Compliance. A review of the literature with possible applications to periodontics.

This paper begins with a review of the literature on compliance. The medical literature suggests that patients with chronic illnesses tend to comply poorly, especially if the disease is not perceived by the patient as particularly threatening. The dental literature covers two principal areas: compliance with oral hygiene regimens and utilization of dental care by the public. These works show that most patients surveyed do not clean their teeth as they have been instructed, and most do not receive routine dental care. The reasons for this noncompliance are highly variable but include lack of pertinent information, fear, economics, and the patient's perception of lack of compassion on the part of the dental therapist. In periodontics the majority of studies have focused on the effectiveness of patient oral hygiene along with its modification and on maintenance therapy. Other work in the periodontal literature is discussed in light of the widespread noncompliance shown by our patients. A number of studies have been undertaken on how best to improve compliance. In general, it has been found that patients comply better when they are informed and positively reinforced, and when barriers to treatment are reduced. Suggestions are made for improving compliance in the periodontal office and for tailoring therapy to predicted compliance levels.