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Norfolk Dental Specialists
Posted on 19th February 2018
Dentistry Company Dental Hygiene

Clinical Study: Patient Compliance and Tooth Loss

One of our dentists consulting a patient.
This is the first in a planned series of clinical study abstracts. Our specialists always stay up-to-date with – and make their own contributions to – the latest developments in their respective fields. We’ll be choosing some of the most interesting studies and sharing the findings with our referring GDPs (and any interested patients!) starting with this fascinating meta-study on patient appointment compliance and tooth loss.  
The Question
“Does a patient’s degree of appointment compliance affect the risk of tooth loss during supportive periodontal treatment?”
It’s a fascinating question and one that every dentist intuitively answers with a resounding: ‘Yes!’ A team of American dentists led by Nadeem Karimbux conducted a meta-study that would provide the data for a scientific answer.
Defining Compliance
The concept of compliance is fairly subjective. It is easier perhaps to be certain when a patient is non-compliant as they will be outright missing appointments. However, there will be borderline cases where a patient is keeping some appointments and constantly rescheduling others. Factors that might influence the degree of a patient’s compliance include the individual’s health beliefs, their long-term emotional wellbeing and how stressed they are feeling on the day in question.
Benefits of Meta-Study
Conducting a meta-study brings many benefits. The number of patients that it is feasible to include in a normal study is necessarily limited. A meta-study looks at all the relevant studies that have been carried out in a particular area and compiles the results into a single study. The greater number of patients means the results of the meta-study will be more statistically significant than the results of any of the smaller studies from which it draws its data.
Primary Outcome
Eight relevant previous studies were combined into a data set of 1409 patients. The patients were pooled according to their rates of appointment compliance. The primary outcome measured was the Risk Ratio of Tooth Loss. The pool of the data set with absolute appointment compliance (an unusually low 10% – other studies put the figure for absolute compliance at around 32%) had a significantly lower rate of tooth loss over five years than those who were in non-compliant pools. The authors calculated that if a compliant patient has 20 teeth properly maintained for more than five years they will likely avoid extraction.
Methodological Limitations
The authors conclude that the risk of tooth loss is clearly affected by compliance, but are unable to draw firm conclusions about the magnitude of the treatment effect due to methodological limitations. All of the studies used were English language studies. Although publication bias was assessed and found to be minimal using the standard Cochrane funnel plot symmetry test, the funnel symmetry observed may have been a false positive as a minimum of 10 studies must be included to definitely distinguish asymmetry if it was there.
Our Approach to Patient Compliance
Familiarity with this kind of clinical research is essential for us. Knowing that patient appointment compliance has an effect on tooth retention allows us to impress upon the patient the importance of keeping appointments. Getting patients to keep appointments involves understanding why they are missing or rescheduling them. At Norfolk Dental Specialists, we listen to our patients and give them the time to share any anxieties so that we can alleviate them. By listening to their concerns, we make sure that the patient has nothing to fear from a course of treatment with us and that keeps appointment compliance high.
You can read our own dental specialists clinical studies in the Norfolk Dental Specialists Journal. Contact our reception on 01603 632525 or email for details.
What do you think about these findings? Do they concur with your own experience? Let us know on Facebook and Twitter.

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