) was calculated. Descriptive statistics and linear regression analyses (1000 bootstrap samples) were performed to analyse the relationships between participants' characteristics and adherence sum scores. Results In total, 485 adolescents started the survey, of whom 393 (72.9%) could be included (57% female; 48.9% aged 13 or 14). The median adherence sum score was 5 (IQR 4, 5), and 22.6% (n=89) had an adherence sum score of 6. Males had a lower adherence sum score than females (-0.442, 95% CI: -0.979, -0.234). Older participants had a lower adherence sum score than younger participants (-0.066, 95%CI: -0.136, 0.002) per year of age. Higher educated participants had a lower adherence sum score than participants with lower education (-0.534, 95%CI: -0.953, -0.096). Limitations Self-reported data may introduce information bias as participants may give socially desirable answers. Conclusions Adherence to the CPGs amongst adolescents with buccal fixed orthodontic appliances is suboptimal, particularly in boys and older adolescents. Tailored educational interventions may address these gaps.