Handling Non-Compliance in Orthodontic Patients

Non-Compliance can be very frustrating in orthodontics. As you scale up, it is unfortunately inevitable that you’ll experience non-compliance on a regular basis. The key to overcoming it is to have a plan of action.

Establish Expectations Upfront with Parents and Patients

Before I even get started, I always discuss expectations in the contract with parents and patients. You might even want to have a separate written compliance contract that outlines this and have both patient and parents sign it. I explain “the why” behind why I prefer compliance-based mechanics for orthodontics (discomfort, patient experience, oral hygiene) and what the expectations are for both parents and teens. I also explain my “3 Strikes” rule with compliance: patients and parents get 3 warnings about non-compliance; after those 3 warnings, further action will be required.

Example #1- Overjet Patient with Elastics

1. Discontinue treatment and leave overjet –this compromised outcome will remain. The patient will then sign a discontinuance form.

2. Some kind of compromised “improvement” option:
– IPR to improve overjet (IPR can be done at no cost but risks include removing protective enamel – N.B. I wouldn’t charge extra for this);
– distalization appliance (If I was going to do the fixed, distalization appliance, I would charge the patient for impression, insertion, lab fee and additional appointments since there is no logical reason for this outside the patient being non-compliant, so maybe a $500-$800 upgrade fee);
– or, extractions (I would charge extra for the actual procedure and also for additional Tx time.)

Example #2- Cross patient with a Schwartz expander

For RPE, I would charge the patient an upgrade fee for converting from removable to fixed; an impression/lab fee; and, for an insertion. If they still aren’t turning, have the patient come in weekly and you can turn for them – I would charge a small fee for this too.

Demonstrate good patient management, by thinking about the “why” behind the non-compliance. Of course, if it is an issue like the mom is blind or has a disability and can’t turn that’s a different story: just have them stop by weekly for someone in your office to turn for them.

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